Personal Protective Equipment Protocols Lead to a Delayed Initiation of Patient Assessment in Mountain Rescue Operations.

van Veelen, Michiel J., Giulia Roveri, Ivo B. Regli, Tomas Dal Cappello, Anna Vögele, Michela Masè, Marika Falla, and Giacomo Strapazzon. Personal protective equipment protocols lead to a delayed initiation of patient assessment in mountain rescue operations. High Alt Med Biol. 24:127-131, 2023. Introduction: Mountain rescue operations can be challenging in austere environmental conditions and remote settings. Airborne infection prevention measures include donning of personal protective equipment (PPE), potentially delaying the approach to a patient. We aimed to investigate the time delay caused by these prevention measures. Methods: This randomized crossover trial consisted of 24 rescue simulation trials intended to be as realistic as possible, performed by mountain rescue teams in difficult terrain. We analyzed the time needed to perform an airborne infection prevention protocol during the approach to a patient. Time delays in scenarios involving patients already wearing versus not wearing face masks and gloves were compared using a linear mixed model Results: The airborne infection prevention measures (i.e., screening questionnaire, hand antisepsis, and donning of PPE) resulted in a time delay of 98 ± 48 (26-214) seconds on initiation of patient assessment. There was a trend to a shorter time to perform infection prevention measures if the simulated patient was already wearing PPE consisting of face mask and gloves (p = 0.052). Conclusion: Airborne infection prevention measures may delay initiation of patient assessment in mountain rescue operations and could impair clinical outcomes in time-sensitive conditions. Trial registration number 0105095-BZ Ethics Committee review board of Bolzano.

The role of modifiable risk factors in incident cancer in transport, rescue, and security industries.

PURPOSE: Examine the risk for site-specific incident cancer across representative transport, rescue, and security industries. METHODS: This Danish nationwide register-based study included all 302,789 workers from transport, rescue and security industries in 2001-2015 and 2,230,877 individuals aged 18-64 years from a total sample of the economically active population for comparison. We used Cox models to estimate the hazard ratios (HRs) of incident cancers. We categorized site-specific cancers by using population-attributable fraction (PAF) estimates from the previous literature. RESULTS: During an average follow-up of 13.4 years, 22,116 incident cancer cases were recorded in these industries. Compared with the reference population, the age-adjusted cancer incidence with a high PAF was higher among men in seafaring (HR 1.28; 95% CI 1.14-1.43), and land transport (HR 1.32; 95% CI: 1.26-1.37), and among women in seafaring (HR 1.26; 95% CI: 1.01-1.57), land transport (HR 1.21; 95% CI: 1.12-1.32), aviation (HR 1.22; 95% CI: 1.05-1.41), and police force (HR 1.21; 95% CI: 1.04-1.40). Overall, tobacco and physical inactivity were the most significant risk factors of cancer. CONCLUSIONS: Regardless of considerable disparities in incident cancer attributable to modifiable risk factors across industries, the total incident cancer rate was elevated in all industries in both sexes.

Developed multiple-layer perceptron neural network based on developed search and rescue optimizer to predict iron ore price volatility: A case study.

In economic investment, the role of forecasting is very important because in an economic project, the investor must carefully examine the dimensions of the work such that one of the most important and perhaps the main factor of a future investor and an economic enterprise is the work done by Costs and revenues are determined. Due to the fact that the volatility of iron ore price is affected by various factors, so it is not possible to determine a simple and general function to predict its price. There are several methods for predicting price, but the most appropriate of these is a method that examines variables in a nonlinear and dynamic manner that is closer to reality. Therefore, in this research, an improved and optimized neural network is proposed to facilitate this task. The idea is to employ a developed version of Search and Rescue optimization algorithm to enhance the training ability of the neural network to present an efficient forecasting tool for iron ore price volatilities. Different variables are used for the method verification and its results are compared with basic neural network, particle swarm optimization-based, Intelligent Integrated Optimizer, Genetic Neural Network to show its superiority. Simulation results demonstrate that by the proposed method has a satisfying and better fitting with the data compared with the other methods.

Estimating Total Energy Expenditure for Fire-Fighters during Large Scale Disaster Response Training Using a Tri-Axial Accelerometer.

