Heat Injuries (Continued)

As promised, this post will include several additional sources of information. One presentation is from Dr. Max Bursey from a previous Heat Conference. Use these slides to reference the latest proposed definitions and solutions. This one may be helpful to use for your hot weather training as it was originally designed for a large audience and it is fairly comprehensive.

I also have a hip pocket training PowerPoint below that I made awhile back. I’ve presented it several times to medics for hot weather training and it seems to work well. It’s a mix of slides from a lot of different sources. I admit that I have not yet taken the time to improve it visually. I’m trying to push out info on this site hastily while working around my actual job. Once I get more content on this site, I will go back and revise the PowerPoint for you guys. I chose to include this one also, though, because I think it will be helpful to explain some of the concepts. I include it below with a narrated version from me, as well as the raw version if you wish to use those slides to jazz it up a bit.

One of the biggest culture change issues that the docs at Fort Benning are trying to drive: “Drinking adequate water doesn’t necessarily prevent heat injuries.” That’s a tough point to sell. But we have to convince the masses that hyponatremia is also a threat. Appropriate hydration is good. Heat mitigation by way of proper preparation and heat dumping strategies should also be a part of the conversation. Informed medics can be excellent advisors to their leaders.

DRIP DROP (link goes to Amazon) can also be a useful way to prevent hyponatremia as well as dehydration. It is discussed more in the next post.

Feel free to reach out to me if these presentations don’t convince you. I’m willing to engage in a dialogue with you or even present more information here.

RAPID COOLING IS THE TREATMENT FOR HEAT ILLNESS

Aid Station Treatment Room at Ranger School

Ice Immersion Tank for Rapid Cooling

Ice Water Immersion tank- Ranger School

CLICK HERE TO GO TO THE FINAL HEAT INJURY POST IN THE SERIES


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.

Heat Injuries

We have to agree on the definition before we can discuss treatment. Many different definitions and opinions exist out there. Fort Benning has taken the lead on research and committees to help shape these opinions.

Photo from MASCAL Exercise in 2015

It happens all the time. You go to the field and a dude passes out. No one knows what to do. You preach hydration. But will that really help? What do you do now?

As I said, Fort Benning has been leading the way by holding annual heat conferences and bringing in speakers from all over the US and Britain, and by bringing in the Army research teams. The U.S. Army Ranger School has been testing prevention and treatment methods, and they’ve conducted a few studies themselves. As you probably know, Ranger school sees a lot of heat casualties. The stats below were collected from the Emergency Room at Fort Benning.

Heat Casualties for Fort Benning in 2019

  • Heat Strokes: 74
  • Heat Injuries: 23
  • Exercise Associated Hyponatremia: 8

There have been several cases over the last decade of heat injuries and hyponatremia that resulted in death at Fort Benning, GA. These deaths highlight the importance of prompt recognition and treatment of heat related injuries.

I’m always amazed when I meet a leader who has never heard of ice sheets; it still happens from time to time. But did you know that there are other options. Did you know other things are being done?

One of the big issues is that various training centers and military installations have differing definitions of a “heat stroke” or a “heat injury.” We can’t even agree on apples to apples to know how extensive the problem is and if there is a trend. And we can’t decide on a standard treatment either. Below is a table of heat illnesses at different installations. But remember, they don’t all define it the same way!

Definitions As Proposed by Fort Benning

  • Exercise-Induced Muscle Cramps (Heat Cramps)
    • Brief, recurrent, agonizing skeletal muscle cramping of the limbs and trunk
    • May be due to electrolyte loss and/or fatigue
    • Not believed to pre-dispose to serious heat related illness
    • Consider adding electrolytes and/or rest
  • Heat Edema:
    • Dependent extremity edema (hands and feet) owing to venous and interstitial fluid pooling
    • Loosen clothes, elevate legs
    • Self limited
    • Often confusing and difficult to be certain of diagnosis as other more serious conditions can result in single limb edema. However, in the setting of heat exposure in a young individual without other medical problems, it may be easier to diagnose
  • Heat rash
    • Red papules, or sometimes vesicles, found in areas where sweat is often trapped.
    • This heat obstructed rash cannot fully participate in sweating and evaporative cooling. The patient may be pre-disposed to heat injury until clears, due to inability to effectively dump heat
    • Often responds to cooling, removing tight or occlusive clothing, limiting sweating, and sometimes use of Hydrocortisone cream (1% typically used)
  • Sunburn
    • Pre-disposes to heat injury for same reasons as heat rash- ineffective heat dumping
    • Treat pain with Tylenol/NSAIDs. Avoid sunlight. May also use zinc cream or ointment, aloe, or cool compresses
  • Heat Exhaustion
    • Symptoms include fatigue, dizziness, headache, nausea, tachycardia, hyperventilation, headaches.
    • No Altered mental status!
    • Treatment would usually consist of cessation of activity, cooling, removal from the heat, and expeditious cooling to prevent progression to more severe heat illness
  • Exertional Heat Injury
    • A Heat illness of Heat Exhaustion or heat stroke that results in any end- organ damage.
      • Liver enzymes may be elevated, cardiac enzymes may be elevated, creatinine may be elevated, etc. Often damages the brain, heart, gut, liver, kidneys, and skeletal muscles
  • Exertional Heat Stroke
    • Similar symptoms to heat exhaustion, but with altered mental status
      • combativeness, delirium, obtundation, or coma
      • Must treat with rapid cooling and cessation of heat stress.
      • Rectal temperature is often greater than 104 degrees F.
Photo from MASCAL Exercise in 2015

These definitions were proposed last year at the Heat Forum at Fort Benning, by Dr. Max Bursey, DO. I have borrowed that information from the author in order to present it here, with permission. I will post the full slides on my next post.

