Behaviorally segmented audiences for managing sunscreen chemical pollution risk in protected coastal natural resource areas

This audience segmentation of visitors at coastal parks in Hawaii and North Carolina addresses an emergent natural resource management concern and risk to aquatic ecosystems: sunscreen chemical pollution. Four audiences were identified that correspond to different behavioral profiles: sunscreen protection tourists, multimodal sun protection tourists, in-state frequent park visitors, and frequent beachgoers who skip sunscreen. The second-largest audience, sunscreen protection tourists, represents 29% of visitors at Cape Lookout National Seashore and 25% at Kaloko-Honokōhau National Historical Park. This group ranks of most concern for chemical pollution because they use sunscreen, but not typically mineral formulations or other methods such as protective clothing, and they have lower levels of sunscreen chemical issue awareness. The identification of similar audience segments across regions with differing cultural characteristics and sunscreen regulation status suggests the robustness of the model and its indicator variables, with implications for both environmental protection and public health. Further, coastal visitors' interest in enacting pro-environmental sun protection behaviors during their next park or beach visit indicates the potential for natural resource managers to holistically address risks in both domains through targeted interventions with audiences of most concern.

An Experimental Cold Gas Cannon for the Study of Porcine Lung Contusion and Behind Armor Blunt Trauma

Behind armor blunt trauma (BABT) is a non-penetrating injury caused by the rapid deformation of body armor, by a projectile, which may in extreme circumstances cause death. The understanding of the mechanisms is still low, in relation to what is needed for safety threshold levels. Few models of graded kinetic energy transfer to the body exist. We established an experimental model for graded BABT. The cold gas cannon was air-driven, consisted of a pressure vessel, a barrel, and a pressure actuator. It required short training to operate and was constructed by standard components. It produced standardized expulsion of plastic projectiles with 65 mm and weight 58 g. Velocity correlated linearly to pressure (R 0.9602, p < 0.0001), equation Y = 6.558*X + 46.50. Maximum tested pressure was 10 bar, velocity 110 m/s and kinetic energy (Ek) 351 J. Crossbred male swine (n = 10) mean weight (SD) 56 ± 3 kg, were subjected to BABT, mean Ek (SD) 318 (61) J, to a fix point on the right lateral thorax. Pulmonary contusion was confirmed by physiological parameters pO2 (p < 0.05), SaO2 (p < 0.01), pCO2 (p < 0.01), etCO2 (p < 0.01), MPAP (p < 0.01), Cstat (p < 0.01), intrapulmonary shunt (Q's/Q't) (p < 0.05), and qualified trans-thoracic ultrasound (p < 0.0001). The consistent injury profile enabled for the addition of future experimental interventions.

Heat strain of Japanese firefighters wearing personal protective equipment: a review for developing a test method

The aim of this review was to develop a test method for the evaluation of heat strain for structural firefighters wearing personal protective equipment (PPE) in Japan. We analysed a series of our laboratory's questionnaires and experimental studies and reviewed international standards on test methods. We investigated the actual average working conditions (total firefighting time on one incidence, working time with full PPE, maximum temperature and humidity during firefighting) at structural firefighting site in Japan by conducting a large-scale questionnaire survey of Japanese firefighters. We discussed test subjects (firefighters vs. non-firefighters; body size; physical fitness), exercise intensity (absolutes vs. relative; light vs. heavy) and duration, experimental temperature and relative humidity, experimental clothing items including station uniforms (shorts vs. long), and measurement variables (physiological and subjective responses), and suggested a standard test method to evaluate the heat strain of firefighters in hot and humid environments.Practitioner summary: We reviewed studies on human wear trials of firefighting personal protective equipment (PPE) in hot environments and suggested a standard test method to evaluate the heat strain of firefighters. The test method can be internationally utilised to examine the comfort functions and heat stress of PPE in hot, humid environments.

Thermal response of human body with immersion suit in cold environment

Hypothermia caused by cold water immersion is one of the main causes of death in marine accidents. Immersion suit is a kind of protective clothing when implementing flying tasks over the sea in cold seasons, with the main function to slow down the loss of human heat in water and prolong the survival time. In this study, the thermal properties and wearing types of immersion suit and underwear were analyzed. The subjects with internal- and external-wear immersion suit exposed to the experimental environments for 2 h in five working conditions. The core temperature, weighted average skin temperature, and average body temperature were measured and calculated. Both internal- and external-wear immersion suits could fulfil the cold protection requirements under the experimental conditions. The results of clothing parameter tests and physiological experiments both exhibit that the external-wear immersion suit has better thermal insulation effect. And the tolerance time in low-temperature water was predicted, which is crucial for effective and efficient rescue during shipwreck in adverse thermal scenarios. In future research, a comprehensive evaluation and analysis of the thermal insulation performance of immersion suit could be completed in combination with the water ingress of the clothing, the subjects' thermal comfort, and flexibility of the clothing.

Are there sex differences in physiological parameters and reaction time responses to overload in firefighters?

Male and female firefighters work side-by-side in the same in strenuous and risky conditions. Anthropometrics, physiological, and reaction time (mean of reaction time -MRT-, and errors made -E) parameters of 12 Female and 13 Male firefighters were compared. Effect of overload (step test with and without equipment) on the MRT and E were analyzed on 3 trials (T1 = 1-1s, T2 = 0.5-1s, T3 = 0.5–0.5s), compared with a pre-test condition (basal). T-test between males and females was applied to assess differences (p<0.05) in all parameters. ANOVA with repeated measures and Bonferroni on 3 conditions of step test between males and females was applied in reaction time variables. Between MRT and E, in T1, T2 and T3 trials and the 3 test conditions, ANCOVA models with interactions were used. Differences (p<0.05) in anthropometric, physiological and reaction time data emerged across groups, and on the 3rd trials (T3 vs T1 and T2) in reaction time parameters of each group. ANCOVA showed differences (p<0.001) in E among trials. Post hoc showed significant differences in T1vsT3 and T1vsT2. MRT x trial interaction was extremely significant (P<0.001). Implementing fitness and reaction time exercise programs is important to decrease the injury risk and increase work capacity in firefighters with reference to female workers.

Influence of age, geographical region, and work unit on heat strain symptoms: a cross-sectional survey of electrical utility workers

This study assessed self-reported heat strain symptoms in workers of a state wide electrical utility distributor to determine risk differences between age groups, geographical work regions and work units. Out of a total 3,250 workers, 918 (∼28%) outdoor staff completed an online survey, which assessed the frequency of self-reported heat strain symptoms in the work and post-work settings, factors contributing to symptoms and symptom management. Heat strain symptoms were grouped into chronic low-grade cases and isolated high-grade cases based on the severity and frequency of symptoms. The risk (likelihood) of an employee being classified as either a chronic low-grade or isolated high-grade case was calculated and compared to the mean risk of all categories to determine risk difference, expressed as -1.00 to 1.00. For chronic low-grade cases, the 41-50 years age group had significantly increased risk (+0.08, p < 0.05) while the over 60 years age group had significantly decreased risk (-0.14, p < 0.05). Two of the three regions (p < 0.01) and three of the nine work units also demonstrated risk differences (p < 0.01) for chronic low-grade cases. Work units were the sole grouping to demonstrate risk difference for isolated high-risk cases. Work units with greater exposure to heat and higher requirement for protective clothing, such as Underground (+0.19, p < 0.05), Overhead - Predominantly Live Line (+0.18, p < 0.01), and Overhead - Distribution and Transmission (+0.11, p < 0.05) were at greater risk of reporting heat stress symptoms. This study demonstrates that the pattern of self-reported chronic low-grade heat strain cases differs to isolated high-grade cases within the electrical utility industry. Age, geographical location, and work unit independently alter the risk of chronic low-grade heat strain, while the risk of isolated high-grade heat strain was only related to work unit. These outcomes support implementation of a flexible and targeted approach to heat stress management in large and diverse organizations in which employees are routinely exposed to heat.

