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Physiological, psychophysical, and psychological responses of firefighters to firefighting training drills.

This study was designed to describe the physiological, psychophysical, and psychological responses of firefighters to firefighting drills in a training structure containing live fires. Fifteen male firefighters, wearing standard turnout gear which resulted in full encapsulation, performed two firefighting tasks (advancing fire hose, chopping wood) while inside the training structure. Measurements of heart rate, tympanic membrane temperature, blood lactate, perceptions of respiration, mood, perceived exertion, and thermal sensation were obtained after 8 min of advancing fire hose, and again after 8 min of chopping. Heart rate and temperature increased significantly from baseline and from advancing hose to wood chopping, whereas blood lactate increased initially after advancing the hose and remained elevated at the end of the chopping task. At the completion of the test (both tasks), mean heart rate (182.3 b.min-1), temperature (40.1 degrees C, [104.1 degrees F]), and blood lactate (3.8 mMol) suggested that the firefighting tasks used in this study impose considerable physiological strain on firefighters. Psychophysical and psychological data mirrored the greater physiological strain following firefighting tasks performed in a hot environment while wearing full turnout gear.

Adult↗

Impact of a modern firefighting protective uniform on the incidence and severity of burn injuries in New York City firefighters.

The New York City Fire Department (FDNY) is the largest fire department in the United States, with over 11,000 firefighters. In 1994, FDNY changed to a modern firefighting protective uniform. The major difference between traditional and modern uniforms is that modern uniforms include both protective over-coat and over-pant, whereas traditional uniforms include only the over-coat. Furthermore, modern uniforms are manufactured using improved thermal protective textiles that meet or exceed current National Fire Protection Association standards for structural firefighting. The purpose of this study was to determine the impact of the modern uniform on the incidence and severity of FDNY burn injuries. We also evaluated the incidence and severity of other non-burn injuries to determine whether there was serious adverse impact. The number of lower-extremity burns decreased by 85% when 2 years' experience while wearing the modern uniform was compared with 2 years while wearing the traditional uniform. Upper-extremity burns and head burns decreased by 65% and 40%, respectively. Severity indicators (days lost to medical leave, hospital admissions, and skin grafts) for lower- and upper-extremity burn injuries were all substantially reduced. This occurred without significant change in the incidence or severity of trunk burns, heat exhaustion, inhalation injuries (actually decreased), or cardiac events. The reduction in the incidence and severity of burn injuries, the major occupational injury affecting this workforce, has been so dramatic and without untoward effects that the introduction of the modern uniform must be characterized as a sentinel event in the history of firefighter health and safety.

Adult↗

Impact of a design modification in modern firefighting uniforms on burn prevention outcomes in New York City firefighters.

Our aim was to determine the impact of three different firefighting uniforms (traditional, modern, and modified modern) on the incidence and severity of thermal burn injuries, the major occupational injury affecting firefighters. Injury data were collected prospectively for the entire New York City Fire Department (FDNY) firefighting force wearing FDNY's traditional uniform (protective over-coat) from May 1, 1993 to August 31, 1993; FDNY's modern uniform (protective over-coat and over-pant) from May 1, 1995 to August 31, 1995; and FDNY's modified modern uniform (short sleeved shirt and short pants, rather than long-sleeved shirt and long pants, worn under firefighter's protective over-clothes) from May 1, 1998 to August 31, 1998. Outcome measures were burn incidence and severity. Adverse outcomes were heat exhaustion and cardiac events. During this 12-month study, 29,094 structural fires occurred. The incidence rate for upper extremity burns was 2341 per 100,000 fires and for lower extremity burns, 2076 per 100,000 fires. With the change from the traditional to modern uniform, the distribution of burns per fire decreased significantly (P = 0.001) for upper extremity burns (86%) and lower extremity burns (93%). With the change from traditional to modern uniform, days lost to medical leave for upper or lower extremity burns decreased by 89%. The majority of burns occurred at the lower arm and mid-leg, and the change to the modern uniform decreased such burns by 87% and 92%. Burn incidence and severity were not significantly affected by the change to the modified modern uniform. The distribution of heat exhaustion or cardiac events per fire was not significantly affected by the change from the traditional to modern uniform, and heat exhaustion was decreased (P < 0.001) by the change to the modified modern uniform. In conclusion, the modern uniform dramatically reduced burn incidence and severity without adverse impact. The modified modern uniform significantly reduced heat exhaustion without significantly affecting thermal protection.

