DÄ internationalArchive31-32/2019Health risks and interventions in exertional heat stress

Review article

Health risks and interventions in exertional heat stress

Dtsch Arztebl Int 2019; 116: 537-44. DOI: 10.3238/arztebl.2019.0537

Leyk, D

For technical reasons, the English full text will be published approximately two weeks after the German print edition has been published.

Institut für Präventivmedizin der Bundeswehr: Oberstarzt Prof. Dr. med. Dr. Sportwiss. Dieter Leyk, Dr. rer. medic. Karl Jochen Glitz
Deutsche Sporthochschule Köln: Prof. Dr. med. Dr. Sportwiss. Dieter Leyk
Bundeswehrkrankenhaus Hamburg: Generalarzt Dr. med. Joachim Hoitz
Abteilung Geriatrie und Geriatrische Rehabilitation des Robert-Bosch-Krankenhauses Stuttgart: Prof. Dr. med. Clemens Becker
Bundeswehrzentralkrankenhaus Koblenz: Oberstabsarzt Dr. med. Kai Nestler
Institut und Poliklinik für Arbeitsmedizin, Umweltmedizin und Präventionsforschung der Universität zu Köln: Prof. Dr. med. Claus Piekarski
1.Leyk D: Körperliche Arbeit bei Hitzestress: Eine oft unterschätzte Belastung und Gefahr. Wehrmed Mschr 2018; 62: 354–6.
2.Bedno SA, Li Y, Han W, et al.: Exertional heat illness among overweight U.S. Army recruits in basic training. Aviat Space Environ Med 2010; 81: 107–11 CrossRef
3.Epstein Y, Moran DS, Shapiro Y: Exertional heatstroke in the Israeli defence forces. In: Pandolf KB, Burr RE (eds.): Textbooks of military medicine. Volume 1: Medical aspects of harsh environments. Falls Church: Office of the Surgeon General 2001; 281–92.
4.Israel S: Thermoregulation und Wasserhaushalt. In: Badtke G, Bittmann F (eds.): Lehrbuch der Sportmedizin. 4th edition. Heidelberg: Barth 1999; 268–76.
5.Galloway SD, Maughan RJ: Effects of ambient temperature on the capacity to perform prolonged cycle exercise in man. Med Sci Sports Exerc 1997; 29: 1240–9 CrossRef
6.Racinais S, Moussay S, Nichols D, et al.: Core temperature up to 41.5 º C during the UCI Road Cycling World Championships in the
heat. Br J Sports Med 2019; 53: 426–9 CrossRef MEDLINE
7.Lucas RAI, Epstein Y, Kjellstrom T: Excessive occupational heat exposure: a significant ergonomic challenge and health risk for current and future workers. Extrem Physiol Med 2014; 3: 1–8 CrossRef MEDLINE PubMed Central
8.Xiang J, Bi P, Pisaniello D, Hansen A: Health impacts of workplace heat exposure. An epidemiological review. Ind Health 2014; 52: 91–101 CrossRef MEDLINE PubMed Central
9.Epstein Y, Druyan A, Heled Y: Heat injury prevention—a military perspective. J Strength Condit Res 2012; 26: 82–6.
10.Cheuvront SN, Haymes EM: Thermoregulation and marathon running: biological and environmental influences. Sports Med 2001; 31: 743–62 CrossRef MEDLINE
11.Veltmeijer MTW, Eijsvogels TMH, Thijssen DHJ, Hopman MTE: Incidence and predictors of exertional hyperthermia after a 15-km road race in cool environmental conditions. J Sci Med Sport 2015; 18: 333–7 CrossRef MEDLINE
12.Schickele E: Environment and fatal heat stroke. War II. An analysis of 157 cases occurring in the army in the U.S. during World War II. Military Surgeon 1947; 100: 235–56 CrossRef
13.Cassuto Y, Israeli R, Gertner A: Accumulated effects of work under
heat stress final report. Beersheba: Beer Sheva Ben Gurion University of the Negev 1980.
14.Gardner JW, Kark JA, Karnei K, et al.: Risk factors predicting exertional heat illness in male marine corps recruits. Med Sci Sports Exerc 1996; 28: 939–44 CrossRef
15.Moore AC, Stacey MJ, Bailey KGH, et al.: Risk factors for heat illness among British soldiers in the hot collective training environment. J R Army Med Corps 2016; 162: 434–9 CrossRef MEDLINE PubMed Central
16.Glitz KJ, Gorges W, Leyk D, Piekarski C: Arbeit unter klimatischer Belastung: Hitze. LEITLINIE. In: Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin e. V. (DGAUM) (ed.): Leitlinien der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin e. V. AWMF online – Das Portal der wissenschaftlichen Medizin 2012.
