A Profile of Injuries Sustained by Firefighters: A Critical Review

Work bout handling of a search dog reduces handgrip strength and increases firefighters' risk of falls

OBJECTIVES

Firefighters work with dogs as support for their search activities for victims. Firefighters who handle dogs supposedly have higher acute muscle pain, more stumbling, and fatigue. This study aimed to verify the influence of a mantrailing dog on the firefighter's psychophysiological and muscular responses and the number of imbalances in a simulated activity of searching for people.

METHODS

The sample consisted of 10 canine operators characterized by mass (92.57 ± 9.66 kg), height (1.78 ± 0.06 m), age (37.8 ± 2.1 yr), and length of service (9.5 ± 4.6 yr), who performed a search activity under 2 experimental conditions (dog condition and control condition). The simulated search activity consisted of a predefined hike of 2.5 km between the beginning of a search and the place where the sham victim was hidden. Cardiometabolic variables, pain level, and muscular performance were measured pre and postactivity (time factor). The number of imbalances suffered during hiking was also quantified.

RESULTS

ANOVA data indicated interactions (condition × time) related to handgrip strength (P < 0.05). Handgrip strength was reduced in the postsearch activity with the dog, and it increased the control when compared to the preactivity (-12.3% versus +9.2%). Also, the level of pain and discomfort in the neck, trunk, and hip regions was higher with dogs (P < 0.05). Under the dog and control conditions, there were 25 and 05 imbalances, respectively, during the hike. There were no significant differences between the experimental conditions for vertical jump performance and cardiovascular responses either with dog or control.

CONCLUSIONS

The findings of this study highlight that a mantrailing dog with the firefighter increased the number of slips, trips, sudden changes in direction, and loss of body balance, accompanied by a reduction in handgrip strength, and increased acute pain in the neck, trunk, and hip. These findings may contribute to support strategies for mitigating injuries and optimizing the performance of canine operators in the fire department and other units cinotechnic.

Age-Related Differences in Body Fat and Fitness of Firefighters Participating in a Health and Wellness Program

ABSTRACT

Lockie, RG, Dulla, JM, Higuera, D, Ross, K, Orr, RM, Dawes, JJ, and Ruvalcaba, TJ. Age-related differences in body fat and fitness of firefighters participating in a health and wellness program. J Strength Cond Res 38(6): 1127-1135, 2024-Fitness tends to decline, whereas body fat increases, with age, which could impact firefighter occupational performance later in their careers. Health and wellness program participation could reduce these age-related changes. Archival data from 270 firefighters (258 men and 12 women) from a health and wellness program were analyzed. Data included body mass index; body fat percentage (BF%); waist circumference (WC); waist-to-hip ratio (WHR); sit and reach; grip strength; absolute and relative predicted 1 repetition maximum (1RM) leg press; crunches; push-ups; and estimated maximal aerobic capacity (V̇o2max). Firefighters were grouped by age ≤29 (n = 29); 30-34 (n = 44); 35-39 (n = 38); 40-44 (n = 39); 45-49 (n = 48); 50-54 (n = 42); and 55+ (n = 30) years. A univariate analysis of covariance, with sex as a covariate and Bonferroni's post hoc adjustment, determined between-group differences. Effect sizes (d) were calculated. Key results included that the 55+ group had higher BF% and WC compared with the 3 youngest groups (p ≤ 0.002; d = 0.86-1.08). The 50-54 group had higher BF% than the 30-34 group (p = 0.010; d = 0.77). The 55+ group had a greater WHR, lower grip strength, and completed fewer crunches and push-ups than most younger groups (p ≤ 0.05; d = 0.60-1.32). The 50-54 and 55+ groups had a lower 1RM leg press and V̇o2max compared with the younger groups (p ≤ 0.009; d = 0.77-1.79). The program appeared generally effective, with limited differences in groups below 49 years of age. Greater disparities in fat mass and fitness tended to occur in the older groups (50-54, 55+ groups). The data highlighted that older firefighters were participating in the optional program, which could lead to better health outcomes.

Developing risk profiling for firefighters: Enhancing safety and performance

Firefighters encounter numerous complex and ever-changing hazards when carrying out emergency response activities, necessitating the development of effective risk profiling methods to enhance both their safety and operational efficiency. This study outlines a comprehensive approach to constructing risk profiles tailored specifically for firefighters, integrating various methodologies to create a robust and adaptable framework. The methods used incorporating historical incident data, environmental variables, and individual firefighter characteristics to identify and assess potential risks. Additionally, the risk profiling framework include Psychosocial risk factors are also considered, allowing for a holistic understanding of the human element in firefighting risk assessment. By developing risk profiles to the specific needs and characteristics of firefighters, this method aims to significantly improve their safety, ability to make decisions, and overall operational efficiency in the demanding and ever-changing setting of emergency response situations. This article discussed methods•To identify safety cultures using questionnaires•To analyse risk from incident reports using content analysis•To verify and validate risk using thematic analysis from Focus Group Discussion.

Skeletal muscle fitness and physiology as determinants of firefighter performance and safety: a narrative review

Firefighters routinely perform tasks that are reliant on their muscular fitness, which includes muscular strength, power and endurance. Separately, firefighters can present with unique skeletal muscle physiology characteristics due to the strenuous nature of this occupation. This review aims to summarise muscular fitness and physiology as determinants of a firefighter's ability to perform occupation-specific tasks, identify the relevance of both muscular fitness and physiology to a firefighter's risk for sustaining a work-related injury, and address the contributions of muscular fitness and physiology on a firefighter's ability to recover from tasks and their readiness for performing subsequent or future tasks. The presented evidence reveals muscular fitness can determine a firefighter's capacity to perform their job effectively, while also influencing risk for occupational injury. Collectively, this review indicates exercise training emphasising improvements in muscular strength, power, and endurance (i.e. resistance training) should be encouraged in this occupation.

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.

Relationships between job stress, post-traumatic stress and musculoskeletal symptoms in firefighters and the role of job burnout and depression mediators: a bayesian network model

INTRODUCTION

Job stress, post-traumatic stress disorder (PTSD), and negative psychological outcomes in firefighters can be caused, or aggravated, by their work. These mental disorders can impart musculoskeletal symptoms. This study aimed to investigate relationships between musculoskeletal and psychological disorders in a population of firefighters using a Bayesian network model.

METHODS

This cross-sectional study, conducted in 2022, included 2339 firefighters who completed questionnaires during their rest periods. The questionnaires comprised of demographical information, the Occupational Stress Questionnaire-HSE, the PTSD Checklist, Maslach Burnout Inventory, Center for Epidemiologic Studies - Depression scale (CES-D), and Nordic Musculoskeletal Questionnaire. GeNIe academic software was used to analyze the Bayesian network.

RESULTS

High job stress and high PTSD each increased the probability of musculoskeletal symptoms by 34%. When combined, high job stress and high PTSD increased the probability of musculoskeletal symptoms by 37%. Among the mediator's burnout and depression, depression had the highest association with musculoskeletal symptoms.

