Return to Duty Following Exertional Heat Stroke: A Review.

This article focuses on best practices and challenges in return to duty (RTD) following exertional heat stroke (EHS) among military personnel. EHS, characterized by extreme hyperthermia and central nervous system dysfunction, requires rapid diagnosis and cooling to prevent severe morbidity and mortality. Current RTD guidelines vary across U.S. military branches and rely on clinical judgment, biochemical markers, and, in some cases, Heat Tolerance Testing (HTT)—a protocol originally developed by the Israeli Defense Force (IDF) but not universally accepted in the U.S. Military due to limitations in sensitivity and applicability. The review emphasizes a multifactorial approach to RTD decisions, incorporating clinical recovery, normalized biomarkers, mitigation of risk factors, and modified HTT results, while highlighting the need for further research to develop standardized, evidence-based protocols tailored to diverse military populations.