17.Gaffin SL, Hubbard RW: Pathophysiology of heatstroke. In: Pandolf KB, Burr RE (eds.): Textbooks of military medicine. Volume 1: medical aspects of harsh environments. Falls Church: Office of the Surgeon General 2001; 161–208.
18.Glitz KJ, Leyk D: Der Schlag der Hitze. Präventionsmaßnahmen eines Hitzemanagements. Wehrmed Wehrpharm 2016; 16: 95–7.
19.Sawka MN, Pandolf KB: Physical exercise in hot climates: physiology, performance, and biomedical issues. In: Pandolf KB, Burr RE (eds.): Textbooks of military medicine. Volume 1: medical aspects of harsh environments. Falls Church: Office of the Surgeon General 2001; 87–133.
20.Rintamäki H, Rissanen S: Heat strain in cold. Ind Health 2006; 44: 427–32 CrossRef MEDLINE
21.Di Prampero PE: Energetics of muscular exercise. Rev Physiol Biochem Pharmacol 1981; 89: 143–222.
22.Margaria R, Cerretelli P, Aghemo P, Sassi G: Energy cost of running. J Appl Physiol 1963; 18: 367–70 CrossRef MEDLINE
23.Noakes TD: A modern classification of the exercise-related heat illnesses. J Sci Med Sport 2008; 11: 33–9.
24.Smith J, Wallis L: Cooling methods used in the treatment of exertional heat illness. Br J Sports Med 2005; 39: 503–7.
25.Spitzer H, Hettinger T, Kaminsky G: Tafeln für den Energieumsatz bei körperlicher Arbeit. 6th edition. Berlin, Köln: Beuth Verlag 1982.
26.Stegemann J: Leistungsphysiologie: Physiologische Grundlagen der Arbeit und des Sports. Stuttgart: Thieme 1977.
27.Glitz KJ, Seibel U, Gorges W, Witzki A, Piekarski C, Leyk D: Reducing heat stress under thermal insulation in protective clothing: microclimate cooling by a ‘physiological’ method. Ergonomics 2015; 58: 1461–9 CrossRef MEDLINE
28.Dorman LE, Havenith G: The effects of protective clothing on energy consumption during different activities. Eur J Appl Physiol 2009; 105: 463–70 CrossRef MEDLINE
29.Glitz KJ, Seibel U, Gorges W, Piekarski C, Leyk D: Gesundheit und Leistung im Klima. 1. Mitteilung: Hitze. Wehrmed Mschr 2011; 55: 290–4.
30.Lee JH, Kim YK, Kim KS, Kim S: Estimating clothing thermal insulation using an infrared camera. Sensors 2016; 16: 341 CrossRef MEDLINE PubMed Central
31.Yaglou CP, Minard D: Control of heat casualties at military training centers. AMA Arch Ind Health 1957; 16: 302–16.
32.Stacey M, Woods D, Ross D, Wilson D: Heat illness in military populations: asking the right questions for research. J R Army Med Corps 2014; 160: 121–4 CrossRef MEDLINE
33.DIN (Deutsches Institut für Normung e. V): DIN EN ISO 7243: Ergonomie der thermischen Umgebung – Ermittlung der Wärmebelastung durch den WBGT-Index (wet bulb globe temperature); 13.100(7243). Berlin: Beuth Verlag GmbH 2017
34.Armstrong LE, Casa JD, Millard-Stafford M, Moran DS, Pyne WS, Roberts OW: Exertional heat illness during training and competition. Med Sci Sports Exerc 2007; 39: 556–72 CrossRef MEDLINE
35.Wenzel HG, Piekarski C: Klima und Arbeit. München: Bayerisches Staatsministerium für Arbeit und Sozialordnung 1982.
