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Heat Illness Risk Management

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Presentation on theme: "Heat Illness Risk Management"— Presentation transcript:

1 Heat Illness Risk Management
Slide Set for Unit/Installation Training Applications* Heat Illness Risk Management * This slide deck was prepared for adaption and local use by units/installation personnel when conducting heat injury and illness prevention training. The information presented in these slides and notes sections (as posted) has been approved by the Injury Prevention Program (IPP) of the US Army Public Health Command (USAPHC) as of May The IPP can be contacted at for technical consultation regarding heat illness prevention. The requirement for Army Health Illness Prevention training is established by the Army Medical Command – the current (2013) policy memorandum is at https://www.us.army.mil/suite/doc/ This presentation material includes images from as well as slides from US Army Safety Center website (https://safety.army.mil/.../hotweather/2007/Heat_Injury.ppt). Additional information links and resources may be obtained from USAPHC at: LASTED UPDATED BY PHC: 17 June 2013 There are notes to many of the slides in this slide deck that provide additional details for the presenter. The IPP can be contacted at for technical consultation regarding heat illness prevention. UNCLASSIFIED

2 Heat Illness Risk Management
Presenters Name Presenters Command Local Contact Information insert date This slide deck was prepared for adaption and local use by units/installation personnel when conducting heat injury and illness prevention training. The presenter should consider any necessary adoptions to reflect local/units specific requirements and protocols. The USAPHC does not take responsibility for the appropriateness and authorization of local procedures; USAPHC IPP can however be contacted for technical consultation. UNCLASSIFIED

3 Outline Introduction and key terms
Five steps of heat illness risk management Types of heat-related injuries: Exertional Heat Illnesses (EHI) Water intoxication Quiz questions Exercises This training presentation is designed to address the key elements of a health illness prevention program as required by *** This slide deck was prepared for adaption and local use by units/installation personnel when conducting heat injury and illness prevention training. The information presented in these slides and notes sections (as posted) has been approved by the Injury Prevention Program (IPP) of the US Army Public Health Command (USAPHC) as of June The IPP can be contacted at for technical consultation regarding heat illness prevention.

4 Why you need to know about heat illness:
   Despite well documented and effective techniques for preventing heat illnesses, they continue to be a threat to Soldiers in training and combat. Over 1600 heat casualties in 2012 Army Active component required medical attention and/or lost duty time    Even mild heat illness and dehydration can significantly degrade performance The best solution is prevention!  In addition to this training being required per OTSG Policy Heat Injury Prevention Program for the 2013 Heat Season, 30 April 2013 at https://www.us.army.mil/suite/doc/ , Army doctrinal guidance per TB MED 507 provides operational reasons that this is required: DEHYDRATION: Degrades performance Losing 4% of body weight due to dehydration degrades physical performance 50% This 4% body weight loss is possible in under 2 hrs! Increases core body temp Every 1% loss of body weight increases core temp °C or °F (increasing risk of more serious heat illness)

5 Key Terms Exertional Heat Illness (EHI) refers to a spectrum of disorders (e.g., cramps, heat exhaustion, heat injury, heat stroke) resulting from total body heat stress. Primarily heat casualties are forms of heat exhaustion while more severe cases are heat stroke (potentially fatal). Total Body Heat Stress = Total Heat Load on an individual = Heat generated by the body (due to metabolism and activity) + Heat gained from the environment - Heat lost in the environment Wet Bulb Globe Temperature (WBGT) is a composite temperature used to estimate the effect of temperature, humidity, wind speed (wind chill), and visible and infrared radiation (usually sunlight) on humans While there is a range of adverse effects that can result from the body over heating, the 2 major kinds of heat illnesses that are referred to as heat casualties: heat exhaustion (can be milder or more severe) and heat stroke (most severe form of heat illness and possibly fatal). The overall Wet Bulb Globe Temperature (WBGT) is more than just a basic thermometer temperature reading – its determine with special equipment and calculated to reflect several components of an ‘actual temperature’ experienced by personnel that includes air, humidity and wind: WBGT is derived from the following formula: 0.7Tw + 0.2Tg + 0.1Td Tw = Natural wet-bulb temperature (combined with dry-bulb temperature indicates humidity) Tg = Globe thermometer temperature (measured with a globe thermometer, also known as a black globe thermometer) Td = Dry-bulb temperature (actual air temperature) Temperatures may be in either Celsius or Fahrenheit The WBGT index was developed in 1956 by the United States Marine Corps at Parris Island to reduce heat stress injuries in recruits

