“high risk” units guide … · protection against wounds and insects. insulation is not...

The incidence of heat injuries has seen a general decline

since 1987. It has, however, remained fairly constant at about 3.5

cases per 1000 population since 1995. The “high risk” units are

the Training Schools (BMTC, SISPEC, OCS), Infantry units and Guards

units. This is because of the transitional status from the comfort of

civilian life to the tough military training of the basic trainees in

BMT, while the Infantry and Guards units generally have a higher

training intensity. In 1998, OCS and SISPEC have seen the largest

increase in the percentage of heat injury cases amongst all units.

The time of the year with the highest incidence of heat injuries

are April to May which coincides with the period of the year with

the highest Wet Bulb Globe Thermometer (WBGT) readings which

represents an index of heat and humidity. The pattern for the time

of the day with the highest incidence of heat injuries is a bimodal

one with peaks at 0800 to 0959hrs and 1600 to 1759hrs. These

peaks straddle the 1130 to 1530hrs period in which formal physical

training is currently prohibited as stipulated in the TSR. In the early

night hours of 1800 to 1959hrs, we have the third highest number

of heat injuries.

Education of our Commanders and the proper supervision

of training and heat injury prevention measures are key factors in

preventing heat injuries from occurring. We hope that the material

presented in this book will enable our Commanders to equip

themselves with the knowledge required.

FOREWORDFOREWORD

CONTENTSCONTENTSPage

Chapter 1 What Are Heat Injuries ………....… 1DefinitionTypes of Heat Injuries

Chapter 2 What Causes Heat Injuries .............. 2Heat Gain and Heat LossAcclimatisationDehydrationPhysical Indicators of Dehydration

Chapter 3 “Soldier at Risk” Profile ..................... 8

Chapter 4 Preventing Heat Injuries ................... 9Heat Injury Prevention Factors6 Do’s for Prevention of Heat InjuriesUrine GuideRisk Recognition and Management

Chapter 5 Management of Heat Injuries ....... 21General Management7 R Management Model

Chapter 6 Commanders’ Role ........................ 23Before Exposure to HeatDuring Exposure to HeatAfter Exposure to Heat

Appendix A - Work Intensity of Military Tasks

Reference List

1

Chapter 1WHAT ARE HEAT INJURIES?

DEFINITIONA heat injury occurs when a soldier engages inphysical activity to the extent where the heatproduction within his body exceeds its ability to loseheat adequately. This results in a rise in inner body(body core) temperature to the levels at which normalbody functions are interfered with. This may leadto temporary or permanent disturbances in bodilyfunctions.

The three types of heat injuries:The three types of heat injuries:The three types of heat injuries:The three types of heat injuries:The three types of heat injuries:

✷ Heat crampsHeat crampsHeat crampsHeat crampsHeat cramps - are the result of excessive saltand water losses due to profuse sweating insoldiers whose bodies are attempting to rapidlylose heat. It presents as intermittent musclecramps, which usually occur on the legs (calvesand thighs).

✷ Heat exhaustion Heat exhaustion Heat exhaustion Heat exhaustion Heat exhaustion - is a more severe form of heatinjury. It implies a significant loss of water fromthe body. The signs and symptoms are:

◆ weakness,◆ exhaustion,◆ headaches,◆ dizziness and◆ profuse sweating with an elevated body

temperature.✷ Heat strokeHeat strokeHeat strokeHeat strokeHeat stroke - is the most serious form of heat

injuries. It manifests with a body coretemperature of 41O Celsius and above. Soldiersmay present with confusion, aggressivebehaviour and may progress into a comatosedstate. It is a medical emergency!It is a medical emergency!It is a medical emergency!It is a medical emergency!It is a medical emergency!

Chapter 1WHAT ARE HEAT INJURIES?

Heatinjuries

kill

In this chapter:In this chapter:In this chapter:In this chapter:In this chapter:

••••• DefinitionDefinitionDefinitionDefinitionDefinition••••• Types of HeatTypes of HeatTypes of HeatTypes of HeatTypes of Heat

InjuriesInjuriesInjuriesInjuriesInjuries

2

The human body gains heat continuously throughvarious channels. This gain is even more significantin a soldier exerting himself physically in a hot andhumid environment. There are many processesthrough which body heat is lost. A soldier is able toregulate his body temperature and stay safe.However, factors such as acclimatisation, hydrationand rest play a very important role. Lack ofacclimatisation, poor physical fitness, obesity, illnessand a lack of instinct to drink water adequately aremajor risk factors for heat injuries. These are allthe factors, which may be present in a newlyrecruited soldier.

