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Dr Alan Porter, writing in The Lancet, says that an officer cadet who died while training at the Royal Military Academy, Sandhurst, did so during an exercise that had been used since the Second World War but was both dangerous and irrelevant.

The 23-year old cadet was a fit sportsman, Dr Porter says, who collapsed after a six-mile
exercise of alternate fast marching and running. He died from exertional heat illness brought on by the violent exertion of doing the exercise wearing a double layer of battle fatigues while
carrying 40lb of kit, including a water bottle, webbing, pack, rifle and helmet.

Dr Porter says that two other cadets at the college near Camberley, Surrey, have been admitted to intensive care after similar exercises, suggesting that their lives had also been in danger.

Although there is an indication that there has been a change of attitudes in the Army over the past decade, which has reduced the number of such cases, Dr Porter says there appears to be a persistent problem at Sandhurst.

The cadet who died had collapsed once before during a shorter run, but the Royal Army Medical Corps seemed to have no protocol for the ongoing care of people who have been affected in this way.

Dr Porter says that the British Army seems to be preoccupied with water drills, even though these are not applicable to training. 'There is historical reason for this relating to the route marches in hot climates associated with the foreign campaigns of the past," he says. "In the context of collapses from exertional heat illness in present day Army training in the UK,
however, water discipline and intake are largely irrelevant.

"British soldiers in training who collapse and die from heat illness have not had time to become severely dehydrated. They collapse not because they have ceased to sweat but
because, with occlusive clothing, their sweat cannot evaporate."

Dr Porter says the alternate fast march and run exercise is dangerous and irrelevant. The
argument that a soldier may have to advance to battle in this way does not stand up to scrutiny; he says.

"A junior commander has a duty to bring his men into action in the best possible physical condition and not strung out over half a mile, with a third of the platoon evacuated with heat illness," he says.

Another problem is the way in which instructors have no idea of how to cope with someone who starts to lag behind the rest or who collapses.

"Until it is proven otherwise, they are dealing with an extreme medical emergency that could prove fatal. It demands immediate action in the field before the soldier is evacuated, as is the practice in the US Marines.

"A collapsed soldier should be pulled into the shade, partly or wholly undressed, sprayed  with water and fanned vigorously, all as a matter of urgency."

Dr Porter says that in view of the dangers, orders that ignore the dangers of heat illness should he considered unlawful and soldiers should be entitled to challenge them, resist them and may even have a duty to do so.