CONCLUSIONS

Job stress and PTSD can increase musculoskeletal symptoms and are influenced by psychological mediators (like burnout and depression). Adopting preventive and therapeutic measures to mitigate job stress and PTSD, mitigate and rehabilitate WMSD, and manage associated mediators are critical for the mental and physical health of firefighters.

Isokinetic Shoulder Strength and its Associations to Injury in Tactical Populations: A Critical Review

The aim of this review is to evaluate existing isokinetic testing protocols for the shoulder in tactical occupations, document their shoulder strength profiles, and determine any associations to shoulder injury. Four electronic databases were searched (Medline/Pubmed, Ovid/Emcare, CINAHL/Ebsco and Embase) using the keywords police OR law enforcement, firefighter, military, AND isokinetic. Articles were eligible if they had at least one cohort of a tactical population and included isokinetic testing of the glenohumeral joint. The search yielded 275 articles. After screening for duplicates and inclusion criteria, 19 articles remained for review, six of which assessed injury correlation. 17 articles evaluated military personnel and two examined firefighters. Articles were categorized by study design, population, isokinetic protocols, strength outcome measures and statistical measures. Concentric internal rotation (IR) and external rotation (ER) strength at 60 degrees/second were reported most frequently (84% of cases). There was a paucity of testing speeds, repetition ranges and contraction types evaluated when compared to existing literature in other populations with high shoulder injury occurrence such as overhead and collision athletes. Outside of military cohorts, there is limited data available to characterise the isokinetic strength profile of the shoulder in tactical occupations. Meta-analysis for injury association was unable to be performed due to independent variable and statistical heterogeneity. However, a best evidence synthesis suggested conflicting evidence to support the association of injury with isokinetic strength testing in tactical populations. Future studies should prioritise prospective designs utilising variable speeds, repetition schemes and contraction types to better capture the dynamic occupational demands in tactical groups.

Posture Evaluation of Firefighters During Simulated Fire Suppression Tasks

BACKGROUND

Posture mechanics during fire suppression tasks are associated with musculoskeletal injuries in firefighters.

METHODS

This study uses the Ovako Working Posture Analyzing System (OWAS) ergonomics tool to describe and evaluate the postures of 48 firefighters during 3 simulated tasks: (a) hose drag, (b) hose pull, and (c) high-rise pack lift. Ergonomics intervention prioritizations based on the OWAS action classification (AC) scores were identified using Wilcoxon signed-rank tests. Chi-square analyses identified associations between firefighter characteristics and OWAS AC scores.

FINDINGS

The initial hose pick-up phase of each task was identified as a high priority for ergonomics intervention (OWAS AC = 4) in 45.8%, 54.2%, and 45.8% of cases for Tasks 1, 2, and 3, respectively. Lower BMI was associated with higher AC scores for the initial hose pick-up during Task 3 (likelihood ratio = 9.20, p value = .01).

CONCLUSION

The results inform ergonomics priorities for firefighter training based on the tasks analyzed. Application to Practice: This study evaluates the posture mechanics of three commonly performed firefighting tasks. The results help inform an ergonomics training intervention focused on posture mechanics during occupational activities for firefighters.

Etiology of Exercise Injuries in Firefighters: A Healthcare Practitioners' Perspective

The purpose of this study was to query healthcare practitioners (HCPs) who treat firefighter injuries to identify risk factors and mechanisms associated with musculoskeletal injuries during exercise. A phenomenological design was utilized to understand the experiences of HCPs while treating firefighters' musculoskeletal injuries due to exercise. Semi-structured interviews were conducted with 14 HCPs. Two interviews were pilot-tested with HCPs to ensure reliability and validity. Interviews were transcribed and uploaded to a qualitative analysis software program. Although the study inquired about injuries incurred by any exercise modality (e.g., endurance and resistance training), injuries induced during resistance training were prominent among HCPs as resistance training emerged as a primary exercise injury mechanism. HCPs indicated that the back and shoulder were prevalent anatomical exercise injury locations. Risk factors for exercise injuries included age, immobility, movement proficiency, and factors associated with fatigue. Exercise injury mechanisms included poor resistance training technique and overexertion. These findings could guide exercise program design, use of movement assessments, and the identification of other countermeasures to decrease the risk of resistance training exercise injuries among firefighters.

Occupation-Induced Fatigue and Impacts on Emergency First Responders: A Systematic Review

Fatigue in emergency first responders (EFRs) is known to affect performance abilities and safety outcomes for both patients and EFRs. The primary aim of this review was to determine the main contributors to occupation-induced fatigue in EFRs and its subsequent impacts. Following the PRIMSA checklist, academic databases (Medline, Embase, CINAHL, and SPORTDiscus) were searched using key terms with results subjected to inclusion and exclusion criteria. Populations of interest were firefighters, paramedics, or emergency call centre personnel. Of the 5633 records identified, 43 studies, which reported on 186 unique measures from a total population of 6373 participants, informed the review. Synthesis revealed fatigue was caused by lack of sleep during the shift and consistent poor sleep quality which negatively impacted cognitive function, alertness, and physical and mental health while increasing safety-compromising behaviours and injuries. Both subjective and objective assessments of fatigue are necessary for effective risk management in EFRs. EFRs that are consistently fatigued are at a greater risk of poor physical and mental health, reduced cognitive function, and increased injuries. No studies reported on fatigue in emergency call centre personnel, highlighting a literature gap. Funding was provided by the Australian Capital Territory Emergency Services Agency. Preregistration was filed in OSF: osf.io/26f3s.

Exploring Canadian Career Firefighters' Understanding of the Return-to-Work Process After Musculoskeletal Injuries

PURPOSE

Firefighters perform dangerous and physically demanding work, increasing their risk of musculoskeletal injuries that can lead to work absences. Return-to-work procedures can help firefighters return-to-work sooner and safely. The purpose of this study was to explore what firefighters understand about return-to-work procedures in their workplaces, and what firefighters believe the facilitators and barriers to return-to-work are.

METHODS

Thirty-eight Canadian career firefighters were recruited for semi-structured interviews. Qualitative descriptive methods were used to analyze the transcripts. Two researchers performed the inductive coding and thematic analysis.

RESULTS

Five themes were identified: 1. Variation in the return-to-work process knowledge among firefighters based on their experiences; 2. Accessible medical resources and treatments to support injury recovery; 3. Light duties must be meaningful and suitable; 4. Pressures to return-to-work too soon may lead to negative consequences; and 5. Heavy physical demands of firefighting may become a barrier for return-to-work. 'Factors affecting RTW depended on personal experiences and context' was the overarching theme identified, as many reported facilitators for return-to-work were also reported as barriers in different contexts. There was a variation in the experiences and understanding of return-to-work.