The present study was conducted to estimate total energy expenditure (TEE) of fire-fighters using tri axial-accelerometers in conjunction with an activity log survey on a large number of subjects undergoing training mimicking a large-scale disaster. Subjects were 240 fire-fighters participating in a two-day fire-fighting training dedicated to large-scale natural disasters. Data was analyzed by job type of activity group and the job rank, and by comparing the average. The average TEE of the total survey training period is about 3619 (±499) kcal, which is the same value of expenditure for professional athletes during the soccer game season. From the activity group, the rescue and other teams consumed significantly more energy than the fire and Emergency Medical Team (EMS) teams. From the job rank, Fire Captain (conducting position) consumed significantly lower energy than the Fire Lieutenant and Fire Sergeant. Furthermore, it was found that a middle position rank consumed the most energy. This research supports a need to reconsider the current rescue food (and protocols) to supplement the energy expenditure of fire-fighters. In addition, since there was a significant difference between the job type and the job rank, it is necessary to examine the energy amount and shape suitable for each.

Influence of post-disaster evacuation on incidence of hyperuricemia in residents of Fukushima Prefecture: the Fukushima Health Management Survey.

AIM: After the Great East Japan Earthquake, over 160,000 residents in Fukushima Prefecture were forced to evacuate the area around the Fukushima Daiichi power plant following nuclear accident there. Health problems in these evacuees have since become a major issue. We have examined the association between evacuation and incidence of hyperuricemia among residents in Fukushima. METHODS: We conducted a cohort study of residents aged 40-90 years without hyperuricemia at the time of the Fukushima disaster. Among 8173 residents who met the inclusion criteria before the disaster, 4789 residents (men: 1971, women: 2818; follow-up duration: 1.38 years; and follow-up rate: 58.6%) remained available for follow-up examinations at the end of March 2013. The main endpoint was incidence of hyperuricemia, defined by the Japanese committee guidelines, using local health data from before and after the disaster. We divided participants by evacuation status and compared outcomes between groups. Using a logistic regression model, we estimated the odds ratio for incidence of hyperuricemia, adjusting for potential confounders, age, gender, waist circumference, physical activity, and alcohol consumption. RESULTS: Incidence of hyperuricemia was higher in evacuees (men 10.1%; women 1.1%) than in non-evacuees (men 7.4%, women 1.0%). Evacuees had higher body mass index, waist circumference, triglycerides, LDL-cholesterol, fasting plasma glucose, HbA1c, and lower HDL-cholesterol after the disaster than non-evacuees. We found that evacuation was associated with incidence of hyperuricemia (adjusted odds ratio: 1.38; 95% confidence interval: 1.03-1.86). CONCLUSION: This is the first study to demonstrate an association between evacuation after a disaster and increased incidence of hyperuricemia.

Mass evacuation and increases in long-term care benefits: Lessons from the Fukushima nuclear disaster.

BACKGROUND: Though mass evacuation may increase the need for long-term care (LTC) services, how the need for LTC services increases and how the public LTC system affects it is not well understood. We evaluated changes in public LTC benefits for the people living in the mandatory evacuation areas established after the 2011 Fukushima nuclear disaster and examined the roles of the universal LTC insurance system in Japan. METHODS: In order to evaluate the effect of the mandatory evacuation on LTC benefits, we examined the trends of LTC benefits in the Fukushima evacuation group and the nationwide non-evacuation group. We first decomposed per-elderly-individual benefits at the municipality level into the LTC certification rate and per-certified-individual benefits, and then implemented difference-in-differences analysis using these variables as outcomes. RESULTS: Per-elderly-individual benefits significantly increased from 2012 onward in the evacuation group, and this was explained by an increase in the certification rate rather than in per-certified-individual benefits. Increases in per-elderly-individual benefits and the certification rate in the post-disaster period were observed in all but the highest care level, and the corresponding outcomes for the highest care level decreased immediately after the disaster. We also found that the increase in the certification rate had been mostly realized by an increase in the number of certified individuals. CONCLUSIONS: The increase in LTC benefits can be associated with the impact of the increase in the number of people newly certified to receive LTC benefits after the mandatory evacuation. In order to cope with the increase in utilization of long-term care and associated costs after disasters in aging societies, both formal long-term care services and social support for informal care for evacuees should be considered important.

