A non-invasive device to continuously determine heat strain in humans

Heat stroke remains a very dangerous, potentially lethal illness in humans. The Physiological Strain Index (PSI), originally based on heart rate and rectal temperature recordings in humans, describes heat strain in quantitative terms. The objective of our study was to establish whether the rectal temperature recordings serving to determine the PSI could be replaced by a non-invasive skin temperature sensor combined with a heat flux sensor (Double Sensor) attached to the inside of a helmet. We assumed (i) that the difference between the recordings by the device under test and the rectal temperature should be less than ±1.0 °C for ±2 S.D. at 10, 25, and 40 °C ambient temperature, and (ii) that the temperature predictions based on the Double Sensor temperature should differ by less than 1 PSI score from the calculations based on recordings of the rectal temperature. Twenty male subjects participated in the study. Rectal, nasopharyngeal, and skin temperatures, heat flux, and cardiovascular data were collected continuously during different experimental setups at ambient temperatures of 10, 25, and 40 °C. Depending on the protocols, the exercise intensities varied from 25% to 55% of the individual VO_2max. A comparison of the recordings obtained from the device under test with those of the rectal temperature revealed that (i) the recordings of the Double Sensor differed by −0.16 to 0.1 °C from the mean rectal temperature, (ii) the concordance correlation coefficients (CCC) during all work and rest periods rose with rising ambient temperatures (all work periods: 10 °C: 0.49; 25 °C: 0.69; 40 °C: 0.75; all rest periods: 10 °C: 0.39; 25 °C: 0.81; 40 °C: 0.74), and that (iii) the Double Sensor in the helmet showed that during all rest periods and in all ambient conditions, the temperature dropped much more quickly than what was recorded when taking the rectal temperature (p<0.01). When we compared the PSI values based on the rectal temperature recordings to those determined by the Double Sensor, it was found that (i) the PSI based on the Double Sensor recordings differed by −0.27 to 0.17 from the mean PSI established by rectal temperature recordings. Furthermore, the CCC for the PSI rose during all work periods (10 °C: 0.81, 25 °C: 0.93, 40 °C: 0.87) and rest periods (10 °C: 0.68; 25 °C: 0.93; 40 °C: 0.79). In conclusion, under warm/hot environmental conditions the device under test provided a reliable method of assessing the PSI in operational environments to improve physiological situational awareness and safety in action. However, there are some limitations that reduce the device's performance in cold environments; these need to be investigated further.