Recent advances in the prevention and management of exertional heat stroke and their implications for military health services

The high incidence of exertional heat stroke (EHS) has posed a huge threat to the health and combat capability of military personnel.This paper reviews recent advancements in the prevention and management of EHS in general and three pivotal interventions—heat acclimatization, hydration strategies, and cooling interventions—in particular. An optimized framework for military medical support to EHS is recommended. In terms of heat acclimatization, it is recommended that China's military learn from short-term training protocols employed inother countries, and that a hybrid model combining basic acclimatization with short-term intensive training be adopted. Moreover, intelligent monitoring technologies are to beused as an alternative to traditional laboratory-based heat tolerance tests. Hydration strategies call for individualized regimensand the adherence to the principle of “high-frequency and small-volumes” of fluid intake. Cooling interventions ought to revolve around the critical “golden 30 minutes” therapeutic window, with cold water immersion (CWI) designated as the first option. Additionally, research that aims to investigate the viability of seawater as a CWI alternative is proposed. Based on foreign experience and the realities in China, this paper recommends a comprehensive, integrated and tripartite strategy that involves acclimatization, hydration, and cooling for the whole-process prevention and control of EHS. This approach is expected to provide data for mitigating EHS during military operations in hot and humid environments and for enhancing the efficiency of military medical support.