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FLUID REPLACEMENT AND HEAT STRESS
Prior to the 15-hour flight to the Mid-East, each soldier received two box lunches and two 1-liter containers of Gatorade. Upon arrival, warm potable water was availabel, but it was not palatable. Gatorade powder was added to water storage containers at two-thirds strength. During the next 36 hours of duty there were no heat casualties.
The second case report involved a Ranger Batallion of approximately 750 soldiers who were involved in a mission designed to rescue U.S. citizens in 1983. One half of these men flew from Fort Lewis, Washington (air temperature of 7°–13°C). Prior to this mission, soldiers were allowed to rest for 4 to 6 h. They remained in full combat gear for 6 h prior to their parachute jump and were not relieved until they had spent 6 h in intermittent combat at a site that was covered with dense plant growth (ambient conditions of 29°–32°C, 85% relative humidity). The load which the average soldier carried weighed 29 to 34 kg, but some men carried gear weighing more than 45 kg. Prior to this operation, Rangers drank 10 to 12 liters of water per day and a forced hydration program was followed during this mission; each man carried 4 liters of pure water. Gatorade also was utilized, by diluting it to one-quarter strength with water. This Ranger unit experienced no heat casualities during this mission despite being relatively unacclimatized.
The purposes of this paper are to comment on the first case report by K. Alitz (Appendix 1) and the second by C. Donovan (Appendix 2) presented during this conference, and to emphasize the specific need (or lack of need) for carbohydrate-electrolyte solutions, which soldiers experience during duty in hot environments. Because this paper focuses on fluids and electrolytes, it is helpful to reiterate the following aspects of their reports: (1) Gatorade was used in dilute form at two-thirds (K. Alitz, Security Operations Training Facility, Fort Bragg, North Carolina, personal communication, 1989) and one-quarter (C. Donovan, Tuttle Army Health Clinic, personal communication, 1989) strength, (2) meals were sacrificed so that the mission could be accomplished, and (3) Donovan stated that a rigorous hydration program virtually eliminated heat illness at a time when other U.S. personnel experienced significant heat casualties. In regard to the third point, the Heat Research Division of the U.S. Army Research Institute of Environmental Medicine (USARIEM), has received a recent communication describing a similar hydration program at Fort McClellan, Alabama (D. Compton, USA MEDDAC, Fort McClelland, Alabama, personal communication, 1988). This program resulted in a decrease in July-August heat casualties from 21 (1987) to 6 (1988), when troops were placed on a regimen of drinking 0.5-1 quart of water per hour.