HEAT GAIN AND HEAT LOSS

HEAT GAIN

Heat gain by the body is due to:

◆ Heat generated within the body by muscleactivity and other body functions. An exampleof work intensities of military tasks, as definedby US Army, is shown in Appendix A.

◆ Direct radiation from the sun’s rays

◆ Heat transfer from the air

◆ High humidity which hinders the cooling of thebody through the evaporation of sweat

HEAT LOSS

The body loses heat through:

◆ Evaporation of sweat

◆ Radiation of heat outwards from the bodysurface

Chapter 2WHAT CAUSES HEAT INJURIES?

HeatInjuries

result froma failure inthe system


••••• Heat Gain and HeatHeat Gain and HeatHeat Gain and HeatHeat Gain and HeatHeat Gain and HeatLossLossLossLossLoss

••••• AcclimatisationAcclimatisationAcclimatisationAcclimatisationAcclimatisation••••• DehydrationDehydrationDehydrationDehydrationDehydration••••• Physical IndicatorsPhysical IndicatorsPhysical IndicatorsPhysical IndicatorsPhysical Indicators

of Dehydrationof Dehydrationof Dehydrationof Dehydrationof Dehydration

Chapter 2WHAT CAUSES HEAT INJURIES?

3

◆ Transfer of heat from the skin to thesurrounding air (convection)

◆ Breathing

◆ Urination

BODY HEAT REGULATION :“STAYING SAFE”

◆ In order for the body to lose heat adequately,regular rest in a cool or shady environment isalso required. This allows the heat loss processto keep up with and “overtake” the heat gainprocess. Concurrent hydration is critical.

◆ High air temperature, high relative humidityand exposure to the sun make it difficult forsoldiers to regulate their body temperature.

◆ Excessive clothing will prevent heat from beinglost to the environment.

◆ When the environmental conditions and/ orclothing prevent the heat generated within thebody from being dissipated, the bodytemperature will rise significantly. If this cycleis not stopped, heat injuries will occur.

◆ The heat injuries are commonly associated withhard work in hot weather. However, they canalso occur in relatively cool conditions whensoldiers are dressed in heavy protectiveclothing.

◆ The same principles apply at night as well. Ifthere is inadequate cooling of the body duringphysical exertion at night, heat injuries canoccur.

Thesoldiers in

their first 6months oftrainingare at

higher risk

4

ACCLIMATISATION

WHAT IS ACCLIMATISATION?

◆ Acclimatisation is the ability of the body toundergo physiological adaptations so that thesoldier is able to cope better with theenvironmental and physiological heat stress.

FACTS ON ACCLIMATISATION

◆ Newly enlisted soldiers (e.g. BMT recruits) aregenerally not acclimatised adequately to heat.Social habits and norms such as the extensiveavailability of air-conditioning contribute tothis observation. Therefore, soldiers in theirfirst six months of training are at higher riskof heat injuries.

◆ Heat acclimatisation increases sweating (by50-100%) and this enhances the evaporativecooling capacity of the body. Increasedsweating, however, can lead to dehydration.As such, the soldiers can adapt to heat (i.e.they can acclimatise), but not to dehydration.

◆ Physically fit soldiers acclimatise more rapidlythan the less fit.

DEHYDRATION

WHAT IS DEHYDRATION?

◆ Dehydration refers to the reduction of bodywater content to that below the normalphysiological (and safe) level. Some degree ofdehydration is inevitable when working in a hotand humid environment. This is due to waterloss through sweating.

Acclimatisationstays withthe soldier

wherever hegoes

5

Thirst isnot a

reliableindicator ofdehydration.It may betoo late.

FACTS ON DEHYDRATION

◆ New soldiers are more prone to dehydrationas they generally tend not to have a “drinkinghabit”. They tend to drink water only whenextremely thirsty and this is too late. Havingnot trained regularly in hot and humidconditions, they do not have an “instinct” todrink water beyond the point of thirst. Theymust be trained to do so.

