[Doczilla]

I don't know exactly why patients who suffer heat injury once are more likely to have it again. It's more than simply, "he got too hot". The causes of heat injury are multifactorial; to some extent it depends on the individual's physiological mechanisms (high basal metabolic rate, ability to sweat easily, body mass), any intercurrent diseases (infection, neurological disease, skin disease), medications or drugs (antihistamines, caffeine, anticholinergics, stimulants), and behavioral issues (not taking the time to acclimatize, not taking preventive measures, not paying heed to his body's warning signs, ramping up physical activity in hot/humid environments quickly rather than working slowly up to the desired activity level). Some of these can be modified or avoided, such as not engaging in strenuous exercise in hot environments while being treated for certain diseases. Others are difficult to change or even predict. It's likely that many of the factors that lead to the heat injury will still be there the next time.

In young healthy recruits, poor education on the subject, poor preparation, and poor acclimatization are most often the culprits. Fortunately these can be modified. With proper education and preventive measures, along with acclimatization (usually requires and hour or two of activity in the heat per day over a week, with gradually increasing intensity), the heat injury may be avoided. They can't expect to get off the plane from Minnesota at Ft. Bragg in June and go for a 5 mile run without having some fellas drop out.

Something I forgot to mention in my previous post (but is probably intuitive to most here) is that pre-hydration in anticipation of strenuous activity in the heat is important. If you know your guys are going out in the heat today, start them off right with a couple of cups of water or sports drink before they go. Obviously not RIGHT before they head out the door (because of cramping), but an hour or two.

'zilla