The adverse skin reactions of health care workers using personal protective equipment for COVID-19

In December 2019, a new coronavirus was found in Wuhan, Hubei Province, China, and spread rapidly throughout the country, attracting global attention. On February 11, the World Health Organization (WHO) officially named the disease caused by 2019-nCoV coronavirus disease 2019 (COVID-19). With the increasing number of cases, health care workers (HCWs) from all over China volunteered to work in Hubei Province. Because of the strong infectivity of COVID-19, HCWs need to wear personal protective equipment (PPE), such as N95 masks, latex gloves, and protective clothing. Due to the long-term use of PPE, many adverse skin reactions may occur. Therefore, the purpose of this study is to explore the adverse skin reactions among HCWs using PPE.Questionnaires were used for the research; a quantitative study was carried out to determine the incidence of adverse skin reactions among HCWs using PPE.A total of 61 valid questionnaires were collected. The most common adverse skin reactions among HCWs wearing N95 masks were nasal bridge scarring (68.9%) and facial itching (27.9%). The most common adverse skin reactions among HCWs wearing latex gloves were dry skin (55.7%), itching (31.2%), and rash (23.0%). The most common adverse skin reactions among HCWs wearing protective clothing were dry skin (36.1%) and itching (34.4%).When most HCWs wear PPE for a long period of time, they will experience adverse skin reactions. The incidence of adverse skin reactions to the N95 mask was 95.1%, that to latex gloves was 88.5%, and that to protective clothing was 60.7%.

Effectiveness of a field-type liquid cooling vest for reducing heat strain while wearing protective clothing

This study examined the effectiveness of a field-type liquid cooling vest (LCV) worn underneath an impermeable protective suit on heat strain during walking. Eight men walked for 60 min at a moderate speed (3.0 km/h) wearing the suit in a warm environment (33°C, 60% relative humidity) without (control, CON) or with the LCV. A smaller increase in rectal temperature was recorded in participants in the LCV than in the CON condition (37.6 ± 0.1°C vs. 37.9 ± 0.1°C, p<0.05). Walking while wearing the LCV reduced the level of physiological heat strain, as measured by the mean skin temperature (35.5 ± 0.1°C vs. 36.3 ± 0.1°C), chest sweat rate (13.5 ± 3.0 mg/cm²/h vs. 16.6 ± 3.8 mg/cm²/h), chest cutaneous vascular conductance (349 ± 88% vs. 463 ± 122%), body weight loss (0.72 ± 0.05% vs. 0.93 ± 0.06%), and heart rate (101 ± 6 beats/min vs. 111 ± 7 beats/min) (p<0.05, for all comparisons). These changes were accompanied by a decrease in thermal sensation and discomfort. These results suggest that a field-type LCV attenuates exertional heat strain while wearing impermeable protective clothing.

Wearing body armour and backpack loads increase the likelihood of expiratory flow limitation and respiratory muscle fatigue during marching

The effect of load carriage on pulmonary function was investigated during a treadmill march of increasing intensity. 24 male infantry soldiers marched on six occasions wearing either: no load, 15 kg, 30 kg, 40 kg or 50 kg. Each loaded configuration included body armour which was worn as battle-fit or loose-fit (40 kg only). FVC and FEV₁ were reduced by 6 to 15% with load. Maximal mouth pressures were reduced post load carriage by up to 11% (inspiratory) and 17% (expiratory). Increased ventilatory demands associated with carrying increased mass were met by increases in breathing frequency (from 3 to 26 breaths·min^-1) with minimal changes to tidal volume. 72% of participants experienced expiratory flow limitation whilst wearing the heaviest load. Loosening the armour had minimal effects on pulmonary function. It was concluded that as mass and exercise intensity are increased, the degree of expiratory flow limitation also increases. Practitioner Summary: This study investigated the effect of soldier load carriage on pulmonary function, to inform the trade-off between protection and burden. Load carriage caused an inefficient breathing pattern, respiratory muscle fatigue and expiratory flow limitation during marching. These effects were exacerbated by increases in mass carried and march intensity.

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

Firefighters work in unpredictable conditions, necessitating the use of personal protective equipment (PPE). However, the additional weight from the PPE and self-contained breathing apparatus (SCBA) alters their centre of mass (COM), restricts movement and limits vision (face mask) contributing to a firefighters' challenge of maintaining balance. Thus, the purpose of this study was to quantify the effects of firefighter PPE on static and dynamic balance. Participants performed two sets of three functional balance tests: (1) Static Single Leg (SSL); (2) Dynamic Single Leg (DSL); (3) Limits of Stability (LOS). The balance tests were performed under one control and three randomised PPE conditions: (1) athletic clothing; (2) turnouts; (3) turnouts + SCBA; (4) turnouts + SCBA + face mask. Our study found turnouts + SCBA both with and without the face mask negatively affected dynamic balance. These findings identify factors in fall-related injuries and strategies to reduce occupational risk. Practitioner summary: Slips, trips and falls are the most common cause of injury in firefighters. Our study investigated the effects of firefighter personal protective equipment (PPE) on static and dynamic balance utilising a computerised balance instrument. We found that turnouts with a self-contained breathing apparatus (SCBA) with or without face mask negatively affected balance.

Could wearing motorcycle protective clothing compromise rider safety in hot weather?

Motorcycle protective clothing (PPE) effectively reduces the risk of injury in crashes, however in hot conditions many motorcyclists ride unprotected. Recent work found available motorcycle PPE to be thermally inefficient in hot weather with potential to cause significant thermal strain under average Australian summer conditions. The current study investigated the potential for the cognitive and psychophysical concomitants of thermal strain to compromise reaction times, mood and fatigue with potential consequences for motorcyclists' safety.

METHOD

Volunteers wearing motorcycle PPE participated in a 90 min trial (cycling 30 W) in 35 °C, 40%RH with overhead radiant heaters and a fan to simulate wind speed. Heart rate, core and skin temperature were recorded continuously. Reaction time and subjective ratings of thermal sensation and comfort, workload and mood were recorded at baseline, during rest breaks at 25 min intervals and on completion of the trail. Repeated measures analysis assessed each participant's performance against their own baseline.

