title: Case ascertainment of heat illness in the British Army: evidence of under-reporting from analysis of Medical and Command notifications, 2009-2013.
abstract: BACKGROUND
  Heat illness in the Armed Forces is considered preventable. The UK military relies upon dual Command and Medical reporting for case ascertainment, investigation of serious incidents and improvement of preventive practices and policy. This process could be vulnerable to under-reporting.
  
  
  OBJECTIVE
  To establish whether heat illness in the British Army has been under-reported, by reviewing concordance of reporting to the Army Incident Notification Cell (AINC) and the Army Health Unit (AHU) and to characterise the burden of heat illness reported by these means.
  
  
  METHODS
  Analysis of anonymised reporting databases held by the AHU and AINC, for the period 2009-2013.
  
  
  RESULTS
  565 unique cases of heat illness were identified. Annual concordance of reporting ranged from 9.6% to 16.5%. The overall rate was 13.3%. July was the month with the greatest number of heat illness reports (24.4% of total reporting) and the highest concordance rate (30%). Reports of heat illness from the UK (n=343) exceeded overseas notifications (n=221) and showed better concordance (17.1% vs 12.8%). The annual rate of reported heat illness varied widely, being greater in full-time than reservist personnel (87 vs 23 per100 000) and highest in full-time untrained personnel (223 per100 000).
  
  
  CONCLUSIONS
  The risk of heat illness was global, year-round and showed dynamic local variation. Failure to dual-report casualties impaired case ascertainment of heat illness across Command and Medical chains. Current preventive guidance, as applied in training and on operations, should be critically evaluated to ensure that risk of heat illness is reduced as low as possible. Clear procedures for casualty notification and surveillance are required in support of this and should incorporate communication within and between the two reporting chains.
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.|Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stacey
authors.affiliation: Department of Surgery and Cancer, Imperial College, London, UK.|Hammersmith Hospital, Du Cane Road, Greater London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Brett
authors.affiliation: Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK.|Carnegie Research Institute, Leeds Beckett University, Leeds, UK.
authors.forename: D
authors.initials: D
authors.lastname: Woods
authors.affiliation: Army Health Unit, Army Medical Directorate, Camberley, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jackson
authors.affiliation: Army Health Unit, Army Medical Directorate, Camberley, UK.
authors.forename: D
authors.initials: D
authors.lastname: Ross
mesh_terms: D003625:Data Collection; D016208:Databases, Factual; D018882:Heat Stress Disorders / Q000453:epidemiology*; D006801:Humans; D008889:Military Personnel; D012107:Research Design; D006113:United Kingdom / Q000453:epidemiology
keywords: EPIDEMIOLOGY; OCCUPATIONAL & INDUSTRIAL MEDICINE; PREVENTIVE MEDICINE