5/2003: Physical Capabilities of Instructors at the End of Hot Fire Training

On 5th May 2006 the responsibilities of the Office of the Deputy Prime Minister (ODPM) transferred to the Department for Communities and Local Government. Department for Communities and Local Government Eland House Bressenden Place London SW1E 5DU Telephone: 020 7944 4400 Website: www.communities.gov.uk Documents downloaded from the www.communities.gov.uk website areCrown Copyright unless otherwise stated, in which case copyright is assigned to Queens Printer and Controller of Her Majestys Stationery Office. Copyright in the typographical arrangement rests with the Crown. This publication, excluding logos, may be reproduced free of charge in any format or medium for research, private study or for internal circulation within an organisation. This is subject to it being reproduced accurately and not used in a misleading context. The material must be acknowledged as Crown copyright and the title of the publication specified. Any other use of the contents of this publication would require a copyright licence. Please apply for a Click-Use Licence for core material at www.opsi.gov.uk/click-use/system/online/pLogin.asp or by writing to the Office of Public Sector Information, Information Policy Team, St Clements House, 2-16 Colegate, Norwich NR3 1BQ. Fax: 01603 723000 or e-mail: HMSOlicensing@cabinet-office.x.gsi.gov.uk. This publication is only available online via the Communities and Local Government website: www.communities.gov.uk Alternative formats under Disability Discrimination Act (DDA):if you require this publication in an alternative format please email alternativeformats@communities.gsi.gov.uk

The findings and recommendations in this report are those of the consultant authors and do not necessarily represent the views or proposed policies of Communities and Local Government. Note: The following publication was issued by our former department, the Office of the Deputy Prime Minister (ODPM). ODPM became Communities and Local Government on 5 May 2006 all references in the text to ODPM now refer to Communities and Local Government. Contents Front page Abstract Management summary 1. Introduction 2. Questionnaire 3. Methods 4. Results 5. Discussion 6. Conclusions 7. Recommendations Acknowledgements References

Go to table of contents Front page Firefighter training: Determination of the physical capabilities of instructors at the end of hot fire training exercises by Dr Clare Elgin & Prof Michael Tipton Department of Sport and Exercise Science University of Portsmouth The text of this publication may not be reproduced, nor may talks or lectures based on the material contained within the document be given without the written consent of the Head of the Fire Research Division. The views expressed by the authors of this report do not necessarily reflect those of the Office of the Deputy Prime Minister Research report number 5/2003 Office of the Deputy Prime Minister Fire Research Division Portland House, Zone 18/D Stag Place London, SW1E 5LT Crown copyright

Go to table of contents Abstract The aim of this study was to determine whether fire-fighter instructors are capable of performing a simulated rescue task after undertaking a live fire training exercise. Ten instructors performed a rescue task on 2 occasions, the first acted as a control and was conducted when they were euhydrated and normothermic. The second task was undertaken 10 min after a live fire-fighting training exercise resulting in an average deep body temperature of 38.1C. All instructors were able to successfully complete both rescue tasks though heart rate and rating of perceived exertion were higher after the training exercise. In a second study, 6 out of 7 instructors were able to fully complete a rescue task conducted 79 s after a training exercise that increased deep body temperature to 38.3C. Although most of the instructors were able to perform a rescue task after the live fire training exercise, they were close to their physiological limit and therefore in more severe situations a rescue may not be possible.

Go to table of contents Management summary High deep body temperatures and heart rates have been observed in fire-fighter instructors at the end of some live fire training exercises suggesting their ability to perform a rescue may be compromised. The aim of this study was to determine whether fire-fighter instructors are capable of performing a simulated rescue task after undertaking a "Hot Fire" training exercise. A questionnaire was sent to all the UK Fire Service brigades to determine the worst case scenario for rescuing a collapsed fire-fighter. 89% of brigades responded, and with consultation from the instructors at the Fire Service College a representative rescue task was devised. Ten fire-fighter instructors undertook 2 simulated rescues, which involved dragging a 80.6 kg dummy 23 m along the flat and down 2 flights of stairs. Prior to the first rescue (Rcontrol), the instructors had not been exposed to heat within the previous 12 hr. The second rescue (Rhot) was undertaken approximately 10 min after they had acted as a safety officer in a Hot Fire training exercise (HF1) lasting about 40 min. In a second study, 7 fire-fighter instructors undertook a simulated rescue (Rflat) involving dragging a 85 kg dummy 30 m along the flat, approximately 79 s after being in a Hot Fire exercise (HF2) lasting on average 41 min. Throughout the Hot Fire exercises and rescue tasks the instructors wore their full protective clothing and self contained breathing apparatus. All the instructors were able to complete Rcontrol and Rhot. Six out of the 7 instructors were able to complete Rflat, the instructor who did not complete Rflat was able to drag the dummy 20 m. Results are shown in Table 1 and 2. HF 1 HF 2 End rectal temperature (C) 38.1 0.4 38.3 0.7 Mean HR (bpm) 131 18 121 20 Fluid loss (L) 1.48 0.70 0.89 0.29 Table 1. Physiological responses to the Hot Fire training exercises Variable Rc Rhf Rflat Before HR (bpm) 75 9 110 25 * 129 32 Rating of Perceived Exertion 6.5 0.9 12.1 1.8 * Perceived inability to perform rescue 0.6 1.0 3.5 1.7 * 4.1 1.5 During Rescue time (s) 90.1 28.6 78.7 15.6 41.7 6.9 Max HR (bpm) 162 16 180 15 * 182 20 After Rating of Perceived Exertion 13.3 2.4 15.7 2.1* 16.3 2.4 Lactate (mmol.L-1) 5.84 2.79 6.08 1.76 8.3 1.9 Table 2. Physiological responses during rescue tasks. Statistical comparison was only made between Rc and Rhf, and asterix indicates a significant difference between Rc and Rhf. The instructors were able to complete a rescue task (Rhot) simulating a worst case scenario at the end of a Hot Fire exercise, however they experienced a greater physical strain during Rhot compared to Rcontrol. The 10 min period between HF1 and Rhot may have been crucial in enabling the instructors to recover and perform the rescue task. When the rest period was

reduced to 79 s (Rflat), 6 out of 7 instructors were able to drag the dummy the full 30 m. The instructor, who could not complete the full 30 m dummy drag, was one of the less fit instructors. Within the limits of the current study, instructors are capable of performing a rescue at the end of a Hot Fire exercise. However, the rescue tasks resulted in near maximal HR suggesting they probably had very little spare physical capacity. Therefore in less favourable situations (higher deep body temperatures, greater levels of dehydration, less fit or experienced instructors, or a casualty heavier than 85 kg) a rescue may not be possible.

Go to table of contents 1. Introduction Fire-fighters can be exposed to severe toxic and thermal environments during their normal duties. During "Hot Fire" training exercises, air temperatures around the fire-fighter are typically 100C to 170C with peak temperatures up to 235C (Foster and Roberts 1994; Eglin and Tipton 2000). Burns occur when the skin temperature is elevated to 44C and the severity of the burn increases logarithmically with increasing skin temperature and duration of exposure (Ripple et al. 1990). Therefore, protective clothing and self-contained breathing apparatus (SCBA) are essential in order to protect fire-fighters from severe environmental conditions. However, the protective clothing worn by a fire-fighter not only acts as a barrier to external heat, it also impairs heat loss from the body. Fire protective clothing is relatively impermeable to water vapour (Pascoe et al. 1994; Goldman et al. 1990) and therefore inhibits evaporation of sweat which is the only method of heat dissipation from the body in a hot environment. This results in a greater increase deep body temperature during exercise when protective firefighting clothing is worn compared to normal work uniform (Duncan et al. 1979; Faff and Tutak 1989; Smith et al. 1995; Skoldstrom 1987; White and Hodous 1987). In addition, the weight of the protective clothing and SCBA also represents a physiological burden. This increases the metabolic cost of any given task (Duggan 1988; Duncan et al. 1979), and thus the amount of heat produced. This may be compounded by the "hobbling" or encumbering effect of the bulky clothing (Duggan 1988; Goldman 1990; Home Office 1996; Patton et al. 1995). For any activity, this added metabolic cost decreases the time to fatigue and heat illness (Louhevaara et al. 1995). Fire-fighting involves strenuous physical activity (Lemon and Hermiston 1977; Romet and Frim 1987). The level of activity required depends on the task undertaken during the fire-fighting scenario and the role of the individual (Romet and Frim 1987). During fire-fighting scenarios at a fire ground, Romet and Frim (1987) reported that search and rescue tasks were the most demanding, resulting in heart rates above 150 beats.min-1 and increases in deep body temperature of 1.3C in the "leading hand". Less physiological demand was placed on the other members of the fire-fighting team. Performing a simulated ceiling overhaul task in the heat (90C) for 16 min resulted in an average heart rate of 175 beats.min-1 corresponding to approximately 90% of the age-predicted maximum. At the end of this exercise deep body temperature, measured using an infrared tympanic thermometer, averaged 39.82C (Smith et al. 1997). In drills comprising of sets of fire-fighting tasks conducted in a building containing fires, heart rates above 180 beats.min-1 and increases in tympanic membrane temperature of 1.5C have been observed (Smith and Petruzzello 1998). Similarly, during simulated smoke dives in the heat, near maximal and maximal heart rates were recorded in young, very fit, firefighters (Lusa et al. 1993). During a real fire situation, a heart rate of over 160 beats.min-1 for 90 min was recorded in a fire-fighter during 2 consecutive fires, and whilst fire-fighting for 15 min averaged 188 beats.min-1 (Barnard and Duncan 1975). These studies show that considerable physiological strain can be placed on an individual performing fire-fighting tasks. Few studies have examined the responses of instructors during Hot Fire exercises. One preliminary study investigated the responses of fire-fighter training officers during real and simulated training exercises (Williams et al. 1996). The heart rate of four instructors was monitored during five different training exercises. During two of the five exercises, the training officers experienced heart rates that approached or exceeded their age-predicted maximum and were higher than the heart rates of trainee fire-fighters. Under the contract "Physiological