Comparative Review on the Cost-Effectiveness Analysis of Relief Teams' Deployment to Sudden-Onset Disasters.

When a disaster exceeds the capacity of the affected country to cope with its own resources, the provision of external rescue and health services is required, and the deployment of relief units requested. Recently, the cost of international relief and the belief that such deployment is cost-effective has been questioned by the international community; unfortunately, there is still little informed debate and few detailed data are available. This paper presents the results of a comparative review on the cost-effectiveness analysis (CEA) of search and rescue (SAR) and Emergency Medical Team (EMT) deployment. The aim of this work is to provide an overview of the topic, highlight the criteria used to assess the effectiveness, and identify gaps in existing literature. The results show that both deployments are highly expensive, and their success is strongly related to the time they need to be operational; SAR deployments are characterized by limited outcomes in terms of lives saved, and EMTs by insufficient data and lack of detailed assessment. This research highlights that the criteria used to assess the effectiveness need to be explored further, considering different purposes, lengths of stay, and different activities performed, especially for any comparison. This study concludes that data reporting should be mandatory for humanitarian response agencies.

The development of a functional and valid physical employment assessment standard for NSW Mines Rescue Brigadesmen.

BACKGROUND: Given the physical demands of mining and rescue operations, a physical employment standard was warranted to ensure capable workers are selected. While evaluations of muscular strength and muscular and cardiorespiratory endurance domains are common, assessment of a worker's ability to meet the physically demanding postural requirements is often neglected. OBJECTIVE: The aim of this investigation was to develop a valid assessment for NSW Mines Rescue Brigadesmen that replicated the combined muscular and cardiorespiratory endurance and postural demands of constructing a timber pillar. METHODS: Oxygen consumption () V̇O2) was measured and dominant postures identified when incumbent Brigadesmen constructed a timber pillar. A shelf-stacking assessment was designed and validated. RESULTS: When Brigadesmen performed the block placement role, the task elicited a mean V̇O2 of 1.6 L.min-1, and required repeated placement of ∼8.7 kg blocks from 0 to 3.0 m. A shelf stacking assessment (5 min, mean V̇O2 1.7 L.min-1) replicating dominant postures and requiring repeated block placement at 0, 0.65, 1.10, 1.64 and 2.20 m was developed. The demand of the test, performed within a discontinuous circuit, was subsequently verified (1.6 L.min-1). CONCLUSIONS: A valid, physiological aptitude test that considered the job-related movement patterns, in addition to cardiorespiratory and muscular endurance requirements, was developed for Brigadesmen.

Increased Incidence of Thyroid Cancer among World Trade Center First Responders: A Descriptive Epidemiological Assessment.

An increased incidence of thyroid cancer among 9/11 rescue workers has been reported, the etiology of which remains unclear but which may, at least partly, be the result of the increased medical surveillance this group undergoes. This study aimed to investigate thyroid cancer in World Trade Center (WTC) responders by looking at the demographic data and questionnaire responses of thyroid cancer cases from the Mount Sinai WTC Health Program (WTCHP). WTCHP thyroid cancer tumors were of a similar size (p = 0.4), and were diagnosed at a similar age (p = 0.2) compared to a subset of thyroid cancer cases treated at Mount Sinai without WTC exposure. These results do not support the surveillance bias hypothesis, under which smaller tumors are expected to be diagnosed at earlier ages. WTCHP thyroid cancer cases also reported a past history of radiation exposure and a family history of thyroid conditions at lower rates than expected, with higher than expected rates of previous cancer diagnoses, family histories of other cancers, and high Body Mass Indexes (BMIs). Further research is needed to better understand the underlying risk factors that may play a role in the development of thyroid cancer in this group.

Consideration of Medical and Public Health Coordination - Experience from the 2016 Kumamoto, Japan Earthquake.

