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The Institute of Naval Medicine runs a Heat Illness Clinic (HIC), seeing about 140 military patients a year who have been referred following an episode of heat illness (HI). Patients undertake assessment of maximal aerobic fitness (VO2max) followed by a heat tolerance test (HTT), in which they walk on a treadmill at 60 % VO2max in a warm environment (34 °C dry bulb, relative humidity 40 % with a WBGT of 27 °C). Initially patients are fully clothed and carry a rucksack (mass 14 kg) to raise the deep body temperature, at 30 min the jacket and rucksack are removed and at 45 min the t-shirt removed. Patients continue to exercise until thermal equilibrium (i.e. a plateau of rectal temperature) is achieved (60 min to 90 min). Rectal temperature (Tre), mean skin temperature (Tmsk), heart rate (HR) and sweat rate (SR) are recorded. Patients in which thermal equilibrium is not achieved are considered to demonstrate abnormal thermoregulation and "fail" the HTT. These patients are reviewed at least once a minimum of 8 weeks later, and if they consistently fail the HTT and there is a suspicion of malignant hyperthermia (MH) they are recommended for referral to the Malignant Hyperthermia Unit, Leeds. MH is a genetic condition in which too much calcium is released from the intracellular store into the cytoplasm in response to certain triggering agents, e.g. the anaesthetic halothane. This leads to a rise in cellular metabolism and heat production, particularly within skeletal muscle, and it has been suggested that individuals with underlying MH are more susceptible to HI [1].

extreme physiology and medicine

Comparison of performance on a heat tolerance test of military personnel that have suffered heat illness and subsequently been diagnosed with malignant hyperthermia and controls