CONCLUSION

There is a lack of knowledge of the return-to-work processes. Firefighters require access to clear return-to-work policies and procedures and treatments that are targeted to firefighting duties to support recovery from injuries and regain physical abilities after an injury. Firefighters must be able to perform all essential duties before returning to firefighting work, as returning to work too soon can lead to further injury.

Traumatic muscle injury

Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis. The diagnosis of muscle injury is based on patient history and physical examination. Imaging may be indicated to eliminate differential diagnoses. The management of muscle injury has changed within the past 5 years from initial rest, immobilization and (over)protection to early activation and progressive loading using an active approach. One challenge of muscle injury management is that numerous medical treatment options, such as medications and injections, are often used or proposed to try to accelerate muscle recovery despite very limited efficacy evidence. Another challenge is the prevention of muscle injury owing to the multifactorial and complex nature of this injury.

Peripheral vestibular loss in noise-exposed firefighters

Introduction

Occupational workers are increasingly aware of the risk of noise overexposure to the auditory system but lack awareness about potential risks to the vestibular system. The purpose of this study was to investigate changes in vestibular end organ function in a known at-risk noise-exposed population, firefighters compared to age- and sex-matched controls using electrophysiologic measures of cervical vestibular evoked myogenic potentials (cVEMP).

Methods

A cross-sectional observational study compared cVEMP response characteristics in 38 noise-exposed firefighters. Firefighters were grouped by years of exposure in the fire service. The cVEMP responses were compared within firefighter groups and between firefighters and age- and sex-matched controls. Dependent variables included the response characteristics of amplitude, latency and threshold.

Results

cVEMP response amplitudes were significantly decreased in firefighters compared to their age- and sex-matched controls. Threshold of the cVEMP responses were significantly higher in firefighters compared to controls and firefighters had a higher incidence of absent cVEMP responses compared to controls. Response amplitudes decreased with increasing years in the fire-service at an increased rate compared to their age- and sex-matched controls. Latency of the cVEMP response was not significantly different in firefighters compared to controls. These findings are consistent with both animal and human studies suggesting noise-induced changes in the sacculocollic pathway.

Discussion

In the absence of any reported vestibular symptoms or auditory indicators of noise-induced hearing loss, these early effects on the vestibular system point to a potential hidden vestibular loss.

A systematic model to identify and reduce work-related musculoskeletal disorders in firefighters, and improve their function

INTRODUCTION

Firefighting is a high-risk job with a high prevalence of work-related musculoskeletal disorders (WMSDs). The aim of his study was to determine the prevalence of WMSDs, estimate the likelihood of subsequent disorders, and investigate the effect of NASM-based training protocol on firefighters function.

METHOD

First, prevalence and region of WMSDs in all 524 male Isfahan firefighters were determined by Medical-history-questionnaire. Then, functional movement screen (FMS) separated firefighters to the 2-dimension FMS score (FMSCS≤14 or FMSCS>14) to show at risk firefighters. Finally, 40 Participants with both FMSCS≤14 and common WMSDs randomly assigned to either an intervention (IG) (n = 20) or control (CG) (n = 20) group. The IG received NASM-based training, while the CG engaged in daily activities. Outcomes included movement efficiency during landing error scoring system-real time, Y balance, single-leg squat, and deep squat, which were assessed in pretest and posttest.

RESULTS

The prevalence of disorders was 52.1%, which lower limb, back, upper limb, and neck were the highest prevalence respectively. Only lower limb and back disorders could identify individuals at disorder risk with a likelihood of 89% and 71%, sequentially. Also, movement performance significantly improved in all functional tests in IG relative to CG.

CONCLUSIONS

Considering high disorder rate in firefighters, the value of our study lies in alleging a systematic model periodically to reduce WMSDs and risk of subsequent disorders. Not only our model determined the prevalence of WMSDs, but it also identified those who are at risk. In addition, our model represents exercise therapy as a solution.

Investigation and analysis of training injury and its psychological effects on firefighters in Beijing A cross-sectional study

Firefighters' high-intensity training often leads to injuries in the musculoskeletal system. Studies have found that these injuries in the musculoskeletal system may contribute to poor psychological issues. At the same time, low psychological well-being increases the risk of injuries, illness, and mortality. According to research reports, firefighters generally have a good psychological state. So this study aims to survey and analyze the training-related injuries and psychological states of firefighting and rescue personnel in Beijing. This cross-sectional study employed a questionnaire survey to gather data from a total of 214 firefighters in a certain city. The participants were required to complete a questionnaire about musculoskeletal injuries and psychological status, and then these data were statistically analyzed. The incidence of training-related injuries is relatively high among firefighting and rescue teams, with the highest proportions observed in the lower back, knees, and ankles. Overweight and obese firefighters are more prone to ankle injuries. In the group with injuries, the subjective well-being index is lower compared to the group without injuries. Firefighters experiencing moderate to severe pain due to injuries exhibit lower subjective well-being indices compared to those with mild pain. Psychological resilience and the impact of pain on training and sleep can predict the subjective well-being index of firefighters. It is recommended that firefighting and rescue teams enhance preventive measures for musculoskeletal injuries during training to elevate the subjective well-being of firefighters.

The allostatic load model: a framework to understand the cumulative multi-system impact of work-related psychosocial stress exposure among firefighters

Firefighting is recognised as a profession where health and well-being can be affected by a variety of occupational factors, such as physical, thermal, and chemical stressors. Along with the risks intuitively associated with the fire service, however, psychosocial stress has begun to attract attention as another variable deserving of consideration. Indeed, long-term exposure to work-related psychosocial stress has been linked with poor health outcomes in many workers; however, despite this association, very little has been done to examine how such stressors become biologically embedded in firefighters. To help facilitate research into how psychosocial stress can affect health-related outcomes in the fire service, we propose a framework centered on the notion of allostatic load. First, we reviewed the occupational characteristics that may generate psychosocial stress within firefighters before introducing allostatic load (that is, dysregulation across various physiological systems caused by the need to manage ongoing stressors). Next, we provided a summary of how allostatic load can be measured and touched on the framework's utility for studying the cumulative effects of work-related stress on firefighter health. After this, factors that may influence the steps leading from stress exposure to health outcomes were discussed; in particular, we commented upon how research in this area should consider specific non-modifiable (age, sex, and ethnicity) and modifiable (psychosocial resources and behavioural habits) factors. Finally, we presented methodological barriers and opportunities that may arise when using the allostatic load framework with this professional group. By introducing the framework, we hope to provide a tool that may be used by those interested in stress-health research in firefighters to build the evidence needed to inform primary prevention measures.

Weight Status and Binge Drinking Among Male and Female Florida Firefighters

OBJECTIVE

The aim of the study is to examine the association between weight status and binge drinking among Florida firefighters.

