Report of 182 cases of exertional heatstroke in the French Armed Forces

Abstract

Objectives: Exertional heatstroke (EHS) remains a major problem for the military. The aim of our study was to describe medical history and clinical and biological features of EHS in a large military cohort. Methods: We conducted a retrospective study among military subjects admitted to the Military Teaching Hospital Laveran for EHS from 2004 to 2006. Results: Of the 182 subjects, EHS occurred most often at the end (80%) of a timed race of 8 km in battle clothes (84%) between the months of May and October (87%). The subjects were physically fit. Motivation was the primary intrinsic factor reported. A previous episode of EHS was reported by 15.4% of the subjects. Comas or seizures occurred more frequently in subjects whose temperatures exceeded 41°C (p = 0.03). Alanine aminotransferase was consistently increased in subjects who experienced EHS. We observed acute renal failure in 31.3% of the subjects, liver insufficiency in 12%, and disseminated intravascular coagulation in 1%. High creatine kinase levels alone did not correlate with renal failure. Conclusions: Detection of severe EHS in the field before the onset of multiple organ failure is challenging. The determination of the factors contributing to recurrence is urgently needed as EHS remains a life-threatening condition.