The neurological effects of acute physical exhaustion on inhibitory function.

OBJECTIVE: We aimed to investigate the neural mechanisms underlying the inhibitory function performance of maritime Search and Rescue (SAR) personnel in states of physical exhaustion. BACKGROUND: SAR missions pose serious challenges to the cognitive function of SAR personnel, especially in extreme environments and physical exhaustion. It is important to understand SAR personnel's cognitive performance and neural activity under exhaustion to improve the efficiency of task execution and ensure work safety. METHOD: Twenty-six maritime SAR personnel were recruited to simulate boat operations until they reached a self-imposed state of exhaustion. The exhaustion state was monitored by maximum heart rate and subjective fatigue scale. Two event-related potentials, N200 and P300, were measured during a Go-Nogo task before and after a session of acute exhaustive tasks. RESULTS: After exhaustion, a marked reduction in accuracy, a notable increase in N200 amplitude, and a substantial decline in P300 amplitude under the Nogo condition were observed compared to the baseline phase. Pre- and post-exhaustion comparisons using standardized low-resolution brain electromagnetic tomography revealed reduced activations in the right middle temporal gyrus's N200 component after exhaustion in SAR personnel during the Nogo condition. CONCLUSION: The results suggest that acute physical exhaustion significantly impacts the inhibition ability of SAR personnel, prolonging the conflict monitoring phase and weakening the response inhibition phase. These findings provide valuable insights into how physical exhaustion affects cognitive functions critical to the safety and effectiveness of SAR operations, and can inform strategies to improve training and equipment to enhance performance under extreme conditions.

Suburban firefighter perceptions of health and wellness using patient-reported outcome measures.

BACKGROUND: Firefighting is among the most dangerous professions and requires exceptional physical fitness and focus while working. Patient-reported outcomes are a commonly used method to evaluate subjective health information and may be utilized by fire departments to identify the health status of firefighters and provide insight to promote their health and wellness. OBJECTIVE: This study is a novel analysis of firefighters' self-reported health to potentially identify musculoskeletal dysfunction, assist in therapeutic intervention, and improve overall health and wellness. METHODS: Firefighters were evaluated using seven different self-reported health surveys to assess various physical capabilities and quality of life. The questionnaires were delivered via online format and administered once to provide a snapshot of a suburban Oklahoma fire department. RESULTS: Using the Disablement in the Physically Active Scale, 14 of the 35 firefighters answered "slight, moderate, or severe" for the pain and motion variables. Only two of the firefighters indicated no stiffness or soreness after activity on the Nirschl Phase Rating Scale. The firefighters mean rating for "energy/fatigue" via the RAND-36 was 54.14 out of 100. CONCLUSION: Firefighters frequently report pain, impaired motion, and soreness, indicating areas in which health and wellness interventions may be helpful. The incorporation of periodic health surveys into firefighter health and wellness programming can highlight the presence of concerns, as well as intervention effectiveness by subjective health status reporting. By combining the health surveys with aerobic and core strength exercises, fire departments may be able to monitor and improve firefighter health.

Worldwide prevalence of obesity among firefighters: a systematic review protocol.

INTRODUCTION: Obesity may interfere with job performance and increase the risk of injury during firefighting activity. Obesity also has many deleterious effects on health indices and is associated with higher all-cause mortality. Studies report a high prevalence of obesity in the fire service. Also, firefighters' work schedule (12-hour to 24-hour shifts) and food availability during night shifts may be related to weight gain. Studies in American firefighters have shown annual weight gain between 0.5 and 1.5 kg. This study aims to report the obesity prevalence in the fire service to describe how it varies based on country and region, job status, type of firefighter and gender. METHODS AND ANALYSIS: The main outcome evaluated will be obesity prevalence. We will systematically search the literature databases PubMed, Medline, Web of Science, Sportdiscus, Academic Search Premier, Cumulative Index of Nursing and Allied Health Literature (CINAHL), SciTech Premium Collection, Sports Medicine & Education Index, Research Library and Scopus. One reviewer will perform the search. Two independent reviewers will select studies, extract data from eligible studies and evaluate their methodological and reporting quality. Agreement between reviewers will be measured using Cohen's kappa. Other data of interest will include age, body mass index, body fat percentage, job status (career, volunteer or military), years of service and type of firefighter (eg, structural and wildland firefighter). We will produce a narrative summary of our findings. Tables will be generated to summarise data. ETHICS AND DISSEMINATION: This systematic review does not require ethics clearance since published studies with non-identifiable data will be used. The results of the systematic review will be disseminated via publication in a peer-reviewed journal and through conference presentations. PROSPERO REGISTRATION NUMBER: CRD42019129122.

