Exertional Heat Illness pp 1-16 | Cite as
Overview of Exertional Heat Illness
- 335 Downloads
Abstract
Exertional heat illness (EHI) is a cause for concern in athletic, military, occupational, and recreational settings where individuals are participating in physical activity, especially in hot environmental conditions. EHI includes a spectrum of medical conditions that range from non-life-threatening, such as heat syncope, to potentially fatal in the case of exertional heat stroke. Given the severity of the latter condition, it is prudent for clinicians providing medical care in the aforementioned settings to develop evidence-based protocols for the prevention, recognition, treatment and return to activity for each of the medical conditions falling under the classification of EHI. The aim of this chapter is to provide an overview of the classification and nomenclature of EHI, particularly the specific conditions contained within this general domain. We will discuss the current incidence and epidemiology of EHI to provide additional context surrounding the content covered within this text.
Keywords
Nomenclature Classification Epidemiology Incidence Exertional heat stroke Physical activityReferences
- 1.A Roman experience with heat stroke in 24 B.C. Bull N Y Acad Med. 1967;43(8):767–8.Google Scholar
- 2.Armed Forces Health Surveillance Branch. Update: heat illness, active component, U.S. Armed Forces, 2018. MSMR. 2019;26(4):15–20.Google Scholar
- 3.Abriat A, Brosset C, Brégigeon M, Sagui E. Report of 182 cases of exertional heatstroke in the French Armed Forces. Mil Med. 2014;179(3):309–14.PubMedCrossRefGoogle Scholar
- 4.Bricknell MC. Heat illness—a review of military experience (part 1). J R Army Med Corps. 1995;141(3):157–66.PubMedCrossRefGoogle Scholar
- 5.Bricknell MC. Heat illness—a review of military experience (Part 2). J R Army Med Corps. 1996;142(1):34–42.PubMedCrossRefGoogle Scholar
- 6.Gardner JW, Gutmann FD, Potter RN, Kark JA. Nontraumatic exercise-related deaths in the U.S. military, 1996–1999. Mil Med. 2002;167(12):964–70.PubMedCrossRefGoogle Scholar
- 7.Hakre S, Gardner JW, Kark JA, Wenger CB. Predictors of hospitalization in male Marine Corps recruits with exertional heat illness. Mil Med. 2004;169(3):169–75.PubMedCrossRefGoogle Scholar
- 8.Stacey MJ, Parsons IT, Woods DR, Taylor PN, Ross D, Brett SJ. Susceptibility to exertional heat illness and hospitalisation risk in UK military personnel. BMJ Open Sport Exerc Med. 2015;1(1):e000055.PubMedPubMedCentralCrossRefGoogle Scholar
- 9.Henderson A, Simon JW, Melia WM, Navein JF, Mackay BG. Heat illness. A report of 45 cases from Hong Kong. J R Army Med Corps. 1986;132(2):76–84.PubMedCrossRefGoogle Scholar
- 10.Bedno SA, Li Y, Han W, Cowan DN, Scott CT, Cavicchia MA, et al. Exertional heat illness among overweight U.S. Army recruits in basic training. Aviat Space Environ Med. 2010;81(2):107–11.PubMedCrossRefGoogle Scholar
- 11.Carter R, Cheuvront SN, Williams JO, Kolka MA, Stephenson LA, Sawka MN, et al. Epidemiology of hospitalizations and deaths from heat illness in soldiers. Med Sci Sports Exerc. 2005;37(8):1338–44.PubMedCrossRefGoogle Scholar
- 12.Epstein Y, Moran DS, Shapiro Y, Sohar E, Shemer J. Exertional heat stroke: a case series. Med Sci Sports Exerc. 1999;31(2):224–8.PubMedCrossRefGoogle Scholar
- 13.Rav-Acha M, Hadad E, Epstein Y, Heled Y, Moran DS. Fatal exertional heat stroke: a case series. Am J Med Sci. 2004;328(2):84–7.PubMedCrossRefGoogle Scholar
- 14.Arbury S, Lindsley M, Hodgson M. A critical review of OSHA heat enforcement cases: lessons learned. J Occup Environ Med. 2016;58(4):359–63.PubMedCrossRefGoogle Scholar
