Materiały źródłowe

• #1 Heat Stroke: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/166320-overview

  In the United States, heat waves claim more lives each year than all other weather-related exposures combined (hurricanes, tornadoes, floods, and earthquakes). According to the Centers for Disease Control and Prevention (CDC), from 2004-2018, an average of 702 heat-related deaths occurred in the United States annually. This timeframe included a total of 10,527 deaths resulting from exposure to heat-related conditions. Of these, approximately 90% occurred from May through September. Approximately one third (37%) occurred in Arizona, California, and Texas, despite these states comprising only 23% of the US population. Heat stroke and deaths from excessive heat exposure are more common during summers with prolonged heat waves. […] Heat stroke is uncommon in subtropical climates. The condition is recognized increasingly in countries that experience heat waves rarely (eg, Japan), and it commonly affects people who undertake a pilgrimage to Mecca, especially pilgrims who come from a cold environment. In 1998, one of the worst heat waves to strike India in 50 years resulted in more than 2600 deaths in 10 weeks. Unofficial reports described the number of deaths as almost double that figure.

• #1 Acute Management of Heat Stroke: Facts and Figures | IntechOpen

  https://www.intechopen.com/chapters/88937

  Heat-related illnesses range from heat exhaustion to heat stroke. Heat stroke is a life-threatening medical emergency causing multiple organ dysfunction that if not treated, can be fatal. […] Epidemiology of heat stroke varies depending on geographic location, and reported incidences range from 1.98 to 2.89/100000 per year. […] In the United States, from 2006 to 2010, it was reported to have caused at least 3332 deaths. Heat stroke mortality is correlated with the degree of body temperature elevation, time of initiation of cooling, and number of organs affected. […] Heat stroke is higher in females, with a female-to-male ratio of up to 2.89 versus 0.98 per 1000 person-years. […] During the European heat wave in 2022, thousands of people died due to heat stroke. Heat stroke mortality is expected to rise by 2.5 times by 2050. […] Heat stroke generates a systemic inflammatory and coagulopathy response in combination with heat injury causes organ dysfunctions. Diagnosed with raised body temperature with clinical manifestation and signs and symptoms of organ dysfunction or failure.

• #1 Heat exhaustion and heat stroke among active component members of the U.S. Armed Forces, 2019-2023 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38722363/

  The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the military’s training and operational environments. These illnesses can typically be prevented by appropriate situational awareness, risk management strategies, along with effective countermeasures. In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period. […] In 2023, higher rates of heat stroke were observed among male service members compared to their female counterparts, and female service members experienced higher rates of heat exhaustion compared to male personnel. Heat illness rates were also higher among those younger than age 20, Marine Corps and Army service members, non-Hispanic Black service members, and recruits. Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions.

• #1 Exertional heat illness in adolescents and adults: Epidemiology, thermoregulation, risk factors, and diagnosis – UpToDate

  https://www.uptodate.com/contents/exertional-heat-illness-in-adolescents-and-adults-epidemiology-thermoregulation-risk-factors-and-diagnosis/print

  Exertional heat illness (EHI) is among the leading causes of death in young athletes each year. A report by the United States Centers for Disease Control and Prevention (CDC) found that EHI occurs both during practice and competition and noted a disturbing trend of increasing incidence. […] The United States military reported that the crude incidence of heat stroke and heat exhaustion during the 2019 to 2023 surveillance period were 31.7 and 172.7 cases per 100,000 person-years, respectively. While the rates of incident heat stroke declined during this period, the rates of incident heat exhaustion increased. […] In the United States, the highest incidence of EHS is found among participants in American football, in whom the condition occurs at a rate of over 4 cases per 100,000 athlete exposures.

• #1 Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2019-2023

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11107842/

  Over the 5-year surveillance period, the rate of heat stroke decreased annually from 2019 to 2023, while the rate of heat exhaustion dropped in 2020 compared to 2019 and then increased annually from 2021 to 2023. […] Maintaining regular heat illness surveillance helps identify the magnitude of the impact these conditions have on service member health, training, and force readiness.

• #1 Real-time heat-related illness in NYC.

  https://a816-dohbesp.nyc.gov/IndicatorPublic/data-features/heat-syndrome/

  We can also track heat-related illness with near real-time electronic data from emergency departments at hospitals throughout NYC. […] Heat-related illnesses – including heat exhaustion, muscle cramps, fainting, and heat stroke (the most serious form) – happen when the body cannot cool down enough. […] Heat syndrome is identified in surveillance data by looking for diagnostic codes for heat-related illness and by searching chief complaints (descriptions of why patients are at the ED) for words related to heat exposure and heat-related illness, such as overheating, sunstroke, and similar terms. […] In addition, heat-related illness cases in syndromic surveillance data provide a useful indicator of the lethal impacts of extreme heat events, but the number of HRI cases does not reflect the full burden of health impacts, such as increases in death or hospital visits for heat-sensitive chronic conditions, which are not available in near-real time. […] Tracking heat-related illness (HRI) in near-real time can help provide situational awareness, supplementing the weather forecast as an indicator of public health risk.

• #1 Heat stroke internet searches can be a new heatwave health warning surveillance indicator | Scientific Reports

  https://www.nature.com/articles/srep37294

  The impact of major heatwave shocks on population morbidity and mortality has become an urgent public health concern. […] Current heatwave warning systems suffer from a lack of validation and an inability to provide accurate health risk warnings in a timely way. […] Surveillance during heatwave conditions is of critical public health concern, in order to determine whether the heatwave is associated with an increase in mortality or morbidity so that appropriate public health actions can be taken. […] Current public health surveillance methods of heatwaves do not provide the information quickly enough to detect the increased number of adverse health outcomes in time to respond so its use is normally limited to retrospective analyses in order to better understand the relationship between heatwaves and health.

• #1

  https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health

  The negative health impacts of heat are predictable and largely preventable with specific public health and multi-sectoral policies and interventions. WHO has issued guidance for public health institutions to identify and manage extreme heat risks. […] The frequency and intensity of extreme heat and heat waves will continue to rise in the 21st century because of climate change. Extended periods of high day and nighttime temperature conditions create cumulative stress on the human body, increasing the risk of illness and death from heat exposure. […] The bodys inability to regulate internal temperature and eliminate heat gain in such conditions increases the risk of heat exhaustion and heatstroke. […] Deaths and hospitalizations triggered by extreme hot weather occur rapidly (same day and following days), which means interventions also need to be rapid when a heat alert is issued. […] WHO works with the health sector to strengthen governance, preparedness and response to acute impacts of heatwaves by developing heat action plans, heat early warning systems and advisories, and emergency response plans that map the risks, vulnerable populations, available capacities and resources.

• #1 Climate Change Indicators: Heat-Related Illnesses | US EPA

  https://www.epa.gov/climate-indicators/heat-related-illnesses

  From 2001 to 2010, the 20 states covered in Figure 1 recorded a total of about 28,000 heat-related hospitalizations. The resulting annual rates ranged from 1.1 cases per 100,000 people in 2004 to 2.5 cases per 100,000 people in 2006, with a 10-year average rate of 1.8 cases per 100,000 people (see Figure 1). […] Heat-related hospitalization rates vary widely among the 23 states studied (see Figure 2). Average rates from 2001 to 2010 ranged from fewer than one case per 100,000 people in some states to nearly four cases per 100,000 people in others. The highest rates occurred in Kansas, Louisiana, Missouri, South Carolina, and Tennessee. Relatively high hospitalization rates in the Southeast and Midwest suggest a connection between hotter and more humid summers and increased rates of heat-related illness, compared with other regions.

• #1 Climate Change Indicators: Heat-Related Illnesses | US EPA

  https://www.epa.gov/climate-indicators/heat-related-illnesses

  People aged 65+ accounted for more heat-related hospitalizations than any other age group from 2001 to 2010, and males were hospitalized for heat-related illnesses more than twice as often as females (see Figure 3). Men tend to have a higher risk of heat-related illness than women because they are more likely to work in outdoor occupations such as construction. […] This indicator shows hospitalization rates for heat-related illnesses such as heat exhaustion, heat cramps, mild heat edema (swelling in the legs and hands), heat syncope (fainting), and heat stroke. It is based on hospital discharge records for patients who are admitted to the hospital for 23 hours or more.

• #1 Heat-Related Illnesses | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p482.html

  Most heat-related illnesses can be avoided or minimized. The National Athletic Trainers’ Association and the American College of Sports Medicine endorse similar recommendations for the prevention of heat-related illnesses. Key strategies include acclimatization; adequate hydration; wearing loose-fitting, light-colored clothing; and avoidance of activities during extreme temperatures.