◆ An individual under stress in a hot and humidenvironment may not sense dehydration at theearly stages.

◆ Soldiers may maintain themselves at about 1.5litres below their ideal hydration statuswithout any sense of thirst, thus exhibiting“voluntary dehydration”.

◆ The body may suffer dehydration of 1-2% ofbody weight and perform less effectivelybefore the feeling of thirst is even noticed.

◆ Caffeine and alcohol beverages have diureticproperties, which increase the risk ofdehydration through increased urination.

◆ Heat, wind and dry air increase the body’swater requirements through loss of body wateras sweat.

◆ At high altitudes (>2000 metres above sealevels) there is an increase in the rate ofbreathing due to reduced oxygen levels. Thedryness of the atmosphere also increaseswater loss through breathing. However, thefeeling of thirst becomes less felt, and thedesire to drink is suppressed at an altitude.

6

Newsoldiers

must forma “drinking

habit”

◆ Soldiers often become dehydrated whiletravelling, especially if the trip is long. Waterconsumption is as important during travel asany other time.

◆ Soldiers who are well trained, fit and fullyhydrated tolerate heat exposure moreeffectively than the less fit and dehydratedsoldiers.

EFFECTS OF CLOTHING ONDEHYDRATION

◆ Excessive clothing can contribute todehydration by impeding evaporation of sweat.This causes the body to produce more sweatin order to cool the body. This leads to rise inbody temperature.

◆ Military clothing are worn for camouflage, forload carriage (i.e. for pockets) and forprotection against wounds and insects.

◆ Insulation is not desirable but is an inherentcharacteristic of the protective clothing andthe insulation decreases heat loss.

◆ Multiple layers of clothing, even if thin, willprovide a considerable amount of insulationand, therefore, should be avoided.

7

As commanders, you must understand the physicalindicators of dehydration. This will help you in theidentification and confirmation of the level ofdehydration in your soldiers:

Physical Indicators of DehydrationPhysical Indicators of DehydrationPhysical Indicators of DehydrationPhysical Indicators of DehydrationPhysical Indicators of Dehydration

Skin ◆ Less elastic.◆ On pinch test, the skin regains

its shape slowly

Urine ◆ Reduced in volume and frequency◆ Concentrated and darker

Sweat ◆ Higher sweat rate◆ If sweat production suddenly

stops despite continued heatexposure, dehydration hasreached a severe level

Physical ◆ Reduced enduranceWork ◆ Accelerated onset of fatigueCapacity

Heart Rate ◆ Faster heart rate◆ Work seems increasingly more

tiring and increases the heartrate rapidly

Appetite ◆ Suppressed appetite◆ Food intake is reduced during

water deprivation, and waterintake reduced duringstarvation

Mental ◆ Less alertIndicators ◆ Increased lethargy

◆ Difficulty in concentrating◆ Confusion◆ Irrational behaviour

Dehydrationaffects

physical aswell asmental

capability

8

Chapter 3“SOLDIER AT RISK” PROFILEChapter 3“SOLDIER AT RISK” PROFILE

Timid soldierwho would notreport even ifnot feeling well

Training whilsthaving fever orsuffering from

other illnesse.g. diarrhoea,

flu

Not drinkingenough water

The wellmotivated

soldier who willnot “fall-out”

easily

Performingstrenuous

exercises on ahot and humid

day

Poor state ofhealth

Obese

Loss offitness/

acclimatisation(e.g. after

block leave)

Previous victimof a heatdisorder

Newly enlistedsoldier

Not havingsufficient restbefore, duringand after the

activity

Wearing thickclothing oradditionallayers of

clothing in hotweather

9

Heat Injuries are totally preventable. When a heatinjury occurs, it is an indication of failure in one ormore components of the prevention system. Thismakes prevention at commander’s level even moreimportant. A good understanding of how to preventheat injuries amongst all commanders will go a longway towards the reduction of the incidence of heatinjuries. The following are important factors inprevention of heat injuries:

HEAT INJURY PREVENTION FACTORS

◆ Acclimatisation

◆ Hydration

◆ Work rest cycle

◆ Shade

◆ Clothing

ACCLIMATISATION

HOW DOES ONE ACCLIMATISE?

