Heat Injuries (Final Thoughts for Now)

This will be my last post on this important topic until the next annual MCOE Heat Forum.

I get concerned about training each summer and the absence of knowledge and unit preparedness with regard to heat casualty prevention. Kids die each year on active duty training posts, but what about National Guard units that conduct training in un-manned areas? We read about these tragic stories all the time. Preparation is paramount.

The biggest challenges, in my opinion are:

  1. Ignorance on the issue
    1. Read these posts on Heat Injuries and share them with other medics. Volunteer to conduct a hot weather training class for the unit prior to the summer.
    2. Start trying to change the culture. This idea of “drink enough water to prevent heat injuries” is dying. Adequate and appropriate hydration is important, but the focus should be more about heat load and heat dumping. Over-hydration is killing Soldiers, too.
      1. Look at Drip Drop Packets for electrolyte supplementation during prolonged or consecutive hot training days. There are others, but this one is my favorite because it is nearly equal to an IV with regard to Sodium concentration, and it tastes really good. It’s also Class 8 now. You can even order DripDrop on Amazon, let your Soldiers try it, and then get your supply sergeant to buy it- that’s what I did. My unit used Drip Drop at JRTC and my BN Commander told me that he was convinced it prevented heat casualties (Who really knows?). Whether or not that is true, I do believe it is helpful for preventing hyponatremia and dehydration. Our Best Ranger Competitors use it during their training. Bottom line: Soldiers actually use it because it tastes good. There are several different brands to choose from to replace electrolytes, but Drip Drop is one of two approved by DOD and it tastes far superior to the other. See below for a graph on projected salt loss from the US Army Research Institute of Environmental Medicine.
    3. Get your “guys” to spend time outdoors as it starts getting closer to the training event. Acclimatization is key. Gradually increase exercise in the heat also.
    4. Spread around the cadre heat algorithm (added it below again). Ask your unit PA to review it and consider adding it to the OPORD for distribution. Make sure lowest level Soldiers know what to do. And send the 68W heat algorithm via text to all the medics so that they have it on their phone (they will forget it otherwise).
  2. Lack of Resources
    1. If you cannot prepare or pre-stage Ice Sheets in FLAs and/or Aid Stations, then find another solution.
      1. Ice Water Lavage- EMS on Ft. Benning now uses this as a primary option. They use sports bottles (like those that can be stored on a bicycle) to spray two bottles of water at a time on exposed skin to cool the patient. They typically carry a cooler of 16 bottles or so. If you don’t have a small cooler, then throw a couple ice water bottles in a few ruck sacks. Get creative.
      2. Dump canteens on a heat casualty if nothing else is available. I personally have been in a situation where we ran out of ice sheets and I had everyone line up to take turns dumping canteens of water on the patient. It is better than nothing.
      3. Make prior coordination with local EMS – I always talk to the local guys to let them know what we are going to be doing so they don’t redirect resources unknowingly. I’ve even called the local civilian Air Medevac twice in the last year because I was worried enough about response times.
Go to the Document Repository to access the PDF “Water Requirements and Soldier Hydration”
Example of Sports Bottle for Ice Water Lavage

These are my thoughts and suggestions. Ultimately, just make sure you are prepared and have a plan. I think it is worthwhile to follow algorithms (posted below) decided upon by a large group of medical professionals at the training post that sees the most heat injuries. However, your unit may elect a different or more cautionary approach. I’m just trying to provide more of a resource than what is currently available. Whatever you choose, recognize that this is becoming a more frequent problem and that it deserves your attention.

Algorithm for all Soldiers other than 68W or Medical Providers as proposed by the Maneuver Center of Excellence at Fort Benning, GA
Algorithm for 68Ws as proposed by the Maneuver Center of Excellence at Fort Benning, GA

All content is intended to be educational only. Medics should operate under the supervision of a medical provider and abide by all local laws while stateside. Medics should only practice at the level credentialed, and only at the level allowed. This content is not intended to treat or give a substitution for any credentialed provider. Content is intended to aid in a deployed prolonged care setting. Take guidance from your leaders. Utilize these posts as preparation and as a supplement to your provider’s direction and teaching.

This content is the author’s opinion alone and does not necessarily reflect the opinion, official position, or stance of the Department of Defense, or any other branch of the United States Military.

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Published by Medic Mentor

An Army PA seeking to share knowledge and skills to medics in order to better prepare them for the next fight, and to bridge the gap between future expectations and initial entry training. These posts are samples of similar training I share with my own medics, and are made available here to a wider audience. I am no expert. There are others more qualified, I'm sure. I am simply looking to contribute. Feel free to provide feedback and leave comments to help others.

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