6 Total Body Heat Stress Solar radiation Air Temperature & Humidity
Convection (air currents) Evaporation TOTAL BODY HEAT STRESS IS BASED IN THE OVERALL HEAT REGULATION OF THE BODY: (1) Convection - is heat transfer by moving a gas or liquid over the body, whether induced by thermal currents, body motion or natural movement of air (wind) or water. (a) Heat loss - occurs when air temperature is below skin temperature. (b) Heat gain - occurs when air temperature approaches or exceeds that of the body. (2) Radiation – heat loss and gain. (a) Heat loss - occurs when surrounding objects have lower surface temperature than the body. (b) Heat gain - occurs when surrounding objects have higher surface temperature than body surface temperature. Temperature combinations of the solar, ground and surrounding objects may exist which result in body heat gain, even if the air temperature is below that of the body. (3) Conduction – Conduction of heat to or from solid objects is usually minimal, since little contact surface is involved. (a) Although minimal – heat loss occurs from boots to the ground when the surface ground’s temperature is lower than the boots. (b) Although minimal – heat gain occurs from the ground to the boots usually occurs during hot weather. (4) Evaporation - evaporation of water produces cooling – heat loss. The max heat loss from evaporation is a function of the rate of air motion over the skin and the water vapor pressure differences between the surrounding air and the wet skin. (a) Sweating – sweat glands secrete fluid onto the skin surface permitting evaporative cooling when liquid is converted to water vapor. (b) In hot environments, the amount of heat loss achievable via sweating is the major determinant of the body’s ability to maintain a normal body core temperature. Metabolic (internal) Heat Production

7 WBGT categories 1 <= 79.9 <= 26.6 White 2 80-84.9 26.7-29.3
Category WBGT, °F WBGT, °C Flag color 1 <= 79.9 <= 26.6 White 2 Green 3 Yellow 4 Red 5 => 90 => 32.2 Black REMEMBER: WBGT is not just ‘temperature’ – includes humidity Also - when using this chart: Add 5°F for rucksack or body armor Add 10°F if in MOPP 4

8 Five Steps of Heat Illness Risk Management
Identify hazards Assess hazards Develop controls Implement controls Supervise and evaluate

9 IDENTIFY HAZARDS: Key Risk Factors for EHI
Environment Higher temperature High humidity (WBGT) Activities High exertion Heavy loads/gear Repeated strenuous days Lack of Acclimatization Individual: Poor fitness (2 mi run > 16 min) Body mass index (BMI) > 26 Age>40 Gender (female) Minor illness Medication (e.g. antihistamine, blood pressure, decongestants) Alcohol past 24 hours Prior heat injury Skin rash, sunburn, or poison ivy Blood donation (<3 days) Sleep deprived ALSO: Highly motivated Most commonly though of risk factors are the climate/temperature and the level of physical activity /exertion, however there are numerous individual risk factors to be aware of – especially consider when a single individual has more than one of listed risk factors – the more risk factors the greater the potential risk of EHI. DRUGS THAT INTERFERE WITH TEMPERATURE REGULATION: Antihistamines (benadryl, atarax, ctm) Decongestants (sudafed) High Blood Pressure (diuretics, beta blockers) Psychiatric Drugs (tricyclic antidepressants, antipsychotics NOTE: Despite certain Army policies and training documentation that has been published, to date ( 2013) there is currently NO scientific evidence that caffeine, energy drinks, “fat burners” or dietary supplements affect the body’s ability to regulate heat. Why Highly motivated personnel are at risk- the desire to meet or exceed standards may lead some soldiers to continue to push themselves as early signs/symptoms of EHI occur. These soldiers should not be discouraged from pushing themselves but cadre should be aware of their tendency to push it so that they can be watched more closely.

