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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. 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

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  1. 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. 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

  3. 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

  4. WE ARE A NATION AT WAR Protection of our soldiers against heat stroke is critical to military success

  5. 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. THE WAR ENVIRONMENT 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

  7. 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. 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) BAGHDAD WEATHER USA Today, Tuesday 8 August 2006

  9. 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

  10. 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. 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 PREVENTIVE MEDICINE DOCTRINE http://www.usariem.army.mil/ http://chppm-www.apgea.army.mil/heat http://www.armymedicine.army.mil/index.cfm

  12. The Doctrine is Effective and We Are Operating Effectively USA Today, Tuesday August 8, 2006

  13. 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

  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

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