Hot Weather Presention

[Cms.sloane]

I have been given the awesome but most of the time boring task if giving a Hot Weather Injuries class for ES night. I have done a million of those classes and always hate them becaus people just read out of the task guide. So I wanted to reamp it up mostly and make it fun and interactive. I wanted it to a hands on or mostly real life examples for a cadet group of about 30-45.

I was thinking about making a cadet show dry calmy skin for stroke. You get my point hopefully. Does anybody have any great ideas or ways they did the class. All help would be great. His class would also try to get more in to emergency services.

[N Harmon]

I have been given the awesome but most of the time boring task if giving a Hot Weather Injuries class for ES night. I have done a million of those classes and always hate them becaus people just read out of the task guide. So I wanted to reamp it up mostly and make it fun and interactive. I wanted it to a hands on or mostly real life examples for a cadet group of about 30-45.

I was thinking about making a cadet show dry calmy skin for stroke. You get my point hopefully. Does anybody have any great ideas or ways they did the class. All help would be great. His class would also try to get more in to emergency services.

Unfortunately, our task guides only really talk about heat cramps, heat exhaustion, and heat stroke. They ignore two other common heat-related injuries:

Sunburn - Caused by overexposure of skin to UV light, usually sun light.

Heat rash - Caused by obstructions in sweat glands.

[Major Lord]

The problem is that the differentiation in symptoms for the layman in heat related incidents tend to be the focus of training. Its not so critical that a Cadet can clearly delineate the difference between garden variety over-heating, and more clinically acute stages of heat injury. In other words, it does not matter what you call it; The important thing is that you have the confidence in your abilities to decisively treat a person for a heat ailment. All too often, the victim does not understand how sick he is, and when they lose the ability to make rational decisions it may fall upon you to literally force them into treatment. Focus on the basics:  Hydration as a means of temperature control, recognizing signs and symptoms, appropriate cooling (first aid) and when its time to call 911.

A very graphic demonstration can be done by having a volunteer take a dose of Niacin.  (An OTC medication) They will turn a brilliant and very frightening shade of red and get "heat prickles" Its perfectly safe, and mimics a life threatening heat illness. They should start out denying a problem, and migrate downwards in LOC (level of consciousness) starting from mild confusion and moving towards unconsciousness and death. ( Just in case, use a Senior member you don't really like very much)

Body temperature and LOC are going to be your key indicators on when to blow the 911 whistle. Its generally best to use fairly passive cooling techniques on persons  suffering from heat injuries. Overly aggressive cooling can kill your patient . The Red Cross basic first aid guidelines are safe. Don't forget about radiation burns to the skin and eyes from solar or other UV sources (arc welding, global thermonuclear war, etc)

CAP safety people often talk about the issue solely from the perspective of ORM; You need to bring the subject home to your students by making it clear that failing to act is generally what kills people in these situations. Plenty of time for passivity in the grave. Stress the need for all team members to evaluate their teammates. Are they silent? staring at a rock? Acting weird or incoherent? (yes, I know that this is how Cadets are most of the time, but you know what I mean)
Like all field missions, you are your brothers keeper, so stress the importance of the team monitoring and taking care of their own. You might need them to get back alive.

There is a lot of stale dated info out there. Salt Tablets, which used to be an every day part of treating exposure injuries, have fallen out of favor ( they will make you vomit on an empty stomach anyway) Short of starting Intravenous Therapy on your victim ( always something the Lawyers will love you or) Keep some cold Pedialyte (baby water) on hand if possible , Gatorade is not for sick people. No fluids by mouth for anyone with an altered LOC until you are sure they can keep it, and not projectile vomit all over your nice clean and starched BDU's. Stress CPR training WITH rescue breathing. ( not that new-fangled ceremonial CPR they are teaching)

Good luck!

Major Lord,

[desertengineer1]

Just a quick word of caution from the military side.  The Air Force had this symptom listed in the first publication of the Airman's manual.  There was an incident at Lackland.  Allegedly because the victim did not have hot, dry skin (they were sweating), they did not receive immediate treatment for heat stroke.  By the time the symptoms were recognized it was too late for treatment and the member died at the hospital.

Immediately after, the air force released a correction to the Airman's manual, requiring a pen/ink change to this symptom.

So, caution is warranted in teaching hot, dry skin as a symptom of heat stroke.  Our Current Airman's manual (new edition) does a pretty good job of differentiating exhaustion and stroke.