METHODS

Health survey data collected between 2015 and 2019 among Florida firefighters participating in the Annual Cancer Survey were analyzed for weight class (healthy, overweight, obese) and binge-drinking behaviors. Binary logistic regression models were fit and stratified by sex while controlling for sociodemographic and health characteristics.

RESULTS

Among 4002 firefighter participants, 45.1% binge drink, 50.9% are overweight, and 31.3% are obese. Among male firefighters, being overweight (adjusted odds ratio = 1.34; 95% confidence interval = 1.10-1.64) or obese (1.29; 1.04-1.61) was significantly associated with binge drinking compared with healthy weight counterparts. In female firefighters, being obese (2.25; 1.21-4.22) was significantly associated with binge drinking but being overweight was not.

CONCLUSIONS

Being overweight or obese is selectively associated with binge drinking among male and female firefighters.

Individual responses to the implementation of mandatory fitness testing within a fire department

OBJECTIVES

To examine the effects of implementing a consequential fitness assessment (pull-ups, curl-ups, push-ups, 3 min step test) in a fire department on an individual level.

METHODS

We used a repeated-measures design to analyse fitness assessment data from 2019 to 2020 in Northern Virginia. A total of 631 professional firefighters completed the fitness assessment in both years. Repeated measures analysis of variances (ANOVAs) and multiple regression modelling were used to examine the effects of the fitness assessment and factors associated with changes in fitness, respectively.

RESULTS

Overall all aspects of fitness improved over the first year of implementation with a majority of firefighters improved on all components of the fitness assessment except for pull-ups (16.1% improved). Greater levels of baseline fitness and being female were negatively associated with changes in all fitness measures. Older firefighters had smaller changes in pull-up, curl-up and push-up performance.

CONCLUSIONS

During the first year of fitness assessment implementation, the fire department generally improved. The findings suggest that fire departments which enforce mandatory fitness assessments must establish policies for dealing with inadequate performance and offer resources to aid individual firefighters.

Effect of the Law Enforcement Duty Belt on Muscle Activation during Hip Hinging Movements in Young, Healthy Adults

Sixty percent of all law enforcement officers (LEOs) experience low back pain (LBP), with the LEO duty belt (LEO_DB) commonly reported to be a contributing factor. The primary purpose of the study was to investigate the LEODB's effect on muscular activity and compare it to a tactical vest, which is a commonly used alternative to an LEO_DB. In total, 24 participants (13 male, 11 female; mass, 73.0 ± 11.1 kg; height, 169.0 ± 10.0 cm; age, 24.0 ± 5.8 years) completed a progressive series of hip hinge tasks in a single testing session. All participants completed four conditions (no belt, leather belt, nylon belt, and weight VEST) in a randomized order. Surface electromyography (sEMG) sensors were placed bilaterally on the rectus abdominus, multifidus, biceps femoris, and rectus femoris. Across all tasks, no significant effects of load on muscle activity were found for any of the muscles. Participants rated the VEST condition as more comfortable (p < 0.05) and less restrictive (p < 0.05) than either LEODB. The findings suggest an LEO_DB does not alter muscle activity during bodyweight hip hinging or lifting objects from the ground. Future research should examine whether changes in muscle activity occur with durations of LEO_DB wear more similar to an actual work shift duration for LEOs (≥8 h).

Association between physical fitness and musculoskeletal health in firefighters

Introduction: Firefighters are often placed in situations that require high levels of physical exertion, leading to significant strain on firefighters' musculoskeletal system, predisposing them to musculoskeletal discomfort (MSD) and/or musculoskeletal injury (MSI). Physical fitness programs are often recommended and justified, in part, to prevent injuries. The aim of this study was to determine the association between physical fitness and musculoskeletal health (MSH) in firefighters. Methods: A total of 308 full-time firefighters took part in the study conducted in Cape Town, South Africa. Physical fitness tests encompassed a non-exercise estimation for cardiorespiratory fitness, grip and leg strength for upper and lower body strength, push-ups and sit-ups for muscular endurance, and sit-and-reach for flexibility. The Nordic Musculoskeletal Questionnaire and Cornell Musculoskeletal Discomfort Questionnaire were used to determine MSIs and MSD, respectively. A p-value <0.05 indicated statistical significance. Results: Every one-unit increase in AbVO2max, push-ups, sit-ups, and sit-and-reach decreased the odds of firefighters reporting MSIs by 5% (p = 0.005), 3% (p = 0.017), 3% (p = 0.006), and 3% (p = 0.034), respectively. Every one repetition increase in push-up capacity increased the odds of firefighters reporting neck, elbow and forearm, wrist and hand, and thigh discomfort by 3% (p = 0.039), 4% (p = 0.031), 5% (p = 0.002), and 5%` (p = 0.007), respectively. Every one repetition increase in sit-up capacity increased the odds of firefighters reporting upper back discomfort and thigh discomfort by 5% (p = 0.045) and 7% (p = 0.013), respectively. Conclusion: Maintenance of physical fitness is likely beneficial in reducing MSIs, which, however, may increase the feeling of MSD in firefighters. In addition, it may be noticed that there is an ideal level of physical fitness that is conducive to the reduction of MSIs and should be studied further.

Impact of Physical Fitness on Reasons for Academy Release in Firefighter Trainees

ABSTRACT

Lockie, RG, Orr, RM, Montes, F, Ruvalcaba, TJ, and Dawes, JJ. Impact of physical fitness on reasons for academy release in firefighter trainees. J Strength Cond Res 37(7): 1515-1522, 2023-Firefighter trainees require a certain level of fitness to be admitted to and to complete a fire training academy. There is no research detailing whether there are fitness differences between trainees who graduate (GRAD) or those released due to either injury (RELI) or skills test performance failures (RELP). Archival data from 305 trainees (274 males and 31 females) were analyzed. Trainees completed the following fitness tests at the start of academy: Illinois agility test, metronome push-ups, pull-ups, leg tucks, multistage fitness test, backward overhead medicine ball throw (BOMBT) with a 4.54-kg ball, 10 repetition maximum deadlift, and a farmer's carry with 18-kg kettlebells over a 91.44-m course. Trainees were split into GRAD (245 males and 16 females), RELI (9 males and 1 female), and RELP (20 males and 14 females) groups. Kolmogorov-Smirnov data indicated most data were not normally distributed. Accordingly, Kruskal-Wallis H-tests, with Bonferroni post hoc, calculated between-group fitness test differences. Effect sizes were also derived. Except for the leg tuck and farmer's carry, the RELP group performed significantly poorer in all fitness tests compared with the GRAD group ( p ≤ 0.032). The largest effects were seen for the BOMBT ( d = 1.02), Illinois agility test, and 10 repetition maximum deadlift (both d = 0.78). There were no significant fitness test differences for the GRAD and RELI groups. Trainees with poorer fitness were more likely to be released from academy due to skills test failures. Multiple fitness components, but particularly muscular strength and power, should be developed in trainees to aid their ability to perform academy firefighting tasks.