First Responder Accuracy Using SALT during Mass-casualty Incident Simulation.

INTRODUCTION: During mass-casualty incidents (MCIs), patient volume often overwhelms available Emergency Medical Services (EMS) personnel. First responders are expected to triage, treat, and transport patients in a timely fashion. If other responders could triage accurately, prehospital EMS resources could be focused more directly on patients that require immediate medical attention and transport. HYPOTHESIS: Triage accuracy, error patterns, and time to triage completion are similar between second-year primary care paramedic (PCP) and fire science (FS) students participating in a simulated MCI using the Sort, Assess, Life-saving interventions, Treatment/Transport (SALT) triage algorithm. METHODS: All students in the second-year PCP program and FS program at two separate community colleges were invited to participate in this study. Immediately following a 30-minute didactic session on SALT, participants were given a standardized briefing and asked to triage an eight-victim, mock MCI using SALT. The scenario consisted of a four-car motor vehicle collision with each victim portrayed by volunteer actors given appropriate moulage and symptom coaching for their pattern of injury. The total number and acuity of victims were unknown to participants prior to arrival to the mock scenario. RESULTS: Thirty-eight PCP and 29 FS students completed the simulation. Overall triage accuracy was 79.9% for PCP and 72.0% for FS (∆ 7.9%; 95% CI, 1.2-14.7) students. No significant difference was found between the groups regarding types of triage errors. Over-triage, under-triage, and critical errors occurred in 10.2%, 7.6%, and 2.3% of PCP triage assignments, respectively. Fire science students had a similar pattern with 15.2% over-triaged, 8.7% under-triaged, and 4.3% critical errors. The median [IQR] time to triage completion for PCPs and FSs were 142.1 [52.6] seconds and 159.0 [40.5] seconds, respectively (P=.19; Mann-Whitney Test). CONCLUSIONS: Primary care paramedics performed MCI triage more accurately than FS students after brief SALT training, but no difference was found regarding types of error or time to triage completion. The clinical importance of this difference in triage accuracy likely is minimal, suggesting that fire services personnel could be considered for MCI triage depending on the availability of prehospital medical resources and appropriate training.

First Responder Accuracy Using SALT after Brief Initial Training.

BACKGROUND: Mass-casualty incidents (MCIs) present a unique challenge with regards to triage as patient volume often outweighs the number of available Emergency Medical Services (EMS) providers. A possible strategy to optimize existing triage systems includes the use of other first responder groups, namely fire and police, to decrease the triage time during MCIs, allowing for more rapid initiation of life-saving treatment and prioritization of patient transport. Hypothesis First-year primary care paramedic (PCP), fire, and police trainees can apply with similar accuracy an internationally recognized MCI triage tool, Sort, Assess, Life-saving interventions, Treatment/transport (SALT), immediately following a brief training session, and again three months later. METHODS: All students enrolled in the PCP, fire, and police foundation programs at two community colleges were invited to participate in a 30-minute didactic session on SALT. Immediately following this session, a 17-item, paper-based test was administered to assess the students' ability to understand and apply SALT. Three months later, the same test was given to assess knowledge retention. RESULTS: Of the 464 trainees who completed the initial test, 364 (78.4%) completed the three month follow-up test. Initial test scores were higher (P<.05) for PCPs (87.0%) compared to fire (80.2%) and police (68.0%) trainees. The mean test score for all respondents was higher following the initial didactic session compared to the three month follow-up test (75% vs 64.7%; Δ 10.3%; 95% CI, 8.0%-12.6%). Three month test scores for PCPs (75.4%) were similar to fire (71.4%) students (Δ 4.0%; 95% CI, -2.1% to 10.1%). Both PCP and fire trainees significantly outperformed police (57.8%) trainees. Over-triage errors were the most common, followed by under-triage and then critical errors, for both the initial and follow-up tests. CONCLUSIONS: Amongst first responder trainees, PCPs were able to apply the SALT triage tool with the most accuracy, followed by fire, then police. Over-triage was the most frequent error, while critical errors were rare.