Adult↗

Failing firefighters: a survey of causes of death and ill-health retirement in serving firefighters in Strathclyde, Scotland from 1985-94.

During the decade beginning 1 January 1985, 887 full-time firefighters, all male, left the service of Strathclyde Fire Brigade (SFB). There were 17 deaths--compared to 64.4 expected in the Scottish male population aged 15-54 years--giving a standardized mortality ratio (SMR) of 26, and 488 ill-health retirements (IHR). None of the deaths was attributable to service, the major causes being: myocardial infarction--five, (expected = 17.3; SMR = 29); cancers--three (colon, kidney and lung) (expected = 13.6; SMR = 22); road traffic accidents--two (expected = 4.17; SMR = 48) and suicide--two (expected = 4.9; SMR = 41). Amalgamating the deaths and IHRs showed that the six most common reasons for IHR were musculoskeletal (n = 202, 40%), ocular (n = 61, 12.1%), 'others' (n = 58, 11.5%), injuries (n = 50, 9.9%), heart disease (n = 48, 9.5%) and mental disorders (n = 45, 8.9%). Over 300 IHRs (over 60%) occurred after 20 or more years service. When the IHRs were subdivided into two quinquennia, there were 203 and 302 in each period. Mean length of service during each quinquennium was 19.4 vs. 21.3 years (p = 0.003) and median length was 21 years in both periods; interquartile range was 12-26 years in the first and 17-27 years in the second period (p = 0.002), but when further broken down into diagnostic categories, the differences were not statistically significant, with the exception of means of IHRs attributed to mental disorders (14.5 vs. 19 years, p = 0.03).

Adult↗

[Abnormalities of respiratory function in civil defence firefighter-submarine divers. Respective role of diving and occupational exposure related to occupational firefighter's functions].

Lung function was studied in 20 firemen-submarine divers (mean age 36 +/- 1.2 years) of the French civil defence undergoing the medical check-up compulsory for professional divers (lung function tests are not systematically performed in ordinary firemen). Compared with the CECA standards: (1) vital capacity (VC) was increased, residual volume (RV) was decreased and total lung capacity (TLC) was unchanged; (2) with the exception of peak respiratory flow, all expiratory flow values (FEV1, MEF50, MEF25) were decreased; (3) the permeability factor (KCO) was decreased. These functional abnormalities were moderately worse in subjects who smoked. Some abnormalities (increased VC, decreased RV) are typical of diving activities, but the deterioration of effort-dependent expiratory flow values and alveolar-capillary diffusion must be ascribed to specific nuisances (fumes, polluants, toxic substances) associated with fireman's activities. Monitoring lung function in all professional firemen therefore seems to be necessary, if not indispensable.

Adult↗

The incidence, prevalence, and severity of sarcoidosis in New York City firefighters.

OBJECTIVE: The etiology of sarcoidosis is unknown, but epidemiology suggests that environmental agents are a factor. Because firefighters are exposed to numerous toxins, we questioned whether sarcoidosis was increased in this cohort. SETTING: The New York City Fire Department (FDNY), employing > 11,000 firefighters and nearly 3,000 emergency medical services (EMS) health-care workers (HCWs). DESIGN: In 1985, FDNY initiated a surveillance program to determine the incidence, prevalence, and severity of biopsy-proven sarcoidosis in firefighters. In 1995, EMS HCWs were added as control subjects. RESULTS: Between 1985 and 1998, 4 prior cases and 21 new cases of sarcoidosis were found in FDNY firefighters. Annual incidence proportions ranged from 0 to 43.6/100,000, and averaged 12.9/100,000. On July 1, 1998, the point prevalence was 222/100,000. For EMS HCWs, annual incidence proportions were zero. Radiographic stage 0 or stage 1 sarcoidosis was found in 19 firefighters (76%), and stage 3 was found in 1 firefighter (4%). Pulmonary function (FVC, FEV(1), and diffusing capacity for carbon monoxide) was normal in 17 firefighters (68%), and reduced to </= 65% predicted in 2 firefighters (8%). Maximum oxygen consumption (MVO(2)) was normal in 10 of 17 firefighters (59%), and reduced to 65% predicted in 3 firefighters (12%). Five of seven firefighters (71%) with abnormal MVO(2) had gas exchange abnormalities, and none had O(2) desaturation. All returned to fire fighting. CONCLUSIONS: Annual incidence proportions and point prevalence were increased in FDNY firefighters as compared to EMS HCWs and historical controls. Radiographs and physiologic measurements demonstrated only minimal impairment.