Heat Stroke symptoms:  (Ref AFH 2218 V1, V2 and AFPAM 10-100, pg 183)

Headache
Dizziness
Red face/skin   (my opinion this is almost ALWAYS the case)
Strong, rapid pulse
Confusion, disorientation (again, my experience sees this almost every time)
Hot dry skin or sweating
High Body Temperature (hot to touch)

http://www.e-publishing.af.mil/shared/media/epubs/AFPAM10-100.pdf

Hope this helps.  We're in the desert now.  Daily highs hover around 120 degrees with 70-90 % humidity.  Even the most acclimated, in-shape people are hurting, and we've had several end up at the hospital for treatment. 

Good idea to keep briefing this!!!

Cheers!

[JayT]

Stress CPR training WITH rescue breathing. ( not that new-fangled ceremonial CPR they are teaching)

Major Lord,

New fangled ceremonial CPR, eh? What's wrong with CCR!

[SarDragon]

Keep some cold Pedialyte (baby water) on hand if possible , Gatorade is not for sick people.

Why is Gatorade so bad? I did some checking, and, while the proportions are different (higher concentrations of K+ and Na+ per liter of H₂O, lower sugar overall), the ingredients are essentially the same. Small children need the higher concentrations due to the lower intake level, and less sugar for diarrhea considerations.

[Thom]

Keep some cold Pedialyte (baby water) on hand if possible , Gatorade is not for sick people.

Why is Gatorade so bad? I did some checking, and, while the proportions are different (higher concentrations of K+ and Na+ per liter of H₂O, lower sugar overall), the ingredients are essentially the same. Small children need the higher concentrations due to the lower intake level, and less sugar for diarrhea considerations.

For Adults and Teens I wouldn't prefer either Pedialyte OR Gatorade, though I certainly would use them if they were all I had.

I prefer the more obscure choice of Runners and Tactical Firearms Trainers, Vitalyte, formerly known as Gookinaid.  Named for the inventor, Bill Gookin.  (Yes, its name has occasionally been inferred to be a racial slur of sorts, but it's really just named after the guy who invented it.)

Vitalyte (nee Gookinaid) has about half the sodium and twice the potassium of most Gatorade flavors, with lower overall calories and averages a little less grams of sugar.  It's hard to compare since Gatorade now has about 3 dozen flavors, levels, G1, G2, G3, etc.

In general, Vitalyte is very quickly absorbed and is mixed to be isotonic, meaning it has the same salt levels as the human body.  Some studies found it to be absorbed faster than plain water even when the person wasn't depleted of electrolytes to a significant level, but merely low on water volume in the body.  And there are years of results from long distance runners and the tactical firearms training community to back up its effectiveness.

One last point, in favor of most anything other than Gatorade: Folks suffering from heat exhaustion tend to have very sensitive stomachs and can easily 'reject' any recently consumed liquids with little provocation.  Drinks with milder flavor are generally better tolerated than those with strong flavor.  This means that Gatorade, though refreshing to someone merely thirsty, can be unpalatable to someone in real distress.

Vitalyte (nee Gookinaid) is not only less flavorful than Gatorade in general, but they make different flavors at different strengths.  Their Citrus flavor is intentionally made extremely mild and is very well tolerated by those in distress.  They also make a couple of middle-of-the-road strength flavors, and an Orange drink flavor that is strong enough to use as a punch or recreational drink.  (Though in those cases Gatorade might be a better choice, based on flavor rather than hydration needs.)

By the way, the same rules apply to folks who are sick from something other than heat-related symptoms.  Mild flavors are more likely to be kept down by someone with the flu.


Thom

[Major Lord]

1: Nothing against Gatorade per se, its just not tolerated well by people in severe electrolyte debt. I suggest watering it down if you are seriously using it as a replacement for oral rehydration solution. Worst case, they will vomit, aspirate, and die, but hey, give it a shot! Pedialyte is well tolerated in most cases, and is pretty close to oral rehydration mix in effectiveness.

2: When they take ventilations out of ACLS, you will know that its because it does not work. Long term studies of human physiology tend to suggest that we need air to live, so if its someone who you care about, I suggest compressions and ventilations. If you don't want to get all icky with dead-guy fluids, "CPR Lite" is much cleaner, looks really impressive ( I suggest shouting " Live, Dam you" for dramatic effect) and does not get you all sweaty like CPR that stands a chance of actually working.......

Major Lord

I concur with the post above, although I never knew "Bill" was a racial slur. Live and Learn.

[Major Lord]

Stress CPR training WITH rescue breathing. ( not that new-fangled ceremonial CPR they are teaching)

Major Lord,

New fangled ceremonial CPR, eh? What's wrong with CCR!

You did not by any chance mean "Creedance Clearwater Revival" did you?

