Profiling paramedic job tasks, injuries, and physical fitness: A scoping review

INTRODUCTION

The aim of this review was to identify, collect, appraise, and synthesise research profiling paramedic job tasks, injuries sustained, and current fitness levels, to guide optimal workplace performance and enhance injury mitigation efforts.

METHODS

Following the Preferred Reporting Items for Scoping Reviews, four databases (PubMed, SPORTdiscus, CINAHL, and Embase) were searched using key search terms (derivatives of 'paramedic' and 'injury', 'physical fitness' and 'tasks'). Identified records were screened against eligibility criteria with remaining studies critically appraised.

RESULTS

Of 1675 identified records, 33 were retained. Musculoskeletal injuries exhibited the highest mean injury rate, with sprains and strains the predominant nature of injury, and the back the most frequently injured body part. Among paramedics, handling stretchers and equipment posed the most challenging tasks while for Emergency Medical Services patient extraction was the most physically and mentally demanding task. Male paramedics were generally stronger with more muscular endurance, but less flexibility, than female paramedics. Older paramedics displayed lower levels of strength and flexibility.

CONCLUSION

Tasks involving stretcher handling and patient extraction are reported as being most strenuous for paramedics leading to musculoskeletal injuries, particularly sprains, strains, and back injuries.

Determining the Changes in Law Enforcement Recruit Aerobic Fitness Using the 2.4-km Run and 20-m Multistage Fitness Test. Does the Type of Test Matter?

ABSTRACT

Campbell, P, Maupin, D, Lockie, RG, Dawes, JJ, Simas, V, Canetti, E, Schram, B, and Orr, R. Determining the changes in law enforcement recruit aerobic fitness using the 2.4-km run and 20-m multistage fitness test. Does the type of test matter? J Strength Cond Res 38(6): 1111-1117, 2024-Aerobic fitness is linked with academy graduation, employment, and the long-term health of law enforcement officers and is often used as a training outcome. However, different tests can be used, and aerobic improvements may differ according to the test used. The aim of this study was to determine whether recruits improved to a greater extent in 1 aerobic test compared with the other. Retrospective data from 5 law enforcement recruit cohorts (males = 741; females = 353) who underwent 18 weeks of academy training were analyzed. Initial 20-m multistage fitness test (20MSFT) and 2.4-km run assessments were completed during weeks 4 and 5 of training, with final testing completed during weeks 16 and 17, respectively. A repeated-measures analysis of variance ( p < 0.05) with a Bonferroni post hoc analysis determined changes in aerobic fitness in the 20MSFT and 2.4-km run between male and female recruits. A mean difference of 9.27 (95% confidence intervals [CI] 14.8-10.9; d = 0.63; p < 0.001) shuttle increase in 20MSFT performance and 20.1 (95% CI 16.0-24.2; d = 0.49; p < 0.001) second improvement in 2.4-km run time were demonstrated when averaged across sex, yielding a larger performance improvement for the 20MSFT compared with the 2.4-km run. Conversely, there was a smaller magnitude of change in aerobic fitness between male recruits and female recruits for the 20MSFT ( d = 0.47) compared with the 2.4-km run ( d = 0.50). The findings indicate that current academy training results in improvements to aerobic fitness and to a greater magnitude in the 20MSFT compared with the 2.4-km run. These results may affect policy considerations for law enforcement agencies regarding aerobic test selection.

Law enforcement recruit fitness: Changes across the fitness spectrum

BACKGROUND

Law enforcement is a profession of sedentary physical activity interspersed with physically demanding activity that requires high levels of fitness. It is imperative that agencies training law enforcement recruits maximise their fitness during their time at the academy.

OBJECTIVE

The aim of this study was to investigate changes in physical fitness during academy training.

METHODS

Retrospective data for 10 academy recruit classes, totalling 715 participants, were collected from a US law enforcement agency. The change in performance on two standardised tests were used as outcome measures. Comparisons were made between percentiles utilising one-way ANOVA and a linear mixed model (LMM).

RESULTS

Overall, higher percentiles were found to have smaller improvements in physical fitness than lower percentiles. The results of the LMM support this supposition, showing that lower physical fitness scores resulted in greater improvements in a generalised fitness assessment (value = -0.45, standard error 0.02, p < 0.001) and an occupational assessment (value = -0.49, standard error = 0.02, p < 0.001).

CONCLUSION

The results of this study suggest that recruits with lower physical fitness will see greater improvements during academy training. This could be due to a ceiling effect for the more fit but may also be due to recruits of higher physical fitness being under trained during academy. Utilising ability-based training and prescribing an appropriate workload to recruits of higher fitness may improve overall recruit fitness upon graduation.

Evolution of Physical Training in Police Academies: Comparing Fitness Variables

The purpose of this study was to evaluate the effectiveness of three different physical training approaches to improving cadets' fitness variables. Retrospective data for male and female land management law enforcement officers attending a 15-week training program at three separate time points were provided for analysis. The time points reflected the three different training approaches, including calisthenic training (CT) = 83, functional fitness training (FT) = 90, and strength training (ST) = 110. Inferential data analysis was used to find which mode of exercise had the greatest impact on body composition, cardiovascular endurance, muscular strength, agility, and flexibility. All groups displayed decreases in body fat percentage, with weight loss being more significant within the CT and FT groups, while the ST group increased in body weight. The CT group had the greatest flexibility increases compared to the FT and ST groups. ST training elicited significantly smaller changes in cardiovascular endurance than the FT and CT groups. ST training showed greater improvements in lean mass, while CT and FT showed greater increases in flexibility and endurance. These results suggest that training protocols can increase performance and optimize the abilities to perform job tasks in tactical athletes.