• #1 Extreme Heat | Florida Department of Health

  https://www.floridahealth.gov/programs-and-services/emergency-preparedness-and-response/prepare-yourself/current-hazards/extreme-heat.html

  Heat stroke: Life-threatening; body temperature over 104F causes confusion, unconsciousness, and organ failure. Seek immediate medical help. […] Certain groups face higher risks during extreme heat: […] Elderly: May struggle to adjust to heat and often miss signs of dehydration. […] Children: Dehydrate quickly and need close monitoring. […] Medical conditions: People with heart, lung, or kidney issues, or on specific medications, are more vulnerable. […] Florida summers bring intense heat and humidity, increasing the risk of heat-related health issues. […] By taking these steps and staying informed, you can significantly reduce your risk and stay safe during extreme heat events. It’s important to listen to weather reports, recognize the signs of heat-related illnesses, and adjust your activities accordingly.

• #1

  https://www.eea.europa.eu/en/analysis/publications/the-impacts-of-heat-on-health

  This briefing outlines the status of surveillance for heat-related health impacts and heat-health actions plans in 38 European countries. […] Timely and reliable data on the number of deaths and illnesses associated with heat are essential for deploying targeted emergency responses during hot periods. […] 20 of the EEA-38 countries currently monitor heat impacts on health and three additional countries are developing heat-health monitoring systems. […] 21 of the EEA-38 countries have heat-health action plans (HHAPs) in place, and another four National Public Health Institutes are developing HHAPs. […] The European Climate Risk Assessment describes the current level of risk to human health from heat as critical, growing to catastrophic in the second half of the century, calling for urgent action.

• #1 Signs of Heat Exhaustion & Heat Stroke in Kids – Children’s Health

  https://www.childrens.com/health-wellness/heat-stroke-symptoms-in-children

  Cases of heat stroke spike at the end of June and into July each year and continue through August. […] Heat stroke is a severe type of heat illness that occurs when a child’s body creates more heat than it can release. […] Heat stroke in athletes is not as common as heat exhaustion but is life-threatening. […] High temperatures can put children at risk for heat-related illness.

• #2

  https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health

  Heat is an important environmental and occupational health hazard. Heat stress is the leading cause of weather-related deaths and can exacerbate underlying illnesses including cardiovascular disease, diabetes, mental health, asthma, and can increase the risk of accidents and transmission of some infectious diseases. Heatstroke is a medical emergency with a high-case fatality rate. […] The number of people exposed to extreme heat is growing exponentially due to climate change in all world regions. Heat-related mortality for people over 65 years of age increased by approximately 85% between 20002004 and 20172021. […] Between 20002019 studies show approximately 489 000 heat-related deaths occur each year, with 45% of these in Asia and 36% in Europe. In Europe alone in the summer of 2022, an estimated 61 672 heat-related excess deaths occurred. High intensity heatwave events can bring high acute mortality; in 2003, 70 000 people in Europe died as a result of the JuneAugust event. In 2010, 56 000 excess deaths occurred during a 44day heatwave in the Russian Federation.

• #2 Acute Management of Heat Stroke: Facts and Figures | IntechOpen

  https://www.intechopen.com/chapters/88937

  Heat-related illnesses range from heat exhaustion to heat stroke. Heat stroke is a life-threatening medical emergency causing multiple organ dysfunction that if not treated, can be fatal. […] Epidemiology of heat stroke varies depending on geographic location, and reported incidences range from 1.98 to 2.89/100000 per year. […] In the United States, from 2006 to 2010, it was reported to have caused at least 3332 deaths. Heat stroke mortality is correlated with the degree of body temperature elevation, time of initiation of cooling, and number of organs affected. […] Heat stroke is higher in females, with a female-to-male ratio of up to 2.89 versus 0.98 per 1000 person-years. […] During the European heat wave in 2022, thousands of people died due to heat stroke. Heat stroke mortality is expected to rise by 2.5 times by 2050. […] Heat stroke generates a systemic inflammatory and coagulopathy response in combination with heat injury causes organ dysfunctions. Diagnosed with raised body temperature with clinical manifestation and signs and symptoms of organ dysfunction or failure.

• #2 Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2019-2023

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11107842/

  The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the militarys training and operational environments. […] In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. […] The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period. […] Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions. […] From 2019 to 2023, the crude annual incidence rate of heat stroke decreased 15.6%, while the crude annual incidence rate of heat exhaustion increased by 4.6% during the same period.

• #2 Exertional heat illness in adolescents and adults: Epidemiology, thermoregulation, risk factors, and diagnosis – UpToDate

  https://www.uptodate.com/contents/exertional-heat-illness-in-adolescents-and-adults-epidemiology-thermoregulation-risk-factors-and-diagnosis

  In the United States, the highest incidence of EHS is found among participants in American football, in whom the condition occurs at a rate of over 4 cases per 100,000 athlete exposures. […] A comprehensive study of fatal episodes of EHS among military personnel provides further insight into important risk factors. […] Other studies emphasize the importance of adverse environmental conditions in heat illness. Data from large-scale endurance events, such as marathons, show a strong correlation between the severity of environmental conditions and the incidence of heat illness, especially EHS. […] A four-year study of collegiate American football players found the incidence of heat illness to be closely associated with rising wet bulb globe temperature (WBGT) and lack of heat acclimatization.

• #2 Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2019-2023

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11107842/

  Heat exhaustion and heat stroke are reportable medical events (RMEs) in the U.S. Military Health System (MHS). […] Ongoing surveillance of heat illnesses is necessary to determine if prevention guidelines and countermeasures are working, in addition to identifying high-risk groups and activities that may lead to heat illness. […] This update presents summaries of heat stroke and heat exhaustion case counts, incidence rates, and locations between 2019 and 2023. […] The crude annual incidence rate of heat stroke decreased 15.6% from 2019 through 2023, with a 5.9% decline from 2022 to 2023. […] The 2,263 cases of heat exhaustion in 2023 correspond to a crude incidence rate of 172.7 cases per 100,000 p-yrs. […] The incidence rate of heat exhaustion among recruits was 12.5 and 13.5 times higher than other enlisted service members and officers, respectively.

• #2 Heat-related illness surveillance data for Thursday, July 28, 2022 – King County, Washington

  https://kingcounty.gov/en/dept/dph/about-king-county/about-public-health/news/news-archive-2022/july-29-heat-illness

  High temperatures are forecast for the Puget Sound Region this week. Heat can be deadly, but deaths from heat are preventable. […] Serious health problems from heat include kidney failure, stroke, and heart attacks. Heat exhaustion and heat stroke are also risks. […] Emergency department visits for heat-related illnesses (HRI) are defined as those that meet a syndrome definition that include mention of the terms „hyperthermia,” „sun stroke,” „heat exhaustion,” or related terms. It also captures visits with diagnostic codes for heat-related illnesses, such as heatstroke. […] EMS incidents for suspected heat-related illness include prehospital clinical impressions and patient symptoms of heatstroke, sunstroke, heat exhaustion, heat-related illness, and heat syncope.

• #2 Heat stroke internet searches can be a new heatwave health warning surveillance indicator | Scientific Reports

  https://www.nature.com/articles/srep37294

  The impact of major heatwave shocks on population morbidity and mortality has become an urgent public health concern. […] Current heatwave warning systems suffer from a lack of validation and an inability to provide accurate health risk warnings in a timely way. […] Surveillance during heatwave conditions is of critical public health concern, in order to determine whether the heatwave is associated with an increase in mortality or morbidity so that appropriate public health actions can be taken. […] Current public health surveillance methods of heatwaves do not provide the information quickly enough to detect the increased number of adverse health outcomes in time to respond so its use is normally limited to retrospective analyses in order to better understand the relationship between heatwaves and health.

• #2

  https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health

  The negative health impacts of heat are predictable and largely preventable with specific public health and multi-sectoral policies and interventions. WHO has issued guidance for public health institutions to identify and manage extreme heat risks. […] The frequency and intensity of extreme heat and heat waves will continue to rise in the 21st century because of climate change. Extended periods of high day and nighttime temperature conditions create cumulative stress on the human body, increasing the risk of illness and death from heat exposure. […] The bodys inability to regulate internal temperature and eliminate heat gain in such conditions increases the risk of heat exhaustion and heatstroke. […] Deaths and hospitalizations triggered by extreme hot weather occur rapidly (same day and following days), which means interventions also need to be rapid when a heat alert is issued. […] WHO works with the health sector to strengthen governance, preparedness and response to acute impacts of heatwaves by developing heat action plans, heat early warning systems and advisories, and emergency response plans that map the risks, vulnerable populations, available capacities and resources.

• #2 Climate Change Indicators: Heat-Related Illnesses | US EPA

  https://www.epa.gov/climate-indicators/heat-related-illnesses

  From 2001 to 2010, the 20 states covered in Figure 1 recorded a total of about 28,000 heat-related hospitalizations. The resulting annual rates ranged from 1.1 cases per 100,000 people in 2004 to 2.5 cases per 100,000 people in 2006, with a 10-year average rate of 1.8 cases per 100,000 people (see Figure 1). […] Heat-related hospitalization rates vary widely among the 23 states studied (see Figure 2). Average rates from 2001 to 2010 ranged from fewer than one case per 100,000 people in some states to nearly four cases per 100,000 people in others. The highest rates occurred in Kansas, Louisiana, Missouri, South Carolina, and Tennessee. Relatively high hospitalization rates in the Southeast and Midwest suggest a connection between hotter and more humid summers and increased rates of heat-related illness, compared with other regions.