OBJECTIVE: The aim of this study was to identify disaster medical operation improvements from the 2016 Kumamoto Earthquake (Kumamoto Prefecture, Japan) and to extract further lessons learned to prepare for future expected major earthquakes. METHODS: The records of communications logs, chronological transitions of chain of command, and team registration logs for the Disaster Medical Assistant Team (DMAT), as well as other disaster medical relief teams, were evaluated. RESULTS: A total of 466 DMAT teams and 2,071 DMAT team members were deployed to the Kumamoto area, and 1,894 disaster medical relief teams and 8,471 disaster medical relief team member deployments followed. The DMAT established a medical coordination command post at several key disaster hospitals to designate medical coverage areas. The DMAT evacuated over 1,400 patients from damaged hospitals, transported medical supplies to affected hospitals, and coordinated 14 doctor helicopters used for severe patient transport. To keep constant medical and public health operations, DMAT provided medical coordination management until the local medical coordination was on-track. Several logistic teams, which are highly trained on operation and management of medical coordination command, were dispatched to assist management operation. The DMAT also helped to establish Disaster Coordination and Management Council at the prefectural- and municipal-level, and also coordinated command control for public health operations. The DMAT could provide not only medical assistance at the acute phase of the disaster, but also could provide medical coordination for public health and welfare. CONCLUSION: During the 2016 Kumamoto Earthquake, needs of public health and welfare increased enormously due to the sudden evacuation of a large number of residents. To provide constant medical assistance at the disaster area, DMAT, logistic teams, and other disaster medical relief teams must operate constant coordination at the medical headquarter command. For future expected major earthquakes in Japan, it will be required to educate and secure high enough numbers of disaster medical assistance and health care personnel to provide continuous medical and public health care for the affected area residents.Kondo H, Koido Y, Kawashima Y, Kohayagawa Y, Misaki M, Takahashi A, Kondo Y, Chishima K, Toyokuni Y. Consideration of medical and public health coordination - experience from the 2016 Kumamoto, Japan Earthquake. Prehosp Disaster Med. 2019;34(2):149-154.

Impact of a Half Dome Cable Permitting Process on Search and Rescue Activity, Hiker Mortality Rates, and Operational Costs Above Little Yosemite Valley.

INTRODUCTION: The summit of Yosemite's Half Dome is reached using cable handrails for the final 146 m (480 ft). Access to these cables was restricted to users with permits in 2010. The authors aim to describe the impact of permitting on search and rescue (SAR) in the region of the park most affected by permitting. METHODS: An observational study from 2005 to 2009 and 2011 to 2015 comparing the number of incidents, major incidents (exceeding $500), victims, and fatalities before and after permitting the use of cable handrails on Half Dome in the area above Little Yosemite Valley (LYV) and parkwide. Each year was analyzed separately with t tests and Mann-Whitney U tests. Data are presented as mean±SD. RESULT: The number of hikers in the study area was reduced by up to 66% by permitting. Above LYV from 2005 to 2009, there were 85 SAR incidents, 134 victims, 8 fatalities, 38 major incidents, and annual SAR costs of $44,582±28,972. From 2011 to 2015, the same area saw 54 SAR incidents, 156 victims, 4 fatalities, 35 major incidents, and annual SAR costs of $27,027±19,586. No parameter showed statistical significance. Parkwide SAR incidents decreased from 232 to 198 annual incidents (P=0.013) during the same time period, with parkwide mortality increasing from 8 to 12 deaths annually (P=0.045). CONCLUSIONS: SAR incidents, victims, fatalities, or costs above LYV did not decrease after cable handrail permitting. Parkwide SAR activity decreased during the same intervals. This strongly suggests that overcrowding is not the key factor influencing safety on Half Dome. This discordant trend warrants close observation over 5 to 10 y.

Anatomy of Mine Rescue Teams' Casualty Incidents: A Basis for Medical Emergency Preparedness and Injury Prevention.

OBJECTIVE: Mine rescue teams bear a high risk of injury. To improve medical emergency preparedness and injury prevention, this work analyzed the causes and severity of mine rescue teams' casualty incidents, the primary injuries, and the link between the causes and the occurrences of the casualty incidents. METHODS: A total of 81 cases from 1953 to 2013 were used to analyze the casualty incidents of mine rescue teams based on the frequency of accidents. A panel with 4 rescue experts was set up to ensure the accuracy of the analysis. RESULTS: The 81 casualty incidents occurred in 7 types of rescue work and were due to 6 causes. Organizational and personal factors were the leading cause, followed by rescue skill and equipment factors. Problems with decision-making and command have gradually become the primary inducement of casualty incidents in recent years, with an average death toll reaching up to 6 to 7 people. The main injuries causing death to team members were blast injury, burns, poisoning, suffocation, blunt trauma, and overwork injury. Some of the injured died because of medical emergency response failure. CONCLUSION: The construction of emergency medical teams and the preparedness of disaster medicine need to be improved to reduce the mortality of the injured team members. Actions according to the causes of casualty incidents should be adopted for injury prevention. (Disaster Med Public Health Preparedness. 2019;13:695-699).

