| 4. In which ways is the initiative creative and innovative?
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At Fort Thepsatreesrisoonthorn Hospital, we concluded that the most important factor to ensure the safety for heatstroke patients is the medical emergency interventions. As mentioned previously, we invented the simple assembly tools to help and immediately reduce the severity of injuries from heatstroke. It is called "heatstroke kits". The box of heatstroke kits contains easy to use equipment which is easy to reach and is displayed at the emergency room. The goal is to reduce the body temperature as quickly as possible, including saving the time of searching and using inappropriate equipment.
The Heatstroke Kits contains a hair dryer, towels, bed sheets, basin, water bottle, fan, Vaseline and thermometers (under armpit thermometer and rectal thermometer). The results prove that the Heatstroke Kits can actually prevent heatstroke. We provided the Heatstroke Kits including the usage manual to the New Soldier Training Section to use and implement the Kits to improve by the guidelines of the Army Medical Department by surveillance proactive with the individual factor (fever, excessive BMI) and the environmental factor (Temperature and humidity) for the armed forces. We ensured supervising the practice including before and during training at the Training Section. We ensure to complete the daily check list for the soldiers to be monitored and to recognize the symptoms by themselves. We coordinated approaching to delivery heatstroke kits to treatment team of the public hospital which is affiliated with the Ministry of Health. We provided advisors for the emergency room nurses to ensure the same standards as us. Moreover, we also provided the advice for the training section for the instruction to reduce the body temperature during their afternoon training by providing an innovative water tunnel.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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According to the cause of death from heatstroke in the military training every year, the Department of Medicine, Fort Thepsatreesrisoonthorn Hospital recognized the major improvement initiatives. The mission of the hospital is to be responsible for health care for the population in the camp which is about 15,000 people, particularly in targeting the armed forces which trains 4,000 new soldiers annually, covering the location Nakhon Si Thammarat, Trang and Krabi by improving the integration of the protection and surveillance proactively with 10 military unit leaders including 300 trainers. We assessed, prepared and monitored 10 units for the training and accommodation environment of the troops.
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| 6. How was the strategy implemented and what resources were mobilized?
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In 2013-2014 the Royal Thai Army Medical Department and the Army Hospital reviewed the implementation of the protection plan and surveillance of heatstroke in the military relay every year. We improved the prevention and the proactive surveillance by controlling factors including fever, BMI and environmental factors which are the temperature and the humidity. We adjusted the training plan to suit the situation on a daily basis, but we found 8 cases had heat cramp and 6 cases had heat tetany, which was a small number but it may progressed to heatstroke without proper management. In 2015, Fort Thepsatreesrisoonthorn Hospital decided to create a partnership network with the military leaders and the trainers to work together for the integration prevention surveillance and proactive by creating awareness among the trainers. We provided the training session about the disease by sending the teams to observe the armed forces. We recognized that the armed forces need to improve the symptom recognition and practicum skills. The Department of Preventive Medicine provides education about the symptoms of heatstroke and the action plan and procedures to help them. Later, The Army Medical Department developed the daily heatstroke injuries reporting systems via The Royal Thai Army Heatstroke (RTA heatstroke) program for new soldiers to record the details of the surveillance, personal factors and environment factors. The Fort Thepsatreesrisoonthorn Hospital involved checking and providing treatment for heatstroke injuries. At The Fort Thepsatreesrisoonthorn Hospital, we concluded that heatstroke is a medical emergency requiring immediate treatment. We developed the Heatstroke Kits including the usage manual and placed at the training unit, the emergency room and the local hospital of Health Department. We ensure the accuracy and standard of the tool kits. We ensured that the Heatstroke Kits will be able to use immediately when the injury from heat appeared and could reduce the severity of the symptoms. We provided the practicum for the action plan and procedures including referring the patients to the specialist as quickly as possible.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The troop leaders, the trainer teams involved in tracking the individual factors to measure the body temperature every night before going to bed. In case of high temperature, the training is avoided and sent the patient to the hospital. Assess the dehydration, daily color of urine check and weekly weight check including highlight the right sleeve to provide the trainers notice the change. Provide observing environment factors including temperature and humidity at 8.00am, 10.00am, 1.00pm, 3.00pm and 5.00pm or before evening exercise. Ensure to maintain ventilated sleeping room and rest for eight hours per day. Provide the clean and plenty of drinking water (measure by the colour of urine) by keep the water bottle during training. Provide hygienic and nutritious food for the new soldiers to support water and mineral which lose during training. Provide the towels and the buckets for the new soldiers to use in case of injuries from heat. Provide the collaboratively working with the hospital to practice the action and procedures plan before beginning training session and retraining weekly. Attend the education session from the hospital, the Army Region 4th and the Royal Thai Army Medical Department. And the last, complete incident daily report to the hospital.
