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Ercolani J, Cure L, Misasi P. Identifying and validating perceived workload metrics for emergency medical services. APPLIED ERGONOMICS 2024; 118:104270. [PMID: 38518729 DOI: 10.1016/j.apergo.2024.104270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 02/24/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
The most common workload surrogates used by Emergency Medical Services (EMS)- overall call volume (CV) and unit hour utilization (UHU)-have not been validated. This study investigates the relationship between EMS operational metrics and perceived workload, measured through the NASA task load index (TLX) survey. We paired crew member survey responses with the operational metrics based on dispatch data. Linear regression was used to evaluate the influence of each metric on perceived workload. Logistic regression was used to identify values of workload indicating a fair day's work. We found that the overall CV (p < 0.001, R2=0.32) and UHU (p < 0.001, R2=0.22) explained less variability in perceived workload than a priority (P)-stratified CV (p < 0.001, R2=0.41). However, we found no clear fair day's workload threshold. We conclude that a priority-stratified CV is a better workload surrogate than a CV and UHU.
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Affiliation(s)
- Jenna Ercolani
- Industrial, Systems and Manufacturing Engineering, Wichita State University, 1845 Fairmount St, Wichita, KS, 67220, USA.
| | - Laila Cure
- Industrial, Systems and Manufacturing Engineering, Wichita State University, 1845 Fairmount St, Wichita, KS, 67220, USA.
| | - Paul Misasi
- Sedgwick County EMS, 1015 Stillwell, Wichita, KS, 67213, USA.
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2
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Johnsen AM, Wagman P, Broström A, Fransson EI. Work-, lifestyle-, and health-related factors among women and men working in the emergency medical services. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2024; 30:651-661. [PMID: 38632949 DOI: 10.1080/10803548.2024.2332115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Objectives. This study aimed to describe work-, lifestyle-, and health-related factors among ambulance personnel, and to analyse differences between women and men. Methods. The cross-sectional study (N = 106) included self-reported and objective measures of work, lifestyle, and health in 10 Swedish ambulance stations. The data collection comprised clinical health examination, blood samples, tests of physical capacity, and questionnaires. Results. A high proportion of the ambulance personnel reported heavy lifting, risk of accidents, threats and violence at work. A low level of smoking and alcohol use, and a high level of leisure-time physical activity were reported. The ambulance personnel had, on average, good self-rated health, high work ability and high physical capacity. However, the results also showed high proportions with risk factors for cardiovascular disease (CVD), e.g., high blood pressure, and high levels of blood lipids. More women than men reported high work demands. Furthermore, women performed better in tests of physical capacity and had a lower level of CVD risk factors. Conclusions. Exposure to work-related factors that might affect health was common among ambulance personnel. Lifestyle- and health-related factors were somewhat contradictory, with a low proportion reporting lifestyle-related risk factors, but a high proportion having risk factors for CVD.
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Affiliation(s)
- Anna M Johnsen
- School of Health and Welfare, Jönköping University, Sweden
| | - Petra Wagman
- School of Health and Welfare, Jönköping University, Sweden
| | - Anders Broström
- School of Health and Welfare, Jönköping University, Sweden
- Department of Clinical Neurophysiology, Linköping University Hospital, Sweden
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3
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Malone AL, Armstrong DP, MacPhee RS, Fischer SL. Factors influencing the likelihood of females passing the Ottawa paramedic physical ability test. APPLIED ERGONOMICS 2024; 116:104187. [PMID: 38056128 DOI: 10.1016/j.apergo.2023.104187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/26/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
The Ottawa Paramedic Physical Ability Test (OPPAT) was launched in Ontario as a physical employment standard for front-line paramedics. When considering pass rates based on sex, males had a higher likelihood of passing than females. To help understand how to improve pass rates among females we aimed to understand if factors such as participant demographics, college type, employment status and/or peak heart rate (a surrogate of fitness level) were related to OPPAT pass rates. Females who were employed, who were educated in a public paramedic college, and who had higher body mass were more likely to successfully complete the OPPAT. Those educated in a public paramedic college were more than twice as likely to pass relative to those educated in a private college program. This may underscore a need to further explore different modes of paramedic education to understand why public college program trained students are more likely to pass.
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Affiliation(s)
- Alexander L Malone
- Department of Kinesiology, Faculty of Health Sciences, University of Waterloo, Waterloo, Canada
| | - Daniel P Armstrong
- Department of Kinesiology, Faculty of Health Sciences, University of Waterloo, Waterloo, Canada
| | - Renée S MacPhee
- Kinesiology & Physical Education and Health Sciences, Wilfrid Laurier University, Waterloo, Canada
| | - Steven L Fischer
- Department of Kinesiology, Faculty of Health Sciences, University of Waterloo, Waterloo, Canada.