monitoring of fire-fighters during training" the authors monitored 13 Breathing Apparatus Instructors during 44 live fire training exercises at the Fire Service College (FSC), Moreton-inMarsh (Eglin and Tipton 2000). The physiological responses of the instructors to the exercises varied considerably due to differences in the heat loading and physical activity. At the end of the exercises, the deep body temperature of the instructors averaged 38.5C; in 8 exercises it exceeded 39C. Maximum heart rate during the exercises averaged only 138 beats.min-1, however, in 5 exercises it exceeded 90% of the individual's heart rate reserve. Thus during a proportion of the training exercises the instructors experienced considerable physiological strain and two instructors showed signs of heat stress, viz. nausea and dizziness. The combined effect of heat and physical exertion can impair physical and mental performance. To gauge whether any performance decrement might have occurred, the instructors were asked whether they thought they could perform a rescue at the end of the training exercise. Although all the instructors believed they would have had no problems performing a rescue after live fire training exercises conducted in modified containers, this was not the case for those conducted in the fire buildings ("Hot Fire" exercises). After 3 (out of 20 exercises involving 12 different instructors) of these exercises, the instructor doubted his ability to perform a rescue, and 1 instructor was sure he would not be capable. As the key function of the instructors is to act as safety officers during the training exercises, and hence be responsible for rescuing a collapsed trainee fire-fighter, these findings were cause for concern. In an extension of this study, we measured the energy demand of rescuing a 50 kg dummy wearing SCBA from a fire building. Even though the dummy was considerably lighter than the average fire-fighter, there was no heat exposure and the instructors were assisted, the simulated rescues required heart rates of 160 bpm and an average energy expenditure of 47 kcal. If no heat was dissipated, this would result in an increase in deep body temperature of 0.6C. Given the highest deep body temperature at the end of a Hot Fire exercise was 40.6C and heart rates up to 194 beats.min-1 were observed, it was concluded that the ability to perform a rescue at the end of an exercise may be severely compromised. There have been no studies that have examined the ability to perform a rescue after being exposed to the severe environmental conditions experienced during fire-fighter training exercises. The worst case scenario would involve an instructor having to rescue a student firefighter at the end of an arduous training exercise. The aim of this study was to determine the physical capabilities of instructors at the end of a live fire training exercises (Hot Fire exercise), to establish whether they can be reasonably expected to perform such a task. To ensure the study was relevant to the fire-fighting training establishments throughout the UK, a questionnaire was sent to all the UK Fire Service brigades. From the responses to these questionnaires, and through consultation with the instructors at the FSC, a typical "worst case scenario" rescue task was developed. The ability of instructors to perform this rescue task was examined when fresh (euhydrated and normothermic) and after acting as a safety officer in a live fire training exercise. It was hypothesised that the physical demand of performing the rescue task after heat exposure would be greater than the control rescue to the point of preventing a rescue from being completed.

Go to table of contents 2. Questionnaire 2.1 Introduction Prior to any of the field testing, a questionnaire (Appendix A) was sent out to all of the UK Fire Service brigades (n=54), the aim being to inform the protocol for the rescue task and ensure that it was relevant to the brigades. The questionnaire asked whether training exercises involving exposure to fire or heat were conducted at the brigades' training facility and the staff to student ratio on these exercises. Information on procedures, risk assessments and methods for casualty evacuation, the furthest distance a casualty may have to moved to safety and the major obstacles to be negotiated during a rescue were requested. The brigades were also asked to say how many rescues they had performed during a training exercise in the previous 2 years (1999 to 2001), and what issues had arisen as a consequence. In addition, they were asked to give details of any health surveillance or fitness assessments conducted on their instructors/safety officers. 48 brigades completed the questionnaire (response rate of 89%), 47 of which conduct their own fire training exercises involving exposure to heat. The training exercises conducted by the brigades are shown in Table 2.1. Training Exercise Number of Brigades Staff : student ratio

(mean sd) Live flame / fire 43 0.36 0.16 Heat 40 0.32 0.10 Heat and humidity 30 0.32 0.08 Table 2.1. Number of brigades undertaking fire-fighting training exercises involving exposure to heat and the staff student ratio on those exercises (n=48). Risk assessments have been carried out for the training exercises conducted in all but two brigades, one of which is currently in the process of writing them. The procedures for evacuation of the training facilities are fully documented in most brigades, however the best route for evacuation of a casualty usually forms part of the safety brief rather than being documented (Table 2.2). In all cases, the method of casualty evacuation was manual, a few brigades reported they may use stretchers or trolleys. One training facility has a lift in some fire houses, and use of a hydraulic platform for recovery of a casualty, otherwise no mechanical aids are used to assist recovery. Documentation Training Facility Evacuation 28 19 3 Casualty Evacuation Route 13 25 1

Fully documented Part of safety brief Fully documented & part of safety brief No documentation 3 10 Table 2.2. Number of brigades that document the procedures for evacuation of the training

facility and the best routes of casualty evacuation (n=48). In every brigade an instructor or safety officer performing a rescue would have help from either another instructor (n=19), a student (n=2) or both (n= 26). In the worst case scenario, the furthest distance a casualty may have to be moved to safety was reported to average 9.8 6.7 m (range 3.5 to 30 m). The furthest distance that one person may have to move a casualty averaged 5.9 3.5 m (range 1.5 to 15 m), however, 17 brigades reported that this was not applicable and that an instructor would never have to move a casualty unaided. The number and type of obstacles that may hinder a casualty rescue varied between training facilities, however the most common was stairs (Table 2.3). Obstructions Indoors Outdoors Doors 13 Stairs 32 28 Ladders 7 5 Crawl ways 3 Hatch ways or equivalent 3 2 Partitions 4 Confined spaces 3 Furniture 6 Gangways 1 Table 2.3. Number of brigades that have obstructions inside and outside their fire training facility, and the nature of those obstructions (n=48). Nine brigades reported that a fire fighter had collapsed in the past 2 years at their training facility. The details of the collapses and the control issues that were subsequently put in place to prevent another occurrence are shown in Table 2.4. Brigade Number ID collapsed 1 1 2 5 11 13 14 25 28 48 1 2 2 1 2 1 2 3 Cause of collapse Not specified Control measures