RESULTS

Core temperatures increased by 2 °C (p < .0001), skin temperatures (3 °C, (p < .0001) and heart rates (66bpm, p < .0001). Reaction times fluctuated 36 ms 8% (p < .0001) over the trial. Subjective workload increased 68% (p = 0.001) and mood deteriorated 33 points (p < .0001) including feeling less alert (p = <.0001), contented (p = 0.001) and calm (p = 0.0004). Multivariate repeated measures analysis found significant associations between core temperature and workload (p = 0.01), mood (p = 0.001) and reaction time (<.0001). Skin temperature and workload (p = 0.02), mood (p = 0.01) and reaction time (<.0001). Subjective ratings of temperature sensation and wetness discomfort were associated respectively with increased workload (p = 0.0001, p = 0.004), mood change (p < .0001, p = 0.04) and reaction time (p < .0001, p < .0001).

CONCLUSIONS

The physiological impact of wearing thermally inefficient motorcycle PPE in hot conditions could impair motorcyclists cognitive and psychophysical functioning and, potentially, their riding performance and safety. These outcomes indicate an urgent need for manufacturers to develop motorcycle PPE that is effective and suitable for use, in hot conditions.

Using trunk posture to monitor heat strain at work

This study aimed to determine if trunk posture during walking is related to increases in rectal temperature (T_re). 24 males treadmill walked in one of four conditions (1): 30 min at 3.0 mph and 0% grade, 20 °C and 50% relative humidity (RH), wearing healthcare worker (HCW) PPE; (2): 30 min at 3.0 mph and 0% grade, 27.5 °C and 60% RH, HCW PPE; (3): 30 min at 3.0 mph and 0% grade, 32.5 °C and 70% RH, HCW PPE; and (4): 40 min at 40% VO₂max, 30 °C and 70% RH, wearing firefighter PPE. Trunk posture (Zephyr BioHarness 3) and T_re were measured continuously. T_re was positively related to trunk posture, controlling for covariates (B = 3.49, p < .001). BMI and age moderated this relationship (T_re×age, B = 0.76, p < .001; T_re*BMI, B = -1.85, p < .001). Trunk posture measurement may be useful in monitoring fall potential and magnitude of heat stress of workers in hot environments. Practitioner Summary: Occupational hyperthermia increases worker risk for heat illness and injury but is difficult to monitor in the field. This investigation shows that trunk posture is independently and positively related to core temperature. Non-invasive measurement or visual inspection of trunk posture could provide novel insight on individual heat strain level.

The maximum evaporative potential of constant wear immersion suits influences the risk of excessive heat strain for helicopter aircrew

The heat exchange properties of aircrew clothing including a Constant Wear Immersion Suit (CWIS), and the environmental conditions in which heat strain would impair operational performance, were investigated. The maximum evaporative potential (im/clo) of six clothing ensembles (three with a flight suit (FLY) and three with a CWIS) of varying undergarment layers were measured with a heated sweating manikin. Biophysical modelling estimated the environmental conditions in which body core temperature would elevate above 38.0°C during routine flight. The im/clo was reduced with additional undergarment layers, and was more restricted in CWIS compared to FLY ensembles. A significant linear relationship (r2 = 0.98, P<0.001) was observed between im/clo and the highest wet-bulb globe temperature in which the flight scenario could be completed without body core temperature exceeding 38.0°C. These findings provide a valuable tool for clothing manufacturers and mission planners for the development and selection of CWIS's for aircrew.

Influence of work clothing on physiological responses and performance during treadmill exercise and the Wildland Firefighter Pack Test

This study investigated physiological responses and performance during three separate exercise challenges (Parts I, II, and III) with wildland firefighting work clothing ensemble (boots and coveralls) and a 20.4 kg backpack in four conditions: U-EX (no pack, exercise clothing); L-EX (pack, exercise clothing); U-W (no pack, work clothing); and, L-W (pack and work clothing). Part I consisted of randomly-ordered graded exercise tests, on separate days, in U-EX, L-EX and L-W conditions. Part II consisted of randomly-ordered bouts of sub-maximal treadmill exercise in the four conditions. In Part III, subjects completed, in random-order on separate days, 4.83 km Pack Tests in L-EX or L-W conditions. In Part I, peak oxygen uptake was reduced (p < .05) in L-W. In Part II, mass-specific oxygen uptake was significantly higher in both work clothing conditions. In Part III, Pack Test time was slower (p < .05) in L-W. These results demonstrate the negative impact of work clothing and load carriage on physiological responses to exercise and performance.

Investigation of the thermal hazardous effect of protective clothing caused by stored energy discharge

In addition to direct thermal energy from a heating source, a large amount of thermal energy stored in clothing will continuously discharge to skin after exposure. Investigating the thermal hazardous effect of clothing caused by stored energy discharge is crucial for the reliability of thermal protective clothing. In this study several indices were proposed and applied to evaluate the impact of thermal energy discharge on human skin. The heat discharge from different layers of fabric systems was investigated, and the influences of air gaps and applied compression were examined. Heat fluxes at the boundaries of fabric layers and the distribution of heat discharge were determined. Additionally, the correlation between heat storage during exposure and heat discharge after exposure was identified. The results demonstrated that heat discharge to the skin could be correlated with heat storage within the fabric, however, it highly depended on the air gap under clothing, the applied compression, and the insulation provided by the fabric layers. Results from this study could contribute to thoroughly understanding the thermal hazardous effect of clothing and enhance the technical basis for developing new fabric combinations to minimize energy discharge after exposure.

Fluid replacement advice during work in fully encapsulated impermeable chemical protective suits

A major concern for responders to hazardous materials (HazMat) incidents is the heat strain that is caused by fully encapsulated impermeable chemical protective suits. In a research project, funded by the US Department of Defense, the thermal strain experienced when wearing these suits was studied. One particular area of interest was the fluid loss of responders during work in these suits as dehydration may be an additional health concern to the heat strain. 17 City of Raleigh firemen and 24 students were tested at two different labs. Subjects between the ages of 25 and 51 were used for human subject trials in a protocol approved by the local ethical committee. Six different Level A HazMat suits were evaluated in three climates: moderate (24°C, 50% RH, 20°C WBGT), warm-wet (32°C, 60% RH, 30°C WBGT), and hot-dry (45°C, 20% RH, 37°C WBGT, 200 W/m² radiant load) and at three walking speeds: 2.5 km/hr, 4 km/hr, and 5.5 km/hr. 4 km/hr was tested in all three climates and the other two walking speeds were tested in the moderate climate. Weight loss data was collected to determine fluid loss during these experiments. Working time ranged from as low as 20 min in the hot-dry condition to 60 min (the maximum) in the moderate climate, especially common at the lowest walking speed. The overall results from all experiments showed that fluid loss ranged from 0.2-2.2 L during these exposures, with the average fluid loss being 0.8 L, with 56% of the data between 0.5 L and 1 L of fluid loss. Further analysis showed that a suggestion of drinking 0.7 Liter per hour would safely hydrate over 50% of responders after one work-rest cycle. Applying this fluid volume over three work-rest cycles only put 11% of responders at risk of hypohydration vs. the 57% at risk with no fluid intake.