10 IDENTIFY HAZARDS: NOTE
Hot weather is a key risk factor for heat injuries HOWEVER: Heat illnesses can occur under green flag temperature conditions due to previous days’ conditions and dehydration.

11 IDENTIFY HAZARDS: Heat Illness Hazards are Cumulative
H Heat category past 3 days E Exertion level past 3 days A Acclimation/ other individual risk factors T Time (length of exposure and recovery time) A cluster of heat illnesses on prior days = HIGH RISK

12 IDENTIFY HAZARDS: Lack of Acclimatization
Body needs to adjust to environmental heat stressors prior to high exertion activities Acclimatization requires aerobic exercise in warm environment. Simply being outside doing normal activities is not sufficient Acclimatization guide on USAPHC Heat Illness Prevention webpage

13 ASSESS HAZARDS Utilize the WBGT temperature index Know your Soldiers
Add 5°F for rucksack or body armor Add 10°F if in MOPP 4 Know your Soldiers Identify individual's at increased risk Monitor and maintain hydration status Assess morning and evening as well as during training Factor in previous days’ conditions & activities Consider temperature, activity levels, illnesses Use a risk management matrix The web bulb temp index alone does not represent the full extent of the hazards – it must be adjusted (raised) to address additional clothing/protective equipment. Also – be aware that - Some persons are at higher risk so may have heat illness at lower temps – especially if illness, on certain medications, or had previous heat illness Intense activity will increase hazard previous high activity days and or high temp days can result in heat illness even a moderate temperature day

14 Example Heat Illness Risk Management Matrix
Risk Factors Risk Level 0 points/circle Low Risk 1 point/circle Medium Risk 2 points/circle High Risk 3 points/circle Extreme Risk Risk Management Worksheet All controls implemented Not all controls implemented WBGT Add 5 F backpack or body armor < Cat 1 Cat 1 Cat 2-3 Cat 4-5 Back-to-back Cat 5 days 1 2-3 >4 Heat Illnesses in past 2 days Heat Cramps Heat Exhaustion Heat Stroke/ Death Workload in past 2 days (see TR workload classification chart) Easy Easy or Moderate Moderate or Hard Hard Projected workload Heat acclimatization days >13 7-13 3-6 <3 Leader/NCO presence Full Time Substantial Minimal None Cadre duty experience 18 months 7-18 months 1-6 months <1 month Communication System (tested at training site) Radio and landline phone Landline phone only Radio only Previous 24 hours sleep >7 hours 5-7 hours 2-4 hours <2 hours Food/salty snacks every 4 hours <4 hours 4-6 hours 6-7 hours Onsite 91W/CLS and iced sheets (min. 8 single bed sheets/company in cooler) Both iced sheets & Medic, EMT, or CLS Only Iced sheets Medic, EMT, or CLS Add Circled Blocks with points/circle Total Score: 0-7 = Low Risk; 7-15 = Medium Risk; = High Risk; = Extreme Risk >11 Total Score should have onsite Medic, EMT, or CLS and organic evacuation transportation. Prior an training or operational activity leaders should prepare a risk assessment matrix like this one to determine the degree of heat hazard risk to units. High or Extremely High risk conditions should be avoided

