SINGAPORE: You’re trudging through an 8km route march under the blazing sun. Your integrated load bearing vest traps heat like a furnace. Your helmet feels sticky as sweat trickles down your cheeks.
You turn to look at your buddy. He’s not walking straight. Disoriented, he tells you he doesn’t feel right - something about feeling weak and dizzy.
In a situation like this, what should you do?
First,recognisethat your buddy is showing signs of heat injury. Move him in the shade to rest and remove his clothing. Reduce his temperature as quickly as possible by applying a wet towel or pouring water on his body.
If he is conscious, give him water to rehydrate. If he is not breathing or does not have a pulse, resuscitate with cardiopulmonary resuscitation. Finally, rush him to the nearest medical facility.
These steps were from the Singapore Armed Forces (SAF)’s 7R management model on heat injury, an issue which has been in the spotlight following the death of full-time national serviceman Dave Lee on Apr 30.
AdvertisementAdvertisementHe had been hospitalised for nearly two weeks with "signs of heat injury" after completing an 8km fast march in Bedok Camp, the Ministry of Defence (MINDEF) said.
The 19-year-old Guardsman was treated by SAF medics before being taken to Changi General Hospital, where his condition worsened, MINDEF added. As with all training-related deaths, an independent Committee of Inquiry (COI) will be convened to investigate the incident.
According to a 1999 edition of an SAF commanders’ guide to preventing heat injuries seen by Channel NewsAsia, Guards units are considered “high risk” because they “generally have a higher training intensity”.
“The time of the year with the highest incidence of heat injuries are April to May which coincides with the period of the year with the highest Wet Bulb Globe Thermometer readings,” the guide said.
The Wet Bulb Globe Temperature refers to a composite measure of heat, humidity and wind chill.
DIFFERENT TYPES OF HEAT INJURY
But what exactly are heat injuries?
It is when one participates in physical activity to the point that heat production within the body exceeds its ability to lose heat adequately, the guide said. This results in a rise in body core temperature that can lead to “temporary or permanent disturbances” in bodily functions.
The guide also categorised heat injuries into three types: Heat cramps, heat exhaustion and heat stroke.
Heat cramps, which are intermittent muscle cramps that usually occur on the legs, result from excessive salt and water loss due to profuse sweating. Heat exhaustion is more severe and points to a significant loss of water. Signs include exhaustion, headaches and dizziness.
The most serious form, heat stroke, comes with a body core temperature of 41 degree Celsius and above. “Soldiers may present with confusion, aggressive behaviour and may progress into a comatose state,” the guide said, stressing that heat stroke is a medical emergency.
SAF recruits going through a route march. (Photo: Facebook/Basic Military Training Centre)
“When the body is unable to adapt to the heat stress, the chemical changes that take place in the body can lead to inflammation in various organs and cause damage,” Dr Philip Koh, who runs a clinic in Tampines, told Channel NewsAsia.
“When the vital organs are damaged enough, it leads to death. And this can be quite accelerated in certain conditions.”
To that end, Dr Koh stressed that speed is important when it comes to recognising heat injury symptoms and treating them.
“If you think the person looks a bit off, either see a doctor or go straight to the hospital,” he added. “Because rehydration with water or 100 Plus may or may not be enough. If it’s not enough, then you need to get a drip going.”
PREVENTION VERSUS CURE
When it comes to prevention, Dr Koh said soldiers should have enough rest and ensure their bodies are conditioned before an activity. “If there’s anything along the way that the soldier is not able to cope with, this should be picked up,” he added.
Factors that help prevent heat injuries include acclimatisation, hydration and having proper work-rest cycles, the SAF guide said.
Acclimatisation involves progressive training to help soldiers get used to the heat. “The intensity of exercise should be gradually increased each day, working up to an appropriate physical training schedule adapted for the environment,” the guide said.
Commanders are also responsible for ensuring soldiers regularly consume fluids, the guide stated. “Soldiers tend not to sense that they are dehydrated and must therefore be consciously reminded to replace the water that is lost through sweating,” it said.
As for work-rest cycles, the guide pointed out that commanders should prevent a “dangerous” increase in body temperature by reducing the pace of work and increasing the duration of rest, especially in very hot and humid conditions.
SAF guidelines based on the Wet Bulb Globe Temperature concept state that above 33 degree Celsius, troops should work 15 minutes at a stretch, followed by 30 minutes rest. During this Code Black category, commanders can also choose to delay or postpone training.
The guide also includes a risk assessment matrix that tells commanders how to respond to causal factors of heat injuries.
Other measures include ensuring soldiers remove unnecessary layers of clothing and teaching them to monitor their hydration through the colour and volume of their urine. In 2012, the SAF introduced a compulsory temperature-taking regime for soldiers.
DECREASE IN CASES
According to 2010 SAF-Ministry of Health guidelines on managing heat injuries, a retrospective review of exertional heat injury in the SAF from 1990 to 2008 revealed that heat injury cases had decreased from 50 to about five cases per 10,000 training population.
This follows the “introduction of a system for risk management during training, soldier education, hydration regime and acclimatisation and periodisation training”, the guidelines said.
Channel NewsAsia has contacted MINDEF for comment on heat injuries in the SAF.
The US Army takes a similar approach to heat injuries, according to a training document published in 2016 by its Training and Doctrine Command. Brigade commanders are also required to conduct heat illness prevention and treatment training for subordinate leaders every year.