• #2 Climate Change Indicators: Heat-Related Illnesses | US EPA

  https://www.epa.gov/climate-indicators/heat-related-illnesses

  People aged 65+ accounted for more heat-related hospitalizations than any other age group from 2001 to 2010, and males were hospitalized for heat-related illnesses more than twice as often as females (see Figure 3). Men tend to have a higher risk of heat-related illness than women because they are more likely to work in outdoor occupations such as construction. […] This indicator shows hospitalization rates for heat-related illnesses such as heat exhaustion, heat cramps, mild heat edema (swelling in the legs and hands), heat syncope (fainting), and heat stroke. It is based on hospital discharge records for patients who are admitted to the hospital for 23 hours or more.

• #2

  https://www.eea.europa.eu/en/analysis/publications/the-impacts-of-heat-on-health

  The surveillance of the health impacts of heat is central to the public health response to this climate hazard. […] Over a quarter of countries in Europe do not have HHAPs, which may negatively impact their preparedness to heat. […] HHAPs are recognised as a key tool for reducing deaths and preventing other health impacts during periods of high temperatures. […] According to the 2024 survey, 12 of the 28 responding NPHIs have HHAPs in place at either the national, regional or local level, while four more are in the process of developing HHAPs. […] The lack of timely data in the remaining countries can be regarded as an obstacle to timely and effective action against heat-related deaths. […] Data on the health impacts of heat is also essential for the long-term development of public health policies, selecting adaptive measures and planning for future heat-related impacts on human health and healthcare systems.

• #2 Heat-related Illnesses | Health & Human Services

  https://hhs.iowa.gov/data/health/heat-related-illnesses

  Heat-related illness includes a range of health impacts from milder conditions like heat rash and heat cramps to the most common type, heat exhaustion. The most serious heat-related illness is heat stroke. Heat stroke can cause death or permanent disability if emergency treatment is not provided. […] When temperatures increase, communities across the United States are vulnerable to heat-related illnesses which may lead to heat stroke and death. […] Heat-related death or illnesses are preventable if you follow a few simple steps. […] Air conditioning is the strongest protective factor against heat-related illness. Exposure to air conditioning for even a few hours a day will reduce the risk for heat-related illness.

• #2 Beat the Heat | Pima County, AZ

  https://www.pima.gov/2042/Beat-the-Heat

  Heat-related illness, like heat exhaustion or heat stroke, is when our bodies cannot properly cool themselves. Our bodies normally cool down by sweating, but during extreme heat a person’s body temperature might rise faster than it can cool itself down, sometimes causing severe illness or death. […] Each year, nearly 2,000 people visit Arizona emergency rooms because of heat-related illnesses. […] The good news is that heat-related illnesses and deaths are preventable. […] Although anyone can suffer from heat-related illness, some people are at greater risk than others: Infants and young children, People who are pregnant, People 65 years of age or older, People who are overweight, People who overexert during work or exercise, People who are physically ill, especially with heart disease or high blood pressure, or who take certain medications, such as for depression, insomnia, or poor circulation.

• #2 Signs of Heat Exhaustion & Heat Stroke in Kids – Children’s Health

  https://www.childrens.com/health-wellness/heat-stroke-symptoms-in-children

  Cases of heat stroke spike at the end of June and into July each year and continue through August. […] Heat stroke is a severe type of heat illness that occurs when a child’s body creates more heat than it can release. […] Heat stroke in athletes is not as common as heat exhaustion but is life-threatening. […] High temperatures can put children at risk for heat-related illness.

• #3

  https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health

  Heat is an important environmental and occupational health hazard. Heat stress is the leading cause of weather-related deaths and can exacerbate underlying illnesses including cardiovascular disease, diabetes, mental health, asthma, and can increase the risk of accidents and transmission of some infectious diseases. Heatstroke is a medical emergency with a high-case fatality rate. […] The number of people exposed to extreme heat is growing exponentially due to climate change in all world regions. Heat-related mortality for people over 65 years of age increased by approximately 85% between 20002004 and 20172021. […] Between 20002019 studies show approximately 489 000 heat-related deaths occur each year, with 45% of these in Asia and 36% in Europe. In Europe alone in the summer of 2022, an estimated 61 672 heat-related excess deaths occurred. High intensity heatwave events can bring high acute mortality; in 2003, 70 000 people in Europe died as a result of the JuneAugust event. In 2010, 56 000 excess deaths occurred during a 44day heatwave in the Russian Federation.

• #3 Acute Management of Heat Stroke: Facts and Figures | IntechOpen

  https://www.intechopen.com/chapters/88937

  Heat-related illnesses range from heat exhaustion to heat stroke. Heat stroke is a life-threatening medical emergency causing multiple organ dysfunction that if not treated, can be fatal. […] Epidemiology of heat stroke varies depending on geographic location, and reported incidences range from 1.98 to 2.89/100000 per year. […] In the United States, from 2006 to 2010, it was reported to have caused at least 3332 deaths. Heat stroke mortality is correlated with the degree of body temperature elevation, time of initiation of cooling, and number of organs affected. […] Heat stroke is higher in females, with a female-to-male ratio of up to 2.89 versus 0.98 per 1000 person-years. […] During the European heat wave in 2022, thousands of people died due to heat stroke. Heat stroke mortality is expected to rise by 2.5 times by 2050. […] Heat stroke generates a systemic inflammatory and coagulopathy response in combination with heat injury causes organ dysfunctions. Diagnosed with raised body temperature with clinical manifestation and signs and symptoms of organ dysfunction or failure.

• #3 Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2019-2023

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11107842/

  The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the militarys training and operational environments. […] In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. […] The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period. […] Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions. […] From 2019 to 2023, the crude annual incidence rate of heat stroke decreased 15.6%, while the crude annual incidence rate of heat exhaustion increased by 4.6% during the same period.

• #3 Heat-Related Illnesses | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p482.html

  Heat-related illnesses comprise a spectrum of syndromes resulting from disruption of thermoregulation in people exposed to high environmental heat. Symptoms range from heat edema and exercise-associated muscle cramps to exercise-associated collapse, heat exhaustion, and life-threatening heat stroke. Athletes, outdoor laborers, and military personnel are at greatest risk. […] The incidence of heat-related illness in U.S. high school athletes is 1.6 cases per 100,000 athletic exposures, or approximately 9,000 cases annually, with the highest rates occurring during football season. It is the third leading cause of death in high school athletes. In the U.S. Armed Forces, there were 2,163 cases of heat-related illness and 464 cases of heat stroke in 2017, with an incidence of 1.41 and 0.38 cases per 1,000 person-years, respectively. The incidence has gradually increased since 2014. The rate of emergency department visits for heat-related illnesses was five per 10,000 visits from 2006 to 2010 (n = 326,497); 75% of these patients were diagnosed with heat exhaustion and 5.4% with heat stroke. Approximately 12% of these patients were admitted, and the mortality rate was 0.07%.

• #3 Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2019-2023 | Health.mil

  https://health.mil/News/Articles/2024/04/01/MSMR-Heat-Illness-2024

  Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions. […] Many factors inherent to military training and operational environments can increase risk of heat illness: environmental factors (e.g., heat and humidity), occupational factors (e.g., strenuous activity and intense training), and personal factors (e.g., highly motivated individuals and populations). […] Despite these risks, heat illness incidence and severity can be reduced by implementing and enforcing appropriate countermeasures. […] Heat exhaustion and heat stroke are reportable medical events in the U.S. Military Health System. All occurrences that require medical intervention or result in change of duty status must be reported.

• #3 Using web data to improve surveillance for heat sensitive health outcomes | Environmental Health | Full Text

  https://ehjournal.biomedcentral.com/articles/10.1186/s12940-019-0499-x

  Elevated and prolonged exposure to extreme heat is an important cause of excess summertime mortality and morbidity. To protect people from health threats, some governments are currently operating syndromic surveillance systems. […] The results show that the number of heat-related illness and dehydration cases exhibited a significant positive relationship with web data. […] Our findings suggest web data created by social medias and search engines could improve the current syndromic surveillance systems. In particular, heat-related illness and dehydration cases were positively related with web data. […] The goal of this study is to examine the relationship between social media messages/web search results and health outcomes, and ultimately improve upon models that only consider temperature.

