From weightlifter to bedridden: Marine’s tale reflects military’s growing heatstroke problem
Bryant Scott was a big, fit Marine: a machine-gunner, marathon runner, weightlifter, and perfect-PT-test scorer. He planned to become an officer and to make the Corps his career.
But during a hot July day in 2016 on a Camp Pendleton, Calif., land navigation course, the 28-year-old collapsed. Another Marine found him unconscious in a dry riverbed near the last checkpoint. He dragged Scott under a bridge, opened his shirt, dumped his own canteen water over him and called for help. By the time got Scott got to the hospital, his core temperature was 109 degrees Fahrenheit.
He was in a coma for two weeks. His liver had to be replaced with a donor’s. He lost 65 pounds of muscle and didn’t have the strength to lift his arms.
“My recovery was a lonely road,” Scott said. “My mental recovery took almost twice as long. I’d had a pretty bright future.”
Scott suffered severe exertional heatstroke, defined by a core body temperature of 104 degrees or higher, when heat, humidity and exertion overwhelm and crash the body’s thermoregulation system.
According to military records, Scott was one of 115 servicemembers hospitalized in 2016 for heatstroke, which is a life-threatening emergency. Two years later, that number was 166 troops.
Incidents of heatstroke and less serious heat exhaustion have increased steadily among servicemembers in recent years, though some experts say the numbers still might be grossly underreported.
Each year, heatstroke is responsible for “two to three fatalities and hundreds of serious illnesses,” said Maj. Gen. Paul Benenati, Army Training and Doctrine Command’s deputy chief of staff. He wrote in a memo last year that unusually high temperatures in 2017 “especially challenged TRADOC leaders” and highlighted flaws in the Army’s required reporting of the incidents, which hampered prevention efforts.
Heat-illness risk could be minimized with “careful planning, quality training, active leadership,” Benenati’s memo said.
But an annual report in April found that incident rates of heatstroke diagnoses in active-duty troops increased steadily between 2014 and 2018 — with 578 heatstroke diagnoses last year. At least 2,214 troops last year were diagnosed with heat exhaustion — in which the subject experiences muscle cramps, dizziness and vomiting — also a record high, according to the report.
“The numbers, despite all the prevention methods, keep climbing,” said Dr. Francis O’Connor, medical director of the Consortium for Health and Military Performance (CHAMP) at the Uniformed Services University of the Health Sciences. “It’s concerning. It’s a huge readiness issue.”
Most heat illness victims will recover and return to duty, O’Connor said, “but there are significant lost duty days.” Returning to full duty can take up to four months, he said.
From Fortnite to 10-mile hikes
Doug Casa, chief executive officer of the Korey Stringer Institute at the University of Connecticut, named for the Minnesota Vikings offensive tackle who died of heatstroke at the NFL team’s preseason training camp in 2001, estimated cases of heatstroke are underreported “by a factor of 10,” he said.
“I don’t think (the official reports) even come close,” Casa said.
Benenati’s memo also said reports often were missing basic information such the “wet bulb globe temperature” — the measure of heat and humidity that is supposed to guide appropriate training — at the times of incidents. Such gaps “impeded analysis to identify trends and prevent reoccurrences,” the general wrote.
Basic training recruits represent the largest percentage of heat illness victims, particularly at bases located in the hot, humid southeastern U.S., usually in the summer.
High heat and humidity can put even seasoned athletes at risk. Most recruits are far from seasoned athletes. They’re stricken most often in the first week or two, studies show.
Most haven’t exercised since high school gym class, Casa said. A lot of them smoke.
“Someone who’s been playing Fortnite all day is now having to exercise eight hours a day in 95-degree weather,” Casa said. “You couldn’t have a worse situation.”
Recruits should be given more time to acclimate to the heat before being physically stressed, he said. “It’s an easy fix.”
Experts also have suggested moving more basic training cycles to cooler months or even to bases located in cooler states.
But it’s not solely unacclimated recruits at risk. Exertional heatstroke ranks as the third-leading cause of sudden death in high school athletes, according to a 2015 article in The Journal of Applied Physiology, and is also a problem in collegiate sports.
Airborne and Ranger schools at Fort Benning, Ga., helped make it the base with the most heat illnesses in the military, O’Connor said.
“This is intense training,” he said. “You’ve got some people really mixing it up.”
Increased use of dietary supplements and medications also contribute to the numbers, experts said.
The Navy’s latest guidance, which highlights heat-illness risks and calls for more acclimation time, also advises sailors to avoid a range of products before strenuous activities, including stimulants, alcohol, energy drinks and pre-workout or weight-loss products. The guidance came following multiple deaths of sailors following fitness tests earlier this year.
Punishment before treatment
Marines, who largely are based at posts in warmer, southern latitudes and have been known to push training limits, have the highest rate of heat illnesses, military studies have found.
An investigation into the August 2015 death of Cpl. Alexis Aaron Alcaraz, 22, a Marine who collapsed and died on a 6-mile unit hike at Camp Lejeune, N.C., found that he’d dropped out of a hike a few weeks earlier, the Marine Corps Times reported after obtaining the investigation report through a records request. A previous heat illness increases the risk of a future heat illness.
Alcaraz, who had served three years in the Corps and had top fitness test scores, received no treatment for the earlier incident and instead was disciplined, the report found.
In the later incident, within five minutes of his collapse, a “safety vehicle” arrived and he was “packed in ice” to lower his body temperature, the report said.
He was taken to the Camp Lejeune Naval Hospital and was pronounced dead there.
In most cases, rapid cooling of a heatstroke victim — best done by immersion in a tub of cold water, monitoring cooling with a rectal thermometer — can make up for failed or unimplemented prevention strategies.
“If you can get their temperature under 104 within 30 minutes, the data shows, it’s 100% survivability,” Casa said. “Imagine the families when they realize a $150 tub and ice and water would have saved their son.”
Yet numerous bases don’t consistently have cold-water immersion readily available, he said.
In Scott’s case, it’s not clear how long he had lain untreated in the riverbed. The military told him 30 minutes, he said, but his doctors said it was two hours.
His injuries and liver transplant put an end to his Marine Corps career. He has to take immunosupressants, which make him more likely to get infections like pneumonia, which he contracted after he returned home.
Scott, who earned a master’s degree in 2017, now works for an engineering and project-services-support company near his home in eastern Washington. He breeds dogs, he said, and invests in the stock market.
He misses the Marines.
“It was quite the substantial loss,” he said. “Not only for me, but for the Corps. I would have done anything for them.”