Poliomyelitis: The Role of Military in the Final Campaign

The authors document three proven cases of exert ional heatstroke with permanent neuropsychological impairment.Each of these cases developed heatstroke during supervised exercise and should have received prompt attention.The delay between collapse and cooling was not documented.A death of a cadet at the Royal Military Academy in England, and a death of a 16-year old football player in Chicago have been recently reported.Both cases involved significant delay in undressing and aggressive cooling.A high sense of awareness for heat stroke needs to be maintained.The use of exercise guidelines that prohibit exertion in excessive heat are needed.Strict water discipline is required.The use of WBGT is highly recommended.Exercises should be cancelled when temperature conditions are dangerous.Any person who exhibits changes in state of consciousness after heat exposure must be treated immediately regardless of rectal temperature.Prompt cooling by immediate undressing in the shade, and the use of ice, or water and fanning, is mandatory.This is particularly important when the collapsed victim is dressed in full battle gear or a football uniform.Clothing must be removed immediately.Cooling measures cannot be delayed until the patient is transported to the hospital.Minutes are critical to prevent cellular death and permanent impairment.If treatment is immediate, response is usually dramatic and rapid.The protocols followed at the Marine Recruit Training Center at Parris Island, SC, have produced excellent results with low morbidity and mortality despite a large number of heat injury cases.Out of 1,500 cases documented over a 10-year period, only 80 cases of heat stroke required hospitalization with only one fatality.Their regimen includes immediate undressing and cooling with ice water in the field.The authors cite a variable temperature range (1030F-1050F) for heat stroke.The use of rectal temperature as an indication of brain or vascular temperature needs to be taken with a grain of salt during periods of rapid change, such as the onset of exertional heatstroke or during the treatment of heatstroke.There is a substantial rectal temperature