No change required, followed predetermined plan Heat exhaustion Reduced the temperature and exposure time Cylinder valve not turned Specific brief to ensure that it is on enough turned on - buddy system in place Not specified Health and Safety investigation ongoing Heat exhaustion attributed Dietary advice included in safety to hypoglycaemia brief Ill health Rescues completed satisfactorily & according to plan Illness exacerbated by Reviewed documentation on fluid alcohol consumption consumption. Not specified New management systems put in place Heat exhaustion Procedures proved effective, ambient temperature closely

considered Table 2.4. Incidence of collapsed students in training facilities in the past 2 years (1999 to 2001). The cause of collapse and any control measures put in place to avoid the problem recurring are also detailed. The method of assessing fitness for work before an individual is assigned the role of an instructor or safety officer, and the health surveillance of those already in this role varies considerably between brigades. The prevalence of the methods employed by the brigades for assessing fitness and health are shown in Table 2.5. Notably only one brigade reported measuring core temperature (using an aural thermometer) after every exposure. Method Fitness assessment Health surveillance Questionnaire 2 Medical 21 7 Fitness test 9 2 Occupational Health Department initiative 23 Training centre initiative 15 Self assessment 2 Log books 4 Core temperature monitoring 1 Other 1 1 None 13 6 Not answered 4 2 Table 2.5. Number of brigades that assess fitness to work before an individual is assigned the role of an instructor/safety officer and the methods used. Also shown is the number of brigades that undertake health surveillance on instructor/safety officers and how this is conducted. 2.2 Development of the rescue task The responses to the questionnaire indicated that an instructor/safety officer would be helped by another instructor or student. The furthest distance a collapsed individual may have to be dragged to safety was 30 m, though 15 m was the maximum one person may have to move a casualty. The major obstructions to a rescue were stairs, doors, ladders and furniture (Table 2.3). Based on this information, a worst case rescue task scenario was devised in consultation with instructors from the FSC. It was decided that the rescue would be performed in the cold side of the BA School as it is a "typical" fire house and would be available throughout the trial, thus enabling the rescue task to remain constant for each individual. For this particular building, the instructors determined that the worst case scenario for rescuing a victim would be if they collapsed by the door separating the cold and hot side of the building on the second floor (effectively in the middle of the building furthest away from an exit). An individual who collapsed here would have to be moved along a corridor (approximately 15 m) to fresh air and then down 2 flights of stairs to clear the building. The width of the corridor (0.95 m) was too narrow to enable 2 instructors to drag a victim and the only way 2 people could actively participate in the rescue would be to carry the casualty. This was considered more demanding than having one person drag the victim on their own, and in a real situation they decided that one instructor would do the drag and have other instructors available to take over should they become fatigued. Having the instructor conduct

the rescue on their own also negated the problem of determining the contribution of effort put in by the instructor who was being monitored and ensuring that this was kept constant for all rescues. Thus, it was concluded that the rescue task would involve a single person drag of a dummy representative of the weight of a fire-fighter along a 15 m corridor and down 2 flights of stairs.

Go to table of contents 3. Methods 3.1 Introduction The experimental protocol was approved by the University of Portsmouth ethics committee. Thirteen fire-fighting instructors from the Fire Service College (FSC) Moreton-in-Marsh acted as subjects for the trials detailed below after giving informed written consent. All experiments were conducted in the fire grounds of the FSC, Moreton-in-Marsh. 3.2 Simulated rescue task 3.2.1 General Ten instructors performed 2 simulated rescues of a 80.6 kg dummy (including the mass of the SCBA strapped to dummy) in a cool smoke-free environment. The first rescue acted as a control and was performed when the instructors had not been exposed to heat in the previous 12 hours (Rcontrol). The second rescue was performed after the instructors had been exposed to the heat during a live fire-fighter training exercise (Rhot). Both Rcontrol and Rhot were conducted in the cold side of the BA School. During the Rcontrol, the instructors wore their normal full protective clothing and a Metamax respiratory mask and a rucksack weighing 11 kg which replaced and simulated their breathing apparatus set. During the Rhot, the instructors wore the same clothing as they had in the Hot Fire exercise with either their SCBA or the weighted rucksack containing the Metamax. The rescue task was only conducted if the instructor was happy to do so (i.e. the rating of their ability to perform a rescue was less than 7 - see below) and they had a rectal temperature below 39.5C (only measured during Rhot).

Figure 3.1 Instructor performing simulated rescue task (Rcontrol). The instructor has dragged the dummy along a corridor and down 2 flights of stairs and has a further 8 m to drag the dummy. The instructor is wearing a RUCs containing the Metamax system for measuring oxygen consumption which has been weighted the same as the SCBA.

After measurement of resting oxygen consumption (Rcontrol) or arrival from the Hot Fire exercise (Rhot), the instructor walked up 2 flights of stairs to where the dummy was located. The rescue involved turning the dummy 180 in a corridor 0.95 m wide and then dragging it along a flat corridor for 14.8 m to reach the stairs. There were 2 obstructions in the corridor - a door they had to push open and a fire hose which reduced the width of the corridor to 0.63 m. The instructors then dragged the dummy down 2 flights of stairs (8 steps per half flight 0.18 m height, width 1.04 m, total vertical height 5.8 m) and then 8 m along level tarmac to the finish. Throughout the rescue, the instructor was guided by another firefighter who ensured they did not trip, but who did not give any physical assistance in dragging the dummy (Figure 3.1). The time taken to complete the rescue was measured from the point at which the instructor reached the dummy. 3.2.2 Measurements during Rcontrol and Rhot Oxygen consumption (VO2) was measured using a portable measuring system (Metamax, Cortex Biophysik) during all of the Rcontrols and 6 Rhots. VO2 was recorded every 20 s during a 5 min rest period (prior to Rcontrol only), throughout the rescue and 15 min of recovery. During both rescues heart rate was recorded at least every 15 s using a Polar heart rate monitor (Polar Electro Oy, Kempele, Finland). Blood lactate was measured from a finger prick sample of blood taken before and 2 min after both rescues using a portable hand held lactate analyser (Lactate Pro, Arkray Inc, Kyoto, Japan). Rating of perceived exertion (RPE, a 15 point scale from 6 to 20, modified from Borg 1970) was obtained before and immediately after both rescues. The instructors were also asked to rate their ability to perform the rescue on a scale of 0 to 7 (0 being easily, 7 being impossible) prior to both rescues. Total metabolic demand of the rescue task was calculated from the total VO2 (L) measured during the rescue task and recovery minus resting VO2 (L) over the same time period. In Rcontrol resting VO2 was calculated from the average of at least 3 min during the resting period. Since in Rhot there was no resting period, the lowest VO2 prior to the rescue task was taken as the resting VO2. Total aerobic demand was defined as the total VO2 (L) measured during the rescue task above resting levels. Total anaerobic demand was defined as the total VO2 (L) during recovery above resting levels; it was assumed that this was representative of the oxygen consumption that could not be met aerobically during the rescue task (Bilzon et al. 2001). 3.3 Hot fire exercise 3.3.1 General Ten instructors were monitored during live fire-fighter training exercises (Hot Fire exercises) in which they acted as safety officers. Every effort was made to try and ensure that the physiological monitoring did not interfere with the work conducted by the instructor. Therefore no restrictions were made on food or drink before the testing period other than the standard recommendation that they should try and be fully hydrated prior to the exercise. The Hot Fire exercises were conducted in one of the purpose built fire houses within the FSC either the BA School (n=6), Ship (n=2), Commercial (n=1) or Domestic (n=1) buildings. The fire and smoke bale loading for the Hot Fire exercises varied between buildings and exercises. In some cases the instructors were assigned to the same floor, but more often, they were on different levels. During the Hot Fire exercise, the instructors' principle task was to monitor the