Major Lord

[Thom]

1: Nothing against Gatorade per se, its just not tolerated well by people in severe electrolyte debt. I suggest watering it down if you are seriously using it as a replacement for oral rehydration solution. Worst case, they will vomit, aspirate, and die, but hey, give it a shot! Pedialyte is well tolerated in most cases, and is pretty close to oral rehydration mix in effectiveness.

2: When they take ventilations out of ACLS, you will know that its because it does not work. Long term studies of human physiology tend to suggest that we need air to live, so if its someone who you care about, I suggest compressions and ventilations. If you don't want to get all icky with dead-guy fluids, "CPR Lite" is much cleaner, looks really impressive ( I suggest shouting " Live, Dam you" for dramatic effect) and does not get you all sweaty like CPR that stands a chance of actually working.......

Major Lord

I concur with the post above, although I never knew "Bill" was a racial slur. Live and Learn.

So, Major, where do I send the bill for my replacement keyboard?  I bit on that one, to the tune of needing a towel to clean up my drink...   :clap:

Seriously, I also concur with watering down Gatorade.  That's actually pretty standard practice and seems to work OK if that's what you have to work with.

As to the CPR issue, there are a number of studies completed, and more under way right now to examine the effectiveness of 'Gorilla CPR' with no ventilation provided.

Personally, I recommend that everyone do as they were taught when they got certified most recently.  To do otherwise invites legal problems, and in all likelihood if the version you were taught by an accredited teacher/system/school wasn't going to save someone, then the alternative method wouldn't have either.  People forget the failure rate on CPR is something like 90% or more.

That said, the early results for Gorilla CPR (or whatever you want to call it) show that it actually INCREASES survival rates. There are some different reasons bandied about, but the biggest is of course that people are less put off by the ick factor of kissing a stranger (who will invariably vomit INTO YOUR OPEN MOUTH at some point...) and so they just 'go for the gusto' on the chest compressions.

Studies also show that blood oxygenation is perfectly acceptable for up to 8 minutes after a patient stops breathing.  Essentially, you are recycling the air already in the lungs, passing oxygen across to the bloodflow generated by the chest compressions, for several minutes before the partial pressure of oxygen in the lungs drops to a dangerous level.  In effect, the patient just experiences a slight drop in oxygen level no worse than ascending to a few thousand feet.  Not optimal, but not worth stopping to perform rescue breathing either.

The newest studies are trying to figure out if two-rescuer CPR, where one person only does chest compressions, and the other only does rescue breathing, is better or worse than Gorilla CPR.

The phrase Gorilla CPR was coined when they started going from a slow steady compression rate to 'as fast and as deep as you can for as long as you can keep it up'.  You look pretty frenetic doing it, kind of like a gorilla trying to break open a Samsonite...

Again, most folks should ONLY do as they were taught, and get re-certified annually.


Thom

[Major Lord]

Sorry about the Keyboard....... My sense of humor often seizes my fingers like an evil demon while I am typing......

I did not really want to reopen the argument about the "new CPR" .  Remember a few years back that Dr Heimlich studies showed it was actually better to do just ventilations and no compressions because the interthoracic pressure change was greater than sloppy compressions and the dead guy still got O2? Things change.

BLS CPR when carried out under the best of circumstances by trained professionals with good airway training and gear is still only a matter of a couple of percent ( increasing dramatically with defibrillation, and again with ACLS drugs) My view is that a person who is pulseless and apneic is what we call "Dead" and anything is an improvement over that ( with the possible exception of becoming an AMWAY salesman) Watch the Pulse-Ox monitor while doing CPR and you will see if air or no-air improves the patients O2 Saturation. I guess I would augment my recommendation for CAP members at least that they should learn the best CPR system they can, rather than the most expeditious. ( I will save the no-ventilation CPR for Democrats......)

Since the initial point of the thread was about adding a little "oomph" to the heat related injury presentation, perhaps the most critical thing is to emphasize that any heat related injury has the very real possibility of requiring treatment for shock, respiratory,  and/or cardiac failure. Chiropractors might want to make spinal adjustments, and homeopaths mights want to give them Ginseng, but lets focus on the basics and the need for someone to make critical care decisions actively, rather than to wait for borderline situations to develop into acute and critical illness.

Major Lord

[desertengineer1]

Why is Gatorade so bad? I did some checking, and, while the proportions are different (higher concentrations of K+ and Na+ per liter of H₂O, lower sugar overall), the ingredients are essentially the same. Small children need the higher concentrations due to the lower intake level, and less sugar for diarrhea considerations.

I'm currently deployed in the middle east.  We're reminded daily that Gatorade and other electrolyte drinks are not to be used 100% of the time.  Only after prolonged exposure under high-demand conditions do they seem to help. 