• #3 Heat stroke internet searches can be a new heatwave health warning surveillance indicator | Scientific Reports

  https://www.nature.com/articles/srep37294

  The impact of major heatwave shocks on population morbidity and mortality has become an urgent public health concern. […] Current heatwave warning systems suffer from a lack of validation and an inability to provide accurate health risk warnings in a timely way. […] Surveillance during heatwave conditions is of critical public health concern, in order to determine whether the heatwave is associated with an increase in mortality or morbidity so that appropriate public health actions can be taken. […] Current public health surveillance methods of heatwaves do not provide the information quickly enough to detect the increased number of adverse health outcomes in time to respond so its use is normally limited to retrospective analyses in order to better understand the relationship between heatwaves and health.

• #3

  https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health

  The negative health impacts of heat are predictable and largely preventable with specific public health and multi-sectoral policies and interventions. WHO has issued guidance for public health institutions to identify and manage extreme heat risks. […] The frequency and intensity of extreme heat and heat waves will continue to rise in the 21st century because of climate change. Extended periods of high day and nighttime temperature conditions create cumulative stress on the human body, increasing the risk of illness and death from heat exposure. […] The bodys inability to regulate internal temperature and eliminate heat gain in such conditions increases the risk of heat exhaustion and heatstroke. […] Deaths and hospitalizations triggered by extreme hot weather occur rapidly (same day and following days), which means interventions also need to be rapid when a heat alert is issued. […] WHO works with the health sector to strengthen governance, preparedness and response to acute impacts of heatwaves by developing heat action plans, heat early warning systems and advisories, and emergency response plans that map the risks, vulnerable populations, available capacities and resources.

• #3 Heat stroke epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Heat_stroke_epidemiology_and_demographics

  The United States Centers for Disease Control (CDC) reports an average of 9000 cases per year among high school athletes. The highest incidence of heat stroke in athletes in the United States has been reported among football players. Young athletes are more prone to exertional heat stroke while, classic heat stroke is more common among elderly. Men are more affected by heat stroke than women. […] The United States Centers for Disease Control report a weighted average of 9237 cases of exercise heat stroke among high school athletes per year for the period 2005 to 2009. Its incidence has been increased among the United States military personnel in 2014 compared to 2013 despite preventive measures. […] In Saudi Arabia, the incidence varies seasonally, from 22 to 250 cases per 100,000 population. Epidemiologic studies showed an incidence of 17.6 to 26.5 cases per 100,000 population in urban areas of the United States during heat waves. The highest incidence of exertional heat stroke in athletes in the United States is among football players and it’s approximately 4.5 cases per 100,000 athlete exposures. […] Exertional heat stroke is more common in age group 15-50 years. Classic heat stroke is more common in early childhood and elderly. […] Exertional heat stroke is more common among men than in women. […] Heat stroke is more common among Asian/Pacific Islander than other ethnicities.

• #3 Using web data to improve surveillance for heat sensitive health outcomes | Environmental Health | Full Text

  https://ehjournal.biomedcentral.com/articles/10.1186/s12940-019-0499-x

  We found a disproportionate disease burden by sex for some disease categories. There were proportionately more male than female heat-related illness and renal disease cases while the opposite was true for cardiovascular disease, respiratory disease, and dehydration. […] We first analyzed the relationship between heat-related illness and web data using a GLM (logit family, binary link function) due to the small number of cases. […] Most of the web data were positively associated with dehydration ED cases. Dehydration was positively correlated with heat, AC, AC repair, heat stroke, park, pool, swim, and water. […] We also investigated the relationship between maximum temperature and five different types of health outcomes. Overall, maximum temperature provided the strongest and most consistent relationships with the number of heat-related illness cases.

• #3

  https://www.eea.europa.eu/en/analysis/publications/the-impacts-of-heat-on-health

  This briefing outlines the status of surveillance for heat-related health impacts and heat-health actions plans in 38 European countries. […] Timely and reliable data on the number of deaths and illnesses associated with heat are essential for deploying targeted emergency responses during hot periods. […] 20 of the EEA-38 countries currently monitor heat impacts on health and three additional countries are developing heat-health monitoring systems. […] 21 of the EEA-38 countries have heat-health action plans (HHAPs) in place, and another four National Public Health Institutes are developing HHAPs. […] The European Climate Risk Assessment describes the current level of risk to human health from heat as critical, growing to catastrophic in the second half of the century, calling for urgent action.

• #3 Extreme Heat | Florida Department of Health

  https://www.floridahealth.gov/programs-and-services/emergency-preparedness-and-response/prepare-yourself/current-hazards/extreme-heat.html

  Heat stroke: Life-threatening; body temperature over 104F causes confusion, unconsciousness, and organ failure. Seek immediate medical help. […] Certain groups face higher risks during extreme heat: […] Elderly: May struggle to adjust to heat and often miss signs of dehydration. […] Children: Dehydrate quickly and need close monitoring. […] Medical conditions: People with heart, lung, or kidney issues, or on specific medications, are more vulnerable. […] Florida summers bring intense heat and humidity, increasing the risk of heat-related health issues. […] By taking these steps and staying informed, you can significantly reduce your risk and stay safe during extreme heat events. It’s important to listen to weather reports, recognize the signs of heat-related illnesses, and adjust your activities accordingly.

• #3 Extreme Heat | Florida Department of Health

  https://www.floridahealth.gov/programs-and-services/emergency-preparedness-and-response/prepare-yourself/current-hazards/extreme-heat.html

  Extreme heat is one of the leading weather-related causes of death in the U.S., and Florida is particularly vulnerable due to its long summers and high humidity. […] These conditions can overwhelm the bodys cooling system, leading to heat-related illnesses like heat exhaustion and heat stroke, especially for vulnerable populations such as the elderly, children, and those with pre-existing health conditions. […] Extreme heat occurs when high temperatures, often accompanied by high humidity, overwhelm the bodys natural cooling mechanisms. This condition can cause heat-related illnesses such as heat exhaustion, heat stroke, and dehydration. […] Heat-related illnesses can develop quickly, especially during prolonged exposure to extreme heat. The most common illnesses include: […] Heat exhaustion: Heavy sweating, weakness, dizziness, nausea, and headache. Can progress to heat stroke if untreated.

• #4

  https://www.who.int/news-room/fact-sheets/detail/climate-change-heat-and-health

  Heat is an important environmental and occupational health hazard. Heat stress is the leading cause of weather-related deaths and can exacerbate underlying illnesses including cardiovascular disease, diabetes, mental health, asthma, and can increase the risk of accidents and transmission of some infectious diseases. Heatstroke is a medical emergency with a high-case fatality rate. […] The number of people exposed to extreme heat is growing exponentially due to climate change in all world regions. Heat-related mortality for people over 65 years of age increased by approximately 85% between 20002004 and 20172021. […] Between 20002019 studies show approximately 489 000 heat-related deaths occur each year, with 45% of these in Asia and 36% in Europe. In Europe alone in the summer of 2022, an estimated 61 672 heat-related excess deaths occurred. High intensity heatwave events can bring high acute mortality; in 2003, 70 000 people in Europe died as a result of the JuneAugust event. In 2010, 56 000 excess deaths occurred during a 44day heatwave in the Russian Federation.

• #4 Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2019-2023

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11107842/

  The observed decrease in heat stroke coincident with observed increase in heat exhaustion may demonstrate evidence of successful awareness and prevention efforts emphasizing recognition of the early signs and symptoms of less severe heat illness, which resulted in avoidance of more severe illness such as heat stroke. […] Many factors inherent to military training and operational environments can increase risk of heat illness: environmental factors (e.g., heat and humidity), occupational factors (e.g., strenuous activity and intense training), and personal factors (e.g., highly motivated individuals and populations). […] Despite these risks, heat illness incidence and severity can be reduced by implementing and enforcing appropriate countermeasures. […] Heat illness occurs within a continuum of severity, from less severe (e.g., heat cramps, rash, edema, and syncope), then to heat exhaustion, followed by potentially life-threatening (e.g., heat stroke).

• #4 Heat-Related Illnesses | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p482.html

  Heat-related illnesses comprise a spectrum of syndromes resulting from disruption of thermoregulation in people exposed to high environmental heat. Symptoms range from heat edema and exercise-associated muscle cramps to exercise-associated collapse, heat exhaustion, and life-threatening heat stroke. Athletes, outdoor laborers, and military personnel are at greatest risk. […] The incidence of heat-related illness in U.S. high school athletes is 1.6 cases per 100,000 athletic exposures, or approximately 9,000 cases annually, with the highest rates occurring during football season. It is the third leading cause of death in high school athletes. In the U.S. Armed Forces, there were 2,163 cases of heat-related illness and 464 cases of heat stroke in 2017, with an incidence of 1.41 and 0.38 cases per 1,000 person-years, respectively. The incidence has gradually increased since 2014. The rate of emergency department visits for heat-related illnesses was five per 10,000 visits from 2006 to 2010 (n = 326,497); 75% of these patients were diagnosed with heat exhaustion and 5.4% with heat stroke. Approximately 12% of these patients were admitted, and the mortality rate was 0.07%.

