Two Casualties at Kilometre Six
On the sixth kilometre of an 8 km route march, at 14:20 in May, with the temperature at 34°C and humidity high, Cadet Deshmukh, 15, in full uniform with a pack, stops sweating, begins to stagger, and answers questions with confused, slurred replies. His skin is hot and dry and his pulse is about 130. Ten metres away Cadet Naik is sitting on the road holding a cramped calf and vomiting after drinking a large bottle of water at once. There are twelve cadets with you, four one-litre water bottles left, one first-aid pouch with ORS sachets and bandages and no ice, and the nearest point a vehicle can reach is about 400 m back. The ANO is with the rear group 1.5 km behind. You are the senior cadet in charge of this group, and the two nearest cadets are looking at you.
1. Triage these two cadets. Who is treated first, and what exactly are you distinguishing between?
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Deshmukh first, immediately, and everything else waits.
The discriminator is the mental state and the skin, not the temperature reading you do not have. Heat exhaustion gives heavy sweating, cool clammy skin, weakness and dizziness, but the casualty is lucid and can tell you what is wrong. Heat stroke gives altered mental state - confusion, slurred speech, staggering - with hot skin, and sweating may have stopped, which is a deterioration, not an improvement. A pulse of 130 in a 15-year-old at rest on the road fits the same picture. Heat stroke kills; heat exhaustion does not, if it is treated.
Naik has exercise-associated cramp and gastric upset from drinking a large volume of plain water at once. Uncomfortable, but he is conscious, talking, and not confused. He is treated second - by a named cadet, not by you.
What you do not do: walk Deshmukh 400 m to the road head, give him water by mouth while he is confused (aspiration risk), or wait for the ANO to arrive before starting to cool him.
2. Give the management with what you actually have: four litres of water, ORS, bandages, no ice, a vehicle 400 m away, the ANO 1.5 km back.
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Cool first, transport second.
- Move him into shade now - a tree, a wall, the shadow of a vehicle - lay him flat and raise the legs slightly.
- Strip the uniform to the waist and remove the boots. Cooling outranks modesty.
- Evaporative cooling: pour water over him, soak shirts or cloths and lay them on him, and fan continuously with a file cover or cap. Keep the cloths wet and keep replacing them - a dry cloth is a blanket.
- Wet the neck, armpits and groin, where the large vessels lie close to the skin. Ice would be better, but water and moving air are what you have and they work.
- Send two cadets - never one - to the road head with a clear message: 'Heat stroke, confused casualty, need a vehicle and an ambulance.'
- One cadet with a notebook: time, pulse, breathing, and any change in consciousness.
- ORS in small sips only once he is alert and swallowing properly. Not before.
- Hand over to the ANO and then to the hospital with the times and everything done - the timeline is part of the treatment.
Naik: shade, gentle calf stretch, small sips of ORS, no more plain water in bulk.
3. Does the march continue? What do you change, and what do you record?
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The march does not continue as planned. This group stays in shade until the vehicle comes, and then moves by transport. The last 2 km proves nothing, and a collapse at 14:20 is not the moment to demonstrate stamina.
What changes afterwards:
- March timings move to before 09:00 or after 17:00.
- Water is carried per cadet, not per group - roughly a litre per cadet per hour in that heat.
- A buddy system and a head count at every rest, with the medical pair at the rear of the column and the pouch with them.
- ORS and salt before the march, not after; a shaded rest every 30–40 minutes.
What is recorded in the camp diary: the time the symptoms began, the signs at each check, the time cooling started, the time the vehicle was called and arrived, who was informed, and the hospital's diagnosis. That record answers the questions that will certainly be asked, and it tells the unit whether this was one cadet's bad luck or a bad plan.