Exploring the link between EHI and Malignant Hyperthermia .ppt by suchufp


									ACSM Roundtable: Heat Illness:
 Return to Duty/Return to Play

                      Francis G. O’Connor, MD, MPH
        Associate Professor of Military and Emergency Medicine
             Department of Military and Emergency Medicine
     Medical Director, Consortium for Health and Human Performance
          Uniformed Services University of the Health Sciences
How do you return this
  Soldier to Duty?
Or this one…?
                   You Go to AR 40-501

• AR 40-501 Standards
  of Medical Fitness
  – Chapter 3
  – Paragraph 45. Heat
    Illness and Injury

  Francis G. O’Connor, Aaron D. Williams, Steve Blivin,Yuval Heled,
  Patricia Deuster, and Scott D. Flinn: Guidelines for Return to Duty
   (Play) After Heat Illness: A Military Perspective. Journal of Sport
              Rehabilitation. Volume 16 (3): August 2007.
                            AR 40-501

• Definitions
  – Heat Exhaustion: collapse,
    including syncope, occurring
    during or immediately following
    exercise-heat stress without
    evidence of organ damage or
    systemic inflammatory activation.
  – Heat Stroke: a syndrome of
    hyperpyrexia, collapse, and
    encephalopathy with evidence of
    organ damage and/or systemic
    inflammatory activation occurring
    in the setting of environmental
    heat stress
                            AR 40-501

• Heat Exhaustion
  – Individual episodes of heat
    exhaustion are not cause for
    referral to an MEB.
  – However, soldiers suffering from
    recurrent episodes (three or
    more in less than 24 months)
    should be referred for a
    complete medical evaluation for
    contributing factors.
                                           Sergeant Patrick
  – If no remediable factor causing           McCaffrey
    recurrent heat exhaustion is
    identified, then the soldier will be
    referred for an MEB.
                             AR 40-501

• Heat Stroke
  – Soldiers will be referred to an MEB
    after an episode of heat stroke.
  – If the soldier has had a full clinical
    recovery, and particularly if a
    circumstantial contributing factor to
    the episode can be identified, the
    MEB may recommend a trial of duty
    with a P-3 profile for three months.
     • No vigorous activity over 15 minutes;
     • No maximal efforts such as a two mile
     • Heat exposure restriction.
                                  AR 40-501

• Heat Stroke
  – If after three months the soldier has not
    manifested any heat intolerance, the profile
    may be modified to a P-2 and normal
    unrestricted work may be permitted.
  – Maximal exertion and significant heat
    exposure (such as wearing MOPP gear)
    are still restricted.
  – If there is no heat intolerance, including a
    season of significant environmental
    stress, normal activities may be resumed
    and the soldier returned to full duty.         Mission Oriented
  – Any evidence of significant heat intolerance   Protective Posture
    requires a referral to a PEB.                     (MOPP) IV
• Womack Army
• Fort Bragg, NC
Pfc. David M. Kirchhoff in
   Cedar Rapids, Iowa

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