15 DEVELOP CONTROLS Plan in advance:
Estimate heat risk level 1 day prior Adjust activity distances, durations, pace, and loads Conduct high-intensity training in cooler morning hours Ensure proper resources at appropriate locations Functional WBGTs Water/electrolytes Ice sheets (in cooler filled 1/3 water, 2/3 ice) Medical: resources, locations, communication systems Establish SOPs, train, and test Soldiers Heat Illness Prevention and Hydration cards and sunscreen to all Place Heat Illness Prevention posters and urine guides in bathrooms, bulletin boards, DFAC, training areas, etc. Identify how to monitor hydration & high risk personnel While Planning – identify ways to minimize the hazard - Consider: Previous 2 days of heat exposure and Predicted Heat Category for that day Training events (distance, pace, breaks, etc.) and Work-rest cycle, hydration guidelines, etc. Uniform/equipment Location, Time of day Plan communication capabilities, water, food/snacks, medical, and evacuation support. Recommend commercial electrolyte beverages (diluted to half-strength) in high-risk months (or when daily water consumption exceeds gallons/day). Ensure water control points throughout designated training areas. Ensure canteens/hydration packs are properly cleaned daily (FM 21-10), especially when using flavored commercial electrolyte beverages. Pre-plan changes if METT-TC/Heat Category changes or if heat casualties occur - what to do if? __________________________________ Parachute 550 cord or the Ogden cord* can be tied to: button hole, ear plug case, or shoe laces to: tie knots or black beads (one for each canteen ) to indicate for DAILY hydration status Red beads on cord are used for “at risk” soldiers. ALTERNATIVES FOR MARKING HIGH RISK: Velcro Red patch on upper left sleeve or red arm band * Ogden cords can be locally purchased for $1.00 per package (138 (6X9mm) pony beads) Other colors consist of black, red, or blue beads can make 23 Ogden cords. A 1,200 foot roll of Type II Nylon (550 cord) costs $ Approximately 757 Ogden cords can be produced from 1 roll. _________________________________

16 NOTE: All fluids provide water, whether milk, fruit juice, etc.

17 See USAPHC Website for Heat Illness Prevention Products:
NOTE: This card is a useful field tool but is not a definitive indicator of hydration status and not for clinical use. Urine color can be affected by certain food or medications. Urine color will take some time to change after consumption of fluids or after high physical activity This is an example “card” for soldiers made available by PHC – it also comes as a poster. Hardcopies of these and other heat prevention products can be ordered free online from USAPHC at NOTE: this urine chart is NOT a definitive indicator of hydration status and NOT for clinical use. Urine color can be affected by certain food or medications. Urine color will take some time to change after consumption of fluids

18 IMPLEMENT CONTROLS: Monitoring Hydration and Personnel
Buddy system - Assign Low risk to High risk personnel Track high risk personnel and individual hydration status Daily intake (1 knot/black bead per canteen) Use red beads for “at-risk” Soldiers Place water at key points e.g., at land navigation objectives Provide and monitor Electrolyte drinks Meal intake Local protocol should be established to both identify those who are at greater risk and the hydration status f each soldier (this can help determine if an heat related injury could be due to too much water or over hydration (hyponatremia) as is discussed later _______________________________ Parachute 550 cord or the Ogden cord* can be tied to: button hole, ear plug case, or shoe laces to: tie knots or black beads (one for each canteen ) to indicate for DAILY hydration status Red beads on cord are used for “at risk” soldiers. ALTERNATIVES FOR MARKING HIGH RISK: Velcro Red patch on upper left sleeve or red arm band * Ogden cords can be locally purchased for $1.00 per package (138 (6X9mm) pony beads) Other colors consist of black, red, or blue beads can make 23 Ogden cords. A 1,200 foot roll of Type II Nylon (550 cord) costs $ Approximately 757 Ogden cords can be produced from 1 roll. _________________________________

19 IMPLEMENT CONTROLS: Change events to minimize heat load
Avoid back-to back strenuous days especially Category 4-5 Modify time of day – complete activities earlier/later Adjust Activity: Wide spacing between Soldiers Reduce pace and/or distance Breaks Shade Soldiers whenever possible Reduce clothing and load: Uniform Backpacks, body armor, helmets, etc (training) Dump excess heat Allow/provide field showers Cool overnight temp (fans, air conditioning, cool showers) Implement planned protocols to avoid or mitigate health risks- e.g., skip back to back days, minimize activity intensity and clothing and load, change time of day, provide adequate hydration breaks and water supply, provide shade and shower systems (NOTE: Wide spacing between Soldiers = e.g., 60 feet)

