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Eifling KP, Gaudio FG, Dumke C, Lipman GS, Otten EM, Martin AD, Grissom CK. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2024 Update. Wilderness Environ Med 2024; 35:112S-127S. [PMID: 38425235 DOI: 10.1177/10806032241227924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The Wilderness Medical Society (WMS) convened an expert panel in 2011 to develop a set of evidence-based guidelines for the recognition, prevention, and treatment of heat illness. The current panel retained 5 original members and welcomed 2 new members, all of whom collaborated remotely to provide an updated review of the classifications, pathophysiology, evidence-based guidelines for planning and preventive measures, and recommendations for field- and hospital-based therapeutic management of heat illness. These recommendations are graded based on the quality of supporting evidence and the balance between the benefits and risks or burdens for each modality. This is an updated version of the WMS clinical practice guidelines for the prevention and treatment of heat illness published in Wilderness & Environmental Medicine. 2019;30(4):S33-S46.
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Affiliation(s)
- Kurt P Eifling
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Flavio G Gaudio
- Department of Emergency Medicine, New York-Presbyterian Hospital / Weill Cornell Medical College, New York, NY
| | - Charles Dumke
- School of Integrative Physiology and Athletic Training, University of Montana, Missoula, MT
| | | | - Edward M Otten
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
| | - August D Martin
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Fayetteville, AR
| | - Colin K Grissom
- Pulmonary and Critical Care Division, Intermountain Medical Center and the University of Utah, Salt Lake City, UT
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2
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Freidin N, Hayes E, Struthers SA. Implications of climate change on acute kidney injury. Curr Opin Nephrol Hypertens 2024; 33:83-88. [PMID: 37678384 DOI: 10.1097/mnh.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE OF REVIEW Climate change is an active and growing threat to human health. This review examines the evidence linking climate change to kidney diseases, with a focus on acute kidney injury (AKI). RECENT FINDINGS A growing body of evidence documents the adverse impact of various environmental and occupational exposures on kidney health. Extreme heat exposure increases the risk for AKI in vulnerable populations, particularly outdoor workers. These effects are being seen in both developed and developing nations, impacting equatorial as well as more northern climates. Climate change is also increasing the risk of water-borne and vector-borne infections, which are important causes of AKI in tropical regions. Due to overlapping environmental and social risk factors, populations in low-income and middle-income countries are likely to be disproportionately affected by climate-related health impacts, including heightened risk for kidney diseases. SUMMARY Climate change will adversely impact global kidney health over the course of the century through effects on temperature and risk of endemic infections. Alongside efforts to aggressively reduce carbon emissions, additional research is needed to guide public and environmental health policies aimed at mitigating the impact of climate change on human health.
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Affiliation(s)
- Natalie Freidin
- Medical University of South Carolina, Charleston, South Carolina
| | - Eily Hayes
- Medical University of South Carolina, Charleston, South Carolina
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3
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AlSahow A. The Impact of Hot Ambient Temperature and Prolonged Fasting Duration during Ramadan on Patients with Chronic Kidney Disease: A Literature Review. Int J Nephrol 2023; 2023:2636507. [PMID: 38106546 PMCID: PMC10725313 DOI: 10.1155/2023/2636507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/14/2023] [Accepted: 11/18/2023] [Indexed: 12/19/2023] Open
Abstract
The Islamic (lunar) calendar has 11 fewer days each year than the Gregorian (solar) calendar. Consequently, ambient temperatures during the month of Ramadan and the duration of the presunrise-to-sunset fast will change each year. At some point, individuals observing Ramadan will experience prolonged periods of fasting during the hot summer months. In this manuscript, findings published in the English-language medical literature that address the impact of prolonged fasting during the warmer summer months on patients with chronic kidney disease, including dialysis and transplantation patients, are reviewed. This is of particular concern given the accelerated pace of global warming. The limitations of the evidence that is currently available are also discussed, and an approach that might be used to standardize future evaluations of the impact of fasting on kidney health is suggested.
