NARRATIVE: THIS ALARACT MESSAGE REPLACES URGENT ALARACT 056/2018, WHICH IS NOW INACTIVE. THIS MESSAGE INCLUDES A REVISED URINE TEST CARD.

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1 UNCLAS RAAUZATZ RUJAAAA UUUU--RUJAAAA. ZNR UUUUU R Z JUL 18 FM ALARACT RELEASE AUTHORITY WASHINGTON DC TO ZEN/ALARACT RUJAAAA/ALARACT RELEASE AUTHORITY WASHINGTON DC RUJIAAA/AMMOCO FOURTH SUPBN RUJAAAA/USAITA OMS ARMY PLA MANAGER WASHINGTON DC RUJAAAA/ALARACT NIPR BT UNCLAS SUBJ/URGENT ALARACT 057/ PUBLIC HEALTH ALERT: HEAT ILLNESS (UPDATE) THIS URGENT ALARACT MESSAGE HAS BEEN TRANSMITTED BY JSP ON BEHALF OF HQDA OTSG//DASG-HSZ-PPM/DAMO-DASG// NARRATIVE: THIS ALARACT MESSAGE REPLACES URGENT ALARACT 056/2018, WHICH IS NOW INACTIVE. THIS MESSAGE INCLUDES A REVISED URINE TEST CARD. 1.(U) REFERENCES. 1.A. ALARACT 050/ HEAT ILLNESS PREVENTION FOR 2018 HEAT SEASON /29JUN18// 1.B. AR /STANDARDS OF MEDICAL FITNESS/14JUN17// _WEB_FINAL.PDF 2.(U) SITUATION. SINCE JANUARY 2018, MORE THAN 480 CASES OF HEAT ILLNESS HAVE BEEN REPORTED, WITH 272 REPORTED IN JUNE LEADERS AND SOLDIERS MUST UNDERSTAND THAT THE PREVENTION OF HEAT ILLNESS IS VITAL TO SUSTAIN COMBAT POWER. HEAT ILLNESS CONTINUES TO THREATEN INDIVIDUAL HEALTH AND PERFORMANCE OF OUR SOLDIERS, DEPARTMENT OF THE ARMY (DA) CIVILIANS, AND THE COLLECTIVE HEALTH OF OUR FORCE ARMY-WIDE. IN 2017, 955 CASES OF EXERTIONAL HEAT ILLNESS (EHI) WERE REPORTED TO ARMY PUBLIC HEALTH CENTER (APHC) AS REPORTABLE MEDICAL EVENTS (RMES); 183 CASES WERE REPORTED AS HEAT STROKE. HEAT STROKE IS THE MOST SERIOUS HEAT-RELATED ILLNESS AND CAN CAUSE DEATH OR LEAD TO PERMANENT DISABILITY. 3.(U) MISSION. LEADERS, SOLDIERS, AND MEDICAL PROVIDERS AT ALL LEVELS MUST IMPLEMENT BASIC, EFFECTIVE MEASURES IN ORDER TO PREVENT HEAT ILLNESS AND INCREASE READINESS. 4.(U) EXECUTION. 4.A.(U) CONCEPT OF THE OPERATION. 4.A.1.(U) SOLDIERS, LEADERS, AND MEDICAL PROVIDERS ALL PLAY IMPORTANT ROLES IN REDUCING THE INCIDENCE, SEVERITY, AND IMPACT OF HEAT ILLNESS AND ARE RESPONSIBLE FOR IMPLEMENTING BASIC MEASURES TO AID IN THE PREVENTION OF HEAT