36.Casa DJ, DeMartini JK, Bergeron MF, et al.: National athletic trainers‘ association position statement: exertional heat illnesses. JAT 2015; 50: 986–1000 CrossRef PubMed Central
37.Périard JD, Racinais S, Sawka MN: Adaptations and mechanisms of human heat acclimation: applications for competitive athletes and sports. Scand J Med Sci Sports 2015; 25: 20–38 CrossRef MEDLINE
38.Sawka MN, Castellani JW, Pandolf KB, Young AJ: Human adaptations to heat and cold stress. In: North Atlantic Treaty Organization (NATO) (ed.): RTO HFM Symposium on „Blowing Hot and Cold: Protecting Against Climatic Extremes“. Dresden 2002; KN4–1–15.
39.Racinais S, Alonso JM, Coutts AJ, et al.: Consensus recommendations on training and competing in the heat. Scand J Med Sci Sports 2015; 25: 6–19.
40.Huonker M: Hitzeerkrankungen beim Sport – Prophylaxe und Therapie. Dtsch Z Sportmed 2003; 54: 122–3.
e1.Robine JM, Cheung SLK, Le Roy S, et al.: Death toll exceeded 70,000 in Europe during the summer of 2003. C R Biol 2008; 331: 171–8.
e2.Barriopedro D, Fischer EM, Luterbacher J, Trigo RM, García-Herrera R: The hot summer of 2010. Redrawing the temperature record map of Europe. Science 2011; 332: 220–4 CrossRefMEDLINE
e3.Bund/Länder Ad-hoc Arbeitsgruppe, Gesundheitliche Anpassung an die Folgen des Klimawandels (GAK): Handlungsempfehlungen für die Erstellung von Hitzeaktionsplänen zum Schutz der menschlichen Gesundheit. Bundesgesundheitsblatt 2017; 60: 662–72.
e4.Merte S: Estimating heat wave-related mortality in Europe using singular spectrum analysis. Climatic Change 2017; 142: 321–30 CrossRef
e5.Deutscher Wetterdienst: Hitzewellen. www.dwd.de/DE/service/lexikon/Functions/glossar.html?lv2=101094&lv3=624852 (last accessed on 4 July 2019).
e6.Sévellec F, Drijfhout SS: A novel probabilistic forecast system predicting anomalously warm 2018–2022 reinforcing the long-term global warming trend. Nat Commun 2018; 9: 3024 CrossRefCrossRef PubMed Central
e7.Åstrand PO, Rodahl K (eds.): Textbook of work physiology: physiological bases of exercise. New York: McGraw-Hill 1986.
e8.Nielsen M: Die Regulation der Körpertemperatur bei Muskelarbeit. Skand Arch Physiol 1938; 79: 193–230 CrossRef
e9.Bittner MI: Auswirkungen von Hitzewellen auf die Mortalität in Deutschland [Effects of heat waves on mortality in Germany]. Gesundheitswesen 2014; 76: 508–12 CrossRef MEDLINE
e10.Holst F: Konditionstraining unter Hitzeakklimatisation. In: Jelinek T (ed.): Kursbuch Reisemedizin. Stuttgart: Georg Thieme Verlag 2012; 276–7.
e11.Armstrong LE, Maresh CM: The induction and decay of heat acclimatisation in trained athletes. Sports Med 1991; 12: 302–12 CrossRefMEDLINE
e12.Taylor NAS: Human heat adaptation. Compr Physiol 2014; 4: 325–65.
e13.Bytomski JR, Squire DL: Heat illness in children. Curr Sports Med Rep 2003; 2: 320–4 CrossRefMEDLINE
e14.Bar-Or O: Children and physical performance in warm and cold environments. In: Boileau RA (ed.): Advances in pediatric sport sciences. Vol 1: Biological issues. Champaign: Human Kinetics Publishers 1984; 117–30.
e15.Müller S, Thöns M: Memorix Kindernotfälle. Stuttgart: Georg Thieme Verlag 2019.
e16.Falk B, Dotan R: Children’s thermoregulation during exercise in the heat—a revisit. Appl Physiol Nutr Metab 2008, 33: 420–7 CrossRefMEDLINE
e17.Frye AJ, Kamon E: Sweating efficiency in acclimated men and women exercising in humid and dry heat. J Appl Physiol Respir Environ Exerc Physiol 1983; 54: 972–7 CrossRef MEDLINE
e18.Plowman SA, Smith DL: Exercise physiology for health, fitness, and performance. 4th edition. Philadelphia: Lippincott Williams & Wilkins Health 1997.