◆ Acclimatisation to heat involves repeatedexposure to heat, sufficient to raise the corebody temperature by at least 1O Celsius and toinduce moderate to profuse sweating.

◆ During the first two days of heat exposure,light activities would be appropriate. By thethird day of heat exposure, 3 km runs at thepace of the slowest participant are feasible.

Chapter 4PREVENTING HEAT INJURIES

Heatinjuries

arepreventable


••••• Heat injuryHeat injuryHeat injuryHeat injuryHeat injuryprevention factorsprevention factorsprevention factorsprevention factorsprevention factors

••••• 6 Do’s for6 Do’s for6 Do’s for6 Do’s for6 Do’s forPrevention of HeatPrevention of HeatPrevention of HeatPrevention of HeatPrevention of HeatInjuriesInjuriesInjuriesInjuriesInjuries

••••• Urine GuideUrine GuideUrine GuideUrine GuideUrine Guide••••• Risk RecognitionRisk RecognitionRisk RecognitionRisk RecognitionRisk Recognition

and Managementand Managementand Managementand Managementand Management

Chapter 4PREVENTING HEAT INJURIES

10

◆ Significant acclimatisation can be attained in4-5 days. Full heat acclimatisation takes 7-14days with carefully supervised exercise for 2-3 hours daily in the heat.

◆ The intensity of exercise should be graduallyincreased each day, working up to anappropriate physical training schedule adaptedfor the environment.

◆ Maintenance-level physical trainingprogrammes should be conducted in themorning or evening, during the cooler hours.

◆ Soldiers should attain the highest possiblephysical fitness level in a gradual andprogressive manner.

HYDRATION

◆ Soldiers tend not to sense that they aredehydrated and must therefore be consciouslyreminded to replace the water that is lostthrough sweating.

◆ “Voluntary” dehydration can be minimised byproviding cool, flavoured water and byproviding sufficient time for drinking.

◆ It is the responsibility of the Commanders toensure regular consumption of fluids by theirsoldiers.

Acclimatisationdoes NOT

reduce, andmay

actuallyincrease,

waterrequirements

11

TIPS ON HYDRATION

Palatability

◆ A palatable flavoured beverage will encouragethe soldiers to drink fluids in quantities thatmay match their needs

◆ Water can be consumed in larger volumes attemperatures between 15-20O Celsius

◆ The amount carbonated (fizzy) beverages thatcan be comfortably consumed is less

What to drink:

◆ Plain water in sufficient volume will help thehydration process

◆ Providing cool water with added electrolytesis difficult but will be helpful

◆ If the administration system allows it, attemptsshould be made to provide cool water withelectrolytes. This will especially be useful forpoorly acclimatised individuals such as recruits

The international guidelines, as advocated by the USand British Armies are:

◆ Heat exposure less than 90 minutes - Plain, coolwater

◆ Heat exposure exceeding 90 minutes - cool,suitably flavoured carbohydrate-electrolytebeverage (concentration - no more than 8%, or2 table spoons of sugar per litre)

◆ Heat exposure exceeding 240 minutes -Flavoured carbohydrate-electrolyte beveragesupplemented with one tea spoon of salt per litre

Water isthe most

ideal drink

12

BeyondBMT, thesoldier’sinstinctto drinkmust be

maintainedthrough

supervision

What NOT to drink:

◆ Carbonated drinks (feeling of being bloated)

◆ Alcohol, coffee, tea (diuretic property)

◆ Commercially available Oral RehydrationSolutions (unpalatable, designed to replacefluid lost in diarrhoea, but not suitable for useduring activities in heat)

◆ Carbohydrate-electrolyte beverageconcentrations greater than 8% (delays waterabsorption)

◆ Hot drinks, when cooler ones are available

◆ Drinks of unknown ingredients

SALT

◆ For the first few days of acclimatisation, thesoldiers may have an increased saltrequirement because of an increase in salt lossthrough sweat.

◆ Once acclimatised, the soldier should obtainenough salt from his daily meals to make upfor the amount lost during sweating.

◆ The only instance where extra salt should beadded is during severe sweating or the earlystages of training in a hot and humid climatefor the unacclimatised soldiers.