Monitoring the Health of Public Health Responders: Development and Use of the Responder Safety, Tracking, and Resilience System (R-STaR) for Hurricane Matthew.

ABSTRACTOn October 7, 2016, Hurricane Matthew traveled along the coasts of Florida, Georgia, and South Carolina causing flooding and power outages. The Georgia Department of Public Health (DPH) developed the Web-based Responder Safety, Tracking, and Resilience (R-STaR) system to monitor the health and safety of public health responders and to inform disaster response planning for Hurricane Matthew. Using R-STaR, responders (n = 126) were e-mailed a daily survey while deployed to document injuries or harmful exposures and a post-deployment survey on their post-deployment health and satisfaction with using R-STaR. DPH epidemiologists contacted responders reporting injuries or exposures to determine the need for medical care. Frequencies were tabulated for quantitative survey responses, and qualitative data were summarized into key themes. Five percent (6/126) of responders reported injuries, and 81% (43/53) found R-STaR easy to use. Suggestions for R-STaR improvement included improving accessibility using mobile platforms and conducting pre-event training of responders on R-STaR. Lessons learned from R-STaR development and evaluation can inform the development and improvement of responder health surveillance systems at other local and state health departments and disaster and emergency response agencies. (Disaster Med Public Health Preparedness. 2019;13:74-81).

Incidence and strategies for preventing sustained hypothermia of crash victims during prolonged vehicle extrication.

BACKGROUND: Vehicle extrication of crash victims is a highly-demanding challenge, due to the frequently life-threatening injuries of entrapped occupants. In this phase, crash victims are often exposed to the outdoor-temperature, with the risk of sustained hypothermia. Hypothermia can significantly raise the morbidity and mortality rates of crash victims. Therefore, we have correlated the incidence of severe car accidents with entrapped patients, the outdoor conditions, and expenditure of time for extrication. Furthermore, different warming strategies have been evaluated regarding their integrability within the rescue procedure. METHODS: To estimate the incidence of severe car accidents with entrapped patients, we performed retrospective data mining for the cold season of a three-year period in a rural district in Germany. We evaluated the integrability of a chemical heated blanket, its combined application with a forced-air warmer, or with an infrared radiator for patient warming. Therefore, we analysed the time tracking of extrication reference points during extrication exercises undertaken by the rescue services, simulating a severe vehicle accident and evaluated questionnaires administered to rescue personnel and subjects. Furthermore, we monitored subjects' physiologic parameters to estimate the warming effect. RESULTS: Incidence analysis resulted in extrication times of up to 80 min, representing two severely-entrapped patients per month in the cold seasons, corresponding to about four entrapments per 100.000 inhabitants every year. Of the different warming strategies analysed, the chemical blanket and the combination infrared radiator/chemical blanket were favoured regarding the items 'operator convenience', 'weight/size/handling', 'stability in positioning', 'time needed for installation', 'manpower requirement', 'hindrance during extrication operation', 'versality during extrication process', and 'robustness' by the rescue personnel; the forced-air warmer and the infrared radiator were preferred with regard to 'warming effect', the forced-air warmer and the chemical blanket was advantageous with regard to 'physical protection'. CONCLUSIONS: Vehicle extrication procedures are time consuming, a relevant finding that provides a rationale for discussing and optimising the rescue procedure to prevent sustained hypothermia. We determined that combined application of an infrared radiator and a chemical blanket is advantageous in terms of integration into the rescue process. However, a more detailed investigation, focussing on warming efficacy, must be performed.

Appeal to the Rule of Rescue in health care: discriminating and not benevolent?

Thirty years of debate have passed since the term "Rule of Rescue" has been introduced into medical ethics. Its main focus was on whether or why medical treatment for acute conditions should have priority over preventive measures irrespective of opportunity costs. Recent contributions, taking account of the widespread reluctance to accept purely efficiency-oriented prioritization approaches, advance another objection: Prioritizing treatment, they hold, discriminates against statistical lives. The reference to opportunity costs has also been renewed in a distinctly ethical fashion: It has been stipulated that favoring help for identifiable lives amounts to a lack of benevolence for one's fellow creatures. The present article argues against both objections. It suggests that the debate's focus on consequences (deaths or severe ill health) should be reoriented by asking which aspects of such states of affairs are actually attributable to a decision maker who judges within a specific situation of choice.