Maybe I can describe a little better what we're seeing.

Temps here are averaging 120-130 degrees.  Under normal, limited exposure conditions, water is best.  You still get regular meals whose salt and electrolyte contents provide what you need.

But there's a threshold.  Many jobs here such as aircraft maintenance, civil engineering, and others like aerial port and SFS put members in an almost continuous exposure.  In THOSE cases, electrolyte drinks are called for, but only after XX liters of clear water.  The guidance from the med group is based on experience, sadly.

On the most severe days, no one leaves the building without a clear bottle of water in-hand.  10 minutes in desert heat, in working conditions, can quickly put you down for the count.

The current ROE is to drink clear water as required to keep hydrated.  If you are constantly sweating and exerting, a single bottle of gatorade, staggered in-between , is best to keep electrolytes suppled.

Bottom line here...  Gatorade is called for sparingly when you are in the heat under sustained exertion.  But it's never a substitute for a constant supply of clear water.

[Major Lord]

Roger to all the above, I think we were discussing Gatorade or similar primarily as a treatment for someone who has already tipped the edge into illness. Plain old water is the best thing ever! I can say from experience that nothing beats Normal Saline IV therapy when your dipstick is too low to let the brain in your engine run well. Its better to avoid that. BTW, have you tried frying an egg on the Tarmac? Just curious......Do chickens come the store alive and pre-cooked?

Stay safe out there in the sandbox.

Major Lord

[desertengineer1]

No egg trick here, yet.  But this is a picture from the temp sensor outside our building (and it's in the shade!!)

[davidsinn]

No egg trick here, yet.  But this is a picture from the temp sensor outside our building (and it's in the shade!!)

What picture?

[DakRadz]

The one that shows the local temp (for desertengineer) to be 129.9 degrees Fahrenheit, sir.

I'm guessing that you're browser won't let you view it; I promise that I see a picture in his post AND your quote of his post.

[davidsinn]

The one that shows the local temp (for desertengineer) to be 129.9 degrees Fahrenheit, sir.

I'm guessing that you're browser won't let you view it; I promise that I see a picture in his post AND your quote of his post.

I'll take your word for it. I don't have a clue why it's not showing up.

Edit:
http://sphotos.ak.fbcdn.net/hphotos-ak-ash2/hs153.ash2/40994_1370957270285_1122357299_30846436_4870302_n.jpg That one? Was that posted using the board's image tag? Or using HTML?

[Cms.sloane]

may i say that i did a great job with the presention. i thank everybody for your ideas about Gatorade and stuff. it really did help.

[Krapenhoeffer]

Hey, thought I would chime in on the Cardiocerebral Resuscitation issue... AHA just redid their guidelines. They now recommend the use of CCR for witnessed cardiac arrests. Not to mention that most jurisdictions have already modified their protocols to use CCR. The AHA just put the official stamp of approval on it. Evidence based medicine is the name of the game in EMS land.

Not to mention that there was a patient in my neck of the woods who was in V Fib for over 45 minutes, and was discharged from the hospital with no brain damage. CCR works, and we have Science to back it up.

[Major Lord]

V-fib for 45 minutes and lived, let alone no brain damage? Maybe V-Tach, but a totally non perfusing rhythm for 45 minutes? I would like to see the after action on that one! I am skeptical of your "science"........any written documentation of any kind on this, or is this just an anecdote?

Major Lord

[desertengineer1]

The one that shows the local temp (for desertengineer) to be 129.9 degrees Fahrenheit, sir.

I'm guessing that you're browser won't let you view it; I promise that I see a picture in his post AND your quote of his post.

I'll take your word for it. I don't have a clue why it's not showing up.

Edit:
http://sphotos.ak.fbcdn.net/hphotos-ak-ash2/hs153.ash2/40994_1370957270285_1122357299_30846436_4870302_n.jpg That one? Was that posted using the board's image tag? Or using HTML?

Yes.  Sorry, I can't get it to post anything other than a link to the photo.  Should have posted the link as well.

The last few days haven't been as hot.  125 yesterday, 127 the day before. 

I'm in Kuwait now, and it's a different flavor of hot - even more dangerous, IMHO.  ~135 degrees at peak and very low humidity.  Although it feels more comfortable than the previous location, it sucks the water out of you pretty fast.  I didn't know how dehydrated I was yesterday until almost too late.  Got a little light headed, took down two full bottles of water in 20 minutes, urine was still dark (sorry, sounds gross, but it's the MOST reliable hydration feedback you have - critical to watch out here).

