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Risk factors for heat illness among British soldiers in the hot Collective Training Environment
  1. Alice C Moore1,
  2. M J Stacey2,3,
  3. K G H Bailey4,
  4. R J Bunn5,
  5. D R Woods2,6,
  6. K J Haworth4,
  7. S J Brett3,7 and
  8. S E F Folkes4
  1. 1Department of Medicine, Frimley Health Foundation Trust, Frimley, UK
  2. 2Department of Military Medicine, RCDM, Birmingham, UK
  3. 3Department of Surgery and Cancer, Imperial College London, London, UK
  4. 4Occupational Medicine, Headquarters Army Recruiting and Training Division, Upavon, Wiltshire, UK
  5. 5Environmental Monitoring Team, Army Medical Directorate, Camberley, UK
  6. 6Carnegie Research Institute, Leeds Beckett University, Leeds, UK
  7. 7General Intensive Care Unit, Hammersmith Hospital, Du Cane Road, Greater London, UK
  1. Correspondence to Maj M J Stacey, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, Du Cane Road, London W120HS, UK; M.stacey13{at}


Background Heat illness is a preventable disorder in military populations. Measures that protect vulnerable individuals and contribute to effective Immediate Treatment may reduce the impact of heat illness, but depend upon adequate understanding and awareness among Commanders and their troops.

Objective To assess risk factors for heat illness in British soldiers deployed to the hot Collective Training Environment (CTE) and to explore awareness of Immediate Treatment responses.

Methods An anonymous questionnaire was distributed to British soldiers deployed in the hot CTEs of Kenya and Canada. Responses were analysed to determine the prevalence of individual (Intrinsic) and Command-practice (Extrinsic) risk factors for heat illness and the self-reported awareness of key Immediate Treatment priorities (recognition, first aid and casualty evacuation).

Results The prevalence of Intrinsic risk factors was relatively low in comparison with Extrinsic risk factors. The majority of respondents were aware of key Immediate Treatment responses. The most frequently reported factors in each domain were increased risk by body composition scoring, inadequate time for heat acclimatisation and insufficient briefing about casualty evacuation.

Conclusions Novel data on the distribution and scale of risk factors for heat illness are presented. A collective approach to risk reduction by the accumulation of ‘marginal gains’ is proposed for the UK military. This should focus on limiting Intrinsic risk factors before deployment, reducing Extrinsic factors during training and promoting timely Immediate Treatment responses within the hot CTE.


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  • Contributors ACM, MJS and KGB are responsible for the overall content as guarantors. All eight authors meet the authorship criteria endorsed by BMJ: substantial contributions to the conception of the work; drafting and revising the work critically for important intellectual content; final approval of the version to be published; agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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