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Activity title

Development of a NATO STANREC for Physiological Status Monitoring to Mitigate Exertional Heat Illness.

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Human Factors and Medicine

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exertional, heat, illness, monitoring, physiological, Wearables


With an increased focus on Pacific and Middle East theaters the requirement for militaries to conduct exercises and operations in hot environments, where the risk of Exertional Heat Illness (EHI) is increased, has and will become more important.. Also, of concern is the risk of EHI in temperate environments due to the often high intensity activity undertaken in military training and the requirement to wear personal protective equipment and carry load. Ensuring that there is robust policy in place to provide guidance on how best to protect personnel from EHI in these environments is essential. Developing a NATO Standardisation Recommendation (STANREC) would enable alignment across member nations making the planning, risk assessment, monitoring and interpretation of real-time Physiological Status Monitoring (PSM) feedback information a valuable deployable asset. A previous NATO HFM Panel, HFM 132 (2007-2010), outlined biosensor development efforts in several countries and explored their potential in the protection of soldiers. A more recent NATO HFM Panel, HFM 260 (2016-2019) has developed these original concepts into functioning prototypes, mainly centered around mitigating heat illness whilst exercising in hot environments. This panel has successfully field tested and in some cases, are transitioning into implementation as part of business as usual PSM technology into military units. HFM 260 highlighted the proliferation of wearable monitors in the commercial marketplace as interesting motivational tools for fitness behaviors but emphasised the lack of sophistication and ruggedisation in terms of accuracy, appropriate tactical communication and most importantly validated algorithms or models to provide relevant and meaningful actionable information that a soldier or commander could use. This concern has now largely been addressed where due to the advancement of prototype development of these wearable technologies it is now possible to individualise and therefore enhance heat acclimatisation practices, monitor in real-time personnel in different environments and in different states of personal protective equipment whilst undertaking military activity, thus providing commanders with dynamic individual and group risk assessment capability. However, the policy and risk assessment decisions that underpin the planning of activities, together with the philosophical, legal and medical implications still remain extant.


1. The main objective is to develop policy recommendations across the spectrum of applied exertional heat illness mitigation technologies, including standardised work rest guidance, specifications/ qualifications for the use of dynamic training/ mission risk assessment tools, and physiological monitoring technologies. 2. Multinational scientific support collaborations with considerable peer reviewed publications from panel member partnerships. Specific examples of priorities for the panel include: • Development of a NATO STANREC for the Integration of Physiological Status Monitoring to Mitigate Exertional Heat Illness. • Assessment of risk using mission planning tools. • Identify viable militarily relevant heat illness risk assessment models and applications/ apps • Develop sensor specifications for real-time physiological status monitoring sensors that could be used during training and/ or operations • Identify gaps and lessons learned from field deployment that assess heat illness risk and provide real-time monitoring. • Assess state-of-the-art and international scope of biosensor development • Explore civilian biosensor development efforts which can be leveraged for military applications • Identify technology gaps and areas for collaboration and additional investment and create a strategic roadmap for development within a mutual open system architecture


This effort will focus on the development and validation of algorithms and protocols that identify individual risk of EHI. This effort will include: • The integration of core temperature estimation algorithms with change in gait detection (wobble) index that will provide predict ahead ability for heat stroke prevention. • The differentiation of heat exhaustion from heat stroke • Additional markers and algorithms that predict EHI such as, the adaptive physiological strain index, will also be examined for efficacy. • The development of a predication capability for EHI will lead to Safety case development for introduction of PSM into military training. • Further, physiological monitoring allows for the continued development of performance enhancement through individualised strategies for heat acclimatisation.

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