The profession of arms is inherently dangerous. Every Soldier
knows that when they take the oath to support and defend the
Constitution of the United States against all enemies, foreign and
domestic, they could lose their life. But not every loss occurs in a
desert or mountain range halfway around the world. The risks back
home are just as deadly.
It was early morning when the Soldiers
assembled for training, which would include a water survival
assessment, combatives, and equipment layout and inspections for an
upcoming land navigation exam. Following a physical evaluation and
breakfast at the dining facility, the Soldiers returned to the
battalion S4 area for issuance of personal gear. They were then
given a one-hour dead reckoning familiarization course before
walking two kilometers to a pond for water survival assessments.
It was during the water survival assessment that one Soldier
started exhibiting abnormal personality traits and signs of fatigue.
Still, the Soldier was able to complete his assessment and walked
back to the covered training area, or CTA, with everyone else for
equipment layout. During the layout, the Soldier appeared
disoriented, as did a few other Soldiers, and was the last to
complete each of the assigned tasks. However, no one thought he
showed any signs of needing medical attention.
equipment layout, the Soldiers were instructed to eat their lunch
MREs and issued two powdered electrolyte replacement packets that
can be added to water in canteens. They then moved across camp to
the combatives pit, where they underwent two more hours of training
and strenuous exercise in Heat Category 5 temperatures. Once again,
the accident Soldier showed signs of mental delay and exhaustion,
but he continued with training. Afterward, the Soldiers returned to
the CTA to secure their gear and receive personal locator devices
for the next day’s land navigation training before turning in for
Image with a U.S. Army soldier "safely" drinking water during a combat patrol
was created by USA Patriotism! from U.S. Navy photo by Petty Officer
1st Class Dave Hites.
Back at the barracks, the accident Soldier appeared dazed
as he sat on his bunk. He then threw up a large amount of
water. Some fellow Soldiers immediately summoned two
instructors, who called battalion medics and asked that they
meet them at the CTA. The instructors, who were also combat
lifesaver certified, moved the Soldier to the CTA and
administered heat illness treatments, during which time the
Soldier began having seizures.
As medics continued
treatment, emergency medical service personnel arrived and
transported the Soldier to a local hospital. A CT scan
showed the Soldier had brain swelling, so he was transferred
to another facility for surgery. Once there, however,
doctors determined the Soldier was brain dead. He was
removed from life support and died the following day.
this accident happen?
The Soldier died of hyponatremia, a condition that occurs when
the sodium level in the blood becomes too low. While there
are several possible causes of hyponatremia, including
certain medications and heart, kidney and liver problems,
another contributor is drinking too much water, which is
most often seen in those participating in high-intensity
activities. Humans lose sodium through sweat, and drinking
too much water during those activities can dilute the
blood’s sodium content.
Signs and symptoms of
hyponatremia include nausea and vomiting, confusion, loss of
energy or fatigue, and seizures. During acute hyponatremia,
which can occur when too much water is consumed during
physical activity, the blood’s sodium levels drop quickly.
This can result in rapid brain swelling, which can lead to
coma and death.
What can be done to prevent similar
There are several measures that can help
prevent similar training accidents in the future. First and
foremost, leaders must regularly emphasize the
12-quart-per-day maximum fluid intake guidelines found in
TRADOC Regulation 350-29. To combat their deteriorating
conditions due to the cumulative impact of extreme heat,
some Soldiers begin self-correcting by drinking more water.
Excess fluid consumption can be deadly.
should help Soldiers establish a habit of self-monitoring
fluid intake. To get an accurate measurement, Soldiers
should completely consume a full container before refilling
it; they can then track the amount by counting the total
number of containers consumed. Visual training aids and
posters stressing hydration protocols, which can be
displayed in areas such as restrooms and near water
fountains, can help reinforce consumption guidelines. In
addition, leaders should stress that overhydrating can be
just as life threatening as under hydrating.
must also implement adjustments to training events to allow
Soldiers to receive additional electrolyte supplementation
during high heat category conditions. A Soldier without the
appropriate level of electrolytes in his or her system to
offset early symptoms of an exertion-related heat illness
could overhydrate throughout the course of the day.
Additional heat mitigation protocols must also be put into
place, including providing Soldiers with time under a shaded
area or CTA, ensuring immersion tables are set up and
present for each event and having full ice sheet kits
readily available. Medics should be on site to provide
assistance at all scheduled training events. The U.S. Army
Public Health Center warns that Soldiers potentially
suffering from hyponatremia should not be given more water
or intravenous fluids. Instead, if the Soldier is awake,
have them consume salty foods or snacks and evacuate them
for medical treatment immediately. These measures can be
helpful in early treatment of heat illnesses, but the main
goal should always be injury prevention.
Soldiers need to recognize the symptoms of heat illnesses in
their battle buddies. Remember, heat illnesses are
preventable. By accurately and effectively monitoring
themselves as well as their battle buddies, Soldiers can
help keep similar incidents from occurring in their units.
Note... According to the
U.S. Army Public Health Center, hyponatremia is a medical
emergency that most often occurs in TRADOC initial entry training
units, especially during basic combat training/one station unit
training. Hyponatremia’s symptoms can be mistaken for heat
exhaustion, but the treatment is different. Soldiers suffering from
hyponatremia should be evacuated immediately.
By Chris Frazier, U.S. Army Combat Readiness Center
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