Prediction of development of fatigue during a simulated ambulance work task from physical performance tests

The aims of this study were (1) to identify which physical performance tests could best explain the development of fatigue during a simulated ambulance work task, (2) to investigate the effect of height and weight and (3) to investigate in what respects these findings differ between female and male ambulance personnel. Forty-eight male and 17 female ambulance personnel completed a test battery assessing cardio-respiratory capacity, muscular strength and endurance, and co-ordination. The subjects also completed a simulated ambulance work task -- carrying a loaded stretcher. The work task was evaluated by development of fatigue. Univariate and multiple regression analyses were used to investigate to what extent the tests in the test battery were able to explain the variance of developed fatigue. The explained variance was higher for female than for male ambulance personnel (time > 70% of HRpeak: R2 = 0.75 vs 0.10, accumulated lactate: R2 = 0.62 vs 0.42, perceived exertion: R2 = 0.75 vs 0.10). Significant predictors in the models were VO2max, isometric back endurance, one-leg rising, isokinetic knee flexion and shoulder extension strength. Height, but not weight, could further explain the variance. The high physical strain during carrying the loaded stretcher implies the importance of investigating whether improved performance, matching the occupational demands, could decrease the development of fatigue during strenuous tasks.     

Jerry can carriage is an effective predictor of stretcher carry performance

Carrying a casualty on a stretcher is a critical task conducted in a range of occupations. To ensure that personnel have the requisite physical capacity to conduct this task, two bilateral jerry can carries were used to predict individual performance in a four-person stretcher carry. Results demonstrated a bilateral 22-kg jerry can carry (R² = 0.59) had superior predictive ability of stretcher carry performance than a bilateral 15-kg jerry can carry (R² = 0.46). Pre- to post-carry changes in grip endurance (p > 0.05), back–leg isometric strength (p > 0.05) and leg power (p > 0.05) were not significantly different between carry tasks. There was no significant difference in heart rate (p > 0.05) and oxygen consumption (p > 0.05) between the stretcher carry and either jerry can carry. Thus, on the basis of performance correlations and physiological measures, the 22-kg jerry can carry is an appropriate predictive assessment of four-person stretcher carriage.

Practitioner Summary: This study investigated the ability of a jerry can carry to predict individual performance on a four-person stretcher carry. Performance correlations were substantiated with physiological measures to demonstrate similar physical requirements between task and test. These results can be used to set physical employment standards to assess stretcher carriage.     

Experimental validation of a subject-specific maximum endurance time model

This study aimed at experimentally validating a subject-specific maximum endurance time (MET) model. Thirty health participants (15 males and 15 females; Age: mean = 21.5 years, SD = 1.6 years) volunteered to conduct an isometric elbow flexion task until exhaustion. The endurance times of each participant were measured under relative exertion levels ranging from 30% MVC (Maximum Voluntary Contraction) to 70% MVC at 10% intervals. Assessment of the model showed that the intensity–endurance time relationship for each studied individual could be well fitted by the subject-specific MET model (R² > 0.89). The fatigue rates identified from the model fitting were normally distributed (Mean = 0.96 min^?1, SD = 0.29 min^?1). In addition, the fatigue rates of the male group were significantly higher than the female group. The subject-specific MET model can be used to predict the MET for individual workers, and further support physical task design, based on the fatigability data of a targeted worker population.

Practitioner Summary: Ergonomists have extensively used MET models in physical fatigue assessment and physical task design. A subject-specific MET model could be used to predict the MET at individual levels, and also to support work design for a target worker population, based on the fatigability data distribution obtained from sampled workers.     

The effects of a 1-year physical exercise programme on development of fatigue during a simulated ambulance work task

The aim of the study was to evaluate the effects of individually prescribed physical exercise programmes on development of fatigue during the carrying of a loaded stretcher up and down the stairs. Nineteen ambulance personnel performed the training for 1 year. Testing occurred before and after 1 year of the training. Both the training group (n = 19) and the control group (n = 15) were assessed for physical capacity and lactate concentration in blood and ratings of perceived exertion during carrying a stretcher on the stairs. When comparisons were made between those who had been training three times/week for 1 year and the control group, lactate concentration was significantly decreased. In conclusion, markers of fatigue during stretcher carrying can be reduced by the use of individually prescribed physical exercise programmes.     