e19.Shapiro Y, Pandolf KB, Avellini BA, Pimental NA, Goldman RF: Heat balance and transfer in men and women exercising in hot—dry and hot—wet conditions. Ergonomics 1981; 24: 375–86 CrossRefMEDLINE
e20.Sidman RD, Gallagher EJ: Exertional heat stroke in a young woman. Gender differences in response to thermal stress. Acad Emerg Med 1995; 2: 315–9 CrossRefMEDLINE
e21.Marsh SA, Jenkins DG: Physiological responses to the menstrual cycle: implications for the development of heat illness in female athletes. Sports Med 2002; 32: 601–14 CrossRefMEDLINE
e22.An der Heiden M, Muthers S, Niemann H, Buchholz U, Grabenhenrich L, Matzarakis A: Schätzung hitzebedingter Todesfälle in Deutschland zwischen 2001 und 2015 [Estimation of heat-related deaths in Germany between 2001 and 2015]. Bundesgesundheitsblatt 2019; 62: 571–9 CrossRefMEDLINE
e23.Bouchama A, Dehbi M, Chaves-Carballo E: Cooling and hemodynamic management in heatstroke. Practical recommendations. Crit Care 2007; 11: R54.
e24.Bunker A, Wildenhain J, Vandenbergh A, et al.: Effects of air temperature on climate-sensitive mortality and morbidity outcomes in the elderly. A systematic review and meta-analysis of epidemiological evidence. EBioMedicine 2016; 6: 258–68 CrossRef MEDLINEPubMed Central
e25.Siebert H, Uphoff H, Grewe HA: Monitoring hitzebedingter Sterblichkeit in Hessen [Monitoring heat-related mortality in Hesse]. Bundesgesundheitsblatt 2019; 62: 580–8 CrossRef MEDLINE
e26.Herrmann A, Haefeli WE, Lindemann U, Rapp K, Roik P, Becker C: Hitzebedingte Gesundheitsschäden älterer Menschen – Epidemiologie und Prävention. Z Geront Geriat 2019; Accepted for Publication.
e27.Fenske NA, Lober CW: Structural and functional changes of normal aging skin. J Am Acad Dermatol 1986; 15: 571–85.
e28.Tsuchida Y: Age-related changes in skin blood flow at four anatomic sites of the body in males studied by xenon-133. Plast Reconstr Surg 1990; 85: 556–61 CrossRefMEDLINE
e29.Bar-Or O: Effects of age and gender on sweating pattern during exercise. Int J Sports Med 1998; 19 (Suppl 2): S106–7.
e30.Anderson RK, Kenney WL: Effect of age on heat-activated sweat gland density and flow during exercise in dry heat. J Appl Physiol 1987; 63: 1089–94 CrossRef MEDLINE
e31.Ho CW, Beard JL, Farrell PA, Minson CT, Kenney WL: Age, fitness, and regional blood flow during exercise in the heat. J Appl Physiol 1997; 82: 1126–35 CrossRefMEDLINE
e32.Braga AL, Zanobetti A, Schwartz J: The time course of weather-related deaths. Epidemiology 2001; 12: 662–7.
e33.Flynn A, McGreevy C, Mulkerrin EC: Why do older patients die in a heatwave? QJM 2005; 98: 227–9 CrossRefMEDLINE
e34.Becker C, Haefeli WE, Herrmann A, Rapp K, Lindemann U: Prävention hitzebedingter Risiken bei älteren Menschen: Vermeidung von hitzebedingter Übersterblichkeit. ÄBW 2018; 47: 362–3.
e35.Vanakoski J, Seppälä T: Heat exposure and drugs. A review of the effects of hyperthermia on pharmacokinetics. Clinical Pharmacokinetics 1998; 34: 311–22 CrossRefMEDLINE
e36.Westaway K, Frank O, Husband A, et al.: Medicines can affect thermoregulation and accentuate the risk of dehydration and heat-related illness during hot weather. J Clin Pharm Ther 2015; 40: 363–7.
e37.Kraft U: Gesundheitsrisiken in Hitzeperioden. Fulda 2015.
e38.Lõhmus M: Possible biological mechanisms linking mental health and heat—a contemplative review. Int J Environ Res Public Health 2018; 15: 1515 CrossRefCrossRefPubMed Central
e39.Cheshire WP, Fealey RD: Drug-induced hyperhidrosis and hypohidrosis: incidence, prevention and management. Drug Saf 2008; 31: 109–26 CrossRe MEDLINE
e40.Ashburn MA, Ogden LL, Zhang J, Love G, Basta SV: The pharmacokinetics of transdermal fentanyl delivered with and without controlled heat. J Pain 2003; 4: 291–7 CrossRef
e41.Bedno SA, Urban N, Boivin MR, Cowan DN: Fitness, obesity and risk of heat illness among army trainees. Occup Med 2014; 64: 461–7.
