59th MDW evaluates, improves heat illness procedures

Published Oct. 9, 2015
By Tech. Sgt. Christopher Carwile
59th Medical Wing Public Affairs

JOINT BASE SAN ANTONIO-LACKLAND, Texas -- The 59th Medical Wing is implementing new capabilities to provide potentially life-saving treatments for Air Force trainees engaging in high-intensity physical training in the hot and humid conditions of San Antonio.

To ensure basic military training and technical school students receive this rapid care, health officials are working with the Korey Stringer Institute at the University of Connecticut to review and update 59th MDW and 37th Training Wing policies for responding to suspected exertional heat illness, including exertional heat stroke. Exertional heat stroke is a life-threatening medical emergency that results from prolonged exertion in the heat, resulting in failure of the body's mechanisms for self-cooling.

The training works hand-in-hand with an upcoming Exertional Heat Illness Response Policy Letter from the 59th MDW and guidance from the Air Force Medical Operations Agency.

"With rapid response and proper treatment, heat stroke is 100 percent survivable with no lasting effects," said KSI's chief operating officer Dr. Douglas Casa, who lead the training team here.

"We need to respond quickly once someone goes down or shows signs of heat stroke; the clock for cooling them doesn't start when they go down, it starts when (body temperature) rises above 105 degrees," Casa said.

A core body temperature above 105 degrees Fahrenheit for 30 to 60 minutes usually results in temporary damage to vital organs - including brain, liver, kidneys or muscle - that could affect a military career; 60 to 90 minutes results in permanent organ damage and possibly death, Casa explained.

"The bottom line - if you take away nothing else from this training - is that you must get the core temperature under 105 within the first 30 minutes," Casa stressed throughout the training.

Members of the 559th Medical Group initially met with members of the Consortium for Health and Military Performance and KSI to review response procedures in 2014. During those discussions, the group identified areas that were not up to the current evidence-based standard of care for exertional heat stroke.

"We have updated Air Force-wide policies and created a new medical wing instruction on how heat stroke is to be treated, based on the latest research and guidance from leading experts in the field like KSI. This is so important to the health of our trainees, especially when San Antonio has high heat during the extensive basic and technical school training sessions," said Maj. Asha Mandhare, 559th MDG Trainee Health Surveillance Flight commander.

Casa and his team taught the new procedures to members of the 559th MDG and the 37th TRW, conducting multiple training sessions with medical technicians, first responders, training squadron staff and military training instructors and leaders Sept. 29-30. Five JBSA training locations where the highest-risk training occurs were selected. The sessions focused on response and treatment procedures for heat stroke victims.

The new policies and procedures focus on three key points: first, accurate diagnosis of core body temperature; second, on-site ice-water immersion for victims of exertional heat stroke; and third, the cool first, transport second principle. Other important points include the role of training instructors and cadre, who are the key to early recognition of dangerous symptoms.

During a heat-related medical emergency, MTLs and MTIs will provide a non-medical support role - such as helping with transportation - while medical technicians and first responders aid the victim. Casa's team taught medics and cadre to place sheets and towels soaked in ice-cold water on the head and body to cool victims while en route to an immersion tub. If a tub is not available the procedure is a stand-alone measure.

There are currently six immersion sites located at key training areas across JBSA, with a seventh on the way, according to Mandhare.

"We are very grateful to have (Casa) out here; he's the who's who of heat stroke," said Capt. (Dr.) Nathaniel Nye, sports medicine physician and Versatile Injury Prevention and Embedded Reconditioning element chief.

"By far, the most important thing I do is work with the military," Casa said. "Sports are just wins and losses on the field, what (you) do here is what really matters."