- 15.Arbury S, Jacklitsch B, Farquah O, Hodgson M, Lamson G, Martin H, et al. Heat illness and death among workers—United States, 2012–2013. MMWR Morb Mortal Wkly Rep. 2014;63(31):661–5.PubMedPubMedCentralGoogle Scholar
- 16.Arcury TA, Summers P, Talton JW, Chen H, Sandberg JC, Spears Johnson CR, et al. Heat illness among North Carolina Latino farmworkers. J Occup Environ Med. 2015;57(12):1299–304.PubMedPubMedCentralCrossRefGoogle Scholar
- 17.Bonauto D, Anderson R, Rauser E, Burke B. Occupational heat illness in Washington state, 1995–2005. Am J Ind Med. 2007;50(12):940–50.PubMedCrossRefGoogle Scholar
- 18.Dutta P, Rajiva A, Andhare D, Azhar GS, Tiwari A, Sheffield P, et al. Perceived heat stress and health effects on construction workers. Indian J Occup Environ Med. 2015;19(3):151–8.PubMedPubMedCentralCrossRefGoogle Scholar
- 19.Fortune M, Mustard C, Brown P. The use of Bayesian inference to inform the surveillance of temperature-related occupational morbidity in Ontario, Canada, 2004–2010. Environ Res. 2014;132:449–56.PubMedCrossRefGoogle Scholar
- 20.Gubernot DM, Anderson GB, Hunting KL. Characterizing occupational heat-related mortality in the United States, 2000–2010: an analysis using the census of fatal occupational injuries database. Am J Ind Med. 2015;58(2):203–11.PubMedPubMedCentralCrossRefGoogle Scholar
- 21.Wu X, Brady JE, Rosenberg H, Li G. Emergency department visits for heat stroke in the United States, 2009 and 2010. Inj Epidemiol. 2014;1(1):8.PubMedPubMedCentralCrossRefGoogle Scholar
- 22.Kerr ZY, Casa DJ, Marshall SW, Comstock RD. Epidemiology of exertional heat illness among U.S. high school athletes. Am J Prev Med. 2013;44(1):8–14.PubMedCrossRefGoogle Scholar
- 23.Kerr ZY, Yeargin SW, Hosokawa Y, Hirschhorn RM, Pierpoint LA, Casa DJ. The epidemiology and management of exertional heat illnesses in high school sports during the 2012/13–2016/17 academic years. J Sport Rehabil. 2019:1–7. https://doi.org/10.1123/jsr.2018-0364. [Epub ahead of print].
- 24.Yeargin SW, Kerr ZY, Casa DJ, Djoko A, Hayden R, Parsons JT, et al. Epidemiology of exertional heat illnesses in youth, high school, and college football. Med Sci Sports Exerc. 2016;48(8):1523–9.PubMedCrossRefGoogle Scholar
- 25.Grundstein AJ, Ramseyer C, Zhao F, Pesses JL, Akers P, Qureshi A, et al. A retrospective analysis of American football hyperthermia deaths in the United States. Int J Biometeorol. 2012;56(1):11–20.PubMedCrossRefGoogle Scholar
- 26.DeMartini JK, Casa DJ, Stearns R, Belval L, Crago A, Davis R, et al. Effectiveness of cold water immersion in the treatment of exertional heat stroke at the Falmouth Road Race. Med Sci Sports Exerc. 2015;47(2):240–5.PubMedCrossRefGoogle Scholar
- 27.Armed Forces Health Surveillance Branch. Update: heat injuries, active component, U.S. Armed Forces, 2013. MSMR. 2014;21(3):10–3.Google Scholar
- 28.Barnes SR, Ambrose JF, Maule AL, Kebisek J, McCabe AA, Scatliffe K, et al. Incidence, timing, and seasonal patterns of heat illnesses during U.S. Army basic combat training, 2014–2018. MSMR. 2019;26(4):7–14.PubMedGoogle Scholar
- 29.Spector JT, Krenz J, Rauser E, Bonauto DK. Heat-related illness in Washington State agriculture and forestry sectors. Am J Ind Med. 2014;57(8):881–95.PubMedPubMedCentralCrossRefGoogle Scholar
- 30.Spector JT, Bonauto DK, Sheppard L, Busch-Isaksen T, Calkins M, Adams D, et al. A case-crossover study of heat exposure and injury risk in outdoor agricultural workers. PLoS One. 2016;11(10):e0164498.PubMedPubMedCentralCrossRefGoogle Scholar