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Affiliation(s)
- Ali AlSahow
- Division of Nephrology, Jahra Hospital, Jahra, Kuwait
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Pryor RR, Haboian K, Fitts T, Stooks JJ. Tarp-Assisted Cooling for Exertional Heat Stroke Treatment in Wildland Firefighting. Wilderness Environ Med 2023; 34:490-497. [PMID: 37748988 DOI: 10.1016/j.wem.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/26/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Exertional heat stroke is a life-threatening emergency necessitating immediate treatment with rapid body cooling. A field-expedient alternative may be tarp-assisted cooling, requiring only water and a tarp. The objective of this study was to compare core temperature (Tc) cooling rates of tarp-assisted cooling using the limited resources available to a wildland firefighter and the current standard care provided in wilderness settings. METHODS This cross-over, randomized control trial of 17 healthy individuals consisted of exercise in a 42±1°C, 32±4% relative humidity environment while wearing wildland firefighter attire, followed by cooling. Body cooling consisted of either pouring 11 L of 25±1°C water over the torso while lying supine on a tarp configured to hold water close to the individual (Tarp) or dousing the water on the participant followed by lying supine with a light breeze, current standard care in the wilderness (Current Care). Cooling occurred until Tc reached 38°C. RESULTS Participants walked until a similar Tc was achieved in Tarp (39.59±0.04°C) and Current Care (39.55±0.22°C; P=0.36). Core temperature cooling rate was not different between Tarp (0.076±0.042°C·min-1) and Current Care (0.088±0.046°C·min-1; P=0.41). CONCLUSIONS In hyperthermic individuals, Tarp did not provide a faster cooling rate compared to the current exertional heat stroke care provided in the wilderness, and both provided a slower cooling rate than that provided by the traditional method of cold water immersion (>0.20°C·min-1) to treat exertional heat stroke patients.
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Affiliation(s)
- Riana R Pryor
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY.
| | - Kara Haboian
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | - Triniti Fitts
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
| | - Jocelyn J Stooks
- Center for Research and Education in Special Environments, Department of Exercise and Nutrition Sciences, University at Buffalo, Buffalo, NY
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Verhey JT, Poon SK. General Medical Emergencies in Athletes. Clin Sports Med 2023; 42:427-440. [PMID: 37208057 DOI: 10.1016/j.csm.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This article focuses on the management of the most common on-field medical emergencies. As with any discipline in medicine, a well-defined plan and systematic approach is the cornerstone of quality health care delivery. In addition, the team-based collaboration is necessary for the safety of the athlete and the success of the treatment plan.
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Affiliation(s)
- Jens T Verhey
- Orthopaedic Surgery Residency, Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Steven K Poon
- Sports Medicine Section, Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA.
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Naldo R, Boeckman J, Vanos JK, Kavouras SA, Wardenaar FC. Short hydration education video and hiker fluid selection and consumption at trails, a non-randomized quasi-experimental field study. Nutr Health 2023:2601060221150303. [PMID: 36632648 DOI: 10.1177/02601060221150303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Education may improve hiker safety on trails. Aim: To investigate the impact of an educational video on hiker fluid selection and fluid consumption in a hot environment. Methods: Quasi-experimental field study at hiking trails in which the intervention group (INT) viewed a three-minute hydration education video, whereas the control group (CON) did not. Before the hike, all hikers were asked if they wanted to select extra fluid, which was provided by the research team. Results: A total of n = 97 hikers participated in the study, with n = 56 in INT (32 male) and n = 41 in CON (25 male). Despite absolute differences in environmental conditions, the differences fell within the same WBGT category. The total amount of fluid brought to the trails by participants was different between INT: 904 (503-1758) mL and CON: 1509 (880-2176) mL (P = 0.006), but participants in the INT group selected extra fluid (41%; n = 23) significantly more often when compared with participants in the CON group (7%; n = 3; P < 0.001). As a result, there was no difference in the amount of fluid brought on the trail between INT: 1047 (611-1936) mL and CON: 1509 (932-2176) mL (P = 0.069), nor for fluid consumption between INT: 433 (289-615) mL/h and CON: 489 (374-719) mL/h (P = 0.18). Conclusions and Implications: A 3-min educational video may encourage hikers to select additional fluid before the start of their hike but does not appear to increase fluid intake.