The presenters often advised that Heat related illnesses are not well defined in the literature. They also emphasized that heat related illnesses should be thought of as a spectrum and not strict defined definitions; there is bleed over. We cannot devise too strict of definitions. Not until this is better understood with analyzed data.

The committee did develop protocols and algorithms, however. And these algorithms have been used for a few years now at Fort Benning. I believe that they are very helpful and practical. I have used them at my own FTXs. I teach this to all my medics. They seem to work well.

I cannot usurp your provider or designated medical supervision, but I do believe that this protocol should be presented to your leadership for adoption. It was developed as a committee amongst several physicians, medics, nurses, and mid-level providers. It is now the Maneuver Center of Excellence heat policy. I have some screenshots of the algorithms below, and the entire policy is in the link below for download (pdf).

Screenshot of Heat Algorithm for Untrained/CLS

Screenshot of Heat Algorithm for 68Ws

Does hydration really help? Is this the main issue? The Benning docs would argue it is not. Adequate proper hydration is important. However, over-hydration is also a problem, too. The next post will focus on more of this topic, as well as a PowerPoint that you can use to conduct your own internal hot weather/heat injury training for your unit.

CLICK HERE TO GO TO “HEAT INJURIES (CONTINUED) POST. This post includes more info, thoughts, pictures, and presentations on the topic.

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.

Common Foot and Ankle Injuries

This post is all about foot and ankle injuries. What is an Emergency? What needs to be evacuated now? What can you take care of yourself? How can you prevent further harm? What steps can be taken for open fractures to improve outcomes?

Until I find a better way to present material, its gonna have to be powerpoint. Just about all medical lectures are powerpoint- a fact of life. It’s part of higher learning. This video is only 8 minutes long. That means I’ll probably have to make more videos if Medics wanna dive a little deeper or get more specific. This is not comprehensive. Shoot me an email and let me know.

This educational video contains:

  • What is an Emergency?
  • How to think about injuries
  • When to Xray
  • Initial Management of Open Fractures to prevent infection
  • A few Splinting and Casting Principles
  • Plantar Fasciitis

Contact me by Email: admin@nextlevelmedic.com

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.

WRITING SOAP NOTES

A NECESSARY EVIL TO LEARN

It’s boring stuff. I know. But it is important. It is important to know how to properly document issues for your guys. It’s important to know how to write a medical note properly on a SF600 in order to help your team.

This video is a quick 6 minute powerpoint (I know!) presentation that teaches you how to think. It teaches you how to approach the note. It teaches you how to write better notes that don’t waste your team’s time. It helps you be a contributor. And it helps your battle buddy have a good note that will document his or her injury for their medical records.

Writing good SOAP notes means that you know how to begin a proper assessment. It means that you are a good “doc” because it demonstrates that you know how to think independently when a patient comes to you.

TAKE THE TIME. Hunker down for just 6 minutes.

I also recommend you watch the next video about “How to take a good History” as this is crucial to getting to the proper diagnosis.

How to Take a Good History

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.

FROM ANOTHER PERSPECTIVE

Want to learn something I haven’t covered? Send me an email! I want to teach what you want to learn.

Email me at: admin@nextlevelmedic.com

What to Expect

Over the next few weeks to months, I intend to post regularly. As I develop hip pocket training for the medics under my supervision, I will post it here so that others can benefit.

My intent is to deliver content that is relevant, helpful, and pithy. I know that medics all over the world sit in trucks and aid stations waiting for something to happen. This blog and my short videos can come with you. Utilize your time wisely. Increase your knowledge. Prepare.

It is my opinion that if we should find ourselves in a Near Peer fight, that the medic will become isolated. Already we are spreading our resources thin. Right now it is happening, and it is intentional. It could become more widespread in a Near Pear fight.

My aim is to make the medic or corpsman better. I want to deliver training that can assist a 68W, a navy corpsman, an 18D, or a flight medic to be able to take care of their “guys” without pulling them out of the fight. Trauma is not the only reason that Soldiers leave the battlefield. Being able to handle smaller situations could be extremely beneficial to prevent or delay evacuation.

I believe that I can teach medics to be eyes and ears for a provider. I can teach them to take a history and perform a relevant exam. If possible, they can relay this information back to a provider who can assist with the diagnosis and treatment plan for the medic to execute. This would be a win to keep the Soldier in the fight.

Again, my goal will be to deliver a myriad of content that is aimed at the medic level in order to improve care in austere environments. Please do provide me feedback on my content and send me suggestions for topics at admin@nextlevelmedic.com.

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.

Want to learn something I haven’t covered? Send me an email! I want to teach what you want to learn.

Email me at: admin@nextlevelmedic.com

Contact me by Email: admin@nextlevelmedic.com

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.

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