Affiliation:
1. F. Edward Hebert School of Medicine, Uniformed Services University , Bethesda, MD 20814, USA
2. Special Warfare Training Wing, Special Warfare Human Performance Support Group , JBSA-Lackland, TX 78236, USA
Abstract
ABSTRACT
Introduction
Exertional heat stroke (EHS), which presents with extreme hyperthermia and alteration to the central nervous system, disproportionately affects the military, where warfighters are expected to perform in all types of environmental conditions. Because of an incomplete understanding of individualized recovery from EHS, there are several shortcomings with the current guidance on return to duty (RTD) following an EHS. The purpose of this manuscript is to provide an updated literature review of best practices for return to duty following EHS to guide decision making regarding EHS and explore areas of future research for medical staff who work with warfighters.
Materials and Methods
A literature review related to EHS in both athlete and military populations, as well as any existing guidelines for RTD, was conducted using PubMed and Covidence.
Results
Twenty-one articles were identified for this updated review on EHS and RTD, with recommendations focused during and after an EHS event, as well as the role of heat tolerance testing (HTT).
Conclusions
EHS has a high morbidity and mortality rate if not treated rapidly. Because the extent of end-organ damage is dependent on the amount of time that the individual is hyperthermic, rapid diagnosis via rectal thermometry, and efficient cooling methods are imperative to the wellbeing of EHS patients. Following EHS, gradual RTD recommendations within the limits of operational demand should be implemented to reduce the risk for a subsequent heat injury event. While many versions of HTT, most notably the Israeli Defense Force (IDF) protocol, have been created to guide RTD recommendations, a universal assessment for heat tolerance has yet to be adopted. As such, medical personnel should apply a multifactorial approach to ensure safe RTD.
Publisher
Oxford University Press (OUP)
Subject
Public Health, Environmental and Occupational Health,General Medicine
Reference21 articles.
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2. Use of the heat tolerance test to assess recovery from exertional heat stroke;Mitchell;Temperature (Austin),2019
3. Exertional heat stroke: pathophysiology, epidemiology, diagnosis, treatment, and prevention;Knapik;J Spec Oper Med,2019
4. Update: heat illness, active component, U.S. Armed Forces, 2021;Williams;Msmr,2022
5. Exertional heat stroke in sport and the military: epidemiology and mitigation;Périard;Exp Physiol,2022