Stress responses in surgical trainees during simulation-based training courses in laparoscopy.

BACKGROUND: Simulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees' stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees' stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting. METHODS: We conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants' stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored. RESULTS: Twenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05). CONCLUSION: Trainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees' stress response during simulation-based skills training courses.

Health promoting leadership practices in four Norwegian industries.

The aim of this article is to address health promoting leadership; what do leaders actually do to promote health at work? Leadership practice plays a crucial role in the workplace and greatly affects the working environment and working conditions. Through a theoretical and empirical approach, we seek to find characteristics/patterns of health promoting leadership. The definition of health promoting leadership is a democratic and supportive leadership style, where leaders seek to motivate and inspire their employees. The study in this article is based on qualitative research methods. We have investigated and compared leadership practice in four different organizations/industries in Norway: construction, oil and gas, health care and cleaning. These organizations and professions are quite different, and thus leadership must be understood and developed within its context. However, we found some generic characteristics of health promoting leadership: hands-on, accessible, supportive, inclusive and democratic. Current literature only rarely addresses how leadership affects health promotion at work. Consequently, more knowledge is needed about how leaders really succeed in creating healthy workplaces and healthy employees.

The dry-heat loss effect of melt-spun phase change material fibres.

Phase change materials (PCM) have the ability to store latent heat when they change phases, a property that gives clothing that incorporates PCM its cooling effect. This study investigated the effect of dry-heat loss (cooling) of a novel melt-spun PCM fibre on the basis of the area covered, mass, the latent heat of fusion and melting temperature, compared to a known PCM clothing product. PCM fibres with melting temperatures of 28.4 and 32.0°C and PCM packs with melting temperatures of 28.0 and 32.0°C were studied. The results showed that the PCM fibres had a larger initial peak cooling effect than that of the PCM packs. The duration of the cooling effect of PCM fibres was primarily dependent on the PCM mass and the latent heat of fusion capacity, and secondly on the covered area and melting temperature of the PCM. PRACTITIONER SUMMARY: This study investigates the cooling effect of PCM fibres on a thermal manikin. The PCM fibres had a high but short-lasting cooling effect. This study contributes to the knowledge of how the body's temperature regulation may be affected by the cooling properties of clothing that incorporates PCM.

Effect of ambient temperature on female endurance performance.

Ambient temperature can affect physical performance, and an ambient temperature range of -4 °C to 11 °C is optimal for endurance performance in male athletes. The few similar studies of female athletes appear to have found differences in response to cold between the genders. This study investigated whether ambient temperature affects female endurance performance. Nine athletes performed six tests while running on a treadmill in a climatic chamber at different ambient temperatures: 20, 10, 1, -4, -9 and -14 °C and a wind speed of 5 m s(-1). The exercise protocol consisted of a 10-min warm-up, followed by four 5-min intervals at increasing intensities at 76%, 81%, 85%, and 89% of maximal oxygen consumption. This was followed by an incremental test to exhaustion. Although peak heart rate, body mass loss, and blood lactate concentration after the incremental test to exhaustion increased as the ambient temperature rose, no changes in time to exhaustion, running economy, running speed at lactate threshold or maximal oxygen consumption were found between the different ambient temperature conditions. Endurance performance during one hour of incremental exercise was not affected by ambient temperature in female endurance athletes.

Heat strain in professional firefighters: physiological responses to a simulated smoke dive in extremely hot environments and the subsequent recovery phase.

Firefighters risk heat strain during occupational tasks when exposed to extremely hot environmental conditions and performing high-intensity work. Relevant training scenarios are therefore essential. This study investigated the effect of a single simulated smoke dive and the following recovery phase on physiological and perceptual responses. Nineteen professional male firefighters (43 ± 8 yr) performed a 2-min stair walk and a15-min simulated smoke dive in a two-floor heat chamber (110 °C to 272°C) (HEAT), followed by a 5-min stair walk outside the heat chamber. Heart rate (HR), gastrointestinal temperature (Tgi) and skin temperatures were registered continuously during the test. The Tgi increased significantly from the start (37.5 ± 0.3°C) to the end of HEAT (38.4 ± 0.4°C) and further increased after the heat exposure (39.6 ± 0.5°C).The HR also increased significantly from the start (92 ± 14 bpm) to the end of HEAT (185 ± 13 bpm) and increased after the heat exposure to a maximum of 190 ± 13 bpm. The simulated smoke dive induced high physiological strain on the firefighters, and the increase in Tgi and HR after the hot exposure must be considered during live fire events when repeated smoke dives are required.