-The Armed Forces Responsibility
Self-care and self-observation including the colleagues for the symptom of heatstroke are regularly exercising, drinking plenty of water, eating hygienic and nutritious food, resting for at least eight hours per day and reporting immediately to the trainers in case of feeling unwell.
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| 8. What were the most successful outputs and why was the initiative effective?
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With developing a collaborative network integration operation, preventive and proactive surveillance, 16 agencies joined the network including the Fort Thepsatreesrisoonthorn Hospital, three Ministry of Health hospitals, 10 new soldier training units, the Fourth Army Area Medical Department Head office and Royal Thai Army Medical Department.
With the development of the protection systems and proactive, we assessed the risk and modified the training plan to suit the circumstances of daily training with the trainer teams who provided knowledge and skills to assess the situation to save the lives of 200 officers.
According to the awareness, practice skills, self-care and observation, we have at least 4,000 officers per year that completed the education and the assessment of the training sessions for the heatstroke injuries.
The development of heatstroke kits and emergency preparation at the risk areas, we provided 14 sets per area such as one set for the Emergency Room at Fort Thepsatreesrisoonthorn Hospital, three sets for the Emergency Room at the local Health Department Hospital and 10 sets for the new soldier training unit.
According to the action plan development and the practicum for the communication and transfer the patients to the specialist, we develop the implementation system report and adjust the training plan according to the situation on daily basis. We developed a patient transfer plan in the emergency situation. The Fort Thepsatreesrisoonthorn Hospital joined the soldier training unit to practice 16 return exercises per year. We practiced the action plan and transferable the patients in 4 sessions per year with the local Health Department Hospital. As above mentioned, we promoted the good health of the population- based approach with sustainable development as prescribed by the United Nations.
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| 9. What were the main obstacles encountered and how were they overcome?
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According to the military unit’s daily injuries from heat report, we recognized that the level of the injuries were ‘heat exhaustion’. A Preventive Medicine team immediately checked and found that the daily report was completed by the military unit trainer who has never attended the practical session before, which caused him to misidentify the symptom which was heat edema instead of heat exhaustion. We decided to solve the solution by provided the training sessions for all of the soldiers’ trainers before military training began, also we created a LINE group for exchanging and updating the current information for all 10 training units.
The daily report of the risk areas shown that some of the military training units haven’t submitted the report because the military training took too long to finish and they was unable to monitor the body temperature and daily urine color checking. We solved this problem by provided thermometers for all the new soldiers including advice that they should monitor together at the same time. We isolated the soldiers whose body temperature had reached 37.2 Celsius degrees. We ensured that the soldiers had the urine color self-test instead of testing by their trainers.
According to the information that we have got from the LINE message, we recognized that the trainers would like all of the new soldiers who had high temperature admitted in the hospital. We decided to review the hospital admission policies as the case of the body’s temperature must higher than 38.0 Celsius degrees and occur only during the training.
We established the injuries from heat situation monitoring centre at the Fort Thepsatreesrisoonthorn Hospital to monitor the new soldiers at one month before their first military training. We established a working network by preparing the available medical emergency staff, actions and procedures practicum including provided knowledge for the armed forces and ensuring that they will be able to take care of themselves and their peers. The new soldier training units have the responsibility for following the individual factors to improve the appropriate action plans. The Royal Thai Army Medical Department updated the daily reports via RTA heatstroke program which The Fort Thepsatreesrisoonthorn Hospital used to communicate with the new soldier training units then return the report details back to the Royal Thai Army Medical Department. The new soldiers training units, the Health Department Hospital and us worked together to improve and maintain the heatstroke kits at the hospital to ensure the same standard equipment and the patient transfer time reduction.
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