title: The effects of continuous hot weather training on risk of exertional heat illness.
abstract: OBJECTIVE
  To determine whether cumulative daily average wet-bulb globe temperature (WBGT) index, over one or two preceding days, is a better measure for predicting cases of exertional heat illness (EHI) than current daily average WBGT, which is the standard heat index used by the Marine Corps; and to identify the most accurate index of heat stress to prevent and predict future cases of EHI.
  
  
  METHODS
  A case-crossover study was conducted in male and female Marine Corps recruits in basic training at Marine Corps Recruit Depot, Parris Island, SC. Weather measurements were obtained for 2069 cases of EHI during 1979-1997 and for randomly selected control periods before and after each EHI episode.
  
  
  RESULTS
  The risk of EHI increased with WBGT (OR = 1.11 degrees F(-1); 95% CI, 1.10-1.13). EHI risk was associated not only with the WBGT at the time of the event (OR = 1.10 degrees F(-1); 95% CI, 1.08-1.11) but with the previous day's average WBGT as well (OR = 1.03 degrees F(-1); 95% CI, 1.02-1.05). Alternative combinations of WBGT components were identified that better predicted EHI risk.
  
  
  CONCLUSIONS
  Our results provide evidence for a cumulative effect of previous day's heat exposure on EHI risk in these Marine Corps recruits. A simple index for use in predicting EHI risk is proposed that includes the dry-bulb temperature and the relative humidity.
authors.affiliation: Biophysics and Biomedical Modeling Division, U.S. Army Research Institute of Environmental Medicine, 42 Kansas Street, Natick, MA 01760-5007, USA. robert.wallace@na.amedd.army.mil
authors.forename: Robert F
authors.initials: RF
authors.lastname: Wallace
authors.forename: David
authors.initials: D
authors.lastname: Kriebel
authors.forename: Laura
authors.initials: L
authors.lastname: Punnett
authors.forename: David H
authors.initials: DH
authors.lastname: Wegman
authors.forename: C Bruce
authors.initials: CB
authors.lastname: Wenger
authors.forename: John W
authors.initials: JW
authors.lastname: Gardner
authors.forename: Richard R
authors.initials: RR
authors.lastname: Gonzalez
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D018592:Cross-Over Studies; D015444:Exercise / Q000502:physiology*; D005260:Female; D018882:Heat Stress Disorders / Q000209:etiology*; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008889:Military Personnel; D005082:Physical Exertion / Q000502:physiology; D012307:Risk Factors; D013022:South Carolina; D014887:Weather