IN THE FIELD

◆ Recruits must be trained to drink waterregularly beyond the point of thirst. Wherepossible, cool drinks should be providedadministratively, especially during high riskactivities (e.g. Route Marches).

13

◆ Beyond BMT, the soldier’s instinct to drinkmust be maintained through supervision.

◆ Commanders must ensure that each soldieralways has at least one full water bottle inreserve and that he knows when and wherewater resupply will be available.

◆ Plan to provide water resupply at intervals ofno more than three hours.

◆ Prevent the heating up of water in jerry cansby reducing direct exposure to the sun.

◆ Drinking adequately is the soldier’s personalresponsibility but it is the commander’sresponsibility to supervise and to make thesoldier aware of this.

WORK/ REST CYCLES

◆ Body temperature can rise rapidly due to thecombination of sustained activities andexcessive heat. To prevent a dangerousincrease in body temperature, heat productionmust be minimised by reducing the pace of workand increasing the duration of rest. This isespecially important in very hot and humidconditions.

◆ The maximum possible sweat rate (approx. 2litres/hour) is higher than the rate of waterabsorption from the gut (approx. 1.5 litres/hour). This makes the pre-activity hydrationand rest during activity even more important.

◆ The Training Safety Regulations (TSR) provideguidance on work-rest cycles for some specificactivities (e.g. Route Marches).

Whenshade is

available,use it

14

CLOTHING

◆ Soldiers should wear light clothing wheneverpossible.

◆ Soldiers should not be allowed to wearunnecessary layers of clothing.

6 Do’s for Prevention of Heat Injuries

◆ DoDoDoDoDo drink water until you are no longer thirstyand then a little more

◆ DoDoDoDoDo rest well before and in between strenuousexercises

◆ DoDoDoDoDo loosen your clothing while resting

◆ DoDoDoDoDo report sick if you are not feeling wellbefore, after or during strenuous exercises

◆ DoDoDoDoDo avoid exercises if medical leave is granted

◆ DoDoDoDoDo remember the 7R’s of the first aid for heatinjuries

URINE GUIDE

◆ If the body is in the water balance, the urinewould a pale straw colour.When water loss fromthe body exceeds water intake, the kidneysneed to conserve water, making the urine muchmore concentrated with waste products andsubsequently darker in colour.

◆ Teach your soldiers to monitor hydrationstatus by noting the colour and volume of theirurine.

◆ Even dehydrated personnel will continue toproduce urine, called “obligatory urine”.

Evendehydratedpersonnel

willcontinue to

produceurine,called

“obligatoryurine”

15

◆ When dehydration is inevitable for operationalreasons, obligatory water loss in urine can bereduced by avoiding diuretics like coffee andtea.

URINE COLOUR CHART

Minimiserisk,

maximiseperformanceand results

◆ Dark yellow urine is a sure indicator that thesoldier is dehydrated and that the fluidconsumption must be increased.

◆ The aim is to produce urine no darker thancolour 3 of the Urine Colour Chart. Desire tourinate less than twice per day and/ orproducing urine darker than colour 3 in thechart indicate severe dehydration; the soldiermust start drinking immediately.

RISK RECOGNITION ANDMANAGEMENT

◆ The commanders must be familiar with the RiskAssessment Matrix outlined in the next fewpages. It describes the risk factors, remedialactions and commanders’ role in preventing theheat injuries.

Urine Color Test

1

2

3

4

5

6

7

8

16

RISK ASSESSMENT MATRIXRISK ASSESSMENT MATRIXRISK ASSESSMENT MATRIXRISK ASSESSMENT MATRIXRISK ASSESSMENT MATRIX

CAUSALCAUSALCAUSALCAUSALCAUSALFACTORFACTORFACTORFACTORFACTOR REMEDIAL ACTIONSREMEDIAL ACTIONSREMEDIAL ACTIONSREMEDIAL ACTIONSREMEDIAL ACTIONS COMMAND ACTIONSCOMMAND ACTIONSCOMMAND ACTIONSCOMMAND ACTIONSCOMMAND ACTIONS