Adult↗

Human factors in firefighting: ergonomic-, cardiopulmonary-, and psychogenic stress-related issues.

There are many issues in firefighting that involve human factors and cardiopulmonary conditioning. Population-based mortality and disability surveillance studies suggest a relatively small but significant excess of disability but not mortality from nonmalignant cardiovascular disease for firefighters. More targeted cohort and case-control studies do not support such an excess and instead suggest a strong healthy worker effect. Pulmonary function among firefighters has been extensively studied, with contradictory findings. Extreme exposures and long-term exposure in combination with cigarette smoking may be risk factors for respiratory disorders and accelerated decline in airflow. It appears likely that individual firefighters who show early signs of illness are often selectively transferred out of active firefighting positions. Despite exposure to substances such as carbon monoxide that may predispose to cardiovascular mortality and morbidity, excesses are not consistently shown in mortality studies. Clinical studies of individual firefighters do suggest an elevated risk for myocardial ischemia. The ergonomic demands of firefighting are extreme at peak activity because of high energy costs for activities such as climbing aerial ladders, the positive heat balance from endogenous and absorbed environmental heat, and encumbrance by bulky but necessary protective equipment. The psychological stresses of firefighting include long periods of relative inactivity punctuated by highly stressful alarms and extremely stressful situations such as rescues, as reflected in physiological and biochemical indicators. Firefighters are at risk for depression and post-traumatic stress disorder, although morale overall is generally much higher than in comparable occupations. Women firefighter candidates as a group perform less well on selection test simulating the demands of active firefighting, but some individual women perform very well.

Cardiovascular Diseases↗

Investigation of a unique time-space cluster of sarcoidosis in firefighters.

A unique cluster of three cases of sarcoidosis developed recently among 10 white firefighters who trained together as apprentices in 1979. This led us to hypothesize that firefighters are at increased risk of this condition because of the combined effect of smoke exposure and infection with a communicable agent, such as Chlamydia pneumoniae, a recently proposed cause of sarcoidosis. We conducted a case-finding questionnaire survey of 1,282 active and retired male Providence firefighters and police officers and then evaluated both the index apprenticeship class and two control cohorts by chest radiography, seromarkers of T lymphocyte activation (neopterin and sIL-2R), and chlamydial serology. One additional case of sarcoidosis was identified among the 990 (77%) survey respondents. No new cases were detected in the subsequent laboratory investigation of 46 (87%) firefighters from the index 1979 apprenticeship class, 53 (75%) firefighter controls from the 1974 and 1980 classes, or 50 (30%) police officer controls from 1973-1981 classes. The cohorts did not differ with regard to either C. pneumoniae antibody titers or sIL-2R levels, but serum neopterin was elevated (> 9.0 nmol/L) in 20% (eight of 41) of the index cohort, 22% (11 of 51) of firefighter controls, and 4% (two of 48) of police officers. Logistic regression found firefighting to be the only significant predictor of neopterin elevation (odds ratio 5.8; 95% CI, 1.3 to 26.9). Our results suggest that firefighters may be at risk of T lymphocyte activation. Determining whether this reflects an enhanced risk of lymphocytic alveolitis and whether firefighters are more likely to develop sarcoidosis requires further study.

Adult↗

Engineering excellence: options to enhance firefighter compliance with standing orders for first-responder defibrillation.