“Heat injuries are totally preventable,” the SAF guide said. “When a heat injury occurs, it is an indication of failure in one or more components of the prevention system.”
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You turn to look at your buddy. He’s not walking straight. Disoriented, he tells you he doesn’t feel right - something about feeling weak and dizzy.
In a situation like this, what should you do?
First,recognisethat your buddy is showing signs of heat injury. Move him in the shade to rest and remove his clothing. Reduce his temperature as quickly as possible by applying a wet towel or pouring water on his body.
If he is conscious, give him water to rehydrate. If he is not breathing or does not have a pulse, resuscitate with cardiopulmonary resuscitation. Finally, rush him to the nearest medical facility.
These steps were from the Singapore Armed Forces (SAF)’s 7R management model on heat injury, an issue which has been in the spotlight following the death of full-time national serviceman Dave Lee on Apr 30.
AdvertisementAdvertisementHe had been hospitalised for nearly two weeks with "signs of heat injury" after completing an 8km fast march in Bedok Camp, the Ministry of Defence (MINDEF) said.
The 19-year-old Guardsman was treated by SAF medics before being taken to Changi General Hospital, where his condition worsened, MINDEF added. As with all training-related deaths, an independent Committee of Inquiry (COI) will be convened to investigate the incident.
According to a 1999 edition of an SAF commanders’ guide to preventing heat injuries seen by Channel NewsAsia, Guards units are considered “high risk” because they “generally have a higher training intensity”.
“The time of the year with the highest incidence of heat injuries are April to May which coincides with the period of the year with the highest Wet Bulb Globe Thermometer readings,” the guide said.
The Wet Bulb Globe Temperature refers to a composite measure of heat, humidity and wind chill.
DIFFERENT TYPES OF HEAT INJURY
But what exactly are heat injuries?
It is when one participates in physical activity to the point that heat production within the body exceeds its ability to lose heat adequately, the guide said. This results in a rise in body core temperature that can lead to “temporary or permanent disturbances” in bodily functions.
The guide also categorised heat injuries into three types: Heat cramps, heat exhaustion and heat stroke.
Heat cramps, which are intermittent muscle cramps that usually occur on the legs, result from excessive salt and water loss due to profuse sweating. Heat exhaustion is more severe and points to a significant loss of water. Signs include exhaustion, headaches and dizziness.
The most serious form, heat stroke, comes with a body core temperature of 41 degree Celsius and above. “Soldiers may present with confusion, aggressive behaviour and may progress into a comatose state,” the guide said, stressing that heat stroke is a medical emergency.
“When the body is unable to adapt to the heat stress, the chemical changes that take place in the body can lead to inflammation in various organs and cause damage,” Dr Philip Koh, who runs a clinic in Tampines, told Channel NewsAsia.
“When the vital organs are damaged enough, it leads to death. And this can be quite accelerated in certain conditions.”
To that end, Dr Koh stressed that speed is important when it comes to recognising heat injury symptoms and treating them.
“If you think the person looks a bit off, either see a doctor or go straight to the hospital,” he added. “Because rehydration with water or 100 Plus may or may not be enough. If it’s not enough, then you need to get a drip going.”
PREVENTION VERSUS CURE
When it comes to prevention, Dr Koh said soldiers should have enough rest and ensure their bodies are conditioned before an activity. “If there’s anything along the way that the soldier is not able to cope with, this should be picked up,” he added.
Factors that help prevent heat injuries include acclimatisation, hydration and having proper work-rest cycles, the SAF guide said.
Acclimatisation involves progressive training to help soldiers get used to the heat. “The intensity of exercise should be gradually increased each day, working up to an appropriate physical training schedule adapted for the environment,” the guide said.
Commanders are also responsible for ensuring soldiers regularly consume fluids, the guide stated. “Soldiers tend not to sense that they are dehydrated and must therefore be consciously reminded to replace the water that is lost through sweating,” it said.
As for work-rest cycles, the guide pointed out that commanders should prevent a “dangerous” increase in body temperature by reducing the pace of work and increasing the duration of rest, especially in very hot and humid conditions.
SAF guidelines based on the Wet Bulb Globe Temperature concept state that above 33 degree Celsius, troops should work 15 minutes at a stretch, followed by 30 minutes rest. During this Code Black category, commanders can also choose to delay or postpone training.
Other measures include ensuring soldiers remove unnecessary layers of clothing and teaching them to monitor their hydration through the colour and volume of their urine. In 2012, the SAF introduced a compulsory temperature-taking regime for soldiers.
DECREASE IN CASES
According to 2010 SAF-Ministry of Health guidelines on managing heat injuries, a retrospective review of exertional heat injury in the SAF from 1990 to 2008 revealed that heat injury cases had decreased from 50 to about five cases per 10,000 training population.
This follows the “introduction of a system for risk management during training, soldier education, hydration regime and acclimatisation and periodisation training”, the guidelines said.
Channel NewsAsia has contacted MINDEF for comment on heat injuries in the SAF.
The US Army takes a similar approach to heat injuries, according to a training document published in 2016 by its Training and Doctrine Command. Brigade commanders are also required to conduct heat illness prevention and treatment training for subordinate leaders every year.
“Heat injuries are totally preventable,” the SAF guide said. “When a heat injury occurs, it is an indication of failure in one or more components of the prevention system.”
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