Table 2.

Adapted summary of the US Army universal precautions protocol³⁴

Leader and individual prevention measures
Identify and assess hazards
Check recent and anticipated environmental conditions and associated heat stress levels
Determine unique group and individual risk factors
Use the HEAT acronym:
Heat levels and associated risk
Exertion levels planned
Acclimation level of those present for training
Time factors including duration of activity and recovery time
Develop and implement risk controls
Plan training in advance and estimate risk of collapse events, taking into account:
Training event characteristics
Uniform and equipment needed
Location and time of day of key activities
Institute the following protocols according to hazard identified:
Adjust activity distances, duration, pace, and loads
Include work/rest cycles
Conduct high-intensity training in cooler morning hours
Ensure no consecutive days of high-intensity activity
Ensure proper resources available:
Equipment for checking wet-bulb globe temperatures (measure of heat stress in direct sunlight, taking into account temperature, humidity, wind speed, sun angle, and cloud cover)
Water, snacks, and electrolyte beverages
Medical resources and communication capabilities
Establish standard operating procedures, tested on soldiers

Adapted from Nelson et al.³⁴