Heatstroke death

Medical panel to review SAF strategy for heat injuries

The Singapore Armed Forces said there have been no recorded deaths from heatstrokes among soldiers in the past nine years, due to measures put in place.
The Singapore Armed Forces said there have been no recorded deaths from heatstrokes among soldiers in the past nine years, due to measures put in place.ST FILE PHOTO

External panel will comprise docs from the public healthcare sector

An external review panel comprising doctors in the public healthcare sector will be convened to independently review the existing strategy for heat injury prevention and management, a senior Singapore Armed Forces (SAF) commander said yesterday.

This is a separate track from the Committee of Inquiry (COI) that has been convened and police investigations, that could lead to a coroner's inquiry.

In a letter to The Straits Times Forum published today, Brigadier-General Kenneth Liow, Commander of the Army Training and Doctrine Command, said: "Based on these (COI) findings, the SAF will take appropriate measures to improve our overall strategy against heatstrokes to achieve zero fatalities."

There have been no recorded deaths from heatstrokes among soldiers in the past nine years, he said, due to a number of measures that have been put in place over the years.

He gave this update to address concerns expressed by Straits Times readers yesterday after full-time national serviceman Dave Lee Han Xuan, 19, died on Monday.

Corporal First Class Lee was warded in Changi General Hospital on April 18 for heatstroke during his training to be a Guardsman at the 1st Battalion Singapore Guards.

Preliminary investigations showed that in CFC Lee's case, heatstroke prevention measures were taken "and temperature recordings were normal prior to the activity", BG Liow said.

"We are deeply saddened and disappointed that despite these measures, his condition did not improve, resulting in his demise," he said, adding that SAF will "spare no efforts in improving our systems to achieve zero fatalities".

Wearable technology to detect and prevent heat injuries have also been evaluated but as yet no suitable solutions have been found, said BG Liow.

He added: "We will continue to evaluate new ones as they appear".

In a separate statement, the SAF outlined its heatstroke prevention measures:


Soldiers who are physically unwell have a higher risk of suffering from heat-related injuries.

Before any activity, the temperature of soldiers is taken to allow SAF units to detect servicemen who are unwell, but are not willing to take themselves out of training and their duties.

However, temperature-taking may not be fool-proof as there are mild illnesses without fever, such as diarrhoea, that may not be picked up during temperature-taking. Soldiers with temperatures above 37.5 deg C will not be allowed to participate in training.

These servicemen should rest for 10 minutes before having their temperatures retaken. If their temperature remains above 37.5 deg C, the soldiers must seek medical attention.


First-year soldiers undergoing SAF courses, or in units undergoing training to turn operational, must have supervised water parades.

For strenuous activities, servicemen must drink additional water before, during and after training, up to the point of thirst.

Enough water points will also be made available for training.


Prolonged strenuous activities can be done sustainably and safely by following a work-rest cycle based on readings of a wet globe bulb temperature. This reading is a measure of heat stress on people based on factors such as temperature, humidity, sunlight and wind speed.

For the SAF, the reading determines the ratio of work to rest. High readings will result in a high heat load on the body.

So, higher readings generally mean that a soldier has to reduce the training tempo and factor in rest in between training periods.


The volume of training for servicemen should be progressive and vary in intensity to allow soldiers to acclimatise safely.


If a serviceman gets a heat injury during training, measures are taken on site to cool him, based on established protocols. They include removing his clothes and applying ice or water on him.

The duty medic on site also has medical equipment in his combat medic bag for additional treatment and resuscitation, such as intravenous drips to rehydrate heat-injured soldiers.

If the heat injury and the condition of the affected serviceman deteriorate despite the steps taken, the duty medic can use an automated external defibrillator and airway adjuncts to stabilise his condition.

After treatment on site, the injured serviceman is taken to the nearest medical facility in camp, where he will be put under a body-cooling unit to bring down his body temperature further. He will also be closely monitored at the same time. The body-cooling unit sprays a mist of water - dispersed continuously by a fan - over the serviceman's body.

Medical officers and medics are also trained and equipped to resuscitate an unstable heat-injured soldier, such as through intubation and artificial ventilation, if the casualty develops complications such as completely losing consciousness.

Once the serviceman has been sufficiently stabilised, he is evacuated by ambulance to the nearest hospital for further treatment.


A version of this article appeared in the print edition of The Straits Times on May 04, 2018, with the headline 'Medical panel to review SAF strategy for heat injuries'. Print Edition | Subscribe