[Effort-Reward Imbalance in the Emergency Rescue Service - A Cross-Sectional Study on Prevalence and Influencing Factors among Full-Time Emergency Service Employees]. / Berufliche Gratifikationskrisen im Rettungsdienst ­ Eine Querschnittstudie zu Häufigkeit und Einflussfaktoren bei hauptamtlich tätigem Rettungsdienstpersonal.

INTRODUCTION: The emergency service is a challenging field of activity. The Effort-Reward Imbalance model explains on the basis of the ratio between reward/effort the appearance of occupational stress. For the first time, this study examines the extent of Effort-Reward Imbalance in rescue services in Germany. METHODS: Full-time emergency service employees of a German Red Cross District Association were consulted. N=82 employees (78.8%) participated (M age=37.78 years, 73.2% male). In addition to the Effort-Reward-Imbalance-Questionnaire, the study included other tools to measure anxiety, depression, health, social support, bullying and optimism of the employees. RESULTS: N=58 persons (70.7%) reported an effort-reward imbalance. The existence of an Effort-Reward Imbalance was related to older age, lower education, higher professional qualification (working as a paramedic) and existing partnership. Persons with an effort-reward imbalance reported poorer health and lower social support. DISCUSSION: The high number of persons with Effort-Reward Imbalance in emergency services in Germany coincides with international studies. CONCLUSION: The results demonstrates the need for preventive support and further research.

Apostle Islands National Lakeshore: A Review of Search and Rescue and Emergency Medical Services Operations, 2006-2015.

INTRODUCTION: Apostle Islands National Lakeshore (APIS) lies at the northern tip of Wisconsin and is home to a network of 21 islands along Lake Superior. The goal of this report is to investigate search and rescue (SAR) and emergency medical services (EMS) trends at APIS in an effort to improve visitor safety and resource allocation. METHODS: This study is a retrospective analysis reviewing APIS SAR reports and annual EMS summary reports from January 1, 2006, to December 31, 2015. Information related to incident type, incident date, individual demographic characteristics and activities, injury/illness type, cost, and contributing factors were recorded and analyzed in frequency tables. RESULTS: From 2006 to 2015, APIS SAR conducted 133 total missions assisting 261 individuals-200 not injured/ill, 57 injured/ill, and 4 fatalities. Median cost per SAR incident involving aircraft totaled $21,695 (range: $2,993-141,849), whereas incidents not involving aircraft had a median cost of $363 (range: $35-8,830). Nonmotorized boating was the most common activity resulting in SAR incidents. All 4 fatalities were attributed to drowning while kayaking or swimming. Cold-related injury/illness accounted for nearly half of all injuries/illnesses (45%) with the most commonly reported contributing factor being high winds. EMS responded to a total of 134 incidents. Trauma and first aid accounted for 43% and 34% of EMS workload, respectively. CONCLUSIONS: Overall, this study highlights the hazards associated with the frigid and rough conditions of Lake Superior. The reported results aim to help APIS personnel more saliently convey risks to visitors and plan appropriately in an effort to decrease the need for future rescues.

Managers' response to mental health issues among their staff.

BACKGROUND: Many organizations are implementing mental health training for managers to facilitate better communication between managers and employees suffering from mental health problems. Much of this training focuses on improving managers' mental health literacy and reducing stigma. However, it is unclear whether this focus is appropriate or whether other targets, such as improving skills and confidence, should be given greater consideration. AIMS: To test whether knowledge, attitudes and confidence are associated with managers' behavioural responses to mental health issues among their staff. METHODS: Managers from a large Australian fire and rescue service completed a questionnaire addressing their knowledge, attitudes, confidence and behavioural responses when managing employee mental health issues. The relationship was assessed using logistic regression. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS: Eighty-five managers responded (response rate 66%). Managers' confidence was the strongest predictor of their behaviour. Managers who felt confident discussing mental health were significantly more likely to make contact with an employee who was suspected to be suffering from a mental illness (OR 15.79, 95% CI 3.03-82.37, P < 0.01) or was on sickness leave for mental health reasons (OR 19.84, 95% CI 2.25-175.15, P < 0.01). Non-stigmatizing attitudes towards mental illness also significantly predicted contact with a staff member off work due to mental health problems (OR 5.22, 95% CI 1.21-22.54, P < 0.05). CONCLUSIONS: Our findings suggest that manager mental health training should focus on building their confidence and reducing stigma in order to have the greatest chance of altering workplace practices.