- 31.Fuhrmann CM, Sugg MM, Ii CEK, Waller A. Impact of extreme heat events on emergency department visits in North Carolina (2007–2011). J Community Health. 2016;41(1):146–56.PubMedCrossRefGoogle Scholar
- 32.Mirabelli MC, Quandt SA, Crain R, Grzywacz JG, Robinson EN, Vallejos QM, et al. Symptoms of heat illness among Latino farm workers in North Carolina. Am J Prev Med. 2010;39(5):468–71.PubMedPubMedCentralCrossRefGoogle Scholar
- 33.Biggs C, Paterson M, Maunder E. Hydration status of South African forestry workers harvesting trees in autumn and winter. Ann Occup Hyg. 2011;55(1):6–15.PubMedGoogle Scholar
- 34.Donoghue AM. Heat illness in the U.S. mining industry. Am J Ind Med. 2004;45(4):351–6.PubMedCrossRefGoogle Scholar
- 35.Lambert GP. Intestinal barrier dysfunction, endotoxemia, and gastrointestinal symptoms: the “canary in the coal mine” during exercise-heat stress? Med Sport Sci. 2008;53:61–73.PubMedCrossRefGoogle Scholar
- 36.Meshi EB, Kishinhi SS, Mamuya SH, Rusibamayila MG. Thermal exposure and heat illness symptoms among workers in Mara Gold Mine. Tanzania Ann Glob Health. 2018;84(3):360–8.PubMedCrossRefGoogle Scholar
- 37.Acharya P, Boggess B, Zhang K. Assessing heat stress and health among construction workers in a changing climate: a review. Int J Environ Res Public Health. 2018;15(2) https://doi.org/10.3390/ijerph15020247.PubMedCentralCrossRefPubMedGoogle Scholar
- 38.El-Shafei DA, Bolbol SA, Awad Allah MB, Abdelsalam AE. Exertional heat illness: knowledge and behavior among construction workers. Environ Sci Pollut Res Int. 2018;25(32):32269–76.PubMedCrossRefGoogle Scholar
- 39.Lyle DM, Lewis PR, Richards DA, Richards R, Bauman AE, Sutton JR, et al. Heat exhaustion in the Sun-Herald City to Surf fun run. Med J Aust. 1994;161(6):361–5.PubMedCrossRefPubMedCentralGoogle Scholar
- 40.Richards D, Richards R, Schofield PJ, Ross V, Sutton JR. Management of heat exhaustion in Sydney’s the Sun City-to-Surf run runners. Med J Aust. 1979;2(9):457–61.PubMedCrossRefGoogle Scholar
- 41.Brodeur VB, Dennett SR, Griffin LS. Exertional hyperthermia, ice baths, and emergency care at the Falmouth Road Race. J Emerg Nurs JEN Off Publ Emerg Dep Nurses Assoc. 1989;15(4):304–12.Google Scholar
- 42.DeMartini JK, Casa DJ, Belval LN, Crago A, Davis RJ, Jardine JJ, Stearns RL. Environmental conditions and the occurrence of exertional heat illnesses and exertional heat stroke at the Falmouth road race. J Athl Train. 2014;49(4):478–85.PubMedPubMedCentralCrossRefGoogle Scholar
- 43.Yard EE, Gilchrist J, Haileyesus T, Murphy M, Collins C, McIlvain N, et al. Heat illness among high school athletes—United States, 2005-2009. J Safety Res. 2010;41(6):471–4.PubMedCrossRefGoogle Scholar
- 44.World Health Organization. International statistical classification of diseases and related health problems. 10th revision. Malta: WHO; 2011.Google Scholar
- 45.Weiner JS, Horne GO. A classification of heat illness. A memorandum prepared for the climatic physiology committee of the medical research council. Br Med J. 1958;1:1533–5.CrossRefGoogle Scholar
- 46.Armed Forces Health Surveillance Branch. Armed forces reportable medical events guidelines and case definitions. 2017;39–40.Google Scholar
- 47.DeGroot DW, Mok G, Hathaway NE. International classification of disease coding of exertional heat illness in U.S. Army soldiers. Mil Med. 2017;182(9):e1946–50.PubMedCrossRefGoogle Scholar
- 48.Dickinson JG. Heat illness in the services. J R Army Med Corps. 1994;140(1):7–12.PubMedCrossRefGoogle Scholar
- 49.Casa D, Armstrong L. Exertional heatstroke: a medical emergency. In: Armstrong L, editor. Exertional heat illnesses. Champaign: Human Kinetics; 2003. p. 29–56.Google Scholar
