b. Treatment. The lowering of the patient's body temperature as rapidly as
possible is the most important objective in the treatment of heatstroke. The longer the
temperature remains elevated, the greater of threat to life. Measures to lower the
individual's body temperature should be initiated at the earliest possible moment. In the
field, the patient's clothes should be removed. If there is any source of cool water
nearby, the patient should be immersed in water, or otherwise it should be sprinkled
over the patient and its evaporation hastened by fanning. In addition to these cooling
measures, the attendants should rub the patient's extremities and trunk briskly to
increase circulation to the skin. The patient should be removed to a hospital
immediately, and measures to cool the body should be continued until the hospital is
reached. During transportation, the skin should be kept moist; the passage of air
currents through the opened door of an ambulance will aid cooling. If ice bags
(including the chemical ice bags) are available placing at least two at the neck and/or
axilla will be helpful. When the patient reaches the hospital, further cooling measures
should be carried out immediately by placing him in a tub of water and ice. Continuous
massage of the patient's extremities should be carried out to promote vasodilation and
heat loss. After the rectal temperature is reduced to 102F, the patient should be
removed to a bed and the temperature taken every 10 minutes. Details of hospital
management of these patients are not included in this publication because these
seriously ill patients may develop various complications. Their management should be
by physicians.
4-14. PREVENTION OF ADVERSE EFFECTS OF HEAT
Successful prevention of adverse effects of heat depends largely on education of
personnel, both those exposed to heat, and especially those charged with the
supervision of such personnel. Specifically, prevention of heat injury involves the
application of measures for increasing the resistance of exposed persons and reducing
the exposure as much as practicable. Resistance is increased by replenishing water
and salt losses from the body as they occur, by gradual acclimatization of individuals to
hot environments, and by the maintenance of the optimum physical condition of
personnel. Heat stress is decreased by reducing the workload and by introducing any
measure that will protect the individual from the hot environment. Each of these
measures is discussed briefly in the following paragraphs.
4-15. WATER
a. The human body is highly dependent on water to cool itself in a hot
environment. Evaporating heat is the primary means the body utilizes for cooling. An
individual subjected to high heat stress may lose water well in excess of one quart per
hour by sweating. Water losses must be replaced or else rapid decrease in the ability to
work, rise in body temperature and heat rate, deterioration of morale, and heat
exhaustion will occur. Water loss should be replaced preferably by periodic intake of
adequate amounts of water through the work period. Table 4-3 may be used as a guide
to estimate the drinking water requirements for personnel exposed to heat stress.
During the period of moderate activity, with moderate conditions prevailing, water
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