Heat strain during military training activities: The dilemma of balancing force protection and operational capability

Military activities in hot environments pose 2 competing demands: the requirement to perform realistic training to develop operational capability with the necessity to protect armed forces personnel against heat-related illness. To ascertain whether work duration limits for protection against heat-related illness restrict military activities, this study examined the heat strain and risks of heat-related illness when conducting a military activity above the prescribed work duration limits. Thirty-seven soldiers conducted a march (10 km; ∼5.5 km h^-1) carrying 41.8 ± 3.6 kg of equipment in 23.1 ± 1.8°C wet-bulb globe temperature. Body core temperature was recorded throughout and upon completion, or withdrawal, participants rated their severity of heat-related symptoms. Twenty-three soldiers completed the march in 107 ± 6.4 min (Completers); 9 were symptomatic for heat exhaustion, withdrawing after 71.6 ± 10.1 min (Symptomatic); and five were removed for body core temperature above 39.0°C (Hyperthermic) after 58.4 ± 4.5 min. Body core temperature was significantly higher in the Hyperthermic (39.03 ± 0.26°C), than Symptomatic (38.34 ± 0.44°C; P = 0.007) and Completers (37.94 ± 0.37°C; P<0.001) after 50 min. Heat-related symptom severity was significantly higher among Symptomatic (28.4 ± 11.8) compared to Completers (15.0 ± 9.8, P = 0.006) and Hyperthermic (13.0 ± 9.6, P = 0.029). The force protection provided by work duration limits may be preventing the majority of personnel from conducting activities in hot environments, thereby constraining a commander's mandate to develop an optimised military force. The dissociation between heat-related symptoms and body core temperature elevation suggests that the physiological mechanisms underpinning exhaustion during exertional heat stress should be re-examined to determine the most appropriate physiological criteria for prescribing work duration limits.