Overview of Exertional Heat Illness

  • William M. AdamsEmail author
  • John F. Jardine


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.


Nomenclature Classification Epidemiology Incidence Exertional heat stroke Physical activity 


  1. 1.
    A Roman experience with heat stroke in 24 B.C. Bull N Y Acad Med. 1967;43(8):767–8.Google Scholar
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. [Epub ahead of print].
  24. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 34.
    Donoghue AM. Heat illness in the U.S. mining industry. Am J Ind Med. 2004;45(4):351–6.PubMedCrossRefGoogle Scholar
  35. 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. 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. 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) Scholar
  38. 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. 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. 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. 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. 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. 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. 44.
    World Health Organization. International statistical classification of diseases and related health problems. 10th revision. Malta: WHO; 2011.Google Scholar
  45. 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. 46.
    Armed Forces Health Surveillance Branch. Armed forces reportable medical events guidelines and case definitions. 2017;39–40.Google Scholar
  47. 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. 48.
    Dickinson JG. Heat illness in the services. J R Army Med Corps. 1994;140(1):7–12.PubMedCrossRefGoogle Scholar
  49. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 60.
    Ellis FP. Heat illness. I. Epidemiology. Trans R Soc Trop Med Hyg. 1976;70(5–6):402–11.PubMedCrossRefGoogle Scholar
  61. 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. 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. 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. 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. 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. 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. 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. 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. 69.
    Adams WM. Exertional heat stroke within secondary school athletics. Curr Sports Med Rep. 2019;18(4):149–53.PubMedCrossRefGoogle Scholar
  70. 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. 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. 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. 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. 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; [Epub ahead of print].PubMedCrossRefGoogle Scholar
  75. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
  86. 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. 87.
    Hanson PG, Zimmerman SW. Exertional heatstroke in novice runners. JAMA. 1979;242(2):154–7.PubMedCrossRefGoogle Scholar
  88. 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. 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. 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. 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. Scholar
  92. 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. 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. 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. 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. 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. 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. 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

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of KinesiologyUniversity of North Carolina at GreensboroGreensboroUSA
  2. 2.Korey Stringer InstituteUniversity of ConnecticutStorrsUSA

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