Global prevalence and associated factors of sleep disorders and poor sleep quality among firefighters: A systematic review and meta-analysis

Lack of sleep can affect the health and performance of firefighters. This systematic review and meta-analysis estimated the global prevalence of sleep disorders and poor sleep quality among firefighters and reported associated factors. Four academic databases (Scopus, PubMed, Web of Science, and Embase) were systematically searched from January 1, 2000 to January 24, 2022. These databases were selected as they are known to index studies in this field. The search algorithm included two groups of keywords and all possible combinations of these words. The first group included keywords related to sleep and the second group keywords related to the firefighting profession. The relevant Joanna Briggs Institute checklist was used to evaluate study quality. Data from eligible studies were included in a meta-analysis. In total, 47 articles informed this review. The pooled prevalence of sleep disorders and poor sleep quality in firefighters were determined as 30.49% (95% CI [25.90, 35.06]) and 51.43% (95% CI [42.76, 60.10]), respectively. The results of a subgroup analysis showed that individuals in low- and middle-income countries (LMICs) had a higher prevalence of sleep disorders than those in high-income countries (HICs) but HICs had a higher prevalence of poor sleep quality than LMICs. Various factors, including shift work, mental health, injuries and pain, and body mass index were associated with sleep health. The findings of this review highlight the need for sleep health promotion programs in firefighters.

Prevention of Lower Extremity Musculoskeletal Injuries in Tactical and First Responder Populations: A Systematic Review and Meta-Analysis of Randomized Trials From 1955 to 2020

ABSTRACT

Sinnott, AM, Krajewski, KT, LaGoy, AD, Beckner, ME, Proessl, F, Canino, MC, Nindl, BC, Turner, RL, Lovalekar, MT, Connaboy, C, and Flanagan, SD. Prevention of lower extremity musculoskeletal injuries in tactical and first responder populations: A systematic review and meta-analysis of randomized trials from 1955 to 2020. J Strength Cond Res 37(1): 239-252, 2023-Lower extremity musculoskeletal injuries (LEMSIs) impose a significant burden on tactical and first responder populations. To determine the effectiveness of LEMSI prevention strategies, we performed a systematic review and meta-analysis of randomized controlled trials published in English from 1955 to 2020 (PROSPERO: CRD42018081799). MEDLINE, EMBASE, Cochrane, CINAHL, ProQuest, and DTIC databases were searched for trials that assigned military service members, police, firefighters, or paramedics to LEMSI prevention interventions with a minimum surveillance period of 12 weeks. Evidence was synthesized as odds ratios (OR) for LEMSI occurrence between individuals assigned to interventions and those assigned to standard activities. Risk of bias was assessed with the Cochrane Risk of Bias tool 2.0. Random-effects meta-analyses were conducted for (a) physical training and (b) footwear modifications to reduce LEMSI and (c) footwear modifications to reduce stress fractures specifically. Certainty in the body of evidence was determined with the GRADE approach. Of 28,499 records, 18 trials comprised of more than 11,000 subjects were synthesized. Interventions included physical training (8, N = 6,838), footwear modifications (8, N = 3,792), nutritional supplementation (1, N = 324), and training modifications (1, N = 350). Overall risk of bias was generally moderate ( N = 7 of 18) or high ( N = 9 of 18). Physical training (OR = 0.87, 95% CI [0.71, 1.08], p = 0.22, I 2 = 58.4%) and footwear modification (OR = 1.13, 95% CI [0.85, 1.49], p = 0.42, I 2 = 0.0%) did not reduce LEMSI or stress fractures (OR = 0.76, 95% CI [0.45, 1.28], p = 0.30, I 2 = 70.7%). Our results indicate that there is weak evidence to support current LEMSI prevention strategies. Future efforts will benefit from longer surveillance periods, assessment of women and nonmilitary populations, improved methodological rigor, and a greater breadth of approaches.

Effects of load carriage on measures of postural sway in healthy, young adults: A systematic review and meta-analysis

Load carriage (LC) is a contributing factor to musculoskeletal injury in many occupations. Given that falls are a common mechanism of injury for those frequently engaging in LC, understanding the effects of LC on postural stability (PS) is necessary. A systematic review and meta-analysis was conducted to examine effects of LC on PS. Sixteen and 9 studies were included in the qualitative and quantitative synthesis, respectively. In most studies, it was found that LC leads to a decrease in PS with significant effects on center of pressure (COP) sway area (standardized mean difference = 0.45; p < 0.005) and COP anterior-posterior excursion (standardized mean difference = 0.52; p < 0.05). Furthermore, load magnitude and load placement are factors which can significantly affect COP measures of PS. It is recommended to minimize load magnitude and equally distribute load when possible to minimize LC effects on PS. Future research should examine additional factors contributing to differences in individual PS responses to LC such as changes in muscle activation and prior LC experience.

Inflammatory and psychological consequences of chronic high exposure firefighting

OBJECTIVES

This study aimed to examine the impact of extreme heat exposure frequency on inflammation and well-being in UK Fire Service personnel.

METHODS

136 Fire personnel and 14 controls (CON) were recruited [92 Firefighters (FF), 44 Breathing Apparatus Instructors (BAI)]. BAI were split into low (LBAI; ≤15 exposures per month) and high (HBAI; ≥20 exposures per month) categories. Measures of inflammation, mood and fatigue were collected at 0, 3 and 6 month times points. These variables were analysed for differences between groups and association with frequency of exposure.

RESULTS

HBAI exhibited raised IL-1β, IL-6, IL-10, IgE and lower IgM (p < 0.05). In addition, IL-1β, IL-6, IL-10 and IgM were associated with monthly exposure number, with exposures accounting for 15.4% of the variance in IL-6, 11.8% of IL-1β and 25.2% of IL-10. No differences in mood or fatigue were reported (p > 0.05).

CONCLUSION

High exposure firefighting consistently causes systemic inflammation without perceptual recognition of potential health risks.

Inter-Rater and Intra-Rater Reliability of Return-to-Work Screening Tests for UK Firefighters Following Injury

The aim of this study was to assess the inter-rater and intra-rater reliability of a return-to-work (RTW) screening test to be used on UK firefighters following injury. The inter rater and intra-rater reliability of eight tasks involved in a screening test was used to assess readiness to RTW for UK firefighters following injury. These tasks included the following: (1) putting on and removing a breathing apparatus set (BA), (2) a ladder lift simulation, (3) a ladder carry simulation, (4) a light portable pump (LPP) lift and carry simulation, (5) a hose run, (6) a ladder climb with leg lock, (7) a casualty evacuation and (8) a confined space crawl simulation. The inter-rater reliability between each individual screening task was interpreted as Excellent (ICC = 0.94-1.00) for eleven (68.75%) of the screening task videos and as Good (ICC = 0.75-0.88) for five (31.25%) of the screening task videos. Intra-rater reliability was interpreted as Excellent (ICC = 1) for twenty-six participants (74.3%), Good (ICC = 0.76-0.88) for eight participants (22.9%) and Moderate for one participant (2.8%). Due to the reliability of this screening test, it allows conclusions to be made from the results which can inform a RTW decision for a firefighter.

