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Heat illness experience at BMH Shaibah, Basra, during Operation TELIC: May–July 2003
  1. Jamie Coleman1,2,
  2. S Fair1,2,
  3. H Doughty1,2 and
  4. M J Stacey3,4
  1. 1 Army Medical Service 202 Midlands Field Hospital Reserve, Birmingham, UK
  2. 2 University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3 Military Medicine, Royal Center for Defence Medicine, Birmingham, UK
  4. 4 Surgery and Cancer, Imperial College London, London, UK
  1. Correspondence to LtCol M J Stacey, Military Medicine, Royal Center for Defence Medicine, Birmingham, B15 2SQ, UK; M.stacey13{at}


This is an observational study of heat-related illness in UK Service Personnel deployed into summer conditions in Northern Kuwait and Southern Iraq. Among 622 hospitalisations reported during a 9-week period at the historical British Military Hospital, Shaibah, 303 consecutive admissions are reviewed in detail. Several clinical syndromes attributable to thermal stress were observed. These ranged from self-limiting debility to life-threatening failures of homeostasis, with 5.0% developing a critical care requirement. Hyponatraemia was a commonly occurring electrolyte disturbance by which, relative to the local reference range, a majority of heat-attributed admissions were affected. Reductions in measured serum sodium could be profound (<125 mmol/L in 20.1% of all heat-related casualties). Hypokalaemia was observed in half of cases, though only a minority were affected by severely low potassium (<2.5 mmol/L in 4.0%). Despite preventive measures prescribed on hospital discharge, illness and significant biochemical derangements could recur upon return to duties in the heat. We reiterate the need for primary prevention of heat illness wherever possible and importance of early, effective interventions to treat and protect Service Personnel from secondary injury. We also highlight the requirement for comprehensive assessment to inform prognostication and occupational decision-making in relation to extreme climatic heat, including aeromedical evacuation. We draw additional attention to the contribution of psychological factors in select cases and identify research questions to improve understanding of environment-induced incapacitation in general.

  • chemical pathology
  • other metabolic
  • porphyria
  • epidemiology
  • occupational & industrial medicine

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  • Correction notice This article has been corrected since it first published. Acknowledgements section has been added.

  • Contributors JC and SF conceived the work. JC, SF and MJS undertook data analysis and drafted the manuscript. HD critically appraised and edited the work. All authors agree with the publication of the final version and accept responsibility for it.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The opinions expressed are personal and not those of the MOD.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.