Additional helmet and pack loading reduce situational awareness during the establishment of marksmanship posture

The pickup of visual information is critical for controlling movement and maintaining situational awareness in dangerous situations. Altered coordination while wearing protective equipment may impact the likelihood of injury or death. This investigation examined the consequences of load magnitude and distribution on situational awareness, segmental coordination and head gaze in several protective equipment ensembles. Twelve soldiers stepped down onto force plates and were instructed to quickly and accurately identify visual information while establishing marksmanship posture in protective equipment. Time to discriminate visual information was extended when additional pack and helmet loads were added, with the small increase in helmet load having the largest effect. Greater head-leading and in-phase trunk-head coordination were found with lighter pack loads, while trunk-leading coordination increased and head gaze dynamics were more disrupted in heavier pack loads. Additional armour load in the vest had no consequences for Time to discriminate, coordination or head dynamics. This suggests that the addition of head borne load be carefully considered when integrating new technology and that up-armouring does not necessarily have negative consequences for marksmanship performance. Practitioner Summary: Understanding the trade-space between protection and reductions in task performance continue to challenge those developing personal protective equipment. These methods provide an approach that can help optimise equipment design and loading techniques by quantifying changes in task performance and the emergent coordination dynamics that underlie that performance.

Cardiovascular and respiratory effects of the neoprene wetsuit in non-immersed divers

A neoprene wetsuit is widely used to reduce thermal dispersion during diving. Recent observations have pointed out that elastic recoil of the wetsuit might have significant compressive effects, able to affect water and electrolyte homeostasis during both dry and immersed conditions. The aim of this study was to evaluate the possible cardiovascular and respiratory effects of the neoprene wetsuit in dry conditions in a sample of experienced divers. Twenty-four (24) healthy divers were evaluated by Doppler-echocardiography and by spirometry in basal conditions and while wearing a full neoprene wetsuit. During wetsuit conditions, we observed a significant decrease in heart rate (-5%; p ⟨ 0.05) and cardiac output (-12%; p ⟨ 0.05), and a significant increase in total peripheral resistances (15%; p ⟨ 0.05). Moreover, a significant reduction of right ventricular early diastolic filling was observed (-15%; p ⟨ 0.05). As concerns pulmonary function, a significant reduction of vital capacity (-2%; p ⟨ 0.001) and expiratory reserve volume (-25%; p ⟨ 0.001), and a significant increase of inspiratory capacity (9%; p ⟨ 0.001) and tidal volume (25%; p ⟨ 0.05) were observed. These data support the hypothesis that neoprene elastic recoil, possibly due to a compression exerted on chest, might affect systemic circulation (decreasing cardiac output and impairing right ventricular filling) and respiratory function.

Lead Aprons Are a Lead Exposure Hazard

PURPOSE

To determine whether lead-containing shields have lead dust on the external surface.

METHODS

Institutional review board approval was obtained for this descriptive study of a convenience sample of 172 shields. Each shield was tested for external lead dust via a qualitative rapid on-site test and a laboratory-based quantitative dust wipe analysis, flame atomic absorption spectrometry (FAAS). The χ² test was used to test the association with age, type of shield, lead sheet thickness, storage method, and visual and radiographic appearance.

RESULTS

Sixty-three percent (95% confidence interval [CI]: 56%-70%) of the shields had detectable surface lead by FAAS and 50% (95% CI: 43%-57%) by the qualitative method. Lead dust by FAAS ranged from undetectable to 998 μg/ft². The quantitative detection of lead was significantly associated with the following: (1) visual appearance of the shield (1 = best, 3 = worst): 88% of shields that scored 3 had detectable dust lead; (2) type of shield: a greater proportion of the pediatric patient, full-body, and thyroid shields were positive than vests and skirts; (3) use of a hanger for storage: 27% of shields on a hanger were positive versus 67% not on hangers. Radiographic determination of shield intactness, thickness of interior lead sheets, and age of shield were unrelated to presence of surface dust lead.

CONCLUSIONS

Sixty-three percent of shields had detectable surface lead that was associated with visual appearance, type of shield, and storage method. Lead-containing shields are a newly identified, potentially widespread source of lead exposure in the health industry.

Parafricta Bootees and Undergarments to Reduce Skin Breakdown in People with or at Risk of Pressure Ulcers: A NICE Medical Technologies Guidance

As part of the development of the National Institute for Health and Care Excellence (NICE) Medical Technologies Guidance on Parafricta Bootees and Undergarments to reduce skin breakdown in people with, or at risk of, pressure ulcers, the manufacturer (APA Parafricta Ltd) submitted clinical and economic evidence, which was critically appraised by an External Assessment Centre (EAC) and subsequently used by the Medical Technologies Advisory Committee (MTAC) to develop recommendations for further research. The University of Birmingham and Brunel University, acting as a consortium, were commissioned to act as the EAC, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC's findings and the final NICE guidance. Very little comparative evidence was submitted to demonstrate the effectiveness of Parafricta Bootees or Undergarments. The sponsor submitted a simple cost analysis to estimate the costs of using Parafricta in addition to current practice-in comparison with current practice alone-in hospital and community settings separately. The analysis took a National Health Service (NHS) perspective. The basis of the analysis was a previously published comparative study, which showed no statistical difference in average lengths of stay between patients who wore Parafricta Undergarments and Bootees, and those who did not. The economic model incorporated the costs of Parafricta but assumed shorter lengths of stay with Parafricta. The sponsor concluded that Parafricta was cost saving relative to the comparators. The EAC made amendments to the sponsor's analysis to correct for errors and to reflect alternative assumptions. Parafricta remained cost saving in most analyses, and the savings per prevalent case ranged from £757 in the hospital model to £3455 in the community model. All analyses were severely limited by the available data on effectiveness-in particular, a lack of good-quality comparative studies.

Influence of the diving wetsuit on standard spirometry

INTRODUCTION A well-fitting wetsuit exerts a pressure on the body that may influence spirometry. This pressure is expected to reduce the forced vital capacity (FVC) due to hampered inspiration. Since the shape of the spirometric flow curve should not be changed by the pressure effects of the wetsuits, FVC, the forced expiratory volume during the first second of expiration (FEV₁), the peak expiratory flow (PEF) and the flow between 25 and 75% of FVC (FEF25-75) should change to the same degree. This study investigates the influence of a wetsuit on spirometric variables using age, suit thickness and suit type as the parameters.

METHODS

Spirometry (dry) was performed in 28 volunteers (12 women), aged 27-69 years.

RESULTS

The wetsuit (3.8 mm, range 2-7 mm) resulted in a change in FVC of -4.0% (P = 2∙E-08 〈 0.001), in FEV₁ of -3.6% (P = 3∙E-05 〈 0.001) and in PEF of -2.4% (P = 0.03); the FEF25-75 may also diminish. The FEV₁/FVC ratio did not change. The decreases can be regarded as a quasi-ageing effect of about 3.5 years. No influence of age, suit thickness and suit type was found.

CONCLUSION

The wetsuit appears to impair ventilatory mechanics. Both the medical examiner and the diver should be aware that a too-thick or too-tight suit might be a potential pulmonary risk factor in diving.

Biophysical Assessment and Predicted Thermophysiologic Effects of Body Armor

INTRODUCTION

Military personnel are often required to wear ballistic protection in order to defend against enemies. However, this added protection increases mass carried and imposes additional thermal burden on the individual. Body armor (BA) is known to reduce combat casualties, but the effects of BA mass and insulation on the physical performance of soldiers are less well documented. Until recently, the emphasis has been increasing personal protection, with little consideration of the adverse impacts on human performance.

OBJECTIVE

The purpose of this work was to use sweating thermal manikin and mathematical modeling techniques to quantify the tradeoff between increased BA protection, the accompanying mass, and thermal effects on human performance.