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.

Exploring Predictive Ability of Fitness Test Data Relative to Fire Academy Graduation in Trainees: Practical Applications for Physical Training

This study investigated the predictive abilities of fitness tests relative to academy graduation in firefighter trainees. Archival fitness test data from 305 trainees were analyzed, including: Illinois agility test (IAT); push-ups; pull-ups; leg tucks; multistage fitness test; 4.54-kg backwards overhead medicine ball throw (BOMBT); 10-repetition maximum deadlift; and a 91.44-m farmers carry with 18-kg kettlebells. Within the department, trainees were allocated points for each test. Trainees were split into graduated (245 males, 16 females) or released (29 males, 15 females) groups. Independent samples t-tests and effect sizes calculated between-group fitness test differences (raw and scaled points). To provide a binary definition for the sensitivity/specificity analysis, trainees were defined as those scoring 60+ points for a test, and those scoring 0 points. For each test, the binary result (graduated/released) was plotted against the trainee's test performance (60+ Points/0 Points). Receiver operating curves were plotted for each fitness test, and the area under the curve (AUC) determined accuracy. Trainees who graduated performed more push-ups, pull-ups, and leg tucks than released trainees, and scored more points in all tests (p≤0.005; d=0.34-1.41). Pull-ups, BOMBT, leg tuck, and the farmer's carry had high sensitivity (>80% true positive rate); the IAT had high specificity (83.3% for the true negative rate). Metronome push-ups, BOMBT points, and total points had fair accuracy for predicting academy graduation (AUC=0.709-0.754). While the data demonstrated that trainees who graduated tended to have better total-body muscular strength, endurance, and power, fitness tests may not be appropriate as a sole predictor for academy graduation.

The Impact of Footwear on Occupational Task Performance and Musculoskeletal Injury Risk: A Scoping Review to Inform Tactical Footwear

The aim of this scoping review was to investigate the impact of footwear on worker physical task performance and injury risk. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews protocol and registered in the Open Science Framework. Key search terms were entered into five academic databases. Following a dedicated screening process and critical appraisal, data from the final articles informing this review were extracted, tabulated, and synthesised. Of 19,614 identified articles, 50 articles informed this review. Representing 16 countries, the most common populations investigated were military and firefighter populations, but a wide range of general occupations (e.g., shipping, mining, hairdressing, and healthcare workers) were represented. Footwear types included work safety boots/shoes (e.g., industrial, gumboots, steel capped, etc.), military and firefighter boots, sports shoes (trainers, tennis, basketball, etc.) and various other types (e.g., sandals, etc.). Occupational footwear was found to impact gait and angular velocities, joint ranges of motion, posture and balance, physiological measures (like aerobic capacity, heart rates, temperatures, etc.), muscle activity, and selected occupational tasks. Occupational footwear associated with injuries included boots, conventional running shoes, shoes with inserts, harder/stiffer outsoles or thin soles, and shoes with low comfort scores-although the findings were mixed. Occupational footwear was also linked to potentially causing injuries directly (e.g., musculoskeletal injuries) as well as leading to mechanisms associated with causing injuries (like tripping and slipping).

Effects of a healthy lifestyle intervention and COVID-19-adjusted training curriculum on firefighter recruits

There are knowledge gaps regarding healthy lifestyle (HLS) interventions in fire academy settings and also concerning the impacts of the pandemic on training. We enrolled fire recruits from two fire academies (A and B) in New England in early 2019 as the historical control group, and recruits from academies in New England (B) and Florida (C), respectively, during the pandemic as the intervention group. The three academies have similar training environments and curricula. The exposures of interest were a combination of (1) an HLS intervention and (2) impacts of the pandemic on training curricula and environs (i.e. social distancing, masking, reduced class size, etc.). We examined the health/fitness changes throughout training. The follow-up rate was 78%, leaving 92 recruits in the historical control group and 55 in the intervention group. The results show an HLS intervention improved the effects of fire academy training on recruits healthy behaviors (MEDI-lifestyle score, 0.5 ± 1.4 vs. − 0.3 ± 1.7), systolic blood pressure (− 7.2 ± 10.0 vs. 2.9 ± 12.9 mmHg), and mental health (Beck Depression score, − 0.45 ± 1.14 vs. − 0.01 ± 1.05) (all P < 0.05). The associations remained significant after multivariable adjustments. Moreover, a 1-point MEDI-lifestyle increment during academy training is associated with about 2% decrement in blood pressures over time, after multivariable adjustments (P < 0.05). Nonetheless, the impacts of pandemic restrictions on academy procedures compromised physical fitness training, namely in percent body fat, push-ups, and pull-ups.

Weighting of Firefighting Turnout Gear Risk Factors According to Expert Opinion

Firefighters in Taiwan often wear expired protective clothing, which raises concerns regarding their safety. Extending the service life of fire protective clothing can improve firefighter safety and ensure environmental sustainability. In this study, an analytic hierarchy process was used to understand which risk factors should be prioritized in the design of firefighting turnout gear. We surveyed 30 experts in the field of firefighting and safety management on the importance of various risk factors related to turnout gear. A risk level of 70% was taken as the threshold of tolerable risk. The rankings of the weighted risk factors demonstrate that eliminating 12 of the 28 risk factors will result in 73% safety. These 12 factors are, in order of maximum risk, insufficient flame resistance, insufficient heat resistance, putting on the suit components in the wrong order, insufficient resistance to tears and punctures, poor agility, heavy overall weight, insufficient water resistance, lack of flame-retardant fibers, high levels of toxicity, insufficient internal circulation, no air filtration device, and poor air permeability. Consideration of these factors in the design of fire protective clothing can extend service life, help achieve sustainable development goals, and ensure firefighters’ safety.

Musculoskeletal Disorders Associated with Occupational Driving: A Systematic Review Spanning 2006–2021

Several occupations require workers to spend long periods of time driving road vehicles. This occupational task is associated with musculoskeletal disorders. The purpose of this review was to collate, synthesize, and analyze research reporting on musculoskeletal disorders associated with occupational driving, in order to develop a volume of evidence to inform occupational disorder mitigation strategies. A systematic search of academic databases (PubMed, EBSCO host, CINAHL, SPORTDiscus, and Web of Science) was performed using key search terms. Eligible studies were critically appraised using the Joanna Briggs Institute critical appraisal checklists. A Cohen’s kappa analysis was used to determine interrater agreement between appraisers. Of the 18,254 identified studies, 25 studies were selected and appraised. The mean critical appraisal score is 69% (range 38–100%), with a fair level of agreement (k = 0.332). The studies report that musculoskeletal disorders, most commonly lower back pain, is of concern in this population, particularly in truck, bus, and taxi drivers. Risk factors for these occupations include long hours in a sitting position, years in the profession, vehicle ergonomics, and vibration.

