R 230027Z AUG 07 ZUI ASN-A00235000001 ZYB
FM COMDT COGARD WASHINGTON DC//CG-11//
TO ALCOAST
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UNCLAS //N06260//
ALCOAST 412/07
COMDTNOTE 6260

SUBJ: HEAT INJURIES

A. COAST GUARD CUTTER HEAT STRESS PROGRAM, COMDTINST M6260.17

1. SEVERAL MISHAPS RELATED TO HEAT INJURIES HAVE BEEN REPORTED IN THE PAST MONTH INCLUDING A NEAR FATAL CASE OF HEAT STROKE. UNIT COMMANDERS ARE RESPONSIBLE FOR ENSURING THAT THE PREVENTIVE MEASURES IN THE HEAT STRESS PROGRAM ARE FOLLOWED PER REFERENCE "A".

UNIT COMMANDERS SHOULD CONSIDER HAVING EITHER A SAFETY STAND DOWN OR ALL HANDS MEETING TO DISCUSS HEAT INJURIES AND THEIR PREVENTION.

UNIT COMMANDERS SHALL REFER TO THE WORK/REST SCHEDULE TABLE NOTED IN HTTP://WWW.USCG.MIL/HQ/G-W/G-WK/WKS/INDEX.HTM UNDER "HOT TOPICS" AS WELL AS THE PREVENTIVE MEASURES NOTED BELOW TO ESTABLISH A SAFER WORKING ENVIRONMENT.

2. IT IS VERY IMPORTANT THAT ALL COAST GUARD PERSONNEL MAINTAIN A HIGH LEVEL OF AWARENESS OF THE POTENTIAL FOR SERIOUS ILLNESS OR DEATH DUE TO EXPOSURE TO HIGH TEMPERATURES. THE MAJOR CATEGORIES OF HEAT INJURY ARE NOTED BELOW:

A. HEAT STROKE.

1. HEAT STROKE IS CONSIDERED A MEDICAL EMERGENCY WHICH IS CAUSED BY THE SHUTDOWN OF THE BODYS THERMOREGULATORY SYSTEM. THIS RESULTS IN A SIGNIFICANT RISE IN THE BODYS CORE TEMPERATURE AND BEGINS TO ADVERSELY AFFECT THE BODYS MAJOR ORGAN SYSTEMS. IF UNTREATED, HEAT STROKE MAY RESULT IN DEATH. SIGNS INCLUDE THE FOLLOWING: ALTERED MENTAL STATUS, HOT DRY SKIN, DEEP AND RAPID BREATHING, RAPID PULSE, AND HIGH BODY TEMPERATURE.

2. PREVENTION. IMPLEMENT AN APPROPRIATE WORK/REST SCHEDULE TO

PREVENT HEAT RELATED INJURIES. DRINK ADEQUATE AMOUNTS OF WATER THROUGHOUT THE WORK PERIOD. PER THE INSTITUTE OF MEDICINE, ADEQUATE FLUID INTAKE IS APPROXIMATELY 10 CUPS (80 OUNCES) FOR WOMEN TO 13 CUPS (100 OUNCES) FOR MEN OF WATER OR OTHER NON CAFFEINATED BEVERAGES A DAY. THE NEED FOR FLUIDS VARIES DEPENDING ON ACTIVITY LEVEL, CLIMATE AND TEMPERATURE. DRINK ADEQUATE AMOUNTS OF FLUIDS THE DAY BEFORE A PLANNED WORK PERIOD WHERE PHYSICAL ACTIVITY IS EXPECTED UNDER HEAT STRESS CONDITIONS. ALCOHOL CONSUMPTION SHOULD BE AVOIDED DURING THESE PERIODS. EAT WELL- BALANCED MEALS BEFORE AND DURING THE WORK CYCLE AND GET A MINIMUM OF EIGHT HOURS OF SLEEP THE NIGHT BEFORE. ACCLIMATIZATION TO THE ENVIRONMENT IS IMPORTANT FOR THOSE WITH PRIOR HISTORY OF HEAT RELATED INJURIES.

3. TREATMENT. SEEK IMMEDIATE EMERGENCY MEDICAL ASSISTANCE AND MOVE THE VICTIM TO A COOL ENVIRONMENT. REMOVE ANY CONSTRICTED CLOTHING TO COOL THE SKIN. APPLY COOL (NOT COLD) WATER ON THE VICTIM BY IMMERSION IN A TUB, PLACING THEM IN A SHOWER, SPRAYING WATER ON THE VICTIM THROUGH A HOSE, OR SPONGING THE VICTIM WITH COOL WATER AND FAN THEM UNTIL EMERGENCY MEDICAL PERSONNEL ARRIVE.