That could have been a dangerous situation. 

Also, medical folks here report a dramatic spike in kidney stones during this period.  I guess if the kidneys aren't getting a good volume of water, people dispositioned to stones will get them much faster.

[davidsinn]

The one that shows the local temp (for desertengineer) to be 129.9 degrees Fahrenheit, sir.

I'm guessing that you're browser won't let you view it; I promise that I see a picture in his post AND your quote of his post.

I'll take your word for it. I don't have a clue why it's not showing up.

Edit:
http://sphotos.ak.fbcdn.net/hphotos-ak-ash2/hs153.ash2/40994_1370957270285_1122357299_30846436_4870302_n.jpg That one? Was that posted using the board's image tag? Or using HTML?

Yes.  Sorry, I can't get it to post anything other than a link to the photo.  Should have posted the link as well.

That is really weird. I just tried some different ways of getting it to work and nothing will. Maybe you should look into a different photo host that works and plays well with other browser. I can suggest a few if your interested.

[Hawk200]

I'm in Kuwait now, and it's a different flavor of hot - even more dangerous, IMHO.  ~135 degrees at peak and very low humidity.  Although it feels more comfortable than the previous location, it sucks the water out of you pretty fast.  I didn't know how dehydrated I was yesterday until almost too late.  Got a little light headed, took down two full bottles of water in 20 minutes, urine was still dark (sorry, sounds gross, but it's the MOST reliable hydration feedback you have - critical to watch out here).

That could have been a dangerous situation. 

I can attest to that heat. For me, the end result was a bag and a half of saline and several bottles of water. Not fun. A few days earlier, a soldier died from lack of proper hydration (too many RipIt's, not enough water.

The biggest reason I dehydrated was that I had missed lunch that day. You may not want to eat when it's hot, but you need to. Nutrients help the body retain fluids and keep you in balance. I learned that the hard way.

Even a pack of MRE crackers or other non-junk food edibles will help.

[Krapenhoeffer]

For my case in point, I can't put any other information on the internet other than what I did, without violating County policy. You'll just have to wait for the "scholarly paper" to come out.

But I do have the 2004 paper which showed evidence pointing to the superiority of CCR-based protocols. County Medical Director revised protocols soon after the paper was published, and our survival rates for cardiac arrest jumped to roughly 45%.

http://circ.ahajournals.org/cgi/content/full/111/16/2134

[Major Lord]

The novel theory that intrarterial cerebral blood pressure independent of adequate 02 saturation of the blood strikes me as a hypothesis designed to promote doing compressions only; largely as a means of providing some potential benefit ( Or demonstrating due diligence) without having the PHCP get all icky and sweaty. At worst, its benign, and at best, it may offer some benefits, especially if the alternative is doing nothing. (Long term studies of people who are dead found that most dead people did not tend to improve significantly with time) It was not all that long ago where an entire school of thought promoting induced hypothermia in the field as a means to avoid the creation of free radicals was being advanced....with....no compressions at all! Of course, not too long ago, 9 out of 10 Doctors recommended Winston cigarettes.

Survival rates from sudden cardiac death rates should be improving given the number of AEDs in civilian and First Responder's hands. ( no, the shocker things, not the haji-bombs under the road!) I will wait for more definitive evidence showing that this new technique has some value. If called upon to do solo CPR on someone I don't know (or like) I will keep the CCR option open.


Major Lord

[RADIOMAN015]

Take a look at all of the references and material at:
http://www.af.mil/shared/media/epubs/AFPAM48-151.pdf
http://www.ala.usmc.mil/safety/heatinjury.asp
http://chppm-www.apgea.army.mil/heat/
Others:
http://www.rotc.usaac.army.mil/forms/TRADOC%20heatinjurypreve.ppt
http://www.healthits.us/big5/injuryprev_2.html
http://www.armystudyguide.com/content/powerpoint/First_Aid_Presentations/heat-injuries-2.shtmlhttp://www.slideworld.org/viewslides.aspx/Prevention-of-Heat-Injuries-ppt-101042http://www.pptclasses.com/category/index-safety.htm
http://www.nps.gov/training/tel/Guides/hip_pguide_2004_0527.pdf
http://sisc.kern.org/safetyandlosscontrol/heat_injury_prevention.html

There's a lot of training material out there.  The key issue on this is to be VERY careful in hot weather, know your personnel's individual limitations (remember that any team activity is limited to the potential health hazard of the most susceptible members) and practice "prevention" rather than being forced to react. 

Also don't tell my commander I know to much otherwise I might end up being an assistant safety officer :angel:  Hey but aren't we all suppose to be that anyways!!
RM