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Marvin G, Schram B, Orr R, Canetti EFD. Occupation-Induced Fatigue and Impacts on Emergency First Responders: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7055. [PMID: 37998287 PMCID: PMC10671419 DOI: 10.3390/ijerph20227055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
Fatigue in emergency first responders (EFRs) is known to affect performance abilities and safety outcomes for both patients and EFRs. The primary aim of this review was to determine the main contributors to occupation-induced fatigue in EFRs and its subsequent impacts. Following the PRIMSA checklist, academic databases (Medline, Embase, CINAHL, and SPORTDiscus) were searched using key terms with results subjected to inclusion and exclusion criteria. Populations of interest were firefighters, paramedics, or emergency call centre personnel. Of the 5633 records identified, 43 studies, which reported on 186 unique measures from a total population of 6373 participants, informed the review. Synthesis revealed fatigue was caused by lack of sleep during the shift and consistent poor sleep quality which negatively impacted cognitive function, alertness, and physical and mental health while increasing safety-compromising behaviours and injuries. Both subjective and objective assessments of fatigue are necessary for effective risk management in EFRs. EFRs that are consistently fatigued are at a greater risk of poor physical and mental health, reduced cognitive function, and increased injuries. No studies reported on fatigue in emergency call centre personnel, highlighting a literature gap. Funding was provided by the Australian Capital Territory Emergency Services Agency. Preregistration was filed in OSF: osf.io/26f3s.
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Affiliation(s)
- Graham Marvin
- Tactical Research Unit, Faculty of Health Sciences & Medicine, Bond University, Robina, QLD 4226, Australia
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5
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Ho DC, Tolgyesi D, Beech C, Fischer SL. Identifying the critical physically demanding tasks performed by personal support workers in Canada. APPLIED ERGONOMICS 2023; 112:104069. [PMID: 37320909 DOI: 10.1016/j.apergo.2023.104069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/17/2023]
Abstract
Due to increased work demands, personal support workers (PSWs) are experiencing more work-related injuries. However, little is known about PSW work tasks and their corresponding physical demand. The purpose of this study was to identify critical tasks that are physically demanding and completed frequently as identified by PSWs. Additionally, we identified contextual factors (i.e., environmental-, situational-, patient-related) that influenced physical demands. We surveyed 443 community-based PSWs working in Canada who rated the physical demand associated with client care tasks and identified contextual factors that can increase task specific physical demands. Transferring/repositioning patients, dressing, and bathing were perceived as most demanding. Patient weight and mobility influenced the level of physical demand required for most tasks. These data provide a foundation to develop physical employment standards and task specific education and training to prevent PSW injuries.
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Affiliation(s)
- Daphne C Ho
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1, Canada.
| | | | - Cheryl Beech
- CBI Health, 3300 Bloor St. W. Etobicoke, M8X 2X2, Canada.
| | - Steven L Fischer
- Department of Kinesiology and Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1, Canada.
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Meadley B, Rogers M, Bowles KA, Caldwell J. The bookmark method to establish minimum performance standards for intensive care flight paramedics performing helicopter winch rescue. APPLIED ERGONOMICS 2023; 107:103934. [PMID: 36347089 DOI: 10.1016/j.apergo.2022.103934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 06/16/2023]
Abstract
We aimed to use the bookmark method to establish minimum standards for selecting intensive care flight paramedics. Two subject matter expert (SME) focus groups reviewed nine videos of decreasing duration showing land and water helicopter rescue tasks. Focus Group 1 (FG1, n = 10) viewed videos individually off-site, whilst Focus Group 2 (FG2, n = 9) attended a face-to-face session. All SMEs selected the video they judged as the appropriate pace for the task then reviewed feedback. For both groups, the process was repeated until 80% agreement was achieved, or three rounds were completed (whichever occurred first). FG1 and FG2 achieved agreement after two rounds for the land task. For the water task, FG1 did not reach agreement. FG2 reached consensus after two rounds. The selected task durations were similar. The bookmark method is valuable to determine performance standards for performing winch rescue, and SMEs are more likely to reach consensus when face-to-face.
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Affiliation(s)
- Ben Meadley
- Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Ambulance Victoria, Doncaster, Victoria, Australia.
| | - Matthew Rogers
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Kelly-Ann Bowles
- Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Joanne Caldwell
- Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Victoria, Australia; Department of Physiology, Monash University, Clayton, Victoria, Australia
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7
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Rückenbeanspruchung beim Heben und Tragen im Rettungsdienst: eine Umfrage. Notf Rett Med 2023. [DOI: 10.1007/s10049-022-01109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Waack J, Meadley B, Gosling C. Comparison of physical demanding paramedic work tasks between an Australian and Canadian ambulance service. APPLIED ERGONOMICS 2023; 106:103905. [PMID: 36179542 DOI: 10.1016/j.apergo.2022.103905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Ambulance services require candidates to pass physical employment tests (PETs) to be deemed suitable for the paramedic role. Whilst some research has been undertaken to improve to relevance of these tests, they are often arbitrary and not based on research. The first phase in developing PETs is to generate a list of job tasks. To examine the utility of universal physical tasks tests for ambulance work, we conducted a cross-sectional study, utilising the results from previous work in a Canadian ambulance service to create a physical tasks checklist. These lists were then used by paramedics working for an Australian Service to identify physical tasks in their workplace, and the results from the two services were compared. Patient transfer tasks were similar in frequency and description for both services. Stretcher handling and manoeuvring was identified by Canadian paramedics as highly strenuous, (mean rating of perceived exertion (RPE) 7/10) but were rated mean RPE <3/10 by AV paramedics. Although some tasks between these two services were similar, the ambulance services in this study differed sufficiently with regard to equipment, training and policies mean that similarly titled jobs are not comparable, cross-nationally. Service specific job task analysis is required to develop PETs that ensure employees are specifically selected to meet the requirements of that service.
