title: The physiological impact of body armor cooling devices in hot environments: a systematic review.
abstract: BACKGROUND
  Heat-related illness is a primary threat to unit readiness, and individual body armor (IBA) cooling devices represent one potential solution.
  
  
  OBJECTIVE
  To quantify research findings of active and passive cooling devices designed to reduce physiological strain while wearing IBA during strenuous tasks using a systematic review approach.
  
  
  METHODS
  Literature searches were performed in multiple databases using the key words "physiological," "body armor," "military," "cooling," and "thermal." Two independent reviewers appraised methodological quality using a modified Downs and Black Quality Index. Physiological outcomes were tabulated and effect sizes were calculated when appropriate.
  
  
  RESULTS
  The search yielded 733 citations, with nine articles fitting our inclusion criteria: six articles with active and three articles with passive cooling devices. Results reveal a moderate level of methodological quality. On average, all six active IBA cooling device studies compared to controls (IBA only) reported decreases in one or more measures of physiological strain-core and skin temperature, heart rate. Conversely, passive cooling device effects were negligible.
  
  
  CONCLUSIONS
  Active cooling devices may decrease the physiological strain associated with wearing IBA in hot environments. Further development of optimal cooling strategies to reduce physiological strain during operations where IBA is required is warranted.
authors.affiliation: Graduate School of Nursing, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Carl
authors.initials: C
authors.lastname: Goforth
authors.affiliation: Department of Kinesiology, Towson University, Towson, MD 21252.
authors.forename: Peter
authors.initials: P
authors.lastname: Lisman
authors.affiliation: Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Patricia
authors.initials: P
authors.lastname: Deuster
mesh_terms: D001831:Body Temperature / Q000502:physiology*; D003080:Cold Temperature; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008889:Military Personnel; D011481:Protective Clothing / Q000592:standards*