Extreme occupational heat exposure is associated with elevated haematological and inflammatory markers in Fire Service Instructors.

NEW FINDINGS: What is the central question of this study? Fire service instructors are frequently exposed to live fire scenarios, representing the most extreme chronic occupational heat exposure. These individuals report a series of unique health issues. We sought to identify whether the number of exposures completed was associated with inflammatory and immunological markers and symptoms of ill health. What is the main finding and its importance? Fire service instructors exhibit greater levels of inflammatory markers in comparison to firefighters. The number of exposures to fire is positively related to the prevalence of ill health and inflammation. Implementation of a proposed limit of nine exposures per month might be appropriate to minimize health issues. ABSTRACT: Fire Service Instructors (FSIs) experience ∼10 times more fire exposures than firefighters (FFs), and the increased physiological stress from this potentially puts them at risk of ill health and future cardiac events. The aim of the study was to establish whether FSIs exhibit elevated biomarkers associated with cardiac event risk, identify whether FSIs experience systemic inflammation linked to the frequency of fire exposure and evaluate a proposed exposure limit of nine exposures per month. Blood samples were collected from 110 Fire Service personnel (mean ± SD, age,44 ± 7 years; height, 178.1 ± 7.1 cm; and body mass, 84.3 ± 12.0 kg; FSIs n = 53 and FFs n = 57) for biomarker analysis. Work history details were collected from all participants. Participants with biomarker concentrations above healthy reference ranges were classified as being 'at risk'. The neutrophil-to-lymphocyte ratio, platelet count, cardiac troponin T, interleukin (IL)-6, IL-1ß, C-reactive protein and immunoglobulin G were greater in FSIs than in FFs (P < 0.05). Multiple regression analysis revealed that 18.8% of IL-6, 24.9% of IL-1ß, 29.2% of C-reactive protein and 10.9% of immunoglobulin G variance could be explained by the number of exposures to heat per month. Odds ratios revealed that those FSIs above the nine per month exposure limit were six to 12 times more likely to be classified as 'at risk' and were 16 times more likely to experience symptoms of ill health. Increased cytokine levels suggest that FSIs experience systemic inflammation, which is related to symptoms of ill health. We propose that an exposure limit could reduce the prevalence of these biomarker risk factors and ill health.

Heat tolerance of Fire Service Instructors.

OBJECTIVES: Fire Service Instructors (FSI) experience repeated fire exposures a median of 13 ±â€¯8 times a month; consequently they may develop an acclimatised state. However, the chronic immunological implications of heat acclimation are yet to be understood. This study aimed to establish whether FSI exhibit an increased heat tolerance and altered immunological response to heat exposures, compared to non-exposed individuals. The study also aimed to identify if heat tolerance is related to symptoms of ill health. METHODS: Twenty-two participants were recruited: 11 FSI (age: 41 ±â€¯7 yrs, body mass: 77.4 ±â€¯12.2 kg, height: 174.1 ±â€¯8.2 cm) and 11 non-exposed controls (CON) (age: 41 ±â€¯7 yrs, body mass: 75.9 ±â€¯12.2 kg, height: 177.0 ±â€¯8.1 cm). Participants completed a 40 min heat occupational tolerance test (HOTT) exercising at 6 W kg-1 (50.0 ±â€¯1.0 °C, 12.3 ±â€¯3.3% relative humidity) on two occasions, separated by 2 months. Physiological and perceptual measures were collected throughout and venous blood samples were collected prior to and post exposure. RESULTS: FSI displayed significantly reduced peak rectal temperature (Tre) (-0.42 °C), change in Tre (-0.33 °C), and thermal sensation (-1.0) and increased sweat rate (+0.25 L h-1) at the end of the HOTT compared to CON (p < 0.05). FSI exhibited similar responses to the HOTT as CON for all haematological variables. However, resting interleukin-6, interleukin-1ß, and immunoglobulin G were significantly greater in FSI than CON. There was no difference in responses following the 2 month working period. FSI peak Tre was negatively correlated with symptoms of ill health (rpb = -0.473, p = 0.026) and the number of fire exposures in the previous 2 weeks (rs = -0.589, p = 0.004). CONCLUSION: Despite increased heat tolerance compared to non-exposed individuals, FSI may develop a maladaptation to repeated fire exposures, with elevated resting cytokine levels and an increased prevalence of ill health symptoms.

