SIGNS & SYMPTOMS OF RF- EMF OVEREXPOSURE

Although non-specific to RF-EMF overexposure, any combination of the following signs and symptoms may be related to the incident:

1. Sensation of warmth, perspiring, and/or intense heating of the exposed body part(s).
2. Skin erythema – reddening of the skin.
3. Shocks and burns.
4. Pain, neuropathy, or any sensory injury of the peripheral or central nerve system, e.g., oversensitivity to touch.
5. Headache, lethargy, concentration, dysesthesia, paresthesia, numbness, balance, or tinnitus.
6. Malaise – an overall sense of feeling unwell (mentally or physically).
7. Labored breathing.
8. Nausea, diarrhea.
9. Visual phosphenes, sensitivity to light, blurred vision, keratitis.
10. Transient reduced sperm count.
11. Compartment syndrome – internal heating without obvious burns, thrombosis.
12. Signs and symptoms Post-Traumatic Stress Disorder (PTSD).

EVALUATION OF SUSPECTED INJURY

1. Address any life-threating medical conditions first as directed by Tactical Combat Casualty Care guidelines.
2. Documentation to include:

- Incident facility: shore-base, harbor facility, vessel at harbor, or vessel at sea, etc.
- Individual(s) concerned or involved in the incident.
- Description of the incident.
- Likely cause(s):
  - Suspected vs. confirmed exposure
  - Type of emitter
  - Transmission power (average and peak power)
  - Estimated average power density incident in the individual
  - Transmission frequency
  - Mode: continuous vs. pulse
- Exposure duration.
- Distance from emitting source.
- Which body part or whole body affected.
- Severity of the incident: critical, major, or minor.
- Medical action taken.

NOTE: exposure data above may be obtained from the operator(s) of the RE-EMF device/system in question. Contact unit Safety Officer or Bioenvironmental Engineers for additional information as needed.

3. Physical examination

- Record and evaluate symptoms (e.g., anxiety, warmth, fatigue, headache, nausea, vomiting, pain, etc.) and any implantable medical devices.
- Vital signs.
- Based on initial medical evaluation and overexposure incident investigation/verification, medical providers may consider additional systems-based medical evaluation of potential injury.
  - Neurologic exam and testing for any significant neurologic symptoms or possible injury to the peripheral or central nervous system.
  - Assess and document visual function of each eye, such as visual acuity, pupil, eye lids/lashes, cornea, conjunctiva, iris, lens, vitreous, retina, and optic nerve.
  - Electrocardiogram (EKG).
  - Laboratory testing.
  - Emergency care testing and evaluation required if suspecting compartment syndrome (e.g., pain, swelling, paleness in the limb and sensory loss signs, etc.). For additional information, refer to JTS Acute Extremity Compartment Syndrome and the Role of Fasciotomy in Extremity War Wounds CPG.

4. Initial evaluation of acute injuries due to thermal burns.

- Estimate total body surface area (TBSA) burned using the “Rule of Nine”:
  - Head and neck: 9%
  - Front and back of each arm and hand: 9%
  - Chest: 9%
  - Stomach: 9%
  - Upper back: 9%
  - Lower back: 9%
  - Front and back of each leg and foot: 18%
  - Genital area: 1%
- Grading:
  - Superficial burns (1st degree) appear red, do not blister, and blanch readily. (Note: Superficial 1st degree burn should be excluded from TBSA calculation.)
  - Partial thickness burns (2nd degree) are moist and sensate, blister, and blanch.
  - Full thickness burns (3rd degree) appear leathery, dry, non-blanching, are insensate and often contain thrombosed vessels.
- When the patient is stable and the wounds are cleaned/debrided, re-calculate burn size using the Lund-Browder charts. For additional information, refer to JTS Burn Care CPG.