Fluid intake, hydration, work physiology of wildfire fighters working in the heat over consecutive days

Health risks and mitigation strategies from occupational exposure to wildland fire: a scoping review

OBJECTIVES

Due to accelerating wildland fire activity, there is mounting urgency to understand, prevent, and mitigate the occupational health impacts associated with wildland fire suppression. The objectives of this review of academic and grey literature were to: 1. Identify the impact of occupational exposure to wildland fires on physical, mental, and emotional health; and 2. Examine the characteristics and effectiveness of prevention, mitigation, or management strategies studied to reduce negative health outcomes associated with occupational exposure to wildland fire.

METHODS

Following established scoping review methods, academic literature as well as government and industry reports were identified by searching seven academic databases and through a targeted grey literature search. 4679 articles were screened using pre-determined eligibility criteria. Data on study characteristics, health outcomes assessed, prevention or mitigation strategies studied, and main findings were extracted from each included document. The results of this scoping review are presented using descriptive tables and a narrative summary to organize key findings.

RESULTS

The final sample was comprised of 100 articles: 76 research articles and 24 grey literature reports. Grey literature focused on acute injuries and fatalities. Health outcomes reported in academic studies focused on respiratory health (n = 14), mental health (n = 16), and inflammation and oxidative stress (n = 12). The identified studies evaluated short-term outcomes measuring changes across a single shift or wildland fire season. Most research was conducted with wildland firefighters and excluded personnel such as aviation crews, contract crews, and incident management teams. Five articles reported direct study of mitigation strategies, focusing on the potential usage of masks, advanced hygiene protocols to reduce exposure, fluid intake to manage hydration and core temperature, and glutamine supplementation to reduce fatigue.

CONCLUSIONS

While broad in scope, the evidence base linking wildland fire exposure to any one health outcome is limited. The lack of long-term evidence on changes in health status or morbidity is a clear evidence gap and there is a need to prioritize research on the mental and physical health impact of occupational exposure to wildland fire.

Participatory Development Process of Two Human Dimension Intervention Programs to Foster Physical Fitness and Psychological Health and Well-Being in Wildland Firefighting

Intervention programs designed, delivered, and evaluated by and within organizations are a critical component in the promotion of employee health and well-being and in the prevention of occupational injury. Critical for transference of findings across complex occupational settings is a clearly articulated development process, a reliance on and evaluation of underlying theoretical foundations, and the inclusion of relevant outcomes emerging out of participatory action processes. To date, there have been no documented efforts outlining the development, implementation, or evaluation of human dimension intervention programs targeting wildland firefighters. The purpose of this paper is to outline the development of two collaborative and participatory intervention programs, targeting wildland firefighters’ physical and psychological health and well-being. Two human dimension intervention programs were developed in a collaborative, iterative and participatory process following the Context–Content–Process–Outcomes Framework. First, a physical fitness training intervention program was designed to maintain wildland firefighter’s physical fitness levels and attenuate risk of injury. Second, a psychosocial education intervention program was developed to mitigate the impact of psychosocial risk factors, foster work engagement, and decrease job stress. The current study provides evidence for the capacity of researchers and organizations to collaboratively develop practical programs primed for implementation and delivery.

Hydration Status and Cardiovascular Function

Hypohydration, defined as a state of low body water, increases thirst sensations, arginine vasopressin release, and elicits renin–angiotensin–aldosterone system activation to replenish intra- and extra-cellular fluid stores. Hypohydration impairs mental and physical performance, but new evidence suggests hypohydration may also have deleterious effects on cardiovascular health. This is alarming because cardiovascular disease is the leading cause of death in the United States. Observational studies have linked habitual low water intake with increased future risk for adverse cardiovascular events. While it is currently unclear how chronic reductions in water intake may predispose individuals to greater future risk for adverse cardiovascular events, there is evidence that acute hypohydration impairs vascular function and blood pressure (BP) regulation. Specifically, acute hypohydration may reduce endothelial function, increase sympathetic nervous system activity, and worsen orthostatic tolerance. Therefore, the purpose of this review is to present the currently available evidence linking acute hypohydration with altered vascular function and BP regulation.

Adding sleep restriction to the equation: impact on wildland firefighters' work performance and physiology in hot conditions

PURPOSE

To examine the effects of sleep restriction on firefighters' physical task performance, physical activity, and physiological and perceived exertion during simulated hot wildfire conditions.

METHODS

31 firefighters were randomly allocated to either the hot (n = 18, HOT; 33 °C, 8-h sleep opportunity) or hot and sleep restricted (n = 13, HOT + SR; 33 °C, 4-h sleep opportunity) condition. Intermittent, self-paced work circuits of six firefighting tasks were performed for 3 days. Firefighters self-reported ratings of perceived exertion. Heart rate, core temperature, and physical activity were measured continuously. Fluids were consumed ad libitum, and all food and fluids consumed were recorded. Urine volume and urine specific gravity (USG) were analysed and sleep was assessed using polysomnography (PSG).

RESULTS

There were no differences between the HOT and HOT + SR groups in firefighters' physical task performance, heart rate, core temperature, USG, or fluid intake. Ratings of perceived exertion were higher (p < 0.05) in the HOT + SR group for two of the six firefighting tasks. The HOT group spent approximately 7 min more undertaking moderate physical activity throughout the 2-h work circuits compared to the HOT + SR group.

CONCLUSION

Two nights of sleep restriction did not influence firefighters' physical task performance or physiological responses during 3 days of simulated wildfire suppression. Further research is needed to explore firefighters' pacing strategies during real wildfire suppression.

