Scoping review of the occurrence and characteristics of firefighter exercise and training injuries

Correlation of absolute and relative limb differences in Y-balance test and asymmetry indices of CMJ, SJ and IMTP

OBJECTIVE

Determine the relationship between Y-Balance Test (YBT) and force platform-based assessments, including squat jump (SJ), countermovement jump (CMJ), and isometric mid-thigh pull (IMTP), to evaluate lower limb stability and asymmetry.

METHOD

Sixty-one recruited active professional firefighters were assessed for YBT absolute limb differences (anterior, posteromedial, and posterolateral directions) using the YBT classic formula or a force platform built-in formula, and for asymmetry indices of CMJ, SJ and IMTP derived from the force platform.

RESULTS

The absolute limb differences in YBT anterior (YBT-A) showed a moderate correlation (r > 0.4) with asymmetry indices of SJ concentric peak force (SJ-CPF), IMTP peak force component (IMTP-PFC), and IMTP peak force (IMTP-PF). Subsequently, limb relative differences for YBT-A were calculated using the built-in formula of the force platform, which also showed a moderate correlation (r > 0.4) with asymmetry indices of SJ-CPF, IMTP-PFC, and IMTP-PF. However, when considering either absolute or relative differences, YBT posteromedial asymmetry (YBT-PMA) or YBT posterolateral asymmetry (YBT-PLA) showed weak or negative correlations with asymmetry indices derived from the force platform.

CONCLUSION

This study demonstrated that YBT anterior asymmetry (YBT-AA) calculated by using either the YBT classic formula or the built-in formula of the force platform, showed a moderate correlation with asymmetry indices derived from the force platform. This study provides clinicians and researchers with different test methods for assessing lower limb stability.

Identification and prevention strategies for musculoskeletal injuries among firefighters: A rapid review

Background: Firefighters worldwide play a critical role in safeguarding the public and their work exposes them to significant health and safety risks. The physical demands of firefighting such as fire suppression, victim rescue, and operating in confined, hazardous environments are compounded by the weight of personal protective equipment (PPE) and self-contained breathing apparatus (SCBA). These demands contribute to a high prevalence of musculoskeletal injuries (MSIs). MSIs result in extended recovery times, with firefighters often taking twice as long to return to work compared to other sectors. Objective: To conduct a rapid review in support of an industry partner to explore the prevalence and patterns of musculoskeletal injuries among firefighters, identifying gaps in the literature and proposing strategies for injury mitigation. Methods: A rapid review of peer-reviewed literature, concluding in March 2024, identified a gap in research focusing on the prevention of work-related injuries in firefighters. Results: The review highlights the urgent need for targeted prevention strategies, including fitness, health, and wellness programs, as well as enhanced safety training and improved PPE. The financial burden of non-fatal injuries on fire departments underscores the importance of such preventative measures. Future research should explore the effectiveness of exercise and movement-oriented training programs, particularly among diverse populations, including female and older firefighters. Conclusion: Longitudinal studies are needed to evaluate the long-term benefits and cost-effectiveness of these interventions. A deeper understanding of MSI prevention could lead to the development of specific guidelines that enhance the safety and well-being of firefighters throughout their careers.

Organizational health culture in the Korean firefighter intervention studies: a scoping review

Introduction

This study examines the current state of intervention studies focused on Korean firefighters, who face unique health challenges due to the demands of their work and specific organizational culture. Recognizing a gap in studies tailored to firefighters' needs, this scoping review aimed to identify existing interventions and provide recommendations for future research.

Methods

Following the Joanna Briggs Institute's methodological guidelines for scoping reviews and the PRISMA-ScR checklist, a seven-stage review was conducted. The search included articles from Korean and international journals published up until January 25, 2024. Data were analyzed using a pre-developed framework and the Template for Intervention Description and Replication checklist. This study was registered on the Open Science Framework (OSF) and is accessible at https://osf.io/s378j/.

Results

From 35 articles analyzed, results showed an imbalance in topics, research design, outcome measures, and intervention delivery methods. Additionally, most studies lacked specific focus on firefighters' unique organizational characteristics and needs.

Discussion

The study highlighted three areas for enhancing intervention research quality: designing and tailoring studies to fit the specific demands of firefighting, ensuring ethical considerations, and aligning with the practical needs of firefighters. Future research should prioritize diverse interventions addressing firefighters' health, incorporate sensitive and ethical research designs, and work closely with experts in firefighting to develop adaptable and relevant interventions.

Systematic Review Registration

https://osf.io/s378j/, Registration DOI: https://doi.org/10.17605/OSF.IO/7EQ8M.