InadequateInadequateInadequateInadequateInadequatePhysicalPhysicalPhysicalPhysicalPhysicalConditioningConditioningConditioningConditioningConditioning(Lack of(Lack of(Lack of(Lack of(Lack ofAcclimatisation)Acclimatisation)Acclimatisation)Acclimatisation)Acclimatisation)

Ignorance ofIgnorance ofIgnorance ofIgnorance ofIgnorance ofHeat InjuryHeat InjuryHeat InjuryHeat InjuryHeat InjurySymptomsSymptomsSymptomsSymptomsSymptoms

◆ All soldiers should be physicallyprepared for training from day 1.Training must be progressive as perapproved syllabus

◆ Additional training is required toprepare the soldiers for toughoverseas training e.g. jungle trainingin Brunei

◆ Soldiers must be taught to identifyand understand the symptoms ofheat injuries, and be familiar withthe necessary safety precautions,including 7 R Management Model

◆ Soldiers must be made aware thatheat injuries can kill or causepermanent damage to health. It iseven more important to know thatheat injuries CAN be prevented

◆ Commanders should note progressof the soldiers

◆ “Weak” soldiers should beidentified when training isconducted. (A “weak” soldier is asdescribed below under “illness”)

◆ Remedial training should beconducted for “weak” soldiers

◆ Commanders should be well versedin heat injury symptoms andremedial actions

◆ They must teach the soldiers tolook out for symptoms of heatinjuries, and to take theappropriate remedial actions

◆ All soldiers must be made familiarwith 7R management model

17

InsufficientInsufficientInsufficientInsufficientInsufficientHydrationHydrationHydrationHydrationHydration

◆ Soldiers should be trained to makeit a practice to drink at least 6 litresof water daily

◆ During hot weather and when trainingis intense, water intake should beincreased up to 10 litres daily

◆ During lunch break, soldiers should beencouraged to drink as much wateras possible to replace water loss

◆ During rest periods, soldiers must beencouraged to drink at least 500 mlof water to replace the water loss

◆ Water loss is the heaviest at the endof the day and must be sufficientlyreplaced, especially when training isto continue at night

◆ It must be emphasised to thesoldiers that night training,especially during hot and humidweather, can also cause heat injuries.Water consumption regime should bemaintained during night training too

◆ Constantly remind the soldiers ofthe need for sufficient waterintake

◆ Comply with the water paradeprior to conduct of strenuousactivities (as per TSR Chapter 3,Section 2, para 11)

◆ Monitor that the soldiers drinkenough water during lunch andrest periods. Use the re-supplywater containers as an indicator

◆ Be sure of the water supply: it isthe most basic need in hotclimates

19

IneffectiveIneffectiveIneffectiveIneffectiveIneffectiveTrainingTrainingTrainingTrainingTrainingProgramProgramProgramProgramProgram

‘Gung - ho’‘Gung - ho’‘Gung - ho’‘Gung - ho’‘Gung - ho’soldierssoldierssoldierssoldierssoldiers

◆ Training programmes should avoidstretches of continuous ‘high key’physical activities

◆ Distance from barracks to trainingground should be taken into accountsince rushing between the barracksand training areas can tire thesoldiers even before the trainingcommences

These soldiers over- estimate their abilityto withstand tough training, and hencecontribute to their own physical and heatinjuries

Proper programming of training is acommander’s responsibility

Commanders should identify suchsoldiers and restrain them withoutdampening their enthusiasm

20

‘Timid’ Soldiers‘Timid’ Soldiers‘Timid’ Soldiers‘Timid’ Soldiers‘Timid’ Soldiers

Over demandingOver demandingOver demandingOver demandingOver demandingcommanderscommanderscommanderscommanderscommanders

These soldiers would not speak up even ifnot feeling well, for the fear of being‘marked’

These commanders demand more from thesoldiers, albeit out of good intentions, toconstantly attain “higher standards” e.g.controlled drinking of water during tacticalexercises, increased tempo of physicalexertion such as moving longer distancesat high pace

Commanders should learn todifferentiate these soldiers from the‘idlers and twangers’

Commanders should curb suchtendencies. Soldiers should be trainedwithin “normal” standards before aimingfor “high” standards. Gradualprogression, work-rest cycle, andrespect for each soldier’s individualphysical ability are the key factors tobe considered when setting the goals

21

GENERAL MANAGEMENT◆ All soldiers must be familiar with the 7 R

Management Model, which is outlined in thenext page.