e42.Armstrong LE, Crago AE, Adams R, Roberts WO, Maresh CM: Whole-body cooling of hyperthermic runners: comparison of two field therapies. Am J Emerg Med 1996; 14: 355–8 CrossRef
e43.Fink E, Brandom BW, Torp KD: Heatstroke in the super-sized athlete. Pediatr Emerg Care 2006; 22: 510–3 CrossRefMEDLINE
e44.Allen SB, Cross KP: Out of the frying pan, into the fire. A case of heat shock and its fatal complications. Pediatr Emerg Care 2014; 30: 904–10 CrossRef MEDLINE
e45.Schultz J, Kenney WL, Linden AD: Heat-related deaths in American football. An interdisciplinary approach. Sport Hist Rev 2014; 45: 123–44.
e46.Hawes R, McMorran J, Vallis C: Exertional heat illness in half marathon runners: experiences of the Great North Run. Emerg Med J 2010; 27: 866–7 CrossRefMEDLINE
e47.Coris EE, Ramirez AM, van Durme DJ: Heat illness in athletes. The dangerous combination of heat, humidity and exercise. Sports Med 2004; 34: 9–16 CrossRefMEDLINE
e48.Tennis Australia Limited: AO Heat Stress Scale a Grand Slam first. www.ausopen.com/articles/news/ao-heat-stress-scale-grand-slam-first (last accessed on 4 July 2019).
e49.Fifa: Fifa Fussball-Weltmeisterschaft 2014: Abkühlpausen während der WM in Brasilien. https://de.fifa.com/worldcup/news/keeping-the-players-cool-at-brazil-2014-2369525-2369567 (last accessed on 4 July 2019).
e50.Lucena RL, Steinke ET, Pacheco C, Vieira LL, Betancour MO, Steinke VA: The Brazilian World Cup: too hot for soccer? Int J Biometeorol 2017; 61: 2195–203 CrossRefMEDLINE
e51.Kerr ZY, Marshall SW, Comstock RD, Casa DJ: Exertional heat stroke management strategies in United States high school football. Am J Sports Med 2014; 42: 70–7 CrossRef MEDLINE
e52.Kucera KL, Klossner D, Colgate B, Cantu RC: Annual survey of football injury research. American Football Coaches Association, Waco, Texas 2016.
e53.Glitz KJ, Gorges W, Leyk D, Piekarski C: Arbeit unter klimatischer Belastung: Isolierende Schutzbekleidung als Sonderfall einer Hitzebelastung. In: Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin e. V. (DGAUM) (ed.): Leitlinien der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin e. V. AWMF online – Das Portal der wissenschaftlichen Medizin 2012; 1–16.
e54.Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF (Leitlinienprogramm Onkologie): S3-Leitlinie Prävention von Hautkrebs, Langversion 1. 1, AWMF Registernummer: 032/052OL 2014.
e55.Drexler H: UV-Strahlung (Kapitel 4.3.1). In: Schmitz-Spanke S, Nesseler T, Letzel S, Nowak D (eds.): Umweltmedizin. Neue Erkenntnisse aus Wissenschaft und Praxis. Landsberg am Lech: ecomed Medizin 2017; 296–305.
e56.Cheshire WP: Thermoregulatory disorders and illness related to heat and cold stress. Auton Neurosci 2016; 196: 91–104 CrossRefMEDLINE
e57.Müller S: Hitzeschäden. In: Müller S (ed.): Memorix Notfallmedizin. Stuttgart: Thieme Verlag 2017; 312–7.
e58.Pryor RR, Bennett BL, O‘Connor FG, Young JMJ, Asplund CA: Medical evaluation for exposure extremes: heat. Wilderness Environ Med 2015; 26: S69–75 CrossRef MEDLINE
e59.Hahn JM: Hitzenotfälle. In: Baenkler HW, Goldschmidt H, Hahn JM, et al. (eds): Kurzlehrbuch Innere Medizin. Stuttgart: Georg Thieme Verlag 2015; 627–39.
e60.Hufschmidt A, Lücking CH, Rauer S, Glocker FX: Neurologie compact. Stuttgart: Georg Thieme Verlag 2017.
