Song Qing, Head of the PLA-Wide Expert Group on Heat Stroke Prevention and Treatment, on Correctly Addressing Heat Stroke
Song Qing, Head of the PLA-Wide Expert Group on Heat Stroke Prevention and Treatment, on Correctly Addressing Heat Stroke—— Rectify Concepts, Prevent and Treat Scientifically
■Zhang Mi, PLA Daily Reporter Sun Xingwei; Illustration by Jiang Chen
Heat stroke prevention and treatment is an important task during summer training. In recent years, the PLA-wide heat stroke prevention and treatment system has been essentially established, and prevention and treatment concepts have undergone profound changes: from "passive treatment" to "active prevention," from "summer-season control" to "year-round coverage," and from "expert-led" to "full-personnel participation." Recently, a reporter interviewed Song Qing, Head of the PLA-Wide Expert Group on Heat Stroke Prevention and Treatment, who was in the field guiding unit training, and asked her to discuss what new requirements these conceptual changes place on commanders at all levels, medical support personnel, and training participants respectively.
Reporter: Every summer, heat stroke prevention and treatment is a topic of great concern at all levels. It is understood that in recent years the PLA's concepts regarding heat stroke prevention and treatment have undergone significant changes. Could you briefly introduce these changes?
Song Qing: The concepts of heat stroke prevention and treatment have undergone the following three main shifts.
From "summer-specific prevention and control" to "year-round normalized protection." In the past, many people believed that heat stroke occurred at high frequency only during the high-temperature period of July and August, and that no precautions were necessary when temperatures were lower. However, relevant research has confirmed that the primary triggering factor for exertional heat stroke is vigorous exercise. Even in a cool environment, the human body can rapidly generate large amounts of internal heat during high-intensity activity, and once this exceeds the body's own thermoregulatory capacity, heat stroke can equally result. Improvements in physical fitness reserves and heat tolerance cannot be achieved overnight; if training and operational intensity are suddenly increased upon entering summer, the risk of contracting heat stroke will rise sharply. Therefore, heat stroke prevention work must be moved forward to the winter and spring seasons.
From "expert-led" to "full-personnel participation." In the past, some units believed that heatstroke prevention and cooling was the business of the medical department, and that training was the business of the operations and training department—two separate lines, each managing its own affairs. But heat stroke prevention and treatment is not solely the military physician's concern; it is also the commander's concern, the squad leader's concern, and the soldier's own concern.
From "emphasis on treatment" to "emphasis on prevention." Under the traditional model, what people cared about was "how to treat heat stroke once it occurs"; but the current concept is "the best treatment is to prevent heat stroke from occurring in the first place." This requires us to put our effort into the periods before, during, and after training.
Reporter: When these concepts are implemented in concrete work, what new requirements do they place on commanders at all levels?
Song Qing: The conceptual changes have made the responsibilities of commanders at all levels more clearly defined. I have summarized four new requirements for commanders.
Commanders must proactively transform into risk management officers (风险管控师). Commanders need to balance training advancement with safety assessment, comprehensively evaluating risk levels and judging whether risks are controllable. Specifically, they must understand high temperatures and assess indices, proficiently mastering various high-temperature meteorological indicators and scientifically adjusting training intensity according to different temperatures; precisely identify high-risk groups, such as new recruits, personnel with persistently below-average physical fitness, those lacking experience training in high-temperature environments, personnel who have not completed heat acclimatization (热习服) training, and those who have been away from high-temperature training environments for more than two weeks; and clearly understand safety risks—even under the same temperature conditions, the safety risks of load-bearing marches and light-equipment training differ significantly. Therefore, when organizing training, unit leaders must not simply copy established plans wholesale, but may adjust in real time based on weather conditions, personnel status, training venue, and other factors.
Commanders must serve as effective organizers of heat acclimatization (热习服) training. Many people mistakenly believe that heat acclimatization simply means exposure to sunlight; in fact, it is a rigorous, scientific, and systematic training process. First, when organizing heat acclimatization training, strict control must be maintained over the training cycle. Heat acclimatization requires sustained, repeated physiological adaptation in a hot environment; the complete cycle is typically 10 to 14 days, and arbitrary compression of heat acclimatization time is strictly prohibited. Second, training intensity must be scientifically regulated. Adherence to a gradual progression from low intensity to high intensity and from short duration to long duration is required; at the same time, real-time effectiveness assessment must be conducted, with primary attention to whether training participants exhibit subjective symptoms of discomfort, such as increased sweating and a decrease in the magnitude of heart rate increases.
Commanders must become scientific regulators of training tempo. Summer training must emphasize scientific control of time, intensity, and tempo. New recruits and personnel in initial training should avoid training during the high-temperature period of 12:00 to 15:00 as much as possible; after 45 to 50 minutes of continuous training in a high-temperature environment, a rest period must be arranged; water replenishment must be scheduled, proactive, and incremental—one must not wait until thirsty to drink.
Commanders must become the primary persons responsible for emergency response. Once warning signs of heat stroke are detected in any individual, training must be stopped immediately and the individual assisted in leaving the hot environment; simultaneously, cooling must be implemented immediately, with cooling maintained while calling for help.
Reporter: These requirements are very specific. Facing the changes in heat stroke prevention and treatment concepts, what shifts do medical support (卫勤) personnel need to make?
Song Qing: There are quite a few shifts as well. I have likewise summarized four.