• #4 Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2019-2023

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11107842/

  Heat exhaustion and heat stroke are reportable medical events (RMEs) in the U.S. Military Health System (MHS). […] Ongoing surveillance of heat illnesses is necessary to determine if prevention guidelines and countermeasures are working, in addition to identifying high-risk groups and activities that may lead to heat illness. […] This update presents summaries of heat stroke and heat exhaustion case counts, incidence rates, and locations between 2019 and 2023. […] The crude annual incidence rate of heat stroke decreased 15.6% from 2019 through 2023, with a 5.9% decline from 2022 to 2023. […] The 2,263 cases of heat exhaustion in 2023 correspond to a crude incidence rate of 172.7 cases per 100,000 p-yrs. […] The incidence rate of heat exhaustion among recruits was 12.5 and 13.5 times higher than other enlisted service members and officers, respectively.

• #4 Using web data to improve surveillance for heat sensitive health outcomes | Environmental Health | Full Text

  https://ehjournal.biomedcentral.com/articles/10.1186/s12940-019-0499-x

  Elevated and prolonged exposure to extreme heat is an important cause of excess summertime mortality and morbidity. To protect people from health threats, some governments are currently operating syndromic surveillance systems. […] The results show that the number of heat-related illness and dehydration cases exhibited a significant positive relationship with web data. […] Our findings suggest web data created by social medias and search engines could improve the current syndromic surveillance systems. In particular, heat-related illness and dehydration cases were positively related with web data. […] The goal of this study is to examine the relationship between social media messages/web search results and health outcomes, and ultimately improve upon models that only consider temperature.

• #4 Heat stroke internet searches can be a new heatwave health warning surveillance indicator | Scientific Reports

  https://www.nature.com/articles/srep37294

  As a result, effective surveillance systems for adverse health effects during heatwaves are very rare despite the fact that prompt surveillance information during a heatwave may be of great benefit to public health. […] Mortality data is widely used in surveillance for heatwave health analysis, however there is a considerable time lag between hot conditions and the reporting of deaths, which diminishes its usefulness in affecting health outcomes. […] Furthermore, the mortality data represents the worst health outcome, which is not necessarily appropriate for use in characterizing more general public health concerns during the heatwave period. […] Recently, syndromic surveillance data have been used in heatwave health surveillance, such as by monitoring emergency department visits and calls to emergency or health services.

• #4 Acute Management of Heat Stroke: Facts and Figures | IntechOpen

  https://www.intechopen.com/chapters/88937

  Heat-related illnesses range from heat exhaustion to heat stroke. Heat stroke is a life-threatening medical emergency causing multiple organ dysfunction that if not treated, can be fatal. […] Epidemiology of heat stroke varies depending on geographic location, and reported incidences range from 1.98 to 2.89/100000 per year. […] In the United States, from 2006 to 2010, it was reported to have caused at least 3332 deaths. Heat stroke mortality is correlated with the degree of body temperature elevation, time of initiation of cooling, and number of organs affected. […] Heat stroke is higher in females, with a female-to-male ratio of up to 2.89 versus 0.98 per 1000 person-years. […] During the European heat wave in 2022, thousands of people died due to heat stroke. Heat stroke mortality is expected to rise by 2.5 times by 2050. […] Heat stroke generates a systemic inflammatory and coagulopathy response in combination with heat injury causes organ dysfunctions. Diagnosed with raised body temperature with clinical manifestation and signs and symptoms of organ dysfunction or failure.

• #4 Heat Stroke: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/166320-overview

  In the United States, heat waves claim more lives each year than all other weather-related exposures combined (hurricanes, tornadoes, floods, and earthquakes). According to the Centers for Disease Control and Prevention (CDC), from 2004-2018, an average of 702 heat-related deaths occurred in the United States annually. This timeframe included a total of 10,527 deaths resulting from exposure to heat-related conditions. Of these, approximately 90% occurred from May through September. Approximately one third (37%) occurred in Arizona, California, and Texas, despite these states comprising only 23% of the US population. Heat stroke and deaths from excessive heat exposure are more common during summers with prolonged heat waves. […] Heat stroke is uncommon in subtropical climates. The condition is recognized increasingly in countries that experience heat waves rarely (eg, Japan), and it commonly affects people who undertake a pilgrimage to Mecca, especially pilgrims who come from a cold environment. In 1998, one of the worst heat waves to strike India in 50 years resulted in more than 2600 deaths in 10 weeks. Unofficial reports described the number of deaths as almost double that figure.

• #4 Heat stroke epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Heat_stroke_epidemiology_and_demographics

  The United States Centers for Disease Control (CDC) reports an average of 9000 cases per year among high school athletes. The highest incidence of heat stroke in athletes in the United States has been reported among football players. Young athletes are more prone to exertional heat stroke while, classic heat stroke is more common among elderly. Men are more affected by heat stroke than women. […] The United States Centers for Disease Control report a weighted average of 9237 cases of exercise heat stroke among high school athletes per year for the period 2005 to 2009. Its incidence has been increased among the United States military personnel in 2014 compared to 2013 despite preventive measures. […] In Saudi Arabia, the incidence varies seasonally, from 22 to 250 cases per 100,000 population. Epidemiologic studies showed an incidence of 17.6 to 26.5 cases per 100,000 population in urban areas of the United States during heat waves. The highest incidence of exertional heat stroke in athletes in the United States is among football players and it’s approximately 4.5 cases per 100,000 athlete exposures. […] Exertional heat stroke is more common in age group 15-50 years. Classic heat stroke is more common in early childhood and elderly. […] Exertional heat stroke is more common among men than in women. […] Heat stroke is more common among Asian/Pacific Islander than other ethnicities.

• #4

  https://www.eea.europa.eu/en/analysis/publications/the-impacts-of-heat-on-health

  This briefing outlines the status of surveillance for heat-related health impacts and heat-health actions plans in 38 European countries. […] Timely and reliable data on the number of deaths and illnesses associated with heat are essential for deploying targeted emergency responses during hot periods. […] 20 of the EEA-38 countries currently monitor heat impacts on health and three additional countries are developing heat-health monitoring systems. […] 21 of the EEA-38 countries have heat-health action plans (HHAPs) in place, and another four National Public Health Institutes are developing HHAPs. […] The European Climate Risk Assessment describes the current level of risk to human health from heat as critical, growing to catastrophic in the second half of the century, calling for urgent action.

• #4 Beat the Heat | Pima County, AZ

  https://www.pima.gov/2042/Beat-the-Heat

  Heat-related illness, like heat exhaustion or heat stroke, is when our bodies cannot properly cool themselves. Our bodies normally cool down by sweating, but during extreme heat a person’s body temperature might rise faster than it can cool itself down, sometimes causing severe illness or death. […] Each year, nearly 2,000 people visit Arizona emergency rooms because of heat-related illnesses. […] The good news is that heat-related illnesses and deaths are preventable. […] Although anyone can suffer from heat-related illness, some people are at greater risk than others: Infants and young children, People who are pregnant, People 65 years of age or older, People who are overweight, People who overexert during work or exercise, People who are physically ill, especially with heart disease or high blood pressure, or who take certain medications, such as for depression, insomnia, or poor circulation.

• #4 Extreme Heat | Florida Department of Health

  https://www.floridahealth.gov/programs-and-services/emergency-preparedness-and-response/prepare-yourself/current-hazards/extreme-heat.html

  Extreme heat is one of the leading weather-related causes of death in the U.S., and Florida is particularly vulnerable due to its long summers and high humidity. […] These conditions can overwhelm the bodys cooling system, leading to heat-related illnesses like heat exhaustion and heat stroke, especially for vulnerable populations such as the elderly, children, and those with pre-existing health conditions. […] Extreme heat occurs when high temperatures, often accompanied by high humidity, overwhelm the bodys natural cooling mechanisms. This condition can cause heat-related illnesses such as heat exhaustion, heat stroke, and dehydration. […] Heat-related illnesses can develop quickly, especially during prolonged exposure to extreme heat. The most common illnesses include: […] Heat exhaustion: Heavy sweating, weakness, dizziness, nausea, and headache. Can progress to heat stroke if untreated.

• #5 Heat Stroke: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/166320-overview

  In the United States, heat waves claim more lives each year than all other weather-related exposures combined (hurricanes, tornadoes, floods, and earthquakes). According to the Centers for Disease Control and Prevention (CDC), from 2004-2018, an average of 702 heat-related deaths occurred in the United States annually. This timeframe included a total of 10,527 deaths resulting from exposure to heat-related conditions. Of these, approximately 90% occurred from May through September. Approximately one third (37%) occurred in Arizona, California, and Texas, despite these states comprising only 23% of the US population. Heat stroke and deaths from excessive heat exposure are more common during summers with prolonged heat waves. […] Heat stroke is uncommon in subtropical climates. The condition is recognized increasingly in countries that experience heat waves rarely (eg, Japan), and it commonly affects people who undertake a pilgrimage to Mecca, especially pilgrims who come from a cold environment. In 1998, one of the worst heat waves to strike India in 50 years resulted in more than 2600 deaths in 10 weeks. Unofficial reports described the number of deaths as almost double that figure.