20 SUPERVISE AND EVALUATE
When controls fail, heat injuries occur! Spot checks: Troops Cadre/leaders Medical Be familiar with signs/symptoms of EHI Look for mild signs/symptoms  stop from progressing Take immediate action when EHI is observed or suspected When in doubt, call 911 and begin cooling!! If a heat injury occurs stop training and assess situation Spot check TROOPS: Confirm Battle Buddy System is in place. Monitor food intake (food/salty snack every 4 hrs or less). Check Ogden cords for water intake. Are they drinking BEFORE PT in morning? Monitor urine output (e.g. ‘color test’, and/or Soldiers should be urinating a full bladder every 2-3 hours) Ask questions that require clear thinking (What day is it? Where are you?). Look for Soldiers who are visibly ‘wilting’ or struggling. Look for Soldiers bypassing controls (e.g. not drinking in order to have a full canteen for an inspection). Spot Check CADRE/JUNIOR LEADERS: “What is the current Heat Category?” “Who is at risk?” ”Who is their buddy?” “What actions would you take if … ” Is water available and accessible? Are rapid cooling supplies on-hand? Do you have communication with medical support? Do you have your HIP (Heat Injury Prevention) Pocket Guide card? Spot check medical support Check equipment, personnel, evacuation vehicle, communication, ice sheets for rapid cooling. If no organic medical support, check for coordination of alternatives (gate access for off-post EMS, travel time, procedures, etc.)

21 Recognizing Heat-Related Illnesses Water Intoxication Hyponatremia
Dizziness Headache Nausea Weakness Clumsy/unsteady walk Muscle cramps Heat Exhaustion Water Intoxication Hyponatremia Heat Stroke History of large water consumption Confusion Vomiting (liquid, no food) Convulsions Clear urine Profuse sweating Convulsions and chills Vomiting Confusion, mumbling Combative Passing out (unconscious) KOW THE SIGNS AND CATCH SYMPTOMS EARLY TO PREVENT FOR EVERE CASES: HEAT EXHAUSTION – “Canaries in the coal mine” - need to catch these before they get to more extreme case of “stroke- catch early as they need rest/water/evaluation and possible medical care HEAT STROKE – Medical emergency – Abnormal brain function-rapid cooling and EVAC! These cases can be fatal HYPONATREMIA– Medical emergency – EVAC! NOTE: Most often occurs in TRADOC IET units, especially during BCT/OSUT Mental status changes Vomiting History of consumption of large volume of water Poor food intake Abdomen distended/bloated Large amounts of clear urine (if urine) - Do not give more water or IV! If awake, allow Soldier to consume salty foods or snacks

22 Reacting to a Heat Illness/Casualty Event
MOVE victim to cool location (e.g., shade, A/C car, building) ASSESS victim to determine type of EHI Signs/symptoms Hydration (knots in 550 cord) to check for hyponatremia Risk level (red beads or risk factors) Mental status (for heat stroke) Designate single person to continue monitoring DECIDE which EHI and take proper management approach Heat Exhaustion: rest in shade, rehydrate Heat Stroke: begin rapid cooling, evacuate immediately Hyponatremia: evacuate immediately EVALUATE other Soldiers and adjust training as necessary . “M.A.D.E. in the Shade” - just follow these rules It is critical that a specific person is assigned to STAY with victim and continuously monitor all changes including mental status – Even the slight changes that can occur in minutes may not be noticed if different personnel are checking victim – these slight changes can be critical in ensure best outcome for victim

23 Identify Exertional Heat Stroke – Perform a Mental Status Check
Anyone can do a mental status check by asking the following questions What is your name? What month is it? What year is it? Where are we/you? What were you doing before you became ill? In any case of heat illness symptom – perform a mental health check with these questions – if victim demonstrates mental confusion assume heat stroke victim and get medical help/evacuation ASAP Anyone who undergoes a mental status change, including loss of consciousness, as a result of exertion during warm weather will be assumed to be a heat stroke victim until determined otherwise by medical authority.

