Fort Thepsatreesrisoonthorn Hospital

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
The influence of global warming has caused an increase in the risk of health hazards such as heatstroke. There are two different types of heatstroke which affect different types of patients: exertions heatstroke - heatstroke from heavy exercise, this is most seen in older children, teenagers, athletes, military recruits who are training hard in the hot weather and classic heatstroke (nonexertional) - heatstroke which isn’t caused by exercise. This type of heatstroke occurs most often in very old patients with chronic illnesses such as diabetes, hypertension, older adults, obese patients and patients younger than 5 years old. Both forms of heatstroke may be viewed as minor illnesses, such as heat prickly (rash from the heat), heat edema (swelling in the sun), heat syncope, heat cramp and heat tetany. Heatstroke is a medical emergency which requires urgent treatment, it is predicted that incidence of Heat stroke cases are 17-70% fatalities and lifelong disability. The immediately treatment provided 10% reduce chances of death dramatically. The extremely high temperature in Thailand is the main reason that causes 2 fatalities cases from heatstroke in armed forces annually from constant training. The illnesses continued and increased the number of the heatstroke victims which effected to their families who lived from the heatstroke patients' income. Moreover, the military chiefs and the trainers must be punished for the loss in the army and the human resources in the country. If we have the solutions and implement the strategies, we will be able to solve these problems that may increase the security and safety for the troops. Moreover, it is the solution to increasing the confident and emotional support for the chiefs and the trainers to ensure that trained soldiers are fit and strong because they know that we are able to avoid and prevent injuries from heatstroke. The Fort Thepsatreesrisoonthorn Hospital provided surveillance proactively with stakeholders to continue following individual factors and environmental factors. We provide the immediately assistance with the simple assembly equipments which can prevent heatstroke.

B. Strategic Approach

 2. What was the solution?
The Solution is that we provided surveillance proactively with stakeholders, planning, tracking and maintaining the procedures on both individual and environmental factors including daily checking to ensure that the trainers attend to the training for emergency situations and heatstroke kit using is practiced. We provide immediate assistance with simple assembly equipment which can prevent heatstroke.

 3. How did the initiative solve the problem and improve people’s lives?
The objective: to reduce the chances of severe illness and fatalities from heatstroke in the armed forces including as follow: 1. Create collaborative network integration of operations, prevention and proactive surveillance including hospitals, military leaders, practitioners. 2. Develop prevention Surveillance and proactive risk assessment and modify the training plan to suit the daily situation. 3. Raising awareness, improving skills, self-care and observation for the new soldiers. 4. Develop, maintain and practice with emergency heatstroke kits, observation practice for symptoms of heatstroke and First Aid practice for all staff for heatstroke prevention. 5. Develop plans, procedures and practice with effective communication for emergency situations including protocols for transferring patients.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
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.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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.
 6. How was the strategy implemented and what resources were mobilized?
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.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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.

 8. What were the most successful outputs and why was the initiative effective?
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.

 9. What were the main obstacles encountered and how were they overcome?
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.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
According to the project range from year 2013-2014, we had 6-8 cases of the mild injuries from. In 2015, we had 91 cases of heat edema and heat prickly because of we identified the symptom quicker including used the Royal Thai Army Medical Department’s daily report system and heatstroke kits. In 2016, we had one case of an army officer who had an injury from heat. We provide immediate treatment to the patient by using a heatstroke kit. We were able to save the patient’s life by hazard reduction, the cost of medical treatment is reduced by about one million baht per patient, the chiefs and the trainers don’t have to get punished, the army don’t lose the human resources, the new soldiers develop a sense of security, the trainers develop a sense of confidence for training healthy new soldiers and finally they will be able to use the knowledge to identify and provide first aid to their families and the others who are injured from heat.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Our project impacted the soldiers and their families by providing a sense of security to the government services of care and preparation for constant training, reflecting into practice to prevent loss of life and responsibility for everybody’s lives. We provided a network for injuries from heat prevention, surveillance, and transfer the injury from heat patients. We ensured the soldiers be able to identify the symptoms and provide first aid treatment to themselves and their peers as quickly as possible. The joint team of the supervisors, trainers, the armed force, the Fort Thepsatreesrisoonthorn Hospital and the Health Department Hospital developed the same standard of the injury from heat prevention and protection systems. Therefore, we will be able to help the patients as soon as possible.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
According to the Armed Forces policies which separate the soldiers who are not used to the training environment, overweight or drug addicted. The Armed Forces provided special group training by provided suitable and appropriate exercise and outdoor activities. We modified the plans for the other groups such as the military students by collaborative working with the trainers adjusted to the training schedules from morning classroom learning to learning in the afternoon and training in the morning instead of afternoon to avoid the midday heat. Moreover, they provided female officers to check up and help the female students to avoid sexual harassment.

Contact Information

Institution Name:   Fort Thepsatreesrisoonthorn Hospital
Institution Type:   Academia  
Contact Person:   suppaluk wongwisansri
Title:   Radiographer  
Telephone/ Fax:   +(66)806470790/ +(66)75495156
Institution's / Project's Website:  
Address:   181 Kapang
Postal Code:   80310
City:   Thungsong
State/Province:   Nakhonsrithammarat

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