Protection against cold in prehospital care: wet clothing removal or addition of a vapor barrier.

OBJECTIVE: The purpose of this study was to evaluate the effect of wet clothing removal or the addition of a vapor barrier in shivering subjects exposed to a cold environment with only limited insulation available. METHODS: Volunteer subjects (n = 8) wearing wet clothing were positioned on a spineboard in a climatic chamber (-18.5°C) and subjected to an initial 20 minutes of cooling followed by 30 minutes of 4 different insulation interventions in a crossover design: 1) 1 woolen blanket; 2) vapor barrier plus 1 woolen blanket; 3) wet clothing removal plus 1 woolen blanket; or 4) 2 woolen blankets. Metabolic rate, core body temperature, skin temperature, and heart rate were continuously monitored, and cold discomfort was evaluated at 5-minute intervals. RESULTS: Wet clothing removal or the addition of a vapor barrier significantly reduced metabolic rate (mean difference ± SE; 14 ± 4.7 W/m(2)) and increased skin temperature rewarming (1.0° ± 0.2°C). Increasing the insulation rendered a similar effect. There were, however, no significant differences in core body temperature or heart rate among any of the conditions. Cold discomfort (median; interquartile range) was significantly lower with the addition of a vapor barrier (4; 2-4.75) and with 2 woolen blankets (3.5; 1.5-4) compared with 1 woolen blanket alone (5; 3.25-6). CONCLUSIONS: In protracted rescue scenarios in cold environments with only limited insulation available, wet clothing removal or the use of a vapor barrier is advocated to limit the need for shivering thermogenesis and improve the patient's condition on admission to the emergency department.

Validation of standard ASTM F2732 and comparison with ISO 11079 with respect to comfort temperature ratings for cold protective clothing.

American standard ASTM F2732 estimates the lowest environmental temperature for thermal comfort for cold weather protective clothing. International standard ISO 11079 serves the same purpose but expresses cold stress in terms of required clothing insulation for a given cold climate. The objective of this study was to validate and compare the temperature ratings using human subject tests at two levels of metabolic rates (2 and 4 MET corresponding to 116.4 and 232.8 W/m(2)). Nine young and healthy male subjects participated in the cold exposure at 3.4 and -30.6 °C. The results showed that both standards predict similar temperature ratings for an intrinsic clothing insulation of 1.89 clo and for 2 MET activity. The predicted temperature rating for 2 MET activity is consistent with test subjects' thermophysiological responses, perceived thermal sensation and thermal comfort. For 4 MET activity, however, the whole body responses were on the cold side, particularly the responses of the extremities. ASTM F2732 is also limited due to its omission and simplification of three climatic variables (air velocity, radiant temperature and relative humidity) and exposure time in the cold which are of practical importance.

Validity and reliability of the Cold Discomfort Scale: a subjective judgement scale for the assessment of patient thermal state in a cold environment.

Complementary measures for the assessment of patient thermoregulatory state, such as subjective judgement scales, might be of considerable importance in field rescue scenarios where objective measures such as body core temperature, skin temperature, and oxygen consumption are difficult to obtain. The objective of this study was to evaluate, in healthy subjects, the reliability of the Cold Discomfort Scale (CDS), a subjective judgement scale for the assessment of patient thermal state in cold environments, defined as test-retest stability, and criterion validity, defined as the ability to detect a difference in cumulative cold stress over time. Twenty-two healthy subjects performed two consecutive trials (test-retest). Dressed in light clothing, the subjects remained in a climatic chamber set to -20 °C for 60 min. CDS ratings were obtained every 5 min. Reliability was analysed by test-retest stability using weighted kappa coefficient that was 0.84 including all the 5-min interval measurements. When analysed separately at each 5-min interval the weighted kappa coefficients were was 0.48-0.86. Criterion validity was analysed by comparing median CDS ratings of a moving time interval. The comparison revealed that CDS ratings were significantly increased for every interval of 10, 15, and 30 min (p < 0.001) but not for every interval of 5 min. In conclusion, in a prehospital scenario, subjective judgement scales might be a valuable measure for the assessment of patient thermal state. The results of this study indicated that, in concious patients, the CDS may be both reliable and valid for such purpose.