STUDY OBJECTIVE: To assess the quality of care delivered during first-responder defibrillation and to determine the potential efficacy of modifying existing automated external defibrillator designs to improve first-responder performance. DESIGN: Prospective case series. SETTING: An urban emergency medical services system providing first-responder defibrillation and paramedic care. TYPE OF PARTICIPANTS: Firefighters who completed a four-hour (two-session) course in automated external defibrillator operation. METHODS: Heartstart 2000 defibrillators (Laerdal Medical Corp, Armonk, New York) were used in 241 consecutive resuscitation attempts. Written reports and memory module printouts were abstracted to assess firefighter performance of 11 critical actions. The firefighter's response to each opportunity to perform a critical action was scored using explicit pass/fail criteria. RESULTS: Records of 235 automated external defibrillator uses (97.5%) were submitted for analysis. Firefighters shocked within 15 seconds of a "shock indicated" message in 95% of opportunities and reanalyzed the rhythm within 90 seconds of the third consecutive shock (ie, after one minute of CPR) in 80% of cases. However, firefighters reanalyzed the patient's rhythm too soon in 75% of cases, thereby interfering with recommended intervals of CPR. Firefighters failed to reanalyze the patient's rhythm after device-initiated "check patient" prompts 62% of the time. Memory modules were left in the automated external defibrillator during practice sessions in 64 cases, decreasing available memory to monitor automated external defibrillator use in the field. Three instances of failure to withhold CPR during rhythm analysis resulted in a single inappropriate patient shock. No firefighter was shocked inadvertently. CONCLUSION: Current device algorithms result in effective delivery of the initial three shocks. However, firefighters often fail to interpose recommended intervals of CPR between further attempts at defibrillation. Modification of existing device algorithms to provide additional visual and auditory cues may be preferable to relying on the user to recall accurately all the steps in this infrequently performed procedure.

Allied Health Personnel↗

The short-term effects of smoke exposure on the pulmonary function of firefighters.

The short-term effects of smoke inhalation have been little studied. This study evaluated whether firefighters experience a significant change in spirometric values following exposure to smoke from a fire. Sixty firefighters from the city of Pittsburgh completed a questionnaire (Medical Research Council) and underwent spirometric testing following exposure to house fires. The group contained 25 current smokers, 14 ever smokers, and 21 never smokers. Firefighters reporting cough, phlegm, breathlessness, and chest illnesses were more likely to be current or ever smokers than never smokers. Mean spirometric data obtained before exposure, after a minimum of four off-duty days, showed the following: FVC, 4.50 +/- 0.60L (90 percent of predicted); FEV1, 3.65 +/- 0.56L (96 percent of predicted); FEV1/FVC, 81 +/- 8 percent (106 percent of predicted); FEF25-75%, 3.71 +/- 1.13L/s (96 percent of predicted); and PEF, 7.95 +/- 1.70L/s (87 percent of predicted). After exposure, spirometry was performed on 22 firefighters. All spirometric values decreased after exposure; however, a significant decline was only seen in two indices, the FEV1 and FEF25-75%. This decline was small (3 to 11 percent). Two firefighters experienced an exaggerated decline in spirometric values after exposure, compared to the group as a whole. Neither age, smoking history, location of firefighting, intensity of smoke exposure, or use of a self-contained breathing apparatus explained the reasons for the greater decline in these two individuals. Thus, while firefighters do experience a small decrease in pulmonary function after exposure to house fires, there appears to be a small subgroup of firefighters who develop more substantial and potentially clinically important decreases in pulmonary function after smoke exposure.

Adult↗

Acute health hazards of firefighters after fighting a department store fire.

The purpose of this study was to evaluate the health hazards of firefighters after fighting a department store fire which lasted for 40 hours. Respiratory symptoms of 168 firefighters were collected and the pulmonary functions of 149 firefighters were measured by spirometer two days after fighting the fire and compared to 32 controls. The principal symptoms manifested by firefighters were burning eyes and mucous membrane irritation. Cross-sectional study of the pulmonary functions showed that FEV1.0, FEV1.0/FVC and the flow rates (MMF, FEF25%, and FEF75%) in smoking exposed firefighters were significantly lower than those in smoking controls. However, only FEV1.0 (%) was significantly lower in nonsmoking exposed firefighters than in nonsmoking controls. Both FVC and FEV1.0 showed a declining trend with the duration of fire fighting. This study provides further evidence that firefighters are exposed to irritants during fighting a fire. Exposure to the combustion products could lead to pulmonary function defects, especially in smoking firefighters.

Case-Control Studies↗

Fit-testing for firefighters.