METHODS

Using a sweating thermal manikin, total insulation (IT, clo) and vapor permeability indexes (im) were measured for a baseline clothing ensemble with and without one of seven increasingly protective U.S. Army BA configurations. Using mathematical modeling, predictions were made of thermal impact on humans wearing each configuration while working in hot/dry (desert), hot/humid (jungle), and temperate environmental conditions.

RESULTS

In nearly still air (0.4 m/s), IT ranged from 1.57 to 1.63 clo and im from 0.35 to 0.42 for the seven BA conditions, compared to IT and im values of 1.37 clo and 0.45 respectively, for the baseline condition (no BA).

CONCLUSION

Biophysical assessments and predictive modeling show a quantifiable relationship exists among increased protection and increased thermal burden and decreased work capacity. This approach enables quantitative analysis of the tradeoffs between ballistic protection, thermal-work strain, and physical work performance.

Effect of firefighters' personal protective equipment on gait

The biomechanical experiment with eight male and four female firefighters demonstrates that the effect of adding essential equipment: turnout ensemble, self-contained breathing apparatus, and boots (leather and rubber boots), significantly restricts foot pronation. This finding is supported by a decrease in anterior-posterior and medial-lateral excursion of center of plantar pressure (COP) trajectory during walking. The accumulation of this equipment decreases COP velocity and increases foot-ground contact time and stride time, indicating increased gait instability. An increase in the flexing resistance of the boots is the major contributor to restricted foot pronation and gait instability as evidenced by the greater decrease in excursion of COP in leather boots (greater flexing resistance) than in rubber boots (lower resistance). The leather boots also shows the greatest increase in foot contact time and stride time. These negative impacts can increase musculoskeletal injuries in unfavorable fire ground environments.

Reducing heat stress under thermal insulation in protective clothing: microclimate cooling by a 'physiological' method

Heat stress caused by protective clothing limits work time. Performance improvement of a microclimate cooling method that enhances evaporative and to a minor extent convective heat loss was tested. Ten male volunteers in protective overalls completed a work-rest schedule (130 min; treadmill: 3 × 30 min, 3 km/h, 5% incline) with or without an additional air-diffusing garment (climatic chamber: 25°C, 50% RH, 0.2 m/s wind). Heat loss was supported by ventilating the garment with dry air (600 l/min, ≪5% RH, 25°C). Ventilation leads (M ± SD, n = 10, ventilated vs. non-ventilated) to substantial strain reduction (max. HR: 123 ± 12 b/min vs. 149 ± 24 b/min) by thermal relief (max. core temperature: 37.8 ± 0.3°C vs. 38.4 ± 0.4°C, max. mean skin temperature: 34.7 ± 0.8°C vs. 37.1 ± 0.3°C) and offers essential extensions in performance and work time under thermal insulation.

PRACTITIONER SUMMARY

Heat stress caused by protective clothing limits work time. Performance can be improved by a microclimate cooling method that supports evaporative and to a minor extent convective heat loss. Sweat evaporation is the most effective thermoregulatory mechanism for heat dissipation and can be enhanced by insufflating dry air into clothing.

Heat strain evaluation of overt and covert body armour in a hot and humid environment

The aim of this study was to elucidate the thermophysiological effects of wearing lightweight non-military overt and covert personal body armour (PBA) in a hot and humid environment. Eight healthy males walked on a treadmill for 120 min at 22% of their heart rate reserve in a climate chamber simulating 31 °C (60%RH) wearing either no armour (control), overt or covert PBA in addition to a security guard uniform, in a randomised controlled crossover design. No significant difference between conditions at the end of each trial was observed in core temperature, heart rate or skin temperature (P > 0.05). Covert PBA produced a significantly greater amount of body mass change (-1.81 ± 0.44%) compared to control (-1.07 ± 0.38%, P = 0.009) and overt conditions (-1.27 ± 0.44%, P = 0.025). Although a greater change in body mass was observed after the covert PBA trial; based on the physiological outcome measures recorded, the heat strain encountered while wearing lightweight, non-military overt or covert PBA was negligible compared to no PBA.

PRACTITIONER SUMMARY

The wearing of bullet proof vests or body armour is a requirement of personnel engaged in a wide range of occupations including police, security, customs and even journalists in theatres of war. This randomised controlled crossover study is the first to examine the thermophysiological effects of wearing lightweight non-military overt and covert personal body armour (PBA) in a hot and humid environment. We conclude that the heat strain encountered while wearing both overt and covert lightweight, non-military PBA was negligible compared to no PBA.

The Influence of Arc-Flash and Fire-Resistant Clothing on Thermoregulation during Exercise in the Heat

We evaluated the effect of arc-flash and fire-resistant (AFR) clothing ensembles (CE) on whole-body heat dissipation during work in the heat. On 10 occasions, 7 males performed four 15-min cycling bouts at a fixed rate of metabolic heat production (400 W) in the heat (35°C), each separated by 15-min of recovery. Whole-body heat loss and metabolic heat production were measured by direct and indirect calorimetry, respectively. Body heat storage was calculated as the temporal summation of heat production and heat loss. Responses were compared in a semi-nude state and while wearing two CE styles: (1) single-piece (coveralls) and (2) two-piece (workpant + long-sleeve shirt). For group 1, there was one non-AFR single-piece CE (CE1STD) and three single-piece CE with AFR properties (CE2AFR, CE3AFR, CE4AFR). For group 2, there was one non-AFR two-piece CE (CE5STD) and four two-piece CE with AFR properties (CE6AFR, CE7AFR, CE8AFR, CE9AFR). The workpants for CE6AFR were not AFR-rated, while a cotton undershirt was also worn for conditions CE8AFR and CE9AFR and for all single-piece CE. Heat storage for all conditions (CE1STD: 328 ± 55, CE2AFR: 335 ± 87, CE3AFR: 309 ± 95, CE4AFR: 403 ± 104, CE5STD: 253 ± 78, CE6AFR: 268 ± 89, CE7AFR: 302 ± 70, CE8AFR: 360 ± 36, CE9AFR: 381 ± 99 kJ) was greater than the semi-nude state (160 ± 124 kJ) (all p ≤ 0.05). No differences were measured between single-piece uniforms (p = 0.273). Among the two-piece uniforms, heat storage was greater for CE8AFR and CE9AFR relative to CE5STD and CE6AFR (all p ≤ 0.05), but not CE7AFR (both p > 0.05). Differences between clothing styles were measured such that greater heat storage was observed in both CE1STD and CE2-4AFR relative to CE5STD. Further, heat storage was greater in CE2AFR and CE4AFR relative to CE6AFR, while it was greater in CE4AFR compared to CE7AFR. Body heat storage during work in the heat was not influenced by the use of AFR fabrics in the single- or two-piece uniforms albeit less heat was stored in the two-piece uniforms when no undershirt was worn. However, heat storage was comparable between clothing styles when an undershirt was worn with the two-piece uniform.

