Background: With climate change, heat waves are expected to become more frequent in the near future. Already, on average more than 25 000 "heat deaths" are estimated to occur in Europe every year. However, heat stress and heat illnesses arise not just when ambient temperatures are high. Physical exertion increases heat production within the organism many times over; if not enough heat is lost, there is a risk of exertional heat stress. This review article discusses contributing factors, at-risk groups, and the diagnosis and treatment of heat illnesses. Methods: A selective literature search was carried out on PubMed. Current guidelines and expert recommendations were also included. Results: Apart from muscular heat production (>70% of converted energy), there are other factors that singly or in combination can give rise to heat stress: clothing, climate/acclimatization, and individual factors. Through its insulating properties, clothing reduces the evaporation of sweat (the most effective physiological cooling mechanism). A sudden heat wave, or changing the climate zone (as with air travel), increases the risk of a heat-related health event. Overweight, low fitness level, acute infections, illness, dehydration, and other factors also reduce heat tolerance. In addition to children, older people are particularly at risk because of their reduced physiological adaptability, (multi-)morbidity, and intake of prescription drugs. A heat illness can progress suddenly to life-threatening heat stroke. Successful treatment depends on rapid diagnosis and cooling the body down as quickly as possible. The aim is to reduce core body temperature to <40 °C within 30 minutes. Conclusion: Immediately effective cooling interventions are the only causal treatment for heat stroke. Time once lost cannot be made up. Prevention (acclimatiza tion, reduced exposure, etc.) and terminating the heat stress in good time (e.g., stopping work) are better than any cure.

Heat stress caused by protective clothing limits work time. Performance can be improved by a microclimate cooling method that supports evaporative and to a minor extent convective heat loss. Sweat evaporation is the most effective thermoregulatory mechanism for heat dissipation and can be enhanced by insufflating dry air into clothing.

The thermal insulation properties of a military wet/cold protection glove of the German Bundeswehr were investigated using the thermophysiological simulation device CYBOR with a heated full-scale hand model. The aim of this study was the physiology related and more reliable estimation of a database for the thermal comfort range of the glove in terms of environmental limit temperatures and maximum safe wearing times (limit times). For that purpose the simulation device CYBOR is equipped with a control feature allowing the simulation of the physiological effect that the blood flow into the hands as the dominant heat source is reduced with decreasing skin temperature (vasoconstriction effect). In the simulation test, the criterion defining the thermal comfort range of the glove was the maintenance of a minimum hand phantom skin temperature of 15 degrees C. For various assumed metabolic rates between 50 and 175 W m(-2) and environmental temperatures down to -22 degrees C, the maximum safe wearing times within the thermal comfort range of the military glove were estimated between only 20 min and almost 1 h. The used simulation scenario for the prediction of environmental limit temperatures, however, tends to deliver too low values in correlation to the estimated limit times and needs further critical consideration. The estimated data concerning the thermal comfort range of the wet/cold protection glove of the German Bundeswehr leads to the recommendation for a use of this model in mild cold climatic regions. The presented thermophysiological simulation procedure for the evaluation of the cold protection properties of gloves in terms of maximum safe wearing times within the thermal comfort range can be a useful tool to establish practical operating instructions for soldiers or civilians acting in cold environments.

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