Effects of various protective clothing and thermal environments on heat strain of unacclimated men: the PHS (predicted heat strain) model revisited.

Five protective garments (light summer clothing L, high visibility clothing HV, military clothing MIL, climber coverall CLM and firefighting clothing FIRE) were assessed on eight unacclimated male subjects at two environments: moderate warm environment with high humidity (MWH, 20.0°C, 86% relative humidity) and warm environment with moderate humidity (WMH, 30.0°C, 47% relative humidity). The thermophysiological responses and subjective sensations were reported. The PHS model (ISO7933) was used for predicting thermophysiological responses for each testing scenario. It was found that there were significant differences between clothing FIRE and other clothing on thermal sensation (p<0.05). Significant differences were found on skin humidity sensation between FIRE and L, HV or MIL (p<0.001). The RPE value in FIRE is significantly different with L and HV (p<0.05). In MWH, the post-exercise mean skin temperatures increased by 0.59 and 1.29°C in MIL and CLM. In contrast, mean skin temperatures in L, HV, MIL, CLM and FIRE in WMH increased by 1.7, 2.1, 2.1, 2.8 and 3.3°C, respectively. The PHS model presented good performance on predicted mean skin temperatures in MIL and CLM at the two studied environments. However, the skin temperature prediction with light clothing in WMH was weak. For thick protective clothing, the prediction on rectal temperature was protective. It is thus concluded that the results generated by the PHS model for high insulating clothing and measurements performed in high humidity environments should be explained with caution.

The Universal Thermal Climate Index UTCI compared to ergonomics standards for assessing the thermal environment.

The growing need for valid assessment procedures of the outdoor thermal environment in the fields of public weather services, public health systems, urban planning, tourism & recreation and climate impact research raised the idea to develop the Universal Thermal Climate Index UTCI based on the most recent scientific progress both in thermo-physiology and in heat exchange theory. Following extensive validation of accessible models of human thermoregulation, the advanced multi-node 'Fiala' model was selected to form the basis of UTCI. This model was coupled with an adaptive clothing model which considers clothing habits by the general urban population and behavioral changes in clothing insulation related to actual environmental temperature. UTCI was developed conceptually as an equivalent temperature. Thus, for any combination of air temperature, wind, radiation, and humidity, UTCI is defined as the air temperature in the reference condition which would elicit the same dynamic response of the physiological model. This review analyses the sensitivity of UTCI to humidity and radiation in the heat and to wind in the cold and compares the results with observational studies and internationally standardized assessment procedures. The capabilities, restrictions and potential future extensions of UTCI are discussed.

Effects of heat stress on working populations when facing climate change.

It is accepted that the earth's climate is changing in an accelerating pace, with already documented implications for human health and the environment. This literature review provides an overview of existing research findings about the effects of heat stress on the working population in relation to climate change. In the light of climate change adaptation, the purpose of the literature review was to explore recent and previous research into the impacts of heat stress on humans in an occupational setting. Heat stress in the workplace has been researched extensively in the past however, in the contemporary context of climate change, information is lacking on its extent and implications. The main factors found to exacerbate heat stress in the current and future workplace are the urban 'heat island effect', physical work, individual differences, and the developing country context where technological fixes are often not applicable. There is also a lack of information on the effects on vulnerable groups such as elderly people and pregnant women. As increasing temperatures reduce work productivity, world economic productivity could be condensed, affecting developing countries in the tropical climate zone disproportionately. Future research is needed taking an interdisciplinary approach, including social, economic, environmental and technical aspects.

Evaporative cooling: effective latent heat of evaporation in relation to evaporation distance from the skin.

Calculation of evaporative heat loss is essential to heat balance calculations. Despite recognition that the value for latent heat of evaporation, used in these calculations, may not always reflect the real cooling benefit to the body, only limited quantitative data on this is available, which has found little use in recent literature. In this experiment a thermal manikin, (MTNW, Seattle, WA) was used to determine the effective cooling power of moisture evaporation. The manikin measures both heat loss and mass loss independently, allowing a direct calculation of an effective latent heat of evaporation (λeff). The location of the evaporation was varied: from the skin or from the underwear or from the outerwear. Outerwear of different permeabilities was used, and different numbers of layers were used. Tests took place in 20°C, 0.5 m/s at different humidities and were performed both dry and with a wet layer, allowing the breakdown of heat loss in dry and evaporative components. For evaporation from the skin, λeff is close to the theoretical value (2,430 J/g) but starts to drop when more clothing is worn, e.g., by 11% for underwear and permeable coverall. When evaporation is from the underwear, λeff reduction is 28% wearing a permeable outer. When evaporation is from the outermost layer only, the reduction exceeds 62% (no base layer), increasing toward 80% with more layers between skin and wet outerwear. In semi- and impermeable outerwear, the added effect of condensation in the clothing opposes this effect. A general formula for the calculation of λeff was developed.