The effects of military body armour on the lower back and knee mechanics during toe-touch and two-legged squat tasks

While effective in the prevention of otherwise lethal injuries, military body armour (BA) has been suggested to reduce warfighter's performance and increase injury-related musculoskeletal conditions. Providing the significant role of joint biomechanics in both performance and risk of injury, the immediate and prolonged effects of wearing BA on biomechanics of the lower back and knee during toe-touch (TT) and two-legged squat (TLS) tasks were investigated. The immediate effects of BA were an increase of >40 ms (p ≤ 0.02) in flexion duration of the dominant joint and an ∼1 s (p ≤ 0.02) increase in overall task duration as well as an ∼18% (p = 0.03) decrease in the lumbopelvic rhythm ratio near the mid-range of trunk flexion. In general the prolonged duration of wearing BA (i.e. 45 min of walking) was not found to cause more changes in our measures than walking without BA.

PRACTITIONER SUMMARY

The effects of wearing military BA on biomechanics of the lower back and knee during TT and TLS tasks were investigated. The immediate effects of BA were increased flexion duration, increased overall trial duration and decreased lumbopelvic rhythm near the mid-range of trunk flexion.

Metabolic demands of law enforcement personal protective equipment during exercise tasks

Many occupations require the use of personal protective equipment (PPE) but the added metabolic demands are unknown for certain professions. The purpose of this study was to quantify metabolic and perceptual differences between activity with and without the PPE ensemble required for police officers. Twelve participants were asked to complete experimental and control exercise sessions consisting of three modes of exercise (walking, jogging and stepping). A significant main effect (p < 0.01) for gear was found for heart rate (beats per minute) and VO2 (L/min) between conditions. Dependent t-tests revealed significant differences for perceived effort, discomfort and session rating of perceived exertion between trials. Medium to large effect sizes for all variables with significant main effects between modes (p < 0.01, η2 = 0.51-0.96, 1-β = 0.98-1.0, d = 0.42-2.7) were observed. These findings help to increase awareness of how PPE affects metabolic demands and perception of discomfort during exercise.

Police officer in-vehicle discomfort: appointments carriage method and vehicle seat features

Musculoskeletal pain is commonly reported by police officers. A potential cause of officer discomfort is a mismatch between vehicle seats and the method used for carrying appointments. Twenty-five police officers rated their discomfort while seated in: (1) a standard police vehicle seat, and (2) a vehicle seat custom-designed for police use. Discomfort was recorded in both seats while wearing police appointments on: (1) a traditional appointments belt, and (2) a load-bearing vest/belt combination (LBV). Sitting in the standard vehicle seat and carrying appointments on a traditional appointments belt were both associated with significantly elevated discomfort. Four vehicle seat features were most implicated as contributing to discomfort: back rest bolster prominence; lumbar region support; seat cushion width; and seat cushion bolster depth. Authorising the carriage of appointments using a LBV is a lower cost solution with potential to reduce officer discomfort. Furthermore, the introduction of custom-designed vehicle seats should be considered.

Comparison of firefighters and non-firefighters and the test methods used regarding the effects of personal protective equipment on individual mobility

The aims of this study were 1) to evaluate the current pilot test method and ascertain reliable measurements for a standard test method of mobility with personal protective equipment (PPE), such as physical performance and balance ability tests; 2) to compare two participant groups (firefighters versus non-firefighters) and to investigate whether non-firefighters are appropriate as a standard participant group in the field of PPE or not. Totally, 18 participants (nine professional firefighters and nine untrained males) performed the current pilot test method consisting of a balance test, completed prior to and after a performance test. Significant differences were found between PPE conditions and CON (the control clothing ensemble: T-shirt, shorts, and running shoes) for the functional balance test, physical performance test, heart rate, and subjective evaluations in firefighters group. Therefore, the present pilot test method is valid as a standard test method for assessing mobility while wearing PPE. Moreover, the present result shows that firefighters are more reliable than non-firefighters in testing of PPE with current test methods.

Component contribution of personal protective equipment to the alleviation of physiological strain in firefighters during work and recovery

The purpose of this study was to investigate the components contributions of personal protective equipment on physiological strain in firefighters during exercise and recovery. Eight firefighters participated in trials in which various combinations of personal protective equipment components weighing from 1.3 to 15.1 kg were worn. The results showed that rectal temperature, changes in rectal temperature, mean skin temperature, heart rate, oxygen consumption and blood lactate concentration were smaller in conditions without boots (no-boots) than in other conditions with no helmet, gloves or self-contained breathing apparatus (P < 0.05). Increases in rectal temperature per unit mass of personal protective equipment were approximately twice as small in no-boots condition as the other conditions. These results suggest that the reduction of the boots' mass might be more efficient to alleviate heat strain of firefighters wearing personal protective equipment, rather than the reduction of the mass of self-contained breathing apparatus, helmet or gloves.

PRACTITIONER SUMMARY

As firefighters’ protective boots induce greater physiological burden when compared with a helmet, gloves or self-contained breathing apparatus, personal protective equipment designers need to consider the improvement of boots in terms of mass reduction, improvement of thermal comfort and ease of doffing during recovery to alleviate physiological strain on firefighters.

A review of heat transfer phenomena and the impact of moisture on firefighters' clothing and protection

Protective clothing with high insulation properties helps to keep the wearer safe from flames and other types of hazards. Such protection presents some drawbacks since it hinders movement and decreases comfort, in particular due to heat stress. In fact, sweating causes the accumulation of moisture which directly influences firefighters' performance, decreasing protection due to the increase in radiant heat flux. Vaporisation and condensation of hot moisture also induces skin burn. To evaluate the heat protection of protective clothing, Henrique's equation is used to predict the time leading to second-degree burn. The influence of moisture on protection is complex, i.e., at low radiant heat flux, an increase in moisture content increases protection, and also changes thermal properties. Better understanding of heat and mass transfer in protective clothing is required to develop enhanced protection and to prevent burn injuries.

PRACTITIONER SUMMARY

This paper aims to contribute to a better understanding of heat and mass transfer inside firefighters' protective clothing to enhance safety. The focus is on the influence of moisture content and the prevention of steam burn.

Heat stress evaluation of two-layer chemical demilitarization ensembles with a full face negative pressure respirator

The purpose of this study was to examine the heat stress effects of three protective clothing ensembles: (1) protective apron over cloth coveralls including full face negative pressure respirator (APRON); (2) the apron over cloth coveralls with respirator plus protective pants (APRON+PANTS); and (3) protective coveralls over cloth coveralls with respirator (PROTECTIVE COVERALLS). In addition, there was a no-respirator ensemble (PROTECTIVE COVERALLS-noR), and WORK CLOTHES as a reference ensemble. Four acclimatized male participants completed a full set of five trials, and two of the participants repeated the full set. The progressive heat stress protocol was used to find the critical WBGT (WBGTcrit) and apparent total evaporative resistance (Re,T,a) at the upper limit of thermal equilibrium. The results (WBGTcrit [°C-WBGT] and Re,T,a [kPa m(2) W(-1)]) were WORK CLOTHES (35.5, 0.0115), APRON (31.6, 0.0179), APRON+PANTS (27.7, 0.0244), PROTECTIVE COVERALLS (25.9, 0.0290), and PROTECTIVE COVERALLS-noR (26.2, 0.0296). There were significant differences among the ensembles. Supporting previous studies, there was little evidence to suggest that the respirator contributed to heat stress.