◆ At the first indication of potential heat stress,get your soldiers to stop training, get into theshade, rest and rehydrate.

◆ Early intervention is critical.

◆ Although early symptoms of heat stress canbe controlled by rest, shade and hydration,commanders MUST ensure medical evaluationof heat casualties.

◆ The occurrence of a heat casualty should beconsidered as a warning sign as the entire unitmay be at impending risk.

◆ As a part of the unit’s heat injury preventionrequirements, the soldiers must be well trainedin the heat injury 7R Management Model.

Chapter 5MANAGEMENT OF HEAT INJURIES


••••• GeneralGeneralGeneralGeneralGeneralManagementManagementManagementManagementManagement

••••• 7 R Management7 R Management7 R Management7 R Management7 R ManagementModelModelModelModelModel

Chapter 5MANAGEMENT OF HEAT INJURIES

As soon asthe first

heatcasualtyoccurs,

assess thestatus ofthe whole

unit

22

All soldiersmust befamiliarwith the

7 RManagement

Model

7 R MANAGEMENT MODEL7 R MANAGEMENT MODEL7 R MANAGEMENT MODEL7 R MANAGEMENT MODEL7 R MANAGEMENT MODEL

✓ RRRRRecognise early signs andsymptoms of heat illness:Weakness, tiredness Nausea,vomiting Headache, dizzyDisorientation, confusionInability to work Red,confused look

✓ When in doubt, treat as aheat injury

✓ RRRRRest the heat injury strickensoldier in the shade to cooldown

✓ RRRRRemove all clothing

✓ RRRRResuscitate with cardiopulmonaryresuscitation (CPR) if the soldierhas collapsed (heart beat and/or breathing stopped)

✓ If not sure about correcttechnique, get someone whoknows

✓ RRRRReduce the victim’s bodytemperature as fast aspossible by applying wet towelor by pouring water on his body.

✓ RRRRRehydrate the soldier if heis conscious, by giving himwater

✓ RRRRRush the soldier to thenearest medical facility

RRRRRecogniseSymptoms

RRRRRestcasualty

RRRRRemoveClothing

RRRRResuscitate

RRRRReducetemperature

RRRRRehydrate

RRRRRush tohospital

23

BEFORE EXPOSURE TO HEAT◆ Plan the training programme well

◆ Know your men well and identify those who areat higher risk of heat injuries

◆ Ensure that your men are well rested and wellhydrated (as per TSR chapter 3)

◆ Ensure that they have had their meals

◆ Ensure that ill soldiers report to the medicalofficer

◆ Check on the attire of the men for excessivelayers

◆ Ensure that a water parade (at least 500 ml)was conducted the night before, not less than2 hours prior to sleeping

◆ Ensure that they drink at least 500 ml of waternot less than 30 minutes prior to activity

DURING EXPOSURE TO HEAT◆ Observe the soldiers for early signs of heat

injuries, especially those at higher risk

◆ Ensure that the soldiers hydrate regularlybeyond the point of thirst

◆ Ensure adequate rest, as stipulated in the TSR

◆ Ensure that they drink at least 500 ml of waterduring rest periods to make up for the fluidloss

Chapter 6COMMANDERS’ ROLE


••••• Before ExposureBefore ExposureBefore ExposureBefore ExposureBefore Exposureto Heatto Heatto Heatto Heatto Heat

••••• During ExposureDuring ExposureDuring ExposureDuring ExposureDuring Exposureto Heatto Heatto Heatto Heatto Heat

••••• After Exposure toAfter Exposure toAfter Exposure toAfter Exposure toAfter Exposure toHeatHeatHeatHeatHeat

Chapter 6COMMANDERS’ ROLE

Soldiers dobest what

thecommandersemphasise

24

Ensurethat illsoldiersreport to

the medicalofficer

◆ Ensure that they drink not less than 1 litre ofwater during the mid-day pause

◆ Ensure that there is timely and adequate waterresupply and water points

AFTER EXPOSURE TO HEAT◆ Observe and check the soldiers for signs and

symptoms of impending heat injury

◆ Send suspicious cases to the medical officer

◆ Ensure that the soldiers drink beyond the pointof thirst after the activity and get adequaterest

◆ Ensure that the soldier consumes not less than6 litres of water a day in total, and not lessthan 10 litres a day during intense training inhot weather

25

LAST WORDS◆ The commander’s role and judgement in

acclimatisation, training intensity andhydration is of utmost importance in preventingheat injuries.

