USU - Uniformed Services University of the Health Sciences
11/12/2024 | Press release | Distributed by Public on 11/12/2024 12:51
Beating the Heat: USU’s CHAMP WHEC Program works with the Army Heat Center to Reduce Exertional Injuries and Heat Illness in Service Members
The CHAMP WHEC Program and Army Heat Center collaborate to prevent heat-related injuries in service members through research, data analysis, education, and safety practices, significantly reducing exertional heat stroke cases at Fort Moore and enhancing readiness across the military.
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Soldiers at Fort Moore (formerly Fort Benning) being trained to become Infantrymen make use of immersion troughs filled with ice and water, allowing troops a quick way to cool their bodies during rigorous training in the Georgia heat, July 2018. (Photo credit: Patrick Albright). |
November 12, 2024 by Hadiyah Brendel
Soldiers loaded with gear trek miles under the intense sun at Fort Moore, Georgia, where the Army's Infantry and Armor Basic Combat Training, Airborne, and Ranger Schools are based. In summer, with temperatures often reaching into the 90s, strenuous exercise in such conditions can quickly lead to heat-related illness. These ruck marches are conducted regularly as part of their conditioning and field exercises. In the Infantry and Armor Basic Combat Training programs, ruck marches are typically scheduled weekly or bi-weekly, progressively increasing in distance and load as trainees advance through the program. For Ranger School, ruck marches are even more frequent and intense, forming a core component of their physical training regimen, with distances of 10 to 20 miles under heavy loads as part of their endurance and resilience preparation.
The Warrior Heat-and Exertion Related-Events Collaborative (WHEC), led by the Uniformed Services University's (USU) Consortium for Health and Military Performance (CHAMP), and the Army Heat Center, located at Fort Moore, have worked together for nearly a decade to prevent and treat heat illness, ensuring soldiers return to duty quickly and safely. CHAMP Medical Director Dr. Francis O'Connor and Army Heat Center Director Lt. Col. (Dr.) David DeGroot serve as co-directors of WHEC.
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Army Heat Center Director LTC David DeGroot, pictured above speaking Fort Novosel, AL, serves as WHEC Co-Director, with CHAMP Medical Director Dr. Francis O'Connor. WHEC and the Army Heat Center work in conjunction to track and analyze data on heat exhaustion, heat stroke, and heat injury. (Photo credit: Spc. Jordan Arnold) |
WHEC and the Army Heat Center work in conjunction to track and analyze data on heat exhaustion, heat stroke, and heat injury. These are all distinct conditions, though the terms are often used interchangeably. Heat exhaustion raises the core body temperature up to 104 degrees Fahrenheit. Heat stroke takes it further, with core body temperatures exceeding 104, causing confusion, agitation and even central nervous system damage. Heat injury resembles heat exhaustion, with characteristics of end-organ damage. Exertional heat stroke (EHS) is the Center's main concern, as it's often triggered by intense workouts.
Each month, Fort Moore's Maneuver Center of Excellence Heat Illness Report compiles heat illness data across a range of categories (heat exhaustion, heat injury, heat stroke, hyponatremia), analyzing causes, effectiveness of treatment methods, and emergency response. In August 2024, the report showed a notable decrease in EHS casualty numbers. With 15 cases reported year-to-date and just one in August, the report reflects the lowest year-to-date EHS casualty numbers since the Center began tracking heat casualties in 2019.
DeGroot and O'Connor credit strong leadership for this shift. "They get it," says DeGroot. Military commanders are taking heat illness seriously, understanding its potential dangers. As an example, DeGroot references a colonel at the base who witnessed a heat stroke incident firsthand. The officer, he says, now keeps heat illness top of mind when considering training or operational activities in high temperatures.
WHEC and the Army Heat Center aren't just about data. Education is also key, says O'Connor, explaining they act as consultants and advisors to leaders and trainers. "We're not going to tell you how to train," he says, "but we will give you the tools that will help you evaluate risk." The WHEC's mission is to translate and propagate lessons learned at Fort Moore to other locations across the DoD.
These tools include recommending alternatives to outdoor workouts when possible, or modifications when indoor training isn't an option. The Army Heat Center's location often entails walking long distances in extreme conditions. "If they need to get from point A to point B, they do it on foot," DeGroot says. "The weapons range is four miles away? Great, we'll walk there."
But even in high temperatures, a long outdoor walk can occur safely with sufficient rest breaks, adequate hydration, a slower pace, and lighter loads. Safety and readiness go hand-in-hand. Drill instructor training now includes dedicated heat injury prevention modules, a testament to the commitment and advocacy of Brigade Commanders.
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Soldiers demonstrate how to use ice sheets to treat a heat casualty during an exercise hosted by the Maneuver Center of Excellence, Fort Moore (formerly Fort Benning), Ga. (Photo credit: Markeith Horace) |
The Army Heat Center began as an ad hoc project in 2016, tracking heat casualties at Fort Moore with an Excel spreadsheet, and was formally established three years later. Today, they track and analyze heat injury data, with a mission to develop, identify and disseminate best practices for prevention and treatment of heat illness, and return to duty following exertional heat illness casualties. WHEC works with medical officers of the Army, Navy, and Air Force in supporting the joint, tri-service components of that mission through education and clinical consultation through the Multidisciplinary Case Review Committee (MDCRC).
The Center's research fuels vital research like the WHEC Outcome Analysis Study. This study is developing an ERE pilot registry modeled on the Joint Trauma System's DoD Trauma Registry and similar databases. This pilot registry will house medical records data on exertion-related events/injuries (such as exertional rhabdomyolysis, exertional heat stroke, exercise collapse associated with sickle cell trait, and sudden cardiac arrest). The study team is also working to improve the MDCRC database, so that researchers will be able to analyze data from the ERE registry and MDCRC database to improve prevention strategies, facilitate better return to duty decisions and enhance readiness.
The Center also creates resources for WHEC and a variety of audiences. The Clinical Practice Guideline for the Prevention, Diagnosis, and Management of Exertional Heat Illness provides detailed guidance for medical professionals. And infographics like Heat Exhaustion vs. Heatstroke offers clear first-aid advice to the public.
Although heat-related injuries garner more attention during the summer months, DeGroot emphasizes that heat injuries occur across a wide temperature range, with heat stroke possible in temperatures as mild as the upper 50s. Citing his 2022 research article, "Seasonal Trends for Environmental Illness Incidence in the US Army," which appeared in Military Medicine, DeGroot notes that fully one sixth of heat injuries occur outside the heat season. He also notes that military medical research on heat injuries extends to civilian health, particularly for athletes and those who work outdoors.
"As clinicians," says DeGroot, "we know that the safest thing is to stay inside where it's cool" during times of extreme heat. But as a military officer, he recognizes the need to balance safety and readiness. "There is no training without risk," he says, but through research and education, WHEC and the Army Heat Center are working to mitigate risk and protect service members from heat-related illness.