 Not everyone can be a Marine. The training and discipline that comes with being among the top fighting forces in the military can be grueling, but it's a necessary challenge that ensures Marines are mission-ready no matter where or when they're deployed. The risk of exertional heat injuries, or EHIs, is high under such harsh conditions, but a few precautions can help lower that risk, such as preconditioning, good hydration, getting enough sleep, and good nutrition habits. But sometimes, even with good preparation, heat injuries can still occur, especially in the hot, humid summers of coastal North Carolina. There are four levels of heat injuries. The least severe is heat cramps. These are painful muscle spasms in the legs, arms, and torso. They are best treated with salty snacks and fluid replacement. The second level is heat syncope. This occurs when a runner stops running and does not cool down by walking or jogging. Blood pools in the legs instead of being pumped to the brain, resulting in a collapse or fainting. The casualties should improve quickly with shade, water, and by lying flat with his legs raised. The third level of heat injury is heat exhaustion. This can occur during exercise or other physical exertion, and can result in fatigue, nausea, rapid breathing, accelerated heart rate, and dizziness. Treat heat exhaustion by assisting the victim to a shaded area, loosening or minimizing clothing, and elevating the legs above the heart. The fourth and most serious level of heat injury is heat stroke, which can be life-threatening. The victim might collapse or exhibit an unusual change in their mental status, including confusion, agitation, or seizures. Hey, guys, keep it tight. We've got about 100 meters. Heat stroke casualties sweat in humid environments, but might not sweat in desert environments. Heat stroke is a medical emergency, and treatment should begin immediately. Move the victim to a shaded area or into the safety vehicle. Remove excess gear and clothing. And douse water over the victim. It's critical to get a body temperature reading as quickly as possible with a rectal thermometer. Readings over 103 degrees must be transported to a heat deck, clinic, or medical center emergency department immediately. Begin the transport process by first wrapping the casualty in sheets and towels soaked in ice water. This is known as a burrito wrap. Place handfuls of ice on top of the victim's chest. Then wrap the sheets securely. Notify the heat deck facility, clinic, or ED by radio that the casualty is inbound and provide the patient's vitals. All windows in the vehicle should be opened for air circulation. Throughout transport, continue to add ice every 60 seconds. And rewrap the victim in the wet sheets and towels. The corpsmen should also continue to monitor the marine's temperature and obtain IV access, but they should not begin IV hydration unless the casualty appears to be in shock or presents signs of dehydration. For example, this patient is arriving in a dehydrated state. At the heat deck facility, the patient is transferred to the clinic staff. The heat deck personnel should position the stretcher over a large water container or pool, then place ice packs in the groin area, under the arms, and behind the neck. Cool water should be continuously poured over the casualty from the water in the pool or from another source. This method will cool patients at a rate as high as 0.4 degrees Fahrenheit per minute, meaning it could take only 15 minutes to lower a patient's temperature from 108 to 102 degrees. Continue monitoring the rectal temperature and stop the cooling process when the temperature hits 102 degrees. Once the casualty's temperature begins to drop, move the patient to a cool room inside the clinic. Be sure the air conditioning is set to its lowest setting and all available fans are turned on. If necessary, start a cold IV fluid chilled to approximately 40 degrees. Also continue to monitor blood pressure, cardiac rate, glucose reading, and respiratory rate. If the glucose reading is less than 40, additional glucose can be given orally or through the IV. Patients with a respiratory rate greater than 30 should be placed on oxygen via non-rebreather at 8 to 10 liters per minute. Continue to check the patient's mental status to help determine further treatment. If the patient shows signs of altered mental status and meets criteria per the exertional heat injury instruction, then transport to the emergency department should be initiated. Be sure all treatment records accompany the patient to the ED. And the medical provider should contact the receiving provider to discuss the patient's condition. Lab results and the ED medical provider will determine the best post-stabilization and follow-up care. When it comes to exertional heat injuries, a quick and decisive medical response is critical. Proper treatment in those crucial first minutes can mean the difference between life and death.