The hot weather has arrived, and it is time to start worrying about heatstroke.

Heat illness is most common in the early summer, when people not acclimatized to the heat overdo it.
So during one May weekend in the mountains of Massachusetts, when the temperature went to 95, I treated a lot of heat exhaustion, and two full blown heat stroke patients: One, a 75 year old lady who went shopping, and the other a young jogger.

Both came in confused and hallucinating, with flushed (red) dry skin and were obviously sick. We started IV fluid (it took six of us to hold the jogger down) and piled on ice/cool packs and fans…

Heat stroke can
be fatal, and alas every year we hear about one or two athletes who die during August football training. We also see it when people are on certain medicines that keep you from sweating. The reason it is fatal is that you stop sweating, and the body’s own heat regulation system goes off…and your body temperature goes sky high (over 106).

The best emergency treatment? Take off their clothes, splash on cool water and place fans on the patient: Moving air will evaporate the water to cool the patient without the shivering caused by ice. Rubbing alcohol on the skin to evaporate will work too, but is risky (alcohol can catch fire, and is expensive).

The most common problem is, of course, heat exhaustion, where you get tired, dehydrated and can faint. You may have stomach or leg cramps, and you might throw up. Lots of people fainting at funerals or in church are heat exhaustion. Most people reading this have probably had mild heat exhaustion, where they sat down and drank a cool drink to recover. Usually it’s not fatal, but it can be so bad that it takes a few days to recover.

And the final “heat” problem is related: Dehydration. This is especially insidious in dry climates. When I was a doc with the National Guard, and we had war games in the Idaho desert, we had to go out and keep nagging the men to drink a canteen of water every hour. The locals usually knew this, but many of the units were from California or the mountainous areas, and were unaware of the danger.

Most athletes know to drink lots of fluids, and sports drink companies make a bundle off of their sugar water with a little salt/electrolytes. But those at risk also include the elderly, who often live isolated in tiny apartments with small fans, and can’t escape to the movies or malls like the young during heat waves. That is why the majority of heat related deaths are in the elderly, as the French found out in 2003, when an estimated 15 000 died in a heat wave, or Chicago found out in 1995 when 739 died.

One of the rarely cited stories of heat related illness in history is how God smote the Egyptians to save Israel in the Six Day War, 40 years ago this week.

Right now, if you read the stories about Israel’s winning that war, you would never realize that during the six day war Israel was attacked by six of it’s neighbors at the same time. Egypt attacked Israel with 100 000 troops and 1000 tanks across the Sinai peninsula, and the official story is that Israel won the war by first hitting the Egyptian airforce and then by one of the largest tank battles in history, destroying or capturing the Egyptian advance, pushing it back to the Suez canal.

But back in my National Guard days, some of the older officers when briefing the weekend warriors about the danger of dehydration told us a tale that many of the Egyptian tanks were put out of commission because the crews suffered from heat stroke, heat exhaustion and dehydration.

Back then, I figured this was merely an “urban legend” to scare the young men into not being macho, until I ran across this paragraph in Dunnigan’s book Dirty Little Secrets: The problem was that the Arabs had bought Russian tanks, which are strong and reliable, but since they are made for arctic climates, lack air conditioning. And so the Egyptians discovered what Americans in North Africa learnt twenty five years earlier: it gets very, very hot inside.

“During the severeal Arab Israeli wars, many Arab tanks were put out of action not by mechanical failure or battle damage, but merely by heat exhaustion of the crew. So common was the problem that some Arab leaders were convinced Israel had a secret weapon that inflicted physical weakness on enemy troops.”

So the good news is that God protected Israel by smiting the Egyptians with heat stroke…or more probably by giving them clueless generals who didn’t bother to worry about their troops in the Sinai heat.

The bad news? The US has been busy selling (or giving) Egypt the new airconditioned tanks.


Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she posts medical essays at HeyDoc Xanga blog 

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