When fit-testing firefighters who may be required to wear an SCBA unit in the positive pressure mode for IDLH or structural firefighting applications, use these guidelines. 1. The firefighter shall be allowed to pick the most acceptable respirator from a sufficient number of respirator models and sizes so the respirator is acceptable to, and correctly fits, the firefighter. 2. Before a firefighter may be required to use the SCBA, he/she must be fit-tested with the same make, model, style, and size of respirator that will be used. If different makes, models, styles, and sizes of facepieces are used, the firefighter must be fit-tested for each. 3. Based on current interpretations and guidance, OSHA requires firefighters to be quantitatively or qualitatively fit-tested while in the negative pressure mode. 4. Quantitative fit-testing of these respirators shall be accomplished by modifying the facepiece to allow sampling inside the facepiece and breathing zone of the user, midway between the nose and mouth. This requirement shall be accomplished by installing a permanent sampling probe onto a surrogate facepiece or by using a sampling adapter designed to temporarily provide a means of sampling air from inside the facepiece. 5. Qualitative fit-testing can be accomplished by converting the user's actual facepiece into a negative pressure respirator with appropriate filters or by using an identical negative pressure air-purifying respirator facepiece with the same sealing surfaces as a surrogate for the SCBA facepiece. 6. If after passing the fit-test the firefighter subsequently determines the fit of the respirator is unacceptable, he/she shall be given a reasonable opportunity to select a different respirator facepiece and be retested. 7. The new standard requires initial and at least annual fit-testing using quantitative or qualitative fit-testing protocols. 8. Additional fit-testing may be required whenever physical changes to the employee occur that may affect respirator fit, such as facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight.

Female↗

Acute effects of routine firefighting on lung function.

We undertook a study to determine the acute effects of routine firefighting on lung function and the relationship between these acute effects and nonspecific airway responsiveness. For 29 firefighters from a single fire station, we calculated the concentration of methacholine aerosol that caused a 100% increase in specific airway resistance (Pc100). Over an 8-week period we than measured FEV1 and FVC in each firefighter before and after each 24-hr workshift and after every fire. From 199 individual workshifts without fires, we calculated the mean +/- 2 SD across-workshift change in FEV1 and FVC for each firefighter. Eighteen of 76 measurements obtained within 2 hr after a fire (24%) showed a greater than 2 SD fall in FEV1 and/or FVC compared to two of 199 obtained after routine workshifts without fires (1%; p less than .001). On 13 of 18 occasions when spirometry decreased significantly, we obtained repeat spirometry (postshift) 3-18.5 hr after fires, and on four of these occasions FEV1 and/or FVC were still more than 2 SD below baseline. Decrements in spirometry occurred as often in firefighters with high Pc100s as in those with low Pc100s. In two firefighters in whom FEV1 and FVC fell by more than 10% after fires, we repeated measurements of methacholine sensitivity, and it was increased over the prestudy baseline. These findings suggest that routine firefighting is associated with a high incidence of acute decrements in lung function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Mortality among Boston firefighters, 1915--1975.

Although the nature of firefighting involves particular health hazards, previous mortality and morbidity studies of firemen have produced inconsistent evidence for an increased risk of mortality from cardiovascular disease, respiratory disease, cancer and accidents. Mortality experience since 1915 has been examined in 5655 Boston firefighters, comprising all male members of the city fire department with three or more years of service. The observed cause of death as stated on the death certificates of 2470 deceased firefighters has been compared with the numbers expected based on rates for the male population of Massachusetts and of the United States of America. Among all firefighters, deaths from all causes were 91% of expected. The standardised mortality ratio (SMR) was markedly reduced (less than 50) for infectious disease, diabetes, rheumatic heart disease, chronic nephritis, blood diseases and suicide. The SMR was 86 for cardiovascular deaths, 83 for neoplastic deaths, and 93 for respiratory deaths. The SMR for accidents was 135 for active firefighters. The results suggest that the survival experience of firefighters is strongly influenced by strict entry selection procedures, ethnic derivation, and sociocultural attributes of membership. While excessive morbidity has been demonstrated in firefighters, there does not appear to be a strong association between occupation and cause-specific mortality.

Accidents, Occupational↗

Prevalence of symptoms of posttraumatic stress disorder in German professional firefighters.