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Affiliation(s)
- Rebecca Naldo
- 465849College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Josh Boeckman
- 465849College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Jennifer K Vanos
- School of Sustainability, College of Global Futures, Arizona State University, Tempe, AZ, USA
| | - Stavros A Kavouras
- 465849College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Floris C Wardenaar
- 465849College of Health Solutions, Arizona State University, Phoenix, AZ, USA
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Affiliation(s)
- Cecilia Sorensen
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
| | - Jeremy Hess
- From the Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University (C.S.), and the Department of Emergency Medicine, Columbia Irving Medical Center (C.S.) - both in New York; and the Department of Emergency Medicine, School of Medicine (J.H.), the Department of Environmental and Occupational Health Sciences, School of Public Health (J.H.), and the Department of Global Health, Schools of Medicine and Public Health (J.H.), University of Washington, Seattle
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Savioli G, Zanza C, Longhitano Y, Nardone A, Varesi A, Ceresa IF, Manetti AC, Volonnino G, Maiese A, La Russa R. Heat-Related Illness in Emergency and Critical Care: Recommendations for Recognition and Management with Medico-Legal Considerations. Biomedicines 2022; 10:biomedicines10102542. [PMID: 36289804 PMCID: PMC9599879 DOI: 10.3390/biomedicines10102542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
Hyperthermia is an internal body temperature increase above 40.5 °C; normally internal body temperature is kept constant through natural homeostatic mechanisms. Heat-related illnesses occur due to exposure to high environmental temperatures in conditions in which an organism is unable to maintain adequate homeostasis. This can happen, for example, when the organism is unable to dissipate heat adequately. Heat dissipation occurs through evaporation, conduction, convection, and radiation. Heat disease exhibits a continuum of signs and symptoms ranging from minor to major clinical pictures. Minor clinical pictures include cramps, syncope, edema, tetany, and exhaustion. Major clinical pictures include heatstroke and life-threatening heat stroke and typically are expressed in the presence of an extremely high body temperature. There are also some categories of people at greater risk of developing these diseases, due to exposure in particular geographic areas (e.g., hot humid environments), to unchangeable predisposing conditions (e.g., advanced age, young age (i.e., children), diabetes, skin disease with reduced sweating), to modifiable risk factors (e.g., alcoholism, excessive exercise, infections), to partially modifiable risk factors (obesity), to certain types of professional activity (e.g., athletes, military personnel, and outdoor laborers) or to the effects of drug treatment (e.g., beta-blockers, anticholinergics, diuretics). Heat-related illness is largely preventable.
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Affiliation(s)
- Gabriele Savioli
- Emergency Department, IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Doctoral Program Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Christian Zanza
- Foundation “Ospedale Alba-Bra”, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
- Correspondence:
| | - Yaroslava Longhitano
- Foundation “Ospedale Alba-Bra”, Department of Emergency Medicine, Anesthesia and Critical Care Medicine, Michele and Pietro Ferrero Hospital, 12060 Verduno, Italy
| | - Alba Nardone
- Department of Internal Medicine, Università degli Studi of Pavia, 27100 Pavia, Italy
| | - Angelica Varesi
- Department of Internal Medicine, Università degli Studi of Pavia, 27100 Pavia, Italy
| | | | - Alice Chiara Manetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Gianpietro Volonnino
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy
| | - Aniello Maiese
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Institute of Legal Medicine, University of Pisa, 56126 Pisa, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
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Miyamoto K, Suzuki K, Ohtaki H, Nakamura M, Yamaga H, Yagi M, Honda K, Hayashi M, Dohi K. A novel mouse model of heatstroke accounting for ambient temperature and relative humidity. J Intensive Care 2021; 9:35. [PMID: 33863391 PMCID: PMC8052643 DOI: 10.1186/s40560-021-00546-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Heatstroke is associated with exposure to high ambient temperature (AT) and relative humidity (RH), and an increased risk of organ damage or death. Previously proposed animal models of heatstroke disregard the impact of RH. Therefore, we aimed to establish and validate an animal model of heatstroke considering RH. To validate our model, we also examined the effect of hydration and investigated gene expression of cotransporter proteins in the intestinal membranes after heat exposure. Methods Mildly dehydrated adult male C57/BL6J mice were subjected to three AT conditions (37 °C, 41 °C, or 43 °C) at RH > 99% and monitored with WetBulb globe temperature (WBGT) for 1 h. The survival rate, body weight, core body temperature, blood parameters, and histologically confirmed tissue damage were evaluated to establish a mouse heatstroke model. Then, the mice received no treatment, water, or oral rehydration solution (ORS) before and after heat exposure; subsequent organ damage was compared using our model. Thereafter, we investigated cotransporter protein gene expressions in the