Special Operations Forces Medical Handbook

6-51

overcooling. Constantly monitor the patient’s body temperature and alternate heating and cooling until the
temperature stabilizes. Continue monitoring the patient’s temperature every 10 minutes for the next 48 hours.

2. Hydrate with 1 1/2 liters of D5NS over the first few hours. Over-hydration can increase the likelihood
   of complications.


3. Control the airway to prevent vomiting. Intubate if patient is unconscious. Consider NG tube.


4. Give diazepam 5-10 mg IV or IM to control seizures.
   NOTE: Epinephrine, sodium amytal and morphine are contraindicated. Atropine and other drugs that
   interfere with sweating are also contraindicated.

Patient Education
General: Avoid heat exposure until clinical recovery and a thorough medical evaluation are complete.
Recovery is primarily a function of the magnitude and duration of the temperature elevation. There is an
increased risk for future heat stroke.
Activity: Patients should receive profiles restricting heat exposure (a permanent profile may be issued later)
until clinical recovery is complete and their heat tolerance is evaluated.
Diet: None during initial symptoms, then as tolerated.
Medications: Avoid alcohol, caffeine and other diuretics during convalescence.
Prevention and Hygiene: Avoid heat exposure for several weeks until the body can regulate heat correctly
again.
No improvement/Deterioration: Evacuate for additional testing and treatment with continued cooling en
route.

Follow-up Actions
Reevaluation: Hypotensive patients who do not respond to saline may benefit from carefully titrated
dopamine.
Evacuation/Consultation Criteria: All heat stroke patients need mandatory evacuation and referral.
Evaluation of the potential complications of heat stroke (encephalopathy, coagulopathy, hepatic injury, renal
failure and rhabdomyolysis) requires laboratory tests not available in the basic or advanced management
tools.

Chapter 25: Chemical, Biological, and Radiation (CBR)

Injuries

CBR: Chemical Weapons of Mass Destruction

Lt Col John McAtee, USAF, BSC

Introduction: Weapons of Mass Destruction (WMD) offer unique challenges to the SOF community.
Generally, SOF forces will be operating independently, without medical support or decontamination capability
and in non-permissive areas. Any individual who suddenly becomes a casualty without being wounded,
or is suffering a greater degree of incapacitation than is compatible with his injury should be considered a
possible chemical victim. It is unlikely that a chemical agent would produce only a single casualty under field
conditions, and a chemical attack should be considered with any sudden increase in numbers of unexplained
causalities. Report any use or suspicion of use of a WMD to higher command ASAP. Chemical weapons
come in three basic types: nerve, blood and blister agents.
Symptom onset and severity will vary depending on the following:

1. Whether the agent is vapor or liquid form.


2. Temperature, wind conditions, terrain and humidity.


3. Route of absorption.


4. Specific agent, quantity and duration of exposure.


5. Pre- and Post-exposure treatment and protection.