Procedure for assessing patients referred to the UK’s military Heat Illness Clinic: a case series

2021 ◽  
pp. bmjmilitary-2021-001875
Author(s):  
Carol House ◽  
M Stacey ◽  
D Woods ◽  
A Allsopp ◽  
D Roiz de Sa
Keyword(s):  
Maximal Oxygen Consumption ◽  
Case Series ◽  
Tolerance Test ◽  
Heat Illness ◽  
Physiological Basis ◽  
Exertional Heat Illness ◽  
Heat Tolerant ◽  
The Uk ◽  
Return To Duty ◽  
Repeat Assessment

IntroductionThe UK military operates a Heat Illness Clinic (HIC) to aid the return to exercise, training and occupational duty recommendations for individuals who have suffered exertional heat illness or heatstroke. This paper describes the process of assessment and reports representative data from n=22 patients referred to the HIC.MethodThe assessment included clinical consultation, and measurement of maximal oxygen consumption (V̇O2max) and a heat tolerance test (HTT) conducted on a treadmill in an environmental chamber with an air temperature of 34°C and 44% relative humidity. Patients began the HTT wearing military clothing, carrying a rucksack (mass 15 kg) and walking at 60% V̇O2max, at 30 min the rucksack and jacket were removed and the T-shirt at 45 min, individuals continued walking for 60–90 min. Patients were considered heat tolerant if rectal temperature achieved a plateau.ResultsN=14 patients were heat tolerant on the first assessment and of the n=8 patients required to return for repeat assessment, five were heat tolerant on the second assessment and the remaining three on the third assessment.ConclusionsIn conjunction with patient history and clinical evaluation, the HTT provides a physiological basis to assist with decisions concerning patient management and return to duty following an episode of heat illness.

Exertional Heat Illness: Emerging Concepts and Advances in Prehospital Care

2015 ◽  
Vol 30 (3) ◽  
pp. 297-305 ◽  
Author(s):  
Riana R. Pryor ◽  
Ronald N. Roth ◽  
Joe Suyama ◽  
David Hostler
Keyword(s):  
Heat Stress ◽  
Prehospital Care ◽  
Water Immersion ◽  
Heat Stroke ◽  
Case Series ◽  
Whole Body ◽  
Heat Illness ◽  
Publication Type ◽  
Exertional Heat Stroke ◽  
Exertional Heat Illness

AbstractExertional heat illness is a classification of disease with clinical presentations that are not always diagnosed easily. Exertional heat stroke is a significant cause of death in competitive sports, and the increasing popularity of marathons races and ultra-endurance competitions will make treating many heat illnesses more common for Emergency Medical Services (EMS) providers. Although evidence is available primarily from case series and healthy volunteer studies, the consensus for treating exertional heat illness, coupled with altered mental status, is whole body rapid cooling. Cold or ice water immersion remains the most effective treatment to achieve this goal. External thermometry is unreliable in the context of heat stress and direct internal temperature measurement by rectal or esophageal probes must be used when diagnosing heat illness and during cooling. With rapid recognition and implementation of effective cooling, most patients suffering from exertional heat stroke will recover quickly and can be discharged home with instructions to rest and to avoid heat stress and exercise for a minimum of 48 hours; although, further research pertaining to return to activity is warranted.PryorRR,RothRN,SuyamaJ,HostlerD.Exertional heat illness: emerging concepts and advances in prehospital care.Prehosp Disaster Med.2015;30(3):19.

scholarly journals When Should a Heat-Tolerance Test Be Scheduled After Clinical Recovery From an Exertional Heat Illness?

