Fatal exertional heat stroke: a case series.
BACKGROUND
Exertional heat stroke (EHS) is one of the most serious conditions that occur when excess heat, generated by muscular exercise, exceeds the body's heat-dissipation rate. The consequent elevated body core temperature causes damage to the body's tissues, resulting in a characteristic multiorgan syndrome, which is occasionally fatal.


METHODS
We analyzed the fatal EHS cases that occurred in the Israeli Defence Forces during the last decade according to Minard's paradigm for evaluation of EHS predisposing factors, aiming to characterize the common features and unique circumstances leading to fatality.


RESULTS
Accumulation of predisposing factors, particularly those concerning training regulations, coupled with inappropriate treatment at site, were found to be strong predictors of a grave prognosis. Analysis of the pathologic findings of the fatal EHS cases on autopsy revealed a possible association between the duration and length of exercise prior to EHS occurrence and the extent of pathologic findings.


CONCLUSIONS
Strict adherence to existing training regulations may prevent further heat stroke fatalities.
Rav-Acha
Moshe
M
Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Israel. ilan@hadassah.org.il
Hadad
Eran
E
Epstein
Yoram
Y
Heled
Yuval
Y
Moran
Daniel S
DS
D000293:Adolescent; D000328:Adult; D001344:Autopsy; D001831:Body Temperature; D015444:Exercise; D006359:Heat Exhaustion; D018883:Heat Stroke / Q000401:mortality*; D006801:Humans; D007557:Israel; D008297:Male; D008889:Military Personnel; D010806:Physical Education and Training; D005082:Physical Exertion; D013696:Temperature