- 50.Hess JJ, Saha S, Luber G. Summertime acute heat illness in U.S. emergency departments from 2006 through 2010: analysis of a nationally representative sample. Environ Health Perspect. 2014;122(11):1209–15.PubMedPubMedCentralCrossRefGoogle Scholar
- 51.Fechter-Leggett ED, Vaidyanathan A, Choudhary E. Heat stress illness emergency department visits in national environmental public health tracking states, 2005–2010. J Community Health. 2016;41(1):57–69.PubMedPubMedCentralCrossRefGoogle Scholar
- 52.Nelson NG, Collins CL, Comstock RD, McKenzie LB. Exertional heat-related injuries treated in emergency departments in the U.S., 1997–2006. Am J Prev Med. 2011;40(1):54–60.PubMedCrossRefGoogle Scholar
- 53.Gifford RM, Todisco T, Stacey M, Fujisawa T, Allerhand M, Woods DR, et al. Risk of heat illness in men and women: a systematic review and meta-analysis. Environ Res. 2019;171:24–35.PubMedCrossRefGoogle Scholar
- 54.Kazman JB, Purvis DL, Heled Y, Lisman P, Atias D, Van Arsdale S, et al. Women and exertional heat illness: identification of gender specific risk factors. US Army Med Dep J. 2015;10(2):58–66.Google Scholar
- 55.Naughton MP, Henderson A, Mirabelli MC, Kaiser R, Wilhelm JL, Kieszak SM, et al. Heat-related mortality during a 1999 heat wave in Chicago. Am J Prev Med. 2002;22(4):221–7.PubMedCrossRefGoogle Scholar
- 56.Xu Z, Sheffield PE, Su H, Wang X, Bi Y, Tong S. The impact of heat waves on children’s health: a systematic review. Int J Biometeorol Int J Biometeorol. 2014;58(2):239–47.PubMedCrossRefGoogle Scholar
- 57.Sherbakov T, Malig B, Guirguis K, Gershunov A, Basu R. Ambient temperature and added heat wave effects on hospitalizations in California from 1999 to 2009. Environ Res. 2018;160:83–90.PubMedCrossRefGoogle Scholar
- 58.Xu Z, Cheng J, Hu W, Tong S. Heatwave and health events: a systematic evaluation of different temperature indicators, heatwave intensities and durations. Sci Total Environ. 2018;630:679–89.PubMedCrossRefGoogle Scholar
- 59.Moore AC, Stacey MJ, Bailey KGH, Bunn RJ, Woods DR, Haworth KJ, et al. Risk factors for heat illness among British soldiers in the hot collective training environment. J R Army Med Corps. 2016;162(6):434–9.PubMedCrossRefGoogle Scholar
- 60.Ellis FP. Heat illness. I. Epidemiology. Trans R Soc Trop Med Hyg. 1976;70(5–6):402–11.PubMedCrossRefGoogle Scholar
- 61.Armed Forces Health Surveillance Branch. Update: heat injuries, active component, U.S. Armed Forces, 2010. MSMR. 2011;18(3):6–8.Google Scholar
- 62.Armed Forces Health Surveillance Branch. Update: heat injuries, active component, U.S. Armed Forces, 2011. MSMR. 2012;19(3):14–6.Google Scholar
- 63.Armed Forces Health Surveillance Branch. Update: Heat injuries, active component, U.S. Armed forces, 2012. MSMR. 2013;20(3):17–20.Google Scholar
- 64.Armed Forces Health Surveillance Branch. Update: Heat injuries, active component, U.S. Armed Forces, 2014. MSMR. 2015;22(3):17–20.Google Scholar
- 65.Armed Forces Health Surveillance Branch. Update: heat injuries, active component, U.S. Army, Navy, Air Force, and Marine Corps, 2015. MSMR. 2016;23(3):16–9.PubMedGoogle Scholar
- 66.Armed Forces Health Surveillance Branch. Update: Heat illness, active component, U.S. Armed Forces, 2016. MSMR. 2017;24(3):9–13.Google Scholar
- 67.Armed Forces Health Surveillance Branch. Update: Heat illness, active component, U.S. Armed Forces, 2017. MSMR. 2018;25(4):6–12.Google Scholar
- 68.Bedno SA, Urban N, Boivin MR, Cowan DN. Fitness, obesity and risk of heat illness among army trainees. Occup Med Oxf Engl. 2014;64(6):461–7.CrossRefGoogle Scholar
