Most duties performed by firefighters require the use of personal protective equipment, which inhibits normal thermoregulation during exertion, creating an uncompensable heat stress. Structured rest periods are required to correct the effects of uncompensable heat stress and ensure that firefighter safety is maintained and that operations can be continued until their conclusion. While considerable work has been done to optimize firefighter cooling during fireground operations, there is little consensus on when or how cooling should be deployed. A systematic review of cooling techniques and practices among firefighters and hazardous materials operators was conducted to describe the state of the science and provide recommendations for deploying resources for fireground rehab (i.e., structured rest periods during an incident). Five electronic databases were searched using a selected combination of key words. One hundred forty publications were found in the initial search, with 27 meeting all the inclusion criteria. Two independent reviewers performed a qualitative assessment of each article based on nine specific questions. From the selected literature, the efficacy of multiple cooling strategies was compared during exertion and immediately following exertion under varying environmental conditions. When considering the literature available for cooling firefighters and hazardous materials technicians during emergency incident rehabilitation, widespread use of cooling devices does not appear to be warranted if ambient temperature and humidity approximate room temperature and protective garments can be removed. When emergency incident rehabilitation must be conducted in hot or humid conditions, active cooling devices are needed. Hand/forearm immersion is likely the best modality for cooling during rehab under hot, humid conditions; however, this therapy has a number of limitations. Cooling during work thus far has been limited primarily to cooling vests and liquid- or air-cooled suits. In general, liquid-perfused suits appear to be superior to air-cooled garments, but both add weight to the firefighter, making current iterations less desirable. There is still considerable work to be done to determine the optimal cooling strategies for firefighters and hazardous materials operators during work.

Objective To examine the effect of a 12-week Wellness and Exercise (W&E) program on the quality of life of pediatric burn survivors with burns of ≥ 40% total body surface area. We hypothesized this comprehensive regimen would improve physical and psychosocial outcomes. Methods Children were recruited for participation upon their discharge from the ICU. They were not taking anabolic/cardiovascular agents. Seventeen children participated in the W&E group and 14 children in the Standard of Care (SOC) group. Quality of life was assessed with the Child Health Questionnaire (CHQ) at discharge and 3 months. Children completed the CHQ-CF 87 and caregivers completed the CHQ-PF 28. Results The mean age of children in the W&E group was 14.07y±3.5 and mean TBSA was 58%±11.8. The mean age of children in the SOC group was 13.9y±3.1 and mean TBSA was 49%±7.8. ANOVA did not reveal statistically significant differences between the groups. Matched paired t-tests revealed that parents with children in the W&E group reported significant improvements with their children’s physical functioning, role/social physical functioning, mental health, overall physical and psychosocial functioning post-exercise. Conclusions These results are clinically relevant in that a comprehensive W&E program may be beneficial in promoting physical and psychosocial outcomes.

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