DeGroot David W, Ruby Brent, Koo Alex, O'Connor Francis G
The Army Heat Center, Martin Army Community Hospital, Fort Benning, GA.
Montana Center for Work Physiology and Exercise Metabolism, University of Montana, Missoula, MT.
Wilderness Environ Med. 2025 Sep;36(3):397-404. doi: 10.1177/10806032251332283. Epub 2025 Apr 22.
Austere environments present unique challenges concerning the prevention and treatment of exertional heat-illness patients that may greatly increase the risks of morbidity and mortality. For athletes, occupational groups, and others who may work, train, or compete in austere environments, proper preparation and planning may be lifesaving. The roles of acclimatization and hydration are often emphasized in the literature, but other important risk factors may be overlooked. Work capacity, especially aerobic work capacity, will always be reduced in hot environments, and individuals should understand that simply slowing down, to reduce metabolic heat production, can be considered the universal precaution to mitigate heat stress and strain. Conversely, appropriate rehydration alone does not mitigate other risk factors, such as metabolic heat production, high ambient temperature, or inadequate physical fitness. Risk factor-specific mitigation recommendations are provided, and areas where additional research is needed are identified. The ability to recognize the signs and symptoms of heat illness early in the progression of illness is especially important in austere environments due to the possibility of delayed access to higher levels of medical care. Treatment considerations in austere environments include knowledge of availability and effectiveness of cooling modalities such as natural bodies of water. Medications such as antipyretics, dantrolene, and nonsteroidal anti-inflammatory drugs are not recommended to treat a suspected heat casualty. Aggressive cooling, with the objective of reducing core temperature to <39°C within 30-min, is the treatment priority.
严峻环境给劳力性热射病患者的预防和治疗带来了独特挑战，这可能会大幅增加发病和死亡风险。对于运动员、职业群体以及其他可能在严峻环境中工作、训练或比赛的人来说，适当的准备和规划可能会挽救生命。文献中经常强调适应环境和补水的作用，但其他重要的风险因素可能被忽视。在炎热环境中，工作能力，尤其是有氧运动能力，总会下降，个人应该明白，简单地放慢速度以减少代谢产热，可以被视为减轻热应激和热负荷的通用预防措施。相反，单纯适当补水并不能减轻其他风险因素，如代谢产热、高环境温度或身体素质不佳。本文提供了针对特定风险因素的缓解建议，并确定了需要进一步研究的领域。在严峻环境中，由于可能延迟获得更高水平的医疗救治，在疾病进展早期识别热射病的体征和症状的能力尤为重要。严峻环境中的治疗考虑因素包括了解诸如天然水体等降温方式的可用性和有效性。不建议使用退烧药、丹曲林和非甾体抗炎药等药物治疗疑似热射病患者。积极降温，目标是在30分钟内将核心体温降至<39°C，是治疗的首要任务。
