Pioneering technology, training and treatment is helping to eliminate the risk of potentially fatal heat illness as recruits strive to become Royal Marines Commandos.
State-of-the-art body monitors recording trainee commandos’ physiological data, trained instructors studying that information, and medical teams on hand to treat trainees almost immediately could all-but eliminate the most serious cases of exertional heat illness in those striving to earn the legendary green beret.
Introduced in the spring of this year it already saved the life of one individual and prevented a couple of very serious casualties at Commando Training Centre Royal Marines at Lympstone, near Exeter.
It follows more than three years of work and research led by the Royal Navy’s scientific experts from the Institute of Naval Medicine (INM) in Gosport and the US Army Research Institute of Environmental Medicine, plus the Royal Marines team at Lympstone.
The result is a monitor – Open Body Area Network (OBAN) which records key physiological features as a trainee tackles arduous activities such as the nine-mile speed march or the gruelling ’30 miler’ which epitomises commando training.
Beyond providing the medical officer and instructors with data such as heart rate, the OBAN also records skin temperature and – thanks to a unique algorithm devised by the INM and US military – predicts the estimated core temperature and Heat Strain Index.
Individuals undertaking activity whose core temperature rises above of 40°C may not necessarily be suffering from exertional heat illness – everybody is different, and some trainees may be attuned to such circumstances; this is where the OBAN’s smart algorithm provides invaluable information to allow the medical team to intervene only when necessary.
Other recruits can quickly shift from mild symptoms – dizziness, muscle cramps and exhaustion, to heat stroke causing collapse and loss of consciousness, requiring immediate intervention within a few minutes.
Early recognition of exertional heat illness is key to allowing effective cooling as soon as possible. Untreated, heat stroke can lead to multiple organ failure, permanent disability or in the worst cases loss of life.
The team at Lympstone have two ambulances and a rapid response 4×4 equipped with water, ice and monitoring equipment on standby with medics across Dartmoor during major exercises.
Heat stroke sufferers are rapidly submerged in pods which are filled with ice-cold water, to cool them as quickly as possible while their condition and temperature is constantly monitored, and they’re then transported to hospital or the medical centre at the marines’ base for further treatment and observation.
The goal – beyond initially saving lives – is to return the trainees to training when they’ve fully recovered so they can continue their dream of becoming Royal Marines Commandos.
“Royal Marines’ training is arduous. It pushes people to their physiological limits, but no-one should die in training from heat illness. We do not want to lose anyone and therefore process and education is paramount,” stresses Major Erik Nielsen RM.
“We know a recruit’s physical condition, their training progression, their nutrition and hydration status. Thanks to the data and that knowledge, we can better prevent, intervene and manage the risk of exertional heat illness.”
The team at Lympstone are focused on exertional heat illness – caused by the body overheating through strenuous activity, carrying heavy loads and wearing equipment.
During the spring and summer months they mitigate the impact of the higher ambient temperature to cool trainees down – such as starting at sunrise or running them through Dartmoor’s many streams.
The OBAN and the data it feeds back is hailed as a ‘game changer’ by staff at Lympstone.
More than 200 recruits have benefitted from the system to date. The medical team is certain the life of one trainee has been saved, and a couple more were treated in good time without serious impact on their path to earning the green beret.
“The biggest win for us is not just the wearable technology, though it is exciting and cutting edge,” explained Dr Ross Hemingway.
“It’s also the training and education around it. It’s about having a wider understanding and knowledge of exertional heat illness across the training centre and wider defence.
“The medical and training teams at CTCRM have a much greater understanding of the risks, signs and symptoms and management of exertional heat illness. We are much better educated, prepared and trained to deal with heat illnesses than we were five to six years ago.”
When heat stroke occurs the goal is to reduce the core body temperature to below 39.5°C within 30 minutes to limit damage to the body’s cells.
“Rapid and effective cooling of heat stroke casualties in ice cold water reduces the risk of long-term morbidity and mortality. With the introduction of this capability we have definitely saved one life and prevented long term complications in several others,” said Dr Hemingway.