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

Association of Physical and Emotional Parameters with Performance of Firefighters: A Systematic Review

Firefighting requires a high level of physical fitness and causes substantial psychological stress, engendering musculoskeletal, mental, and cardiac issues. Consequently, it is necessary to measure the preparation of the firefighters daily through the Firefighting Physical Ability Tests (FPATs). According to the literature, some variables are more important for performance in the FPAT. Therefore, we aimed to summarize evidence that relates physical and mental aspects to the FPAT performance. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method, screening 1055 records from databases and selecting 15 that met inclusion criteria. No emotional and psychological variables were correlated with the FPAT. Most research shows significant correlations between the FPAT performance and the following: aerobic fitness, upper body endurance and strength, anaerobic capacity, body fat, and age. Lower body endurance and strength, as well as anaerobic power, had a low number of investigations and need to be further explored. Abdominal endurance showed weak correlations, while flexibility did not show any correlations in most studies, although these should be considered for injury prevention. We recommend that fitness programs and evaluations include a global analysis considering the evidence presented for methodological improvements.

In the heat of the moment: the effects of extreme temperatures on the cognitive functioning of firefighters

Exposure to high temperatures can have detrimental effects on cognitive processing and this is concerning for firefighters who routinely work in extreme temperatures. Whilst past research has studied the effects of heat on firefighter cognition, findings are mixed, and no work has measured the time course of cognitive recovery. This study compared working memory, vigilance, and cognitive flexibility of 37 firefighters before and after they engaged in a live-fire training exercise with temperatures exceeding 115 °C. To assess recovery, cognition was measured on exiting the fire, then 20- and 40-minutes post-fire. Results showed impaired vigilance and cognitive flexibility (increased errors, slower responses) immediately after the fire, but recovery at 20-minutes. These findings indicate that a live indoor fire negatively impacts cognitive processing, but this effect is relatively short-lived and return to baseline functioning is seen 20-minutes after exiting the fire. The findings could be used to inform re-entry and cooling decisions.

The global prevalence of musculoskeletal disorders among firefighters: a systematic review and meta-analysis

This systematic review and meta-analysis study aimed to explore the global prevalence of musculoskeletal disorders (MSDs) among firefighters. A systematical search was performed in three international academic databases (Scopus, PubMed and Web of Science). Overall, 31 articles were included in this review. The pooled prevalence of total MSDs in firefighters was identified as 41% (95% confidence interval [CI] [33, 50]). The prevalence of MSDs in neck, shoulders, upper back, lower back, upper extremity and lower extremity was 9% (95% CI [7, 10]), 11% (95% CI [8, 15]), 8% (95% CI [5, 12]), 31% (95% CI [27, 34]), 13% (95% CI [9, 17]) and 16% (95% CI [14, 18]), respectively. No statistically significant relationship was observed between prevalence of MSDs and year of study, mean age, size of sample, duration of prevalence, region or income level. Demographic, occupational and medical condition factors were identified that can create these disorders among firefighters.

Do extreme temperatures affect cognition? A short review of the impact of acute heat stress on cognitive performance of firefighters

Research shows that exposure to high environmental temperatures can affect task performance. Theoretical explanations outline that heat is a source of stress that competes for limited-capacity resources, therefore if a task is resource-intensive, and/or if heat stress is extreme, performance will suffer. One occupation in which individuals complete demanding tasks and make difficult decisions, often in temperatures exceeding 200°C, is firefighting. Yet very little is currently known about the impact of heat stress on the cognitive functioning of firefighters. This short review summarizes the limited research in this area, focusing on studies that measured cognition of firefighters following a realistic training exercise. The findings are mixed with evidence that heat stress improves, impairs, and has no impact on cognitive functioning. While there are differences in the firefighting activities utilized, and the temperatures that participants were exposed to, it is argued that the varied findings can be attributed to the tasks used to assess cognitive processing, and the cognitive functions being measured. In accordance with the wider field of research, it is concluded that complex functioning, such as sustained attention, vigilance, and working memory is negatively impacted by acute exposure to extreme heat. Greater understanding of factors affecting cognition would inform safety practices and more research is needed to understand how and when heat stress may influence cognition in firefighting scenarios.