2020 ◽  
Vol 55 (3) ◽  
pp. 289-294 ◽  
Author(s):  
Haggai Schermann ◽  
Shir Hazut-Krauthammer ◽  
Yael Weksler ◽  
Sagi Spitzer ◽  
Yoram Epstein ◽  
...  
Keyword(s):  
Heat Tolerance ◽  
Outcome Measure ◽  
Heat Stroke ◽  
Group Versus ◽  
Tolerance Test ◽  
Heat Illness ◽  
Exertional Heat Illness ◽  
Clinical Recovery ◽  
Laboratory Results ◽  
Tolerance Testing

Objective Researchers have produced a hypothesis of transient heat intolerance (HI) after exertional heat stroke (EHS). Based on this hypothesis, heat-tolerance testing (HTT) has been postponed until weeks 6 to 8 after EHS and other types of exertional heat illness (EHI). We compared the HTT results of participants after either EHS or other EHI who were tested earlier (≤6-week group) versus those who were tested later (>6-week group) to verify the hypothesis. Design Cohort study. Setting Data obtained from records of military athletes who experienced EHS or EHI. Patients or Other Participants All participants who underwent HTT after EHI or EHS experienced between 2014 and 2018 and for whom complete data regarding the severity of the event (rectal temperature, neurologic symptoms, and laboratory results) and HTT results were available were included. Participants with suspected EHS and those with other EHIs were evaluated separately. Main Outcome Measure(s) The percentages of participants with HI and mean probability of heat tolerance were compared between those tested within 6 weeks of the event and those tested later. Results A total of 186 participants were included in this study (EHS: 12 in the <6-week group, 9 in the >6-week group; EHI: 94 in the <6-week group, 71 in the >6-week group). In the EHS group, the percentages with HI (33% versus 44%, P = .67) and mean probability of heat tolerance (0.82 versus 0.82, P = .98) did not differ. In the EHI group, participants who were tested after 6 weeks had a greater chance of being diagnosed with HI (38% versus 21.3%, P < .02) Conclusions The HTT results were similar between participants with EHS who were tested early (<6 weeks) and those tested late (>6 weeks). Further investigation of heat-tolerance changes in larger cohorts of patients after EHS is required to verify the theory of transient HI.

The validity of the heat tolerance test in prediction of recurrent exertional heat illness events

2018 ◽  
Vol 21 (6) ◽  
pp. 549-552 ◽  
Author(s):  
Haggai Schermann ◽  
Yuval Heled ◽  
Chen Fleischmann ◽  
Itay Ketko ◽  
Nathan Schiffmann ◽  
...  
Keyword(s):  
Heat Tolerance ◽  
Tolerance Test ◽  
Heat Illness ◽  
Exertional Heat Illness

Guidelines for Return to Duty (Play) after Heat Illness: A Military Perspective

2007 ◽  
Vol 16 (3) ◽  
pp. 227-237 ◽  
Author(s):  
Francis G. O’Connor ◽  
Aaron D. Williams ◽  
Steve Blivin ◽  
Yuval Heled ◽  
Patricia Deuster ◽  
...  
Keyword(s):  
Heat Stroke ◽  
Military Medicine ◽  
Medical Personnel ◽  
The United States ◽  
Tolerance Test ◽  
Heat Illness ◽  
Israeli Defense Force ◽  
Considerable Morbidity ◽  
Army Air Force ◽  
Return To Duty

Since Biblical times, heat injuries have been a major focus of military medical personnel. Heat illness accounts for considerable morbidity during recruit training and remains a common cause of preventable nontraumatic exertional death in the United States military. This brief report describes current regulations used by Army, Air Force, and Navy medical personnel to return active duty warfighters who are affected by a heat illness back to full duty. In addition, a description of the profile system used in evaluating the different body systems, and how it relates to military return to duty, are detailed. Current guidelines require clinical resolution, as well as a profile that that protects a soldier through repeated heat cycles, prior to returning to full duty. The Israeli Defense Force, in contrast, incorporates a heat tolerance test to return to duty those soldiers afflicted by heat stroke, which is briefly described. Future directions for U.S. military medicine are discussed.

scholarly journals Effects of heat: UK exercise Saif Sareea 3 and interpreting military climatic guidance