- 69.Adams WM. Exertional heat stroke within secondary school athletics. Curr Sports Med Rep. 2019;18(4):149–53.PubMedCrossRefGoogle Scholar
- 70.Yeargin SW, Dompier TP, Casa DJ, Hirschhorn RM, Kerr ZY. Epidemiology of exertional heat illnesses in national collegiate athletic association athletes during the 2009–2010 through 2014–2015 academic years. J Athl Train. 2019;54(1):55–63.PubMedCrossRefGoogle Scholar
- 71.Armstrong LE, Johnson EC, Casa DJ, Ganio MS, McDermott BP, Yamamoto LM, et al. The American football uniform: uncompensable heat stress and hyperthermic exhaustion. J Athl Train. 2010;45(2):117–27.PubMedPubMedCentralCrossRefGoogle Scholar
- 72.Kucera KL, Klossner D, Colgate B, Cantu RC. Annual survey of football injury research. Report no.: 2018–01. Chapel Hill: University of North Carolina Chapel Hill; 2018. p. 1–38.Google Scholar
- 73.Adams WM, Hosokawa Y, Huggins RA, Mazerolle SM, Casa DJ. An exertional heat stroke survivor’s return to running: an integrated approach on the treatment, recovery, and return to activity. J Sport Rehabil. 2016;25(3):280–7.PubMedCrossRefGoogle Scholar
- 74.Schwellnus M, Kipps C, Roberts WO, Drezner JA, D’Hemecourt P, Troyanos C, et al. Medical encounters (including injury and illness) at mass community-based endurance sports events: an international consensus statement on definitions and methods of data recording and reporting. Br J Sports Med. 2019; https://doi.org/10.1136/bjsports-2018-100092. [Epub ahead of print].PubMedCrossRefGoogle Scholar
- 75.Roberts WO, Dorman JC, Bergeron MF. Recurrent heat stroke in a runner: race simulation testing for return to activity. Med Sci Sports Exerc. 2016;48(5):785–9.PubMedCrossRefGoogle Scholar
- 76.Sloan BK, Kraft EM, Clark D, Schmeissing SW, Byrne BC, Rusyniak DE. On-site treatment of exertional heat stroke. Am J Sports Med. 2015;43(4):823–9.PubMedCrossRefGoogle Scholar
- 77.Hostler D, Franco V, Martin-Gill C, Roth RN. Recognition and treatment of exertional heat illness at a marathon race. Prehosp Emerg Care. 2014;18(3):456–9.PubMedCrossRefGoogle Scholar
- 78.Noakes T, Mekler J, Pedoe DT. Jim Peters’ collapse in the 1954 Vancouver Empire Games marathon. South Afr Med J. 2008;98(8):596–600.Google Scholar
- 79.Rae DE, Knobel GJ, Mann T, Swart J, Tucker R, Noakes TD. Heatstroke during endurance exercise: is there evidence for excessive endothermy? Med Sci Sports Exerc. 2008;40(7):1193–204.PubMedCrossRefGoogle Scholar
- 80.Johnson EC, Kolkhorst FW, Richburg A, Schmitz A, Martinez J, Armstrong LE. Specific exercise heat stress protocol for a triathlete’s return from exertional heat stroke. Curr Sports Med Rep. 2013;12(2):106–9.PubMedCrossRefGoogle Scholar
- 81.Gosling CM, Forbes AB, McGivern J, Gabbe BJ. A profile of injuries in athletes seeking treatment during a triathlon race series. Am J Sports Med. 2010;38(5):1007–14.PubMedCrossRefGoogle Scholar
- 82.Gosling CM, Gabbe BJ, McGivern J, Forbes AB. The incidence of heat casualties in sprint triathlon: the tale of two Melbourne race events. J Sci Med Sport. 2008;11(1):52–7.PubMedCrossRefGoogle Scholar
- 83.Hosokawa Y, Adams WM, Belval LN, Davis RJ, Huggins RA, Jardine JF, et al. Exertional heat illness incidence and on-site medical team preparedness in warm weather. Int J Biometeorol. 2018;62(7):1147–53.PubMedCrossRefGoogle Scholar
- 84.Weaving EA, Berro VE, Kew MC. Heat stroke during a “run for fun”: a case report. South Afr Med J. 1980;57(18):753–4.Google Scholar
- 85.Smith R, Jones N, Martin D, Kipps C. “Too much of a coincidence”: identical twins with exertional heatstroke in the same race. BMJ Case Rep. 2016;2016 https://doi.org/10.1136/bcr-2015-212592.
