title: Exertional Heat Injury: Effects of Adding Cold (4°C) Intravenous Saline to Prehospital Protocol.
abstract: This article reviews current prehospital treatment for heat casualties and introduces a retrospective study on the addition of cold (4 °C) intravenous (IV) saline to prehospital treatment and its effect on morbidity. The study is a retrospective cohort reviewing electronic medical records of 290 heat casualties admitted to Martin Army Community Hospital, Ft. Benning, GA, comparing two treatment groups; U.S. Army Training and Doctrine Command (ice-sheeting and ambient temperature IV saline) versus Benning (ice-sheeting and cold IV saline). U.S. Army Training and Doctrine Command group significantly differed from Benning group on a number of measures, the median length of stay in the hospital was 3 and 2 d, respectively (P < 0.0001); pCr were 1.8 to 1.4 mg·dL, respectively (difference of 0.4 mg·dL pCr, P < 0.0001). However, creatine phosphokinase, aspartate aminotransferase, and alanine aminotransferase were not significantly different across groups. Findings demonstrate that adding cold IV saline to ice-sheeting as a protocol reduces the length of hospitalization of heat casualties and lowers their peak creatinine values.
authors.affiliation: 1CPT, U.S. Army Health Clinic Hohenfels, Hohenfels, Bavaria, Germany; 2MAJ, Tripler Army Medical Center, Honolulu, HI 96859; 3MAJ, 173rd IBCT(A) Brigade, Vincenza, Italy; 4LTC, DiLorenzo TRICARE Health Clinic, Washington, DC; and 5MAJ, Martin Army Community Hospital, Ft. Benning, GA.
authors.forename: Gordon
authors.initials: G
authors.lastname: Mok
authors.forename: David
authors.initials: D
authors.lastname: DeGroot
authors.forename: Nathanael E
authors.initials: NE
authors.lastname: Hathaway
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Bigley
authors.forename: Christopher S
authors.initials: CS
authors.lastname: McGuire
mesh_terms: D001831:Body Temperature; D003080:Cold Temperature; D004632:Emergency Medical Services / Q000379:methods*; D005440:Fluid Therapy / Q000379:methods*; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007262:Infusions, Intravenous; D008297:Male; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D012965:Sodium Chloride