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Affiliation(s)
- Jacinta Waack
- Ambulance Victoria, Doncaster, Australia; Department of Paramedicine, Monash University, Frankston, Australia.
| | - Ben Meadley
- Ambulance Victoria, Doncaster, Australia; Department of Paramedicine, Monash University, Frankston, Australia; Paramedic Health and Wellbeing Research Unit, Monash University, Frankston, Australia
| | - Cameron Gosling
- Department of Paramedicine, Monash University, Frankston, Australia
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9
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Brisbine BR, Radcliffe CR, Jones MLH, Stirling L, Coltman CE. Does the fit of personal protective equipment affect functional performance? A systematic review across occupational domains. PLoS One 2022; 17:e0278174. [PMID: 36449531 PMCID: PMC9710848 DOI: 10.1371/journal.pone.0278174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/11/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To explore the effect of personal protective equipment (PPE) fit on functional performance across a range of occupational domains. BACKGROUND PPE introduces an ergonomic, human systems integration, and mass burden to the wearer, and these factors are thought to be amplified if PPE is ill-fitting. However, few studies have considered the role of fit (static, dynamic, and cognitive) when evaluating PPE-related performance detriments in occupational settings. METHOD A systematic literature review was conducted to identify relevant studies, which were then critically appraised based on methodological quality and collated to compare key findings and present evidence-based recommendations for future research directions across a range of occupational domains. RESULTS 16 published studies met the inclusion criteria, 88% of which found that the fit of PPE had a statistically significant effect on occupational performance. Poorly sized PPE resulted in slower or increased reaction time; decreased range of motion or mobility; decreased endurance or tolerance; decreased pulmonary function; and altered muscle activation. Limited research met the inclusion criteria and those that did had risks of bias in methodology quality. CONCLUSION Future research evaluating the effect of PPE on performance in occupational settings should aim to recruit a more representative population; consider sex as a covariate; quantify and evaluate PPE fit and performance when integrated with all relevant equipment items; include outcome measures related to all three categories of fit (static, dynamic, cognitive); and assess performance of operationally relevant tasks.
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Affiliation(s)
- Brooke R. Brisbine
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Ceridwen R. Radcliffe
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Monica L. H. Jones
- University of Michigan Transportation Research Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Leia Stirling
- Industrial and Operations Engineering Department, Robotics Institute, University of Michigan, Ann Arbor, MI, United States of America
| | - Celeste E. Coltman
- University of Canberra Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Canberra, ACT, Australia
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10
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Takei Y, Sakaguchi E, Sasaki K, Tomoyasu Y, Yamamoto K, Yasuda Y. Use of the Airstretcher with dragging may reduce rescuers’ physical burden when transporting patients down stairs. PLoS One 2022; 17:e0274604. [PMID: 36103565 PMCID: PMC9473625 DOI: 10.1371/journal.pone.0274604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Transporting patients down stairs by carrying is associated with a particularly high fall risk for patients and the occurrence of back pain among emergency medical technicians. The present study aimed to verify the effectiveness of the Airstretcher device, which was developed to reduce rescuers’ physical burden when transporting patients by dragging along the floor and down stairs. Forty-one paramedical students used three devices to transport a 65-kg manikin down stairs from the 3rd to the 1st floor. To verify the physical burden while carrying the stretchers, ratings of perceived exertion were measured using the Borg CR10 scale immediately after the task. Mean Borg CR10 scores (standard deviation) were 3.6 (1.7), 4.1 (1.8), 5.6 (2.4), and 4.2 (1.8) for the Airstretcher with dragging, Airstretcher with lifting, backboard with lifting, and tarpaulin with lifting conditions, respectively (p < 0.01). Multiple comparisons revealed that the Airstretcher with dragging condition was associated with significantly lower Borg CR10 scores compared with the backboard with lifting condition (p < 0.01). When the analysis was divided by handling position, estimated Borg CR10 values (standard error) for head position were 4.4 (1.3), 2.9 (0.9), 3.2 (0.8), and 4.0 (1.1) for the Airstretcher with dragging, Airstretcher with lifting, backboard with lifting, and tarpaulin with lifting conditions, respectively, after adjusting for participant and duration time (F = 1.4, p < 0.25). The estimated Borg CR10 value (standard error) for toe position in the Airstretcher with dragging condition was 2.0 (0.8), and the scores for the side position were 4.9 (0.4), 6.1 (0.3), and 4.7 (0.4) for the Airstretcher with lifting, backboard with lifting, and tarpaulin with lifting conditions, respectively, after adjusting for participant and duration time (F = 3.6, p = 0.02). Transferring a patient down stairs inside a house by dragging using the Airstretcher may reduce the physical burden for rescuers.