intestinal membranes of mice that received no treatment, water, or ORS. Results The survival rates of mice exposed to ATs of 37 °C, 41 °C, and 43 °C were 100%, 83.3%, and 0%, respectively. From this result, we excluded AT43. Mice in the AT 41 °C group appeared to be more dehydrated than those in the AT 37 °C group. WBGT in the AT 41 °C group was > 44 °C; core body temperature in this group reached 41.3 ± 0.08 °C during heat exposure and decreased to 34.0 ± 0.18 °C, returning to baseline after 8 h which showed a biphasic thermal dysregulation response. The AT 41 °C group presented with greater hepatic, renal, and musculoskeletal damage than did the other groups. The impact of ORS on recovery was greater than that of water or no treatment. The administration of ORS with heat exposure increased cotransporter gene expression in the intestines and reduced heatstroke-related damage. Conclusions We developed a novel mouse heatstroke model that considered AT and RH. We found that ORS administration improved inadequate circulation and reduced tissue injury by increasing cotransporter gene expression in the intestines.
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Affiliation(s)
- Kazuyuki Miyamoto
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan. .,Department of Anatomy, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan.
| | - Keisuke Suzuki
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.,Department of Anatomy, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Hirokazu Ohtaki
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Motoyasu Nakamura
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.,Department of Anatomy, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Hiroki Yamaga
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.,Department of Anatomy, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Masaharu Yagi
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Munetaka Hayashi
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Kenji Dohi
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan.,Department of Anatomy, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
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10
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Ryu JH, Min MK. Diagnosis and treatment of patients with heat-related illnesses. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.4.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Heat stress disorders or heat-related illnesses are a kind of physiological damage that occurs when the body cannot dissipate enough heat due to its thermoregulatory dysfunction. This paper aims to summarize the latest information on the diagnosis and treatment of heat-related illnesses. Heat stress disorders come in a variety of forms including heat edema, heat rash, heat cramps, heat syncope, heat tetany, severe heat exhaustion, and life-threatening heatstroke. Major risk factors may include excessive exercise, continuous exposure to high temperatures or humid environments, lack of acclimation, excessive clothing or protective equipment, obesity, and dehydration. Additional risk factors may include the patientʼs existing medical condition, environmental and personal factors, and the use of various drugs. Mild heat-related illnesses can be treated only by supportive care such as moving patients to a cool place and laying them in a supine position while elevating their legs and loosening their clothes. However, in the case of heatstroke, quickly lowering the body temperature is an essential in reducing the mortality rate. The most effective cooling method is to immerse the entire body in ice cold water.
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Martínez-Sanz JM, Fernández Nuñez A, Sospedra I, Martínez-Rodríguez A, Domínguez R, González-Jurado JA, Sánchez-Oliver AJ. Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114082. [PMID: 32521666 PMCID: PMC7312487 DOI: 10.3390/ijerph17114082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 01/16/2023]
Abstract
During the last few years, the numbers of competitors in endurance and ultra-endurance sports modalities have increased significantly. This type of competition is an extreme challenge for athletes. Therefore, they have an increased the risk of developing medical and nutritional problems. The aim of the work is to estimate the incidence of nutrition-related adverse outcomes in endurance and ultra-endurance sports, considering the variables that influence them. A critical review was carried out based on the PubMed database, by means of a search strategy based on keywords separated by Boolean connectors. For all the results obtained in a period from 2008 to 2019, a series of inclusion/exclusion criteria was applied to select only the studies that fitted the objective of the present study. Results and discussion: Of the 871 publications identified, 33 met the inclusion criteria. The adverse outcomes found included exercise-associated hyponatremia (EAH), heat stroke by exertion (EHS), gastrointestinal (GI) problems, dehydration, and hypothermia; the provision of misinformation to athletes about nutrient intake and hydration during competition was identified as the main cause. Conclusions: The main adverse outcomes in endurance and ultra-endurance sports modalities are EAH, GI inconveniences, and EHS. These problems can affect the performance and health status of the athlete during and post-competition. Several nutritional guidelines have been suggested that can prevent these adverse outcomes, and it is essential to individualize and adjust the nutritional intake and hydration status according to the characteristics of each competition.