e61.Santelli J, Sullivan JM, Czarnik A, Bedolla J: Heat illness in the emergency department. Keeping your cool. Emerg Med Pract 2014; 16: 1–21.
e62.Campell R: Sonnenstich und seine Folgen. Arch Gewerbepath Gewerbehyg 1955; 13: 412–8 CrossRef
e63.Horn P: Über Sonnenstich mit organischen Symptomen. Dtsch Z Nervenheilkd 1915; 54: 269–73 CrossRef
e64.Andreae S, Avelini P, Berg M, et al.: Hitzekollaps/Hitzschlag. In: Andreae S, Avelini P, Berg M, et al. (eds.): LEXIKON der Krankheiten und Untersuchungen. Stuttgart: Georg Thieme Verlag 2008: 431.
e65.Howe AS, Boden BP: Heat-related illness in athletes. Am J Sports Med 2007; 35: 1384–95 CrossRefMEDLINE
e66.Bergeron MF: Heat cramps during tennis: a case report. Int J Sport Nutr 1996; 6: 62–8 CrossRefMEDLINE
e67.Eichner ER: Treatment of suspected heat illness. Int J Sports Med 1998; 19: 150–3.
e68.Ganio MS, Casa DJ, Armstrong LE, Maresh CM: Evidence-based approach to lingering hydration questions. Clin Sports Med 2007; 26: 1–16 CrossRefMEDLINE
e69.Stofan JR, Zachwieja JJ, Horswill CA, Murray R, Anderson SA, Eichner ER: Sweat and sodium losses in NCAA football players. A precursor to heat cramps? Int J Sport Nutr Exerc Metabol 2005; 15: 641–52 CrossRefMEDLINE
e70.Carter R, Cheuvront SN, Vernieuw CR, Sawka MN: Hypohydration and prior heat stress exacerbates decreases in cerebral blood flow velocity during standing. J Appl Physiol 2006; 101: 1744–50 CrossRefMEDLINE
e71.Kenefick RW, Sawka MN: Heat exhaustion and dehydration as causes of marathon collapse. Sports Med 2007; 37: 378–81 CrossRef MEDLINE
e72.Leon LR, Helwig BG: Heat stroke: role of the systemic inflammatory response. J Appl Physiol 2010; 109: 1980–8.
e73.Epstein Y, Roberts WO: The pathopysiology of heat stroke. An integrative view of the final common pathway. Scand J Med Sci Sports 2011; 21: 742–8.
e74.Epstein Y, Roberts WO, Golan R, Heled Y, Sorkine P, Halpern P: Sepsis, septic shock, and fatal exertional heat stroke. Curr Sports Med Rep 2015; 14: 64–9 CrossRef MEDLINE
e75.Casa DJ, Armstrong LE, Kenny GP, O‘Connor FG, Huggins RA: Exertional heat stroke: new concepts regarding cause and care. Curr Sports Med Rep 2012; 11: 115–23 CrossRef MEDLINE
e76.Bouchama A, Knochel JP: Heat stroke. N Engl J Med 2002; 346: 1978–88 CrossRef MEDLINE
e77.Khogali M, Hales JRS (eds.): Heat stroke and temperature regulation. Sydney: Academic Press 1983.
e78.Wilmore JH, Costill DL, Kenney WL: Physiology of sport and exercise. 4th ed. Champaign, Ill.: Human Kinetics 2008.
e79.Pryor RR, Roth RN, Suyama J, Hostler D: Exertional heat illness: emerging concepts and advances in prehospital care. Prehosp Disaster Med 2015; 30: 297–305 CrossRef MEDLINE
e80.Krohn AR, Sikka R, Olson DE: Heat illness in football. Current concepts. Curr Sports Med Rep 2015; 14: 463–71 CrossRef MEDLINE
e81.Porcari J, Bryant C, Comano F: Exercise physiology. Philadelphia: F. A. Davis Company 2015.
e82.Henderson A, Simon JW, Melia WM, Navein JF, Mackay BG: Heat illness. A report of 45 cases from Hong Kong. J R Army Med Corps 1986; 132: 76–84.
e83.Shibolet S, Coll R, Gilat T, Sohar E: Heatstroke: Its clinical picture and mechanism in 36 cases. Q J Med 1967; 36: 525–48.