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Affiliation(s)
- Yutaka Takei
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
- * E-mail:
| | - Eiji Sakaguchi
- Department of Prehospital Emergency Medical Sciences, Hiroshima International University, Hiroshima, Japan
| | - Koichi Sasaki
- Department of Prehospital Emergency Medical Sciences, Hiroshima International University, Hiroshima, Japan
| | - Yoko Tomoyasu
- Department of Prehospital Emergency Medical Sciences, Hiroshima International University, Hiroshima, Japan
| | - Kouji Yamamoto
- Department of Prehospital Emergency Medical Sciences, Hiroshima International University, Hiroshima, Japan
| | - Yasuharu Yasuda
- Department of Prehospital Emergency Medical Sciences, Hiroshima International University, Hiroshima, Japan
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11
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Clusiault D, Davidson JB, Armstrong DP, Fischer SL. The influence of sex and strength capacity on normalized low-back exposure during lifting: Insights from a joint power analysis. APPLIED ERGONOMICS 2022; 102:103756. [PMID: 35413576 DOI: 10.1016/j.apergo.2022.103756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Investigate the influence of sex, strength capacity, and relative load mass on low-back exposure and lower extremity joint power generation in backboard lifting. BACKGROUND Sex and strength have been shown to influence lifting strategy, but without load mass being scaled to strength it is unknown which factor influences low-back exposures, and whether there are interactions with load mass. METHODS Motion capture and force plate data from 28 participants were collected during backboard lifting at load masses scaled to strength capacity. Differences in normalized peak low-back moment, peak knee-to-hip power magnitude ratio and timing were tested as a function of sex, strength, and load mass. RESULTS Stronger participants had lower normalized peak low-back moments (average 32% change from low-capacity across all load masses), with no significant sex effect (p = 0.582). As load mass increased, normalized peak low-back moment, peak knee-to-hip power magnitude and synchronicity decreased. CONCLUSION Training to both increase strength capacity and hip-joint power generation may be a strategy to reduce low-back exposure in backboard lifting.
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Affiliation(s)
- David Clusiault
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Justin B Davidson
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | | | - Steven L Fischer
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
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Chan VCH, Welsh TN, Tremblay L, Frost DM, Beach TAC. A comparison of augmented feedback and didactic training approaches to reduce spine motion during occupational lifting tasks. APPLIED ERGONOMICS 2022; 99:103612. [PMID: 34743974 DOI: 10.1016/j.apergo.2021.103612] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/04/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
Manual handling training may be improved if it relied on the provision of individualized, augmented feedback about key movement features. The purpose of this study was to compare the reduction in sagittal spine motion during manual lifting tasks following two training approaches: didactic (DID) and augmented feedback (AUG). Untrained participants (n = 26) completed lifting tests (box, medication bag, and paramedic backboard) and a randomly-assigned intervention involving 50 practice box lifts. Lifting tests were performed immediately before and after training, and one-week after interventions. Both groups exhibited reductions in spine motions immediately and one-week after the interventions. However, the AUG intervention group elicited significantly greater reductions in 5 of 12 between-group comparisons (3 tasks × 4 spine motion variables). The results of the current study support the use of augmented feedback-based approaches to manual handling training over education-based approaches.
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Affiliation(s)
- Victor C H Chan
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Timothy N Welsh
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Centre for Motor Control, University of Toronto, Toronto, ON, Canada
| | - Luc Tremblay
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada; Centre for Motor Control, University of Toronto, Toronto, ON, Canada
| | - David M Frost
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Tyson A C Beach
- Centre for Motor Control, University of Toronto, Toronto, ON, Canada; Department of Kinesiology & Health Sciences, University of Waterloo, Waterloo, ON, Canada.
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13
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Stein JA, Hepler TC, Cosgrove SJ, Heinrich KM. Critical tasks from the Global War on Terror: A combat-focused job task analysis. APPLIED ERGONOMICS 2021; 95:103465. [PMID: 34044227 DOI: 10.1016/j.apergo.2021.103465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 03/26/2021] [Accepted: 05/13/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Jesse A Stein
- Kansas State University, College of Health and Human Sciences, Department of Kinesiology, 920 Denison Ave., Manhattan, KS, 66506, USA.
