Using trunk posture to monitor heat strain at work

Literature review of physiological strain of personal protective equipment on personnel in the high-consequence infectious disease isolation environment

BACKGROUND

Heat strain and dehydration can affect an individual's physical and mental performance. The purpose of this review was to examine the literature for the impact of heat strain on health care workers (HCWs) who care for patients with high-consequence infectious diseases (HCIDs) while wearing personal protective equipment (PPE), discuss the risks of impaired safety caused by heat strain and dehydration in HCID environments, identify attempts to combat PPE-related heat strain, recognize limitations, and provide suggestions for further research.

METHODS

A literature search was performed in PubMed or MEDLINE and Google Scholar. Authors screened abstracts for inclusion criteria and reviewed articles if the abstracts were considered to include information relevant to the aim.

RESULTS

The search terms yielded 30 articles that were sorted based on environment setting, physiological impact, and interventions.

DISCUSSION

The safety of the HCWs and patients can be enhanced through the development and usage of cooler, more comfortable PPE materials and ensembles to help slow the rate of dehydration and support the regulation of core body temperature.

CONCLUSIONS

Heat strain caused by wearing PPE is an occupational health concern for HCWs in the high-risk environment, that is, HCID care. Future studies are needed to develop innovative PPE ensembles that can reduce heat strain and improve well-being.

Wilderness First Responder Medical Clearance - A Scoping Review with Recommendations

BACKGROUND AND PURPOSE

Due to environmental extremes, as well as the nature of the work itself, wilderness first responders are at risk of incurring medical events in the line of duty. There currently do not exist standardized and scientifically supported methods to screen for a wilderness first responder's risk of incurring a medical event.

METHODS

We performed multiple scoping reviews using PubMed and CINAHL. The reviews covered six medical screening criteria based on previous recommendations from the National Fire Protection Association (NFPA) and the US Forest Service, and we grouped our reviews into two categories: articles that addressed objective screening criteria, and articles that addressed subjective findings with the first responder.

RESULTS

Of the objective criteria, our reviews identified 21 articles addressing the ability to screen for risk of incurring a medical event by evaluation of a first responder's heart rate, 12 by blood pressure assessment, and 56 by assessment of body temperature. Of the subjective criteria we identified 19 articles focused on self-assessment, 34 articles on the use of standardized tools to assess for fatigue and sleepiness, and two articles on assessment of a first responder's urine to determine level of dehydration. We also identified seven additional articles through a hand search. Overall, there were 151 articles identified in our scoping reviews. These articles were largely of low quality, consisting mostly of case series without comparison groups.

CONCLUSION

There is a dearth of high-quality research into the medical assessment of first responders. We recommend that this paper, and measures discussed within it, be used as a starting point in the development of an evidence-based assessment protocol for wilderness first responders. We also recommend the development of a national database of medical events incurred by wilderness first responders to facilitate higher-quality research of screening protocols in this community.

Scoping review on the state of the integration of human physiological responses to evaluating heat-stress

OBJECTIVES

To determine the state of the literature on assessing heat-stress using physiological parameters. To provide recommendations to the nuclear industry regarding worker heat-stress management practices.

METHODS

A scoping review identified relevant articles. A search strategy was developed based on a research question concepts. Identified records were screened with inclusion-exclusion criteria. Included articles underwent data extraction using a qualitative data charting method. A thematic analysis and frequency counts were performed.

RESULTS

1687 articles were identified through four databases. The final inclusion consisted of 34 studies. Articles were classified by determinants of heat exposure risks: core body temperature (direct and indirect), scoring scale including core body temperature, scoring scale including human perception, and others. Heart rate and rectal temperature were the two most utilized physiological measurements.

CONCLUSION

A significant amount of literature examined estimation of core temperature using non-invasive methods, sometimes integrated into wearables. Heat-stress management practices could include perceptual measures to better evaluate heat-strain.

Evaluation of a Wearable Non-Invasive Thermometer for Monitoring Ear Canal Temperature during Physically Demanding (Outdoor) Work

Aimed at preventing heat strain, health problems, and absenteeism among workers with physically demanding occupations, a continuous, accurate, non-invasive measuring system may help such workers monitor their body (core) temperature. The aim of this study is to evaluate the accuracy and explore the usability of the wearable non-invasive Cosinuss° °Temp thermometer. Ear canal temperature was monitored in 49 workers in real-life working conditions. After individual correction, the results of the laboratory and field study revealed high correlations compared to ear canal infrared thermometry for hospital use. After performance of the real-life working tasks, this correlation was found to be moderate. It was also observed that the ambient environmental outdoor conditions and personal protective clothing influenced the accuracy and resulted in unrealistic ear canal temperature outliers. It was found that the Cosinuss° °Temp thermometer did not result in significant interference during work. Therefore, it was concluded that, without a correction factor, the Cosinuss° °Temp thermometer is inaccurate. Nevertheless, with a correction factor, the reliability of this wearable ear canal thermometer was confirmed at rest, but not in outdoor working conditions or while wearing a helmet or hearing protection equipment.