By Brian Hill, Fort Leonard Wood Public Affairs Office
FORT LEONARD WOOD, Mo. (March 29, 2023) — With summer and warmer temperatures on the way here, Maneuver Support Center of Excellence training leaders came together on Monday in Lincoln Hall Auditorium to learn more about the prevention, mitigation, recognition and treatment of heat injuries.
Oscar Powers, MSCoE Safety director, noted heat injuries — including heat exhaustion, heat stroke and other related illnesses — have been on the decline here over the past couple of years, but that mid-Missouri still sees an average of 63 days throughout the summer that reach the high end of the Army’s heat categorization system.
“The purpose of this event is to review established policy and guidance for Fort Leonard Wood organizations for prevention, management and reporting (heat injuries),” Powers said.
Helping explain the prevention, identification and assessment of heat injuries were some of Fort Leonard Wood’s medical experts.
Lt. Col. Patrick Walsh, a brigade surgeon with the 3rd Chemical Brigade, explained some of the basics, including what’s called heat load, or the physiological strain on a person’s body as they attempt to compensate for the stress produced in the body by high environmental temperatures.
“When it’s hotter outside, that increases the load even more,” Walsh said, noting temperature, humidity and wind conditions affect the body and its ability to adjust to heat. “The key things that the body requires to keep a good balance between that physiological strain — so that heat load doesn’t get to be too much — is the appropriate amount of hydration, good nutrition and recovery time, sleep time. The body does the vast majority of its repair and recovery during the hours of sleep.”
Another consideration when it comes to the effects heat has on the body, Walsh said, is that “it builds upon itself.”
“So, they may have done just fine on day one, but they still took a certain amount of strain,” he said. “So now, on day two, they’re not going to be able to tolerate as much as they did on day one, and by day three, a large portion of your population are not going to be even close to being able to tolerate what they tolerated on day one. That’s something we have to consider when we’re taking a look at training schedules.”
The adverse impact of high environmental temperatures can be reduced by drinking enough water, getting proper nutrition, the type of clothing worn, maintaining a high level of fitness and resting after exposure to heat, Walsh said.
“The body’s primary systems for cooling itself are evaporation, radiation — you get some radiation from the skin — and then convection — so, is there a breeze, or is there not a breeze, and then how much of their body’s surface area is getting exposed to that moving air,” Walsh said.
The Army has an acronym — HEAT — to help when trying to prevent heat injuries, Walsh noted.
- High heat category, especially on several sequential days (measure the wet bulb globe temperature, or WBGT, index when the ambient temperature is higher than 75 degrees Fahrenheit).
- Exertional level of training, especially on several sequential days (the past 72 hours must be considered).
- Acclimatization — most individuals’ physiological responses to heat stress improve within 10 to 14 days of exposure to heat and regular strenuous exercise.
- Time (length of heat exposure and recovery time).
Walsh also discussed proper hydration measures. He said water should be consumed before a person gets thirsty and at regular intervals. However, there are dangers when it comes to the over-consumption of water, which can lead to a medical emergency called hyponatremia.
“Soldiers shouldn’t be taking in more than about a quart and a half of fluid per hour on the average,” Walsh said.
In addition to water, Walsh said individuals should ensure they are eating enough to stay hydrated, as food can be an additional source of fluids, and contains electrolytes and carbohydrates necessary to maintain hydration. Males should be consuming a minimum of 1,700 calories per day; females should intake at least 1,450 calories per day — however, Walsh noted each person’s needs will be slightly different.
Maj. Nicholas Kohles, brigade surgeon for the 14th Military Police Brigade, spoke on developing controls for heat injuries, including the Army’s Arm Immersion Cooling System, or AICS.
Extremity immersion in cold water is an effective cooling method, Kohles said. He recommended three to five minutes of arm immersion in water cooled to one degree Celsius — or about 33 to 34 degrees Fahrenheit.
Kohles also explained some of the differences between heat exhaustion and heat stroke, and he provided some of the symptoms cadre should look for.
Heat exhaustion is caused by the loss of body fluids through sweating, vomiting or diarrhea without adequate fluid replacement. Anyone performing physical exertion in hot environments is susceptible, Kohles said.
“People very physically fit can get this,” he added.
Symptoms include excessive sweating with pale, moist, cool skin; headache or dizziness; cramps; loss of appetite; and nausea (with or without vomiting).