The acute effect of training fire exercises on fire service instructors.

Fire service instructors (FSI) regularly experience different types of fire exercises, however the strain experienced from these scenarios is not well understood. This study aims to identify the physiological and perceptual strain of Fire Service Instructors (FSI) to three training exercises: DEMO, ATTACK, COMPARTMENT, and the different roles performed: SETTER, INSTRUCTOR. The study also aims to assess the effect that different exercise patterns over a day (BOX, MULTI, COMBINATION) have on immunological responses. Sixteen FSI (age: 41 ± 8 years, body mass: 83.7 ± 6.7 kg, height: 177.0 ± 6.7 cm) were recruited, with 10 FSI completing the three exercises. Physiological and perceptual measures were collected prior to and immediately post each exercise. Venous blood samples were collected at the beginning and end of each day. One-way analysis of variance (ANOVA) were conducted to assess differences in physiological variables between exercise types, independent samples t-tests were conducted between roles. Day changes in hematological variables were assessed by paired sample t-tests and analyzed by one-way ANOVAs to identify differences between exercise patterns. The COMPARTMENT exercise resulted in a greater change in rectal temperature (ΔTre) (0.49 ± 0.28 °C) than both the DEMO (0.23 ± 0.19 °C, p = 0.045) and ATTACK (0.27 ± 0.22 °C, p = 0.016). Within the COMPARTMENT exercise, the SETTER resulted in a greater ΔTre and rating of perceived exertion than the INSTRUCTOR (0.67 ± 0.29 °C vs. 0.43 ± 0.18 °C, p = 0.027 and 14 ± 2 vs. 11 ± 2, p = 0.001, respectively). Following a day of fire exercises white blood cells (WBC), neutrophils, lymphocytes (LYMPH), monocytes (MONO), platelets (PLT), mean platelet volume (MPV), Interleukin (IL)-6, and cardiac troponin T (cTnT) all increased (p < 0.05). Exercise patterns containing a COMPARTMENT exercise resulted in greater PLT, MPV, and IL-6. Total daily variation in ΔTre was correlated with post-exercise WBC, MONO, and LYMPH. COMPARTMENT exercises produce the greatest physiological strain, with the SETTER role within this exercise causing the greatest ΔTre. Although predominately physiological responses remain within safe limits. Exercise patterns that include a COMPARTMENT exercise also generate a greater inflammatory response.

A new occupational heat tolerance test: A feasibility study.

Heat tolerance tests identify those susceptible to heat illnesses and monitor heat adaptations. Currently, tolerance tests do not replicate the uncompensable heat strain environments experienced in some occupations. In addition, tests can take up to 2 h to complete, and cannot offer intra and inter individual comparisons, due to the use of a fixed exercise intensity. This study aimed to assess the validity and reliability of a new heat occupational tolerance test (HOTT: 40 min at 6 W kg-1 metabolic heat production, 50 °C 10% RH, in protective clothing) to the standard heat tolerance test (HTT: 2 h walk at 5 km h-1 1% gradient, 40 °C 40% RH, in shorts and t-shirt). Eighteen participants (age: 21 ±â€¯3 yrs, body mass: 81.3 ±â€¯5.9 kg) completed trials to assess the validity and/or reliability of the HOTT. Peak rectal temperature (Tre) displayed strong agreement and low measurement error (0.19 °C) between HTT (38.7 ±â€¯0.4 °C) and HOTT (38.6 ±â€¯0.4 °C). Strong agreement was also displayed for physiological and perceptual measures between the two HOTT trials, including peak Tre (38.5 ±â€¯0.4 °C vs. 38.5 ±â€¯0.4 °C) and peak heart rate (182 ±â€¯20 b min-1 vs. 182 ±â€¯21 b min-1). The HOTT is the first tolerance test that assesses individuals' responses whilst wearing protective clothing in high temperatures. It can consistently identify individuals' levels of heat tolerance within a reduced time frame. In addition, it allows for participant monitoring over time and comparisons between individuals to be made. A continuum based approach is recommended when assessing individuals' responses to the HOTT.