• #5 Heat exhaustion and heat stroke among active component members of the U.S. Armed Forces, 2019-2023 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38722363/

  The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the military’s training and operational environments. These illnesses can typically be prevented by appropriate situational awareness, risk management strategies, along with effective countermeasures. In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period. […] In 2023, higher rates of heat stroke were observed among male service members compared to their female counterparts, and female service members experienced higher rates of heat exhaustion compared to male personnel. Heat illness rates were also higher among those younger than age 20, Marine Corps and Army service members, non-Hispanic Black service members, and recruits. Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions.

• #5 Heat Stroke: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/166320-overview

  With the same risk factors and under the same environmental conditions, heat stroke affects all races equally. However, because of differences in social advantages, the annual death rate due to environmental conditions is more than three times higher in Blacks than in Whites. Factors investigated as influencing this disparity include housing and neighborhood characteristics (eg, urban heat islands, crime and safety), using air conditioning (more common among whites, particularly central air conditioning), opening windows, using fans, using cooler public spaces, and social isolation. […] Infants, children, and elderly persons have a higher incidence of heat stroke than young, healthy adults. Infants and children are at risk for heat illness due to inefficient sweating, a higher metabolic rate, and their inability to care for themselves and control their environment. Elderly persons also are at increased risk for heat-related illnesses because of their limited cardiovascular reserves, preexisting illness, and use of many medications that may affect their volume status or sweating ability. In addition, elderly people who are unable to care for themselves are at increased risk for heat stroke, presumably because of their inability to control their environment. The CDC reports that the rate of heat-related mortality tends to be higher in persons aged 65 years and older. Exertional heat stroke (EHS) is a leading cause of injury and death in high school athletes; approximately two-thirds of such cases occur in August and involve football players, often those who are obese or overweight. Lack of acclimatization is a major risk factor for EHS in young adults.

• #5 Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2019-2023 | Health.mil

  https://health.mil/News/Articles/2024/04/01/MSMR-Heat-Illness-2024

  Ongoing surveillance of heat illnesses is necessary to determine if prevention guidelines and countermeasures are working, in addition to identifying high-risk groups and activities that may lead to heat illness. […] This update presents summaries of heat stroke and heat exhaustion case counts, incidence rates, and locations between 2019 and 2023.

• #5 Heat stroke internet searches can be a new heatwave health warning surveillance indicator | Scientific Reports

  https://www.nature.com/articles/srep37294

  Our study showed that the relationship between heat stroke internet searches and health outcomes is much higher than that between temperature and health outcomes. […] The heat stroke internet searches had better predictive ability for health risk than temperature during the heatwave. […] Hence, the identification and prevention of morbidity during a heatwave can be expected to decrease the mortality rate. […] Therefore, the heat stroke internet search is well suited for use as a new heatwave surveillance health outcome proxy. […] Our study is the first to show that web based searching could be useful for predicting risks to health during heatwaves and provides a new heatwave health warning system. […] Internet searches are easily accessible and economical, which could be of benefit for the early warning of health risks and taking preventive measures during the heat wave period.

• #5 Heat stroke internet searches can be a new heatwave health warning surveillance indicator | Scientific Reports

  https://www.nature.com/articles/srep37294

  As a result, effective surveillance systems for adverse health effects during heatwaves are very rare despite the fact that prompt surveillance information during a heatwave may be of great benefit to public health. […] Mortality data is widely used in surveillance for heatwave health analysis, however there is a considerable time lag between hot conditions and the reporting of deaths, which diminishes its usefulness in affecting health outcomes. […] Furthermore, the mortality data represents the worst health outcome, which is not necessarily appropriate for use in characterizing more general public health concerns during the heatwave period. […] Recently, syndromic surveillance data have been used in heatwave health surveillance, such as by monitoring emergency department visits and calls to emergency or health services.

• #5 Heat Illness: Heat Exhaustion and Heat Stroke | 5-Minute Clinical Consult

  https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688398/all/Heat_Illness:_Heat_Exhaustion_and_Heat_Stroke?q=Ataxia

  Heat exhaustion is a mild to moderate form of heat illness displaying dehydration-type symptoms with a normal to elevated temperature (1). […] Heat stroke is characterized by an elevated core temperature 104F with central nervous system (CNS) abnormalities and is a true medical emergency (1),(2). […] Predominant age: more likely in children or elderly. […] Concern for increasing incidence because ambient environmental temperatures continue to rise. […] Roughly 600 deaths per year in the United States.

• #5 Heat stroke epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Heat_stroke_epidemiology_and_demographics

  The United States Centers for Disease Control (CDC) reports an average of 9000 cases per year among high school athletes. The highest incidence of heat stroke in athletes in the United States has been reported among football players. Young athletes are more prone to exertional heat stroke while, classic heat stroke is more common among elderly. Men are more affected by heat stroke than women. […] The United States Centers for Disease Control report a weighted average of 9237 cases of exercise heat stroke among high school athletes per year for the period 2005 to 2009. Its incidence has been increased among the United States military personnel in 2014 compared to 2013 despite preventive measures. […] In Saudi Arabia, the incidence varies seasonally, from 22 to 250 cases per 100,000 population. Epidemiologic studies showed an incidence of 17.6 to 26.5 cases per 100,000 population in urban areas of the United States during heat waves. The highest incidence of exertional heat stroke in athletes in the United States is among football players and it’s approximately 4.5 cases per 100,000 athlete exposures. […] Exertional heat stroke is more common in age group 15-50 years. Classic heat stroke is more common in early childhood and elderly. […] Exertional heat stroke is more common among men than in women. […] Heat stroke is more common among Asian/Pacific Islander than other ethnicities.

• #5 Acute Management of Heat Stroke: Facts and Figures | IntechOpen

  https://www.intechopen.com/chapters/88937

  Heat-related illnesses range from heat exhaustion to heat stroke. Heat stroke is a life-threatening medical emergency causing multiple organ dysfunction that if not treated, can be fatal. […] Epidemiology of heat stroke varies depending on geographic location, and reported incidences range from 1.98 to 2.89/100000 per year. […] In the United States, from 2006 to 2010, it was reported to have caused at least 3332 deaths. Heat stroke mortality is correlated with the degree of body temperature elevation, time of initiation of cooling, and number of organs affected. […] Heat stroke is higher in females, with a female-to-male ratio of up to 2.89 versus 0.98 per 1000 person-years. […] During the European heat wave in 2022, thousands of people died due to heat stroke. Heat stroke mortality is expected to rise by 2.5 times by 2050. […] Heat stroke generates a systemic inflammatory and coagulopathy response in combination with heat injury causes organ dysfunctions. Diagnosed with raised body temperature with clinical manifestation and signs and symptoms of organ dysfunction or failure.

• #5

  https://www.eea.europa.eu/en/analysis/publications/the-impacts-of-heat-on-health

  The surveillance of the health impacts of heat is central to the public health response to this climate hazard. […] Over a quarter of countries in Europe do not have HHAPs, which may negatively impact their preparedness to heat. […] HHAPs are recognised as a key tool for reducing deaths and preventing other health impacts during periods of high temperatures. […] According to the 2024 survey, 12 of the 28 responding NPHIs have HHAPs in place at either the national, regional or local level, while four more are in the process of developing HHAPs. […] The lack of timely data in the remaining countries can be regarded as an obstacle to timely and effective action against heat-related deaths. […] Data on the health impacts of heat is also essential for the long-term development of public health policies, selecting adaptive measures and planning for future heat-related impacts on human health and healthcare systems.

• #5 Beat the Heat | Pima County, AZ

  https://www.pima.gov/2042/Beat-the-Heat

  Heat-related illness, like heat exhaustion or heat stroke, is when our bodies cannot properly cool themselves. Our bodies normally cool down by sweating, but during extreme heat a person’s body temperature might rise faster than it can cool itself down, sometimes causing severe illness or death. […] Each year, nearly 2,000 people visit Arizona emergency rooms because of heat-related illnesses. […] The good news is that heat-related illnesses and deaths are preventable. […] Although anyone can suffer from heat-related illness, some people are at greater risk than others: Infants and young children, People who are pregnant, People 65 years of age or older, People who are overweight, People who overexert during work or exercise, People who are physically ill, especially with heart disease or high blood pressure, or who take certain medications, such as for depression, insomnia, or poor circulation.