A survey of the relationship between work schedule and its effect on the fatigue of rescue personnel in Isfahan with a standard method of CIS202.

CONTEXT: Fatigue is a factor that can have negative effects on family life, social relationship and work. Work schedule is one of the affective factors on personnel's fatigue in different jobs. In this study, the work schedule and its effect on rescue personnel in Isfahan are explored. AIMS: The purpose of this study was to investigate the relationship between work schedules and fatigue among rescue personnel. SETTINGS AND DESIGN: This study is periodical and has been conducted on 72 employees of rescue personnel in Isfahan. MATERIALS AND METHODS: Random sampling was done and the primary data that was collected through fatigue assessment questionnaire after being conducted as a pilot study on 10% of samples were collected to confirm the validity of this study. Finally, the data was given to SPSS11.5 software and were analyzed by descriptive statistics and linear digression. RESULTS: The results showed that from the statistical point of view some parts of work schedules like work hours satisfaction, resting time and work order on total fatigue are effective in linear and inverse way but the item "predictibility of work conditions" does not have a meaningful relationship with total fatigue. Furthermore, the results showed that there is a meaningful and inverse relationship with work hours, resting time and work order with mental fatigue and also the work schedule has a meaningful, linear and inverse relation with mental fatigue and total fatigue. CONCLUSIONS: By increasing the satisfaction of working hours, increasing resting time and also with an increase of work order the total fatigue of rescue personnel will decrease.

Práticas de poder no serviço de atendimento móvel de urgência de Belo Horizonte / Prácticas de poder en el Servicio Móvil de Emergencia de Belo Horizonte / Practices of power in the Mobile Emergency Medical Service of Belo Horizonte

O trabalho do Serviço de Atendimento Médico de Urgência (SAMU) envolve a participação de diversos profissionais que atendem a demandas de diferentes níveis de complexidade, em um amplo território geográfico, com um planejamento de trabalho diferente dos serviços com estruturas exclusivamente fixas. O objetivo deste estudo foi analisar a configuração de práticas de poder no cotidiano do trabalho dos profissionais do SAMU. Trata-se de um estudo de caso qualitativo, cujo cenário foi o SAMU de Belo Horizonte, Minas Gerais, Brasil. A amostra foi composta por 31 trabalhadores, e os dados coletados por entrevista semiestruturada e submetidos à análise de discurso. No contexto das lutas e práticas de poder, destacam-se 'o poder da vaga-zero' e os 'corpos uniformes e imagens de poder no SAMU'. Percebe-se que, no SAMU, o poder está presente como prática social, com sua centralidade se deslocando de acordo com as situações vivenciadas e os interesses em questão.

El trabajo en el Departamento de Atención Médica de Emergencia (SAMU) implica la participación de varios profesionales que respondan a las demandas de los diferentes niveles de complejidad, en un territorio geográfico amplio, con una planificación de trabajo diferente de servicios exclusivamente con estructuras fijas. Este estudio tuvo como objetivo analizar la configuración de prácticas de poder en el trabajo de los profesionales en el SAMU. Es un estudio de caso cualitativo, desarrollado en el SAMU de Belo Horizonte, Minas Gerais, Brasil. La muestra fue de 31 trabajadores. Los datos recogidos a través de entrevistas semiestructuradas fueron sometidos a análisis del discurso. En el contexto de las luchas y las prácticas de poder se destacan el 'poder de vaga-cero' y 'cuerpos uniformes y las imágenes de poder en el SAMU'. Se observó que en el SAMU, el poder está presente como una práctica social, con el centro del movimiento de acuerdo a las situaciones vividas y los intereses en cuestión.

