title: Return to duty/play after exertional heat injury: do we have all the answers? A lesson from two case studies.
abstract: BACKGROUND
  The common practice in the Israel defense Forces is that exertional heat related injury patients undergo a heat tolerance test 6-8 weeks post event as part of the "return to duty" process. In the case of a positive heat tolerance test the individual is classified as heat intolerant, in some cases however, the thermoregulatory recovery may be longer (several months), and therefore a second heat tolerance test is scheduled 6-8 weeks later. The presented case reports emphasize the possibility of different recovery periods of the thermoregulatory center and the distinction between congenital and acquired physiological heat intolerance.
  
  
  METHODS
  Two young healthy males (A and B) were diagnosed with exertional heat related injury during a pre-recruitment sorting process. Both underwent a heat tolerance test, and were found heat intolerant. During the next months they repeated the test several times. Patient A was finally diagnosed as heat tolerant and patient B was diagnosed as heat intolerant.
  
  
  CONCLUSIONS
  Susceptibility to heat is a significant determinant for active young people such as athletes and soldiers. Both cases emphasize the importance of the heat tolerance test (and repeated test when needed) as a criteria for an exertional heat related injury patient to return to duty/play and to perform intense physical activities. These cases also emphasize the effectiveness and sensitivity of the test in identifying a temporary and a permanent state of heat intolerance.
authors.affiliation: The Warrior Health Research Institute, Israel Defense Forces, Medical Corps, Ramat Gan, Israel.|Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Itay
authors.initials: I
authors.lastname: Ketko
authors.affiliation: Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Amit
authors.initials: A
authors.lastname: Druyan
authors.affiliation: The Warrior Health Research Institute, Israel Defense Forces, Medical Corps, Ramat Gan, Israel.|Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Yanovich
authors.affiliation: Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Epstein
authors.affiliation: The Warrior Health Research Institute, Israel Defense Forces, Medical Corps, Ramat Gan, Israel.|Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Heled
keywords: Exercise; Heat injury; Heat tolerance test; Thermoregulation