Short-term heat acclimation prior to a multi-day desert ultra-marathon improves physiological and psychological responses without compromising immune status.

Multistage, ultra-endurance events in hot, humid conditions necessitate thermal adaptation, often achieved through short term heat acclimation (STHA), to improve performance by reducing thermoregulatory strain and perceptions of heat stress. This study investigated the physiological, perceptual and immunological responses to STHA prior to the Marathon des Sables. Eight athletes (age 42 ± 4 years and body mass 81.9 ± 15.0 kg) completed 4 days of controlled hyperthermia STHA (60 min·day‒1, 45°C and 30% relative humidity). Pre, during and post sessions, physiological and perceptual measures were recorded. Immunological measures were recorded pre-post sessions 1 and 4. STHA improved thermal comfort (P = 0.02), sensation (P = 0.03) and perceived exertion (P = 0.04). A dissociated relationship between perceptual fatigue and Tre was evident after STHA, with reductions in perceived Physical (P = 0.04) and General (P = 0.04) fatigue. Exercising Tre and HR did not change (P > 0.05) however, sweat rate increased 14% (P = 0.02). No changes were found in white blood cell counts or content (P > 0.05). Four days of STHA facilitates effective perceptual adaptations, without compromising immune status prior to an ultra-endurance race in heat stress. A greater physiological strain is required to confer optimal physiological adaptations.

Fire service instructor's undergarment choice to reduce Interleukin-6 and minimise physiological and perceptual strain.

Fire Service Instructors frequently experience high levels of physiological and perceptual strain during live fire exposures. Instructors are also at risk of cardiovascular illnesses, with cardiac death being the greatest cause of fire fighter death. Current practice for UK instructors is to select undergarment type based on personal preference, between a boiler suit (BOILER) and a wicking base layer (WBL). Research suggests that shorts and t-shirt (SHORTS) may also be a beneficial alternative undergarment choice. The UK South East Fire Service requested an investigation to identify if undergarment selection can lessen the strain experienced by instructors, and reduce the acute inflammatory response to fire exposures. Eight males completed three 45min sessions in a heat chamber (49.5±1.4°C and 16.9±4.3% RH) whilst performing intermittent walking. At the end of heat exposure change in heart rate was not effected by garment type (p=0.061, ηp2=0.373). Change in rectal temperature was different between garments (p=0.009, ηp2=0.271), with trends suggesting that BOILER resulted in a greater change (1.03±0.60°C) than SHORTS (0.76±0.37°C, p=0.589, d=0.21) and WBL (0.72±0.33°C, p=0.545, d=0.25). Interleukin-6 post exposure was greater for BOILER (6.96±0.28pgmL-1) than both SHORTS (6.59±0.30pgmL-1, p=0.043, d=0.42) and WBL (6.45±0.43pgmL-1, p=0.031, d=0.51). Overall, undergarment type had little impact on physiological or perceptual strain. However, wearing WBL or SHORTS may reduce the inflammatory response, and consequently decrease the risk of cardiovascular events.

Fire service instructors' working practices: A UK survey.

