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PERSPECTIVE article
Front. Physiol.
Sec. Environmental, Aviation and Space Physiology
Volume 16 - 2025 | doi: 10.3389/fphys.2025.1456984
Exertional Heat Illness: International military-oriented lessons learned and best practices for prevention and management
Provisionally accepted
Yoram Epstein 1,2 Nisha Charkoudian 3 David DeGroot 4
Carol House 5
Itay Ketko 2 Lydia Law 6
Alexandra Malgoyre 7 Francis O'Connor 8
Omar Tayari 5
Jason Kai Wei Lee 6*- 1 Tel Aviv University, Tel Aviv, Tel Aviv, Israel
- 2 Institute of Military Physiology, Israel Defense Forces Medical Corps, Tel Hashomer, Israel
- 3 US Army Research Institute of Environmental Medicine (USARIEM), Natick, Massachusetts, United States
- 4 United States Army Heat Centre, Georgia, United States
- 5 UK Armed Forces Heat Illness Clinic, Portsmouth, United Kingdom
- 6 Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- 7 Institut de Recherche Biomédicale des Armées (IRBA), Bretigny sur Orge, France
- 8 Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States
Climate change has resulted in more frequent and intense heat waves, leading to elevated global temperatures and posing a significant health threat to individuals working in hot environments such as military personnel, emergency responders, athletes, and outdoor workers. Ensuring both safety and performance, alongside the increasing risk of exertional heat illnesses (EHI) due to rising temperatures, is hence even more crucial. Extensive research conducted over many years has aimed to understand the causes and impacts of EHI and develop prevention and treatment strategies. This review summarizes the research on the impacts of heat on health and performance in military settings, consolidates evidence-based strategies for EHI prevention and pre-hospital management, summarizes sex differences in heat tolerance, and discusses best practices for recovery and return to duty post-EHI. The aim is to share the knowledge and practices derived from military research to protect the health and performance of individuals in various populations exposed to heat.
Keywords: Climate Change, Exertion, heat tolerance, Exertional heat stroke, military
Received: 29 Jun 2024; Accepted: 11 Feb 2025.
Copyright: © 2025 Epstein, Charkoudian, DeGroot, House, Ketko, Law, Malgoyre, O'Connor, Tayari and Lee. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jason Kai Wei Lee, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
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