Far from Home: Heat-Illness Prevention and Treatment in Austere Environments

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.