Heat Injury Prevention—A Military Perspective

Abstract

Heat-related injuries, and specifically exertional heat stroke, are a significant occupational risk in the armed forces, especially for those soldiers who are rapidly deployed from a temperate climate region to hot climate regions. Traditionally, adaptation to heat was considered as a matter of physiological adaptation. It is clear today that these injuries are mostly avoidable when applying proper education and behavioral adaptations. Education on behavioral adaptation for the prevention of heat injuries should be targeted at the individual and the organization level. This article summarizes the issue of proper preventive measures that should be taken to avoid, or at least minimize, the risk of exertional heat related injuries during military operations and training.

Exertional Heat Stroke in Navy and Marine Personnel: A Hot Topic

“…25 dangerous operations, placing them at even greater risk of EHS. 10 Military units' awareness of heat injury is also important. One military unit or ship might place greater emphasis on work/rest cycles, environmental monitoring, and so on than another unit.…”

“…Ephedra, from the Chinese plant ma-huang, 27 along with 1,3-dimethylamyamine (DMAA), is associated with serious heat injury in athletes 28,29 and with EHS 30 and death 31 in the military. Although the exact mechanism underlying heat injury in many ergogenic aids is not fully characterized, published reports clearly 2 Epstein et al, 10 Casa et al, 17 Glahn et al, 20 and Wallace et al a Based on information from Howe and Boden, 11 Seto et al, 25 Kao et al, 26 Lee, 27 Lopez and Casa, 28 Fink et al, 29 Oh et al, 30 and Eliason et al 31 54 indicate that US Navy and other critical care nurses should screen EHS patients for recently used medications or ingestion of dietary supplement.…”

“…35 During strenuous physical activity, body temperature increases in healthy persons, but as metabolic processes and/or environmental conditions exceed cardiovascular and central nervous system compensation, hyperthermia (T core > 40°C) ensues 13 and the risk of EHS increases. 10 Temperatures as high as 46.5°C (116°F) have been reported in patients who have recovered from heat stroke, 36 but survival at such an extreme T core is rare. The severity of tissue injury due to hyperthermia depends on the critical thermal maximum, 37 defined as the maximum intensity and duration of tissue heating before cellular death occurs.…”

“…Previous military reviews have focused on organizational practices and the onus of responsibility for EHS up the chain of command. 10 For critical care military nurses, however, it is crucial to rapidly recognize and treat heat stroke in the field. Therefore, the aim of this column is to discuss the definition, risk factors, treatment, and nursing implications of EHS.…”

Wilderness medicine

“…[54] Heatstroke is a severe, sometimes fatal, disease that is defi ned as elevated core temperature accompanied by neurologic dysfunction. Heatstroke is a complex process that involves cellular dysfunction, cardiac conduction dysfunction, release of pro-inflammatory cytokines, concomitant intravascular depletion, and subsequent circulatory collapse.…”