Profiling the Typical Training Load of a Law Enforcement Recruit Class

Law enforcement academies, designed to prepare recruits for their prospective career, represent periods of high physical and mental stress, potentially contributing to recruits' injuries. Managing stress via monitoring training loads may mitigate injuries while ensuring adequate preparation. However, it is vital to first understand an academy's typical training load. The aim of this study was to profile the typical training load of law enforcement recruits over the course of 22 weeks. Data were prospectively collected using global positioning system (GPS) units placed on recruits during a portion of the academy training, while a desktop analysis was retrospectively applied to six other classes. A Bland-Altman plot was conducted to assess the agreement between the two methods. A linear mixed model was conducted to analyse the difference in distances covered per week, while other variables were presented graphically. Adequate agreement between the desktop analysis and GPS units was observed. Significant differences (p-value < 0.01) in distance covered (9.64 to 11.65 km) exist between weeks during early academy stages, which coincide with increases (~6 h) in physical training. Significant decreases in distances were experienced during the last five weeks of academy training. Most acute:chronic workload ratios stayed between the proposed 0.8 to 1.3 optimal range. Results from this study indicate that large increases in training occur early in the academy, potentially influencing injuries. Utilizing a desktop analysis is a pragmatic and reliable approach for instructors to measure load.

Risk factors for injuries in female soldiers: a systematic review

Background

Female soldiers form an integral part of any modern defence force. Previous reports have highlighted that female soldiers report injuries at higher rates than male personnel. One possible reason for this is an actual difference in underlying injury rates, purported to be due to several factors, including levels of fitness. The aim of this review was to determine risk factors for injuries in female soldiers.

Methods

A systematic search was conducted for studies which reported on risk factors for injuries in female soldiers. Databases searched included PUBMED, CINAHL and Medline through OVID. Eligible studies were rated for their methodological quality using the Critical Appraisal Skills Program (CASP) tools and data were extracted and synthesized using a critical narrative approach.

Results

A total of 18 articles were included in this review which reported on 18 risk factors for injury. Smoking, previous injury, no history of deployment, heavy occupational tasks, lower levels of aerobic fitness and lower number of push-up repetitions appear to be risk factors for injuries in female soldiers. Age, height, body fat, high or low BMI and body mass do not appear to be consistent risk factors for injury in female soldiers and there appears to be minimal evidence for current levels of activity, sit-up ability, and other assessments of strength, power, speed, or movement being associated with injury risk. Additionally, neither flexibility nor previous levels of activity appear to be associated with injury risk in female soldiers.

Conclusion

Strategies to improve aerobic fitness and upper limb endurance, reduce smoking, and optimise rehabilitation from injuries and risk management for heavy occupational tasks need to be developed for female soldiers. Such strategies are also likely to reduce risks for male soldiers.

How Does Time Spent Working in Custody Influence Health and Fitness Characteristics of Law Enforcement Officers?

This study investigated the influence of time spent working in custody on the health and fitness of law enforcement officers (LEOs). Retrospective analysis was conducted on data from 48 male and 12 female LEOs, divided into groups based upon time spent working custody: LEO ≤ 24 (≤24 months; n = 15); LEO 2547 (25-47 months; n = 24); and LEO 48+ (≥48 months; n = 21). The following were measured: body mass index (BMI); fat mass percentage; waist-to-hip ratio (WHR); resting heart rate (RHR); blood pressure; grip strength; sit-and-reach; push-ups; sit-ups; and YMCA step test recovery heart rate (HR). A univariate ANCOVA (controlling for sex and age) with Bonferroni post hoc determined significant between-group differences. Select assessments were compared to normative data. The LEO 48+ group completed fewer sit-ups than the LEO 2547 group (p = 0.006); there were no other significant between-group differences. Forty-nine LEOs were overweight or obese according to BMI; 52 were fatter than average or above; 27 had a WHR that increased cardiovascular disease risk. Forty-three LEOs had very poor RHR; 52 had elevated blood pressure. Forty-eight LEOs had average-to-very poor step test recovery HR. Irrespective of time spent working in custody, personnel should be physically active to maintain health and fitness and, where possible, engage in formal strength training and conditioning.

The Influence of Aerobic Fitness on Heart Rate Responses of Custody Assistant Recruits during Circuit Training Sessions

This study captured heart rate (HR) responses of custody assistant (CA) recruits undertaking circuit training sessions. Data from 10 male and 12 female CA recruits were analyzed. Based on YMCA step test recovery HR, recruits were divided into higher fitness (HF; top 25%), lower fitness (LF; bottom 25%), and moderate fitness (MF; remaining recruits) groups. HR was measured during two circuit training sessions featuring calisthenics and running. HR zones were defined as: very light (<57% of age-predicted maximum heart-rate [HRmax]); light (57-63% HRmax); moderate (64-76% HRmax); vigorous (77-95% HRmax); and very vigorous (>95% HRmax). A one-way ANOVA, with Bonferroni post hoc, calculated between-group differences in time spent, and percentage of total time, in the HR zones. In session one, the LF group spent less time in the light training zone compared to the MF group, and more time in the very vigorous zone compared to the HF group (p = 0.027-0.047). In session two, the LF group spent more time in the moderate zone compared to both groups, and a greater percentage of time in the very vigorous zone compared to the MF group (p = 0.002-0.004). LF recruits generally worked harder during circuit training than their fitter counterparts, which supported recommendations for ability-based modifications.