The work of Mobile Emergency Medical Service (SAMU) involves the participation of several professionals that meet the demands of different levels of complexity in a huge geographic territory, with planning different of services with exclusively fixed structures. The aim of this study was to analyze the configuration of practices of power in the daily work of professionals of the SAMU. It was a qualitative case study which had been set in the SAMU of Belo Horizonte, Minas Gerais, Brazil. The sample was composed by 31 workers and data were collected using semi-structured interview and than submitted to discourse analysis. In the context of struggles and power relations in SAMU, stands out 'the power of zero vacancy' and the 'uniform bodies and images of power in the SAMU'. It was possible to observe that power in SAMU is present as social practice, with its centrality moving according to lived situations and to interests in question.

A capacitação da equipe que atua no atendimento pré-hospitalar móvel: necessidade e importância da educação permanente na perspectiva dos trabalhadores / Qualification of a mobile pre-hospital care team: the need and the importance of a continuous education in the professionals' point of view / Capacitación del equipo que actúa en la atención pre-hospitalaria móvil: necesidad e importancia de la educación permanente desde la perspectiva de los trabajadores

O atendimento pré-hospitalar móvel representa o primeiro passo para uma rápida e mais eficiente assistência ao cliente que se encontra em situação de urgência/emergência. Com este trabalho, objetiva-se apreender a necessidade e a importância da capacitação da equipe de atendimento pré-hospitalar móvel da área da saúde, que atua no socorro às vítimas de trauma na cidade do Rio Grande-RS, na perspectiva dos trabalhadores. Trata-se de uma pesquisa descritiva, exploratória, com abordagem qualitativa. Participaram do estudo seis sujeitos de três instituições que compartilham o atendimento pré-hospitalar móvel nessa cidade. A coleta de dados foi realizada por meio de entrevista semiestruturada. Os dados foram analisados utilizando-se a técnica de análise temática. A capacitação prévia foi considerada necessária para que o profissional se sentisse seguro, apto para prestar o socorro e conseguisse salvaguardar-se da imperícia dos seus atos que pudessem prejudicar o restabelecimento e potencializar os agravos às vitimas. A maioria dos sujeitos apontou que os aspectos teóricos e práticos da capacitação, atentando para os detalhes das simulações e das experiências vividas, são imprescindíveis e devem ser atualizados de forma constante. A parte prática foi assinalada como indispensável porque habilita o trabalhador para enfrentar com coerência, rapidez e segurança a diversidade de situações de trauma.

The mobile pre-hospital care represents the first step for a quick and efficient assistance to urgency/emergency patients. This study aims to understand the need and the importance of having a qualified team at the mobile pre-hospital care in the city of Rio Grande/RS, from the professionals´ point of view. It is a descriptive and exploratory research with a qualitative approach. Six professionals from three different mobile pre-hospital services participated in the study. Data were collected using a semi-structured interview and analysis was performed with the thematic analysis technique. A previous qualification was considered necessary so the professional felt able to provide adequate care and could avoid malpractices. Most of the professionals noted that both theoretical and practical aspects of the qualification are essential. They also pointed that the simulations and the experiences should be constantly updated. The practical part was considered imperative since it qualifies the professional to act with coherence, rapidity and safety in trauma situations.

La atención pre hospitalaria móvil representa el primer paso para una asistencia rápida y más eficiente al cliente que se encuentra en situación de urgencia/emergencia. El presente trabajo busca captar la necesidad y la importancia de la capacitación del equipo de atención pre-hospitalaria móvil del área de la salud, que socorre a las víctimas de trauma en la ciudad del Río Grande/RS, desde la perspectiva de los trabajadores. Se trata de una investigación exploratoria descriptiva con enfoque cualitativo. Participaron del estudio seis sujetos de tres instituciones que comparten la APH móvil de la ciudad. La recogida de dados fue realizada a través de entrevistas semiestructuradas. Los datos fueron analizados con la técnica de análisis temático. La capacitación previa fue considerada necesaria para que el profesional se sienta seguro y apto para prestar socorro y consiga salvaguardarse de la impericia de sus actos que podrían perjudicar el restablecimiento y potenciar los agravios a las víctimas. La mayoría de los sujetos apunta que los aspectos teóricos y prácticos de la capacitación y hacen hincapié en los detalles de los simulacros y experiencias vividas, considerándolos imprescindibles y que deben ser actualizados de forma constante. La parte práctica fue señalada como indispensable porque habilita el trabajador para enfrentar con coherencia, rapidez y seguridad la diversidad de situaciones de un trauma.