Musculoskeletal injury epidemiology in law enforcement and firefighter recruits during physical training: a systematic review

Objectives

Report the injury epidemiology of law enforcement and firefighter recruits.

Design

A systematic epidemiological review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines was completed.

Data sources

Five online databases were searched from database inception to 5 May 2021.

Eligibility criteria for selecting studies

Prospective and retrospective studies that reported data on musculoskeletal injuries sustained by law enforcement or firefighter recruits were included. We reported on all components of injury where data were available. All injury incidence rates were calculated as per 1000 training days (Poisson 95% CI) to allow comparisons between studies. Study quality was assessed using the Joanna Briggs Institute Quality Assessment Checklist for Prevalence Studies.

Results

No studies reporting firefighter recruits were identified. Eight published studies that reported on injuries to law enforcement recruits were identified. The studies were all low quality, and the credibility of the evidence was assessed as very low. Seven studies reported medical attention injuries, and one study reported the number of medical withdrawals from a recruit training programme. The prevalence of law enforcement recruits with medical attention injuries ranged from 13.7% to 24.5%. The overall medical attention injury incidence rate for law enforcement recruits ranged from 1.67 injuries per 1000 training days (Poisson 95% CI 1.00 to 2.34 injuries per 1000 training days) to 4.24 injuries per 1000 training days (Poisson 95% CI 2.97 to 5.51 injuries per 1000 training days).

Conclusion

This review reported the prevalence and incidence rates for musculoskeletal injuries in law enforcement officers. However, the credibility of the evidence is very low.

PROSPERO registration number

CRD42021251084.

Relationship Between Physical Activity, Coronary Artery Disease Risk Factors and Musculoskeletal Injuries in the City of Cape Town Fire and Rescue Service

Musculoskeletal injuries in firefighters are a common occurrence, that increase as firefighters age, and may be related to the firefighters’ physical activity habits outside of the job. Certain CAD risk factors, such as obesity, cigarette smoking and ageing may be linked to increased injury risk in firefighters. Although firefighters may meet the recommended minimum physical activity minutes, they may remain at risk for sustaining musculoskeletal injuries. Therefore, this study aims to determine the relationship between physical activity and CAD risk factors, between CAD risk factors and musculoskeletal injuries and between physical activity and musculoskeletal injuries. A total of 124 full-time firefighters, males and females, were conveniently recruited from the City of Cape Town Fire and Rescue Service. A researcher-generated questionnaire was used to collect injury, CAD risk factor and physical activity data. The proportion of firefighters who participated in leisure-time physical activity (LTPA) was 63.7%, and those who were physically inactive was 69.4%. The prevalence musculoskeletal injuries among all firefighters was 27.4%. The most prevalent musculoskeletal injury was shoulder injuries in 35.3% of firefighters, followed by multiple injuries in 26.5% and back injuries in 14.7%. Age was a significant predictor of physical inactivity in firefighters [P = .002, OR = 1.08], BMI was a significant predictor of physical inactivity [P = .050, OR = 1.08], cigarette smoking was a significant predictor of firefighters not exercising [P = .007, OR = 2.31] and the total amount of vigorous-intensity exercise was a significant predictor of musculoskeletal injuries [P = .050, OR = 1.00]. In conclusion, older firefighters were more physically inactive and had a higher prevalence of musculoskeletal injuries, and the latter decreased significantly after the age of 50 years. Emphasis should be placed on firefighters exercising in their leisure-time, especially as they aged.

A Methodological Framework to Capture Neuromuscular Fatigue Mechanisms Under Stress

Neuromuscular fatigue is exacerbated under stress and is characterized by shorter endurance time, greater perceived effort, lower force steadiness, and higher electromyographic activity. However, the underlying mechanisms of fatigue under stress are not well-understood. This review investigated existing methods of identifying central mechanisms of neuromuscular fatigue and the potential mechanisms of the influence of stress on neuromuscular fatigue. We found that the influence of stress on the activity of the prefrontal cortex, which are also involved in exercise regulation, may contribute to exacerbated fatigue under stress. We also found that the traditional methods involve the synchronized use of transcranial magnetic stimulation, peripheral nerve stimulation, and electromyography to identify the contribution of supraspinal fatigue, through measures such as voluntary activation, motor evoked potential, and silent period. However, these popular techniques are unable to provide information about neural alterations upstream of the descending drive that may contribute to supraspinal fatigue development. To address this gap, we propose that functional brain imaging techniques, which provide insights on activation and information flow between brain regions, need to be combined with the traditional measures of measuring central fatigue to fully understand the mechanisms behind the influence of stress on fatigue.

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.

Consensus on tasks to be included in a return to work assessment for a UK firefighter following an injury: an online Delphi study

OBJECTIVE

The aim was to provide a consensus tasks needed to be included in a return to work assessment for operational firefighters.

METHODS

A two round online Delphi study was conducted with twenty-four participants including firefighters, service fitness advisers and occupational health managers. A consensus was set at 70% agreement. In round one, participants completed an online survey relating to tasks to be included during a return to work assessment for firefighters following an injury. Round two was an online consensus meeting to discuss the tasks where consensus was not achieved.

RESULTS

A consensus was reached for ten of the thirteen tasks, including the number of repetitions required when lifting a light portable pump and climbing a ladder. A consensus was reached for the total distance equipment which should be carried. This included carrying a ladder, a hose and a light portable pump.

CONCLUSIONS

This study has provided a consensus for tasks to be included when assessing a firefighter for return to work. Further research is needed to understand how to use this assessment optimally.

Psychosocial barriers and facilitators for a successful return to work following injury within firefighters

Objective

The aim was to explore firefighter’s experiences during their recovery from injury. Focused specifically on exploring perceived psychosocial barriers and facilitators firefighters faced during recovery and return to work.

Methods

Semi-structured interviews were used to provide an in-depth understanding of the firefighter’s experiences. The semi-structured interviews were informed by a topic guide. The topic guide focused on five main themes, (1) overall experience of returning to operational duties following an injury, (2) perceived barriers experienced during their return to work, (3) perceived facilitators experienced during their return to work, (4) confidence in participating in physical activity following injury and (5) where they felt areas of improvement could be made with the return to work process. Thematic analysis of the data collected was undertaken using The Framework Method.

Results

Two main themes were sought after transcription: barriers and facilitators. From these, nine subthemes were identified (1) communication, (2) confidence in physical activity participation, (3) modified duties, (4) physiotherapy, (5) return to operational duties, (6) support, (7) inconsistency, (8) use of station gyms, (9) detachment from the watch.

Conclusions

Consideration should be made for the consistency of procedures followed during an individual’s return to work following an injury. Further research is needed to understand if the themes identified in this study are the same for other fire services. Further research is also needed to understand how the findings may be best implemented within the fire service.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01712-z.