| | - Timothy C Hepler
- Kansas State University, College of Health and Human Sciences, Department of Kinesiology, 920 Denison Ave., Manhattan, KS, 66506, USA
| | - Sarah J Cosgrove
- Kansas State University, College of Health and Human Sciences, Department of Kinesiology, 920 Denison Ave., Manhattan, KS, 66506, USA
| | - Katie M Heinrich
- Kansas State University, College of Health and Human Sciences, Department of Kinesiology, 920 Denison Ave., Manhattan, KS, 66506, USA
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Siddall AG, Rayson MP, Walker EF, Doherty J, Osofa JI, Flood TR, Hale B, Myers SD, Blacker SD. Development of physical employment standards of specialist paramedic roles in the National Ambulance Resilience Unit (Naru). APPLIED ERGONOMICS 2021; 95:103460. [PMID: 33991853 DOI: 10.1016/j.apergo.2021.103460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/30/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
AIM To develop evidence-based role-specific physical employment standards and tests for National Ambulance Resilience Unit (NARU) specialist paramedics. METHODS Sixty-two (53 men, 9 women) paramedics performed an array of (1) realistic reconstructions of critical job-tasks (criterion job performance); (2) simplified, easily-replicable simulations of those reconstructions and; (3) fitness tests that are portable and/or practicable to administer with limited resources or specialist equipment. Pearson's correlations and ordinary least products regression were used to assess relationships between tasks and tests. Performance on reconstructions, subject-matter expert and participant ratings were combined to derive minimum acceptable job performance levels, which were used to determine cut-scores on appropriate correlated simulations and tests. RESULTS The majority of performance times were highly correlated with their respective simulations (range of r: 0.73-0.90), with the exception of those replicating water rescue (r range: 0.28-0.47). Regression compatibility intervals provided three cut-scores for each job-task on an appropriate simulation and fitness test. CONCLUSION This study provides a varied and easily-implementable physical capability assessment for NARU personnel, empirically linked to job performance, with flexible options depending on organisational requirements.
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Affiliation(s)
- Andrew G Siddall
- Occupational Performance Research Group, University of Chichester, UK.
| | | | - Ella F Walker
- Occupational Performance Research Group, University of Chichester, UK
| | - Julianne Doherty
- Occupational Performance Research Group, University of Chichester, UK
| | - Josh I Osofa
- Occupational Performance Research Group, University of Chichester, UK
| | - Tessa R Flood
- Occupational Performance Research Group, University of Chichester, UK
| | - Beverley Hale
- Occupational Performance Research Group, University of Chichester, UK
| | - Steve D Myers
- Occupational Performance Research Group, University of Chichester, UK
| | - Sam D Blacker
- Occupational Performance Research Group, University of Chichester, UK
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15
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Xu Y, Lavender SA, Sommerich CM. The efficacy of a lifting strap as an ergonomic intervention for EMS providers: Does it make it easier to raise a supine patient to an upright sitting posture? APPLIED ERGONOMICS 2021; 94:103416. [PMID: 33780856 DOI: 10.1016/j.apergo.2021.103416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
Patient handling related musculoskeletal injuries are prevalent among Emergency Medical Service (EMS) providers. The first step in many patient handling situations is where a supine patient on the floor is brought to a sitting position. This study investigated whether a strap, placed under the patient's torso and long enough that EMS providers can perform the patient raising task in a standing posture, reduced muscular effort. Fifteen participants raised a simulated patient, with the help of an assistant, using the strap method and a traditional method (grasping the shoulders) in an open area, a restricted space, and in a bathtub. Torso postures improved in all location conditions when using the strap. The muscle activation data showed mixed results. While EMG responses from the latissimus dorsi muscles were reduced, EMG activity of the erector spinae muscles increased when the strap was used. Perceived effort assessments supported the use of the strap.
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Affiliation(s)
- Yilun Xu
- Integrated Systems Engineering, USA
| | - Steven A Lavender
- Integrated Systems Engineering, USA; Orthopaedics, The Ohio State University, USA.
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Meadley B, Bowles KA, Smith K, Perraton L, Caldwell J. Defining the characteristics of physically demanding winch rescue in helicopter search and rescue operations. APPLIED ERGONOMICS 2021; 93:103375. [PMID: 33540207 DOI: 10.1016/j.apergo.2021.103375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
Helicopter emergency medical service search and rescue (HEMS SAR) paramedics perform physically demanding winch rescues. Rescue organisations require valid physical employment standards (PES) to ensure personnel can adequately perform duties. There are no studies describing validated PES for HEMS SAR. We convened a subject matter expert (SME) focus group to review historical case data and generate task descriptions for land and water winch rescue as the basis for development of task simulations to assess physiological workload. Sixteen helicopter rescue paramedics with a mean age of 47 (range, 36-52) years and 8 (2-20) years' experience in helicopter rescue participated in a SME focus group. When provided with data from historical cases, SMEs achieved consensus (≥80%) when generating descriptions of winch rescue. This method may be useful to develop simulations for assessment of physiological demands of winch rescue and similar tasks, and to enhance validity and reliability of PES for rescue organisations.
