Feairheller, D. L., Smith, M., Carty, M., & Reeve, E. H. (2023). Blood pressure surge with alarm is reduced after exercise and diet intervention in firefighters. Blood pressure monitoring, 10.1097/MBP.0000000000000649. Advance online publication. https://doi.org/10.1097/MBP.0000000000000649

Background: Cardiac-related incidents are a public health concern for tactical occupations, and cardiovascular disease rates are higher in these populations compared with civilians. Research is needed to examine blood pressure (BP) responses in firefighters. The pager alert is one occupational hazard, and it is unknown if lifestyle change can reduce the systolic surge response.

Purpose: To measure BP surge with alarm in firefighters to determine whether the magnitude is lower after a 6-week tactical exercise and Mediterranean-diet intervention.

Methods: Systolic BP (SBP) and diastolic BP (DBP) surge levels, circulating markers, vascular health, and fitness were analyzed. BP surge with alarm was captured during a 12-hour work shift. Exercise and diet were self-reported. Diet was tracked with diet scores based on a number of servings.

Results: A total of 25 firefighters (43.4 ± 13.9 years) participated. We found changes in the magnitude of BP surge with alarm (SBP surge from16.7 ± 12.9 to 10.5 ± 11.7 mmHg, P < 0.05; DBP surge from 8.2 ± 10.8 to 4.9 ± 5.6 mmHg, P > 0.05) after intervention. We confirm that clinical (127.6 ± 9.1 to 120 ± 8.2 mmHg) and central (122.7 ± 11.3 to 118.2 ± 10.7 mmHg) SBP levels improve with exercise and diet. We report for the first time in firefighters that oxidative stress markers superoxide dismutase (9.1 ± 1.5 to 11.2 ± 2.2 U/ml) and nitric oxide (40.4 ± 7 to 48.9 ± 16.9 μmol/l) levels improve with an exercise and diet intervention.

Conclusion: These findings have implications toward the benefit that short-term lifestyle changes make toward reducing the alarm stress response in first responders.

Wohlgemuth, K., Sekiguchi, Y., & Mota, J. (2023). Overexertion and heat stress in the fire service: a new conceptual framework. American journal of industrial medicine, 10.1002/ajim.23482. Advance online publication. https://doi.org/10.1002/ajim.23482

From the year 2000, the United States Fire Administration (USFA) has been recording all line-of-duty deaths in the fire service. Stress or overexertion caused 1096 out of 2598 total line-of-duty deaths in the United States from 2000 to 2021. Those deaths due to stress or overexertion were further classified as myocardial infarction (90%), cerebrovascular accident (6.8%), other (2.6%), and heat exhaustion (0.6%). Environmental heat exposure is a concern in firefighting, as firefighters work in extreme conditions, such as high ambient temperatures while wearing protective clothing. Heat stress is not only hazardous to the cardiovascular system but may accentuate muscle fatigue and overexertion. In addition, overexertion itself is related to increased incidence of musculoskeletal injuries, usually to the lower extremities. Further, there is a strong physiological mechanistic link to suggest that the increased occupational heat exposure and thermoregulatory strain firefighters experience may be a stressor that increases the risk of injuries. This commentary hopes to show the need for further research on the effects of occupational exposures and physiological strain in the fire service.

Dobek, P., Bowen, H., & Callaghan, P. (2023). Experiences and perceptions of military and emergency services personnel identifying as LGBTQIA+ and their families: a qualitative systematic review protocol. JBI evidence synthesis, 10.11124/JBIES-22-00256. Advance online publication. https://doi.org/10.11124/JBIES-22-00256

Objective: The objective of this review is to explore the perceptions and experiences of military and emergency personnel who identify as LGBTQIA+, and those of their families.

Introduction: LGBTQIA+ military and emergency first response personnel report disproportionately poorer career and personal outcomes than their cisgender and heterosexual counterparts. Research examining the underlying lived experiences and perceptions of people serving who are LGBTQIA+, particularly those of their family members, is sparse. Hence, the aim of this review is to identify, aggregate, and synthesize relevant qualitative research findings.

Inclusion criteria: This review will consider studies of LGBTQIA+ military or emergency first response personnel and their families that include qualitative data-capturing experiences and perceptions of navigating industrial institutions and service communities. Military personnel includes those employed in any role within any military organization; emergency first response personnel will include ambulance workers, paramedics, police, firefighters, and other public safety roles. Families will be limited to any configuration of immediate family members of active or retired LGBTQIA+ service personnel. No limits will be applied to the age of service personnel or their family members, nor to duration or chronology of service.