24 Heat exhaustion versus Heat Stroke 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 HEAT STROKE If Soldier’s brain isn’t working correctly then COOL and CALL!! Strip Rapid cool (ice sheets) Call for evacuation Continue cooling during transport Maintain same person to observe for mental change -If in doubt, or vomiting more than, once treat like heat stroke instead of exhaustion -Rule out hyponatremia prior giving fluids HEAT STROKE: The sooner a victim with heat stroke is cooled, the less damage will be done to his brain and organs NOTES: When stripping victim ensure a same gender helper is present, if possible. The same person should observe the Soldier during cooling and evacuation in order to spot symptom changes. To cool: Cover all but face with iced sheets. Ensure the iced sheet is soaked prior to applying to the casualty. Fan the entire body. Stop cooling if victims starts shivering

25 General Evacuation Criteria
Vomits more than once No improvement after 1 hour of rest and hydration General deterioration Mental status changes/confusion Loss of consciousness Soldiers displaying any of these criteria may be suffering heat stroke rather than heat exhaustion Any soldier who requires cooling with iced sheets should be evacuated to the ER Soldiers displaying any of these criteria (vomiting, no improvement or getting worse during1 hr rest and hydration, or mental status change or loss of consciousness) may be suffering heat stroke rather than heat exhaustion Any soldier who requires cooling with iced sheets should be evacuated to the ER It is critical that a specific person is assigned to STAY with victim from field through transport to medical care and continuously monitor all changes including mental status – Even the slight changes that can occur in minutes may not be noticed if different personnel are checking victim – these slight changes can be critical in ensure best outcome for victim

26 Pre-hospital care Ensure specific individual is assigned to continuously monitor Cooling is the priority- can reduce mortality from 50% to <5% Iced sheets (most effective) but also: Drench with water Fan Shade Stop cooling if shivering occurs Remove outer layers of clothing Rest with feet propped (helmet, sandbag, etc) If conscious, allow victim to sip cool water If unconscious, monitor airway and breathing It is critical that a specific person is assigned to STAY with victim from field through transport to medical care and continuously monitor all changes including mental status – Even the slight changes that can occur in minutes may not be noticed if different personnel are checking victim – these slight changes can be critical in ensure best outcome for victim Immediate Cooling is key – it can be what saves a life. However, if shivering occurs – stop ice and cooling! Remove outer clothing and prop feet up. Try to get a conscious victim to SIP water and if no indication of previous excessive water consumption If unconscious monitor breathing ( perform CPR if necessary)

27 Rapid cooling (ice sheets)
Except face, cover as much exposed skin as possible Also cover the top of the head When sheets warm up, put back into cooler and switch with other clean cold sheets Continue during evacuation Maintain same observer Stop if shivering If ice sheets available – cover as much of exposed skin and top of head – but not face Change out sheets when they get warm Remove if victim starts to shiver It is critical that a specific person is assigned to STAY with victim from field through transport to medical care and continuously monitor all changes including mental status – Even the slight changes that can occur in minutes may not be noticed if different personnel are checking victim – these slight changes can be critical in ensure best outcome for victim

28 Medical Support Issues
Know: When to evacuate Where to evacuate How to evacuate Medical professionals train others: Evacuation decision guidance Cool down with ice sheets Carry adequate iced sheets Coordinate non-military ambulance support (garrison/off-post) Conduct tests to ensure 100% communication Some installations only have clinics instead of hospitals. Some have no Emergency Room. Some units have no organic ground ambulance support. What are alternatives? Medical professionals train others on heat injury evacuation decision guidance. Most important training is how to cool down the soldier (iced sheet treatment) Always carry iced sheets (e.g., 8 sheets per company in large ice water cooler) NOTE: Wash wet sheets and clean cooler daily Coordinate for unit transport and non-military ambulance support (garrison or off-post). What support can they provide? What is their level of training? Do they have gate access? Conduct tests to ensure 100% communication (Cell phone dead zones, radio interfaces).

29 Summary EHI remains a threat to Soldiers and the Mission
5 steps of heat illness risk management Recognize heat-related illnesses EHI Heat Exhaustion Heat Stroke Water intoxication Know what to do - Now some quiz questions and scenarios….

