mg george weightman/mcmr-za (301-619-7613) (dsn 343)/[email protected]...

MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/[email protected] UNCLASSIFIED 04/18/23 17:58Slide 1 of (14)

US Army Medical Research and Materiel Command

Heat Stroke in the Military Population

George W. WeightmanMajor General, Medical Corps

Commanding General

22 October 2008

https://mrmc-www.army.mil/


BRIEFING TOPICSBRIEFING TOPICS

WE ARE A NATION AT WAR

HISTORICAL PERSPECTIVE

THE WAR ENVIRONMENT

CURRENT WAR ENVIRONMENT

PREVENTIVE MEDICINE DOCTRINE

HEAT STROKE IN TODAY’S US MILITARY POPULATION

WE ARE A NATION AT WAR

HISTORICAL PERSPECTIVE

THE WAR ENVIRONMENT

CURRENT WAR ENVIRONMENT

PREVENTIVE MEDICINE DOCTRINE

HEAT STROKE IN TODAY’S US MILITARY POPULATION


U.S. Army Research Institute of Environmental Medicine (USARIEM)

U.S. Army Research Institute of Environmental Medicine (USARIEM)

USARIEM MissionConduct research to sustain / enhance performance (physical &

cognitive) & minimize medical problems during military operations at

environmental extremes of heat, cold, & high terrestrial altitude.

Support Military Materiel Developers (clothing, equipment, food &

pharmaceuticals) & Health Hazard Assessments regarding thermal &

hypoxic stress.

Thermal & Mountain Medicine DivisionCore Areas

Cold Stress Physiology

Heat Stress Physiology

High Altitude Physiology

Environmental Illness (Cold & Heat Injury & Mountain Sickness)

Hydration

Research TopicsAcclimation & Acquired Tolerance

Exposure Guidelines / Decision Aids

Environmental Injury / Illness Susceptibility

Hydration & Nutrition

Performance Optimization


WE ARE A NATION AT WARWE ARE A NATION AT WAR

Protection of our soldiers against heat stroke is critical to military success

Protection of our soldiers against heat stroke is critical to military success


HISTORICAL PERSPECTIVEHISTORICAL PERSPECTIVE

Heat stress and illnesses have caused profound and catastrophic consequences on military operations from biblical to modern times

US Army heat stroke hospitalization rates increased >7-fold over the past 20 years (Carter 2005)


THE WAR ENVIRONMENTTHE WAR ENVIRONMENT

““A soldier fighting is not as simple a A soldier fighting is not as simple a situation as an athlete running a situation as an athlete running a marathon. The soldier is exposed to the marathon. The soldier is exposed to the environment not knowing for how long, environment not knowing for how long, with minimal food and water. The with minimal food and water. The soldier suffers tremendous sleep soldier suffers tremendous sleep deprivation, fear, hard work and deprivation, fear, hard work and exposure to exposure to heatheat and cold.” and cold.”

The ScientistThe Scientist, 2004, 2004

Wars are Fought Outdoors with Extended Exposure Wars are Fought Outdoors with Extended Exposure to Harsh Environments and Exhaustive Workto Harsh Environments and Exhaustive Work


Heat Stress Has an Operational Impact Heat Stress Has an Operational Impact

““Within initial 72h of Within initial 72h of battle, 10% of engaged battle, 10% of engaged infantry (40 cases) were infantry (40 cases) were evacuated and treated for evacuated and treated for dehydration at BAS.”dehydration at BAS.”

Battle of Najaf, Iraq (August 2004)Battle of Najaf, Iraq (August 2004)1LT Dean Stulz, 1-5 CAV, 1LT Dean Stulz, 1-5 CAV, Battalion PA (After Action Brief)Battalion PA (After Action Brief)


BAGHDAD WEATHERUSA Today, Tuesday 8 August 2006

CURRENT WAR ENVIRONMENTCURRENT WAR ENVIRONMENT

““That summer an average soldier That summer an average soldier on an 8-10 hour mission drank on an 8-10 hour mission drank from 2-4 gallons (8-16 qts) of from 2-4 gallons (8-16 qts) of water, and another half gallon (2 water, and another half gallon (2 qts) during the remainder of the qts) during the remainder of the 24-h period while back on base.”24-h period while back on base.”