◆ The responsibility for soldiers’ health safetyis heavily dependent on commanders’ vigilanceand instinct.

◆ A commander must know his soldiers’weaknesses in order to minimise their risk ofheat injury.

◆ The key to the prevention of heat injury isknowledge and education on the risks, causes,and preventive measures.

◆ Immediate first aid and evacuation of a soldiersuffering from a heat injury is critical.

HEAT INJURIES ARE PREVENTABLE.

Heatinjuries arepreventable

Work Intensities of Military TasksWork Intensities of Military TasksWork Intensities of Military TasksWork Intensities of Military TasksWork Intensities of Military Tasks

APPENDIX AAPPENDIX A

ActivityActivityActivityActivityActivityWork IntensityWork IntensityWork IntensityWork IntensityWork Intensity

Source:

Sustaining Soldier Health and Performance in Southwest Asia: Guidance for Small Unit Leaders,USARIEM Technical Note 95-1, 1994.

▼ Lying on ground▼ Standing in Foxhole▼ Sitting in 3 tonner▼ Guard duty▼ Driving a 3 tonner

▼ Clearing rifle▼ Walking on hard surface/3.7 kmh with up

to 30 kg load▼ Manual of Arms

▼ Walking on loose sand/ 3.7 kmh without load▼ Calisthenics▼ Walking on hard surface/ 5.6 kmh with up

to 20 kg load▼ Scouting patrol▼ Crawling full pack▼ Foxhole digging▼ Field assaults▼ Pick and shovel

▼ Walking hard surfaces/ 5.6 kmh with up to30 kg load

▼ Walking hard surface/ 7.2 kmh without load▼ Emplacement digging

Very lightVery lightVery lightVery lightVery light

Light Light Light Light Light

ModerateModerateModerateModerateModerate

HeavyHeavyHeavyHeavyHeavy

This handbook was developed based onThis handbook was developed based onThis handbook was developed based onThis handbook was developed based onThis handbook was developed based onthe following references:the following references:the following references:the following references:the following references:

US Army

British Army

SAF

Others

◆ Occupational and Environmental Health:Prevention Treatment and Control of HeatInjury, TB MED 507, NAVMED P-5052-5, AFP160-1, Washington D.C., 1980.

◆ Sustaining Soldier Health and Performancein Haiti: Guidance for Small Unit Leaders,US Army Research and Materiel CommandFort Detrick, Maryland 21702-5012, 1994.

◆ Sustaining Soldier Health and Performancein Somalia: Guidelines for Small UnitLeaders, USARIEM Technical Note 93-1,1992.

◆ Sustaining Soldier Health and Performancein Southwest Asia: Guidance for Small UnitLeaders, USARIEM Technical Note 95-1,1994.

◆ A Guide for Commanders: Drinking forOptimal Performance during MilitaryOperations in the Heat; Defence Evaluationand Research Agency Centre for HumanSciences, Hampshire, 1998.

◆ Symposium on Recent Advances in thePrevention and Treatment of Heat Stress inthe Military; Proceedings, Defence MedicalResearch Institute, Singapore, 1997.

◆ Know More about Heat Injuries, The SAF HQMedical Corps, 1997.

◆ Sports and Exercise Medicine, LovelaceInstitute for Basic and Applied MedicalResearch, Albuquerque, New Mexico, 1993.

This publication is one of the educational materials of the Army’s Heat Injury Prevention Task Force.It was researched and written by the Soldier Performance Centre, with input from the Army’s GeneralStaff Inspectorate. Comments are welcome, and should be addressed to:

Chief Army Medical OfficerHQ Army Medical Services

75, Loewen RoadAFPN 0041

Singapore 248844Fax - 4711531

First Edition: April, 1999

“high risk” units guide … · protection against wounds and insects. insulation is not...

Documents