. 2021 Nov 18;58(2):84–90. doi: 10.4085/1062-6050-352-21

Table 3.

Return to Activity After EHS With Considerations for Individual Event and Personal Factors

Event	Question	Response	Hypothetical Ideal Route for Return to Activity	Considerations
Recurrent EHS^a	NA	Yes	Consider following up with experts^a	Special^c
EHS	Hyperthermia for <30 min?^a,b	No	Consider following up with experts^a	Special^c
	Hyperthermia for <30 min?^a,b	Yes	Medical assessment and rest^a,d	NA
	Normal examination after medical assessment and rest?^d	No	Rest and modified physical activity^a,d	NA
		No	Reevaluation^a,d	NA
		Yes	Gradually increase exposure^a,d	NA
	Normal examination^d after reevaluation?	No	Rest and modified physical activity^a,d	NA
			Reevaluation^a,d
			Consider HTT^a
		Yes	Gradually increase exposure^a,d	NA
	After gradually increasing exposure, has exercise progressed normally?	No	Consider HTT	NA
		Yes	Cleared for full return to activity	Alternate^e
	Is HTT considered normal?	No	Rest and modified physical activity^a,d	NA
		No	Repeat HTT^a,d	NA
		Yes	Gradually increase exposure^a,d	Alternate^e
	Is follow-up HTT normal?	No	Consider following up with experts^a	Special^c
	Is follow-up HTT normal?	Yes	Gradually increase exposure^a,d	Alternate^e

Abbreviations: EHS, exertional heat stroke; HTT, heat tolerance testing; NA, not applicable.

Modified from or added to the original algorithm of Kazman et al.²³

Hyperthermia was defined as core body temperature >40°C.

Special considerations include (1) characteristics related to the EHS event (eg, time to treatment, treatment modality, time in the hyperthermic state, laboratory values after EHS, and time to normalized laboratory values) and (2) consideration of trait (eg, previous EHS or exertional heat illness episode; neurologic, skin or sweating, metabolic or thermoregulatory, or cardiovascular disorders; and age).

Refer to Table 1 for recommendations.

Alternate considerations include consideration of state, with the EHS most likely due to factors at the time of the event, such as body composition, poor fitness, environment (wet-bulb globe temperature on the day of the EHS event and on days before the event), equipment, dehydration, nutrition, recent illness, sleep deprivation, improper acclimation, clothing, high-intensity exercise, drugs or medications, and work-to-rest ratio.