Heat stroke burden and validity of wearable-derived core temperature estimation during elite military training

ABSTRACT

Objectives

Exertional heat stroke (EHS) remains a significant health concern while training in hot environments, prompting the development of noninvasive wearable technology for monitoring estimated core temperature (ECT). The objective of this study was to review the effectiveness of an ECT device during elite military training by providing a case series of individuals who developed EHS.

Methods

This is a retrospective study of EHS cases during high-intensity training while wearing the ECT device, Zephyr Bioharness^TM. Data was collected from January 2021 through September 2021 at the Air Force Special Warfare Training pipeline in San Antonio, TX. Rectal temperatures of EHS diagnoses, defined by central nervous system (CNS) dysfunction and rectal temperature approaching or >40°C (104°F), were compared to ECT reading via Zephyr Bioharness^TM. Incidence rates and psychometric properties were calculated using R package.

Results

A total of 47,058 daily peak ECT measurements were collected among 1,364 trainees. A total of 499 trainees flagged as potential EHS by Zephyr Bioharness^TM reading >39.7°C (103.5°F). The incidence of confirmed EHS was 0.8/1000 person-months. Of the 10 confirmed EHS cases (9 males, 1 female; age = 23.4 ± 2.7 yrs; BMI = 25 ± 2; body fat = 13 ± 5%), 8 trainees had a peak ECT reading below 39.7°C which resulted in a sensitivity of 20%, specificity of 98.9%, positive likelihood ratio (LR) of 18.93 (95% Confidence Interval [CI] 5.5–65.6), and a negative LR of 0.81 (95% CI 0.6–1.1).

Conclusion

ECT had substantial false positive and negative rates. Further studies are needed to validate this technology in other populations, and the algorithm used in this device needs to be refined to better capture the environmental and physical requirements in the special operations population.

KEYWORDS:

• Heat illness
• sports medicine
• air force
• special operations
• military medicine
• heat safety

Acknowledgements

We acknowledge Dr W. Casan Scott, PhD with assistance in the data formatting and figure, and Dr John J Fraser DPT PhD with assistance in the data analysis and abstract writing.

Disclosure statement

The views represented in this paper are those of the authors only and not representative of the Air Force Special Warfare Training Wing or Department of Defense. There was no funding received by any party involved in this research by any organization.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.