2 ILLNESS. 4.A.2.(U) COMMANDERS AND LEADERS WILL ENSURE ALL PERSONNEL ARE EDUCATED ON THE PREVENTION, RECOGNITION AND TREATMENT OF HEAT ILLNESS (Attachment 1). 4.B.(U) COORDINATING INSTRUCTIONS. 4.B.1.(U) LEADERSHIP IS KEY TO PREVENTING HEAT ILLNESS AND PROVIDING PROPER TREATMENT. THE FOLLOWING ARE CRITICAL STEPS TO ENSURING YOU HAVE A HEALTHY READY FORCE. 4.B.1.A.(U) USE RISK MANAGEMENT GUIDELINES WHEN PLANNING FOR TRAINING IN THE HEAT, INCLUDING CONSIDERATION OF PHYSICAL FITNESS AND ACCLIMATIZATION OF SOLDIERS. 4.B.1.B.(U) ENSURE PERSONNEL ARE TRAINED ON PREVENTION, RECOGNITION, AND BASIC TREATMENT OF HEAT ILLNESS. RAPID COOLING IS THE MOST EFFECTIVE INTERVENTION IN SUSPECTED HEAT ILLNESS. DO NOT DELAY COOLING MEASURES AT THE POINT OF INJURY. PLAN FOR RAPID COOLING INTERVENTIONS (SUCH AS ICE SHEETS) AT TRAINING LOCATIONS. 4.B.1.C.(U) MONITOR THE WET BULB GLOBE THERMOMETER (WBGT) HOURLY WHEN AMBIENT TEMPERATURE IS 75 FAHRENHEIT AND ADJUST ACTIVITY AS NEEDED. 4.B.1.D.(U) KNOW THE CURRENT PROFILE STATUS OF SOLDIERS WITH PREVIOUS HEAT ILLNESS. 4.B.1.E.(U) ENCOURAGE CONSISTENT FOOD AND FLUID INTAKE. DO NOT EXCEED 1 QUART/HOUR UNDER MOST CONDITIONS (MAXIMUM OF 1.5 QUARTS/HOUR OR 12 QUARTS/DAY UNDER VERY STRENUOUS CONDITIONS). LIMIT REFILLS OF REFILLABLE BLADDER SYSTEMS TO 3 LITERS EVERY 3 HOURS. SOLDIERS SHOULD CHECK WITH CADRE OR MEDIC IF MORE FREQUENT REFILLS ARE NEEDED. 4.B.1.F.(U) SOLDIERS WITH PREVIOUS HEAT ILLNESS SHOULD BE MONITORED CLOSELY FOR OVER-HYDRATION; THEY MAY OVER-HYDRATE IN AN ATTEMPT TO AVOID A REPEAT HEAT ILLNESS. 4.B.2.(U) SOLDIERS MUST NOT ALLOW HEAT ILLNESS TO PROGRESS. THE FOLLOWING ARE STEPS TO REDUCE THE LIKELIHOOD OF BECOMING A HEAT CASUALTY. 4.B.2.A.(U) ENSURE ADEQUATE SLEEP, HYDRATION, AND NUTRITION PRIOR TO TRAINING. HYDRATION CAN BE ESTIMATED USING THE URINE COLOR TEST CARD (ATTACHMENT 2). 4.B.2.B.(U) START HYDRATED AND STAY HYDRATED WITH REGULAR INTAKE OF FOOD AND FLUIDS. AVOID EXCESSIVE HYDRATION; IT WILL NOT PREVENT HEAT ILLNESS BUT MAY LEAD TO OVER-HYDRATION.

3 4.B.2.C.(U) RECOGNIZE EARLY SIGNS AND SYMPTOMS OF HEAT ILLNESS IN YOURSELF AND FELLOW SOLDIERS, SUCH AS DIZZINESS, HEADACHE, NAUSEA, WEAKNESS, UNSTEADY WALK, AND MUSCLE CRAMPS. 4.B.2.D.(U) REHYDRATE SLOWLY AND STEADILY AFTER TRAINING; RAPID REHYDRATION MAY LEAD TO OVER-HYDRATION. 4.B.3.(U) PROVIDERS MUST DIFFERENTIATION BETWEEN HEAT ILLNESS AND OVER-HYDRATION. APPROPRIATE TREATMENT IS CRITICAL TO PREVENT FURTHER HARM TO AFFECTED SOLDIERS. 4.B.3.A.(U) INITIAL MANAGEMENT OF SUSPECTED HEAT ILLNESS IS RAPID COOLING. 4.B.3.B.(U) VERIFY SODIUM LEVEL PRIOR TO AND DURING REHYDRATION EFFORTS. 4.B.3.C.(U) HYPERTONIC SALINE IS AN INDICATED TREATMENT IN EXERCISE ASSOCIATED HYPONATREMIA. 4.B.3.D.(U) PROPER PROFILING PER AR WILL MINIMIZE RECURRENT HEAT ILLNESS IN SUSCEPTIBLE SOLDIERS. 4.B.3.E.(U) REINFORCE WITH SOLDIERS THAT EXCESSIVE HYDRATION WILL NOT PREVENT RECURRENT HEAT ILLNESS. 4.B.3.F.(U) NOTIFY PREVENTIVE MEDICINE TO REPORT CASES OF HEAT ILLNESS. 4.B.4.(U) PUBLIC HEALTH ALERT (ATTACHMENT 1) IS AVAILABLE FOR DISTRIBUTION. 4.B.5.(U) DETAILED GUIDANCE OUTLINES CAN BE FOUND IN ALARACT 050/ HEAT ILLNESS PREVENTION FOR 2018 HEAT SEASON. 4.B.6.(U) MORE INFORMATION AS WELL AS HEAT ILLNESS PREVENTION PRODUCTS ARE AVAILABLE AT THE ARMY PUBLIC HEALTH CENTER'S WEBSITE: LNESS-PREVENTION.ASPX 5. (U) HQDA POCS: OTSG/MEDCOM PREVENTIVE MEDICINE STAFF OFFICER: DUNCAN.A.GILLIES.MIL@MAIL.MIL. 6. (U) EXPIRATION DATE: 24 JAN BT #0855

