Koo Caitlyn J, Hintz Courtney, Butler Cody R
F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD 20814, USA.
Special Warfare Training Wing, Special Warfare Human Performance Support Group, JBSA-Lackland, TX 78236, USA.
Mil Med. 2024 May 18;189(5-6):e1312-e1317. doi: 10.1093/milmed/usad388.
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.
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.
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).
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.
劳力性热射病（EHS）表现为极度体温过高和中枢神经系统功能改变，对军队影响尤为严重，因为作战人员需要在各种环境条件下执行任务。由于对EHS个体恢复情况的了解不全面，目前关于EHS后重返工作岗位（RTD）的指导存在若干缺陷。本文的目的是提供一份关于EHS后重返工作岗位最佳实践的最新文献综述，以指导有关EHS的决策，并为与作战人员共事的医务人员探索未来研究领域。
使用PubMed和Covidence对运动员和军队人群中与EHS相关的文献以及任何现有的RTD指南进行了综述。
本次关于EHS和RTD的最新综述共纳入21篇文章，建议聚焦于EHS事件期间和之后，以及热耐受测试（HTT）的作用。
如果不迅速治疗，EHS的发病率和死亡率很高。由于终末器官损伤的程度取决于个体体温过高的时间，通过直肠测温进行快速诊断以及有效的降温方法对于EHS患者的健康至关重要。EHS后，应在作战需求范围内实施逐步的RTD建议，以降低后续热损伤事件的风险。虽然已经制定了许多版本的HTT，最著名的是以色列国防军（IDF）方案，以指导RTD建议，但尚未采用通用的热耐受评估方法。因此，医务人员应采用多因素方法以确保安全的RTD。
