Exertion-Related Illness: The Critical Roles of Leadership and Followership

Exertion-related illness (ERI), despite aggressive efforts with both prevention and emergency action planning, continues to be a considerable threat to both athletes and warfighters. Numerous case reports and series have served to elucidate risk factors, which have in turn become the focus of prevention strategies. While this approach has assisted in mitigating athlete risk, recent institutional guidance has identified the need for greater protection of athletes by accountability of training programs and the recognition of periods of distinct athlete vulnerability. These recommendations, in addition to observations from lessons learned from the aforementioned cluster reports of ERI, have a strong call-out for the role of leadership as both a culprit for injury and a potential mechanism for prevention. This commentary introduces a leader-follower framework and explores this model in the evolution of ERI and offers recommendations as to how we move forward toward making progress in prevention.