1. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 1 of (14) US Army Medical Research and Materiel Command Heat Stroke in the Military Population George W. Weightman Major General, Medical Corps Commanding General 22 October 2008 https://mrmc-www.army.mil/

2. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 2 of (14) BRIEFING 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

3. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 3 of (14) U.S. Army Research Institute of Environmental Medicine (USARIEM) USARIEM Mission Conduct 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 Division Core Areas Cold Stress Physiology Heat Stress Physiology High Altitude Physiology Environmental Illness (Cold & Heat Injury & Mountain Sickness) Hydration Research Topics Acclimation & Acquired Tolerance Exposure Guidelines / Decision Aids Environmental Injury / Illness Susceptibility Hydration & Nutrition Performance Optimization

4. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 4 of (14) WE ARE A NATION AT WAR Protection of our soldiers against heat stroke is critical to military success

5. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 5 of (14) HISTORICAL 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)

6. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 6 of (14) THE WAR ENVIRONMENT “A soldier fighting is not as simple a situation as an athlete running a marathon. The soldier is exposed to the environment not knowing for how long, with minimal food and water. The soldier suffers tremendous sleep deprivation, fear, hard work and exposure to heat and cold.” The Scientist, 2004 Wars are Fought Outdoors with Extended Exposure to Harsh Environments and Exhaustive Work

7. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 7 of (14) Heat Stress Has an Operational Impact “Within initial 72h of battle, 10% of engaged infantry (40 cases) were evacuated and treated for dehydration at BAS.” Battle of Najaf, Iraq (August 2004) 1LT Dean Stulz, 1-5 CAV, Battalion PA (After Action Brief)

8. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 8 of (14) BAGHDAD WEATHER USA Today, Tuesday 8 August 2006 CURRENT WAR ENVIRONMENT “That summer an average soldier on an 8-10 hour mission drank from 2-4 gallons (8-16 qts) of water, and another half gallon (2 qts) during the remainder of the 24-h period while back on base.” SFC Larry Larson, Summer Iraq Operations (email, 4 April 2005)

9. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 9 of (14) Rate of Heat Stroke / Injury Among Active Duty Army, 1 Jan 2000 - 30 Apr 2008* 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

10. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 10 of (14) 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 ? ? ?

11. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 11 of (14) PREVENTIVE 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

12. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 12 of (14) USA Today, Tuesday August 8, 2006 The Doctrine is Effective and We Are Operating Effectively

13. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 13 of (14) 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 YEAR(S)# of Classes# of StudentsHeat Stroke CasesHeat Exhaustion Cases 2002112,65835 (1/75 students)42 (1/63 students) 2003-20063811,96415 (1/797 students)24 (1/498 students) 2002 – Before Heat Mitigation Interventions by USARIEM 2003-2006 – After Heat Mitigation Interventions by USARIEM > 10-fold decrease8-fold decrease

14. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 14 of (14) HEAT STROKE IN TODAY’S US MILITARY POPULATION Continues to be a major problem for US forces Non-deployed soldiers in 2007: 329 incident cases of heat stroke 1,853 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 year Israeli 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

15. MG George Weightman/MCMR-ZA (301-619-7613) (DSN 343)/George.Weightman@us.army.mil UNCLASSIFIED12/2/2015 9:50 PM Slide 15 of (14)