OBJECTIVE: This study investigated the prevalence of posttraumatic stress disorder (PTSD) and comorbid symptoms among professional firefighters in Germany and examined not only primary but also secondary traumatic stress disorder experienced by these firefighters who were exposed to the sufferings of others. METHOD: To estimate the prevalence of trauma-related disorders, a representative group of 402 professional firefighters from the State of Rheinland-Pfalz in Germany was surveyed through use of the General Health Questionnaire, a PTSD Symptom Scale, a stress coping questionnaire, and a self-rating scale to assess bodily complaints. RESULTS: The current prevalence rate of PTSD symptoms among professional firefighters was 18.2%. About 27% of the recruited subjects had a mental disorder according to the General Health Questionnaire. Predictors for the extent of traumatic stress were longer job experience and the number of distressing missions during the last month. Traumatic stress also predicted psychiatric impairment beyond PTSD, such as depressive mood, psychosomatic complaints, social dysfunction, and substance abuse. CONCLUSIONS: The high prevalence of PTSD and other psychiatric impairments in firefighters indicates that they often fail to cope with primary and particularly secondary stress in their daily work. This problem, together with the individual psychological consequences and expenses related to work absenteeism and early retirement, seems to be very specific for the profession of firefighters. The present findings provide a better understanding of the relationship between secondary traumatic stress and PTSD in professional helpers and high-risk populations such as firefighters, emergency workers, and the police.

Adaptation, Psychological↗

Use of contact lenses by firefighters. Part 1: Questionnaire data.

The use of contact lenses by firefighters is currently prohibited. However, many firefighters may benefit from this form of visual correction, without predisposing themselves to additional risk. Visual benefits gained by contact lens wear may increase a firefighter's safety. To determine if it is safe to allow firefighters to use contact lenses 29 were fitted with soft contact lenses and 21 with rigid gas permeable contact lenses. Questionnaires were completed prior to fitting, after 1, 4 and 10 months of contact lens wear. Both soft contact lens (SCL) wearers, and rigid gas permeable contact lens (RGPCL) wearers showed a statistically significantly reduction in the frequency with which they experience irritable foreign bodies and irritant fumes in the eyes, compared to not wearing contact lenses. Firefighters felt that their performance on the fireground had been improved by the use of contact lenses. SCL wearers also benefited from a reduction in the frequency with which they experienced watery eyes and ocular discomfort. There were significantly fewer problems encountered with SCL wearers than RGPCL wearers. The frequency with which firefighters experienced lenses falling out, lens displacement, watery eyes, ocular discomfort, and operational difficulties was significantly less for the SCL group than the RGPCL group. SCL appear to offer considerable benefits for firefighters with refractive error, but their use cannot be sanctioned without assessment of their effect on the ocular adnexa.

Adult↗

Mortality in police and firefighters in New Jersey.

A proportionate mortality study of police and firefighters in New Jersey was conducted using the records of a comprehensive retirement system. Three reference populations were used: U.S. general population, New Jersey general population, and police as a reference group for the firefighters. Overall neither group differed from the New Jersey male population in the cause of death. Analyses by latency showed an increase in skin cancer and cirrhosis in firefighters and cirrhosis in police. With increased time from first employment, an inverse association was found between heart disease and time of first exposure. This was reflected in statistically significant increased proportionate mortality rates (PMR) for arteriosclerotic heart disease (ASHD) (ICD 410-414) for both working police (PMR = 1.15) and firefighters (PMR = 1.2). Retired police and firefighters had PMRs of 0.96 and 0.98, respectively. Firefighters had a significant increase in nonmalignant respiratory disease (PMR = 1.98) and leukemia (PMR = 2.76) when the police were used as a reference group. Potential causes of the above findings are discussed.

Adult↗

The effects of different thermal environments on the physiological and psychological responses of firefighters to a training drill.

Little is known about the impact of thermoregulatory demands on cardiovascular and psychological responses of firefighters during firefighting activities. This study examined selected responses to a training drill in different thermal environments. Male firefighters (n = 16) were randomly assigned to perform a simulated ceiling overhaul task for 16 min in either a neutral (13.7 degrees C) or hot (89.6 degrees C) condition while wearing standard firefighting turnout gear. Physiological and psychological measures were assessed before, after 8 min and 16 min of firefighting activity, and following a 10-min recovery period. The variables assessed included heart rate (HR), tympanic temperature (Ttymp), lactate level (LAC), blood glucose level, ratings of perceived exertion (RPE), perceptions of respiration, thermal sensations (TS) and state anxiety (SA). Significant increases were seen for HR, Ttymp, LAC, RPE and SA, with the increases being much greater following the hot condition. Recovery was significantly slower following work in the hot condition. These findings suggest that the addition of a live fire (a common situation for firefighters) contributes to increased cardiovascular and psychological strain at a standardized workload.

Adult↗