The effect of firefighter personal protective equipment on static and dynamic balance

A systematic review and meta-analysis of musculoskeletal disorders among firefighters

INTRODUCTION

Due to the nature of their job, firefighters face many ergonomic risk factors and are exposed to several musculoskeletal disorders (MSDs). The aim of this systematic review and meta-analysis was to investigate the prevalence of MSDs among firefighters.

MATERIALS AND METHODS

This study was conducted based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The literature search was conducted in the databases of PubMed, Scopus, Web of Science, Science Direct, SID, ISC and Google Scholar without applying a time limitation until the end of July 2022. The random effects model was used for meta-analysis, and the I2 index was used to check heterogeneity among studies. The data were analyzed using STATA version 14 software.

RESULTS

The primary literature searches in the databases identified 1,291 articles, 26 of which were entered the meta-analysis stage after screening, study selection, and quality assessment, including 36,342 firefighters. Based on the results of a meta-analysis, the overall prevalence of MSDs among firefighters was 46.39% (95% CI: 32.45-60.32, I2 = 99.7%, P < 0.001). The prevalence of MSDs was also investigated at neck (18.36%), low back (34.32%), shoulder (18.68%), hands (7.43%), upper back (10.15%), knee (19.97%) and foot (6.66%).

CONCLUSION

Considering the relatively high prevalence of MSDs among firefighters and their higher exposition to specific job-related risk factors of MSDs compared to other professions, it is suggested to provide firefighters with appropriate training, implement ergonomic interventions, and regularly screen them to reduce MSDs.

Investigating the short-term effects of using full-body hospital personal protective equipment and changes in physical workload intensity on human physiological and cognitive performance

The present study investigated the short-term effects of using Personal Protective Equipment (PPE) and physical workload intensity on human physiological and cognitive performance among 21 males and 19 females. PPE1 consisted of a medical coverall and surgical mask, while PPE2 consisted of impermeable full-body coverall, shoe covers, latex gloves, N95 mask, and face shield. Objective assessments were heart rate, energy expenditure, core body temperature, clothing microclimate temperature and humidity, and cognitive performance were the continuous performance test and N-Back test. Subjective assessments included thermal sensation, perceived fatigue/skin wetness/clothing moisture. Using PPE2 and increased workload intensity significantly increased the values of all physiological parameters and the subjective ratings of fatigue, thermal sensation, skin wetness, and clothing moisture. Moreover, the participants' cognitive performance was not affected by the type of PPE.Practitioner summary: Healthcare workers are at the highest risk in the fight against pandemics. Therefore, these people are required to use personal protective equipment. Using this equipment may have difficulties. The results show physiological strain and higher subjective ratings associated with using full-body hospital PPE and increased physical workload.

Quantifying self-contained breathing apparatus on physiology and psychological responses during firefighting: a systematic review and meta-analysis

Objectives. There is no consensus regarding the efficacy of self-contained breathing apparatus (SCBA) on firefighters' physiological and psychological stress responses. This study synthesized and quantified the psycho-physiological demands placed on firefighters wearing SCBA compared to a control group. Methods. Five databases were searched with English-language restrictions from inception to January 2021. As dependent variables, physiological (rectal temperature [T_re], mean skin temperature [T¯sk], heart rate [HR], maximal heart rate [HR_max], maximum oxygen uptake [V_O2max], total sweat rate [TSR]) and psychological (rating of perceived exertion [RPE] and thermal sensation [TS]) responses were continuously collected. This study is registered with PROSPERO (CRD42021228363). Results. Nine eligible studies with 289 participants met the inclusion criteria. The pooled estimates for V_O2max statistically significantly decreased, whereas T¯sk, HR, HR_max, TSR and RPE increased significantly. Additionally, the T_re and TS parameters were elevated but not significant. Subgroup analysis revealed that, except for V_O2max and TSR, the SCBA weight did not differ significantly between groups on any outcome measure. Conclusions. Our meta-analysis indicates that wearing SCBA elicits thermoregulatory, metabolic and psychological stress. However, this is not primarily explained by the weight of SCBA, highlighting the value of ergonomic design and physiological monitoring.

