Brearley Matt, Walker Anthony
National Critical Care and Trauma Response Centre, Level 8 Royal Darwin Hospital, Rocklands Drive, Tiwi, NT 0810 Australia.
Discipline of Sports Studies, Faculty of Health, UC Research Institute for Sport and Exercise, University of Canberra, Canberra, ACT 2601 Australia ; Australian Capital Territory Fire and Rescue, Amberley Avenue, Fairbairn Business Park, Majura, ACT 2609 Australia.
Extrem Physiol Med. 2015 Sep 30;4:15. doi: 10.1186/s13728-015-0034-9. eCollection 2015.
Rapidly cooling firefighters post emergency response is likely to increase the operational effectiveness of fire services during prolonged incidents. A variety of techniques have therefore been examined to return firefighters core body temperature to safe levels prior to fire scene re-entry or redeployment. The recommendation of forearm immersion (HFI) in cold water by the National Fire and Protection Association preceded implementation of this active cooling modality by a number of fire services in North America, South East Asia and Australia. The vascularity of the hands and forearms may expedite body heat removal, however, immersion of the torso, pelvis and/or lower body, otherwise known as multi-segment immersion (MSI), exposes a greater proportion of the body surface to water than HFI, potentially increasing the rates of cooling conferred. Therefore, this review sought to establish the efficacy of HFI and MSI to rapidly reduce firefighters core body temperature to safe working levels during rest periods. A total of 38 studies with 55 treatments (43 MSI, 12 HFI) were reviewed. The core body temperature cooling rates conferred by MSI were generally classified as ideal (n = 23) with a range of 0.01 to 0.35 °C min(-1). In contrast, all HFI treatments resulted in unacceptably slow core body temperature cooling rates (0.01 to 0.05 °C min(-1)). Based upon the extensive field of research supporting immersion of large body surface areas and comparable logistics of establishing HFI or MSI, it is recommended that fire and rescue management reassess their approach to fireground rehabilitation of responders. Specifically, we question the use of HFI to rapidly lower firefighter core body temperature during rest periods. By utilising MSI to restore firefighter Tc to safe working levels, fire and rescue services would adopt an evidence based approach to maintaining operational capability during arduous, sustained responses. While the optimal MSI protocol will be determined by the specifics of an individual response, maximising the body surface area immersed in circulated water of up to 26 °C for 15 min is likely to return firefighter Tc to safe working levels during rest periods. Utilising cooler water temperatures will expedite Tc cooling and minimise immersion duration.
在应急响应后迅速为消防员降温，可能会提高消防部门在长时间事件中的作战效能。因此，人们研究了各种技术，以便在消防员重新进入火灾现场或重新部署之前，将其核心体温恢复到安全水平。美国国家消防协会建议将前臂浸入冷水中（HFI），随后北美、东南亚和澳大利亚的一些消防部门实施了这种主动降温方式。手部和前臂的血管分布可能会加快身体散热，然而，将躯干、骨盆和/或下半身浸入水中，即多段浸入（MSI），比HFI使更大比例的身体表面接触水，这可能会提高降温速度。因此，本综述旨在确定HFI和MSI在休息期间将消防员核心体温迅速降至安全工作水平的效果。共审查了38项研究，涉及55种治疗方法（43种MSI，12种HFI）。MSI带来的核心体温冷却速率通常被归类为理想（n = 23），范围约为0.01至0.35°C·min⁻¹。相比之下，所有HFI治疗导致的核心体温冷却速率都慢得令人无法接受（约0.01至0.05°C·min⁻¹）。基于支持大面积身体浸入的广泛研究领域以及建立HFI或MSI的类似后勤情况，建议消防和救援管理部门重新评估其对现场救援人员康复的方法。具体而言，我们质疑在休息期间使用HFI来迅速降低消防员核心体温的做法。通过利用MSI将消防员的核心体温恢复到安全工作水平，消防和救援部门将采用基于证据的方法，在艰苦、持续的应对行动中保持作战能力。虽然最佳的MSI方案将由具体的应对情况决定，但将最大身体表面积浸入温度高达26°C的循环水中15分钟，可能会在休息期间将消防员的核心体温恢复到安全工作水平。使用更低的水温将加快核心体温冷却并缩短浸入时间。