Identifying the most important, frequent, and physically demanding tasks of Brazilian firefighters

This study aimed to identify the most important, frequently performed, and physically demanding tasks performed by Brazilian firefighters and to identify tasks that could be used to assess physical fitness. A subjective task analysis was conducted. Five hundred twenty-four firefighters (84% male; 16% females) responded to an online survey and rated 37 tasks across three domains (most important, most frequent, and most physically demanding). A dichotomous decision analysis was used to inform the proposed physical fitness tests. Wildland firefighting tasks presented the highest overall mean rate. Traffic control was considered the most important and frequently performed task. Lifeguard rescue was considered the most physically demanding task. The dichotomous analysis identified 14 essential tasks (seven structural firefighting and seven automobile accidents). The tasks identified may be helpful in developing criterion physical fitness tests and training programs related to firefighters' demands.Practitioner summary: The unpredictability, variability, and dangerousness of firefighting make it challenging to observe the physical demands imposed on firefighters. A subjective task analysis was conducted to identify essential tasks performed by Brazilian firefighters. Wildland firefighting, lifeguard rescue, automobile accidents, and structural firefighting tasks were the most important, frequent, and physically demanding.

Overexertion and heat stress in the fire service: a new conceptual framework

From the year 2000, the United States Fire Administration (USFA) has been recording all line-of-duty deaths in the fire service. Stress or overexertion caused 1096 out of 2598 total line-of-duty deaths in the United States from 2000 to 2021. Those deaths due to stress or overexertion were further classified as myocardial infarction (90%), cerebrovascular accident (6.8%), other (2.6%), and heat exhaustion (0.6%). Environmental heat exposure is a concern in firefighting, as firefighters work in extreme conditions, such as high ambient temperatures, while wearing protective clothing. Heat stress is not only hazardous to the cardiovascular system, but may accentuate muscle fatigue and overexertion. In addition, overexertion itself is related to increased incidence of musculoskeletal injuries, usually to the lower extremities. Further, there is a strong physiological mechanistic link to suggest that the increased occupational heat exposure and thermoregulatory strain firefighters experience may be a stressor that increases the risk of injuries. This commentary hopes to show the need for further research on the effects of occupational exposures and physiological strain in the fire service.

Potential impact of metabolic syndrome on cognitive function in US firefighters

Objectives

Among US firefighters, sudden cardiac arrest and psychological stress (i.e., PTSD) are the leading cause of on-duty death. Metabolic syndrome (MetSyn) may influence both cardiometabolic and cognitive health. Here, we examined differences in cardiometabolic disease risk factors, cognitive function, and physical fitness in US firefighters with vs. without MetSyn.

Materials and methods

One hundred fourteen male firefighters, aged 20 to 60 years, participated in the study. US firefighters with MetSyn vs. non-MetSyn were divided by AHA/NHLBI criteria. Of them, we performed a paired-match analysis with respect to the age and BMI of firefighters with (n = 18) vs. without MetSyn (n = 18). The cardiometabolic disease risk factors included blood pressure, fasting glucose, blood lipid profiles [HDL-C, triglyceride (TG)], and surrogate markers of insulin resistance [TG/HDL-C, TG glucose index (TyG)]. The cognitive test included a psychomotor vigilance task as a measure of reaction time and a delayed-match-to-sample task (DMS) as a measure of memory, using the computer-based Psychological Experiment Building Language Version 2.0 program. The differences between MetSyn and non-MetSyn groups in US firefighters were analyzed using an independent t-test adjusted for age and BMI. In addition, Spearman correlation and stepwise multiple regression were conducted.

Results

US firefighters with MetSyn exhibited severe insulin resistance estimated by TG/HDL-C and TyG (Cohen's d > 0.8, all p < 0.01) compared with their age- and BMI-matched counterparts without MetSyn. In addition, US firefighters with MetSyn exhibited higher DMS total time and reaction time compared with non-MetSyn (Cohen's d > 0.8, all p < 0.01). In stepwise linear regression, HDL-C predicted DMS total time (β = - 0.440, R² = 0.194, p < 0.05), and TyG (β = 0.432, R² = 0.186, p < 0.05) predicted DMS reaction time.

Conclusion

US firefighters with vs. without MetSyn were predisposed to metabolic risk factors, surrogate markers of insulin resistance, and cognitive function, even when matched for age and BMI, and there was a negative association between metabolic characteristics and cognitive function in US firefighters. The findings of this study suggest that the prevention of MetSyn may be beneficial to supporting firefighters' safety and occupational performance.