Research on optimal strategy of different fire rescue tasks based on oxygen consumption

Objective

The development of effective rescue strategies is critical for enhancing rescue operations and ensuring firefighter safety. However, limited attention has been given to the exploration of rational rescue strategies in practice, particularly with regard to oxygen consumption. Therefore, this study aimed to identify the optimal rescue strategy by analyzing oxygen consumption across different rescue tasks.

Methods

Sixty male firefighters from the Guilin Fire and Rescue Detachment participated in the study. Their oxygen consumption was measured during the completion of running on flat ground and while running up and down three flights of stairs.

Results

The results found that firefighters with excellent strength and conditioning levels, those carrying a 10 kg load, or those employing the shoulder-carrying technique had less oxygen consumption. Hand-carrying for a 10 kg load when running up or downstairs and shoulder-carrying for 20 and 30 kg loads while running on the ground resulted in lower oxygen consumption. Additionally, firefighters with excellent strength performance when running with 10 and 20 kg loads or those with excellent speed while running on the ground exhibited decreased oxygen consumption.

Conclusion

The current study suggests that firefighters with excellent strength performance are more suited for upstairs rescue tasks, while those with excellent speed performance are better suited for tasks on ground. It is recommended that medium to large loads be carried using the shoulder-carrying technique, and smaller loads be hand-carried when running up or down stairs. Overall, customizing rescue strategies based on firefighters' strength and conditioning, load characteristics, techniques, and specific task requirements is crucial for improving efficiency and reducing risks in rescue operations.

Service-Related Musculoskeletal Injuries in Polish Firefighters: A 2021-2023 Accidents Analysis

Aim: The aim of this study was to analyze service-related musculoskeletal injuries of professional firefighters in 2021-2023. Material and methods: Analysis was completed on the basis of annual reports on the injury status of the State Fire Service (SFS) obtained from the Office of Occupational Safety and Health (OOSH) at General Headquarters. The report databases were searched using keywords typical of bone injuries and including anatomical names: "sprain", "fracture", "dislocation", "bone injury", "bone", "joint", "spine", "skull and "musculoskeletal injury". Results: Events matching the analysis target of N = 1944 (2021-n = 707; 2022-n = 589; 2023-n = 648) accounted for 49.4% from all accidents in the State Fire Service in Poland in the analyzed period. A significant increase in the analyzed period 2021-2023 was observed in events where the cause of injury was sports activities (45% vs. 49% vs. 63%, p < 0.001). A significant decrease was observed in events where the cause of injury was interventions (26% vs. 27% vs. 17%, p < 0.001), technical and maintenance (TM) work (8% vs. 6% vs. 5%, p = 0.008) and category "other" (15% vs. 14% vs. 11%, p = 0.034). Statistically significant differences were found between cause and the type of injury (p = 0.002), season (p < 0.001) and the location of injury (p < 0.001). Conclusions: A large number of musculoskeletal injuries are associated with sports activities, which is inherent in the risks of the activities. The lower extremities are most affected by injuries during sports activities The spring period dominates in the season category, which may be related to the difficulty of the terrain and return to increased sports activity after the winter period.

"Missing Mobility": Perspectives of North American Firefighters on the Risks and Causes of Work-Related Shoulder Disorders: A Qualitative Study

BACKGROUND

Firefighters are routinely exposed to significant work-related musculoskeletal disorders (WRMSDs) which can sometimes be career-ending due to the workplace stressors and the physical demands of the job. Shoulder disorders are the third most frequent WRMSDs that cause pain, disability, and morbidity in the general working population. However, little is known about the task-specific causes and risk factors for work-related shoulder disorders (WSDs) among firefighters (FFs).

OBJECTIVES

To explore the perspectives of FFs who experienced WSDs with respect to the following: (a) risk factors of WSDs; and (b) causative factors for WSDs.

METHODS

Using an interpretive descriptive methodology, we purposefully sampled for age and occupational diversity. Twelve FFs (males, 8 and females, 4) between 26 and 63 years, who experienced WSDs during their career ranging from 3 to 33 years were recruited. One-on-one interviews based on a semi-structured interview guide were conducted via an online Zoom platform and transcribed verbatim. Transcripts were analyzed using reflexive thematic analysis.

RESULTS

The WSDs reported by FFs included rotator cuff tears, labral tears and muscle sprains or strains. Three themes were identified as risk factors for WSDs: (1) too much or too little shoulder exercises is a risk for shoulder injuries; (2) internal contextual factors can increase the risk of shoulder injurie; and (3) personal factors such as age and sex mediate the risk of shoulder injuries. Three themes were reported by FFs as the causative factors of WSDs: (1) unpredictable hazards in harsh environmental conditions can lead to traumatic shoulder injuries; (2) maneuvering heavy equipment in non-ergonomic positions can lead to shoulder strains; and (3) routine firefighting tasks can lead to gradual onset of shoulder injuries.

