Treat heat exhaustion as if the victim were in shock. Move the victim to a cool or air-conditioned area. Loosen the clothing, apply cool wet cloths to the head, axilla, groin, and ankles, and fan the victim. Do not allow the victim to become chilled. (If this does occur, cover with a light blanket and move into a warmer area.) If the victim is conscious, give a solution of 1 teaspoon of salt dissolved in a liter of cool water. If the victim vomits, do not give any more fluids. Transport the victim to a medical treatment facility as soon as possible. Intravenous fluid infusion may be necessary for effective fluid and electrolyte replacement to combat shock. Heat Stroke Sunstroke is more accurately called heat stroke since it is not necessary to be exposed to the sun for this condition to develop. It is a less common but far more serious condition than heat exhaustion, since it carries a 20 percent mortality rate. The most important feature of heat stroke is the extremely high body temperature (105F, 41C or higher) accompanying it. In heat stroke, the victim suffers a breakdown of the sweating mechanism and is unable to eliminate excessive body heat build up while exercising. If the body temperature rises too high, the brain, kidneys, and liver may be permanently damaged. Sometimes the victim may have preliminary symptoms such as headache, nausea, dizziness, or weakness. Breathing will be deep and rapid at first, later shallow and almost absent. Usually the victim will be flushed, very dry, and very hot. The pupils will be constricted (pinpoint) and the pulse fast and strong (fig. 4-50). Compare these symptoms with those of heat exhaustion. When providing first aid for heat stroke, remember that this is a true life-and-death emergency. The longer the victim remains overheated, the more likely irreversible brain damage or death will occur. First aid is designed to reduce body heat fast. Reduce heat immediately by dousing the body with cold water or by applying wet, cold towels to the whole body. Move the victim to the coolest place available and remove as much clothing as possible. Maintain an open airway. Place the victim on his back, with the head and shoulders slightly raised. If cold packs are available, place them under the arms, around the neck, at the ankles, and in the groin. Expose the victim to a fan or air conditioner, since drafts will promote cooling. Immersing the victim in a cold water bath is also very effective. If the victim is conscious, give cool water to drink. Do not give any hot drinks or stimulants. Discontinue cooling when the rectal temperature reaches 102F; watch for recurrence of temperature rise by checking every 10 minutes. Repeat cooling if temperature reaches 103F rectally. Get the victim to a medical facility as soon as possible. Cooling measures must be continued while the victim is being transported. Intravenous fluid infusion may be necessary for effective fluid and electrolyte replacement to combat shock. Prevention of Heat Exposure Injuries LEARNING OBJECTIVE: Determine the steps needed to prevent heat exposure injuries. The prevention of heat exposure injuries is a command responsibility, but the medical department plays a role in it by educating all hands about the medical dangers, monitoring environmental health, and advising the commanding officer. On the individual level, prevention centers on water and salt replacement. Sweat must be replaced ounce for ounce; in a hot environment, water consumption must be drastically increased. Salt should be replaced by eating well-balanced meals, three times a day, salted to taste. In the field, “C” rations contain enough salt to sustain a person in most situations. DO NOT use salt tablets unless specified by a physician. DO NOT consume alcoholic beverages. At the command level, prevention centers on an awareness of the environment. The Wet Bulb Globe 4-61 Figure 4-50.—Heat exhaustion and heat stroke.