Recognize the risk for heat illness

| July 14, 2017 | 1 Comment

Spc. Logan Romine, a 35F/Intelligence Analyst with Headquarters and Headquarters Company, 86th Training Division, stops on the roadside during the 10km ruck march event at the 2012 U.S. Army Reserve Best Warrior Competition at Fort McCoy, Wis., 2012. Hydration and avoidance of over fatigue are factors in combating heat related illnesses.

Dr. Grace Chen, MD, FACEP
Tripler Army Medical Center
HONOLULU — We are well into the summer, and many will be outdoors spending time at the beach, pools, hiking and camping as they try to make the most out of the long days and great weather. However, with these long days and great weather comes the possibility of heat illness.

Heat illnesses include prickly heat, heat edema, heat cramps, heat exhaustion and heat syncope. The U.S. Army had a total of 5,246 cases of heat illnesses (37 resulting in death) from 1980-2002. Heat exhaustion or heat syncope accounted for the majority cases, followed by heat stroke and heat cramps.

New recruits are especially vulnerable, with most of the heat illnesses occurring within the first 12 months of service.

Prickly heat is a rash caused by exposure to heat. You can try to wear sweat-wicking fabrics and use baby powder or other substances to decrease irritation to your skin in the heat.

Heat edema is swelling of the hands and feet in warm weather. This can be treated with elevation of your hands and feet and compression stockings.

Heat cramps are severe leg cramps seen after stopping strenuous exercise. This can be treated with fluid replacement, like drinking water.

Heat exhaustion and heat stroke are by far the most concerning of the heat illnesses. With heat exhaustion, the patient will have an increased pulse, weakness, nausea, vomiting and a lot of sweating, but patients with heat stroke can have damage to their organs.

What to do
With these severe heat illnesses, it is required that the patient be removed from the heat – placing the patient in the shade – with cooling. In the field, this may include undressing the patient of excess clothing and placing ice packs to the axilla and groin area. A fan works well, as does immersion in ice or cold water if it is available.

The patient should be supervised while doing this to prevent drowning. If these methods are not available, cool towels may help.

Try to encourage oral hydration if possible. Also, IV hydration is also helpful if it is available in the field.

Avoid giving the patient any medications that decrease fever, such as Tylenol or Motrin, as this does not work for heat illness. All these patients need to be transported to the hospital.

The best thing to do is to avoid heat illness altogether, as follows:

  • Keep properly hydrated.
  • Bring sunscreen as a sunburn can cause impaired sweating, which is a risk factor for heat accumulation.
  • Keep in shape as there is an increased risk of heat injury among obese or overweight people.
  • Avoid alcohol as it is a diuretic that will make you more susceptible to heat illness.
  • Avoid drugs that increase risk for heat illness, including amphetamines, antihistamines (such as Benadryl), cocaine, diuretics (caffeine is a diuretic) and laxatives.
  • Try to train to maintain a good level of fitness because those people who have better cardiovascular fitness tolerate more activity in heat-strained conditions and acclimatize more rapidly.
  • Try to dress appropriately for the heat as excess clothing can prevent heat exchange.
  • Avoid high exertion activities in exposed or hot areas.
  • Avoid dietary supplements since they could contain substances that increase your risk for heat illness.
  • Get a good night’s sleep before you expose yourself to exercising in the heat.

Please enjoy yourself this summer and be safe!

(Editor’s note: Chen works in the Emergency Department.)

TAMC Tip

Swim Safely

Swimming is a fun, active and healthy way to spend leisure time.

Take a few minutes to keep health and safety in mind to help prevent illness and injury.

  • Ask a buddy to join you when swimming, so you don’t swim alone.
  • Choose swimming sites that have lifeguards.
  • Avoid drinking alcohol before and during swimming.
  • Don’t swallow pool water.
  • Don’t swim when you have diarrhea. Germs can spread in the water and make other people sick.
  • Take a shower and wash your child before swimming.
  • Take your kid on bathroom breaks every 60 minutes, or check diapers every 30-60 minutes.
  • Change diapers in a bathroom or a diaper-changing area and not at poolside. Germs can spread in and around the pool.
  • Wash your hands after using the toilet or changing diapers before getting in the pool.
  • Watch children in and around water at all times.
  • Make sure to keep your ears as dry as possible to help prevent swimmer’s ear.

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Category: Health

Comments (1)

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  1. David DeGroot says:

    To clarify something implied by this article, heat exhaustion and external heat stroke are NOT treated similarly. A heat exhaustion casualty can be treated with rest in the shade, removal of excess clothing and rehydration.

    On the other hand, exertional heat stroke, characterized by central nervous system dysfunction and altered mental status, is a medical emergency that requires rapid aggressive cooling and transport to the nearest hospital for further treatment and evaluation.

    Acclimatization to the heat is an extremely important heat stress mitigation strategy. Those unaccustomed to a hot environment are more susceptible, especially during the first 7-10 days and they should take care not to over-exert themselves during that time.

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