e84.Adams WM, Hosokawa Y, Casa DJ: The timing of exertional heat stroke survival starts prior to collapse. Curr Sports Med Rep 2015; 14: 273–4 CrossRefMEDLINE
e85.Miller KC, Swartz EE, Long BC: Cold-water immersion for hyperthermic humans wearing American football uniforms. JAT 2015; 50: 792–9 CrossRef MEDLINE PubMed Central
e86.Truxton TT, Miller KC: Can temperate-water immersion effectively reduce rectal temperature in exertional heat stroke? A critically appraised topic. J Sport Rehabil 2017; 26: 447–51 CrossRef MEDLINE
e87.Gaudio FG, Grissom CK: Cooling methods in heat stroke. J Emerg Med 2016; 50: 607–16.
e88.Costrini A: Emergency treatment of exertional heatstroke and comparison of whole body cooling techniques. Med Sci Sports Exerc 1990; 22: 15–8.
e89.Miller KC, Truxton T, Long B: Temperate-water immersion as a treatment for hyperthermic humans wearing American football uniforms. JAT 2017; 52: 747–52 CrossRef MEDLINE PubMed Central
e90.Zhang Y, Davis JK, Casa DJ, Bishop PA: Optimizing cold water immersion for exercise-induced hyperthermia. A meta-analysis. Med Sci Sports Exerc 2015; 47: 2464–72 CrossRef MEDLINE
e91.Stewart TE, Whitford AC: Dangers of prehospital cooling: a case report of afterdrop in a patient with exertional heat stroke. J Emerg Med 2015; 49: 630–3 CrossRef MEDLINE
e92.DeMartini JK, Casa DJ, Stearns R, et al.: Effectiveness of cold water immersion in the treatment of exertional heat stroke at the Falmouth Road Race. Med Sci Sports Exerc 2015; 47: 240–5 CrossRefMEDLINE
e93.Butts CL, McDermott BP, Buening BJ, et al.: Physiologic and perceptual responses to cold-shower cooling after exercise-induced hyperthermia. JAT 2016; 51: 252–7 CrossRefMEDLINE
e94.Morrison KE, Desai N, McGuigan C, Lennon M, Godek SF: Effects of intravenous cold saline on hyperthermic athletes representative of large football players and small endurance runners. Clin J Sport Med 2018; 28: 493–9 CrossRef MEDLINE
e95.Taylor NAS, Caldwell JN, van den Heuvel AMJ, Patterson MJ: To cool, but not too cool. That is the question-immersion cooling for hyperthermia. Med Sci Sports Exerc 2008; 40: 1962–9 CrossRef MEDLINE
e96.Casa DJ, McDermott BP, Lee EC, Yeargin SW, Armstrong LE, Maresh CM: Cold water immersion: the gold standard for exertional heatstroke treatment. Exerc Sport Sci Rev 2007; 35: 141–9 CrossRef MEDLINE
e97.Proulx CI, Ducharme MB, Kenny GP: Effect of water temperature on cooling efficiency during hyperthermia in humans. J Appl Physiol 2003; 94: 1317–23 CrossRef MEDLINE
e98.Amit D, Ran Y, Yuval H: Misdiagnosis of exertional heat stroke and improper medical treatment. Mil Med 2011; 176: 1278–80 CrossRefMEDLINE
e99.Roberts WO: Exertional heat stroke and the evolution of field care. A physician‘s perspective. Temperature 2017; 4: 101–3.
e100.Proulx CI, Ducharme MB, Kenny GP: Safe cooling limits from exercise-induced hyperthermia. Eur J Appl Physiol 2006; 96: 434–45 CrossRef MEDLINE
e101.Holman ND, Schneider AJ: Multi-organ damage in exertional heat stroke. Neth J Med 1989; 35: 38–43.
e102.Heneghan HM, Nazirawan F, Dorcaratto D, et al.: Extreme heatstroke causing fulminant hepatic failure requiring liver transplantation: a case report. Transplant Proc 2014; 46: 2430–2 CrossRefMEDLINE
e103.Wallace RF, Kriebel D, Punnett L, Wegman DH, Amoroso PJ: Prior heat illness hospitalization and risk of early death. Environ Res 2007; 104: 290–5 CrossRef MEDLINE
e104.Hausfater P: Dantrolene and heatstroke: a good molecule applied in an unsuitable situation. Crit Care 2005; 9: 23–4.
e105.Leon LR, Bouchama A: Heat stroke. Compr Physiol 2015; 5: 611–47.