Estimation of Future Cancer Burden Among Rescue and Recovery Workers Exposed to the World Trade Center Disaster.

Importance: Elevated rates of cancer have been reported in individuals exposed to the World Trade Center (WTC) disaster, including Fire Department of the City of New York (FDNY) rescue and recovery workers. Objective: To project the future burden of cancer in WTC-exposed FDNY rescue and recovery workers by estimating the 20-year cancer incidence. Design, Setting, and Participants: A total of 14 474 WTC-exposed FDNY employees who were cancer-free on January 1, 2012; subgroup analyses were conducted of the cohort's white male population (n = 12 374). In this closed-cohort study, we projected cancer incidence for the January 1, 2012, to December 31, 2031, period. Simulations were run using demographic-specific New York City (NYC) cancer and national mortality rates for each individual, summed for the whole cohort, and performed 1000 times to produce mean estimates. Additional analyses in the subgroup of white men compared case counts produced by using 2007-2011 FDNY WTC Health Program (FDNY-WTCHP) cancer rates vs NYC rates. Average and 20-year aggregate costs of first-year cancer care were estimated using claims data. Exposures: World Trade Center disaster exposure defined as rescue and recovery work at the WTC site at any time from September 11, 2001, to July 25, 2002. Main Outcomes and Measures: (1) Projected number of incident cancers in the full cohort, based on NYC cancer rates; (2) cancer incidence estimates in the subgroup projected using FDNY-WTCHP vs NYC rates; and (3) estimated first-year treatment costs of incident cancers. Results: On January 1, 2012, the cohort was 96.8% male, 87.1% white, and had a mean (SD) age of 50.2 (9.2) years. The projected number of incident cancer cases was 2960 (95% CI, 2883-3037). In our subgroup analyses using FDNY-WTCHP vs NYC cancer rates, the projected number of new cases in white men was elevated (2714 [95% CI, 2638-2786] vs 2596 [95% CI, 2524-2668]). Accordingly, we expect more prostate (1437 [95% CI, 1383-1495] vs 863 [95% CI, 816-910]), thyroid (73 [95% CI, 60-86] vs 57 [95% CI, 44-69]), and melanoma cases (201 [95% CI, 179-223] vs 131 [95% CI, 112-150), but fewer lung (237 [95% CI, 212-262] vs 373 [95% CI, 343-405]), colorectal (172 [95% CI, 152-191] vs 267 [95% CI, 241-292]), and kidney cancers (66 [95% CI, 54-80] vs 132 [95% CI, 114-152]) (P < .001 for all comparisons). The estimated 20-year cost of first-year treatment was $235 835 412 (95% CI, $187 582 227-$284 088 597). Conclusions and Relevance: We project that the FDNY-WTCHP cohort will experience a greater cancer burden than would be expected from a demographically similar population. This underscores the importance of cancer prevention efforts and routine screening in WTC-exposed rescue and recovery workers.

Mine rescuers' heat load during the expenditure of physical effort in a hot environment, using ventilated underwear and selected breathing apparatus.

Mine rescuers' heat load under the same physical effort load (25% of the maximal oxygen uptake), using three types of breathing apparatus, in newly developed heat-removing underwear and outerwear was assessed for typical work conditions of mine rescuers, under milder and harsher ambient conditions of 32 and 38 °C, respectively, both at relative humidity of 85% and air velocity of 1.0 m/s. Expending physical effort at the same load while using different kinds of breathing apparatus resulted in a similar heat load. Under both milder and harsher ambient conditions, heat storage and sweating intensity were greater than the average limit value recommended by hygienic standards, which indicates that the use of breathing apparatus significantly hinders heat exchange with the environment. The developed clothing for mine rescuers was highly rated, and was considered by most people to be better than that used currently.