Methods: Databases searched will include PsycINFO, PubMed Central, ProQuest Central, Scopus, MEDLINE, Embase, and PTSDpubs. Domain-specific journals will be manually searched, and gray literature and unpublished studies will be searched via ProQuest Central. Study screening and selection against inclusion criteria will be performed in Covidence. Data extraction and critical appraisal will be performed using the standardized JBI templates and checklists for qualitative research. All stages will be performed by 2 independent reviewers, with conflicts resolved by a third reviewer.

Sundberg, N., & Millis, R. M. (2023). A Study of Diurnal Cortisol Adaptations in Sleep-Deprived Firefighters During a 72-Hour Work Shift: A Case Series. Cureus, 15(4), e37504. https://doi.org/10.7759/cureus.37504

Seventy percent of US firefighters are overweight or obese. The combination of sleep deprivation and exposure to traumatic events during 72-hour work shifts, commonly employed in emergency responders, is thought to put firefighters at high risk for a variety of stress-related diseases and suicide. Previous studies suggest that the cortisol awakening response (CAR) may be increased in sleep-deprived emergency responders. This case series was designed to investigate the variations in CAR and associations with measurements of salivary cortisol and testosterone, blood glucose and triglyceride, and blood pressure during a 72-hour work shift. Measurements were made at 08:00 and 20:00 in five participants (one normal weight normotensive, three obese hypertensive, and one morbidly obese normotensive male). Data were characterized by the regression statistic R2 computed from the relationship between diurnal measurement and concentration, with significance at R2≥0.4. The predominant AM CAR adaptation response consisted of no significant 72-h change (flat response) in salivary cortisol (R2<0.4), found in three of the five participants (60%). The normal-weight participant's 72-h AM CAR adaptation was characterized as incremental (R2=0.91), and markedly different than that of the four obese firefighters who exhibited either a flat response (R2<0.4, 60%) or, in one subject, a decremental response (R2=0.40, 20%). The predominant 72-h PM cortisol adaptation was found to be decremental (R2=0.78-0.97) in three of the five participants (60%), including the normal weight subject (R2=0.78). Diurnal salivary cortisol and testosterone exhibited normal physiological circadian variations (P=0.01, AM>PM and P=0.1, AM>PM, respectively). Blood glucose and triglyceride also showed physiological circadian variations (P=0.02 AM<PM and P=0.002 AM<PM, respectively). Diurnal variation of systolic BP was found to be not significant (P=0.2). The flat AM CAR adaptation exhibited in three of four obese hypertensive firefighters may represent a blunted adaptation response, akin to the responses reported for survivors of suicide. These findings suggest that diurnal variations in salivary cortisol and testosterone, blood glucose, and triglyceride may be useful biochemical markers for identifying stress-related adaptations to 72-hour work shifts. Future studies should be designed to correlate diurnal variations in biomarkers with the risk of developing stress-related diseases and suicide in firefighters.

Santos, V., Massuça, L. M., Monteiro, L., Angarten, V., Abel, M. G., Fernhall, B., & Santa-Clara, H. (2023). Comparison of Acute Arterial Responses Following a Rescue Simulation and Maximal Exercise in Professional Firefighters. Healthcare (Basel, Switzerland), 11(7), 1032. https://doi.org/10.3390/healthcare11071032

Cardiovascular events are the leading cause of on-duty deaths among firefighters. Screening firefighters for risk of sudden cardiac event is a critical element of a comprehensive medical program. Although intense physical exertion has been shown to trigger sudden cardiac events in the general population, it is unclear how hemodynamic responses following clinical exercise testing compare to that of performing firefighting tasks in personal protective equipment. Therefore, the purpose of this study was to compare hemodynamic responses following rescue simulation (RS) and maximal exercise in firefighters. This was a cross-over repeated measures study. Thirty-eight professional firefighters (31.8 ± 5.2 yr; VO2peak: 57.9 mL/kg/min) completed a maximal aerobic exercise test (MAET) and an RS. Pulse wave velocity (PWV), pulse pressure (PP), and brachial and central mean arterial pressure (MAP) were measured before and 5 and 15 min post-exercise. The findings indicated that femoral PWV decreased after MAET and RS at both time points (p < 0.005). No significant differences were found in aortic and carotid PWV over time or between conditions (p ≥ 0.05). Significant increases in brachial and central PP and MAP were noted 5 min post-MAET and RS (p = 0.004). In conclusion, the present study demonstrated that peripheral arterial stiffness (AS) decreased in firefighters following both conditions, with no differences in central AS. Our findings provide valuable information on hemodynamic responses similar between RS and MAET, and are important for controlling CVD risk and the AS response.