Performance on a work-simulating firefighter test versus approved laboratory tests for firefighters and applicants.

AIM: Firefighters must meet minimum physical demands. The Norwegian Labour Inspection Authority (NLIA) has approved a standardised treadmill walking test and 3 simple strength tests for smoke divers. The results of the Trondheim test were compared with those of the NLIA tests taking into account possible effects of age, experience level and gender. METHODS: Four groups of participants took part in the tests: 19 young experienced firefighters, 24 senior male firefighters and inexperienced applicants, 12 male and 8 female. RESULTS: Oxygen uptake (VO2) at exhaustion rose linearly by the duration of the treadmill test. Time spent on the Trondheim test was closely related to performance time and peak VO2 on the treadmill test. Senior experienced firefighters did not perform better than equally fit young applicants. However, female applicants performed poorer on the Trondheim test than on the treadmill test. Performance on the Trondheim test was not closely related to muscle strength beyond a minimum. CONCLUSION. Firefighters completing the Trondheim test in under 19 min fit the requirements of the NLIA treadmill test. The Trondheim test can be used as an alternative to the NLIA tests for testing aerobic fitness but not for muscular strength. Women's result of the Trondheim test were poorer than the results of the NLIA treadmill test, probably because of their lower body mass.

Effect of ambient temperature on endurance performance while wearing cross-country skiing clothing.

This study assessed the effects of exposure to cold (-14 and -9 °C), cool (-4 and 1 °C) and moderate warm (10 and 20 °C) environments on aerobic endurance performance-related variables: maximal oxygen consumption (VO(2max)), running time to exhaustion (TTE), running economy and running speed at lactate threshold (LT). Nine male endurance athletes wearing cross-country ski racing suit performed a standard running test at six ambient temperatures in a climatic chamber with a wind speed of 5 m s(-1). The exercise protocol consisted of a 10-min warm-up period followed by four submaximal periods of 5 min at increasing intensities between 67 and 91 % of VO(2max) and finally a maximal test to exhaustion. During the time course mean skin temperature decreased significantly with reduced ambient temperatures whereas T (re) increased during all conditions. T (re) was lower at -14 °C than at -9 and 20 °C. Running economy was significantly reduced in warm compared to cool environments and was also reduced at 20 °C compared to -9 °C. Running speed at LT was significantly higher at -4 °C than at -9, 10 and 20 °C. TTE was significantly longer at -4 and 1 °C than at -14, 10 and 20 °C. No significant differences in VO(2max) were found between the various ambient conditions. The optimal aerobic endurance performance wearing a cross-country ski racing suit was found to be -4 and 1 °C, while performance was reduced under moderate warm (10 and 20 °C) and cold (-14 and -9 °C) ambient conditions.

Work strain and thermophysiological responses in Norwegian fish farming - a field study.

Fish farming is considered as a physical demanding occupation, including work operations with high workloads and awkward work positions for prolonged periods of time. Combined with potential challenging environmental conditions, these factors may negatively affect work performance, comfort and health. This study aimed to explore work strain and thermophysiological responses in Norwegian fish farming. Fourteen workers (age 35 ± 15 yrs) from four fish farms participated in the field studies, and measurements of heart rate (HR), core- and skin temperatures were registered continuously during a work shift. Questions about subjective thermal sensation and comfort were answered. This study has shown that workers at fish farms are periodically exposed to high or low levels of work strain, where the high workloads are manifested as increased core temperature and HR when working. The results are expected to give a better understanding of work strain and environmental challenges during fish farm operations.

Heat tolerance during uncompensable heat stress in men and women wearing firefighter personal protective equipment.