progress of the students conducting search and rescue tasks and fighting the fires, and also to provide safety cover should it be required. There were no incidents requiring the instructors (or any other safety officer) to perform a rescue in the exercises monitored during this study. Throughout the exercise the instructors positioned themselves in the coolest areas that enabled them to observe the student fire-fighters. During a few exercises, when no students were on their floor of the building the instructors rested outside. Prior to the Hot Fire exercise (either just before or just after the exercise briefing) the instructors provided a urine sample, were weighed in minimal clothing and then instrumented with the physiological monitoring equipment (section 3.2.1). Once fully dressed in their firefighting ensemble (section 3.4) the instructors went out to the fire ground where the exercise was being conducted. The instructors were asked to behave during the exercise as if they were not being monitored and not try to get hot or avoid the heat more than they would normally. During the exercise the instructors were asked to report by radio when they changed their position or activity within the building. They were also asked to give a discomfort rating at least every 10 min or when their level of comfort changed. A rating of 1 to 7 was used with 1 being comfortable and 7 being unbearably uncomfortable. At the end of the Hot Fire exercise the instructors performed the simulated rescue which was always conducted in the BA School. When the Hot Fire exercise was conducted at another location they were driven to the start of the rescue. The time lapse between the end of the Hot Fire exercise and the rescue varied depending on the location of the Hot Fire Exercise, the average time being 10.4 3.3 min (range 6 to 21 min). At the end of the Hot Fire exercise and Rhot the instructors were weighed in minimal clothing for measurement of sweat loss. They also filled in a questionnaire (Appendix B) about the Hot Fire exercise they had just performed. In the questionnaire they were asked to indicate how hot and demanding they thought the exercise was by marking a 100 mm line. A mark at 0 mm corresponded to an exercise which was not hot/demanding; at 50 mm it corresponded to an exercise of average heat/demand and 100 mm to an exercise that was very hot/demanding. They were also asked when their last heat exposure had been and what exercise they had taken in the last 24 hours. 3.3.2 Variables Monitored Environmental Temperature Environmental temperature was measured on the outside of the instructors' tunic using a thermocouple (Type K, Grants Instruments, Cambridge, UK) secured at the level of the shoulder. The temperature was recorded every 1 min on the data logger (modified Squirrel 1000 series, Eltek, Cambridge, UK) worn under the tunic. Environmental temperature was also measured in the buildings using thermocouples attached to a metal pole positioned at 0.3, 0.6, 0.9, 1.2, 1.5 and 1.8 m from the ground. The "thermocouple tree" was placed where the instructors would spend most of their time during the exercise (i.e. away from the direct heat of the fire but with a good view of the route the students would take), without being in their way or causing a tripping hazard for the student fire-fighters. The temperatures were recorded every 1 min on a data logger (Squirrel 1200 series, Grants Instruments, Cambridge, UK) placed in a insulated box.

Deep body temperature Deep body temperature was measured using a rectal thermistor (Grants Instruments, Cambridge, UK) inserted 0.15 m beyond the anal sphincter and recorded every 1 min on the data logger (modified Squirrel 1000 series, Eltek, Cambridge, UK). Skin and microclimate temperature Skin temperature was measured on the chest using a skin thermistor (Grants Instruments, Cambridge, UK) attached with adhesive tape. The temperature of the microclimate between the top of the scalp and fire hood (referred to as hood temperature) was measured using a thermistor threaded into the fire hood. Chest, hood and rectal temperature were recorded on a data logger (modified Squirrel 1000 series, Eltek, Cambridge, UK) at 1 min intervals. The data logger was wrapped in a roasting bag and placed in a holder worn under the tunic around the waist, or neck depending on the instructors' preference. Heart rate Heart rate was measured using a Polar heart rate monitor (Polar Electro Oy, Kempele, Finland) and recorded every 15 s throughout the exercise. Sweat rate and fluid intake Fluid intake during the exercise was measured by weighing (Bench scales, Ohaus UK Ltd, Leicester, UK; accuracy 5 g) the water bottles provided to each instructor before the exercise (after providing a urine sample) and at the end of the exercise. Total sweat rate was calculated from the change in "naked" body weight before and after the exercise taking into account fluid intake. Urine analysis The instructors provided urine samples before the Hot Fire exercise for measurement of pH and specific gravity using a Multistix (Bayer Diagnostics, Munchen, Germany). 3.4 Flat drag rescue Preliminary data analysis and discussions with the instructors indicated that the duration of the interval between the Hot Fire exercise and Rhot was critical in their perceived ability to perform the rescue task. One subject reported that he would not have attempted the Rhot immediately on finishing his Hot Fire exercise. However, the transit time to get him from the Hot Fire exercise to where the rescue was conducted (9 min) was sufficient for him to recover enough to perform the Rhot. In light of this, another trial was conducted with a minimal time delay between the end of the Hot Fire exercise and the rescue task (Rflat). Six instructors undertook Rflat (three of which also undertook Rcontrol and Rhot) and one subject (instructor no. 9) undertook two Rflat separated by 3 months giving a total of seven trials. The rescue task was performed immediately after completing a Hot Fire exercise during which they were monitored as above with the exception that temperature recordings were made every 15 s rather than every minute. The Hot Fire exercises were conducted in the

purpose built fire houses within the FSC - the Ship (n=2), the BA School (n=3) and Industrial B (n=2) buildings. The rescue task (Rflat) involved dragging a 68.5 kg dummy wearing SCBA (16.5 kg) around cones placed 10 m apart for a total distance of 30 m (Figure 3.2). In order to ensure the minimum time delay between the end of the Hot Fire exercise and rescue task, the cones and dummy were placed close to the exit of the fire building. Before commencing the rescue task the instructors were asked to rate their ability to perform the rescue (0 to 7). If they gave a rating of 5 or above their rectal temperature was checked and if this was above 39.5C or they gave a rating of 7 they did not conduct the rescue task. Time taken to complete the task was recorded and heart rate was measured every 5 s (Polar Electro Oy, Kempele, Finland). At the end of the Rflat the instructors were asked their rating of perceived exertion (6-20 scale Borg) and 2 min later a finger prick sample blood was taken for measurement of blood lactate concentration (Lactate Pro, Arkray Inc, Kyoto, Japan).

Figure 3.2 Instructor undertaking Rflat. 3.5 Clothing The clothing worn by the instructors varied according to the brigade they came from and their own personal preferences. In general, the instructors wore a T-shirt and overalls under their two-piece protective clothing (from various manufacturers including: Bristol, PBI Gold and Delta). They also wore a fire hood, either a Cromwell or Galley helmet and protective gloves. On their feet they wore 2 pairs of socks and standard steel toe-cap fire boots. The mass of the total clothing ensemble was 10.6 0.7 kg, the SCBA weighed 12.4 kg and the physiological monitoring equipment weighed 0.9 kg. 3.6 Assessment of physical fitness and percentage body fat Aerobic capacity was estimated by measurement of heart rate during a submaximal step test or cycle ergometer test. For the step test, the instructors stepped at a constant pace for 6 min

wearing shorts or track suit, T-shirt and training shoes. Oxygen consumption for the stepping exercise was calculated, and with the heart rate measured during the last 2 minutes of exercise, was used to predict maximal oxygen consumption (VO2max) using the Astrand Ryhming nomogram (1954). The value thus obtained was corrected for age. For the cycle ergometer test, VO2max was predicted from work load and heart rate using the Fitech Counsellor Series (Fitech Ltd, Chester). Percentage body fat was calculated from measurements of skinfold thickness taken at the biceps, triceps, subscapular and supra-iliac according to Durnin and Womersley (1974). 3.7 Statistical analysis Data are given as the arithmetic mean standard deviation. A test of normality (KolmongorovSmirnov) and Levene's test of equal variance were conducted on the data, following which heart rate, oxygen consumption, RPE and blood lactate concentrations in Rcontrol and Rhot were analysed using a paired t-test. Relationships between the perceived ability to perform a rescue and various measures made prior to Rhot and Rflat were analysed using a Spearmans rank correlation coefficient. Statistical significance was taken at the 5% level (P<0.05).

Go to table of contents 4. Results 4.1 General The physical characteristics of the instructors monitored are shown in Table 4.1.

Table 4.1. Physical characteristics and fire fighting experience of instructors. BAI = breathing apparatus instructor, FSC = Fire Service College. Instructor 13 was monitored on his first day as a BAI at the FSC. R1 = Simulated Rescue Task 1 (Rhot and Rcontrol), R2 = Simulated Rescue Task 2 (Rflat). Predicted VO2max values that are marked with an asterix were obtained from a submaximal cycle ergometer test (Fitech). 4.2 Hot fire exercises 4.2.1 Introduction The average duration of the Hot Fire exercises prior to Rhot (HF1) were 40.0 24.3 min (range 12 to 92 min) and prior to Rflat (HF2) were 41.3 12.8 min (range 22.8 to 62.5 min). HF1 and HF2 were rated as 60 18 and 59 24 for demand and 59 19 and 52 26 for heat respectively (0 corresponded to an exercise which was not hot/demanding; 50 to one of average heat/demand and 100 to one that was very hot/demanding). The individual data for HF1 and HF2 are given in Appendices C and D. 4.2.2 Environmental temperature The mean and maximum environmental temperatures recorded within the fire building during the Hot Fire exercises are shown in Table 4.2. Data were not collected for all of the instructors as they changed floors and were therefore not in the same area as the "thermocouple tree".

