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Putting responders first

May 26, 2023

UVic professor and alumna Lynneth Stuart-Hill and graduate student Thomas Service are studying ways to protect emergency personnel from harms they face on the job.

Man and woman monitor a firefighter in full gear walking on a treadmill.

It was, as they say, only a drill—but it turned into a revelation. During one of her first occupational physiology studies, Lynneth Stuart-Hill and her team had set up a simulated car crash outside Victoria High School. They’d recruited people to play victims, students would serve as onlookers—and the city’s media would report on location. All the elements were designed to ramp up pressure on the firefighters, who would be responding to their most stressful call—extracting people from a vehicle. At the start of their shifts, the firefighters ingested core-temperature capsules and were given monitors. Almost as an afterthought, Stuart-Hill also placed monitors on the incident commanders—the leaders who control the scene and give orders. Her main focus was the responders doing the physical work of rushing to save lives within “the golden hour.” But what she found surprised her. The incident commanders showed the strongest physical response to stress.

“What we saw was that their stress response was even higher than the ones who were actually trying to work the jaws of life... Their heart rates were higher, their blood pressures were higher, everything else, so realizing that the stress of incident command, more of a psychological stress, was really manifesting itself physically in these individuals.”
Hand with green surgical gloves holds a capsule.
In the studies, firefighters take a core-temperature capsule that transmits through Bluetooth to a monitor.

Dangers of stress

Stuart-Hill notes that emergency responders are more vulnerable to heart attack than the rest of the population—and stress may be a culprit. “It was just really eye opening to me to see the impact of psychological stress manifesting itself physically,” says Stuart-Hill, who earned a Bachelor of Science in Human Performance at UVic, then a Master of Science in Physical Education, followed by a PhD at UBC.

The findings from the drill that day in 2002 launched an “aha moment” for Stuart-Hill and set her on her research path. She saw the potential for discovery, but also for helping to improve the lives of first responders. She’s now worked with several occupations, including police, fire, conservation officers and both wildland and structural firefighters. One of her graduate students, Marissa Harrington, planned to investigate the stress of nurses on the job—which became a study of nursing during the pandemic. The nurses kept logs noting high-stress incidents, wore monitoring equipment and had stress markers (such as cortisol) heart rate and sleep patterns measured. Harrington’s work also showed stress had a physiological effect.

Stuart-Hill says we need to reconsider these professions that we rely on to keep us safe and healthy. “We have to remember first and foremost that they are humans as well. They have some really unique vulnerabilities in their jobs. One is certainly the psychological component, because they can see some really horrific things. The PTSD and the stress, we’re definitely seeing it in the nurses.”

Higher risk of heart attack

UVic researchers also see these patterns in their work with firefighters, who are under unique stresses, including both shift work and environmental stresses. The nature of the work is also changing. For example, wildland firefighting used to be seasonal—now, due to climate change—the work is year ‘round.

“The fatigue and the burnout that we’re starting to see in some of these emergency-responder occupations, whether it’s emergency response to help people, the environment, or both—it’s having a huge toll on these individuals.” 

The results from the staged scene at Vic High in 2002 launched a series of studies for Stuart-Hill. Later, after a volunteer firefighter died from a cardiac incident at a training facility in Comox, Stuart-Hill started investigating heat and inflammation. She wanted to know how rapidly firefighters gain heat in their “turnout gear,” the heavy, protective clothing they wear at the scene, and how long it takes to dissipate.

Structural firefighters are much more vulnerable to cardiovascular incidents than the general public, says Stuart-Hill. “We have never really known why. They suffer heart attacks two times more often than police and four times more often than paramedics, even though they all do shift work.” 

Man looks at computer screen while in the background a firefighter in full gear walks on a treadmill.
Thomas Service monitors a firefighter as he exercises in full gear on a treadmill in a lab at UVic’s McKinnon building.

Treadmill trials

Researcher Thomas Service knows firsthand how hot wearing that turnout gear can get. He’s a long-time volunteer firefighter with North Saanich Fire Department. Previous studies have shown that when the firefighters become hot in their turnout gear, it starts an inflammatory response in the body and some of those inflammatory proteins have been implicated in atherosclerosis.

Service is leading a double-blind clinical trial of 12 to 15 subjects that involves giving firefighters a placebo at one visit and an anti-inflammatory another time to see if the drug mitigates that response. The firefighters take core-temperature capsules that transmit through blue tooth to a monitor. The subjects exercise in their gear on a treadmill until they reach either 39.5 degrees or physical exhaustion. They are given the antihistamines proactively before they go on the treadmill to see if it will decrease the inflammatory response. If the antihistamines work, it would be a simple way to offset the deleterious effects of heat inflammation.

 “It’s really good, that gear, at protecting you from the external heat of a fire,” Service says. "However, the flip side is that it’s really good at storing the body heat that you produce. When we break down ATP [Adenosine triphosphate] to provide the energy for movement, the muscles are not 100 per cent efficient in the conversion, and this produces heat. The more heat that we produce with the work we are doing—and when there’s not really anywhere for that heat to go because of the properties of the gear— the hotter we get. If it doesn’t allow heat in, it’s not going to allow heat out.”

Firefighter in full gear looking tired with breathing hose attached to mouth and nose.
The subjects exercise in their gear on a treadmill until they reach either 39.5 degrees or physical exhaustion.

Second family

Part of the reason Service chose to continue his studies at UVic—earning a degree in biology, then a Master of Science in Kinesiology and a graduate certificate—is to avoid having to leave his post as a volunteer firefighter and give up his close connections to the community.

“It’s almost like a second family in a sense. When you’re there long enough it’s hard to do something that would pull you away from it. I really enjoy it,” says Service.

Stuart-Hill, for her part, says she avoids the term work-life balance—it should all be life balance, with work fitting within your life, she insists. Although she is devoted to her work, she makes lots of time for pickleball, golf, gardening, walking her two golden retrievers and exercising.

“That’s definitely something that this research has shown me. What you do in your job and what you take home with you is going to affect all the rest of your life.”

Jenny Manzer, BA ’97

This article appears in the UVic Torch alumni magazine.

For more Torch stories, go to the UVic Torch alumni magazine page.