Biomechanics Analysis of the Firefighters' Thorax Movement on Personal Protective Equipment during Lifting Task Using Inertial Measurement Unit Motion Capture

Back injury is a common musculoskeletal injury reported among firefighters (FFs) due to their nature of work and personal protective equipment (PPE). The nature of the work associated with heavy lifting tasks increases FFs' risk of back injury. This study aimed to assess the biomechanics movement of FFs on personal protective equipment during a lifting task. A set of questionnaires was used to identify the prevalence of musculoskeletal pain experienced by FFs. Inertial measurement unit (IMU) motion capture was used in this study to record the body angle deviation and angular acceleration of FFs' thorax extension. The descriptive analysis was used to analyze the relationship between the FFs' age and body mass index with the FFs' thorax movement during the lifting task with PPE and without PPE. Sixty-three percent of FFs reported lower back pain during work, based on the musculoskeletal pain questionnaire. The biomechanics analysis of thorax angle deviation and angular acceleration has shown that using FFs PPE significantly causes restricted movement and limited mobility for the FFs. As regards human factors, the FFs' age influences the angle deviation while wearing PPE and FFs' BMI influences the angular acceleration without wearing PPE during the lifting activity.

Subclinical Hearing Deficits in Noise-Exposed Firefighters

Noise-induced hearing loss (NIHL) is the most prevalent occupational disease in the world and firefighters are at increased risk of NIHL due to their frequent exposure to hazardous levels of noise during service. Adverse effects of NIHL include acceleration of age-related hearing loss and an increased risk of cognitive decline. A critical challenge in addressing NIHL is the delayed clinical presentation of symptoms and lack of sensitive tools for early detection. To study the early clinical symptoms of NIHL in this high-risk group, we collected hearing function data including behavioral audiometric thresholds and distortion product otoacoustic emissions (DPOAEs) in 176 firefighters during annual physical assessments. Results revealed significant deficits in cochlear outer hair cell function in the presence of normal audiograms. Additionally, 55% of firefighters self-reported changes in hearing, while 20% self-reported concerns about their balance. This study is the first to characterize DPOAEs in firefighters who display decreased DPOAE amplitudes with increasing years in the fire service. These effects were observed even when controlling for hearing loss and age and are suggestive of a link between hearing loss and occupational exposure to hazardous noise.

The Effect of Personal Protective Equipment Use on Nurses' Tendencies to Make Medical Errors and Types of Their Medical Errors: A Cross-Sectional Study

This study was conducted to determine the effect of nurses' use of Personal Protective Equipment (PPE) during their care practices on their tendency to make medical errors and types of medical errors. The study was conducted with 505 nurses in Turkey between May 2021 and June 2021. Descriptive statistics, Kruskal-Wallis H test, Spearman's correlation test, and Mann-Whitney U test were used to analyze the data. During the COVID-19 pandemic, nurses often used PPE on different levels. A significant relationship was determined between the type of PPE used by the nurses and falls, hospital infections and patient monitoring/material safety (p < 0.05). The conclusions in this study reveal the necessity of increasing the usability, safety and effectiveness of PPE used by nurses in health institutions.

Preventing and Monitoring Work-Related Diseases in Firefighters: A Literature Review on Sensor-Based Systems and Future Perspectives in Robotic Devices

In recent years, the necessity to prevent work-related diseases has led to the use of sensor-based systems to measure important features during working activities. This topic achieved great popularity especially in hazardous and demanding activities such as those required of firefighters. Among feasible sensor systems, wearable sensors revealed their advantages in terms of possibility to conduct measures in real conditions and without influencing the movements of workers. In addition, the advent of robotics can be also exploited in order to reduce work-related disorders. The present literature review aims at providing an overview of sensor-based systems used to monitor physiological and physical parameters in firefighters during real activities, as well as to offer ideas for understanding the potentialities of exoskeletons and assistive devices.

