Comparison of active cooling devices with passive cooling for rehabilitation of firefighters performing exercise in thermal protective clothing: a report from the Fireground Rehab Evaluation (FIRE) trial.

BACKGROUND: Thermal protective clothing (TPC) worn by firefighters provides considerable protection from the external environment during structural fire suppression. However, TPC is associated with physiologic derangements that may have adverse cardiovascular consequences. These derangements should be treated during on-scene rehabilitation periods. OBJECTIVE: To examine heart rate and core temperature responses during the application of four active cooling devices, currently being marketed to the fire service for on-scene rehabilitation, and compare them with passive cooling in a moderate temperature (approximately 24 degrees C) and with an infusion of cold (4 degrees C) saline. METHODS: Subjects exercised while they were wearing TPC in a heated room. Following an initial exercise period (bout 1), the subjects exited the room, removed the TPC, and for 20 minutes cooled passively at room temperature, received an infusion of cold normal saline, or were cooled by one of four devices (fan, forearm immersion in water, hand cooling, or water-perfused cooling vest). After cooling, the subjects donned the TPC and entered the heated room for another 50-minute exercise period (bout 2). RESULTS: The subjects were not able to fully recover core temperature during a 20-minute rehabilitation period when provided rehydration and the opportunity to completely remove the TPC. Exercise durations were shorter during bout 2 when compared with bout 1 but did not differ by cooling intervention. The overall magnitudes and rates of cooling and heart rate recovery did not differ by intervention. CONCLUSIONS: No clear advantage was identified when active cooling devices and cold intravenous saline were compared with passive cooling in a moderate temperature after treadmill exercise in TPC.

Return to activity considerations in a football player predisposed to exertional heat illness: a case study.

CONTEXT: Heat illness is the third leading cause of death in athletics and a leading cause of morbidity and mortality in exercising athletes. Once faced with a case of heat related illness, severe or mild, the health care professional is often faced with the question of when to reactivate the athlete for competitive sport. Resuming activity without modifying risk factors could lead to recurrence of heat related illness of similar or greater severity. Also, having had heat illness in and of itself may be a risk factor for future heat related illness. The decision to return the athlete and the process of risk reduction is complex and requires input from all of the components of the team. Involving the entire sports medicine team often allows for the safest, most successful return to play strategy. Care must be taken once the athlete does begin to return to activity to allow for re-acclimatization to exercise in the heat prior to resumption particularly following a long convalescent period after more severe heat related illness.

Return to exercise training after heat exhaustion.

CONTEXT: Exertional heat exhaustion (HEX) is the most common form of heat illness experienced by athletes, laborers, and military personnel. Both dehydration stemming from a water and/or salt deficiency and a high ambient temperature must exist for HEX to occur. In the field, appropriate therapy can reduce recovery time. OBJECTIVE: This manuscript provides clinical guidance regarding return to activity. The primary focus of this paper is to describe the evaluation of residual effects and the underlying personal characteristics that initially predispose the athlete to HEX. Attention to these factors will reduce the risk of future episodes.

Guidelines for return to duty (play) after heat illness: a military perspective.

Since Biblical times, heat injuries have been a major focus of military medical personnel. Heat illness accounts for considerable morbidity during recruit training and remains a common cause of preventable nontraumatic exertional death in the United States military. This brief report describes current regulations used by Army, Air Force, and Navy medical personnel to return active duty warfighters who are affected by a heat illness back to full duty. In addition, a description of the profile system used in evaluating the different body systems, and how it relates to military return to duty, are detailed. Current guidelines require clinical resolution, as well as a profile that that protects a soldier through repeated heat cycles, prior to returning to full duty. The Israeli Defense Force, in contrast, incorporates a heat tolerance test to return to duty those soldiers afflicted by heat stroke, which is briefly described. Future directions for U.S. military medicine are discussed.

Time course of recovery and heat acclimation ability of prior exertional heatstroke patients.

Our understanding of the time course of recovery from exertional heatstroke (EH) and the heat acclimation ability of prior EH patients is limited. This manuscript reviews previous findings regarding recovery from EH and presents original research involving the heat acclimation ability of 10 prior EH patients (PH) and 5 control subjects. Heat acclimation, by definition, distinguishes heat-intolerant from heat-tolerant prior heatstroke patients. Nine PH exhibited normal heat acclimation adaptations (40.1 degrees C, 7 d, 90 min.d-1), thermoregulation, sweat gland function, whole-body sodium and potassium balance, and blood values at 61 +/- 7 d after EH. One PH (subject A) did not adapt to exercise in the heat, was defined heat intolerant, but subsequently was declared heat tolerant (11.5 months post-EH). Three PH exhibited large, unexpected increases in serum CPK levels, which resolved upon subsequent testing, and were probably related to their detrained state and the exercise which they performed. It was concluded that: 1) sleep loss and generalized fatigue were the most common predisposing factors for PH; 2) recovery from EH was idiosyncratic and may require up to 1 year in severe cases; 3) PH were not hereditarily heat intolerant, prior to EH; 4) no measured variable predicted recovery from EH, or heat acclimation responses; 5) heat intolerance occurs in a small percentage of prior heatstroke patients, and may be transient or persistent.