• #5 What’s New

  https://www.cdph.ca.gov/Programs/EPO/Pages/Extreme%20Heat%20Pages/BI_Natural-Disasters_Extreme-Heat.aspx

  Climate change is leading to more frequent, more severe, and longer-lasting episodes of extreme heat in California, posing a greater danger to Californians. Heat kills more people directly than any other weather-related hazard. Certain population groups are at greater risk of heat-related health impacts, including unhoused people, those working outdoors or in unconditioned indoor environments, older adults, infants and children, those with chronic health conditions, people with disabilities, pregnant people, and those with low income. However, heat-related illnesses and deaths are preventable. […] Heat-related illnesses include heat cramps, heat exhaustion and most seriously, heat stroke and death. Warning signs of heat-related illnesses vary, but may include heavy sweating, muscle cramps, weakness, headache, nausea or vomiting, paleness, tiredness or dizziness.

• #6 Heat-Related Illnesses | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0415/p482.html

  Heat-related illnesses comprise a spectrum of syndromes resulting from disruption of thermoregulation in people exposed to high environmental heat. Symptoms range from heat edema and exercise-associated muscle cramps to exercise-associated collapse, heat exhaustion, and life-threatening heat stroke. Athletes, outdoor laborers, and military personnel are at greatest risk. […] The incidence of heat-related illness in U.S. high school athletes is 1.6 cases per 100,000 athletic exposures, or approximately 9,000 cases annually, with the highest rates occurring during football season. It is the third leading cause of death in high school athletes. In the U.S. Armed Forces, there were 2,163 cases of heat-related illness and 464 cases of heat stroke in 2017, with an incidence of 1.41 and 0.38 cases per 1,000 person-years, respectively. The incidence has gradually increased since 2014. The rate of emergency department visits for heat-related illnesses was five per 10,000 visits from 2006 to 2010 (n = 326,497); 75% of these patients were diagnosed with heat exhaustion and 5.4% with heat stroke. Approximately 12% of these patients were admitted, and the mortality rate was 0.07%.

• #6 Heat exhaustion and heat stroke among active component members of the U.S. Armed Forces, 2019-2023 – PubMed

  https://pubmed.ncbi.nlm.nih.gov/38722363/

  The most serious types of heat illnesses, heat exhaustion and heat stroke, are occupational hazards associated with many of the military’s training and operational environments. These illnesses can typically be prevented by appropriate situational awareness, risk management strategies, along with effective countermeasures. In 2023, the crude incidence of heat stroke and heat exhaustion were 31.7 and 172.7 cases per 100,000 person-years, respectively. The rates of incident heat stroke declined during the 2019 to 2023 surveillance period, but rates of incident heat exhaustion increased over the same period. […] In 2023, higher rates of heat stroke were observed among male service members compared to their female counterparts, and female service members experienced higher rates of heat exhaustion compared to male personnel. Heat illness rates were also higher among those younger than age 20, Marine Corps and Army service members, non-Hispanic Black service members, and recruits. Leaders, training cadres, and supporting medical and safety personnel must inform their subordinate and supported service members of heat illness risks, preventive measures, early signs and symptoms of illness, and appropriate interventions.

• #6 Exertional heat illness in adolescents and adults: Epidemiology, thermoregulation, risk factors, and diagnosis – UpToDate

  https://www.uptodate.com/contents/exertional-heat-illness-in-adolescents-and-adults-epidemiology-thermoregulation-risk-factors-and-diagnosis/print

  According to our data, only one death from EHS occurred among American collegiate football players between 2003 and 2011 during traditional August practices due to the adoption of heat acclimatization policies in 2003. However, problems persist in high school football and collegiate strength and conditioning training, during which a disproportionate number of deaths have occurred. […] A comprehensive study of fatal episodes of EHS among military personnel provides further insight into important risk factors. […] Data from large-scale endurance events, such as marathons, show a strong correlation between the severity of environmental conditions and the incidence of heat illness, especially EHS. […] According to annual surveillance studies of the Falmouth (Massachusetts, USA) Road Race (7 mile/11 km event), elevations in the temperature and heat index correlate with an increase in the incidence of exertional heat stroke.

• #6 Heat stroke internet searches can be a new heatwave health warning surveillance indicator | Scientific Reports

  https://www.nature.com/articles/srep37294

  Our study showed that the relationship between heat stroke internet searches and health outcomes is much higher than that between temperature and health outcomes. […] The heat stroke internet searches had better predictive ability for health risk than temperature during the heatwave. […] Hence, the identification and prevention of morbidity during a heatwave can be expected to decrease the mortality rate. […] Therefore, the heat stroke internet search is well suited for use as a new heatwave surveillance health outcome proxy. […] Our study is the first to show that web based searching could be useful for predicting risks to health during heatwaves and provides a new heatwave health warning system. […] Internet searches are easily accessible and economical, which could be of benefit for the early warning of health risks and taking preventive measures during the heat wave period.

• #6

  https://www.eea.europa.eu/en/analysis/publications/the-impacts-of-heat-on-health

  The surveillance of the health impacts of heat is central to the public health response to this climate hazard. […] Over a quarter of countries in Europe do not have HHAPs, which may negatively impact their preparedness to heat. […] HHAPs are recognised as a key tool for reducing deaths and preventing other health impacts during periods of high temperatures. […] According to the 2024 survey, 12 of the 28 responding NPHIs have HHAPs in place at either the national, regional or local level, while four more are in the process of developing HHAPs. […] The lack of timely data in the remaining countries can be regarded as an obstacle to timely and effective action against heat-related deaths. […] Data on the health impacts of heat is also essential for the long-term development of public health policies, selecting adaptive measures and planning for future heat-related impacts on human health and healthcare systems.

• #6 Beat the Heat | Pima County, AZ

  https://www.pima.gov/2042/Beat-the-Heat

  Heat-related illness, like heat exhaustion or heat stroke, is when our bodies cannot properly cool themselves. Our bodies normally cool down by sweating, but during extreme heat a person’s body temperature might rise faster than it can cool itself down, sometimes causing severe illness or death. […] Each year, nearly 2,000 people visit Arizona emergency rooms because of heat-related illnesses. […] The good news is that heat-related illnesses and deaths are preventable. […] Although anyone can suffer from heat-related illness, some people are at greater risk than others: Infants and young children, People who are pregnant, People 65 years of age or older, People who are overweight, People who overexert during work or exercise, People who are physically ill, especially with heart disease or high blood pressure, or who take certain medications, such as for depression, insomnia, or poor circulation.

• #6 What’s New

  https://www.cdph.ca.gov/Programs/EPO/Pages/Extreme%20Heat%20Pages/BI_Natural-Disasters_Extreme-Heat.aspx

  Climate change is leading to more frequent, more severe, and longer-lasting episodes of extreme heat in California, posing a greater danger to Californians. Heat kills more people directly than any other weather-related hazard. Certain population groups are at greater risk of heat-related health impacts, including unhoused people, those working outdoors or in unconditioned indoor environments, older adults, infants and children, those with chronic health conditions, people with disabilities, pregnant people, and those with low income. However, heat-related illnesses and deaths are preventable. […] Heat-related illnesses include heat cramps, heat exhaustion and most seriously, heat stroke and death. Warning signs of heat-related illnesses vary, but may include heavy sweating, muscle cramps, weakness, headache, nausea or vomiting, paleness, tiredness or dizziness.

• #7 Heat Exhaustion and Heat Stroke Among Active Component Members of the U.S. Armed Forces, 2019-2023

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11107842/

  Heat exhaustion and heat stroke are reportable medical events (RMEs) in the U.S. Military Health System (MHS). […] Ongoing surveillance of heat illnesses is necessary to determine if prevention guidelines and countermeasures are working, in addition to identifying high-risk groups and activities that may lead to heat illness. […] This update presents summaries of heat stroke and heat exhaustion case counts, incidence rates, and locations between 2019 and 2023. […] The crude annual incidence rate of heat stroke decreased 15.6% from 2019 through 2023, with a 5.9% decline from 2022 to 2023. […] The 2,263 cases of heat exhaustion in 2023 correspond to a crude incidence rate of 172.7 cases per 100,000 p-yrs. […] The incidence rate of heat exhaustion among recruits was 12.5 and 13.5 times higher than other enlisted service members and officers, respectively.

• #7 Heat Stroke: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/166320-overview

  With the same risk factors and under the same environmental conditions, heat stroke affects all races equally. However, because of differences in social advantages, the annual death rate due to environmental conditions is more than three times higher in Blacks than in Whites. Factors investigated as influencing this disparity include housing and neighborhood characteristics (eg, urban heat islands, crime and safety), using air conditioning (more common among whites, particularly central air conditioning), opening windows, using fans, using cooler public spaces, and social isolation. […] Infants, children, and elderly persons have a higher incidence of heat stroke than young, healthy adults. Infants and children are at risk for heat illness due to inefficient sweating, a higher metabolic rate, and their inability to care for themselves and control their environment. Elderly persons also are at increased risk for heat-related illnesses because of their limited cardiovascular reserves, preexisting illness, and use of many medications that may affect their volume status or sweating ability. In addition, elderly people who are unable to care for themselves are at increased risk for heat stroke, presumably because of their inability to control their environment. The CDC reports that the rate of heat-related mortality tends to be higher in persons aged 65 years and older. Exertional heat stroke (EHS) is a leading cause of injury and death in high school athletes; approximately two-thirds of such cases occur in August and involve football players, often those who are obese or overweight. Lack of acclimatization is a major risk factor for EHS in young adults.

