Fort Benning, Ga. is now officially the heart of the Pentagon's efforts to fight heat-related injuries, with the creation of a new, one-of-a-kind "heat center."
Such injuries already were getting increased attention from the military. And with climate change driving ever-hotter weather, it's getting more important to learn how to better fight them.
Benning is the best place for the center simply because it gets so many heat related injuries, said Dr. Meghan Galer, an emergency room doctor at Martin Army Community Hospital on base, who helped come up with the idea.
"No other facility sees the volume and severity of heat related illnesses that we do here to be in a position to do clinically meaningful research," she said. "Any hospital that does anything well - your cancer centers or stroke centers, your pediatric centers - they do a lot of it."
Benning has the most heat related injuries, like heat exhaustion and heat stroke, of any base in the military. It reported more than 1,500 in the four years ending in 2018.
The next highest was Fort Bragg, N.C. with 1,108 and the Marine Corps' Camp Lejeune, N.C., which had 738.
Heat-related injuries have long been a serious focus for the military, and the number reported has been climbing sharply in recent years.
According to one set of Pentagon data, reported cases of heat exhaustion jumped nearly 50 percent between 2014 and 2018. And much more serious heat strokes - when a patient's core temperature can soar so far out of control that it permanently fly damages organs and even kill them - rose nearly 68 percent.
The reasons there are so many cases at Benning and other Southern bases - rather than, say, Fort Irwin in the Mojave Desert next door to Death Valley - are complicated.
Benning is a big base where a lot of young soldiers do basic training; those first few weeks of training are when heat injuries are more common. It's also in a part of the country where it's not only hot for much of the year, but also humid.
"The only week of the year where we won't have any casualties here is between Christmas and New Year's because everybody's taking time off," said Maj. David DeGroot, the director of Benning's new heat center. "Every other week of the year, it's plausible."
Benning also has been especially aggressive about identifying heat cases.
Dr. John Ambrose, an epidemiologist with the Defense Health Agency who studies heat related illness, says that's likely one reason the reported number of cases is so high.
"Fort Benning does a tremendous job of searching out those heat injuries and trying to find them," he said.
"So there may be appear to be more heat injuries at places like Fort Benning, but it's because they're actively finding them and have a very unique system of finding them as opposed to some of the other installations."
Climate change and the record hot summers also may be driving some of the increase in heat injuries across the military.
But Ambrose said the most serious kinds of cases haven't become significantly more common, while milder cases are up. That infers the increase may be driven not by an actual uptick in cases, but mainly by the military's increased focus on the problem.
"Because of that, they're getting to the soldiers quicker and treating them quicker," he said.
Galer said she and another doctor came up with the idea for the center not long after she returned from a deployment to the Middle East.
A young soldier had died of a heat injury on the base just before she left, and she thought about the case a lot, she said.
When she returned, it was clear that the medical staff on the base already was doing cutting edge work to fight such injuries.
One doctor, for example, was getting good results by piping the blood of patients with severe heat stroke through a cooling machine. And all the ambulances on base were equipped to diagnose a potentially-fatal condition called hyponatremia, when a soldier takes in too much water without enough salt.
Those patients could be killed by the aggressive hydration methods used to treat other heat injuries.
In fact, most heat related injuries on base don't involve dehydration, Galer said.
"For so long, there's been this emphasis on hydration, hydration, hydration, drink water, drink water, drink water in the Army," she said. "And the fact of the matter is you cannot drink your way out of a heat stroke, but you can drink yourself to death from hyponatremia. So that message needs to shift a little."
Between the quality of the work that the medical staff was doing and the sheer number of cases at Benning, creating a center seemed an almost obvious idea, she said.
There may not be a way to greatly reduce the number of mild heat illness cases. Troops have to train in the conditions they may fight in.
But serious injuries and deaths are a legitimate target.
Galer said she hopes the center helps end what she calls "the tragedy loop." That's when there's a death, triggering a surge in interest in treating and preventing heat related injuries, then a period of improved performance, but one that eventually fades until another death occurs.
Typically, she said, Benning has suffered a heat-related death about once every three years. It hasn't had one now in about that long, and the center could help make sure there aren't any more.
"No more deaths," she said, listing that as a key goal.
"And address the misconceptions," DeGroot added. "There's so much mixed-messaging out there."
The center will do research studies itself, they said, and also serve as a resource for outside scientists who need a source of solid data on heat related injuries.
They say the center's work should benefit not just troops, but anyone who might fall victim to heat, from construction workers to high school football players.