SFC Larry Larson, Summer Iraq Operations SFC Larry Larson, Summer Iraq Operations (email, 4 April 2005)(email, 4 April 2005)


Rate of Heat Stroke / Injury Among Active Duty Army, 1 Jan 2000 - 30 Apr 2008*

Rate of Heat Stroke among AD Army, 01Jan 2000 - 30 Apr 2008*

20.3

37.3 38.7 35.1

50.9

42.6

36.1

40.6

13.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

2000 2001 2002 2003 2004 2005 2006 2007 2008*

Year

Rate

per

100,0

00 p

ers

on

-years

Data Source: Defense Medical Surveillance System (DMSS)Prepared by Armed Forces Health Surveillance Center (AFHSC), as of 26-JUN-2008

Rate of Heat Stroke / Injury Among Active Duty Army, 1 Jan 2000 - 30 Apr 2008*

*Current as of 30 April 2008


Long-term Effects of Heat Stroke?Long-term Effects of Heat Stroke?

Soldiers hospitalized for heat stroke subsequently had increased mortality (2-4 fold within 30 years) from cardiovascular, liver, and kidney diseases.Wallace et. al., Environ. Res., 2007

?

?

?


PREVENTIVE MEDICINE DOCTRINEPREVENTIVE MEDICINE DOCTRINE

http://chppm-www.apgea.army.mil/heat

http://www.armymedicine.army.mil/index.cfm

http://www.usariem.army.mil/

TB MED 507/AFPAM 48-152(I)

TECHNICAL BULLETIN

HEAT STRESS CONTROL AND HEAT CASUALTY MANAGEMENT

APPROVED FOR PUBLIC RELEASE; DISTRIBUTION IS UNLIMITED.

HEADQUARTERS, DEPARTMENT OF THE ARMY AND AIR FORCE

7 MARCH 2003


USA Today, Tuesday August 8, 2006

The Doctrine is Effective and We Are Operating EffectivelyThe Doctrine is Effective and We Are Operating Effectively


CPT Erik J. Bergeson APA-C DMO Ranger Training Brigade Surgeon (Briefing of November 2006)

Heat Stroke & Heat Exhaustion Cases Before & After Heat Mitigation Intervention

Heat Stroke & Heat Exhaustion Cases Before & After Heat Mitigation Intervention

YEAR(S) # of Classes # of Students Heat Stroke Cases Heat Exhaustion Cases

2002 11 2,658 35 (1/75 students) 42 (1/63 students)

2003-2006 38 11,964 15 (1/797 students) 24 (1/498 students)

2002 – Before Heat Mitigation Interventions by USARIEM2003-2006 – After Heat Mitigation Interventions by USARIEM

> 10-fold decrease 8-fold decrease


HEAT STROKE IN TODAY’S US MILITARY POPULATIONHEAT STROKE IN TODAY’S US MILITARY POPULATION

Continues to be a major problem for US forcesNon-deployed soldiers in 2007:

329 incident cases of heat stroke1,853 incident cases of heat exhaustion

Fort Bragg 7 Nov 07 - 8 Oct 08:Heat Stroke:

92 cases of heat stroke 137 soldiers on restrictions (8 Oct 08)

Heat Exhaustion:66 cases of heat exhaustion 45 soldiers on restrictions (8 Oct 08)

Heat illness/stroke related restrictions:US soldiers may be non-deployable for over a yearIsraeli and French soldiers are reevaluated at 6 to 8 weeks

The return-to-duty/play issues you will be discussing are critical to military success

mg george weightman/mcmr-za (301-619-7613) (dsn 343)/[email protected]...

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