A laboratory validation study of comfort and limit temperatures of four sleeping bags defined according to EN 13537 (2002).

In this study, we validated comfort and limit temperatures of four sleeping bags with different levels of insulation defined according to EN 13537. Six male subjects and four female subjects underwent totally 20 two-hour exposures in four sleeping bags at four intended testing temperatures: 11.2, 3.8, 2.1 and -9.0 °C. The subjective perceptions and physiological responses of these subjects were reported and analyzed. It was found that the EN 13537 defined comfort temperature and limit temperature were underestimated for sleeping bags MA3, HAG and MAM. The predictions are so conservative that further revision may be required to meet the requirements of both manufacturers and consumers. In contrast, for the sleeping bag MA0 with a low level of insulation, the limit temperature defined by EN 13537 was slightly overestimated. In addition, two individual case studies (-28.0 and -32.0 °C) demonstrated that low toe temperatures were widely observed among the male and female subjects, although the mean skin temperatures were almost within the thermoneutrality range (32.0-34.0 °C). It seems that the IREQ model (ISO 11079) overestimated both the comfort and limit temperatures of the sleeping bags. Finally, traditional sleeping bags may be required to be re-designed to provide consumers both whole body comfort as well as local thermal comfort at feet/toes or users need to be made aware of the higher need for their insulation.

Thermal responses to whole-body cooling in air with special reference to arteriovenous anastomoses in fingers.

The arteriovenous anastomoses (AVAs) in the distal parts of the extremities play a significant role in the heat exchange with the environment. The aim of the study was to examine the thermal responses to whole-body cooling in air, and especially the behaviour of finger skin temperature (T(f) , rich in AVAs). Eight young men sat in minimal clothing at 32°C air temperature (T(a) ), which was then lowered gradually to 13°C in 100 min. In the beginning of cooling, T(f) was high and fluctuating, and then suddenly exhibited a rapid fall, while temperatures in other skin sites fell fairly linearly along decreasing T(a) to the end of cooling. During the period from start to the rapid fall in T(f) , rectal temperature decreased from 37·4°C (SD 0.2) to 37·2°C (0·2), mean skin temperature (T(sk) ) from 34·6°C (0·5) to 31·2°C (2·0) and whole-body thermal sensation from 'slightly warm/warm' to 'slightly cool/cold'. The start of the steep fall in T(f) varied considerably between individuals in terms of time (2-75 min), T(a) (16·7 - 32·0°C) and T(sk) (28·8 - 34·7°C). On the other hand, the range of T(f) at that point was narrower (32·1 - 35·8°C). The findings stress the importance of taking into account the distal skin temperatures in thermoregulatory studies in addition to the ordinarily used more proximal and central skin sites. Also, it might be advisable to start such experiments with relatively high and fluctuating T(f) to guarantee that the thermal state of the subject is well defined.

Parallel and serial methods of calculating thermal insulation in European manikin standards.

Standard No. EN 15831:2004 provides 2 methods of calculating insulation: parallel and serial. The parallel method is similar to the global one defined in Standard No. ISO 9920:2007. Standards No. EN 342:2004, EN 14058:2004 and EN 13537:2002 refer to the methods defined in Standard No. EN ISO 15831:2004 for testing cold protective clothing or equipment. However, it is necessary to consider several issues, e.g., referring to measuring human subjects, when using the serial method. With one zone, there is no serial-parallel issue as the results are the same, while more zones increase the difference in insulation value between the methods. If insulation is evenly distributed, differences between the serial and parallel method are relatively small and proportional. However, with more insulation layers overlapping in heavy cold protective ensembles, the serial method produces higher insulation values than the parallel one and human studies. Therefore, the parallel method is recommended for standard testing.

