Frequently Asked Questions
What are heat illnesses and what is tracked by the military?
EHI range from dehydration and mild heat cramps to a more serious condition called heat exhaustion, to the life-threatening medical emergency called heat stroke, or exertional heat stroke (EHS). Only the more serious conditions (heat exhaustion and heat stroke) must be reported by military medical providers (military reportable medical events or RME, RMEs), and are thus the conditions reflected in
military surveillance.
- Milder conditions (not reportable medical events)
More serious EHI, tracked in surveillance:
- Heat exhaustion is when core body temperature has become elevated but remains below 104⁰F, observed signs/symptoms include dizziness, headache, nausea, weakness, unsteady gait, muscle cramps, fatigue; can resolve rapidly with immediate cooling interventions (moving to shade, loosening uniform/removing head gear, encouraging drinking but track volume (no more than 1.5 quarts of water over 1 hour). Rapid intervention is necessary to prevent progression to heat stroke – casualty should be evacuated for further monitoring.
- Heat stroke (EHS) is a life-threatening medical emergency when the core body temperature reaches 104⁰F or higher and is most often observed by a change in mental status (confusion, delirium, combative, loss of consciousness), there may be vomiting, weakness, convulsions and chills. If EHS is suspected, call EMS and evacuate immediately after applying ice sheets to start body cooling – the faster the body is cooled, the less permanent damage to the brain and organs.
- Cover all but the face with ice sheets
- Ensure the ice sheet is soaked prior to applying to the casualty
- Switch ice sheets every 6 minutes with new ice sheets
- Evacuate immediately
Though not RMEs, additional serious conditions associated with strenuous military training especially in hot environments include
exertional rhabdomyolysis
, a pathologic muscle breakdown associated with strenuous physical activity especially in high heat environments, and
hyponatremia, when too much water is consumed causing an imbalance to the body’s chemistry. It is important to differentiate hyponatremia from EHS as additional fluids given to a hyponatremia casualty can be fatal.
- Hyponatremia occurs when too much water has been consumed resulting in a dangerous imbalance to the body’s chemistry. Like heat stroke, mental status changes may be noted and there may be repeated vomiting (clear vomit). Additional signs may include distended/bloated abdomen and large amounts of clear urine.
- Do NOT give more water or IV fluids
-
Help determine if a casualty has consumed excessive water or fluids and/or had poor food/sodium intake
- Call EMS
- If awake, allow casualty to consume salty foods
- Evacuate immediately
What increases a service member's risk of becoming a heat casualty?
Though anyone can become a casualty of heat illness, the following factors can increase or decrease the risk:
-
Outside temperature, humidity, and wind speed. High heat is a primary EHI hazard, so most EHIs occur between May and September, especially when the outside temperature is over 75° Fahrenheit (F). But heat casualties occur throughout the year. Temperature, sunlight, humidity, and wind speed all affect heat illness risk. To combine these elements into a single Risk Category to allow unit leaders to manage operational risks, the military uses the Wet Bulb Globe Temperature (WBGT) index to create Operational Risk Heat Categories so that leaders can balance heat stress risks with other risks faced during their unit's missions.
-
Individual susceptibility factors
- Having had a prior heat illness
- Certain health conditions
- Poor fitness level (low aerobic fitness, and/or excessive weight)
- Certain medications
- Poor nutrition and inadequate hydration
-
Excessive motivation (ignoring personal signs of physical limits)
What are the impacts of heat illness to military readiness?
Heat illness, and dehydration from vigorous activity in heat, is a threat to individual health and to military operational success:
- Individually –
- Losing as much as 4% of body weight from dehydration can degrade physical performance.
- Every 1% loss of body weight increases core temperature (0.10-0.23⁰C or 0.18-0.40⁰F), thereby increasing risk of a more serious heat illness.
- Unit strength –
- Each year thousands of military heat illness casualties require medical attention
- In addition to medical care, the heat illnesses experienced by service members result in many thousands of lost/limited duty days each year
Do service members have to worry about skin cancer?
While skin cancer may not be a concern during a service member's active-duty years, that is when some of the most serious sun exposures may occur. The damage caused by UV radiation builds over time, so more frequent exposures during a lifetime will increase the risk of developing skin cancer. Evidence also suggests that shorter intermittent periods of high-intensity exposures – such as during military deployments to areas of intense sunlight – may be especially dangerous:
- A
scientific review published in the Journal of the American Academy of Dermatology (Jun 2018) identified “an abundance of evidence for an increased risk for skin cancer development among U.S. veteran populations."
- The review concluded that sun protection had not been a priority for many service members who had worked in high-UV-exposure environments. Immediate operational and combat safety concerns took precedence. Findings also noted the inability to avoid peak sunlight hours during missions; continued exposure to highly reflective surfaces, such as sand; little to no emphasis on sun protection; and limited access to sunscreen.
Personal characteristics that may increase risk of skin cancer include:
- Being light-skinned
- Having had a serious blistering sunburn or multiple sunburns in the past
- Having prior personal diagnosis of skin cancer or a family member who has had skin cancer previously (genetics)
- Also, men are at potentially higher risk because they use sunscreen less, are less likely to have their skin checked, and may experience longer exposure durations while participating in outdoor recreational and occupational activities.
Should you seek annual medical skin screening for skin cancer?
The U.S. Preventive Medicine Task Force does not consider annual medical skin cancer screening examinations necessary for all adults, but since some U.S. military personnel have been found to have higher rates of skin cancer than civilians, service members with additional risk factors should talk about their skin health with their healthcare provider. This is especially important if you notice a new or changing mole or unusual spot on the skin.
From:
Soldiers not immune to damage of sun's ray (Jul 2022)