B. HEAT EXHAUSTION.

1. HEAT EXHAUSTION IS ATTRIBUTED TO DEHYDRATION AND EXCESSIVE PHYSICAL ACTIVITY UNDER THE CERTAIN HEAT STRESS CONDITIONS. HEAT EXHAUSTION IS CHARACTERIZED BY AN INABILITY OF THE BODY TO GIVE OFF ENOUGH HEAT DUE TO HEAT OVERLOAD, BUT THE BODYS COOLING MECHANISMS ARE FUNCTIONING. SIGNS OF HEAT EXHAUSTION INCLUDE THE FOLLOWING:

PROFUSE SWEATING, HEADACHE, TINGLING SENSATIONS IN THE EXTREMITIES, SHORTNESS OF BREATH, PALE, MOIST SKIN, WEAK BUT RAPID PULSE, NAUSEA, AND DIZZINESS.

2. PREVENTION. SAME METHODS FOR PREVENTING HEAT STROKE.

3. TREATMENT. SEEK IMMEDIATE MEDICAL ATTENTION. REST CASUALTIES IN A COOL AND/OR SHADED ENVIRONMENT UNTIL SEEN BY AN EMERGENCY MEDICAL TEAM. INDIVIDUALS SHOULD FOLLOW THE REHYDRATION INSTRUCTIONS GIVEN IN (A-2) ABOVE. AFTER RECOVERY, EFFECTED INDIVIDUALS SHOULD NOT RETURN TO FULL PHYSICAL WORK ACTIVITY UNTIL EVALUATED BY MEDICAL.

C. HEAT CRAMPS ("MUSCLE CRAMPS").

1. HEAT CRAMPS ARE MUSCULAR SPASMS CAUSED BY AN ELECTROLYTE IMBALANCE RESULTING FROM SIGNIFICANT WATER LOSS AND INADEQUATE WATER REPLACEMENT (E.G., NOT DRINKING ENOUGH WATER). INSUFFICIENT DIET OR IRREGULAR MEALS DURING THE DAY ALSO CONTRIBUTE TO INEFFICIENT ELECTROLYTE REPLACEMENT. SYMPTOMS OFTEN INCLUDE MOIST COOL SKIN AND PAINFUL CRAMPING OR STRAIN IN THE MUSCLES.

2. PREVENTION METHODS. EAT THREE WELL BALANCED MEALS A DAY AND DRINK WATER AS THE PRIMARY FLUID REPLACEMENT. COMMERCIAL SPORTS- TYPE DRINKS CAN BE CONSUMED AS A SUPPLEMENTAL FLUID REPLACEMENT, BUT NEVER AS A REPLACEMENT FOR WATER.

3. TREATMENT. CEASE PHYSICAL WORK AND SIT IN A COOL AND/OR SHADED AREA. INDIVIDUALS SHOULD FOLLOW THE REHYDRATION INSTRUCTIONS GIVEN IN (A-2) ABOVE. SPORT-TYPE DRINKS ARE PERMITTED, BUT ONLY AFTER DRINKING THE MINIMUM WATER QUANTITY RECOMMENDED. IF MEALS WERE SKIPPED, TAKE A MEAL BREAK.

D. HEAT RASH ("PRICKLY HEAT").

1. HEAT RASH IS CHARACTERIZED BY RED BUMPS, USUALLY IN AREAS WHERE CLOTHING IS RESTRICTIVE, AND GIVES RISE TO A PRICKLING PAIN OR IRRITATION. AS SWEAT INCREASES, THE IRRITATION INCREASES. HEAT RASH IS CAUSED BY THE BLOCKAGE AND INFLAMMATION OF SWEAT DUCTS.

HEAT RASH INTERFERES WITH SLEEP, RESULTING IN DECREASED EFFICIENCY AND CUMULATIVE FATIGUE. IN ADDITION, HEAT RASH IMPAIRS SWEATING, DUE TO SWEAT DUCT BLOCKAGE AND INFLAMMATION, RESULTING IN A DECREASED EVAPORATIVE COOLING PROCESS.

2. PREVENTION METHODS. WEAR LESS RESTRICTIVE CLOTHING AND KEEP THE SKIN DRY AND CLEAN, AS MUCH AS POSSIBLE. KEEP BERTHING AREAS COOL WITH FANS. TAKE FREQUENT SHOWERS FOR CLEANING.

3. TREATMENT. THE BEST TREATMENT FOR HEAT RASH IS TO PROVIDE A COOLER, LESS HUMID ENVIRONMENT AND KEEP THE AFFECTED AREA DRY.

3. POC FOR THE DEPLOYABLE OPERATIONS GROUP AND ASSIGNED DEPLOYABLE SPECIALIZED FORCES IS CDR ORTEGA OR E-MAIL LUIS.A.ORTEGA(AT)USCG.MIL.

4. FOR QUESTIONS CONCERNING THE HEAT STRESS PROGRAM CONTACT CAPT MICHAEL ADESS (CG-1133) AT OR E-MAIL MICHAEL.ADESS(AT) USCG.MIL.

5. INTERNET RELEASE IS AUTHORIZED.

6. CAPT LORI A. MATHIEU, ACTING DIRECTOR OF HEALTH AND SAFETY, SENDS.

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