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Affiliation(s)
- Ben Meadley
- Monash University, Paramedic Health and Wellbeing Research Unit, McMahons Rd, Frankston, 3199, Australia; Monash University, Department of Paramedicine, McMahons Rd, Frankston, VIC, 3199, Australia; Ambulance Victoria, PO Box 2000, Doncaster, VIC, 3108, Australia.
| | - Kelly-Ann Bowles
- Monash University, Paramedic Health and Wellbeing Research Unit, McMahons Rd, Frankston, 3199, Australia; Monash University, Department of Paramedicine, McMahons Rd, Frankston, VIC, 3199, Australia
| | - Karen Smith
- Monash University, Paramedic Health and Wellbeing Research Unit, McMahons Rd, Frankston, 3199, Australia; Monash University, Department of Paramedicine, McMahons Rd, Frankston, VIC, 3199, Australia; Ambulance Victoria, PO Box 2000, Doncaster, VIC, 3108, Australia
| | - Luke Perraton
- Monash University, Paramedic Health and Wellbeing Research Unit, McMahons Rd, Frankston, 3199, Australia; Monash University, Department of Physiotherapy, McMahons Rd, Frankston, VIC, 3199, Australia
| | - Joanne Caldwell
- Monash University, Paramedic Health and Wellbeing Research Unit, McMahons Rd, Frankston, 3199, Australia; Monash University, Department of Physiology, Wellington Rd, Clayton, VIC, 3800, Australia
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Nevola VR, Lowe MD, Marston CA. Review of methods to identify the critical job-tasks undertaken by the emergency services. Work 2020; 63:521-536. [PMID: 31033477 PMCID: PMC6839475 DOI: 10.3233/wor-192914] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND: The roles of the emergency services are challenging and often physically demanding. Readiness to meet these challenges and demands is a fundamental requirement for staff to deliver their roles safely and effectively. Furthermore, employers are required by law to demonstrate every reasonable effort to protect their staff from undue risk of work-related injury. Implementing Physical Employment Standards (PES) enables employers to assign staff to roles for which they are physically-suited whilst contributing to such duty-of-care. However, for PES to be successful and legally-defendable, standards must reflect the demands of those job-tasks which are truly critical to the readiness of these services. OBJECTIVE: To determine whether a standardised approach to identifying critical job-tasks exists in the development of PES for the emergency services. METHODS: Studies which conducted analysis of job-tasks to develop PES within the emergency services were reviewed. RESULTS: Forty-two reported studies (i.e. records) met the inclusion criteria. Methods to determine job-tasks varied but were typically criteria-based incorporating one, or all, of 9 reported techniques. Methods were subjective and based upon reference to past or present job-task performance. CONCLUSION: Correctly determining critical job-tasks is essential for effective, legally-defendable PES. A standardised method to define job-tasks remains to be established.
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Affiliation(s)
- Venturino R Nevola
- Defence Science and Technology Laboratory (DSTL), Fareham, Hampshire, UK
| | - Maxwell D Lowe
- Defence Science and Technology Laboratory (DSTL), Fareham, Hampshire, UK
| | - Colin A Marston
- Defence Science and Technology Laboratory (DSTL), Fareham, Hampshire, UK
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Roy D, Weyman AK, Nolan P. Self-preservation comes at a cost: Why British National Health Service paramedics might be choosing a healthier, but poorer, retirement. SAGE Open Med 2020; 8:2050312120901545. [PMID: 32030124 PMCID: PMC6977097 DOI: 10.1177/2050312120901545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 12/23/2019] [Indexed: 11/15/2022] Open
Abstract
Objectives: To explore and portray the perspectives of National Health Service Ambulance
personnel related to the latest rise in the National Health Service
occupational pension age. Methods: Data gathering took the form of 35 in-depth interviews. A thematic analysis
was used to characterise and articulate key concepts and meanings. The
analysis applied interpretive techniques, as views expressed were from
personal experiences, and allowed for an in-depth analysis of shared
meanings. Results: The themes reported captured the desire of many Ambulance personnel to exit
their employment well in advance of their retirement age, despite
satisfaction gained from patient care. This early exit is being driven by
increased worry that the work demands of the job are unsustainable,
especially for older workers, as clinical responsibilities increase and
their social support diminishes. Also, Ambulance personnel feel betrayed by
their employers, because their retirement is being delayed further by
another change in their pensionable age. Conclusion: There is an increased orientation for ‘living for today’ and indications of a
willingness to sacrifice salary and pension income in order to protect their
health in older age, which has implications for long-term financial and
general well-being in retirement.
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Affiliation(s)
- Deborah Roy
- Department of Psychology, University of
Bath, Bath, UK
- Deborah Roy, School of Psychology, Queens
University Belfast, David Kerr Building, 18-30 Malone Road, Belfast BT9 5BN,
County Antrim, UK.
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19
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Harari Y, Riemer R, Jaffe E, Wacht O, Bitan Y. Paramedic equipment bags: How their position during out-of-hospital cardiopulmonary resuscitation (CPR) affect paramedic ergonomics and performance. APPLIED ERGONOMICS 2020; 82:102977. [PMID: 31670157 DOI: 10.1016/j.apergo.2019.102977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 10/05/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
This study investigates how the positions of paramedic equipment bags affect paramedic performance and biomechanical loads during out-of-hospital Cardiopulmonary Resuscitation (CPR). An experiment was conducted in which 12 paramedic teams (each including two paramedics) performed in-situ simulations of a cardiac-arrest scenario. CPR quality was evaluated using five standard resuscitation measures (i.e., pre- and post-shock pauses, and compression rate, depth and fraction). The spinal loads while lifting, pulling and pushing the equipment bags were assessed using digital human modeling software (Jack) and prediction equation from previous studies. The results highlight where paramedics are currently choosing to position their equipment. They also demonstrate that the positions of the equipment bags affect CPR quality as well as the paramedics' work efficiency, physiological effort and biomechanical loads. The spinal loads ranged from 1901 to 4030N; furthermore, every occasion on which an equipment bag was lifted resulted in spinal forces higher than 3400N, thus exceeding the maximum threshold stipulated by the National Institute for Occupational Safety and Health. 72% of paramedics' postures were categorized as high or very high risk for musculoskeletal disorders by the Rapid Entire Body Assessment. Guidelines related to bag positioning and equipment handling might improve CPR quality and patient outcomes, and reduce paramedics' risk of injury.