Localised boundary air layer and clothing evaporative resistances for individual body segments.

Evaporative resistance is an important parameter to characterise clothing thermal comfort. However, previous work has focused mainly on either total static or dynamic evaporative resistance. There is a lack of investigation of localised clothing evaporative resistance. The objective of this study was to study localised evaporative resistance using sweating thermal manikins. The individual and interaction effects of air and body movements on localised resultant evaporative resistance were examined in a strict protocol. The boundary air layer's localised evaporative resistance was investigated on nude sweating manikins at three different air velocity levels (0.18, 0.48 and 0.78 m/s) and three different walking speeds (0, 0.96 and 1.17 m/s). Similarly, localised clothing evaporative resistance was measured on sweating manikins at three different air velocities (0.13, 0.48 and 0.70 m/s) and three walking speeds (0, 0.96 and 1.17 m/s). Results showed that the wind speed has distinct effects on local body segments. In contrast, walking speed brought much more effect on the limbs, such as thigh and forearm, than on body torso, such as back and waist. In addition, the combined effect of body and air movement on localised evaporative resistance demonstrated that the walking effect has more influence on the extremities than on the torso. Therefore, localised evaporative resistance values should be provided when reporting test results in order to clearly describe clothing local moisture transfer characteristics. PRACTITIONER SUMMARY: Localised boundary air layer and clothing evaporative resistances are essential data for clothing design and assessment of thermal comfort. A comprehensive understanding of the effects of air and body movement on localised evaporative resistance is also necessary by both textile and apparel researchers and industry.

Protection against cold in prehospital care: evaporative heat loss reduction by wet clothing removal or the addition of a vapor barrier--a thermal manikin study.

INTRODUCTION: In the prehospital care of a cold and wet person, early application of adequate insulation is of utmost importance to reduce cold stress, limit body core cooling, and prevent deterioration of the patient's condition. Most prehospital guidelines on protection against cold recommend the removal of wet clothing prior to insulation, and some also recommend the use of a waterproof vapor barrier to reduce evaporative heat loss. However, there is little scientific evidence of the effectiveness of these measures. OBJECTIVE: Using a thermal manikin with wet clothing, this study was conducted to determine the effect of wet clothing removal or the addition of a vapor barrier on thermal insulation and evaporative heat loss using different amounts of insulation in both warm and cold ambient conditions. METHODS: A thermal manikin dressed in wet clothing was set up in accordance with the European Standard for assessing requirements of sleeping bags, modified for wet heat loss determination, and the climatic chamber was set to -15 degrees Celsius (°C) for cold conditions and +10°C for warm conditions. Three different insulation ensembles, one, two or seven woollen blankets, were chosen to provide different levels of insulation. Five different test conditions were evaluated for all three levels of insulation ensembles: (1) dry underwear; (2) dry underwear with a vapor barrier; (3) wet underwear; (4) wet underwear with a vapor barrier; and (5) no underwear. Dry and wet heat loss and thermal resistance were determined from continuous monitoring of ambient air temperature, manikin surface temperature, heat flux and evaporative mass loss rate. RESULTS: Independent of insulation thickness or ambient temperature, the removal of wet clothing or the addition of a vapor barrier resulted in a reduction in total heat loss of 19-42%. The absolute heat loss reduction was greater, however, and thus clinically more important in cold environments when little insulation is available. A similar reduction in total heat loss was also achieved by increasing the insulation from one to two blankets or from two to seven blankets. CONCLUSION: Wet clothing removal or the addition of a vapor barrier effectively reduced evaporative heat loss and might thus be of great importance in prehospital rescue scenarios in cold environments with limited insulation available, such as in mass-casualty situations or during protracted evacuations in harsh conditions.

Deriving the operational procedure for the Universal Thermal Climate Index (UTCI).