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Affiliation(s)
- José Miguel Martínez-Sanz
- Departamento de Enfermería, Grupo de Investigación en Alimentación y Nutrición (ALINUT), Facultad de Ciencias de la Salud, Universidad de Alicante, 03690 Alicante, Spain; (J.M.M.-S.); (I.S.)
| | - Ana Fernández Nuñez
- Facultad de Ciencias de la Salud, Universidad de Alicante, 03690 Alicante, Spain;
| | - Isabel Sospedra
- Departamento de Enfermería, Grupo de Investigación en Alimentación y Nutrición (ALINUT), Facultad de Ciencias de la Salud, Universidad de Alicante, 03690 Alicante, Spain; (J.M.M.-S.); (I.S.)
| | - Alejandro Martínez-Rodríguez
- Analytical Chemistry, Nutrition and Food Sciences Department, Sciences Faculty, University of Alicante, 03690 Alicante, Spain;
| | - Raúl Domínguez
- Facultad de Ciencias de la Salud de la Universidad Isabel I, 09003 Burgos, Spain;
| | - José Antonio González-Jurado
- Facultad del Deporte, Universidad Pablo Olavide de Sevilla, 41013 Sevilla, Spain
- Correspondence: ; Tel.: +34-651-517-571
| | - Antonio J. Sánchez-Oliver
- Departamento de Motricidad Humana y Rendimiento Deportivo, Universidad de Sevilla, 41004 Sevilla, Spain;
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Lipman GS, Gaudio FG, Eifling KP, Ellis MA, Otten EM, Grissom CK. Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Heat Illness: 2019 Update. Wilderness Environ Med 2019; 30:S33-S46. [DOI: 10.1016/j.wem.2018.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/04/2018] [Accepted: 10/22/2018] [Indexed: 10/26/2022]
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13
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Kim JH, Ryoo HW, Moon S, Jang TC, Jin SC, Mun YH, Do BS, Lee SB, Kim JY. Determining the correlation between outdoor heatstroke incidence and climate elements in Daegu metropolitan city. Yeungnam Univ J Med 2019; 36:241-248. [PMID: 31620639 PMCID: PMC6784657 DOI: 10.12701/yujm.2019.00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 11/06/2022] Open
Abstract
Background Heatstroke is one of the most serious heat-related illnesses. However, establishing public policies to prevent heatstroke remains a challenge. This study aimed to investigate the most relevant climate elements and their warning criteria to prevent outdoor heatstroke (OHS). Methods We investigated heatstroke patients from five major hospitals in Daegu metropolitan city, Korea, from June 1 to August 31, 2011 to 2016. We also collected the corresponding regional climate data from Korea Meteorological Administration. We analyzed the relationship between the climate elements and OHS occurrence by logistic regression. Results Of 70 patients who had heatstroke, 45 (64.3%) experienced it while outdoors. Considering all climate elements, only mean heat index (MHI) was related with OHS occurrence (p=0.019). Therefore, the higher the MHI, the higher the risk for OHS (adjusted odds ratio, 1.824; 95% confidence interval, 1.102-3.017). The most suitable cutoff point for MHI by Youden's index was 30.0°C (sensitivity, 77.4%; specificity, 73.7%). Conclusion Among the climate elements, MHI was significantly associated with OHS occurrence. The optimal MHI cutoff point for OHS prevention was 30.0°C.