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Affiliation(s)
- Yaar Harari
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Raziel Riemer
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Eli Jaffe
- Magen-David-Adom(Israeli National Emergency Medical Services), Israel
| | - Oren Wacht
- Department of Emergency Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel; Magen-David-Adom(Israeli National Emergency Medical Services), Israel
| | - Yuval Bitan
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
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20
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Armstrong DP, Makhoul PJ, Sinden KE, Fischer SL. Ranking Stretcher and Backboard Related Paramedic Lifting Tasks Based on Their Biomechanical Demand on the Low Back. IISE Trans Occup Ergon Hum Factors 2019. [DOI: 10.1080/24725838.2019.1688894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Paul J. Makhoul
- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, Canada
| | | | - Steven L. Fischer
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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21
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Armstrong DP, Ross GB, Graham RB, Fischer SL. Considering movement competency within physical employment standards. Work 2019; 63:603-613. [DOI: 10.3233/wor-192955] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Gwyneth B. Ross
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Ryan B. Graham
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
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Armstrong DP, Sinden KE, Sendsen J, MacPhee RS, Fischer SL. The Ottawa Paramedic Physical Ability Test: test-retest reliability and analysis of sex-based performance differences. ERGONOMICS 2019; 62:1033-1042. [PMID: 31092138 DOI: 10.1080/00140139.2019.1618501] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 06/09/2023]
Abstract
The Ottawa Paramedic Physical Ability Test (OPPAT) is a physical employment standard (PES) that candidates must pass as a pre-hire requirement and that incumbents may have to pass prior to returning to work after absence, to demonstrate their physical capabilities as required to safely meet the demands of paramedic work. Consistent with best practice guidelines for PES development, it is important to establish reliability and to investigate sex-based performance differences. Active duty paramedics completed the OPPAT twice while candidates completed the OPPAT six times. Across all participants, a median improvement of 76.0 s was observed in OPPAT performance (922.0-846.0 s) between trial 1 and trial 2. Among candidates, OPPAT performance stabilised by the fourth trial confirming reliability. Sex-based analyses revealed median differences in OPPAT performance time of 39.0 and 63.0 s between males and females during the first and second trials respectively. Practitioner summary: Active duty paramedics and candidates performed the Ottawa Paramedic Physical Ability Test (OPPAT) faster following familiarisation. Among candidates, performance time stabilised by the fourth trial. Performance time was slower among females, but this had less impact on females' ability to meet the OPPAT standard.
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Affiliation(s)
- Daniel P Armstrong
- a Department of Kinesiology, Faculty of Applied Health Sciences , University of Waterloo , Waterloo , Canada
| | - Kathryn E Sinden
- b School of Kinesiology , Lakehead University , Thunder Bay , Canada
| | - Jonathan Sendsen
- a Department of Kinesiology, Faculty of Applied Health Sciences , University of Waterloo , Waterloo , Canada
| | - Renée S MacPhee
- c Departments of Kinesiology and Physical Education/Health Sciences , Wilfrid Laurier University , Waterloo , Canada
| | - Steven L Fischer
- a Department of Kinesiology, Faculty of Applied Health Sciences , University of Waterloo , Waterloo , Canada
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23
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Armstrong DP, Sinden KE, Sendsen J, MacPhee RS, Fischer SL. Evaluating the effect of a strength and conditioning program to improve paramedic candidates' physical readiness for duty. Work 2019; 63:623-633. [PMID: 31282455 DOI: 10.3233/wor-192953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The Ottawa Paramedic Physical Ability Test (OPPAT™) is a physical employment standard for the paramedic sector. If a candidate is unsuccessful in meeting the OPPAT™ performance standard they should be provided with an appropriate accommodation, such as a strength and conditioning program, to improve performance. OBJECTIVE Develop, implement and evaluate the effectiveness of a 4-week strength and conditioning program on improving OPPAT™ performance and associated fitness measures in paramedic candidates. METHODS A 4-week strength and conditioning program was developed to focus on strength and power improvements. Based on initial OPPAT™ performance, participants were divided into high and low performing groups; only the low performing group received the training intervention. OPPAT™ completion times and relevant fitness measures were compared pre- to post- intervention and between groups. RESULTS Over the 4-weeks, peak lower body power and grip strength did not significantly improve in the intervention group, however OPPAT™ performance improved by 10%. The control group had significantly lower OPPAT™ completion times both pre- and post-intervention (19% and 11% lower respectively), as well as greater grip strength and peak lower body power. CONCLUSIONS Implementation of a targeted strength and conditioning program successfully improved OPPAT™ performance in low performing candidates.