Biomechanical risk assessment during field loading of hydraulic stretchers into ambulances

The process of loading a stretcher into an ambulance is known to cause a high incidence of back injuries among paramedics. This study aimed to assess the forces at L5/S1 during real-life stretcher loading activities and to determine the variables that contribute significantly to these forces. Analyses involved 58 paramedics (111 shifts) and 175 stretcher loading activities. Estimates of compression and shear forces at L5/S1 were calculated using the 3DSSPP program. Seventy-one percent of loading activities exceeded the safe loading level of 3.4 kN compression force at L5/S1 (mean: 3.9 kN, min–max: 2.1–7.0 kN). About 92% of the variance can be predicted from a combination of several variables, notably hand load (mean: 0.72 kN/number of paramedics) and back sagittal flexion (mean: 32°). Recommendations to reduce the risk of back injuries are proposed with regard to stretcher and ambulance loading design as well as training in stretcher lifting for paramedics.Relevance to the industryThe results of this study suggest that ambulance stretcher manufacturers should make ergonomic design changes to reduce the physical strain on paramedics’ backs during the process of loading a stretcher into an ambulance. Other preventive measures (e.g., training) must be formulated and applied to reduce the risk of back musculoskeletal disorders during the loading of stretcher patients. For instance, training should focus on back posture, teamwork and equipment/patient positioning on stretchers.     

The effects of a 1-year physical exercise programme on development of fatigue during a simulated ambulance work task

The aim of the study was to evaluate the effects of individually prescribed physical exercise programmes on development of fatigue during the carrying of a loaded stretcher up and down the stairs. Nineteen ambulance personnel performed the training for 1 year. Testing occurred before and after 1 year of the training. Both the training group (n = 19) and the control group (n = 15) were assessed for physical capacity and lactate concentration in blood and ratings of perceived exertion during carrying a stretcher on the stairs. When comparisons were made between those who had been training three times/week for 1 year and the control group, lactate concentration was significantly decreased. In conclusion, markers of fatigue during stretcher carrying can be reduced by the use of individually prescribed physical exercise programmes.     

Maximal manual stretcher carriage: performance and recovery of male and female ambulance workers

The effects of a maximal duration stretcher carriage on heart rate (HR), lactate concentration, hand steadiness and hand-grip strength were studied up to 72 h post-exercise in 17 male and 15 female military ambulance personnel. Using both hands for transport, the participants walked on a treadmill ergometer at a speed of 4.5 km/h. Force measurements at the handlebars yielded mean loads of 245 N (25 kg) on each side. Each step on the treadmill induced additional force oscillations with peak forces up to 470 N corresponding to 130% (women) and 98% (men) of maximal voluntary contraction (MVC). In the males the maximal transport time was about twice the time in women (mean +/- SD: 184 +/- 51 s vs. 98 +/- 34 s). These differences had no significant effect on HR and lactate values. The same applies to hand steadiness, which showed only a transient deterioration immediately after exercise. In contrast to these parameters, substantial differences were seen in hand-grip strength recovery. Immediately after exercise, maximal hand-grip strength decreased by 150 N (25% MVC) in the males vs. 50 N (14%) in the females. Irrespective of gender, individuals with larger hand-grip strength and longer carriage durations (range 120 s-280 s) showed the slowest strength recoveries (up to 72 h) as compared to 1 h of recovery in participants with short transport durations (range 27 s-120 s). These findings suggest that the increasing number of eccentric strains during uninterrupted stretcher carriage induces cumulative muscle damages that may require some days for complete recovery.     

