heat injury risk management presenter’s name presenter’s command local contact information
TRANSCRIPT
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Heat Injury Risk Management
Presenter’s NamePresenter’s Command
Local Contact Information
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Outline
• Five steps of heat injury risk management
• Exertional heat injuries
• Water intoxication
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Five Steps of Heat Injury Risk Management
• Identify hazards
• Assess hazards
• Develop controls
• Implement controls
• Supervise and evaluate
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Heat Injury Hazards are Cumulative
• H- Heat category past 3 days• E- Exertion level past 3 days• A- Acclimation/ other individual risk factors• T- Temperature/rest overnight
• Cluster of heat injuries on prior days= HIGH RISK
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Acclimation
• Acclimation guide for elite schools on CHPPM website
• Acclimation requires aerobic exercise in warm environment. Simply being outside doing normal activities is not sufficient
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Individual Risk Factors
• Poor fitness ( 2 mi run > 16 min)
• Large body mass
• Minor illness
• Drugs (cold and allergy, blood pressure)
• Highly motivated
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Individual risk factors
• Supplements - Ephedrine
• Recent alcohol use
• Prior heat injury
• Skin problems- rash, sunburn, poison ivy
• Age>40
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Hydration/Salts
• Buddy system • Track canteens with
550 cord or pace count cord
• Land nav- place water points at objectives
• Electrolyte drinks• Monitor meal intake
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Impact of dehydration
• Degrades performance -4% dehydration degrades performance 50%
• Increases core body temp -Every 1% increases core temp .1-.23 C
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Risk MitigationAvoid Heat Loading
• Modify schedule- time of day, rest• Clothing- no t-shirt, kevlar• Formations:
– Wide spacing– Shade soldiers whenever possible
• Cumulative- avoid strenuous back-to-back events
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Risk MitigationDump heat load
• Cool overnight temp
• Cold showers
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Develop Controls
• All unit leaders must be familiar with heat injury prevention and recognition
• Mark Soldiers who are high risk
• Ensure water points accessible/ utilized
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Other Controls
• Track Wet Bulb Globe Temp (WBGT)
• Track hydration of Soldiers
• Fluid replacement/ work/ rest guidelines
• Keep urine clear
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Implement controls
• Enforce policies
• Spot check junior leaders
• If 1-2 soldiers suffer heat injury- stop training and assess situation
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Symptoms of mild injury
DizzinessHeadacheNauseaUnsteady walkWeaknessMuscle crampsThese folks need rest, water, evaluationThese are your “canaries in the mine”
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Mild heat injury management
• Rest soldier in shade
• Loosen uniform/ remove head gear
• Have soldier drink 2 quarts of water over 1 hour
• Evacuate if no improvement in 30 min, or if soldier’s condition worsens
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Heat Stroke
• Abnormal brain function- elevated body temperature
• Examples:– Confused– Combative– Passed out– Sudden death
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Heat Stroke
• When a soldier’s brain isn’t working correctly- COOL and CALL
• Treat any soldier who develops abnormal brain function during warm weather activity as a heat stroke victim
• The sooner a victim with heat stroke is cooled, the less damage will be done to his brain and organs
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Pre-hospital care
• Cooling is first priority- can reduce mortality from 50% to 5%
• Drench with water• Fan• Iced sheets• Massage large muscles while cooling• Stop if shivering occurs
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Rapid cooling
• Cover as much exposed skin as possible with the cold, icy sheets.
• Also cover the top of the head
• When sheets warm up, put them back into cooler and then reapply
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Evacuation criteria
• Vomits more than once• No improvement after 1 hour of rest and
hydration• General deterioration• Loss of consciousness/ mental status changes
• Evacuate any soldier who requires cooling with iced sheets due to abnormal brain function to the MEDDAC ER
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Water intoxication
• Usually occurs in TRADOC units• Mental status changes• Vomiting• History of large volume of water consumed• Poor food intake• Abdomen distended/bloated• Copious clear urine
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Summary
• Five steps of heat injury risk management
• Exertional heat injuries
• Water intoxication
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ScenarioAwake victim-
muscle cramps/headache
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ScenarioAwake victim-
muscle cramps/headache• Move to shade/ or air conditioning
• Remove outer layer of clothing/ headgear
• 2 canteens of water over 1 hour
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ScenarioAwake victim- abnormal behavior
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ScenarioAwake victim- abnormal behavior
• Move to shade• Remove outer layer of clothing• Call for evacuation• Begin rapid cooling- iced sheets• May start IV after evacuation and
cooling started
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Additional Information
• Heat injury prevention posters
• Risk management worksheet and video
• CHPPM website
• TRADOC Website
• Evacuation algorithm
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Questions?
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Drugs that Interfere with Thermoregulation
• Antihistamines (benadryl, atarax, ctm)• Decongestants (sudafed)• High Blood Pressure (diuretics, beta
blockers)• Psychiatric Drugs (tricyclic
antidepressants, antipsychotics)