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Exertional Heat Stroke, the Return to Play Decision, and the Role of Heat Tolerance Testing

A Clinician's Dilemma

O'Connor, Francis G., MD, MPH, FACSM; Heled, Yuval, PhD; Deuster, Patricia A., PhD, MPH, FACSM

Current Sports Medicine Reports: July 2018 - Volume 17 - Issue 7 - p 244–248
doi: 10.1249/JSR.0000000000000502
Nutrition and Ergogenic Aids: Special Communication

Exertional heat stroke (EHS) is a leading cause of preventable morbidity and mortality among both athletes and warfighters. Since current evidence suggests that the history of a prior event is an important risk factor for an EHS event, sports medicine providers can find post-EHS return to play/duty (RTP/D) decisions challenging. Heat tolerance testing is a tool that can help with such decisions by exposing the subject to a given heat load under controlled conditions to assess the presence or absence of heat tolerance. This special communication explores the challenge of the RTP/D after an EHS event and the potential role of heat tolerance testing in making this clinical decision.

Heat tolerance testing may have a valuable role in decisions on return to play after exertional heat stroke.

Uniformed Services University of the Health Sciences, Bethesda, MD

Address for correspondence: Francis G. O'Connor, MD, MPH, FACSM, 7305 Scarlet Oak Court, Fairfax Station, VA 22039; E-mail:

Copyright © 2018 by the American College of Sports Medicine.