Page 32 - JSOM Summer 2024

TABLE 1 Patient Summary Details
Ambient Initial Core body Evidence
Training temperature core body temperature at Cooling of excess
Patient Demographics environment & RH, °F/% WGBT, °F temperature, °F ED arrival, °F method Disposition motivation
1 24-y-old Ranger 71.4/92 70.4 107.5 98.1 Cold water Discharged Direct
female O2 School immersion same day quote
2 21-y-old male Initial Entry 63/80 67.8 100.4* 98.5 Ice sheets; Discharged Inferred,
E1 Training 15 min next day confirmed
with direct
questioning
3 33-y-old male Ranger 62/74 58.2 105.4 98.1 Cold water Discharged Direct
E7 School immersion; next day quote
10 min
4 25-y-old male Ranger 67/97 66.8 108.2 106.8 Ice sheets Discharged Direct
E4 Assessment then active 4 days later quote
& Selection water
lavage
5 29-y-old Ranger 75/95 73.5 106.8 102.6 Ice sheets Discharged Inferred,
female O3 Assessment next day confirmed
& Selection with direct
questioning
*First core temperature was obtained after 15-min of ice sheet cooling.
ED = emergency department; RH = relative humidity; WGBT = wet-bulb globe temperature index.

Case 3 as one of the factors in the assessment process, adding to his
In February 2022, a 33-year-old male SFC Ranger Candidate motivation to excel.
with no past heat injuries, who had arrived at Fort Moore less
than 1 week before from a cold weather location, presented Case 5
to the ED after becoming incapacitated during a 12-mile ruck In July 2022, a 29-year-old female CPT with recent antibiotic
march. Ambient conditions were temperature 62°F, 74% RH, treatment, who had arrived at Fort Moore less than one week
and a WBGT of 58.2°F. He reported feeling weak and un- earlier, presented to the ED after developing altered mental
coordinated during the event and ultimately lost conscious- status during a 5-mile run in Ranger Assessment and Selection.
ness. Ranger School medics obtained a rectal temperature of Ambient temperature was 75°F, 95% RH, and a WBGT of
105.4°F and cooled the patient with cold water immersion. 73.5°F. During the event, she reported feeling weakness, dizzi-
Core temperature taken by EMS 10-minutes post immersion ness, and slight shortness of breath. She was eventually unable
was noted as 98.1°F. The patient also complained of coughing to run in a straight line, and ultimately unable to stand. The
during the event and was found on ED-admission radiographs patient was cooled per protocol with ice sheets. Initial core
to have bilateral opacities suggestive of interstitial pneumonia. temperature taken by EMS was noted as 106.8°F and then
During an interview with the heat clinic provider, he noted that 102.6°F. The patient had altered mentation, which improved
he wasn’t feeling well around mile 9 and, had it been a routine during transport to the hospital. The patient desired a specific
training event, he would have slowed down or even stopped assignment within 75th Ranger Regiment. Successful comple-
altogether. However, as the foot march is a pass/fail event at tion of Ranger Assessment and Selection is a pre-requisite for
Ranger School, with no opportunity to re-test if the standard all personnel who serve in the Regiment and the patient ex-
is not met, he continued to press on, as he was strongly moti- pressed strong motivation to succeed.
vated to earn the coveted Ranger tab.
Discussion
Case 4
In May 2022, a 25-year-old male SPC with no significant re- The discussion of motivation as a contributing factor in cases
ported medical history or past heat injuries, who had arrived of EHS brings to light a compelling aspect of human behavior
at Fort Moore one week earlier, presented to the ED after be- that intersects with physiological limitations. One of the defin-
coming incapacitated during a 5-mile run while training for ing features of motivation in the context of EHS is its central
pre-Ranger Assessment and Selection. Ambient conditions role in pushing individuals to exceed their physiological limits.
were temperature 67°F, 97% RH, and a WBGT of 66.8°F. Where a given individual might be very fit and very much “in
During the event, he reported running at his normal pace of tune” with his/ her physiological limits, the literature to date as
7-min/mile, eventually feeling dizzy and uncoordinated, and well as our present case series support the idea that the desire
ultimately losing consciousness. The patient was initially to achieve specific tasks and goals can cause that person to
cooled with ice sheets followed by active water lavage. Ini- ignore those signals.
tial core temperature taken by EMS was noted as 108.2°F. Per
EMS, the patient had altered mentation and remained uncon- Additionally, there are instances where individuals knowingly
scious during transport to the hospital. Subsequent interview disregard other risk factors, such as in the instance of the Sol-
revealed that he had enlisted with the option to attend Special dier (Case 3, above) who was aware of feeling ill at mile 9 of
Forces Assessment and Selection but had failed to be selected a 12-mile ruck march and disclosed later on that he would
for further Special Forces Training. To participate in the pre- have slowed down or stopped had he not been trying to earn a
Ranger Assessment and Selection represented a second chance Ranger tab. Instances like these place personnel at heightened
for him “to be more than just an infantryman,” in his words. risk of heat illness because of their determination to achieve
Moreover, his finishing time on the run event would be used specific objectives. These multifaceted scenarios suggest that

30 | JSOM Volume 24, Edition 2 / Summer 2024