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Affiliation(s)
- Jung Ho Kim
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sungbae Moon
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Tae Chang Jang
- Department of Emergency Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sang Chan Jin
- Department of Emergency Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - You Ho Mun
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Byung Soo Do
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Sam Beom Lee
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jong-yeon Kim
- Department of Preventive Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Leyk D, Hoitz J, Becker C, Jochen Glitz K, Nestler K, Piekarski C. Health Risks and Interventions in Exertional Heat Stress. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:537-544. [PMID: 31554541 PMCID: PMC6783627 DOI: 10.3238/arztebl.2019.0537] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/11/2019] [Accepted: 06/11/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND With climate change, heat waves are expected to become more frequent in the near future. Already, on average more than 25 000 "heat deaths" are estimated to occur in Europe every year. However, heat stress and heat illnesses arise not just when ambient temperatures are high. Physical exertion increases heat production within the organism many times over; if not enough heat is lost, there is a risk of exertional heat stress. This review article discusses contributing factors, at-risk groups, and the diagnosis and treatment of heat illnesses. METHODS A selective literature search was carried out on PubMed. Current guidelines and expert recommendations were also included. RESULTS Apart from muscular heat production (>70% of converted energy), there are other factors that singly or in combination can give rise to heat stress: clothing, climate/acclimatization, and individual factors. Through its insulating properties, clothing reduces the evaporation of sweat (the most effective physiological cooling mechanism). A sudden heat wave, or changing the climate zone (as with air travel), increases the risk of a heat-related health event. Overweight, low fitness level, acute infections, illness, dehydration, and other factors also reduce heat tolerance. In addition to children, older people are particularly at risk because of their reduced physiological adaptability, (multi-)morbidity, and intake of prescription drugs. A heat illness can progress suddenly to life-threatening heat stroke. Successful treatment depends on rapid diagnosis and cooling the body down as quickly as possible. The aim is to reduce core body temperature to <40 °C within 30 minutes. CONCLUSION Immediately effective cooling interventions are the only causal treatment for heat stroke. Time once lost cannot be made up. Prevention (acclimatization, reduced exposure, etc.) and terminating the heat stress in good time (e.g., stopping work) are better than any cure.
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Affiliation(s)
- Dieter Leyk
- Bundeswehr Institute for Preventive Medicine
- German Sport University Cologne
| | | | - Clemens Becker
- Department of Geriatrics and Geriatric Rehabilitation at the Robert-Bosch-Hospital Stuttgart
| | | | | | - Claus Piekarski
- Institute and Policlinic for Occupational Medicine, Environmental Medicine and Prevention Research, University of Cologne
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Benmarhnia T, Zhao X, Wang J, Macdonald M, Chen H. Evaluating the potential public health impacts of the Toronto cold weather program. ENVIRONMENT INTERNATIONAL 2019; 127:381-386. [PMID: 30954724 DOI: 10.1016/j.envint.2019.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/01/2019] [Accepted: 03/17/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Extreme cold weather alert programs have been implemented in some areas to address the significant health impacts of exposure to cold. One such program is the Toronto Cold Weather Program (TCWP) that was implemented in the City of Toronto since 1996 to protect the public from extreme weather conditions. In this paper, we aim to evaluate the effectiveness of the TCWP in reducing mortality and morbidity outcomes related to cold temperatures. METHODS We applied a quasi-experimental study design using the Difference-in-Differences method coupled with propensity-score-matching to determine the effect of the TCMP on daily hospitalizations and deaths due to cardiovascular disease (CVD), coronary heart disease (CHD) or cerebrovascular disease, using two complementary analytical approaches. RESULTS Overall, the analysis did not detect an impact on reduced mortality/morbidity in the City of Toronto from the TCMP. For example, we obtained a Risk Difference (RD) of -0.88 (per 1,000,000 people) (95% CI: -3.27 to 1.51) and a Risk Ratio (RR) of 0.98 (95% CI: 0.91 to 1.05) people for CVD hospitalizations. CONCLUSIONS The TCWP was not found to be effective in reducing cold related mortality and morbidity which demonstrates the importance of improving existing policies related to cold in Canada and other countries.