4 PUBLIC HEALTH ALERT Prevent Heat Illness; Increase Readiness Heat illnesses were responsible for more than 20,500 lost/limited duty days in 2017 Heat illness occurs when the body cannot compensate for increased heat stress. Heat illnesses occur year round in training environments and increase significantly in warmer weather. Since January 2018, more than 480 cases of heat illness have been reported, with 272 reported in June Exercise Associated Hyponatremia, most commonly associated with excess water consumption (over-hydration), can occur in the same conditions as heat illness. This can be a fatal condition if not recognized and properly treated. Soldiers, leaders, and medical providers all play important roles in reducing the incidence, severity, and impact of heat illness. SOLDIERS: Allowing heat illness to progress can take you out of the fight and can even affect your mobility status. Ensure adequate sleep, hydration, and nutrition prior to training. Hydration can be estimated using the Urine Color Test Card. Start hydrated and stay hydrated with regular intake of food and fluids. Avoid excessive hydration; it will not prevent heat illness but may lead to over-hydration. Recognize early signs and symptoms of heat illness in yourself and fellow Soldiers, such as dizziness, headache, nausea, weakness, unsteady walk, and muscle cramps. Rehydrate slowly and steadily after training; rapid rehydration may lead to over-hydration. LEADERS: Preventing heat illness and providing proper treatment are critical steps to ensuring you have a healthy and ready force. Use risk management guidelines when planning for training in the heat, including consideration of physical fitness and acclimatization of Soldiers. Ensure personnel are trained on prevention, recognition, and basic treatment of heat illness. Rapid cooling is the most effective intervention in suspected heat illness. Do not delay cooling measures at the point of injury. Plan for rapid cooling interventions (such as ice sheets) at training locations. Monitor the wet bulb globe thermometer (WBGT) hourly when ambient temperature is 75 Fahrenheit and adjust activity as needed. Know the current profile status of Soldiers with previous heat illness. Encourage consistent food and fluid intake. Do not exceed 1 quart/hour under most conditions (maximum of 1.5 quarts/hour or 12 quarts/day under very strenuous conditions). Limit refills of refillable bladder systems to 3 liters every 3 hours. Soldiers should check with cadre or medic if more frequent refills are needed. Soldiers with previous heat illness should be monitored closely for overhydration; they may over-hydrate in an attempt to avoid a repeat heat illness. PROVIDERS: Differentiation between heat illness and over-hydration and appropriate treatment is critical to prevent further harm to affected Soldiers. Initial management of suspected heat illness is rapid cooling. Verify sodium level prior to and during rehydration efforts. Hypertonic saline is an indicated treatment in Exercise Associated Hyponatremia. Proper profiling per AR will minimize recurrent heat illness in susceptible Soldiers. Reinforce with Soldiers that excessive hydration will not prevent recurrent heat illness. Notify Preventive Medicine to report cases of heat illness. Detailed guidance outlines can be found in ALARACT 050/ HEAT ILLNESS PREVENTION FOR 2018 HEAT SEASON More information as well as heat illness prevention products are available at the Army Public Health Center s website: Updated 12 July 2018 U.S. Army Public Health Center UNCLASSIFIED

5 Are You Hydrated? Take the Urine Color Test Urine Color Chart * Purpose HYDRATED DEHYDRATED OPTIMAL WELL HYDRATED DEHYDRATED: You need to drink more water With normal kidney function, your level of hydration is indicated by the color of your urine. Some vitamins and supplements may cause a darkening of the urine unrelated to dehydration. Since heat-related illness often follows dehydration, this simple test will help protect your health. Dehydration also increases your risk for kidney stones. How does it work? Match your urine color to closest color in the chart and read the hydration level on the chart. Watch the urine stream not the toilet water, as the water in the toilet will dilute your urine color. In response to dehydration, the kidneys conserve water and excrete more concentrated urine; the more concentrated the urine the darker the color. Prevent Dehydration SEEK MEDICAL AID: May indicate blood in urine or kidney disease *This color chart is not for clinical use. Fluid Replacement Guide Heat Category WBGT Index, (ºF) Easy Work Walking on hard surface, 2.5 mph, <30 lb. load; weapon maintenance, marksmanship training. Moderate Work Patrolling, walking in sand, 2.5 mph, no load; calisthenics. Hard Work Walking in sand, 2.5 mph, with load; field assaults. No amount of training in a new climate can reduce the body s requirement for water. Follow the water consumption guidelines in the water consumption table. 1 78º º ½ ¾ ¾ (1)* 2 82º º ½ ¾ (1)* 1 (1¼)* 3 85º º ¾ ¾ (1)* 1 (1¼)* 4 88º º ¾ ¾ (1¼)* 1 (1¼)* 5 > 90º 1 1 (1¼)* 1 (1½)* *Use the amounts in parentheses for continuous work when rest breaks are not possible. Leaders should ensure several hours of rest and rehydration time after continuous work. This guidance will sustain performance and hydration for at least 4 hours of work in the specified heat category. Fluid needs can vary based on individual diiferences (± ¼ qt/hr) and exposure to full sun or full shade (± ¼ qt/hr). Rest means minimal physical activity (sitting or standing) in the shade if possible. Body armor - add 5 F to WBGT index in humid climates. NBC (MOPP 4) - Add 10 F (Easy Work) or 20 F (Moderate or Hard Work) to WBGT Index. CAUTION: Hourly fluid intake should not exceed 1½ qts. Daily fluid intake should not exceed 12 qts. CP (Also available as a tip card) Approved for public release, distribution unlimited.