Firefighters run a risk of heat strain during occupational tasks. The number of female firefighters has been increasing, but research relevant to this group is still scarce. We aimed to investigate whether there are any sex differences in heat tolerance or physiological responses during uncompensable heat stress while wearing firefighter personal protective equipment. Twelve female (28 ± 7 years, 66 ± 5 kg, 51.7 ± 4.7 mL kg-1 min-1) and 12 male (27 ± 7 years, 83 ± 8 kg, 58.8 ± 7.5 mL kg-1 min-1) participants performed walking (maximum of 60 min) at 6W·kg-1, 40 °C, and 14% relative humidity. No differences were observed between groups in heat tolerance, rectal temperature, heart rate, percent body mass loss, thermal sensation, and rate of perceived exertion. Thus, when personnel are selected using gender-neutral physical employment standards, sex is not an independent factor influencing heat tolerance when wearing firefighter personal protective equipment during uncompensable heat stress.

Cognitive Performance During Night Work in the Cold.

Objective: The objective of this study was to investigate how night work at low ambient temperatures affects cognitive performance (short-term memory and reaction time), skin- and core temperature, thermal comfort, sleepiness, and cortisol. We hypothesized that cognitive performance is reduced at night compared with daytime and worsened when exposed to low ambient temperatures. Method: Eleven male subjects were recruited to perform three tests in a climatic chamber at night and daytime: Night -2°C, Night 23°C and Day 23°C. Each test lasted 6 h. Cognitive performance (short-term memory and reaction time), skin- and core temperature, thermal sensation and comfort, cortisol levels and sleepiness were measured during the tests. Results: A lower mean skin temperature and corresponding lower thermal sensation were observed at Night -2°C compared to Day 23°C and Night 23°C. Night work caused increased sleepiness and lower cortisol levels, but was not affected by changes in ambient temperatures, thermal comfort, or skin temperatures. There was no effect of either day/night work nor ambient temperature on the short-term memory or reaction time test. Conclusion: Lower skin- and core temperature were observed at night when exposed to low ambient temperature (-2°C), but there was no effect on short-term memory or reaction time. Increased sleepiness and lower cortisol levels were observed at night compared to daytime and was not influenced by low ambient temperature at night. The result from this study suggests that cognitive performance (short-term memory and reaction time) is not adversely affected by night work when exposed to low ambient temperatures if adequate protective clothing is worn.

Exposure to Bioaerosols During Fish Processing on Board Norwegian Fishing Trawlers.

OBJECTIVES: The main objective was to gain more knowledge on exposure to bioaerosols in the processing area on board fishing trawlers. METHODS: Exposure sampling was carried out during the work shifts when processing fish in the processing area on board five deep-sea fishing trawlers (trawlers 1-5). Exposure samples were collected from 64 fishermen breathing zone and from stationary sampling stations on board five deep-sea fishing trawlers (1-5). Trawlers 2, 3, and 4 were old ships, not originally built for on board processing of the catch. Trawlers 1 and 5 were relatively new and built to accommodate processing machineries. On trawlers 1-4 round fish was produced; the head and entrails were removed before the fishes were frozen in blocks. Trawler 5 had the most extensive processing, producing fish fillets. Samples were analysed for total protein, trypsin activity, parvalbumin, and endotoxin. One side analysis of variance and Kruskal-Wallis H test were used to compare levels of exposure on the different trawlers. RESULTS: Personal exposure to total protein were higher on the three oldest trawlers (2, 3, and 4) compared with the two new trawlers (1 and 5). Highest activity of trypsin was detected on the four trawlers producing round fish (1-4). Parvalbumin was detected in 58% of samples from the fillet-trawler (5) compared with 13% of samples from the four trawlers producing round fish. The highest level of endotoxin was detected when using high-pressure water during cleaning machines and floors in the processing area. CONCLUSIONS: Fishermen in the processing area on board Norwegian trawlers are exposed to airborne bioaerosols as proteins, trypsin, fish allergen parvalbumin, and endotoxin. Levels varied between trawlers and type of production.

Sickness Absence and Hospitalization among Workers on Board Norwegian Fishing Vessels.

