School of Medicine, Uniformed Services University, Bethesda, MD,USA.
Special Warfare Human Performance Support Group, Lackland, TX,USA.
J Sport Rehabil. 2023 Jun 7;32(6):719-724. doi: 10.1123/jsr.2022-0324. Print 2023 Aug 1.
Exertional heat stroke (EHS) is the most deadly form the exertional heat illness with a higher incidence among active duty US military members than in the general population. Current guidelines on EHS recovery timelines and return to duty vary among the military branches. In some cases, individuals experience prolonged heat and exercise intolerance with repeat exertional heat illness events, which can complicate the recovery process. Management and rehabilitation of such individuals is unclear.
This manuscript addresses the case and management of a US Air Force Special Warfare trainee who experienced 2 episodes of EHS, despite early recognition, gold standard treatment, and undergoing 4 weeks of a stepwise recovery after an initial EHS.
After the second episode, a 3-step process was utilized, consisting of a prolonged and personalized recovery period, heat tolerance testing using Israeli Defense Force advanced modeling, and stepwise reacclimatization. This process allowed the trainee to successfully recover from repeat EHS and return to duty, and set a framework for future repeat EHS treatment guidelines.
In individuals with repeat EHS, a prolonged recovery period followed by heat tolerance testing can be used to demonstrate appropriate thermotolerance and safely clear an individual to begin stepwise reacclimatization. Overall, patient care and military readiness may be improved by unified Department of Defense guidelines for return to duty after EHS.
体力性热射病（EHS）是最致命的体力性热疾病形式，在美国现役军人中的发病率高于普通人群。目前，关于 EHS 恢复时间和重返现役的指南因军种而异。在某些情况下，个体经历反复的体力性热不耐受和热射病事件，这可能使恢复过程复杂化。此类个体的管理和康复尚不清楚。
本文介绍了一名美国空军特种作战受训人员的病例和管理情况，尽管他早期得到了识别、采用了金标准治疗，并在初次 EHS 后进行了 4 周的逐步恢复，但仍经历了 2 次 EHS。
第二次发作后，采用了 3 步处理过程，包括延长和个性化的恢复期、使用以色列国防军先进建模进行耐热性测试，以及逐步复温。这一过程使受训人员成功地从反复的 EHS 中恢复并重返现役，并为未来的反复 EHS 治疗指南制定了框架。
对于反复发生 EHS 的个体，延长恢复期后进行耐热性测试可用于证明适当的耐热性，并安全地清除个体，开始逐步复温。总体而言，通过制定统一的国防部 EHS 后重返现役指南，可能会提高患者护理和军队战备水平。