The mean temperature measured on the outside of the instructors' tunic was 48.4 11.2C (n=9) during HF1 and 39.2 15.6C (n=5) during HF2. The maximum temperature measured was 95.6 49.2C during HF1 and 79.2 31.9C during HF2. Environmental Temperature (C) HF1 HF2 Height of thermocouple mean maximum mean maximum 0.3 m 33 9 52 22 22 13 36 4 0.6 m 45 12 75 24 27 19 57 49 0.9 m 54 15 90 30 33 26 79 77 1.2 m 63 18 107 36 56 57 132 108 1.5 m 75 25 135 51 87 87 188 116 1.8 m 99 38 174 61 112 83 233 131 Table 4.2. Mean and maximum temperature standard deviation recorded from the "thermocouple trees" during the Hot Fire exercises, n = 5 for HF1 and n = 3 for HF2. 4.2.3 Deep body temperature Rectal temperatures (Tre) during the Hot Fire exercises are shown in Table 4.3 and Figures 5.1 and 5.2. The individual responses varied considerably depending on the duration of the exercise and the fire loading (Figures 5.1 and 5.2). The highest Tre recorded during HF1 was 38.8C in 2 instructors and during HF2 it was 39.05C in one instructor. After the Hot Fire exercise, Tre increased slightly prior to the start of simulated rescue task and showed a further elevation after completion of the rescue task despite the tunic being opened fully and the gloves and helmet removed. HF1 HF2 Start Hot Fire 37.60 0.13C 37.62 0.29C (n=7) End Hot Fire 37.99 0.37C 38.12 0.68C (n=5) Start rescue 38.05 0.39C 38.29 0.73C (n=6) End rescue 38.20 0.35C 38.43 0.68C (n=6) Total change 0.60 0.35C 0.83 0.56C (n=6) Table 4.3 Mean rectal temperature standard deviation before and after Hot Fire exercises and simulated rescue tasks. Values represent the mean and standard deviations of 10 observations for HF1 and as indicated in parenthesises for HF2.

Figure 4.1 Rectal temperature during HF1 and Rhot. Each line represents the rectal temperature of an individual instructor. The open circle indicates the end of HF1 and the closed square the start of Rhot.

Figure 4.2 Rectal temperature during HF2 and Rflat. Each line represents the rectal temperature of an individual instructor. The open circle indicates the end of HF2 and the closed square the start of Rflat. 4.2.4 Skin and microclimate temperature Chest Tsk averaged 38.01 0.91C during HF1 and the maximum averaged 39.14 1.38C (range 37.0 to 41.2C; n=9). During HF2, the mean chest Tsk was 37.79 1.25C and the maximum averaged 38.85 1.62C (range 36.7 to 41.2C; n=7). Hood T averaged 37.02 1.38C (n=8) during HF1 and the maximum averaged 40.08 2.51C (range 37.15 to 44.65C, n=8). One subject had a head T of over 44C for 5 min. During HF2, the mean hood T was 36.95 2.66C and the maximum averaged 39.21

2.88C (range 36.65 to 43.05C; n=6). 4.2.5 Heart rate Heart rate (HR) during the Hot Fire exercises is shown in Figure 4.3. The maximum HR recorded equated to 87 5% of the instructors' maximum HR (HRmax - either recorded or predicted from age) in HF1 and 77 11% in HF2. In most cases (13/15), HR was found to increase gradually during the Hot Fire exercises, the difference between the average HR during the first and last minute of HF1 was 29.4 22.4 bpm (n=9) and 26.5 28.0 bpm (n=6) for HF2 (see Appendices C and D for individual data).

Figure 4.3 Mean and maximum heart rate during the Hot Fire exercises. Bars represent the mean and the error bars the standard deviation of 9 observations for HF1 and 6 observations for HF2. 4.2.6 Hydration status Prior to the Hot Fire exercises the mean urine specific gravity was 1.019 0.009 (n=7) for HF1 and 1.023 0.009 (n=6) for HF2. The total sweat loss, fluid intake and fluid deficit recorded for the Hot Fire exercises and rescue tasks are given in Figure 4.4. Assuming the sweat loss occurred predominantly from the start of the Hot Fire exercise to the end of the rescue task, this gave a sweat rate of 35 25 ml.min-1 in HF1 (n=10) and 23 12 ml.min-1 in HF2 (n=7). The fluid deficit equated to a loss of 0.6 0.6% body mass in HF1 and 0.6 0.4% body mass in HF2.

Figure 4.4. Mean sweat loss, fluid intake and fluid deficit during the Hot Fire exercises and the rescue tasks. Mean and standard deviation given for both conditions (n= 10 for HF1 and n=7 for HF2). 4.2.7 Discomfort The average discomfort votes during HF1 and HF2 were 3.1 1.3 and 3.1 0.8 respectively. The corresponding maximum discomfort averaged 4.2 1.8 and 3.7 1.1 (1 = comfortable; 7 = maximum discomfort). In one HF1 the maximum discomfort (7) was reported after 5 to 7 min of the start of the exercise. This was due to the very high heat load from the fire in the Domestic building that was compounded by the instructor being unable to leave his post as his radio had malfunctioned. Table 4.4 shows the physiological measurements taken at this time. Measurements at 5 to 7 min Discomfort 7 HR 149 bpm Tre 37.70C Chest Tsk 40.40C Hood T 44.65C Table 4.4. Physiological status of an instructor corresponding to the time when he reported a maximum discomfort vote during a Hot Fire exercise (HF1) in the Domestic building. 4.3 Rcontrol and Rhot Prior to the Rhot the instructors' RPE and rating of inability to perform the rescue were significantly higher than prior to Rcontrol (P<0.001, Table 4.5). Heart rate was also significantly elevated prior to the Rhot compared to the Rcontrol (P<0.001), however there was no difference in the blood lactate levels (Table 4.5). Rhot was conducted 10.4 3.3 min after completion of HF1 in a mean ambient temperature of 19.2 2.0C (n=10). Rcontrol RPE (n=8) 6.5 0.9 Ability to perform rescue 0.6 1.0 Heart rate (n=9) 75 9 bpm Blood lactate (n=9) 1.63 0.79 mmol.L-1 Rhot 12.1 1.8 * 3.5 1.7 * 110 25 bpm* 1.33 0.33 mmol.L-1

Table 4.5. Average rating of perceived exertion and ability to perform the rescue, heart rate and blood lactate levels prior to undertaking Rcontrol and Rhot. Values are the mean standard deviation, n=10 unless otherwise stated. * indicates significant (P<0.001) difference between Rcontrol and Rhot. All ten instructors were able to complete Rcontrol and Rhot. Visual observation of the instructors confirmed that they were taking good care of the dummy's head and shoulder region, but as expected, the limbs would have received considerable bruising during the rescue. The time taken to complete the rescue was not significantly different (P>0.05) between the 2 trials and averaged 90.1 28.6 s (range 48 to 136 s) for Rcontrol and 78.7 15.6 s (range 52 to 102 s) for Rhot. Heart rate during the Rhot was significantly higher than during Rcontrol (P<0.005, Figure 4.5). The heart rate and oxygen consumption profiles for each instructor during both rescues are shown in Appendix E. The average oxygen consumption during Rcontrol and Rhot was 2.25 0.40 L.min-1 and 2.50 0.22 L.min-1 respectively. Total metabolic demand was greater during Rcontrol compared to Rhot (P<0.01), this was due to a greater anaerobic demand (P<0.05) as the aerobic demand was similar (P>0.05, Table 4.6). As a consequence, during Rhot a greater percentage of the energy required was met by aerobic metabolism (P<0.05). Oxygen pulse (VO2/HR) during rest was 5.5 0.3 ml.beat-1 this increased to 14.6 2.2 ml.beat-1 in Rcontrol and 15.5 2.0 ml.beat-1 in Rhot (n=5). Rcontrol Rhot Total metabolic demand (L O2) 6.77 0.98 5.44 1.01 ** Total aerobic demand (L O2) 2.41 0.69 2.39 0.59 Total anaerobic demand (L O2) 4.36 1.22 3.05 1.26 * Aerobic contribution (%) 36.3 12.3 45.5 14.9 * Anaerobic contribution (%) 63.7 12.3 54.5 14.9 * Table 4.6. Mean metabolic demand during Rcontrol and Rhot. The breakdown of the aerobic and anaerobic components of the total metabolic demand are also given (n=6). * and ** indicate a significant (P<0.05 and P<0.01 respectively) difference between Rcontrol and Rhot.

