This article reviews current prehospital treatment for heat casualties and introduces a retrospective study on the addition of cold (4 °C) intravenous (IV) saline to prehospital treatment and its effect on morbidity. The study is a retrospective cohort reviewing electronic medical records of 290 heat casualties admitted to Martin Army Community Hospital, Ft. Benning, GA, comparing two treatment groups; U.S. Army Training and Doctrine Command (ice-sheeting and ambient temperature IV saline) versus Benning (ice-sheeting and cold IV saline). U.S. Army Training and Doctrine Command group significantly differed from Benning group on a number of measures, the median length of stay in the hospital was 3 and 2 d, respectively (P < 0.0001); pCr were 1.8 to 1.4 mg·dL, respectively (difference of 0.4 mg·dL pCr, P < 0.0001). However, creatine phosphokinase, aspartate aminotransferase, and alanine aminotransferase were not significantly different across groups. Findings demonstrate that adding cold IV saline to ice-sheeting as a protocol reduces the length of hospitalization of heat casualties and lowers their peak creatinine values.

Our data suggest that caution is warranted when examining epidemiological surveillance data on EHI severity, as there was disagreement between the laboratory data and the selected ICD-9 code in ∼1/3 of all cases in this cohort. Of note is the lack of an ICD-9 or -10 code for heat injury; we recommend coding for heat exhaustion as the primary diagnosis and additional codes to capture the accompanying muscle, tissue, and/or organ damage.

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Apremilast is a small-molecule biologic approved by the US Food and Drug Administration (FDA) for use in plaque psoriasis, psoriatic arthritis, and Behçet disease. Although apremilast is seemingly a less favorable choice for treating psoriasis in the era of injectable biologics, the drug is an important option for patients in the military. In this article, we review on-label indications and off-label uses for apremilast; highlight the importance of apremilast for managing psoriasis in the military population; and propose other patient populations in whom the use of apremilast is favorable. We also present a case report that highlights and embodies the benefit of apremilast for military service members.

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