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Fatal Exertional Heat Stroke: A Case Series

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ABSTRACT

Background

Exertional heat stroke (EHS) is one of the most serious conditions that occur when excess heat, generated by muscular exercise, exceeds the body’s heat-dissipation rate. The consequent elevated body core temperature causes damage to the body’s tissues, resulting in a characteristic multiorgan syndrome, which is occasionally fatal.

Methods

We analyzed the fatal EHS cases that occurred in the Israeli Defence Forces during the last decade according to Minard’s paradigm for evaluation of EHS predisposing factors, aiming to characterize the common features and unique circumstances leading to fatality.

Results

Accumulation of predisposing factors, particularly those concerning training regulations, coupled with inappropriate treatment at site, were found to be strong predictors of a grave prognosis. Analysis of the pathologic findings of the fatal EHS cases on autopsy revealed a possible association between the duration and length of exercise prior to EHS occurrence and the extent of pathologic findings.

Conclusions

Strict adherence to existing training regulations may prevent further heat stroke fatalities.

Section snippets

Methods

During the years 1992 through 2002, the Heller Institute was informed of every suspected case of heat stroke in the IDF. In each case, a preliminary investigation to establish the diagnosis and examine the circumstances leading to the heat stroke illness was initiated. Diagnosis was confirmed in 134 cases; six of these cases were fatal. The diagnosis of EHS was based on a composite picture including extreme body core temperature elevations, central nervous system disturbances, and hematologic

Discussion

Exertional heat stroke is a threat to all who engage in vigorous physical training. It is particularly of concern in military situations, where the combination of heavy exertion coupled with overmotivation and peer pressure may prove to be detrimental. The classic picture of the fatal EHS cases in our study consists of a highly motivated individual who participates in badly organized military training and exerts himself beyond his capability. Furthermore, in some of the cases, once EHS

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    They were also in good health and predominantly male. Note that the median age of patients with EHS was higher in our study than in studies conducted in the military setting [9–11]. One or more personal or behavioural risk factors were found in 93.3% of patients with EHS, including level of physical fitness (40% of patients had a regular physical activity), overweight, lack of hydration during exercise and lack of heat acclimatization.

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