Figure 4.5. Average mean and maximum heart rate during the Rhot and Rcontrol and the percentage of the instructors' heart rate maximum these values represent (n=9). * indicates a

significant difference between Rcontrol and Rhot (P<0.005). Blood lactate levels after Rcontrol and Rhot were not significantly different averaging 5.84 2.79 mmol.L-1 and 6.08 1.76 mmol.L-1 respectively. RPE after the Rhot was significantly greater (P>0.001) than Rcontrol (Rhot = 15.7 2.1; Rcontrol = 13.3 2.4). No correlation was found between the perceived ability to perform Rhot and the following variables: rectal temperature, heart rate (expressed as percentage of maximum heart rate), chest or hood temperature recorded over 1 minute prior to commencing Rhot, ratings of heat and demand for HF1 duration of rest between HF1 and Rhot or time to complete Rhot. 4.4 Rflat Rflat was performed 79.0 65.0 s after completing a Hot Fire exercise (HF2) in an ambient temperature of 16.3 6.7C (n=7). The subjects rating of their ability to perform the rescue averaged 4.1 1.5 (0 = easy; 7 = impossible; n=7). On six occasions the full 30 m drag was successfully completed, on one occasion the instructor dragged the dummy for 20 m before stopping through exhaustion. The individual data for Rflat are given in Table 4.7. The mean time to complete the 30 m rescue task was 41.7 6.9 s (n=6). For the instructors where the split times were recorded and the full 30 m rescue task was completed (n=5), the mean time taken to drag the dummy 10 m was 11.0 3.7 s and 25.7 3.6 s for 20 m. This was considerably faster than for the instructor who stopped at 20 m (Table 4.7). Mean HR prior to Rflat and after HF2 was 129 32 bpm. The mean HR during Rflat was 172.7 19.1 bpm and maximum HR averaged 182.3 19.7 bpm which corresponded to 96 5% of the instructors HRmax (n=6). At the end of Rflat, RPE averaged 16.3 2.4 and the mean blood lactate level was 8.3 1.9 mmol.L-1 (n=7). Perceived ability to perform Rflat was positively correlated with Tre and Tchest prior to the rescue task (Tre: R2 = 0.771, n = 6, P<0.05; Tchest: R2 = 0.847, n = 7, P<0.01). The strongest correlation was found between the heat and demand rating of HF2 and perceived ability to perform Rflat (R2 = 9.57; P<0.01; Figure 4.6). Rating of ability Tre Rescue time (s) Max HR RPE Lactate Subject (0-7) (C) 10 m 20 m 30 m (bpm) (6-20) (mmol.L-1) 1 2.5 37.40 11.0 29.0 41.8 168 14 8.7 4 6 38.65 23.0 66.0 169 19 7.9 6 2 37.60 7.0 23.0 34.0 159 13 7.0 9 4 17.0 30.0 43.0 207 16 8.1 9 (2) 5.5 39.10 53.8 19 9.4 11 4 38.00 10.0 22.0 36.0 190 15 5.4 13 5 39.00 10.0 24.5 41.5 201 18 11.4 Mean 4.1 38.29 13.6 32.4 41.7 182 16.3 8.3 SD 1.5 0.73 6.4 16.8 6.9 20 2.4 1.9 Table 4.7 Individual data for Rflat. Instructors rating of their ability to perform the rescue task (Rflat), rectal temperature at the start of Rflat, time taken to drag the dummy 10 m, 20 m and 30 m, maximum heart rate during Rflat, rating of perceived exertion at the end of Rflat and

blood lactate levels 2 min post Rflat are given for each instructor. The subject highlighted was unable to complete the 30 m rescue task. The mean and standard deviation are for all the data obtained.

Figure 4.6. Correlation between perceived ability to perform Rflat and rating of heat and demand of HF2. Ability to perform the rescue was rated on a scale of 0 to 7 (0 being easily, 7 being impossible). Heat and demand of the Hot Fire exercise were rated separately on a scale of 0 to 100, 0 corresponded to an exercise which was not hot/demanding, 50 to one of average heat/demand and 100 to one which was very hot/demanding. The rating of heat and demand is the sum of the two ratings (n=7).

Go to table of contents 5. Discussion 5.1 General As soon as 10 min after a Hot Fire training exercise, all ten instructors were able to complete a simulated rescue task involving dragging a 81 kg dummy 15 m along a corridor containing obstacles and then down 2 flights of stairs (Rcontrol and Rhot). From the questionnaire responses it is likely that this rescue task is representative of most worst case scenarios within the UK Brigades. As expected, the instructors found the rescue task harder after they had acted as a safety officer in a Hot Fire exercise. This was reflected in their significantly higher heart rates and RPE scores following Rhot (Figure 4.5). It is therefore encouraging that, despite being exposed to the heat for an average of 40 min, all the instructors monitored were capable of successfully performing a rescue task simulating the worst case scenario of a collapsed fire-fighter in a live fire training exercise. 5.2 Hot fire exercises and deep body temperature Whilst the rescue task probably did represent the worst case scenario judging from the responses to the questionnaire sent out to the Brigades (section 2 and Table 2.3), other factors may not have been. The mean Tre at the end of the Hot Fire exercise (HF1) was 38C with the maximum recorded being 38.8C. This is lower than that recorded previously with fire-fighter instructors, where the mean deep body temperature at the end of the fire-fighter training exercises was 38.5C with 8 out of 26 Hot Fire exercises resulting in a deep body temperature exceeding 39C (Eglin and Tipton 2000). Other studies monitoring fire-fighters have recorded deep body temperatures of 38.3C after two 15 min periods of heavy dynamic work (Ilmarinen et al. 1997), 39C after 24 min of a search and rescue task (Romet and Frim 1987) and 39.8C after a 16 min ceiling haul (Smith et al. 1997). It should, however be noted that in these studies the fire-fighters were undertaking strenuous work, and whilst their heat exposure was shorter, their metabolic heat production would have been much higher. The lower deep body temperatures recorded during HF1 could have been a result of control measures put in place following the results obtained from monitoring instructors from the FSC during Hot Fire exercises (Eglin and Tipton, 2000). The recommendations from that study were that fire-fighters should be encouraged to actively cool down and minimise their physical activity after a live fire training exercise until their deep body temperature has returned to normal. It was also recommended that instructors should not be re-exposed to the heat within a couple of hours and should be encouraged to drink more fluids and monitor their hydration status. Since this study was conducted there has been a complete job rotation at the FSC and all the personnel have changed. As a consequence some of the practices put in place as a result of the recommendations may have been lost. In the present study it was very rare for an instructor to come outside the building for a rest during the Hot Fire exercise, where previously they came out on average for 10.6 11.0 min (n = 19 out of 27 Hot Fire exercises) over the 40 min exercise period. This change in practice could be due to the instructors being unable to leave their post due to the continual presence of students on their section of the building, or a reduction in fire loading within the fire houses resulting in the instructors not finding it necessary to cool down during the Hot Fire exercise. Lower environmental temperatures were measured in the present study (Table 4.1) thus supporting the latter explanation and helping

explain the lower Tre recorded. 5.3 Simulated rescue tasks After completing their Hot Fire exercise the instructors had on average a rest period of 10 min before attempting the rescue task. This delay in commencing the rescue was an inevitable consequence of the need to transport the instructor to the fire building where the rescue task was conducted, and the need to exchange the SCBA worn by the instructors for the Metamax system used to measure oxygen consumption. Many of the instructors commented that they would have found the rescue task more difficult if they had to conduct it immediately the Hot Fire exercise had ended. One instructor reported he would not have attempted the rescue task immediately after a very hot Hot Fire exercise (Table 4.4), but was able to do so with the 9 min rest period. In light of this, another trial was conducted with a minimal time delay between the end of the Hot Fire exercise and the rescue task. Rflat involved dragging an 85 kg dummy 30 m along a flat surface which is the furthest distance reported by the brigades that a casualty may have to be moved to safety during a live fire training exercise. On 6 out of 7 occasions the instructors were able to successfully perform Rflat 1 min 19 s after acting as a safety officer in a Hot Fire exercise which resulted in their Tre being elevated, on average, to 38.1C. The one instructor who did not manage to complete the full 30 m rescue task was able to drag the dummy 20 m. This is further than the furthest distance a safety officer would have to move a casualty on their own, based on the responses to the questionnaire (mean 5.9 m, range 1.5 to 15 m). Therefore, even without a rest period, the results suggest that, within the limits of the current study, the instructors are capable of successfully performing a rescue at the end of a Hot Fire exercise. It should be noted, however, that in a scenario where the Hot Fire exercise was more arduous resulting in higher deep body temperatures and greater levels of dehydration, or the instructor was less fit or experienced or the casualty was heavier than 85 kg a rescue may not be possible. This also presumes that it is acceptable to have the instructors under such a high level of strain whilst performing a rescue. 5.4 Physical demand of the rescue tasks Data from Rcontrol and Rhot demonstrate that performing a rescue is a demanding task (Table 4.6) with HR being close to the instructors' HRmax (Figure 4.5). Despite being exactly the same task, Rhot was found to require a smaller metabolic demand than Rcontrol (Table 4.6). This was probably a learning effect as for safety reasons the Rcontrol was conducted first and skill was required to turn the dummy around 180 in a confined space at the start of the rescue. As a result the aerobic demand of the task was similar in both rescues with an increased additional anaerobic demand in Rcontrol (Table 4.6) however, blood lactate levels measured 2 min post Rcontrol and Rhot were similar. The blood lactate levels 2 min after the rescue tasks averaged 6 mmol.L-1 indicating the task was strenuous. Heart rate prior to and during Rhot was higher than for Rcontrol (Table 4.5, Figure 4.5). During Rhot, the instructors' HR was at, or very close to, their HRmax (Figure 4.5); whilst HR was lower in Rcontrol it still reached 87% HRmax. Interestingly, although significantly higher after Rhot, the RPE scores following the rescue tasks did not reflect these very high HR. The mean RPE for Rhot was 15.7 2.1 and that for Rcontrol was 13.3 2.4 which correspond to a rating