Maximal manual stretcher carriage: performance and recovery of male and female ambulance workers

The effects of a maximal duration stretcher carriage on heart rate (HR), lactate concentration, hand steadiness and hand-grip strength were studied up to 72 h post-exercise in 17 male and 15 female military ambulance personnel. Using both hands for transport, the participants walked on a treadmill ergometer at a speed of 4.5 km/h. Force measurements at the handlebars yielded mean loads of 245 N (25 kg) on each side. Each step on the treadmill induced additional force oscillations with peak forces up to 470 N corresponding to 130% (women) and 98% (men) of maximal voluntary contraction (MVC). In the males the maximal transport time was about twice the time in women (mean ± SD: 184 ± 51 s vs. 98 ± 34 s). These differences had no significant effect on HR and lactate values. The same applies to hand steadiness, which showed only a transient deterioration immediately after exercise. In contrast to these parameters, substantial differences were seen in hand-grip strength recovery. Immediately after exercise, maximal hand-grip strength decreased by 150 N (25% MVC) in the males vs. 50 N (14%) in the females. Irrespective of gender, individuals with larger hand-grip strength and longer carriage durations (range 120 s–280 s) showed the slowest strength recoveries (up to 72 h) as compared to 1 h of recovery in participants with short transport durations (range 27 s–120 s). These findings suggest that the increasing number of eccentric strains during uninterrupted stretcher carriage induces cumulative muscle damages that may require some days for complete recovery.     

Characterization of the metabolic demands of simulated shipboard Royal Navy fire-fighting tasks

The purpose of this study was to quantify the metabolic demand of simulated shipboard fire-fighting procedures currently practised by men and women in the Royal Navy (RN) and to identify a minimum level of cardiovascular fitness commensurate with satisfactory performance. Thirty-four males (M) and 15 females (F) volunteered as subjects for this study (n = 49). Maximal oxygen uptake ([Vdot]O_2max) and heart rate (fc _max) of each subject was assessed during a standardized treadmill test. During the main trials, volunteers were randomly assigned to complete several 4-min simulated shipboard fire-fighting tasks (boundary cooling (BC), drum carry (DC), extinguisher carry (EC), hose run (HR), ladder climb (LC)), at a work rate that was endorsed as a minimum acceptable standard. Heart rate (fc) and oxygen uptake ([Vdot]O2) were recorded at 10-s intervals during rest, exercise and recovery. Participants completed all tasks within an allocated time with the exception of the DC task, where 11 subjects (all females) failed to maintain the endorsed work rate. The DC task elicited the highest (p< 0.01) group mean peak metabolic demand (PMD) in males (43 ml min^-1 kg^-1) and females (42 ml min^-1 kg^-1) who were able to maintain the endorsed work rate. The BC task elicited the lowest PMD (23 ml min^-1 kg^-1), whilst the remaining three tasks elicited a remarkably similar PMD of 38–39 ml min^-1 kg^-1. The human endurance limit while wearing a self-contained breathing apparatus (SCBA) dictates that RN personnel are only able to fire-fight for 20–30 min, while wearing a full fire-fighting ensemble (FFE) and performing a combination of the BC, HR and LC tasks, which have a group mean metabolic demand of 32.8 ml min^-1 kg^-1. Given that in healthy subjects fire-fighting can be sustained at a maximum work intensity of 80% [Vdot]O_2max when wearing SCBA for this duration, it is recommended that all RN personnel achieve a [Vdot]O_2max of 41 ml min^-1 kg^-1 as an absolute minimum standard. Subjects with a higher [Vdot]O_2max than the above quoted minimum are able to complete the combination of tasks listed with greater metabolic efficiency and less fatigue.     