From "standing by at post" to "accompanying support." Medical support personnel must leave clinical settings and go deep into the front lines of training, carrying out their work throughout the entire training process and arranging support in step with the training tempo—for example, deploying in advance by positioning water baths, ice buckets, cold water, emergency medical equipment, and other supplies at locations on the training ground where they can be readily accessed; and conducting active patrols to promptly identify and recognize warning signals during the course of training.
From "single-mode treatment" to "full-process management." In the past, medical support work focused on basic treatment operations such as injections, medication, and evacuation. Today, medical support personnel must enhance their professional capabilities across the complete work chain of "prevention—early warning—emergency response—treatment—rehabilitation" (防—预—救—治—康). During the prevention phase, they must master skills in personnel heat tolerance assessment, heat acclimatization guidance, and heat index monitoring; during the early warning phase, they must be able to rapidly identify early danger signals such as unsteady gait, a burning body, dizziness, and confusion; during the emergency response phase, they must proficiently master on-site management methods that prioritize cooling first and transport second; during the rehabilitation phase, they must be thoroughly versed in heat tolerance recovery training programs and personnel return-to-duty assessment standards.
From "working alone" to "system-wide coordination" (体系协同). Medical support personnel must learn to link up with all parties, working in coordination with commanders, squad and platoon leaders, and all training participants. On one hand, they should routinely organize specialized training for key personnel, teaching front-line squad leaders to rapidly identify early warning signs of heatstroke and screen training participants for physical discomfort; on the other hand, they should establish an efficient and smooth training communication mechanism with commanders, whereby medical support personnel may, in accordance with regulations, put forward professional recommendations to suspend training based on actual conditions such as on-site temperature and humidity and personnel physical status.
From "treating illness" to "preventing illness." Grassroots medical support personnel are not only medical workers but also builders of the safety assurance system. They must improve personnel rosters by establishing a unit-wide heat tolerance file for all personnel and precisely annotating high-risk priority groups; refine contingency plans by clarifying heat stroke response procedures and delineating the responsible parties and medical transport routes for each link including cooling, communication, and evacuation; regularly organize emergency drills so that all personnel proficiently master the key response points of the "golden thirty minutes" (黄金半小时); and conduct post-incident reviews, combing through problems and filling gaps for every heatstroke incident, and continuously optimizing support work.
Reporter: You mentioned earlier "full-personnel participation." What should training participants do to better prevent and treat heat stroke?
Song Qing: Every training participant must become the primary person responsible for their own health. I recommend that training participants achieve the following four things.
Learn to "listen to what the body is saying." A minority of comrades hold the mistaken view that toughing it out is strength and complaining of fatigue is weakness. But when it comes to heat stroke, blindly toughing it out can bring lethal danger. The body sends out warnings before serious problems occur; the key is whether one can detect them in time and respond correctly. Training participants must learn to recognize the early warning signals the body sends: feeling heat radiating from the inside out—not simply the warmth of sun exposure, but a rapid rise in core body temperature; experiencing unsteady gait and swaying as if drunk—not simple fatigue, but the central nervous system already being affected; feeling dizzy and nauseous—not insufficient rest, but heat injury continuously accumulating. I recommend that comrades immediately report when they experience the above discomforts; this is being responsible to oneself, to one's comrades, and to the collective. I will recount a real case here: a soldier had already developed unsteady gait during training, but he thought "I can tough it out, a little rest will fix it," and before long he collapsed. When sent to the hospital, his core body temperature was as high as 41°C, and only after prolonged emergency treatment did he escape danger. If at that moment he had been able to promptly report "I am not feeling well," the outcome might have been entirely different.
Actively participate in heat stroke prevention and treatment. Proactively replenish fluids by developing the habit of drinking water on a regular schedule and in measured amounts; proactively replenish salt by promptly supplementing electrolytes after heavy sweating; pay attention to rest by promptly reporting when physical condition is poor and consciously moving to a shaded area to cool down and recuperate; actively observe comrades—during training, pay more attention to those nearby, and promptly remind and assist anyone found to have an abnormal complexion or unsteady gait.
Shift from "summer surge" to "year-round readiness." Heat tolerance is formed through long-term training, not obtained through short-term sun exposure. It is recommended that everyone develop a year-round physical fitness reserve mindset, building a solid physical fitness foundation during the winter and spring seasons to provide a safety buffer for high-intensity summer training; proactively report one's own status upon returning to the unit or post—situations such as returning from leave, initial return after recovery from illness, and insufficient sleep should be promptly reported to company key personnel; and actively cooperate with heat acclimatization training.
Become a guardian of nearby comrades. In heat stroke prevention and treatment, nearby comrades are timely and critical safety sentinels. It is recommended that every training participant master three basic skills: know how to identify—accurately judge the four categories of danger signals "burning, swaying, dizzy, confused" (烫、晃、晕、乱); know how to respond—at the first moment help remove equipment and gear and immerse in cold water to cool down, rather than blindly supporting the person and sending them to the hospital; know how to report—immediately report upon discovering anything abnormal.
Heat stroke prevention and treatment is not one person's concern; full-personnel participation and collective prevention are required. Commanders, medical support personnel, and training participants must work in coordination, each giving full play to their respective roles, and heat stroke can be effectively prevented. At present, summer training has been fully launched. It is recommended that everyone deeply embed the new prevention and treatment concepts in their minds and implement them in training, so as to build a solid health defense line.
The "8-4-6 Golden Rule" (8-4-6黄金法则) for Heat Stroke Prevention and Treatment