The Universal Thermal Climate Index (UTCI) aimed for a one-dimensional quantity adequately reflecting the human physiological reaction to the multi-dimensionally defined actual outdoor thermal environment. The human reaction was simulated by the UTCI-Fiala multi-node model of human thermoregulation, which was integrated with an adaptive clothing model. Following the concept of an equivalent temperature, UTCI for a given combination of wind speed, radiation, humidity and air temperature was defined as the air temperature of the reference environment, which according to the model produces an equivalent dynamic physiological response. Operationalising this concept involved (1) the definition of a reference environment with 50% relative humidity (but vapour pressure capped at 20 hPa), with calm air and radiant temperature equalling air temperature and (2) the development of a one-dimensional representation of the multivariate model output at different exposure times. The latter was achieved by principal component analyses showing that the linear combination of 7 parameters of thermophysiological strain (core, mean and facial skin temperatures, sweat production, skin wettedness, skin blood flow, shivering) after 30 and 120 min exposure time accounted for two-thirds of the total variation in the multi-dimensional dynamic physiological response. The operational procedure was completed by a scale categorising UTCI equivalent temperature values in terms of thermal stress, and by providing simplified routines for fast but sufficiently accurate calculation, which included look-up tables of pre-calculated UTCI values for a grid of all relevant combinations of climate parameters and polynomial regression equations predicting UTCI over the same grid. The analyses of the sensitivity of UTCI to humidity, radiation and wind speed showed plausible reactions in the heat as well as in the cold, and indicate that UTCI may in this regard be universally useable in the major areas of research and application in human biometeorology.

The UTCI-clothing model.

The Universal Thermal Climate Index (UTCI) was conceived as a thermal index covering the whole climate range from heat to cold. This would be impossible without considering clothing as the interface between the person (here, the physiological model of thermoregulation) and the environment. It was decided to develop a clothing model for this application in which the following three factors were considered: (1) typical dressing behaviour in different temperatures, as observed in the field, resulting in a model of the distribution of clothing over the different body segments in relation to the ambient temperature, (2) the changes in clothing insulation and vapour resistance caused by wind and body movement, and (3) the change in wind speed in relation to the height above ground. The outcome was a clothing model that defines in detail the effective clothing insulation and vapour resistance for each of the thermo-physiological model's body segments over a wide range of climatic conditions. This paper details this model's conception and documents its definitions.

Effect of temperature difference between manikin and wet fabric skin surfaces on clothing evaporative resistance: how much error is there?

Clothing evaporative resistance is one of the inherent factors that impede heat exchange by sweating evaporation. It is widely used as a basic input in physiological heat strain models. Previous studies showed a large variability in clothing evaporative resistance both at intra-laboratory and inter-laboratory testing. The errors in evaporative resistance may cause severe problems in the determination of heat stress level of the wearers. In this paper, the effect of temperature difference between the manikin nude surface and wet textile skin surface on clothing evaporative resistance was investigated by both theoretical analysis and thermal manikin measurements. It was found that the temperature difference between the skin surface and the manikin nude surface could lead to an error of up to 35.9% in evaporative resistance of the boundary air layer. Similarly, this temperature difference could also introduce an error of up to 23.7% in the real clothing total evaporative resistance (R ( et_real ) < 0.1287 kPa m(2)/W). Finally, it is evident that one major error in the calculation of evaporative resistance comes from the use of the manikin surface temperature instead of the wet textile fabric skin temperature.

Determination of clothing evaporative resistance on a sweating thermal manikin in an isothermal condition: heat loss method or mass loss method?

This paper addresses selection between two calculation options, i.e heat loss option and mass loss option, for thermal manikin measurements on clothing evaporative resistance conducted in an isothermal condition (T(manikin) = T(a) = T(r)). Five vocational clothing ensembles with a thermal insulation range of 1.05-2.58 clo were selected and measured on a sweating thermal manikin 'Tore'. The reasons why the isothermal heat loss method generates a higher evaporative resistance than that of the mass loss method were thoroughly investigated. In addition, an indirect approach was applied to determine the amount of evaporative heat energy taken from the environment. It was found that clothing evaporative resistance values by the heat loss option were 11.2-37.1% greater than those based on the mass loss option. The percentage of evaporative heat loss taken from the environment (H(e,env)) for all test scenarios ranged from 10.9 to 23.8%. The real evaporative cooling efficiency ranged from 0.762 to 0.891, respectively. Furthermore, it is evident that the evaporative heat loss difference introduced by those two options was equal to the heat energy taken from the environment. In order to eliminate the combined effects of dry heat transfer, condensation, and heat pipe on clothing evaporative resistance, it is suggested that manikin measurements on the determination of clothing evaporative resistance should be performed in an isothermal condition. Moreover, the mass loss method should be applied to calculate clothing evaporative resistance. The isothermal heat loss method would appear to overestimate heat stress and thus should be corrected before use.