Biomechanical analyses of paramedics simulating frequently performed strenuous work tasks

Firefighters performing emergency rescue functions are at an elevated risk of musculoskeletal injuries. The objective of the current study was to analyze the biomechanical stresses placed on the body based on simulations of the following strenuous and frequently performed emergency rescue tasks: (1) transferring a patient from a bed to a stretcher using bedsheets, (2) transferring a patient from the ambulance stretcher to a hospital gurney, (3) carrying a victim down a set of stairs and through a landing using a stairchair, (4) carrying a victim down a set of stairs and through a landing using a backboard, and (5) carrying a victim down a straight set of stairs using a stretcher. Postural data were analyzed using the University of Michigan's Three-Dimensional Static Strength Prediction Program and the relative risk of low back disorder (LBD) was quantified using the trunk motion model published by Marras et al. (1993, spine 18, 617-628). Peak compression values and the probabilities from the Marras et al. (1993) model indicated that the most hazardous tasks performed as part of this simulation included pulling a victim from a bed to a stretcher, the initial descent of a set of stairs when using the stretcher, and lifting a victim on a backboard from the floor. Overall, the two models were well correlated in their assessment of the task components modelled (r = 0.78). These data indicate where engineering changes to equipment regularly used by emergency rescue personnel would have the greatest impact in reducing the risk of musculoskeletal injury.     

Collaboration Exercises: What Do They Contribute?

This article aims to study whether exercises contribute to learning that can be useful in actual emergency work. It reports the findings of a study about professional emergency personnel's perceptions of the impact of collaboration exercises. Surveys were distributed and collected from emergency personnel in conjunction with three collaboration exercises that took place in Sweden in spring 2012. The survey included personnel holding different positions within the police department, fire department and ambulance services. Among them were also operational personnel such as officers. A total of 94 professional emergency personnel agreed to participate by answering the survey. The response rate was 95%. The study shows that collaborative elements in exercises contribute to perceived learning (R² = 0:53), and that learning, in turn, has a perceived beneficial effect on actual emergency work (R² = 0:26). The perceived results of collaboration, learning and their impact on actual emergency work, however, are moderate. The exercises were characterised by long waiting times and gave few opportunities to practise different strategies. Only a few respondents felt that they learned something about the collaborating organisations' ways of communicating and prioritising. Many also thought that the exercises were more useful for command officers than for operational personnel. Thus, the study shows that by strengthening the collaborative elements of the exercises, the perception of the participants' actual emergency work can be developed.     

Standard and alternative methods of stretcher carriage: performance,human factors,and cardiorespiratory responses

Transporting a casualty on a stretcher is a common task for medical and military personnel. Stretchers are usually carried by hand, but distributing the load to other parts of the body may have advantages. To examine alternative carriage methods, 11 soldiers walked on a treadmill at 4.8 km/h while performing two person carries of a stretcher containing an 80-kg manikin. In separate trials, soldiers carried the stretcher using: (1) hand carriage, (2) shoulder straps, (3) a specially designed harness that allowed load shifting between the hips and shoulders (hip-shoulder system), and (4) a clip that fitted on the belt of standard military load carrying equipment (LCE) and placed the stretcher mass mainly on the hips. With each system, subjects walked until volitional fatigue or 30 min. While walking, expired gases and heart rates were obtained and subjects rated their perceived exertion (Borg Scale). At the conclusion of all four trials, subjects rated each system on a number of subjective measures. Results showed that average (±SD) carriage times were 2.7±1.4, 14.5±8.3, 25.4±8.1, and 21.7±9.9 min with the hand, shoulder, hip-shoulder and LCE systems respectively (p<0.01). Hand carriage resulted in considerably more cardiorespiratory stress (higher heart rate and minute ventilation, p<0.05) than the other three systems, but there were few consistent differences among the other three systems. Perceived exertion in the upper body was less with the hip-shoulder and LCE systems than with the other two systems (p<0.05). Subjects preferred the hip-shoulder and LCE systems overall and for specific subjective characteristics such as comfort, ease of use and stability (p<0.01). These data indicate that moving the stretcher load from the hands and placing that load on the shoulders and/or hips results in improved performance, reduced cardiorespiratory stress and favourable subjective evaluations. Further developmental work should focus on the hipshoulder and LCE systems.     

Metabolic costs of load carriage with different container sizes

Abstract

Six well-trained male subjects carried boxes of varying box width and weight at varying speeds on a level treadmill until steady-state heart rates were obtained. Analysis of the steady-state data for heart rate and metabolic cost led to development of highly accurate predictor models for both factors. The metabolic-cost model accounted for over 94% of the variance (R²>0·94), and the heart-rate model accounted for over 81% of the variance present (R²>0·81). Evaluation of other models for predicting physiological response to carrying loads found their predictions to differ significantly from the data of the present study.     