of "heavy to very heavy" and "somewhat heavy" respectively. With such high HR one would normally expect RPE scores above 18 (Borg 1982). However, the rescue task involves a lot of upper body musculature and this has been found to elevate HR more than the equivalent lower body exercise (Toner et al. 1990). 5.5 Heat and performance Heart rate before and during Rhot was higher than with Rcontrol due to an increase in body temperature (Figure 4.5, Table 4.5). In the heat, peripheral blood vessels dilate to enhance heat dissipation and therefore peripheral blood flow increases. Therefore, during exercise in the heat a greater cardiac output is required to support the increased blood flow to the active musculature and periphery. Cardiac output during exercise in the heat may be further compromised by a reduction in plasma volume (caused by dehydration) and venous return which will reduce stroke volume. Therefore fire-fighting tasks at an elevated body temperature will require a greater cardiac output, but due to heat related decrease in plasma volume maximum cardiac output will be decreased. Stroke volume has been found to decrease by 35% following three 7 min bouts of strenuous fire-fighting tasks in the heat. This resulted in a 30% reduction in cardiac output as HR could only be increased by 8% before reaching the firefighters' HRmax (Smith et al. 2001a). Using the same protocol, but different subjects, Smith et al. (2001b) demonstrated a 15% reduction in plasma volume occurred after the 21 min of firefighting tasks. The results from the current study suggest stroke volume may have been decreased in Rhot compared to Rcontrol as HR was significantly higher despite the total metabolic demand of Rhot being lower than Rcontrol. Prolonged exposure to heat, such as during a Hot Fire exercise, reduces physical capacity and performance (Nielsen et al. 1981; Hargreaves and Febbraio 1998). This is due to an elevation in deep body temperature or dehydration or a combination of both factors (Nielsen et al. 1981). Convergence of mean Tsk and deep body temperature has been suggested as a good predictor of the limit of heat tolerance for workers in encapsulated garments (Pandolf and Goldman 1978). However, Nunneley et al. (1992) have suggested that whilst convergence occurs under severe heat stress, motivated individuals can continue working beyond this point. Tsk on the chest during HF1 increased above Tre in 8 out of 9 instructors and during HF2 in 5 out of 7 instructors. In those instructors where convergence of Tre and Tsk was not observed their Tre had only increased by an average of 0.1C by the end of the Hot Fire exercise. In the instructors where convergence was observed maximal discomfort votes during the Hot Fire exercise averaged 4.0 (range 1 to 5.5 - excluding the instructor who reported 7 after 5 min of a HF1, Table 4.4) suggesting they were not close to their limit of heat tolerance. Given the much higher ambient temperatures experienced in the present study, compared to the laboratory based studies (Pandolf and Goldman 1978; Nunneley et al. 1992), it is unlikely that convergence of chest Tsk and Tre could be used to predict tolerance time during fire-fighting training exercises. The instructor who reported a discomfort vote of 7 had a high hood T as a result of the high radiant heat load in the building. The T under the fire hood for this instructor was 44C for 5 min, which is the lowest skin temperature to cause skin burning after contact with an object for 6 hours (Moritz and Henriques 1947). Therefore, although very uncomfortable, this high T did not result in a burn. The maximum Tsk recorded in the other Hot Fire exercises whilst high, were below 44C and therefore would have an adverse effect on comfort but not induce a burn.

5.6 Hydration status and performance Sweat loss during the Hot Fire exercises and rescue tasks resulted in very mild hypohydration, less than 1% body weight, assuming the water consumed during the Hot Fire exercise was fully absorbed into the blood stream (Figure 4.4). From the literature pertaining to sports performance such a low levels of dehydration is unlikely to affect either thermoregulation or performance (Cheuvront and Haymes 2001; Yoshida et al. 2002). However studies on firefighters working in the heat have shown a 15% reduction in plasma volume after only three 7 min bouts of fire-fighting tasks (Smith et al. 2001b). In addition, dehydration will augment the effect of hyperthermia on the cardiovascular system resulting in a greater reduction in stroke volume and therefore cardiac output (Gonzalez-Alonso et al. 1997). This is particularly relevant to a student fire-fighter who has undertaken strenuous fire-fighting tasks in the heat and is then required to aid in the rescue of a fellow fire-fighter. The level of dehydration as a result of sweat loss during a Hot Fire exercise will be compounded if the fire-fighter starts the exercise in a hypohydrated state. The hydration status of the instructors prior to the Hot Fire exercises was assessed by measuring urine specific gravity (Usg). The average Usg prior to HF1 was 1.019 and 1.023 prior to HF2 suggesting that the instructors were euhydrated (Armstrong et al. 1994). 5.7 Fitness and performance The instructors monitored during the current study had similar levels of fitness to those used in other studies of fire-fighters judging from their predicted VO2max levels (Lemon and Hermiston 1977; White and Hodous 1987 and 1988; Ben-Ezra and Verstrete 1988; Faff and Tutak 1989; Louhevaara et al. 1995; Home Office 1996; Smith and Petruzzello 1998; Eglin and Tipton 2000). The fitter an individual is, the more easily they will be able to perform a given task. The average oxygen consumption during Rcontrol and Rhot was 2.37 0.33 L.min-1. This value is similar to a previous study measuring oxygen consumption during a victim rescue (Lemon and Hermiston 1977). Thus for the instructors with a high VO2max this represented a lower percentage of their VO2max than for the less fit instructors. However, the task was self-paced and therefore the instructor could adjust their pace according to the level of physiological strain. There are inherent errors in using a submaximal test for determining VO2max as several assumptions are made: there is a linear relationship between HR and VO2, all individuals have the same stepping/cycling efficiency, and HRmax is 220-age (unless a higher HR was recorded during the rescue tasks). There was evidence to suggest that the predicted VO2max values obtained using the Fitech cycle ergometer test gave a greater over-estimation of the individuals aerobic capacity than the step test. Given that this test is used routinely at the FSC and other brigades to give advice to fire-fighters on their fitness levels and training required, this submaximal test should be validated against a direct measure of VO2max in the firefighting population. Even when VO2max is determined directly during exhaustive exercise, it has been suggested that a VO2max obtained during arm cranking may be more applicable to determining the relative intensity of fire-fighting tasks requiring a large proportion of upper body activity than a VO2max determined on a treadmill (Weafer 1999). It was noticeable that the only instructor who could not complete the full 30 m dummy drag in Rflat was the oldest fire-fighter and was one of the less fit instructors. Whilst, within limits, age