Shin, Y., Nam, J. K., Lee, A., & Kim, Y. (2023). Latent profile analysis of post-traumatic stress and post-traumatic growth among firefighters. European Journal of Psychotraumatology, 14(1), 2159048. https://doi.org/10.1080/20008066.2022.2159048

Background: Due to the job characteristics, firefighters are repeatedly exposed to trauma incidents. However, not all firefighters exhibit the same level of post-traumatic stress disorder (PTSD) or post-traumatic growth (PTG). Despite this, few studies have looked into firefighters' PTSD and PTG.

Objective: This study identified subgroups of firefighters based on their PTSD and PTG levels, and investigated the influence of demographic factors and PTSD/PTG-related factors on latent class classification.

Method: Latent profile analysis was used to examine the patterns of PTSD and PTG among 483 firefighters in South Korea. Using a cross-sectional design, demographic factors and job factors were examined as group covariates through a three-step approach. PTSD-related factors such as depression and suicide ideation, as well as PTG-related factors such as emotion-based response, were analyzed as differentiating factors.

Results: Four classes were identified and named 'Low PTSD-low PTG (65.2%),' 'Mid PTSD-mid PTG (15.5%),' 'Low PTSD-high PTG (15.3%),' and 'High PTSD-mid PTG (3.9%).' The likelihood of belonging to the group with high trauma-related risks increased with more rotating shift work and years of service. The differentiating factors revealed differences based on the levels of PTSD and PTG in each group.

Conclusions: 34.8% of firefighters experienced changes due to traumatic events while on the job, and some required serious attention. Modifiable job characteristics, such as the shift pattern, indirectly affected PTSD and PTG levels. Individual and job factors should be considered together when developing trauma interventions for firefighters.

Ferreira, D. V., Marins, E., Cavalcante, P., Simas, V., Canetti, E. F. D., Orr, R., & Vieira, A. (2023). Identifying the most important, frequent, and physically demanding tasks of Brazilian firefighters. Ergonomics, 1–26. Advance online publication. https://doi.org/10.1080/00140139.2023.2206072

This study aimed to identify the most important, frequently performed, and physically demanding tasks performed by Brazilian firefighters and to identify tasks that could be used to assess physical fitness. A subjective task analysis was conducted. Five hundred twenty-four firefighters (84% male; 16% females) responded to an online survey and rated 37 tasks across three domains (most important, most frequent, and most physically demanding). A dichotomous decision analysis was used to inform the proposed physical fitness tests. Wildland firefighting tasks presented the highest overall mean rate. Traffic control was considered the most important and frequently performed task. Lifeguard rescue was considered the most physically demanding task. The dichotomous analysis identified 14 essential tasks (seven structural firefighting and seven automobile accidents). The tasks identified may be helpful in developing criterion physical fitness tests and training programs related to firefighters' demands.

Huang, N., Bai, Y., Yang, F., Liu, X., & Guo, J. (2023). The moderating effects of colleagueship on the relationship between mental health and perceived stigma among Chinese firefighters. Psychological trauma : theory, research, practice and policy, 10.1037/tra0001496. Advance online publication. https://doi.org/10.1037/tra0001496

Objective: To date, few studies have examined the relationship among mental health symptom severity, colleagueship, and perceived stigma, especially in Chinese firefighters. This study aims to investigate the association between posttraumatic stress symptoms (PTSS), depressive symptoms, and perceived stigma, taking colleagueship as a moderator.

Method: This cross-sectional study included a total of 1,328 Chinese firefighters. These subjects completed electronic questionnaires from July 1 to August 31, 2021. Multivariate linear regression analyses were performed to assess the relationship between mental health symptoms and perceived stigma and the possible moderating effect of colleagueship on the above relationship.

Results: After adjusting for possible confounders, both PTSS (β = 0.088, 95% CI [0.013, 0.163]) and depressive symptoms (β = 0.252 [0.177, 0.327]) were positively associated with stigma about seeking mental health care. Additionally, colleagueship and its dimensions, such as face (β = 0.090 [0.024, 0.156]), instrumentality (β = 0.234 [0.178, 0.291]), and emotion (β = -0.091 [-0.163, 0.020]), had significant associations with perceived stigma. Moreover, the association between mental health symptoms and stigma was significantly moderated by colleagueship.

Conclusions: Mental health symptom severity is positively associated with perceived stigma, and colleagueship enhanced this relationship. The present findings suggest that anti-stigma campaigns should focus on stigma related to colleagueship in the background of Chinese culture and highlight the need to establish confidential assistance programs and mental health awareness programs.