Impact of the medical clothing on the thermal stress of surgeons

The aim of the presented experiments was to determine thermal stress of surgeons performing their work with a high metabolic rate, wearing clothing characterized by high insulation and impermeability protecting them against water vapour but also in thermal conditions of a warm climate protecting patients against hypothermia. The experiments were conducted with the participation of 8 volunteers. Each subject took part in the experiment four times, i.e. in each of the four tested surgical gowns. The experiments were conducted in a climatic chamber where thermal conditions characteristic of an operating theatre were simulated. The parameters to be measured included: skin temperature, temperature measured in the auditory canal, sweat rate as well as temperature and humidity between clothing and a human body. The conducted experiments provided the grounds to conclude that medical clothing can be regarded as barrier clothing and it can influence thermal load of a human body.

Bilateral traumatic temporomandibular joint luxation in a rat

Bilateral temporomandibular joint (TMJ) luxation was diagnosed postmortem in a female, 6-mo-old CD rat (Rattus norvegicus) after probable head entrapment and subsequent disentanglement from a protective jacket. Clinical antemortem signs included inability to close her mouth, prehend food and drink water, anxiety, and linear skin erosions extending down the right and left commissures of the mouth. Radiography revealed rostral displacement of the mandible with concomitant malocclusion. The combination of clinical signs, acute nature of the presentation, and torn appearance of the protective jacket were strongly indicative of a traumatic etiology. To our knowledge, this is the first reported case of TMJ luxation in a rat.

Heat stress and dehydration in kendo

AIM

This study aimed to analyze sweat rate, water percentage alteration, and temperature variation during kendo practice in order to relate the thermal stress induced by such sports and draw recommendations for its secure practice.

METHODS

Participants were 12 male individuals. The studied variables were: age, weight, stature, body mass index, fat percentage, water loss percentage, tympanic temperature, and sweat rate. Measures were obtained in one day of 120 min practice (T: 24.1 ± 2.5 °C; RH: 73 ± 8.5%) using obligatory training equipment.

RESULTS

The age of participants was on average 26 ± 6.2 years, stature 1.8 ± 0.03 m, weight 78 ± 13.7 kg, BMI 24.12 ± 4.03 kg/m² and fat percentage 15.7 ± 5.1%. Weight and temperature final values were significantly different from the initial ones (P<0.01). Estimated sweat rate was 0.35 L.h-1 (95% CI = [0.299; 0.400]) and estimated percentage of water loss was 0.946% (95% CI = [0.694; 1.174]).

CONCLUSION

Kendo practice using obligatory equipment significantly increases temperature, even when sweat rate and water loss percentage are low. The almost complete obstruction of the evaporative surface leads to heat accumulation, which may result in risks comparable to those of American football players. Thus, preventive measures must be established to minimize the risks of the combination among environment (tropical climate), equipment (bogu) and the high physiological demand of this sport in order to prevent greater damages to the health of practitioners.

The effect of transportation suit induced heat stress on helicopter underwater escape preparation and task performance

Although essential in an emergency such as a helicopter ditching, mandatory survival suits worn by civilian personnel may lead to heat strain during a normal flight. To explore the possibility that wearing a helicopter transportation suit impairs emergency performance, 11 individuals completed underwater escape procedures immediately following a pre-recorded emergency announcement (randomly played between 50 and 90 min) in two ambient temperature conditions (Thermoneutral = 21 °C and Hot = 34 °C). Mean skin and rectal temperatures were recorded throughout the trials, while situation awareness and thermal sensation/comfort were recorded on completion of trials. Results indicate that although mean skin and rectal temperatures were significantly higher at the end of both trials, escape procedures were not impaired. It can therefore be concluded that although conditions inside an offshore transport helicopter are perceived as being hot and uncomfortable, no deficits in escape performance should be expected in the first 90 min of flight.

Cognitive function following treadmill exercise in thermal protective clothing

Occupational injuries are common among firefighters who perform strenuous physical exertion in extreme heat. The thermal protective clothing (TPC) worn by firefighters inhibits normal thermoregulation, placing the firefighter at risk of hypohydration and hyperthermia that may result in cognitive decline. We tested whether cognitive function changes after treadmill exercise in TPC. In an initial study (Cog 1), ten healthy volunteers performed up to 50 min of treadmill exercise while wearing TPC in a heated room. A battery of neurocognitive tests evaluating short-term memory, sustained and divided attention, and reaction time was administered immediately before and after exercise. In a follow-up study (Cog 2), 19 healthy volunteers performed a similar exercise protocol with the battery of cognitive tests administered pre-exercise, immediately post-exercise, and serially up to 120 min after exercise. Subjects performed 46.4 ± 4.6 and 48.1 ± 3.6 min of exercise in the Cog 1 and Cog 2, respectively. In both studies heart rate approached age predicted maximum, body mass was reduced 1.0-1.5 kg, and body core temperature increased to levels similar to what is seen after fire suppression. Neurocognitive test scores did not change immediately after exercise. Recall on a memory test was reduced 60 and 120 min after exercise. The mean of the 10 slowest reaction times increased in the 120 min after exercise. Fifty minutes of treadmill exercise in TPC resulted in near maximal physiologic strain but alterations in neurocognitive performance were not noted until an hour or more following exercise in TPC.

Heat stress in chemical protective clothing: porosity and vapour resistance

Heat strain in chemical protective clothing is an important factor in industrial and military practice. Various improvements to the clothing to alleviate strain while maintaining protection have been attempted. More recently, selectively permeable membranes have been introduced to improve protection, but questions are raised regarding their effect on heat strain. In this paper the use of selectively permeable membranes with low vapour resistance was compared to textile-based outer layers with similar ensemble vapour resistance. For textile-based outer layers, the effect of increasing air permeability was investigated. When comparing ensembles with a textile vs. a membrane outer layer that have similar heat and vapour resistances measured for the sum of fabric samples, a higher heat strain is observed in the membrane ensemble, as in actual wear, and the air permeability of the textile version improves ventilation and allows better cooling by sweat evaporation. For garments with identical thickness and static dry heat resistance, but differing levels of air permeability, a strong correlation of microclimate ventilation due to wind and movement with air permeability was observed. This was reflected in lower values of core and skin temperatures and heart rate for garments with higher air permeability. For heart rate and core temperature the two lowest and the two highest air permeabilities formed two distinct groups, but they did not differ within these groups. Based on protection requirements, it is concluded that air permeability increases can reduce heat strain levels allowing optimisation of chemical protective clothing. STATEMENT OF RELEVANCE: In this study on chemical, biological, radiological and nuclear (CBRN) protective clothing, heat strain is shown to be significantly higher with selectively permeable membranes compared to air permeable ensembles. Optimisation of CBRN personal protective equipment needs to balance sufficient protection with reduced heat strain. Using selectively permeable membranes may optimise protection but requires thorough consideration of the wearer's heat strain.

