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Exertional heat illness represents a spectrum of conditions ranging from the benign to the life-threatening. Prompt assessment and treatment can prevent fatalities in those who present as a heat casualty. More importantly, however, these injuries can be prevented from occurring altogether. This article reviews the physiology of thermoregulation and the pathophysiology of heat injuries associated with exercise. Current approaches toward the diagnosis, treatment, and prevention of exercise-induced heat injuries will also be discussed.