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Affiliation(s)
- Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps, Institution of Oceanography, University of California, San Diego, CA, USA.
| | - Xu Zhao
- Public Health Ontario, Toronto, Canada
| | - John Wang
- Public Health Ontario, Toronto, Canada
| | | | - Hong Chen
- Public Health Ontario, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Applicability of Heat Stress Index in the Context of Military Work: Pilot Study. STUDIES IN SYSTEMS, DECISION AND CONTROL 2019. [DOI: 10.1007/978-3-030-14730-3_34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Charlot K, Tardo-Dino PE, Buchet JF, Koulmann N, Bourdon S, Lepetit B, Roslonski M, Jousseaume L, Malgoyre A. Short-Term, Low-Volume Training Improves Heat Acclimatization in an Operational Context. Front Physiol 2017; 8:419. [PMID: 28670286 PMCID: PMC5472681 DOI: 10.3389/fphys.2017.00419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 05/31/2017] [Indexed: 11/21/2022] Open
Abstract
Personnel who travel to areas with a hot climate (WBGT > 27°C) may suffer from the heat (physiological strain, thermal discomfort, increased probability of heat illness), making them partially or fully inoperative. Performing physical activities during heat acclimatization is known to improve this process (i.e., improve measures of acclimatization for the same duration of acclimation). However, it is unknown whether such training would be efficient in an operative context, characterized by a high volume of work-related physical activity. Thirty French soldiers (Training group, T) performed a short (5 days), progressive, moderate (from three to five 8-min running sets at 50% of the speed at VO2max for 32-56 min) aerobic training program upon arriving at their base in United Arab Emirates (~40°C and 12% RH). A control group (30 soldiers; No Training, NT) continued to perform their usual outdoor military activities (~6 h.d-1). A field heat stress test (HST; three 8-min running sets at 50% of the speed at VO2max) was performed, before and after the heat acclimatization period, to assess physiological and subjective changes. Rectal temperature, heart rate (HR), thermal discomfort at rest and at the end of exercise, rates of perceived exertion (RPE), and sweat loss and osmolality decreased following heat acclimatization in both groups. However, the decreases in the T group were larger than those in the NT group for HR at the end of exercise (-20 ± 13 vs. -13 ± 6 bpm, respectively, p = 0.044), thermal discomfort at rest (-2.6 ± 2.7 vs. -1.4 ± 2.1 cm, respectively, p = 0.013) and at the end of exercise (-2.6 ± 1.9 vs. -1.6 ± 1.7 cm, respectively, p = 0.037) and RPE (-2.3 ± 1.8 vs. -1.3 ± 1.7, respectively, p = 0.035). Thus, we showed that adding short (<60 min), daily, moderate-intensity training sessions during a professional mission in a hot and dry environment accelerated several heat-acclimatization-induced changes at rest and during exercise in only 5 days.
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Affiliation(s)
- Keyne Charlot
- Département Environnements Opérationnels, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Institut de Recherche Biomédicale des ArméesBretigny-Sur-Orge, France
| | - Pierre-Emmanuel Tardo-Dino
- Département Environnements Opérationnels, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Institut de Recherche Biomédicale des ArméesBretigny-Sur-Orge, France
- Ecole du Val de GrâceParis, France
| | - Jean-François Buchet
- Forces Françaises aux Émirats Arabes Unis, Centre Médical InterarméesZayed Military City, United Arab Emirates
| | - Nathalie Koulmann
- Département Environnements Opérationnels, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Institut de Recherche Biomédicale des ArméesBretigny-Sur-Orge, France
- Ecole du Val de GrâceParis, France
| | - Stéphanie Bourdon
- Département Environnements Opérationnels, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Institut de Recherche Biomédicale des ArméesBretigny-Sur-Orge, France
| | - Benoit Lepetit
- Département Environnements Opérationnels, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Institut de Recherche Biomédicale des ArméesBretigny-Sur-Orge, France
| | - Martin Roslonski
- Forces Françaises aux Émirats Arabes Unis, Centre Médical InterarméesZayed Military City, United Arab Emirates
| | - Loïc Jousseaume
- Forces Françaises aux Émirats Arabes Unis, Centre Médical InterarméesZayed Military City, United Arab Emirates
| | - Alexandra Malgoyre
- Département Environnements Opérationnels, Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Institut de Recherche Biomédicale des ArméesBretigny-Sur-Orge, France
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