Physiological strains of wearing aluminized and non-aluminized firefighters' protective clothing during exercise in radiant heat

This study examined the influences of aluminized (Type A) and non-aluminized firefighters' protective clothing (Type B, C, D and CON) on physiological and subjective responses in radiant heat. Total clothing weight was 6.24, 6.38, 6.06, 5.76 and 3.82 kg for Type A, B, C, D and CON, respectively. Eight firefighters performed exercise at an air temperature of 30°C with 50%RH. Three bouts of 10 min-bicycle exercise in radiant heat (a globe temperature of 70°C) was spaced by a 10 min rest with no radiant heat. Results showed that rectal temperature, mean skin temperature, heart rate, and body weight loss were significantly greater in Type A than in other types (p<0.05). For Type A, thermal gradient of the body reached 0.0 ± 0.7°C, heart rate showed a maximum level of 183 ± 11 bpm and 1.9% of body weight was lost due to sweat secretion. Firefighters felt the hottest and most discomfort in Type A. It appeared that firefighters' thermoregulatory mechanism was severely challenged by wearing aluminized protective clothing during exercise in strong radiant heat. Therefore, it is suggested that the safe upper limits while wearing aluminized firefighters' clothing should be distinguished from those for typical firefighters' protective clothing.

A comparison of thermal stress in the submarine escape using immersion half- and full suit in tropical weather operations

OBJECTIVE

Submariners of disabled submarines are subject to drastic weather changes as they are awaiting rescue on the sea surface. Hyperthermia and hypothermia are just two of the adverse conditions that they can experience. The purpose of this study was to investigate the effectiveness of two models of submarine escape and the protective capabilities of immersion suits from environmental changes.

METHOD

A randomized study involving 24 male subjects was conducted to compare the thermal capabilities of the full- versus half-configuration suit in a climate-controlled chamber.

RESULTS

The full-configuration suits tested for a higher mean maximal core temperature (37.76 degrees C / 99.97 degrees F) than the mean maximal core temperature of the half-suits (37.52 degrees C / 99.54 degrees F). The full suits also tested for a higher mean minimal core temperature (36.13 degrees C / 97.03 degrees F) than the mean minimal core temperature (35.95 degrees C / 96.71 degrees F) of the half-suits.

CONCLUSION

Results showed that the full-suit configuration did not induce clinically significant high levels of heat stress as compared to the half-suits, but instead provided better thermal protection against hypothermia than the half-suits.

Asbestos-related diseases in entertainment workers

OBJECTIVES

To investigate asbestos exposure in 4 patients (3 cases of malignant mesothelioma and 1 case ofpleural plagues) previously employed in the entertainment business.

METHODS

The patients were seen at the Occupational Health Unit of the "Clinica del Lavoro Luigi Devoto" in Milan (Italy). Information regarding exposure to asbestos (occupational, environmental, and familial) was collected through a standardized questionnaire administered to the patients by an occupational physician.

RESULTS AND CONCLUSION

The presence of asbestos in the building structures and its use were described by all patients. The presence of asbestos in public buildings used for entertainment such as cinemas and theatres was in fact confirmed by the Occupational Health Services of the Local Heath Unit. An occupational aetiology was recognised in all the cases mentioned above, thus leading to the identification of an atypical occupational sector at risk in the past for asbestos exposure,

The thermal ergonomics of firefighting reviewed

The occupation of firefighting is one that has repeatedly attracted the research interests of ergonomics. Among the activities encountered are attention to live fires, performing search and rescue of victims, and dealing with emergencies. The scientific literature is reviewed to highlight the investigative models used to contribute to the knowledge base about the ergonomics of firefighting, in particular to establish the multi-variate demands of the job and the attributes and capabilities of operators to cope with these demands. The job requires individuals to be competent in aerobic and anaerobic power and capacity, muscle strength, and have an appropriate body composition. It is still difficult to set down thresholds for values in all the areas in concert. Physiological demands are reflected in metabolic, circulatory, and thermoregulatory responses and hydration status, whilst psychological strain can be partially reflected in heart rate and endocrine measures. Research models have comprised of studying live fires, but more commonly in simulations in training facilities or treadmills and other ergometers. Wearing protective clothing adds to the physiological burden, raising oxygen consumption and body temperature, and reducing the time to fatigue. More sophisticated models of cognitive function compatible with decision-making in a fire-fighting context need to be developed. Recovery methods following a fire-fighting event have focused on accelerating the restoration towards homeostasis. The effectiveness of different recovery strategies is considered, ranging from passive cooling and wearing of cooling jackets to immersions in cold water and combinations of methods. Rehydration is also relevant in securing the safety of firefighters prior to returning for the next event in their work shift.

A practical cooling strategy for reducing the physiological strain associated with firefighting activity in the heat

The aim of this study was to establish whether a practical cooling strategy reduces the physiological strain during simulated firefighting activity in the heat. On two separate occasions under high ambient temperatures (49.6 +/- 1.8 degrees C, relative humidity (RH) 13 +/- 2%), nine male firefighters wearing protective clothing completed two 20-min bouts of treadmill walking (5 km/h, 7.5% gradient) separated by a 15-min recovery period, during which firefighters were either cooled (cool) via application of an ice vest and hand and forearm water immersion ( approximately 19 degrees C) or remained seated without cooling (control). There was no significant difference between trials in any of the dependent variables during the first bout of exercise. Core body temperature (37.72 +/- 0.34 vs. 38.21 +/- 0.17 degrees C), heart rate (HR) (81 +/- 9 vs. 96 +/- 17 beats/min) and mean skin temperature (31.22 +/- 1.04 degrees C vs. 33.31 +/- 1 degrees C) were significantly lower following the recovery period in cool compared with control (p < 0.05). Core body temperature remained consistently lower (0.49 +/- 0.02 degrees C; p < 0.01) throughout the second bout of activity in cool compared to control. Mean skin temperature, HR and thermal sensation were significantly lower during bout 2 in cool compared with control (p < 0.05). It is concluded that this practical cooling strategy is effective at reducing the physiological strain associated with demanding firefighting activity under high ambient temperatures.

The effect of hyperhydration on physiological and perceived strain during treadmill exercise in personal protective equipment

Work in personal protective equipment (PPE) impairs thermoregulation causing cardiovascular stress, increased core body temperature, and hypohydration. We examined the effect of pretreating first responders performing treadmill exercise in PPE with an infusion of normal saline on physiological and perceptual strain. Ten (eight males, two females) euhydrated subjects performed treadmill exercise on two occasions wearing a chemical resistant coverall, air purifying respirator, butyl gloves, and heavy boots. During the hyperhydration session, normal saline was rapidly infused through an arm vein prior to donning PPE. Exercise duration and maximum core temperature did not differ between euhydrated and hyperhydrated conditions. Perceptual strain index (PeSI) was higher than physiological strain index (PhSI) in the euhydrated condition (P = 0.002) but neither index differed between the control and experimental conditions. Intravenous hyperhydration did not reduce physiological stress, increase exercise, or influence perceptual strain time when compared to the euhydrated condition in moderately fit individuals.

Acute lower limb ischemia associated with use of an immersion suit

External compression is a rare cause of acute lower limb ischemia. Workers required to wear immersion suits during helicopter simulation training are exposed to external compressive forces which can alter the hemodynamics in arterial bypass conduits. Herein a case of arterial thromboembolization to the lower limb following the wearing of an immersion suit, in a patient who had undergone arterial bypass surgery 13 yr previously is presented. The potential for this episode of acute leg ischemia being a direct result of the compressive forces exerted by the immersion suit and the possible implications for wearers of immersion suits following arterial graft surgery is discussed.