1. DR. PARTHA PRATIM DAS
MD (Medicine)
CMO(SG)/Comdt

2. INTRODUCTION
 Second largest paramilitary force -Total strength
2,65,000 (2021 – 2022 )
 Challenges to provide medical care in case of
emergency or illness due to sheer orduous nature of
deployment of troops
 A variety of operational areas ranging from hot desert
of Rajasthan, Rann of Kutch of Gujarat to icy heights
in J&K ,riverine and dense jungle in West Bengal and
North-East.

3. Contd.
 The anti- Naxal operation units of BSF in Chhattisgarh
and Orissa are facing the extreme climate i.e. hot and
humid weather in the difficult terrine in the dense
jungle and are frequently suffering from different
diseases related to extreme weather, water and vector
borne diseases.
 Poor hygiene and sanitation, lack of clean potable
water
 Stress and prolong duty hours

4. Diseases in difficult areas
 Water borne diseases
- Diarrhea, dysentery, cholera, typhoid, acute viral
hepatitis
 Vector borne diseases
- Malaria, Dengue, Chikunguneya, Japanese
encephalitis (JE), Acute encephalitis syndrome (AES)

5. Contd.
 In extreme hot condition
- Heat rash, heat cramp, heat exhaustion, heat
stroke ( life threatening )
- aggravation of previous co morbid medical illness
 In the high altitude area
- Acute cold urticaria, frost bite, chillblain, AMS,
HAPE, HACE etc.

6. What is Hyperthermia ?
 It is an abnormally high body temperature or
overheating
 Abnormalities in the thermoregulation by
hypothalamus – heat generation and heat dissipation
mismatch
 Occurs when body absorbs or generate more heat than
it can release
 Usually the result of overexertion in hot and humid
condition
 Most of the Hyperthermia are preventable

7. Different types of Hyperthermia
 It is a group of heat illness
 Milder form – Heat cramp and heat rash
 Severe form - Heat exhaustion and heat stroke

8. Contributing factors
 Dehydration
 Obesity and poor physical fitness
 Gender – Males are more prone to heat related illness
 Prior history of heat related illness
 Excessive consumption of alcohol
 Electrolyte imbalance
 Having premorbid medical illnesses
 Certain medication like antipsychotic, sedatives,
betablockers, diuretics etc.
 Wearing heavy or tight clothing in hot area

9. Symptoms
 Symptoms of heat exhaustion include –
 Blurred vision
 Dizziness
 Increased heart rate
 Fatigue
 Headache
 Lightheadedness or syncope
 Low core temperature and BP
 Nausea and vomiting

10. Contd.
 Symptoms of heat stroke( often similar to those of heat
exhaustion) may also include
 Anhidrosis
 Disturbance in body balance
 Hot, flushed pale skin ( normal or increased core
temperature)
 Low or high blood pressure
 Seizures, hyperventilation

11. Complications of heat illness
 Rhabdomyolysis
 ARDS
 AKI
 Compartment syndrome
 Acute hepatic dysfunction
 Electrolyte abnormalities
 ACS
 DIC

12. Treatment of Heat exhaustion
 Stop physical activity and rest in a cool ventilated
environment
 Remove heavy or tight clothes
 Drink plenty of water or ORS to replace electrolyte
 Apply a cool compress over body
 Gently stretching of muscles
 Other supportive measures including IVF

13. Treatment of Heat Stroke
 It is a medical emergency that requires treatment in a
hospital
 Cold sponging
 Keep in a cool ventilated environment
 Apply ice pack to the neck, groin and armpits
 Avoid giving any medication including aspirin and
acetaminophen
 IVF (NS or RL) and other supportive measures

14. Preventive measures
 Drink water every 15 minutes when working or
exercising, drink a total of 2-4 glasses of water each
hour
 Take periodic rest in the shades, a cool area or air-
conditioned place
 Wear a hat and loose, light weight, light colored cotton
clothing
 Avoid eating hot, spicy and heavy meals

15. Contd.
 Do not drink alcohol or beverages that contain caffeine
 Monitor urine output
 Stay in air-conditioned or well-ventilated areas during
heat waves
 Avoid going outdoors for activities or exercise when
the temperature and humidity are high

24. Diseases of extreme cold
 Acute cold urticaria
 Frostbite
 Chillblain
 AMS
 HAPE
 HACE

25. Acute cold urticaria
 Acute skin reaction to cold- appears within minutes
after cold exposure
 Develops itchy welts (hives)
 May lead to low BP and fainting
 Swelling of hands, lips
 In severe form – may develop anaphylaxis and
angioedema

26. Risk Factors
 Young adult with certain inherited traits – primary
acquired and familial types – causes painful welts and
flu like symptoms
 Underlying health conditions – secondary acquired –
Hepatitis or cancer

27. Management
 Protect skin from cold
 Antihistaminics
 Avoid ice cold drinks
 Standard treatment protocol for severe form – IVF, Inj
Epinephrine, Moist oxygen and other supportive
measures

28. Frostbite
 Common but often underestimated conditions
 Causes – prolonged exposures to extreme cold and
cold metal – damage to cells and soft tissues
 Usually affects extremities – fingers, toes and ears
 Injures skin and the tissues underneath like muscles,
nerves and joints

29. Symptoms
 Numbness
 “ Pins and needles” sensation of the affected area
 Redness
 Pale or waxy colour and feel (in severe form )
 Swelling
 Blisters or scabs
 Extremely painful initially – loss of sensation in severe
form
 Complications – neuropathies, stiffness, arthritis,
gangrene, amputation

30. Frostbite

31. Treatment
 Remove all wet clothes
 Wrap the affected area with a sterile clean cloth
 Rewarming of the area with warm water
(around 105 degree F)
 Dress with sterile bandage
 Antibiotics and NSAIDS
 Inj TT
 Rehydration
 Oxygen therapy- Hyperbaric oxygen therapy
 Avoid – space heaters, electric blanket and submersion in
extreme hot water, don’t try to remove frost bitten skin

32. Chillblains
 These are small, itchy swelling on the skin as a reaction
to the extreme cold
 Usually affects the extemities
 Normally heal within a few weeks – rarely cause any
permanent damage
 Can also occur on areas of the feet exposed to pressure
such as bunion

33. Chillblains

34. Risk factors
 Poor circulation
 Family history of chillblain
 Regular exposure to cold, damp or draughty
conditions
 Poor diet or low body weight
 History of Lupus or Raynaud’s phenomenon
 Smokers

35. Treatment
 Usually self limiting in favorable condition
 Rewarming
 Topical use of soothing lotions or moisturizers
 Eat hot milk
 Avoid tight shoes and boots
 May take Tab Nifedepine to improve peripheral
circulation