30 HEAT ILLNESS RISK MANAGEMENT QUIZ QUESTIONS
What is heat load? Which of the 3 parts of the WBGT is most significant? How many (F°) are added to WBGT for body armor? What drugs can increase risk of EHI? What are 3 other personal risk factors for EHI? Name 3 controls can be done to reduce risk of EHI? What 2 things do you do to monitor High risk personnel? What is the most severe form of EHI? What is the most critical action for a suspect EHS victim? When and how is the ice sheet used? Heat generated by the body + heat gained from environment – heat lost to environment WBGT= 0.7T(wet-humidity) T(dry temp) + 0.1T(wind): Humidity is key! 5 F° are added to WBGT for body armor Cold, flu, blood pressure, and certain antidepressants (NOT caffeine or dietary supplements) See slide 8 See examples below - Pair up with a low risk Buddy, - Mark with red beads/patch Heat stroke Cool (and call) When vomited >once or otherwise determined/suspected to be in heat stroke _____________________________________________________ Example controls: Move training to cooler times/places (always drink BEFORE early am runs). Adjust work-rest cycles (TR ). Drink cool water frequently (but no more than 1.5 qts/hr or 12 qts/day). Eat food (vegetables, fruits, salty snacks, electrolyte-beverages or gels* (every 4 hrs or less). Consume sufficient electrolytes (salty snacks/soups, electrolyte beverages or gels). Ensure cooling capabilities (showers, fans).  Adjust clothing-equipment. Wear sunscreen lotion (SPF 50, sweat proof).

31 Heat Illness Risk Management Exercise 1: FTX 8K FOOT MARCH
SITUATION: A BCT company conducting an 8KM foot march at approximately 0700 (July). It is week 4. WBGT: WBGT: It is WBGT 3 (Yellow). It has been WBGT 4 for 2 preceding days. UNIFORM/EQUIPMENT: Soldiers were wearing their ACU with pants unbloused and rolled 2x, sleeves rolled 2x, combat boots, advanced combat helmet and ALICE pack (modified IAW with guidance). EXERCISE/WORKLOAD: Soldiers have been qualifying at the range for M16A2 rifle marksmanship and conducting physical training from 0530 to 0630 everyday during this week 4 of BCT. SOP: Installation SOP requires any uniform or POI changes to reduce the heat load to be made by Senior Leader on the ground. SUPPORT: Unit does not have organic medical support. Med Clinic is approx 2 miles away. Each platoon has CLS-trained Drill NCOs. EVENT: PVT Golf was on prescribed ENTEX for colds. PVT Golf fell down twice then collapsed at the 4km point. Unit cadre took his temperature via Thermoscan at 103º F. 1SG Hotel reached PVT Golf and noted symptoms were the same to those he had witnessed with his own father’s heart attack. Cadre evacuated PVT Golf to the nearest clinic (1.6 miles away/ a two-minute drive) where PVT Golf received 2-IV’s, required artificial respiration, and his temp rose to 108º F. Ice sheets were used and PVT Golf was evacuated by ground ambulance to an Army Community Hospital and was subsequently transferred to an Army Medical Center (AMC) later that day. His condition improved that day but developed signs of possible liver failure the next day and Med staff arranged for a liver transplant. On third day PVT Golf suffered a heart attack and was pronounced dead within the hour. Conduct an AAR.: What actions IAW the Risk Management process should have been taken? What actions should you as the senior leader on the ground take NOW?

32 Heat Illness Risk Management Exercise 2: RIFLE RANGE
SITUATION: An OSUT company is on a 5k march from the rifle range to the barracks at 1500 hours in a regular formation. Pace is 2.5 mph on a hard surface. It is Week 4. WBGT: It is WBGT 2 (Green). It has been WBGT 3/4 previous 3 days. UNIFORM/EQUIPMENT: Soldiers are wearing BDUs, patrol caps, web belts with canteens and ponchos, and rifles. Sleeves are down and pants are bloused. EXERCISE/WORKLOAD: Soldiers have been training all day since They took the PT test yesterday and the obstacle course the previous day. SOP: Installation SOP allows the Senior Leader on-the-ground to make any uniform or POI changes to reduce the heat load. SUPPORT: Unit does not have organic medical support (field ambulance and Medic/EMT). Ambulance service is provided by a local civilian hospital 20 minutes away. Each platoon has CLS-trained Drill NCOs. EVENT: Pvt Alpha wanders off into the tree line and is talking to the trees, mumbling incoherently. The Platoon NCO, SSG November, puts Pvt Alpha back into the marching formation at the head of the formation “to slow the march pace down.” Pvt Alpha wanders off again, talking to himself, unresponsive to questions. Conduct an AAR: What actions IAW the Risk Management process should have been taken? What actions should you as the senior leader on the ground take NOW?