Control of posture during tasks representing common work-related postures – a reliability study

Assessment of control of posture using a task battery that represents work-related postural conditions is highly recommended for providing a comprehensive understanding of collective postural demands. However, dearth of evidence exists on the reliability of a task battery, thus precluding its use as an outcome measure in field research. This study investigated the intrasession reliability and systematic variation of force plate derived centre of pressure (COP) measures obtained during repeated performance of a task battery (lifting task, limits of stability and bipedal and unipedal stance). COP signals obtained during each task performance were processed to derive various time-domain COP measures. Statistical analyses revealed that 13 of the 19 COP measures displayed excellent relative (ICC_(2,3) ≥ 0.75) and acceptable absolute reliability (SEM%: ≤ 10). Although COP measures displayed systematic variation, the differences were less or equal to the measurement error, except COP measures of unipedal stance and limits of stability. The chosen task battery is reliable and can be used for comprehensive evaluation of control of posture, in both field and laboratory research.

Practitioner Summary: Repeated evaluation of multiple tasks together sequentially could introduce measurement variability. This study investigated intrasession reliability of a task battery representing common work-related postures. The chosen task battery was found to be reliable with acceptable measurement error and can be used in field research settings for evaluation of control of posture.     

The physical strain of dairy farming

The aim of this study was to estimate the physical stress and strain in dairy farming, using ambulatory heart rate and oxygen consumption measurements. The rate of perceived exertion was estimated with Borg scale. The maximal oxygen consumption was measured in the laboratory. The study group consisted of eight male and 15 female farmers. The handling of feed and manure was the heaviest work task in dairy farming. The aerobic capacity ([Vdot]O₂ max) of female farmers (26 ± 3 ml/min/kg) was below average, and their work required over 50% of [Vdot]0₂ max during most of the tasks. The [Vdot]0₂ max of male fanners (32±10 ml/min/kg) was moderate, and most work tasks required below 50% of [Vdot]0₂ max. The mean heart rate in dairy farming tasks was 99 beats min^-1 in men and 116 beats min^-1 in women. However, according to the rate of perceived exertion, the men experienced the same work tasks as subjectively more heavy than did the women. The physical strain of female farmers in dairy farming seems to be too high because of heavy work tasks and relatively low [Vdot]0₂ max of women. Special attention should be paid to these factors in the occupational health services for farmers.     

Differences in functional performance of the shoulder musculature with obesity and aging

The workforce includes an increasing number of workers who are obese and/or older, which may lead to higher rates of workplace injuries. We examined the main and interactive effects of obesity and age on strength and functional performance during sustained isometric exertions involving shoulder flexion in two postures. Four groups of eight participants each (non-obese (18.5 < BMI < 25 kg/m²) young (18–25 years), non-obese older (50–65 years), obese (30 < BMI < 40 kg/m²) young, and obese older) completed static endurance tasks in each posture, at fixed target levels of shoulder moment. Shoulder strength was ∼25% higher with obesity and equivalent between age groups. Both obesity and age affected endurance time, with the obese and younger groups both having shorter endurance. Obesity and age did not have an interactive effect on endurance time and the results were inconclusive regarding acute fatigue effects for individuals who are older and obese. Further work is needed under more realistic task conditions, to explore the likely complex effects of these individual differences.     

