How ready is your team for the threat of summer heat? Published June 19, 2009 By Lt. Col. Paul Gourley 6 AMDS commander MacDill AFB, Fla -- The dog days of Summer are upon us. With the increase in temperature and outdoor activity it can be expected that there will be cases of heat related illness. My first real experience with serious heat illness was during my emergency medicine residency at Fort Hood Texas. It was a typical hot afternoon in central Texas in the emergency department, busy but manageable. That all changed in a matter of minutes. A call came across our air ambulance radio saying that helicopters were inbound from one of our ranges with six heat stroke casualties. The emergency department staff quickly went to work preparing for and then treating the critically ill patients. Luckily, the quick actions of the pre-hospital and emergency department personnel resulted in a good outcome and all the patients recovered well. After the incident our staff all had similar questions of how could this have happened in a controlled training environment and were there medics in the field to advise commanders on preventing heat related issues. As we soon found, out there were plenty medics in the field. In fact the patients themselves were all medics as the training that was going on was for the Expert Field Medical Badge. They had decades of medical knowledge but failed in one key area, prevention. Our take away from this incident was that constant vigilance to prevention is the key to combating heat illness. As the Air Force enters the "101" Critical Days of Summer, it is important that all Airmen review Heat-related illnesses. With proper education and planning heat-related illnesses are clearly preventable. Information on heat related illness is available in the new Airman's Manual. Heat-related illnesses range from minor conditions such as prickly heat, heat cramps, heat exhaustion to a major condition, heat stroke. All these conditions occur because of a body's inability to properly cope with a heat stress placed on it. Additionally age (very young and old), certain skin and medical conditions, obesity, many common medications and alcohol use weaken the body's ability to compensate to heat stress. Through the proper wear of clothing, adequate intake of electrolyte drinks and salt containing foods, a high degree of physical fitness and proper acclimatization to a hot environments these conditions can be prevented. A great resource for proper acclimatization can be found at: http://www.usariem.army.mil/download/heatacclimatizationguide.pdf. Prickly Heat (heat rash) is an inflammation of the sweat pores of the body. It is occurs when sweat pores are blocked. The rash is found mainly over clothed areas of the body. It is red and raised and itchy in nature. Over-the-counter antihistamines will help with the itching. If the rash becomes pustular medical care should be sought. Prickly heat can be prevented by wearing light, loose fitting, clean clothing and avoiding recurrent sweating if possible. Heat Cramps are muscle cramps that occur when individuals who are involved in activities that cause profuse sweating drink water or low electrolyte liquids instead of commercial electrolyte drinks such as PowerAde® or Gatorade® to replace their fluid losses. Cramps are mainly located in the calves but may occur in other muscle groups. The treatment for heat cramps is moving the individual to a cool environment and replacing the fluid and salt losses. In mild cases this can be done with commercial electrolyte drinks. Medical care should be sought if the individual has severe cramping or does not improve with electrolyte drinks. Prevention is through maintaining good salt intake and drinking commercial electrolyte drinks for hydration during strenuous activities. Salt tablets should not be taken by themselves since it may cause stomach upset and they do not replace fluid loss from sweating. Heat Exhaustion occurs due to the body's loss of fluids and electrolytes when it is exposed to heat stress. Symptoms include weakness, headache, light-headedness, profuse sweating, dizziness, nausea, vomiting and muscle cramps. The individual's temperature may be normal and their mental status is normal. Treatment is focused on moving the individual to a cool place, loosening or removing clothing, sprinkling/misting water on and fanning the person. Cooling to the point of shivering should be avoided because it is the body's way to retain heat. If the person is not vomiting, drinking of commercial electrolyte drinks should be encouraged. It is very important to understand that heat exhaustion can lead to heat stroke. If someone has severe symptoms, has a questionable mental state, or is not improving with the above treatment, medical care should be sought immediately. Individuals with heat exhaustion should rest and drink plenty of fluids over the following 24-48 hours. Heat stroke is a life-threatening emergency that requires immediate treatment. People with heat stroke can have all the symptoms of heat exhaustion plus an altered mental status and a temperature >104°F. The hallmark that differentiates heat stroke from heat exhaustion is an altered mental status. This means the individual will be confused, lack good judgment, unable to walk properly, have seizures or become unconscious. There are two types of heat stroke, classic heat stroke and exertional heat stroke. "Classic" heat stroke is seen generally in the elderly population during a heat wave. They are exposed to heat over several days. Their skin is generally hot and dry and they have altered mental status. Exertion heat stroke occurs much more commonly in the military environment. It is mainly seen in young persons that are performing strenuous work in a hot environment. The bodies of these individuals are generally not acclimated to the hot weather. They will have altered mental status and be sweating profusely. Just as in a medical stroke, time is critical. The longer a person has symptoms of heat stroke, the more chance they have of complications to include death. The emergency medical system must be activated- call 911. The person should be removed from the heat, have their clothing removed and lay down. Cooling with misting water and fanning should be done immediately while waiting for the ambulance. If the person is able drink, encourage them to sip liquids. Never try to give an unconscious person anything to drink. Prevention of heat stroke and heat exhaustion focuses on adequate hydration, proper heat acclimatization, and avoiding the overexposure of individuals to hot environments. 14 years later I have thankfully not had another incident like the one during my residency. The Air Force Medical Service recognizes that the best way to combat heat-related illness is prevention. Hopefully the above arms everyone with the knowledge to have a safe, enjoyable, heat illness free summer.