Background: All over the world, commercial fishing is known to be a hazardous occupation. Although several causal analyses of occupational accidents have been published in recent years, knowledge of the prevalence of sick leave, diagnosis and hospitalization among workers on board Norwegian fishing vessels is still sparse.Objective: The objective of this study is to provide new knowledge about the prevalence of doctor-certified sick leave among Norwegian fishers compared to an age- and gender-matched control population. A comparison of diagnoses and hospitalizations between these groups is also presented.Methods: A sample of fishers (n = 25,971) was selected by Statistics Norway (SSB), based on occupation as fishers in 2008-2013. An age- and gender-matched control population (n = 77,913) was also selected. Outpatient consultation and hospitalization data were received from the Norwegian Patient Registry (NPR).Results: Fishers have significantly lower rates of sick leave than the general working population as a whole, but a significantly higher rate sick leave than an age- and gender-matched control population. The most common cause of sick leave in both fishers and controls was musculoskeletal problems. Fishers had a higher number of hospital stays than the control group; the stays were more often unscheduled and lasted longer than those of the control group.Conclusion: The results emphasize the continued need for preventive occupational health strategies in the fishing industry.

Physiological and perceptual strain of firefighters during graded exercise to exhaustion at 40 and 10 °C.

Purpose. To study whether perceptual identification should be included as a measure to evaluate physiological stress. Methods. Physiological variables oxygen uptake (VO2), ventilation, heart rate, blood lactate concentration, rectal temperature (Trec) and mean skin temperature, and perceptual variables rate of perceived exertion, thermal sensation and time to exhaustion, were measured at submaximal and maximal intensities during graded exercise on a treadmill to exhaustion in 12 firefighters wearing protective clothing and extra mass at 40 and 10 °C. Physiological strain index (PhSI) and perceptual strain index (PeSI) were calculated. Results. Apart from Trec, all physiological and perceptual variables were higher at submaximal intensities of 40 °C. Time to exhaustion was 16% shorter and the corresponding VO2 was reduced by 7% in the heat. A high correlation (r = 89) between PhSI and PeSI was found at both temperatures. PeSI scores were equal to PhSI at both ambient temperatures, except at the two highest intensities in the heat, where PeSI was higher. Conclusions. These findings support use of perceptual identification to evaluate physiological stress. However, at very high intensities under hot conditions the perceptual strain was estimated higher than the physiological strain. More precise indexes are needed to include perceptual measures in safety standard.

Musculoskeletal symptoms among workers in the commercial fishing fleet of Norway.

BACKGROUND: Fishers exposed to unfavourable environmental conditions may suffer negative health ef- fects. This study aimed to identify musculoskeletal symptoms in professional fishers in Norway using data from several sources; register data, telephone survey and questionnaire. MATERIALS AND METHODS: Professional fishers (n = 25,971) registered in the period 2008-2013 were selected by Statistics Norway (SSB). An age- and gender-matched control population (n = 77,913) was also selected. Outpatient consultation and hospitalisation data were received from the Norwegian Patient Registry (NPR). To obtain information about self-reported symptoms, 832 registered fishers on board Norwegian fishing vessels were interviewed by telephone, and a questionnaire was distributed to the crews of 5 trawlers (n = 153). RESULTS: Data from NPR showed that fishers, compared to the control population, suffered significantly more acute incidents related to musculoskeletal disorders (5.4% vs. 4.8%, respectively), injuries to arms (11.3% vs. 9.8%), feet (8.4% vs. 8%), and back (0.9% vs. 0.7%). In the telephone survey, 61% and 43% reported that they performed monotonous work operations and heavy lifting often or very often, respec- tively. Thirty-three per cent had experienced pain in neck/shoulders/arms often or very often during the previous 12 months, and 93% believed this was fully or partly due to their work situation. The questionnaire among trawler crew members showed that 57% and 60% had experienced stiffness and/or pain in neck/ /shoulders and lower back/small of the back respectively during the previous 12 months. CONCLUSIONS: Data from the register study, telephone survey and questionnaire all confirmed that musculo- skeletal problems are common among fishers and related to their work situation. However, 77% of the fishers in all vessel groups and on board the 5 trawlers reported their own health as being very good or good.

Physical activity levels among offshore fleet seafarers.