IMPLICATIONS

Our results emphasized the inter-related and multifaceted nature of the risks and causative factors that increase the risk of traumatic or gradual onset WSDs among FFs. There is a need for a comprehensive prevention and self-management program that addresses fire-specific prevention and treatment program that addresses modifiable environmental, behavioral and personal risks factors.

Exploring Canadian Career Firefighters' Understanding of the Return-to-Work Process After Musculoskeletal Injuries

PURPOSE

Firefighters perform dangerous and physically demanding work, increasing their risk of musculoskeletal injuries that can lead to work absences. Return-to-work procedures can help firefighters return-to-work sooner and safely. The purpose of this study was to explore what firefighters understand about return-to-work procedures in their workplaces, and what firefighters believe the facilitators and barriers to return-to-work are.

METHODS

Thirty-eight Canadian career firefighters were recruited for semi-structured interviews. Qualitative descriptive methods were used to analyze the transcripts. Two researchers performed the inductive coding and thematic analysis.

RESULTS

Five themes were identified: 1. Variation in the return-to-work process knowledge among firefighters based on their experiences; 2. Accessible medical resources and treatments to support injury recovery; 3. Light duties must be meaningful and suitable; 4. Pressures to return-to-work too soon may lead to negative consequences; and 5. Heavy physical demands of firefighting may become a barrier for return-to-work. 'Factors affecting RTW depended on personal experiences and context' was the overarching theme identified, as many reported facilitators for return-to-work were also reported as barriers in different contexts. There was a variation in the experiences and understanding of return-to-work.

CONCLUSION

There is a lack of knowledge of the return-to-work processes. Firefighters require access to clear return-to-work policies and procedures and treatments that are targeted to firefighting duties to support recovery from injuries and regain physical abilities after an injury. Firefighters must be able to perform all essential duties before returning to firefighting work, as returning to work too soon can lead to further injury.

Strategies for Improving Firefighter Health On-Shift: A Review

The fire service suffers from high rates of cardiovascular disease and poor overall health, and firefighters often suffer fatal and non-fatal injuries while on the job. Most fatal injuries result from sudden cardiac death, while non-fatal injuries are to the musculoskeletal system. Previous works suggest a mechanistic link between several health and performance variables and injury risk. In addition, studies have suggested physical activity and nutrition can improve overall health and occupational performance. This review offers practical applications for exercise via feasible training modalities as well as nutritional recommendations that can positively impact performance on the job. Time-efficient training modalities like high-intensity interval training and feasible modalities such as resistance training offer numerous benefits for firefighters. Also, modifying and supplementing the diet and can be advantageous for health and body composition in the fire service. Firefighters have various schedules, making it difficult for planned exercise and eating while on shift. The practical training and nutritional aspects discussed in this review can be implemented on-shift to improve the overall health and performance in firefighters.

Musculoskeletal Injuries, Exercise Behaviors, and Reproductive Health Are Related to Physical Fitness of Female First-Responders and Health Care Providers

Introduction

Musculoskeletal injuries (MSKi) are the most common injury type experienced by first-responders and health care providers (HCPs), making them a significant threat to physical and mental well-being. Female reproductive health and injury history has been related to physical fitness in female members of the Canadian Armed Forces. This relationship has not been explored in Canadian protective services personnel (first-responders) or HCPs.

Methods

Fifty-seven females employed as firefighters, paramedics, law enforcements, or HCPs completed a physical fitness protocol to assess the following: (1) muscular power (standing long jump and medicine ball throw), (2) muscular strength (4 repetition maximum (4RM) back squats and bench press), (3) muscular endurance (Biering-Sorenson test, single-leg wall sit, and push-ups), (4) flexibility (sit-and-reach), and (5) aerobic capacity (graded treadmill VO2max test). Spearman rho correlation analyses were applied to descriptive analysis, independent-samples t-test, one-way ANCOVA (adjusted by age), and chi-square test. Spearman rho correlation analyses were used to compare physical fitness results for female reproductive health history (e.g., parity status), previous MSKi, and physical activity behaviors (e.g., sports participation). A p value of <0.05 is considered significant.

Results

History of childbirth, body composition, and exercise behaviors were related to physical fitness (i.e., standing long jump, Biering-Sorenson test, bench press, and back squat) in law enforcement, firefighting, paramedicine, and health care personnel.

Conclusions

Physical training programs aimed at supporting parous first-responders or HCPs should emphasize lower body power, lower body strength, and upper body strength.