• #7

  https://www.eea.europa.eu/en/analysis/publications/the-impacts-of-heat-on-health

  The surveillance of the health impacts of heat is central to the public health response to this climate hazard. […] Over a quarter of countries in Europe do not have HHAPs, which may negatively impact their preparedness to heat. […] HHAPs are recognised as a key tool for reducing deaths and preventing other health impacts during periods of high temperatures. […] According to the 2024 survey, 12 of the 28 responding NPHIs have HHAPs in place at either the national, regional or local level, while four more are in the process of developing HHAPs. […] The lack of timely data in the remaining countries can be regarded as an obstacle to timely and effective action against heat-related deaths. […] Data on the health impacts of heat is also essential for the long-term development of public health policies, selecting adaptive measures and planning for future heat-related impacts on human health and healthcare systems.

• #7 Extreme Heat | Florida Department of Health

  https://www.floridahealth.gov/programs-and-services/emergency-preparedness-and-response/prepare-yourself/current-hazards/extreme-heat.html

  Heat stroke: Life-threatening; body temperature over 104F causes confusion, unconsciousness, and organ failure. Seek immediate medical help. […] Certain groups face higher risks during extreme heat: […] Elderly: May struggle to adjust to heat and often miss signs of dehydration. […] Children: Dehydrate quickly and need close monitoring. […] Medical conditions: People with heart, lung, or kidney issues, or on specific medications, are more vulnerable. […] Florida summers bring intense heat and humidity, increasing the risk of heat-related health issues. […] By taking these steps and staying informed, you can significantly reduce your risk and stay safe during extreme heat events. It’s important to listen to weather reports, recognize the signs of heat-related illnesses, and adjust your activities accordingly.

• #8 Heat Stroke and Heat Exhaustion : Emergency Preparedness : What We Do : East-Central District Health Department

  https://ecdhd.ne.gov/our-programs/emergency-preparedness/heat-stroke-and-heat-exhaustion.html

  High temperatures kill hundreds of people every year. Heat-related deaths and illness are preventable, yet more than 700 people die from extreme heat every year in the United States. […] Those who are at highest risk include people 65 and older, children younger than two, and people with chronic diseases or mental illness. […] People at greatest risk for heat-related illness can take the following protective actions to prevent illness or death: Stay in air-conditioned buildings as much as you can

• #8 Beat the Heat | Pima County, AZ

  https://www.pima.gov/2042/Beat-the-Heat

  Heat-related illness, like heat exhaustion or heat stroke, is when our bodies cannot properly cool themselves. Our bodies normally cool down by sweating, but during extreme heat a person’s body temperature might rise faster than it can cool itself down, sometimes causing severe illness or death. […] Each year, nearly 2,000 people visit Arizona emergency rooms because of heat-related illnesses. […] The good news is that heat-related illnesses and deaths are preventable. […] Although anyone can suffer from heat-related illness, some people are at greater risk than others: Infants and young children, People who are pregnant, People 65 years of age or older, People who are overweight, People who overexert during work or exercise, People who are physically ill, especially with heart disease or high blood pressure, or who take certain medications, such as for depression, insomnia, or poor circulation.

• #9 Heat Stroke: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/166320-overview

  With the same risk factors and under the same environmental conditions, heat stroke affects all races equally. However, because of differences in social advantages, the annual death rate due to environmental conditions is more than three times higher in Blacks than in Whites. Factors investigated as influencing this disparity include housing and neighborhood characteristics (eg, urban heat islands, crime and safety), using air conditioning (more common among whites, particularly central air conditioning), opening windows, using fans, using cooler public spaces, and social isolation. […] Infants, children, and elderly persons have a higher incidence of heat stroke than young, healthy adults. Infants and children are at risk for heat illness due to inefficient sweating, a higher metabolic rate, and their inability to care for themselves and control their environment. Elderly persons also are at increased risk for heat-related illnesses because of their limited cardiovascular reserves, preexisting illness, and use of many medications that may affect their volume status or sweating ability. In addition, elderly people who are unable to care for themselves are at increased risk for heat stroke, presumably because of their inability to control their environment. The CDC reports that the rate of heat-related mortality tends to be higher in persons aged 65 years and older. Exertional heat stroke (EHS) is a leading cause of injury and death in high school athletes; approximately two-thirds of such cases occur in August and involve football players, often those who are obese or overweight. Lack of acclimatization is a major risk factor for EHS in young adults.

• #9 Beat the Heat | Pima County, AZ

  https://www.pima.gov/2042/Beat-the-Heat

  Young people are more at-risk than adults for heat-related illness because they are more likely to over-exert themselves outdoors without adequate hydration. […] People who use certain medications may have to take extra precautions when it gets hot. Some medications can increase your risk for suffering from heat-related illnesses and can even raise the risk for hospitalization or death. […] Excessive heat causes changes in emotions and behavior that can result in feelings of anger, irritability, aggression, discomfort, stress, and fatigue.

• #10 Heat Stroke: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/166320-overview

  With the same risk factors and under the same environmental conditions, heat stroke affects all races equally. However, because of differences in social advantages, the annual death rate due to environmental conditions is more than three times higher in Blacks than in Whites. Factors investigated as influencing this disparity include housing and neighborhood characteristics (eg, urban heat islands, crime and safety), using air conditioning (more common among whites, particularly central air conditioning), opening windows, using fans, using cooler public spaces, and social isolation. […] Infants, children, and elderly persons have a higher incidence of heat stroke than young, healthy adults. Infants and children are at risk for heat illness due to inefficient sweating, a higher metabolic rate, and their inability to care for themselves and control their environment. Elderly persons also are at increased risk for heat-related illnesses because of their limited cardiovascular reserves, preexisting illness, and use of many medications that may affect their volume status or sweating ability. In addition, elderly people who are unable to care for themselves are at increased risk for heat stroke, presumably because of their inability to control their environment. The CDC reports that the rate of heat-related mortality tends to be higher in persons aged 65 years and older. Exertional heat stroke (EHS) is a leading cause of injury and death in high school athletes; approximately two-thirds of such cases occur in August and involve football players, often those who are obese or overweight. Lack of acclimatization is a major risk factor for EHS in young adults.

• #10 Beat the Heat | Pima County, AZ

  https://www.pima.gov/2042/Beat-the-Heat

  Young people are more at-risk than adults for heat-related illness because they are more likely to over-exert themselves outdoors without adequate hydration. […] People who use certain medications may have to take extra precautions when it gets hot. Some medications can increase your risk for suffering from heat-related illnesses and can even raise the risk for hospitalization or death. […] Excessive heat causes changes in emotions and behavior that can result in feelings of anger, irritability, aggression, discomfort, stress, and fatigue.

• #11 Heat Stroke: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/166320-overview

  With the same risk factors and under the same environmental conditions, heat stroke affects all races equally. However, because of differences in social advantages, the annual death rate due to environmental conditions is more than three times higher in Blacks than in Whites. Factors investigated as influencing this disparity include housing and neighborhood characteristics (eg, urban heat islands, crime and safety), using air conditioning (more common among whites, particularly central air conditioning), opening windows, using fans, using cooler public spaces, and social isolation. […] Infants, children, and elderly persons have a higher incidence of heat stroke than young, healthy adults. Infants and children are at risk for heat illness due to inefficient sweating, a higher metabolic rate, and their inability to care for themselves and control their environment. Elderly persons also are at increased risk for heat-related illnesses because of their limited cardiovascular reserves, preexisting illness, and use of many medications that may affect their volume status or sweating ability. In addition, elderly people who are unable to care for themselves are at increased risk for heat stroke, presumably because of their inability to control their environment. The CDC reports that the rate of heat-related mortality tends to be higher in persons aged 65 years and older. Exertional heat stroke (EHS) is a leading cause of injury and death in high school athletes; approximately two-thirds of such cases occur in August and involve football players, often those who are obese or overweight. Lack of acclimatization is a major risk factor for EHS in young adults.

• #11 Beat the Heat | Pima County, AZ

  https://www.pima.gov/2042/Beat-the-Heat

  Young people are more at-risk than adults for heat-related illness because they are more likely to over-exert themselves outdoors without adequate hydration. […] People who use certain medications may have to take extra precautions when it gets hot. Some medications can increase your risk for suffering from heat-related illnesses and can even raise the risk for hospitalization or death. […] Excessive heat causes changes in emotions and behavior that can result in feelings of anger, irritability, aggression, discomfort, stress, and fatigue.

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