Challenges and Controversies in COVID-19: Masking the General Population may Attenuate This Pandemic's Outbreak

SARS-CoV-2, the virus that causes COVID-19, spreads i. a., by respiratory droplets. The use of masks in preventing spread is controversial; masks are considered useless by many, while being mandated in some locations. Here, the effect of masking the general population on a COVID-19-like epidemic is estimated by computer simulation using three separate types of software. The main questions are whether mask use by the general population can limit the spread of SARS-CoV-2 in a country and how to identify opportunities when mask use is cost-effective and safe. To address these questions, the protective effects of different types of masks, the side-effects of masks, and avenues for improvements of masks and masking are addressed. Main results: (i) Any type of mask, even simple home-made ones, may be of value, even if the protective effect of each mask (here dubbed "one mask-protection") is low. Strict adherence to mask use does not appear to be critical but increasing one mask-protection to >50% was found to be advantageous. (ii) Masks do seem to reduce the number of new cases even if introduced at a late stage in an epidemic, but early implementation helps reduce the cumulative and total number of cases. (iii) The simulations suggest that it might be possible to eliminate a COVID-19 outbreak by widespread mask use during a limited period. There is a brief discussion of why the reported effect size of masking varies widely, and is expected to do so, because of different filtration abilities of different masks, differences in compliance and fitting, other routes of transmission, pre-existing immunity, and because a system of interconnected, disease-prone individuals has non-linear properties. A software solution to visualize infection spread is presented. The results from these simulations are encouraging, but do not necessarily represent the real-life situation, so it is suggested that clinical trials of masks are now carried out while continuously monitoring effects and side-effects. As mask use is not without risks and costs, it is suggested that governments and scientists have an important role in advising the public about the sensible use of masks.

Human Factor Considerations in Using Personal Protective Equipment in the COVID-19 Pandemic Context: Binational Survey Study

Background

Full level 1 personal protective equipment (PPE) is used in various domains and contexts. Prior research has shown influences of such equipment on performance, comfort, and contamination levels. The coronavirus disease (COVID-19) pandemic forced a pervasive requirement of PPE, with little preparation, rushed deployment, inadequate time for training, and massive use by personnel who are inexperienced or not qualified in its effective use.

Objective

This study aims to examine the key human factors (physical and ergonomic, perceptual and cognitive) that influence the use of level 1 PPE when attending to patients with suspected or confirmed COVID-19.

Methods

The research approach consisted of a short survey disseminated to health care professionals in two countries, Israel and Portugal, with similar demographics and health care systems. The survey included 10 items with a 5-point Likert scale regarding the key human factors involved in level 1 PPE, as identified in prior research.

Results

A total of 722 respondents from Israel and 301 respondents from Portugal were included in the analysis. All the respondents reported using level 1 PPE with patients with COVID-19 in the range of several hours daily to several hours weekly. The Cronbach α was .73 for Israel and .75 for Portugal. Responses showed high levels of difficulty, with medians of 4 for items related to discomfort (n=539/688, 78% in Israel; n=328/377, 87% in Portugal), hearing (n=236/370, 64% in Portugal; n=321/642, 50% in Israel), seeing (n=697/763, 89% in Israel; n=317/376, 84% in Portugal), and doffing (n=290/374, 77% in Portugal; n=315/713, 44% in Israel). A factor analysis showed a set of strongly related variables consisting of hearing, understanding speech, and understanding the situation. This suggests that degradation in communication was strongly associated with degradation in situational awareness. A subsequent mediation analysis showed a direct effect of PPE discomfort on situational awareness (P<.001); this was also influenced (mediated) by difficulties in communicating, namely in hearing and understanding speech.

Conclusions

In 2020, the COVID-19 pandemic is paving the way for updating PPE design. The use of already deployed technology affords ample opportunities to improve, adapt, and overcome caveats. The findings here suggest that the use of level 1 PPE with patients with COVID-19 has perceptual and cognitive effects, in addition to physical and ergonomic influences. Efforts should be taken to mitigate the harmful effects of such influences, both regarding the performance of medical actions and the risk of contamination to health care workers. Such efforts involve the design of PPE; the introduction of technologies to enhance vision, hearing, and communicating during the use of PPE; and training staff in using the equipment and in effective communication and teamwork protocols.