2020 ◽  
Vol 166 (6) ◽  
pp. 401-405 ◽  
Author(s):  
Samuel White ◽  
M B Smith
Keyword(s):  
Care Pathway ◽  
Case Series ◽  
Care Facility ◽  
Heat Illness ◽  
Aeromedical Evacuation ◽  
Preventative Measures ◽  
Care Facilities ◽  
Treatment Facilities ◽  
Service Publication ◽  
The Uk

IntroductionOver recent years much research, both civilian and military, has occurred in the field of heat illness. This has helped force health protection and medical management of service personnel operating in hot climates. Exercise Saif Sareea 3 in Oman saw a collection of presentations to the deployed UK medical treatment facilities due to the effects of heat.MethodThis paper aims to describe the case series of 24 casualties that presented to the deployed primary care facilities and 17 that were admitted to the deployed secondary care facility due to the effects of heat.ResultsOnly 10 casualties fulfilled the in-theatre diagnostic criteria for heat illness, of which two were of moderate severity and required aeromedical evacuation to the UK.ConclusionsCommanders appeared extremely well read on Joint Service Publication 539 (JSP539; May 2017) Heat Illness and Cold Injury: Prevention and Management, following the Brecon enquiry, and were proactive in managing their force in preventative measures. This likely contributed towards the low numbers of patients with heat illness seen on the exercise. JSP539 did, however, appear to have some limitations when trying to apply it to all patients seen within the operational patient care pathway, and some areas for development are discussed.

Accuracy of the perceptual strain index in a compensable heat strain environment among participants with and without a history of exertional heat illness

2021 ◽  
pp. 102863
Author(s):  
Cynthia Weiner ◽  
Josh B. Kazman ◽  
Preetha A. Abraham ◽  
Patricia A. Deuster
Keyword(s):  
Heat Strain ◽  
Heat Illness ◽  
Strain Index ◽  
Exertional Heat Illness ◽  
History Of

scholarly journals Cardiorespiratory fitness assessment using risk-stratified exercise testing and dose–response relationships with disease outcomes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tomas I. Gonzales ◽  
Kate Westgate ◽  
Tessa Strain ◽  
Stefanie Hollidge ◽  
Justin Jeon ◽  
...  
Keyword(s):  
Cardiorespiratory Fitness ◽  
Maximal Oxygen Consumption ◽  
Estimation Method ◽  
The Novel ◽  
Exercise Tests ◽  
Metabolic Equivalent ◽  
Fitness Assessment ◽  
Disease Outcomes ◽  
All Cause Mortality ◽  
The Uk

AbstractCardiorespiratory fitness (CRF) is associated with mortality and cardiovascular disease, but assessing CRF in the population is challenging. Here we develop and validate a novel framework to estimate CRF (as maximal oxygen consumption, VO2max) from heart rate response to low-risk personalised exercise tests. We apply the method to examine associations between CRF and health outcomes in the UK Biobank study, one of the world’s largest and most inclusive studies of CRF, showing that risk of all-cause mortality is 8% lower (95%CI 5–11%, 2670 deaths among 79,981 participants) and cardiovascular mortality is 9% lower (95%CI 4–14%, 854 deaths) per 1-metabolic equivalent difference in CRF. Associations obtained with the novel validated CRF estimation method are stronger than those obtained using previous methodology, suggesting previous methods may have underestimated the importance of fitness for human health.

scholarly journals On the real-time prevention and monitoring of exertional heat illness in military personnel

2021 ◽  
Author(s):  
M.J. Buller ◽  
S.K. Delves ◽  
A.L. Fogarty ◽  
B.J. Veenstra
Keyword(s):  
Real Time ◽  
Military Personnel ◽  
Heat Illness ◽  
The Real ◽  
Exertional Heat Illness

Orthopedic injuries associated with use of electric scooters in the UK: A dangerous trend? Case series and review of the literature

2021 ◽  
Vol 22 (3) ◽  
pp. 242-245
Author(s):  
George J. M. Hourston ◽  
Albert Ngu ◽  
James Hopkinson-Woolley ◽  
Kuldeep Stöhr
Keyword(s):  
Case Series ◽  
Review Of The Literature ◽  
Orthopedic Injuries ◽  
The Uk
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