The global prevalence of musculoskeletal disorders among firefighters: a systematic review and meta-analysis

This systematic review and meta-analysis study aimed to explore the global prevalence of musculoskeletal disorders (MSDs) among firefighters. A systematical search was performed in three international academic databases (Scopus, PubMed and Web of Science). Overall, 31 articles were included in this review. The pooled prevalence of total MSDs in firefighters was identified as 41% (95% confidence interval [CI] [33, 50]). The prevalence of MSDs in neck, shoulders, upper back, lower back, upper extremity and lower extremity was 9% (95% CI [7, 10]), 11% (95% CI [8, 15]), 8% (95% CI [5, 12]), 31% (95% CI [27, 34]), 13% (95% CI [9, 17]) and 16% (95% CI [14, 18]), respectively. No statistically significant relationship was observed between prevalence of MSDs and year of study, mean age, size of sample, duration of prevalence, region or income level. Demographic, occupational and medical condition factors were identified that can create these disorders among firefighters.

Firefighters' muscle activity change during firefighting training program

BACKGROUND

Research on muscle activity to reduce injuries during firefighting training has getting increasing attention.

OBJECTIVE

The purpose of this study was to assess the activity changes in nine muscles of firefighters during the seven firefighting training programs, and to analyze the influence of different firefighting training programs on muscle activity.

METHODS

Ten healthy male firefighters were recruited to measure the field surface electromyographic activities (including the percentage of Maximum Voluntary Contraction electromyography (% MVC) and the integrated electromyography value (iEMG)) during all the firefighting training programs.

RESULTS

The results showed that the electromyographic activity of gastrocnemius (GA) was stronger in climbing the hooked ladder and climbing the six-meter long ladder training programs. Arms, shoulders, and lower limb muscles were more activated, myoelectric activities were more intense, and fatigue in these areas was more likely to occur during climbing five-story building with loads. Compared with other muscles, erector spine (ES) had a higher degree of activation during different postures of water shooting. The Borg scale scores of shoulders, trunk, thighs and calves were also higher.

CONCLUSION

After completing all training programs, GA, tibialis anterior (TA), trapezius (TR), and ES were strongly activated, and all muscles had obvious force. The % MVC and iEMG analyses correspond well with the Borg Scale score. The results can provide certain reference for reducing the musculoskeletal injury of firefighters, carrying out scientific training and formulating effective injury prevention measures for them.

Investigation and analysis of training injury and its psychological effects on firefighters in Beijing A cross-sectional study

Firefighters' high-intensity training often leads to injuries in the musculoskeletal system. Studies have found that these injuries in the musculoskeletal system may contribute to poor psychological issues. At the same time, low psychological well-being increases the risk of injuries, illness, and mortality. According to research reports, firefighters generally have a good psychological state. So this study aims to survey and analyze the training-related injuries and psychological states of firefighting and rescue personnel in Beijing. This cross-sectional study employed a questionnaire survey to gather data from a total of 214 firefighters in a certain city. The participants were required to complete a questionnaire about musculoskeletal injuries and psychological status, and then these data were statistically analyzed. The incidence of training-related injuries is relatively high among firefighting and rescue teams, with the highest proportions observed in the lower back, knees, and ankles. Overweight and obese firefighters are more prone to ankle injuries. In the group with injuries, the subjective well-being index is lower compared to the group without injuries. Firefighters experiencing moderate to severe pain due to injuries exhibit lower subjective well-being indices compared to those with mild pain. Psychological resilience and the impact of pain on training and sleep can predict the subjective well-being index of firefighters. It is recommended that firefighting and rescue teams enhance preventive measures for musculoskeletal injuries during training to elevate the subjective well-being of firefighters.

Weight Status and Binge Drinking Among Male and Female Florida Firefighters

OBJECTIVE

The aim of the study is to examine the association between weight status and binge drinking among Florida firefighters.

METHODS

Health survey data collected between 2015 and 2019 among Florida firefighters participating in the Annual Cancer Survey were analyzed for weight class (healthy, overweight, obese) and binge-drinking behaviors. Binary logistic regression models were fit and stratified by sex while controlling for sociodemographic and health characteristics.

RESULTS

Among 4002 firefighter participants, 45.1% binge drink, 50.9% are overweight, and 31.3% are obese. Among male firefighters, being overweight (adjusted odds ratio = 1.34; 95% confidence interval = 1.10-1.64) or obese (1.29; 1.04-1.61) was significantly associated with binge drinking compared with healthy weight counterparts. In female firefighters, being obese (2.25; 1.21-4.22) was significantly associated with binge drinking but being overweight was not.

CONCLUSIONS

Being overweight or obese is selectively associated with binge drinking among male and female firefighters.