- 86.Roberts WO. Exertional heat stroke during a cool weather marathon: a case study. Med Sci Sports Exerc. 2006;38(7):1197–203.PubMedCrossRefGoogle Scholar
- 87.Hanson PG, Zimmerman SW. Exertional heatstroke in novice runners. JAMA. 1979;242(2):154–7.PubMedCrossRefGoogle Scholar
- 88.McEntire SJ, Suyama J, Hostler D. Mitigation and prevention of exertional heat stress in firefighters: a review of cooling strategies for structural firefighting and hazardous materials responders. Prehosp Emerg Care. 2013;17(2):241–60.PubMedCrossRefGoogle Scholar
- 89.Petruzzello SJ, Gapin JI, Snook E, Smith DL. Perceptual and physiological heat strain: examination in firefighters in laboratory- and field-based studies. Ergonomics. 2009;52(6):747–54.PubMedCrossRefGoogle Scholar
- 90.Cheung SS, Petersen SR, McLellan TM. Physiological strain and countermeasures with firefighting. Scand J Med Sci Sports. 2010;20(Suppl 3):103–16.PubMedCrossRefGoogle Scholar
- 91.Hollowell DR. Perceptions of, and reactions to, environmental heat: a brief note on issues of concern in relation to occupational health. Glob Health Action. 2010;3:5632. https://doi.org/10.3402/gha.v3i0.5632.CrossRefGoogle Scholar
- 92.Lucas RAI, Epstein Y, Kjellstrom T. Excessive occupational heat exposure: a significant ergonomic challenge and health risk for current and future workers. Extreme Physiol Med. 2014;3:14.CrossRefGoogle Scholar
- 93.Fortune MK, Mustard CA, Etches JJC, Chambers AG. Work-attributed illness arising from excess heat exposure in Ontario, 2004–2010. Can J Public Health. 2013;104(5):e420–6.PubMedCrossRefGoogle Scholar
- 94.Riley K, Wilhalme H, Delp L, Eisenman DP. Mortality and morbidity during extreme heat events and prevalence of outdoor work: an analysis of community-level data from Los Angeles County, California. Int J Environ Res Public Health. 2018;15(4):E580.PubMedCentralCrossRefPubMedGoogle Scholar
- 95.Petitti DB, Harlan SL, Chowell-Puente G, Ruddell D. Occupation and environmental heat-associated deaths in Maricopa county, Arizona: a case-control study. PLoS One. 2013;8(5):e62596.PubMedPubMedCentralCrossRefGoogle Scholar
- 96.Xiang J, Hansen A, Pisaniello D, Bi P. Extreme heat and occupational heat illnesses in South Australia, 2001–2010. Occup Environ Med. 2015;72(8):580–6.PubMedCrossRefGoogle Scholar
- 97.Harduar Morano L, Watkins S, Kintziger K. A comprehensive evaluation of the burden of heat-related illness and death within the Florida Population. Int J Environ Res Public Health. 2016;31:13(6).Google Scholar
- 98.Tustin AW, Lamson GE, Jacklitsch BL, Thomas RJ, Arbury SB, Cannon DL, et al. Evaluation of occupational exposure limits for heat stress in outdoor workers—United States, 2011–2016. MMWR Morb Mortal Wkly Rep. 2018;67(26):733–7.PubMedPubMedCentralCrossRefGoogle Scholar