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Affiliation(s)
- Daniel P Armstrong
- Department of Kinesiology, University of Waterloo, Waterloo, ONT, Canada
| | - Kathryn E Sinden
- School of Kinesiology, Lakehead University, Thunder Bay, ONT, Canada
| | - Jonathan Sendsen
- Department of Kinesiology, University of Waterloo, Waterloo, ONT, Canada
| | - Renée S MacPhee
- Kinesiology & Physical Education and Health Sciences, Wilfrid Laurier University, Waterloo, ONT, Canada
| | - Steven L Fischer
- Department of Kinesiology, University of Waterloo, Waterloo, ONT, Canada
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24
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Larouche D, Bellemare M, Prairie J, Hegg-Deloye S, Corbeil P. Overall risk index for patient transfers in total assistance mode executed by emergency medical technician-paramedics in real work situations. APPLIED ERGONOMICS 2019; 74:177-185. [PMID: 30487098 DOI: 10.1016/j.apergo.2018.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/13/2018] [Accepted: 08/31/2018] [Indexed: 05/23/2023]
Abstract
Few studies have quantified the risk of musculoskeletal disorders during patient transfers in total assistance mode in real-life prehospital emergency care situations. An index to assess the overall risk of patient transfers was created; it makes it possible to quantify risk based on the patient's position and the height of the patient's location. An analysis of 71 transfers executed by paramedics in actual work situations showed that moving a patient from the ground was characterized by acute sagittal flexions and axial rotations, respectively, 42% and 12% of the time. When the patient was lying on a raised surface, the lifting index and perceived exertion were the lowest (2.55; easy). According to the overall risk index, patient transfers from the ground are the riskiest. Paramedics execute many risky lifts even in favorable patient handling contexts.
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Affiliation(s)
- Dominique Larouche
- Université Laval, Département de Kinésiologie, 2300 rue de la Terrasse, Québec Québec, G1V 0A6, Canada.
| | - Marie Bellemare
- Université Laval, Département des relations industrielles, 1025 Avenue des Sciences Humaines, Québec Québec, G1V 0A6, Canada.
| | - Jérôme Prairie
- Université Laval, Département de Kinésiologie, 2300 rue de la Terrasse, Québec Québec, G1V 0A6, Canada.
| | - Sandrine Hegg-Deloye
- Centre de recherche du CHU de Québec, Université Laval, Hôpital de l'Enfant-Jésus, 1401, 18e rue, local H-604, Québec Québec, G1J 1Z4, Canada.
| | - Philippe Corbeil
- Université Laval, Département de Kinésiologie, 2300 rue de la Terrasse, Québec Québec, G1V 0A6, Canada; Centre for interdisciplinary research in rehabilitation and social integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Quebec City, QC, Canada.
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25
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Lad U, Oomen NMCW, Callaghan JP, Fischer SL. Comparing the biomechanical and psychophysical demands imposed on paramedics when using manual and powered stretchers. APPLIED ERGONOMICS 2018; 70:167-174. [PMID: 29866307 DOI: 10.1016/j.apergo.2018.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 02/28/2018] [Accepted: 03/01/2018] [Indexed: 06/08/2023]
Abstract
The aim of this investigation was to compare the effect of three different stretchers (two powered and one manual) on the biomechanical and psychophysical demands experienced by paramedics when performing routine stretcher handling activities. Eight experienced paramedics performed stretcher raising, lowering, unloading and loading tasks. Video data of task performance and static force requirements were recorded and input into a posture matching program with a quasi-static linked segment model (3DMatch) to compute peak and cumulative L4/L5 compression and shear forces and shoulder moments during each activity. Ratings of perceived exertion (RPE) were recorded from paramedics upon the completion of each task. Use of powered stretchers with load assist functionality reduced the demands on paramedics. Peak L4/L5 forces were reduced by 13-62% and 58-93% for compression and shear respectively when using powered stretchers to perform routine stretcher handling activities. Shoulder flexor moments and RPE scores were reduced by 16-95% and 29-60% respectively when using the powered stretchers compared to the manual stretcher. However, cumulative forces showed mixed results. Although powered stretcher use decreased peak forces, loading and unloading a powered stretcher took 1.5 to 3.4 times longer then when using the manual stretcher, which may explain the mixed results regarding cumulative forces. Based on the RPE scores, paramedics preferred power stretchers relative to the manual stretcher. This study demonstrates that powered stretchers can reduce peak biomechanical and psychophysical exposures associated with the development of musculoskeletal disorder (MSD) during routine stretcher handling activities with minimal increases in cumulative exposures.
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Affiliation(s)
- Uma Lad
- University of Waterloo, Department of Kinesiology, 300 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Nathalie M C W Oomen
- University of Waterloo, Department of Kinesiology, 300 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Jack P Callaghan
- University of Waterloo, Department of Kinesiology, 300 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Steven L Fischer
- University of Waterloo, Department of Kinesiology, 300 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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