33 Heat Illness Risk Management Exercise 3: TRAINING
SITUATION: A BCT company was doing a 3k road march in a regular formation at 1400 hrs (June). Pace is 3.5 mph on an asphalt road. It is Week 2. WBGT: It is WBGT 2 (Green)(84° WBGT). It has been WBGT 2 the previous 3 days. UNIFORM/EQUIPMENT: Soldiers are wearing BDUs, patrol caps, body armor without plates, web belts with canteens and ponchos, and rifles. Sleeves are down and pants are bloused. EXERCISE/WORKLOAD: Soldiers have been training all day since Last 3 days have been classroom training. SOP: Installation SOP allows the Senior Leader on-the-ground to make any uniform or POI changes to reduce the heat load. SUPPORT: Ambulance service is provided by a local military hospital. Each platoon has CLS-trained Drill NCOs. EVENT: Pvt Bravo collapses and is unconscious for >5 minutes. The SGT Delta, the Platoon CLS, thinks it is a Heat Stroke and starts Rapid Cooling. Pvt Bravo regains consciousness after 5 minutes and appears ok. SGT Delta takes Pvt Bravo to the BN medic’s office to get his opinion, but the medic is not in. SGT Delta then takes Pvt Bravo to the BDE medic to get her opinion, but she is not in. Finally, as Pvt Bravo’s condition worsens, SGT Delta takes him to the hospital at 1700 hrs. Conduct an AAR. What actions IAW the Risk Management process should have been taken? What actions should you as the senior leader on the ground take NOW?

34 Heat Illness Risk Management Exercise 4: QUALIFYING
SITUATION: BCT Soldiers are qualifying on the M16 at the weapons firing range. A Range Control Officer is in charge of the range. WBGT: It is WBGT 4 (RED). It has been WBGT 4 the previous 3 days. UNIFORM/EQUIPMENT: Soldiers are wearing BDUs, helmets, body armor with plates, and rifles. Sleeves are rolled up and pants are bloused. EXERCISE/WORKLOAD: Soldiers have been in classroom training all day indoors in A/C since 0500. SOP: Installation SOP allows the Senior Leader on-the-ground to make any uniform or POI changes to reduce the heat load. SUPPORT: Ambulance service is provided by the local military hospital. An ambulance with a Medic/EMT is on the range. EVENT: PVT Echo, goes to the SGT Charlie, the Drill Instructor and reports that she feels ill. She fails to tell SGT Charlie that she is a previous heat injury. She is directed to hydrate and to continue qualifying. PVT Echo moves on to the range, begins firing, and collapses unconscious. The medic, SP4 Whiskey, puts PVT Echo in the A/C bus, does not have Rapid Cooling supplies, and attempts to start an IV 3 times without success. He advises SGT Charlie that he needs a MEDEVAC immediately. SGT Charlie declines the request, stating a MEDEVAC will close the range, throwing off the training schedule, and he will get in trouble if he has an heat injury on the range. SP4 Whiskey loses PVT Echo’s pulse and starts CPR, requesting a MEDEVAC again. SGT Charlie requests the MEDEVAC. Conduct an AAR.: What actions IAW the Risk Management process should have been taken? What actions should you as the senior leader on the ground take NOW?

35 Additional Information
Links to Army Policy statements, heat injury references, TRADOC Policy, and Heat Injury Prevention Products are available on the Public Health Command Heat Illness Prevention webpage at Also – see the TRADOC Surgeon Heat Risk Manual at

36 Questions?


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