Functional Movement Quality of Firefighter Recruits: Longitudinal Changes from the Academy to Active-Duty Status

Approximately half of the injuries experienced by firefighters consist of musculoskeletal injuries (MSKIs). Functional movement quality may be associated with MSKI risk within this tactical athlete population. Previous research indicates that measures of body composition change among firefighter recruits progressing from academy training through active-duty service, but similar changes in functional movement quality have yet to be examined. The purpose of this study was to describe longitudinal changes in functional movement quality of firefighter recruits. Body mass index (BMI), body fat (BF), and Functional Movement Screen (FMS) data were collected from 26 male firefighter recruits at the onset (W1) and completion (W14) of their training academy, and at the completion of their probationary period of active-duty service (W38). After adjusting for changes in BMI and BF across time, significant changes (ps < 0.05) in Composite FMS scores were identified, with significant increases in from W1 to W14 and from W14 to W38, as well as an overall increase from W1 to W38. These results suggest that the development of firefighter-specific skills can decrease the MSKI risk of firefighter recruits by facilitating enhanced functional movement competencies, particularly during tasks that require single-leg movement and core strength and stability.

What Factors Predict Upper Body Push to Pull Ratios in Professional Firefighters?

Shoulder joint injuries are common for professional firefighters. A potential cause of shoulder injury is an imbalance between anterior (push) and posterior (pull) shoulder joint musculature. Understanding what contributes to these imbalances may help to identify areas needing improvement. The purpose of this study was to investigate different push to pull (P2P) ratios and the relationships among common upper body fitness assessments, body composition, and push to pull (P2P) ratios in firefighters. Thirty-three professional firefighters completed the following testing protocol: one-repetition maximum (1RM) bench press, pull-up repetitions to failure, push-up repetitions to failure, and a body composition assessment. The endurance P2P (eP2P) was computed by dividing the number of push-up by pull-up repetitions, while strength P2P (sP2P) was the relative 1RM divided by pull-up repetitions. Bivariate relationships among variables were assessed with correlation coefficients and linear regression assessed association between eP2P and sP2P (p ≤ 0.05). The sP2P and eP2P were not associated (R 2 = 0.032, p = 0.99). Strength P2P was related with bench press 1RM (r = 0.80) and push-ups (r = 0.40). Endurance P2P was related with pull-up repetitions (r = -0.62), body fat percentage (r = 0.40), and fat mass index (r = 0.34). The results of the present study suggest sP2P and eP2P ratios should not be used interchangeably. To improve sP2P and eP2P for firefighters, it is recommended to improve the strength of anterior and posterior upper body musculature, respectively, and reduce total body fat mass.

Conservative Interventions for Non-Specific Low Back Pain in Tactical Populations: A Systematic Review of Randomized Controlled Trials

Limited evidence exists about non-specific low back pain (NSLBP) interventions among tactical personnel (police officers, firefighters, or army forces). The aim was to identify and systematically review the findings of randomized control trials (RCTs) investigating conservative interventions for the treatment NSLBP in tactical personnel. A search of seven databases for randomized controlled trials RCTs were conducted. Two independent reviewers extracted data and assessed the risk of bias (PEDro scale). Five RCTs (n = 387 military subjects; median PEDro score = 7/10) were included. The trials were highly heterogeneous, differing in pain and disability outcome measures, duration of NSLBP symptoms (acute, nonacute, nonchronic, and chronic), types of intervention (exercise, manual therapy, and physical therapy), types of control groups, and intervention durations (4–12 weeks). Two studies reported that strengthening exercise interventions were not effective for reducing pain or disability in military personnel with chronic or nonacute NSLBP. Manual therapy treatment was more effective than usual activities in current pain and pain typical symptoms in soldiers with acute NSLBP after four weeks. A multidimensional intervention reduced disability in military personnel with non-chronic NSLBP after four weeks. Strong evidence does not exist for the efficacy of any conservative interventions in the reduction of pain and disability in tactical populations with NSLBP.

Impact of an 11-Week Strength and Conditioning Program on Firefighter Trainee Fitness

Physical fitness is an important aspect of physical health and wellbeing. The aim of this study was to investigate the effects of 11-weeks of formal strength and conditioning training conducted during fire academy training on the physical fitness characteristics of firefighter trainees. Archived physical fitness data for 23 male fire academy trainees (age: 27.6 ± 4.3 y; height: 178.5 ± 6.9 cm; body mass [BM]: 83.9 ± 1.8 kg; BM index [BMI]: 26.8 ± 2.8 kg/m2) were analyzed for this study. These data included vertical jump height, maximum pull-up repetitions, hand grip strength, lower-body strength (3RM Hexbar) and aerobic fitness. Trainees performed three sessions per week (two resistance training sessions and one aerobic conditioning session) in addition to fire academy training. A repeated measures ANOVA revealed significant (p < 0.05) pre-post decreases in BM and BMI and significant increases in upper- and lower-body strength, and aerobic fitness. Strength and conditioning programs are beneficial for improving firefighter trainees’ physical fitness even when run concurrently with fire academy training and with limited space and equipment. This increased fitness may aid in mitigating known occupational injury risks to this population and improve task performance.

Characterizing Objective and Self-Reported Levels of Physical Activity Among Florida Firefighters Across Weight Status Category: A Cross-Sectional Pilot Study

Background: Firefighters suffer from a disproportionally high burden of chronic diseases that could be prevented from regular bouts of physical activity (PA). The goal(s) of this pilot study were to (a) describe typical PA levels in professional paid firefighters, and (b) assess their ability to estimate their own levels of PA. Methods: A repeated measures study design was used to assess self-reported and objectively measured levels of PA from a non-probabilistic sample of firefighters (n = 18) over 1 week. Objective measures of PA, measured by accelerometry were defined as the number of minutes spent in sedentary, light, moderate, and vigorous PA. Firefighters completed a follow-up questionnaire recording their self-reported levels of PA. Results: Obese (body mass index [BMI] > 30 kg/m²) firefighters spent 8,033 ± 2,543 minutes/week in sedentary activity, overweight (BMI = 25-29 kg/m²) firefighters 6,533 ± 1,587 minutes/week, and healthy weight (BMI = 18.5-24.9 kg/m²) firefighters 5,846 ± 1,160 minutes/week. The difference in self-reported weekly minutes spent in light, moderate, and vigorous activity and objectively measured minutes in activity was calculated. Healthy weight firefighters reported the least difference (1,924 minutes/week), followed by the overweight (3,884 minutes/week) and obese (5,749 minutes/week). Conclusion/Application to Practice: Firefighters poorly estimated their true level of PA compared with their objectively measured PA and obese firefighters reported the greatest inconsistency. Occupational health nurses should aim to support firefighters in achieving PA levels that assist firefighters to achieve a healthy weight and educate them about what it means to be engaged in each level of PA.