We thank Dr. Bloomfield for his comments. We share his concern regarding the troublesome antichemical gear and discussed it in our article.1The psychological and performance effects of the protective gear have also been previously addressed.2Stressful exercise causes fluid shifts, dehydration, and heat stroke, which must be prevented or treated if encountered.3,4The antichemical suit further hampers adequate temperature regulation and is recognized as a cause of dehydration.

In the Middle East, especially during the summer, dehydration and heat stroke are common, especially in the elderly and in civilians or army corps involved in outdoor strenuous exercise.1 

We agree with Dr. Bloomfield that the first step in preventing dehydration and heat stroke is training and education.

It is important to note that according to chemical attack protocols, civilians are expected to wear only an antichemical facemask rather than the full protective gear. The problems mentioned are of major concern for those wearing the full protective suit, namely trained personnel, military and medical, who are required to treat and evacuate attack victims as well as perform other military operations while under such an attack.

* Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. draviw@tasmc.health.gov.il

Flaishon R, Sotman A, Ben-Abraham R, Rudick V, Varssano D, Weinbroum AA: Antichemical protective gear prolongs time to successful airway management: A randomized, crossover study in humans. Anesthesiology 2004; 100:260–6
Krueger GP: Psychological and performance effects of chemical-biological protective clothing and equipment. Mil Med 2001; 166(12 Suppl):41–3
Reardon M, Fraser B, Omer J: Physiological effects of thermal stress on aviators flying a UH-60 helicopter simulator. Mil Med 1998; 163:298–303
Mudambo SM, Reynolds N: Body fluid shifts in soldiers after a jogging/walking exercise in the heat: Effects of water and electrolyte solution on rehydration. Cent Afr J Med 2001; 47:220–5