per se has little effect on performance it is often associated with a decline in physical fitness (Hossack and Bruce 1982) as a result of a more sedentary life style (Buskirk and Hodgson 1987). It is the reduction in fitness and therefore cardiovascular, respiratory and thermoregulatory function that will impair the ability of a fire-fighter to perform in the heat. This is supported by a study conducted by Faff and Tutak (1989) where fire-fighter exercise tolerance time in the heat was not found to be related to age (21 to 32 y vs. 36 to 42 y) but was increased with fitness (>39 ml.kg-1.min-1). It is also noteworthy that this instructor had the least current experience of hot wears as he was in a management position. Experience in Hot Fire exercises is important as not only will it result in favourable physiological adaptations through heat acclimation (Armstrong and Maresh 1991), but will also enable the fire-fighter to keep cooler through behavioural adaptations such as knowing where the cooler areas of the building are. 5.8 Perceived ability to perform the rescue task All the instructors perceived correctly that they would be able to perform Rcontrol and Rhot and as expected, they thought they were more able to perform Rcontrol than Rhot (Table 4.5). The rating of their perceived ability to perform the Rhot was not correlated to any physiological variable measured prior to the rescue task neither was it correlated to HR during Rhot. The instructor who did not complete Rflat gave a rating of 6 indicating that he thought he could perform the rescue but would find it extremely difficult. Unlike Rhot, several of the variables measured prior to Rflat correlated with their perceived ability to perform the rescue task. This suggests that Tre, chest Tsk and in particular the level of stress perceived during HF2 influenced their perception of their ability to perform the rescue task (Figure 4.6). This suggests that elevated Tre and Tsk as a result of the stress of the Hot Fire exercise reduced their perceived ability to perform the rescue task. It is unclear why no such correlations were observed with Rhot, this may have been due to the psychological benefit derived from the rest period between HF1 and Rhot, however it should be borne in mind that the subject numbers were small. 5.9 Cardiovascular risk in firefighters A review of epidemiological studies by Guidotti (1995) on fire-fighter mortality concluded that there was no conclusive evidence to suggest that fire-fighters have an increased risk of death from heart attack over the normal population. However, there may be a risk of sudden heart attack and cardiac decompensation following sudden maximal exertion or carbon monoxide exposure (Guidotti 1995). A survey of fire-fighters in the USA in 1993 indicated that heart attacks accounted for over 50% of all on-duty fire-fighter deaths, a similar statistic was found for deaths on the fireground (NFPA cited by Bone et al. 1994). 95% of these heart attacks were attributed to stress and over exertion (NFPA cited by Bone et al. 1994). An earlier report on the causes of line-of duty fire-fighter deaths in the USA between 1977 and 1986 found 47% of deaths (612) were caused by heart attacks (Picher 1987). 50% of these heart attacks were associated with fire suppression tasks, 25% with responding or returning from an alarm call and 6% occurred during training. Therefore exposure to heat during a Hot Fire exercise and sudden high intensity exercise such as rescuing a collapsed student fire-fighter could put the instructor at increased risk of a fatal heart attack. The risk of a cardiovascular accident is greater in an individual who has underlying

cardiovascular disease. This is supported by the findings of the survey conducted by Picher (1987), where of the fire-fighters whose medical condition prior to their fatal heart attack was known (n=257), 40.5 % had some prior heart-related condition (e.g. previous heart attacks or coronary bypass surgery) that had impaired their performance. In addition, 39.3% had severe arteriosclerotic heart disease (defined as arterial occulsion greater than 50%) and 9% had hypertension. Good physical fitness will reduce the strain associated with carrying out a task and therefore reduce the risk of a heart attack. In a study assessing the physical fitness of 150 full time firefighters from a municipal fire department it was found that the fire-fighters had a similar level of fitness to that of the general sedentary population (Saupe et al. 1991). In addition, in Saupe and co-workers study the vast majority of fire-fighters over 30 years old fell below the recommended minimum VO2max of 39 ml.kg-1.min-1. It is not clear whether, since this paper was published, measures to increase the physical fitness of fire-fighters have succeeded, or whether a similar pattern of fitness is found in fire-fighters in UK brigades. Given the very high heart rates observed during the rescue tasks, particularly after completing the Hot Fire exercise, it would be prudent to medically screen safety officers to assess their fitness levels and their risk of heart attack. The responses from the questionnaire show that prior to becoming a safety officer a fire-fighter is given a medical in approximately half the brigades in the UK, whereas in only 7 brigades a fitness test is conducted (Table 2.5). Still fewer brigades conduct periodic fitness testing of their instructors (Table 2.5). Knowledge of the fitness levels of the instructors could help in managing a Hot Fire training exercise by positioning the fittest safety officer in the least accessible regions of a fire building were the rescue of a collapsed student would be more difficult. Alternatively management systems could be put in place which mean that, where possible, instructors would not have to perform a rescue when either hyperthermic or hypohydrated. This may involve rotating staff during the Hot Fire exercise to reduce their increase in deep body temperature or ensuring there was a rescue team on standby outside the building.

Go to table of contents 6. Conclusions The physiological responses of the instructors observed during the Hot Fire training exercises were within the range of those reported previously. The rescue tasks devised were representative of the worst case scenario that a single instructor may face according to the responses to a questionnaire sent out to all the brigades in the UK. These rescue tasks were very demanding and approached the physiological limits of the majority of current instructors. Despite the arduous nature of the rescue tasks, the instructors monitored were capable of performing a rescue task after acting as a safety officer in a live fire training exercise. Evidence from this study showing a sweat loss of 1.5 L during the Hot Fire exercise and rescue task confirms the importance for all fire-fighters involved in Hot Fire training exercises to be fully hydrated at all times. It is likely that in less favourable situations (higher deep body temperatures, greater levels of dehydration, less fit or experienced instructor, or a casualty heavier than 85 kg) a rescue may not be possible, or attempts to continue to do so may result in a "heart attack" in the rescuer. It should also be considered whether it is acceptable to expect less fit fire-fighter instructors to undertake such a strenuous task in combination with heat exposure.

Go to table of contents 7. Recommendations It is recommended that physical fitness tests for instructors acting as safety officers during live fire training exercises are undertaken prior to starting the post and then followed up every 6 months to 1 year. From the literature on the physical demand of fire-fighting tasks (Bilzon et al. 2001; Gledhill and Jamnik 1992) and the VO2 measured during the rescue task in the current study it is suggested that the minimum VO2 max should be 40 to 45 ml.kg-1.min-1. However, lower levels of fitness may be overcome by using management strategies as suggested below. Given that fitness assessment is important prior, and during, employment as a safety officer, any test used to assess aerobic capacity should be properly validated against a direct measure of VO2max in an appropriate population (i.e. fire-fighters representative of the instructor population - aged 25 to 45 y). The information obtained from the fitness tests could be used as a management tool to determine where instructors should be placed within a fire building. The fittest instructor, who is likely to be most capable of performing a rescue should be placed in the least accessible region of the fire building. If the training exercise is likely to be arduous and/or the instructors are less fit, it is recommended that extra staff are available outside the building in case a rescue is required. Alternatively, staff could be rotated so that their exposure to the heat is reduced. The instructors monitored were fairly accurate in their perceived ability to perform the rescue task and this was related to the stress experienced during the Hot Fire exercise. Therefore, by asking the instructors how they perceive their level of stress during a live fire training exercise (using a simple 1 to 7 scale) an indication of their ability to perform a rescue will be obtained. This could then be used to relocate instructors during the Hot Fire exercise to avoid a reduction in performance caused by heat stress. Prior to the start of Hot Fire training exercises the instructors and student fire-fighters should be encouraged to have their tunics open to prevent their deep body temperature from rising before they start the exercise. The instructors should rest outside the fire building whenever possible during the exercises to reduce their heat exposure. In addition all fire-fighters should be encouraged to actively cool down after the fire-fighter training exercises to prevent their deep body temperature from rising further. This can be achieved simply by opening tunics (with the possible use of fans, Carter et al. 1999) or by immersing the hands in cold water (House 1998). Fire-fighter instructors and students should be encouraged to drink plenty of fluids before, during (where possible) and after a heat exposure. They should drink at least 1.5 times the amount of weight they have lost through sweating (e.g. if they have lost 1 kg during an exercise they should drink 1.5 L fluid). It will take approximately 4 hours to rehydrate (Bilzon et al. 2000), though this will vary depending on the extent of dehydration and the volume and nature of fluid ingested. Monitoring of hydration status should be encouraged, this can be done by weighing every day or checking urine colour against a chart relating urine colour to hydration status. It should be remembered that alcohol consumption and illness can result in dehydration.

Go to table of contents Acknowledgements We would especially like to like to thank the following people: all the instructors at the Fire Service College, Moreton in Marsh for participating in the trial and giving valuable feedback throughout; Paul Grimshaw for supporting the study and allowing us to use the facilities at the FSC, Sue Coles and Guy Roberts for all their help and support during the trial; Jonathan Dalzell for his excellent help with the data collection; Frank Golden for help and advice in writing the report, all the brigade training officers who responded to the questionnaire.

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