First aid for heat exhaustion includes loosening the uniform and removing head gear; placing the individual in a shady area; and having them drink no more than 1 to 1.5 quarts of water per hour. The individual should be constantly monitored and evacuated for medical treatment if symptoms worsen or do not improve after rest and rehydration.
Heat stroke is caused by exposure to high temperatures and a rise in body temperature, with a failure in the body’s cooling mechanisms, Kohles said.
Symptoms include confusion, weakness, dizziness, headache, seizures, nausea, stomach cramps or pain, red or hot skin, and rapid and weak respiration and pulse. Unconsciousness and collapse may occur suddenly.
“A Soldier with a heat stroke may also stop sweating,” Kohles said.
First aid for heat stroke includes fully removing the individual’s outer clothing and using ice sheets to attempt to rapidly cool the individual. Cadre should report a suspected heat stroke victim to range control and evacuate them immediately to the nearest emergency room via ambulance, while maintaining cooling techniques and constant monitoring of their mental status — ask questions, such as their name, where they are or what year it is — level of consciousness, breathing and pulse.
After a briefing on General Leonard Wood Army Community Hospital’s care and return-to-duty procedures for heat injuries, battalion commanders were invited to explain some of their lessons learned and best practices with regards to heat injury prevention.
Involving trainees in their medical emergency drills improves the unit’s ability to quickly react if someone has a heat injury, said Lt. Col. Jarrad Glasenapp, 3rd Battalion, 10th Infantry Regiment commander.
“We integrate the trainees into those drills, where they know immediately where the ice is, and they can bring those to the victim and support the drill sergeants in those operations,” Glasenapp said.
Heat injury prevention for the trainees is discussed a lot, Glasenapp noted, but there also needs to be a focus on the cadre as well.
“We talk to them a lot about nutrition, the use of sunscreen, work-rest cycles, rotations of those drill sergeants out there — that’s a huge part of it,” he added.
In addition to the information provided in Lincoln Hall Auditorium, the event concluded with a “Soldier-down” demonstration on MSCoE Plaza by cadre from the 169th Engineer Battalion. In the demonstration, a Soldier collapsed, and two cadre members responded. After assessing the potential for a heat stroke, the Soldier was carried into the shade, his outer clothing was removed and ice sheets were applied in anticipation of medical evacuation to the nearest emergency room.
One of the forum’s attendees, 1st Battalion, 48th Infantry Regiment Command Sgt. Maj. Matthew Reed, said heat injury prevention training is “vitally important for our team.”
“While Fort Leonard Wood maintains significantly lower rates of heat injuries compared to other training installations, our teams change frequently as cadre and drill sergeants move in and out of position due to (permanent change of station) moves,” Reed said.
Establishing baseline knowledge and proliferating best practices are essential components to learning organizations, “such as ours,” he said.
“I believe one of the reasons we do so well here at Fort Leonard Wood is because we place a high emphasis on coupling hard training with protocols that ensure the safety of our Soldiers,” Reed said. “You don’t have to sacrifice one for the other — battalions can do both, so long as risk is appropriately assessed and mitigated.”
Reed said he found the battalions’ best practices portion of the event particularly useful, specifically how Glasenapp’s unit incorporates trainees into their heat injury response exercises.
“That’s a good technique that ensures both cadre and trainees understand how to prevent, identify and treat hot-weather injuries,” Reed said. “We intend to integrate it in our battalion.”
More information on preventing heat injuries is available on the Defense Centers for Public Health website.
About Fort Leonard Wood
Fort Leonard Wood is a thriving and prosperous installation that has evolved from a small basic training post more than 80 years ago to a premier Army Center of Excellence that trains nearly 80,000 military and civilians each year.
Fort Leonard Wood is home to the U.S Army Maneuver Support Center of Excellence and three U.S. Army schools: the U.S. Army Engineer School; U.S. Army Chemical, Biological, Radiological and Nuclear School; and the U.S. Army Military Police School. In addition to training engineer, CBRN and military police specialties for the Army, Fort Leonard Wood also provides gender-integrated in-processing and Basic Combat Training for new Soldiers.
Fort Leonard Wood also hosts and trains with the largest Marine Corps Detachment and Air Force Squadron on any Army installation as well as a large Navy construction detachment.
More information about Fort Leonard Wood is at: https://home.army.mil/wood/index.php/about/mission