Combined effects of working environmental conditions in VDT work

The combined effects of city noise and luminance of the computer display were evaluated from the changes in lymphocytes and mental activities of participants. Healthy male students were tested under the following four experimental conditions: (1) a calculating task on a video display terminal (VDT) with luminance of 90 cd m^-2 without city noise; (2) a calculating task on a VDT with luminance of 20 cd m^-2 without city noise; (3) a calculating task on a VDT with luminance of 90 cd m^-2 with city noise of 70 dB(A); and (4) a calculating task on a VDT with luminance of 20 cd m^-2 with city noise of 70 dB(A). A visual reaction test (VRT) was performed, and critical flicker fusion frequency (CFF), heart rate (HR), numbers of circulating white blood cells (WBCs), lymphocyte subsets and subjective symptoms of fatigue were measured (1) before; (2) just after; and (3) 30 min after each 60 min test. Subjective symptoms of fatigue significantly increased just after experiments conducted under the two noisy conditions. VRT and CFF showed significant changes in the case of the highluminance display with noise. WBCs and neutrophils showed significant increases in the two quiet conditions. These results suggested that high luminance with noise had the most effect on subjective fatigue and mental activities.     

The specificity of endurance training on muscular power and muscle fibre size

In an effort to further examine the specificity of training concept, six female student volunteers (mean age=25.3 years) were endurance trained three times a week for a period of twelve weeks. The training consisted of thirty minutes of continuous running per workout. Identical test batteries were administered prior to (pre) and immediately following (post) the treatment period. Each battery of tests consisted of three measures of muscular leg power (vertical jump test, 18-29 m sprint, and the Margaria Step Test), and two measures of cardiovascular endurance (Cooper's 12 minute run, and V?O₂ max during treadmill running). A muscle biopsy from the lateral aspect of the gastrocnemius muscle was also included. The biopsy specimens were stained for myosin ATPase. Percentages of fast twitch (FT) and slow twitch (ST) muscle fibres as well as mean individual FT and ST fibre areas were determined. The training produced significant changes in the exercising subjects for thel2-minute run (p=0.006)and VO₂max(p=0.003). No changes were found in the tests of muscular power or individual fibre areas. These data indicate that the endurance training program was of sufficient intensity to effect an increase in cardiovascular fitness. However, these improvements in endurance were not accompanied by any significant changes in muscular leg power or individual muscle fibre size.     

A modified version of the three-compartment model to predict fatigue during submaximal tasks with complex force-time histories

The three-compartment model (3CM) was validated previously for prediction of endurance times by modifying its fatigue and recovery rates. However, endurance times do not typically represent work demands, and it is unknown if the current version of the 3CM is applicable for ergonomics analysis of all occupational tasks. The purpose of this study was to add biological fidelity to the 3CM, and validate the model against a series of submaximal force plateaus. The fatigue and recovery rates were modified to represent graded physiological motor unit characteristics (termed 3CM_GMU). In nine experiments of submaximal efforts, the 3CM_GMU produced a root-mean squared difference (RMSD) of 4.1 ± 0.5% MVC over experiments with an average strength loss (i.e. fatigue) of 31.0 ± 1.1% MVC. The 3CM_GMU model performed poorly for endurance tasks. The 3CM_GMU model is an improvement for evaluating submaximal force patterns consisting of intermittent muscle contractions of the hand and forearm.

Practitioner Summary: We modified an existing fatigue model using known physiological properties in order to predict fatigue during nine different submaximal force profiles; consistent with efforts seen in industrial work. We expect this model to be included in digital human modelling software, for the assessment of repetitive work and muscle fatigue in repetitive tasks.

Social Media Summary: The proposed model has applications for estimating task fatigue in proactive ergonomic analyses of complex force patterns using digital human models.     

Reviewing ambulance design for clinical efficiency and paramedic safety

This study aimed to review the layout of the patient compartment in a UK ambulance for paramedic efficiency and safety using: (1) link analysis; (2) postural analysis. Paramedics were observed over 16 shifts (130 h) carrying out a range of clinical tasks. The most frequently occurring clinical tasks were checking blood oxygen saturation, oxygen administration, monitoring the heart and checking blood pressure. Access to the equipment and consumables to support these tasks had been designed for the attendant seat (head end of the stretcher), however, a link analysis found that paramedics preferred to sit along side the stretcher which resulted in increased reach distances. The higher frequency tasks were found to include over 40% of working postures which required corrective measures. It was concluded that future ambulance design should be based on an ergonomics analysis (including link analysis and postural analysis) of clinical activities.