Advanced technology has rationalized and simplified operations at sea; however, this development has resulted in higher demands being made of the operator. Good health has become an important safety factor: a good state of health is crucial both to preventing strain injuries and to ensuring alertness and optimal performance at work. Physical activity is a powerful preventive "medicine" for the maintenance of good health and the prevention of overweight and musculoskeletal disorders. The aim of this paper is to analyse the habits and preferences of seafarers with regard to physical activity. Individual health factors, physical activity levels and work-related problems were surveyed on board vessels in a Norwegian shipping company. A questionnaire was completed by 577 seafarers. The results demonstrated that 70% of the respondents exercised twice or more times per week when at home, whereas only 39% exercised on board. Twenty per cent never exercised on board, and 5% never exercised at home. Walking is preferred by 70% of seafarers at home, as well as cycling and doing manual work. On board, walking, cycling and manual work are the most common types of exercise. Strength training is more often preferred on board than at home. Preventing illness and injury, a pleasant and inviting gym on board, and keeping weight under control are the three most important motivational factors. The results show that there is significant potential for improving and organising exercise-related activities on board as a means of maintaining good health and improving the performance of seafarers.

Safer work clothing for fishermen.

The fisherman's work environment consists of many potential risks. A study of occupational accidents in the Norwegian fishing industry in the nine-year period from 1998 to 2006 shows that more than 3/4 of the deaths were caused by loss of fishing vessel or man-overboard accidents. Furthermore, the greatest risk of drowning is found in the smallest fleet. The aim of our project was to develop safer work clothing and through this contribute to a reduction in work accidents and injuries in the fishing fleet. We considered that it is possible to produce protective work clothing that satisfies a specification of requirements covering the fishermen's needs for protection and comfort during work. An end user-centred process including twenty-three personal interviews and a questionnaire was used to clarify the fishermen's needs and wishes before detailed design and product development. We identified an overview of all the fishermen's needs for protection during work, and produced a prioritised list of functional requirements for the clothing. The results show that the clothing previously preferred by fishermen does not satisfy all the users' demands for safety, functionality and comfort. These demands have been taken into consideration when designing improved work clothing for the fishing fleet. A selected number of prototypes were developed on the basis of the established specification of requirements. The prototypes were evaluated according to the users' requirements through tests in SINTEF's Work Physiology Laboratory and on board fishing vessels. The results demonstrate that the new protective clothing satisfies the fishermen's requirements.

Thermophysiological responses and work strain in fishermen on deep-sea fishing vessels.

BACKGROUND: Fishermen working on deep-sea vessels in the Barents and Norwegian Sea are exposed to low air temperatures, strong winds, high humidity, rain, snow and work at different intensities. Few studies have investigated the effect of environmental work factors on the physiology of this occupational group. The aim of the study was to investigate work strain and thermophysiological responses of fishermen on the trawl and factory decks of deep-sea vessels. MATERIALS AND METHODS: Twenty-five professional male fishermen (age 39 ± 13 years) were recruited to the study which was performed on three trawlers in the Norwegian Sea in April, June and August 2014. During a six-hour shift, heart rate (HR), core (Tc) and mean skin (Ts) temperatures were recorded, and questions about subjective thermal sensation and comfort were answered. RESULTS: Short periods of hard (above 86% of HRmax) work raised Tc by 0.8°C to 37.8°C and decreased Ts by 2.3°C to 29.8°C during work on the trawl deck, and subjects reported being warm and sweaty. On the factory deck long periods of fairly light (between 52% and 66% HRmax) work, Tc of 37.4°C and Ts of 30.9°C were measured. CONCLUSIONS: Fishermen experience intermittent periods of heavy work on the trawl deck shown with elevated core temperature and HR. Work on the factory deck includes long periods of repetitive work with light to moderate work strain. A better understanding of work strain and environmental challenges during work on Norwegian deep-sea vessels will help identify exposure risks during work in the cold and heat.

Effects of montelukast and salmeterol on physical performance and exercise economy in adult asthmatics with exercise-induced bronchoconstriction.