Can the PHS model (ISO7933) predict reasonable thermophysiological responses while wearing protective clothing in hot environments?

In this paper, the prediction accuracy of the PHS (predicted heat strain) model on human physiological responses while wearing protective clothing ensembles was examined. Six human subjects (aged 29 ± 3 years) underwent three experimental trials in three different protective garments (clothing thermal insulation I(cl) ranges from 0.63 to 2.01 clo) in two hot environments (40 °C, relative humidities: 30% and 45%). The observed and predicted mean skin temperature, core body temperature and sweat rate were presented and statistically compared. A significant difference was found in the metabolic rate between FIRE (firefighting clothing) and HV (high visibility clothing) or MIL (military clothing) (p < 0.001). Also, the development of heart rate demonstrated the significant effects of the exposure time and clothing ensembles. In addition, the predicted evaporation rate during HV, MIL and FIRE was much lower than the experimental values. Hence, the current PHS model is not applicable for protective clothing with intrinsic thermal insulations above 1.0 clo. The results showed that the PHS model generated unreliable predictions on body core temperature when human subjects wore thick protective clothing such as firefighting clothing (I(cl) > 1.0 clo). The predicted mean skin temperatures in three clothing ensembles HV, MIL and FIRE were also outside the expected limits. Thus, there is a need for further extension for the clothing insulation validation range of the PHS model. It is recommended that the PHS model should be amended and validated by individual algorithms, physical or physiological parameters, and further subject studies.

Cooling vests with phase change materials: the effects of melting temperature on heat strain alleviation in an extremely hot environment.

A previous study by the authors using a heated thermal manikin showed that the cooling rates of phase change material (PCM) are dependent on temperature gradient, mass, and covering area. The objective of this study was to investigate if the cooling effects of the temperature gradient observed on a thermal manikin could be validated on human subjects in extreme heat. The subjects wore cooling vests with PCMs at two melting temperatures (24 and 28°C) and fire-fighting clothing and equipment, thus forming three test groups (vest24, vest28 and control group without the vest). They walked on a treadmill at a speed of 5 km/h in a climatic chamber (air temperature = 55°C, relative humidity = 30%, vapour pressure = 4,725 Pa, and air velocity = 0.4 m/s). The results showed that the PCM vest with a lower melting temperature (24°C) has a stronger cooling effect on the torso and mean skin temperatures than that with a higher melting temperature (28°C). Both PCM vests mitigate peak core temperature increase during the resting recovery period. The two PCM vests tested, however, had no significant effect on the alleviation of core temperature increase during exercise in the heat. To study the possibility of effective cooling of core temperature, cooling garments with PCMs at even lower melting temperatures (e.g. 15°C) and a larger covering area should be investigated.

Climate change and occupational heat stress: methods for assessment.

BACKGROUND: Presumed effects of global warming on occupational heat stress aggravate conditions in many parts of the world, in particular in developing countries. In order to assess and evaluate conditions, heat stress must be described and measured correctly. OBJECTIVE: Assessment of heat stress using internationally recognized methods. DESIGN: Two such methods are wet bulb globe temperature (WBGT; ISO 7243) and predicted heat strain (PHS; ISO 7933). Both methods measure relevant climatic factors and provide recommendations for limit values in terms of time when heat stress becomes imminent. The WBGT as a heat stress index is empirical and widely recognized. It requires, however, special sensors for the climatic factors that can introduce significant measurement errors if prescriptions in ISO 7243 are not followed. The PHS (ISO 7933) is based on climatic factors that can easily be measured with traditional instruments. It evaluates the conditions for heat balance in a more rational way and it applies equally to all combinations of climates. RESULTS: Analyzing similar climatic conditions with WBGT and PHS indicates that WBGT provides a more conservative assessment philosophy that allows much shorter working time than predicted with PHS. CONCLUSIONS: PHS prediction of physiological strain appears to fit better with published data from warm countries. Both methods should be used and validated more extensively worldwide in order to give reliable and accurate information about the actual heat stress.