The Impact of Heat Exposure and Sleep Restriction on Firefighters' Work Performance and Physiology during Simulated Wildfire Suppression

This study was designed to examine the effects of ambient heat on firefighters' physical task performance, and physiological and perceptual responses when sleep restricted during simulated wildfire conditions. Thirty firefighters were randomly allocated to the sleep restricted (n = 17, SR; 19 °C, 4-h sleep opportunity) or hot and sleep restricted (n = 13, HOT + SR; 33 °C, 4-h sleep opportunity) condition. Firefighters performed two days of simulated, intermittent, self-paced work circuits comprising six firefighting tasks. Heart rate, and core temperature were measured continuously. After each task, firefighters reported their rating of perceived exertion and thermal sensation. Effort sensation was also reported after each work circuit. Fluids were consumed ad libitum. Urine volume and urine specific gravity were analysed. Sleep was monitored using polysomnography. There were no differences between the SR and HOT + SR groups in firefighters' physiological responses, hydration status, ratings of perceived exertion, motivation, and four of the six firefighting tasks (charged hose advance, rake, hose rolling, static hose hold). Black out hose and lateral repositioning were adversely affected in the HOT + SR group. Working in hot conditions did not appear to consistently impair firefighters work performance, physiology, and perceptual responses. Future research should determine whether such findings remain true when individual tasks are performed over longer durations.

The impact of fire suppression tasks on firefighter hydration: a critical review with consideration of the utility of reported hydration measures

Background

Firefighting is a highly stressful occupation with unique physical challenges, apparel and environments that increase the potential for dehydration. Dehydration leaves the firefighter at risk of harm to their health, safety and performance. The purpose of this review was to critically analyse the current literature investigating the impact of fighting ‘live’ fires on firefighter hydration.

Methods

A systematic search was performed of four electronic databases for relevant published studies investigating the impact of live fire suppression on firefighter hydration. Study eligibility was assessed using strict inclusion and exclusion criteria. The included studies were critically appraised using the Downs and Black protocol and graded according to the Kennelly grading system.

Results

Ten studies met the eligibility criteria for this review. The average score for methodological quality was 55 %, ranging from 50 % (‘fair’ quality) to 61 % (‘good’ quality) with a ‘substantial agreement’ between raters (k = .772). Wildfire suppression was considered in five studies and structural fire suppression in five studies. Results varied across the studies, reflecting variations in outcome measures, hydration protocols and interventions. Three studies reported significant indicators of dehydration resulting from structural fire suppression, while two studies found mixed results, with some measures indicating dehydration and other measures an unchanged hydration status. Three studies found non-significant changes in hydration resulting from wildfire firefighting and two studies found significant improvements in markers of hydration. Ad libitum fluid intake was a common factor across the studies finding no, or less severe, dehydration.

Conclusions

The evidence confirms that structural and wildfire firefighting can cause dehydration. Ad libitum drinking may be sufficient to maintain hydration in many wildfire environments but possibly not during intense, longer duration, hot structural fire operations. Future high quality research better quantifying the effects of these influences on the degree of dehydration is required to inform policies and procedures that ensure firefighter health and safety.

Firefighters' Physical Activity across Multiple Shifts of Planned Burn Work

Little is currently known about the physical activity patterns of workers in physically demanding populations. The aims of this study were to (a) quantify firefighters’ physical activity and sedentary time within (2-h periods) and across planned burn shifts; and (b) examine whether firefighters’ activity levels during one shift or 2-h period was associated with their activity levels in the following shift or 2-h period. Thirty-four salaried firefighters (26 men, 8 women) wore an Actical accelerometer for 28 consecutive days. Time spent sedentary (SED) and in light- (LPA), moderate- (MPA) and vigorous-intensity physical activity (VPA) were derived using validated cut-points. Multilevel analyses (shift, participant) were conducted using generalised linear latent and mixed models. Firefighters spent the majority of a planned burn shift (average length 10.4 h) or 2-h period engaged in LPA (69% and 70%, respectively). No significant associations were observed between SED and physical activity levels between consecutive planned burned shifts or 2-h periods. The physical activity that a firefighter engaged in during one shift (or 2-h period) did not subsequently affect their physical activity levels in the subsequent shift (or 2-h period). Further research is needed to establish how workers in physically demanding populations are able to sustain their activity levels over long periods of time.

Occupational heat stress in Australian workplaces

The aim of this review was to summarize the current state of knowledge on heat stress risk within typical Australian occupational settings. We assessed identified occupations (mining, agriculture, construction, emergency services) for heat production and heat loss potential, and resultant levels of physiological heat strain. A total of 29 reports were identified that assessed in-situ work settings in Northern Territory, South Australia, Western Australia, Queensland, New South Wales and Victoria, that measured physiological responses and characterized the thermal environment. Despite workers across all industries being regularly exposed to high ambient temperatures (32-42°C) often coupled with high absolute humidity (max: 33 hPa), physiological strain is generally low in terms of core temperature (<38°C) and dehydration (<1 % reduction in mass) by virtue of the low energy demands of many tasks, and self-regulated pacing of work possible in most jobs. Heat stress risk is higher in specific jobs in agriculture (e.g. sheep shearing), deep underground mining, and emergency services (e.g., search/rescue and bushfire fighting). Heat strain was greatest in military-related activities, particularly externally-paced marching with carried loads which resulted in core temperatures often exceeding 39.5°C despite being carried out in cooler environments. The principal driver of core temperature elevations in most jobs is the rate of metabolic heat production. A standardized approach to evaluating the risk of occupational heat strain in Australian workplaces is recommended defining the individual parameters that alter human heat balance. Future research should also more closely examine female workers and occupational activities within the forestry and agriculture/horticulture sector.