Analysis of Fire Service Instructors (FSI) working practices and health is needed to minimise health risks related to heat illness, cardiovascular events and immunological stress. Online surveys were distributed to UK FSI and Firefighters (FF). One hundred and thirty FSI (age: 43 ± 7yrs) and 232 FF (age: 41 ± 8yrs) responded. FSI experienced 2-10 live fires per week, with 45% of FSI reporting management does not set a limit on the number of exposures. Few FSI followed hydration guidelines, or cooling methods. New symptoms of ill health were reported by 41% of FSI and 21% of FF. FSI with ≥11 Breathing Apparatus exposures per month were 4.5 times (95% CI 1.33-15.09) more likely to experience new symptoms. A large proportion of FSI are experiencing new symptoms of illness after starting their career, and guidelines on exposure and hydration are not universally in place to reduce the risk of future health problems.

Women Firefighters' Health and Well-Being: An International Survey.

OBJECTIVES: This study aimed to identify specific health and well-being issues that women firefighters may experience as part of their daily working practices. Issues identified from this under-represented population can drive future research, education, and strategy to guide safety and health practices. METHODS: A total of 840 women firefighters from 14 separate countries (255 United Kingdom and Ireland, 320 North America, 177 Australasia, and 88 mainland Europe) completed the survey over a 4-month period. Questions related to general health and well-being and role-specific health concerns, gender-related issues, and available exercise facilities. RESULTS: Women firefighters in North America reported a higher prevalence of lower back (49%) and lower limb (51%) injuries than all other groups. North American respondents reported more heat illnesses (45%) than respondents from other places (36%). Although many participants did not respond, of those who did, 39% thought the menstrual cycle (199/512) or menopause (55/151) affected their work, and 36% were concerned for their ability to meet future job demands. Sixteen percent felt confident they could complete the role after 60 years of age. Women firefighters identified a lack of strength and conditioning support (50%) or lack of gym access (21%). There appears to be poor availability of female-specific personal protective equipment, with availability greatest in the United Kingdom (66%) compared with the sample as a whole (42%). CONCLUSIONS: There is a need for female-specific strength and conditioning support and facilities to decrease injury and illness risk and improve longevity. Research and education into gynecological issues, heat exposure, and their effects on women firefighters' fertility and cancer risk is required.

Practical pre-cooling methods for occupational heat exposure.

This study aimed to identify a pre-cooling method to reduce the physiological and perceptual strain, and the inflammatory response, experienced by individuals who wear personal protective equipment. Eleven males (age 20 ±â€¯2 years, weight 75.8 ±â€¯9.3 kg, height 177.1 ±â€¯5.0 cm) completed 15min pre-cooling (phase change vest [PCV], forearm cooling [ARM], ice slurry consumption [ICE], or a no cooling control [CON]) and 45min intermittent walk (4  km h-1, 1% gradient) in 49.5 ±â€¯0.6 °C and 15.4 ±â€¯1.0% RH, whilst wearing firefighter ensemble. ICE reduced rectal temperature (Tre) before heat exposure compared to CON (ΔTre: 0.24 ±â€¯0.09 °C, p < 0.001, d = 0.38) and during exercise compared to CON, ARM, and PCV (p = 0.026, ηp2 = 0.145). Thermal sensation was reduced in ICE and ARM vs. CON (p = 0.018, ηp2 = 0.150). Interleukin-6 was not affected by pre-cooling (p = 0.648, ηp2 = 0.032). It is recommended that those wearing protective equipment consume 500 ml of ice slurry 15min prior to work to reduce physiological and perceptual strain.

Visceral leishmaniasis-associated hemophagocytic lymphohistiocytosis in a traveler returning from a pilgrimage to the Camino de Santiago.

We report the case of a 73-year-old American traveler who presented with 3 weeks of fatigue, fevers, chills, and pancytopenia. Clinical and laboratory findings were consistent with hemophagocytic lymphohystiocytosis (HLH) and bone marrow biopsy revealed amastigotes consistent with visceral leishmaniasis. The range of endemic visceral leishmaniasis transmission now extends into northern Spain and travelers to this region should use personal protective measures against sand fly exposure.