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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/. BRIEFING TOPICS. WE ARE A NATION AT WAR HISTORICAL PERSPECTIVE THE WAR ENVIRONMENT

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Us army medical research and materiel command heat stroke in the military population

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/


Briefing topics
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


U s army research institute of environmental medicine usariem
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 & HeatInjury & Mountain Sickness)

      • Hydration

    • Research Topics

      • Acclimation & Acquired Tolerance

      • Exposure Guidelines / Decision Aids

      • Environmental Injury / Illness Susceptibility

      • Hydration & Nutrition

      • Performance Optimization


We are a nation at war

WE ARE A NATION AT WAR (USARIEM)

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


Historical perspective
HISTORICAL PERSPECTIVE (USARIEM)

  • 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 environment
THE WAR ENVIRONMENT (USARIEM)

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

“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


Heat stress has an operational impact
Heat Stress Has an Operational Impact (USARIEM)

“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)


Current war environment
CURRENT WAR ENVIRONMENT (USARIEM)

“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)

BAGHDAD WEATHER

USA Today, Tuesday 8 August 2006


Rate of heat stroke injury among active duty army 1 jan 2000 30 apr 2008
Rate of Heat Stroke / Injury Among Active Duty Army, 1 Jan 2000 - 30 Apr 2008*

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

*Current as of 30 April 2008

Data Source: Defense Medical Surveillance System (DMSS)

Prepared by Armed Forces Health Surveillance Center (AFHSC), as of 26-JUN-2008


Long term effects of heat stroke
Long-term Effects of Heat Stroke? 2000 - 30 Apr 2008*

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 doctrine

TB MED 507/AFPAM 48-152(I) 2000 - 30 Apr 2008*

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

PREVENTIVE MEDICINE DOCTRINE

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

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

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


The doctrine is effective and we are operating effectively
The Doctrine is Effective and 2000 - 30 Apr 2008*We Are Operating Effectively

USA Today, Tuesday August 8, 2006


Heat stroke heat exhaustion cases before after heat mitigation intervention
Heat Stroke & Heat Exhaustion Cases Before & After Heat Mitigation Intervention

CPT Erik J. Bergeson APA-C DMO Ranger Training Brigade Surgeon

(Briefing of November 2006)

2002 – Before Heat Mitigation Interventions by USARIEM

2003-2006 – After Heat Mitigation Interventions by USARIEM

> 10-fold decrease

8-fold decrease


Heat stroke in today s us military population
HEAT STROKE IN TODAY’S Mitigation InterventionUS 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