The utility of tympanic versus oral temperature measurements of firefighters in emergency incident rehabilitation operations

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.

Psychological, Physical, and Heat Stress Indicators Prior to and after a 15-Minute Structural Firefighting Task

Firefighters work in strenuous conditions for prolonged periods wearing up to 20 kg of personal protective equipment. This often contributes to significant heat and cardiovascular strain. This study examined the relationships between psychological and physical measures taken prior to undertaking a 15 min firefighting task, and the occurrence of heat stress and high levels of fatigue following the task. Nine qualified firefighters completed a 15 min “live burn” scenario designed to mimic a fire started by a two-seater couch in a lounge room and completed simulated tasks throughout the duration. Logical reasoning, speed and accuracy, general motivation and fatigue, and physical and mental effort were recorded pre-scenario, and at 0- and 20-min post-scenario. General motivation and fatigue scores at 0- and 20-min post-scenario were highly correlated with each other (rs = 0.90; p = 0.001). The general motivation and fatigue scores, at 0- and 20-min post-scenario, were also strongly related to pre-task logic/reasoning test scores (Post 0 rs = −0.77, p = 0.016; Post 20 rs = −0.87, p = 0.002). Firefighters with lower logical reasoning and speed and accuracy scores were more susceptible to fatigue and impaired cognition when exposed to rises in core temperature and heat stress.

The Impact of Occupational Tasks on Firefighter Hydration During a Live Structural Fire

Structural firefighting is a highly stressful occupation with firefighters performing intense bouts of physical activity in environmental extremes while wearing impermeable, heavy and restrictive personal protective equipment. The aim of this study was to investigate the impact of performing occupational tasks during an active structural fire on firefighters’ hydration status. Nine fully qualified firefighters (mean ± SD age = 39.22 ± 7.89 years) completed a 15 min ‘live’ fire scenario while performing occupational tasks. Urine Specific Gravity (USG), body weight and tympanic membrane temperature were measured pre-scenario and at 0 and 20 min post-scenario. There was a significant decrease in body weight (0 min and 20 min p < 0.0005) and increase in tympanic membrane temperature (0 min and 20 min p < 0.0005) following the fire scenario. There was no significant change in USG post-scenario. Short duration firefighting operations can cause significant fluid loss, as measured by change in body weight but not necessarily USG.

Medical Monitoring During Firefighter Incident Scene Rehabilitation

OBJECTIVE

The objective of this study was to retrospectively investigate aspects of medical monitoring, including medical complaints, vital signs at entry, and vital sign recovery, in firefighters during rehabilitation following operational firefighting duties.

RESULTS

Incident scene rehabilitation logs obtained over a 5-year span that included 53 incidents, approximately 40 fire departments, and more than 530 firefighters were reviewed. Only 13 of 694 cases involved a firefighter reporting a medical complaint. In most cases, vital signs were similar between firefighters who registered a complaint and those who did not. On average, heart rate was 104 ± 23 beats·min(-1), systolic blood pressure was 132 ± 17 mmHg, diastolic blood pressure was 81 ± 12 mmHg, and respiratory rate was 19 ± 3 breaths·min(-1) upon entry into rehabilitation. At least two measurements of heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate were obtained for 365, 383, 376, and 160 cases, respectively. Heart rate, systolic and diastolic blood pressures, and respiratory rate decreased significantly (p < 0.001) during rehabilitation. Initial vital signs and changes in vital signs during recovery were highly variable.

CONCLUSIONS

Data from this study indicated that most firefighters recovered from the physiological stress of firefighting without any medical complaint or symptoms. Furthermore, vital signs were within fire service suggested guidelines for release within 10 or 20 minutes of rehabilitation. The data suggested that vital signs of firefighters with medical symptoms were not significantly different from vital signs of firefighters who had an unremarkable recovery.

Comparing tympanic temperatures in both ears to oral temperature in the critically ill adult

Tympanic temperatures are often used in the critical care units to measure core body temperatures when pulmonary artery catheters are not available. This study was conducted to compare tympanic temperatures in the right and left ear with oral temperatures. The findings of this study show that choosing the optimal site for each patient and using patient-specific site consistently would result in better tracking of changes in temperature and, thus, timely diagnosis of fever.