STUDY OBJECTIVES: To compare the effect of montelukast and the long-acting beta(2)-agonist salmeterol on cardiopulmonary exercise economy and physical performance in adult patients with asthma during exercise. DESIGN AND PATIENTS: Asthmatic patients (n = 18), aged 18 to 35 years with exercise-induced bronchoconstriction (EIB), using a double-blind, double-dummy cross-over design. Montelukast, 10 mg/d, was compared to inhaled salmeterol, 50 microg bid. The study medication was administered for at least 5 days prior to testing, with a washout period of at least 5 days. Treadmill exercise tests (5.3% inclination, -15 degrees C ambient temperature) were performed at work loads of 80% of maximal oxygen uptake (Vo(2)max) [6 min], rest (4 min), 60% of Vo(2)max (6 min), and finally step increments until exhaustion. MEASUREMENTS AND RESULTS: We investigated parameters of gas exchange, physical performance, and lung function. After montelukast, the oxygen pulse was higher than after salmeterol, at 80% of Vo(2)max (p = 0.035), and 6 min at 60% of Vo(2)max (p = 0.011). Lung function during exercise, running time to exhaustion, Borg score, lactate levels, Vo(2)max, carbon dioxide elimination, minute ventilation, ventilatory equivalents, respiratory exchange ratio, and heart rate were not significantly different between the two treatments. The maximal postexercise fall in FEV(1) from baseline occurred 2 min after run to exhaustion, and was greater after salmeterol than after montelukast: mean, 16.2% (SD, 11.0) vs 10.0% (SD, 12.2) [p < 0.001]. CONCLUSIONS: In adult asthmatics with EIB, montelukast may have a more favorable effect on the oxygen pulse, thus suggesting improved gas exchange during exercise.

Comparison of three different prehospital wrapping methods for preventing hypothermia--a crossover study in humans.

BACKGROUND: Accidental hypothermia increases mortality and morbidity in trauma patients. Various methods for insulating and wrapping hypothermic patients are used worldwide. The aim of this study was to compare the thermal insulating effects and comfort of bubble wrap, ambulance blankets / quilts, and Hibler's method, a low-cost method combining a plastic outer layer with an insulating layer. METHODS: Eight volunteers were dressed in moistened clothing, exposed to a cold and windy environment then wrapped using one of the three different insulation methods in random order on three different days. They were rested quietly on their back for 60 minutes in a cold climatic chamber. Skin temperature, rectal temperature, oxygen consumption were measured, and metabolic heat production was calculated. A questionnaire was used for a subjective evaluation of comfort, thermal sensation, and shivering. RESULTS: Skin temperature was significantly higher 15 minutes after wrapping using Hibler's method compared with wrapping with ambulance blankets / quilts or bubble wrap. There were no differences in core temperature between the three insulating methods. The subjects reported more shivering, they felt colder, were more uncomfortable, and had an increased heat production when using bubble wrap compared with the other two methods. Hibler's method was the volunteers preferred method for preventing hypothermia. Bubble wrap was the least effective insulating method, and seemed to require significantly higher heat production to compensate for increased heat loss. CONCLUSIONS: This study demonstrated that a combination of vapour tight layer and an additional dry insulating layer (Hibler's method) is the most efficient wrapping method to prevent heat loss, as shown by increased skin temperatures, lower metabolic rate and better thermal comfort. This should then be the method of choice when wrapping a wet patient at risk of developing hypothermia in prehospital environments.

Comparison of thermal manikins of different body shapes and size.

Differences between manikins may be present due to manikin body shapes (male versus female). In order to examine such differences a study was designed. Comparisons were carried out based on: (1) tight versus loose clothing; (2) serial versus parallel calculation models; (3) even versus uneven clothing (insulation) distribution; and (4) the effect of donning clothes. Differences were observed between female and male manikins depending on body shape. However, these differences were within the range that was observed in the Subzero project, and were comparable with differences between manikins of male body shapes. Manikins behaved differently according to clothing adjustments. Tight-fitting clothes resulted in smaller differences. The effects of donning clothes were more pronounced with the serial calculation model, while the results generated by the serial and parallel calculation models differed more if the insulation was unevenly distributed (24% and 12% respectively). In order to examine the effect of body size, two baby manikins were compared to an adult manikin. The experimental conditions involved air layer insulation measurements (AL), lying on the back on an insulating surface (OB), and lying on the back on an insulating surface, covered with a sheet (OBS, baby manikins only). The acquired AL insulation for all manikins were very similar. The insulation value of adult manikin tested under condition OB differed from the others. This was related to flexible joints allowing the arms and legs to be in contact with the insulating surface, while baby manikins retained their arms and legs in the air. The baby manikins performed similarly in OBS tests.