The importance of using infrared thermography (IRT) to assess skin temperature (t) is increasing in clinical settings. Recently, its use has been increasing in sports and exercise medicine; however, no consensus guideline exists to address the methods for collecting data in such situations. The aim of this study was to develop a checklist for the collection of t using IRT in sports and exercise medicine. We carried out a Delphi study to set a checklist based on consensus agreement from leading experts in the field. Panelists (n = 24) representing the areas of sport science (n = 8; 33%), physiology (n = 7; 29%), physiotherapy (n = 3; 13%) and medicine (n = 6; 25%), from 13 different countries completed the Delphi process. An initial list of 16 points was proposed which was rated and commented on by panelists in three rounds of anonymous surveys following a standard Delphi procedure. The panel reached consensus on 15 items which encompassed the participants' demographic information, camera/room or environment setup and recording/analysis of t using IRT. The results of the Delphi produced the checklist entitled "Thermographic Imaging in Sports and Exercise Medicine (TISEM)" which is a proposal to standardize the collection and analysis of t data using IRT. It is intended that the TISEM can also be applied to evaluate bias in thermographic studies and to guide practitioners in the use of this technique.

AFD experienced a more intense protracted finger vasoconstriction than CAU during hand immersion, whilst ASN experienced an intermediate response. This greater sensitivity to cold may explain why AFD are more susceptible to cold injuries.

Objective The use of personal cooling systems to mitigate heat strain on first-responders achieves two potential performance benefits relative to the absence of such cooling: (1) the completion of a workload with less effort; and/or (2) the completion of a greater workload for the same effort. Currently, claims made by manufacturers regarding the capability of their products for use in conjunction with chemical/biological protective clothing remain largely unsubstantiated. The purpose of this investigation was to evaluate the means by which heat strain can be alleviated during uncompensable heat stress in chemical/biological clothing, using the ASTM F2300-10 methodology. Methods Eight healthy males completed five trials of continuous walking (4.5 km h −1 ; 35°C; 49% RH) for up to 120 min while wearing one of four cooling systems and/or a National Fire and Protection Association 1994 Class-3 chemical/biological ensemble. The four cooling methods (ice vest [IV], phase-change vest [PCM], water-perfused suit [WS], and combination ice slurry/ice vest [SLIV]) and no cooling (CON). Results We observed significant improvements in trial times for IV (18 ± 10 min), PCM (20 ± 10 min) and SLIV (22 ± 10 min), but no differences for WS (4 ± 7 min). Heart rate, rectal, mean skin, and body temperatures were significantly lower in all cooling conditions relative to control at various matched time points in the first 60 min of exercise. Thermal sensation, comfort and perceived exertion all had significant main effects for condition, and time, there were no differences in their respective interactions. Conclusion The IV, PCM, and SLIV produced lower heart rate, mean skin, rectal and mean body temperatures in addition to improved work times compared to control. The WS did not improve work times possibly as a result of the cooling capacity of the suit abating, and magnifying thermal insulation. Considering the added time and resources required to implement combination cooling in the form of ice slurry and ice vest (SLIV), there was no significant additive effect for perception, cardiovascular strain, rectal temperature and total trial time relative to the phase change vest or ice vest alone. This may be a product of a “ceiling” effect for work limit set to 120 min as part of ASTM F2300-10.

New Findings What is the central question of this study?Does non‐freezing cold injury (NFCI) alter normal peripheral vascular function? What is the main finding and its importance?Individuals with NFCI were more cold sensitive (rewarmed more slowly and felt more discomfort) than controls. Vascular tests indicated that extremity endothelial function was preserved with NFCI and that sympathetic vasoconstrictor response might be reduced. The pathophysiology underpinning the cold sensitivity associated with NFCI thus remains to be identified. Abstract The impact of non‐freezing cold injury (NFCI) on peripheral vascular function was investigated. Individuals with NFCI (NFCI group) and closely matched controls with either similar (COLD group) or limited (CON group) previous cold exposure were compared (n = 16). Peripheral cutaneous vascular responses to deep inspiration (DI), occlusion (PORH), local cutaneous heating (LH) and iontophoresis of acetylcholine and sodium nitroprusside were investigated. The responses to a cold sensitivity test (CST) involving immersion of a foot in 15°C water for 2 min followed by spontaneous rewarming, and a foot cooling protocol (footplate cooled from 34°C to 15°C), were also examined. The vasoconstrictor response to DI was lower in NFCI compared to CON (toe: 73 (28)% vs. 91 (17)%; P = 0.003). The responses to PORH, LH and iontophoresis were not reduced compared to either COLD or CON. During the CST, toe skin temperature rewarmed more slowly in NFCI than COLD or CON (10 min: 27.4 (2.3)°C vs. 30.7 (3.7)°C and 31.7 (3.9)°C, P < 0.05, respectively); however, no differences were observed during the footplate cooling. NFCI were more cold‐intolerant (P < 0.0001) and reported colder and more uncomfortable feet during the CST and footplate cooling than COLD and CON (P < 0.05). NFCI showed a decreased sensitivity to sympathetic vasoconstrictor activation than CON and greater cold sensitivity (CST) compared to COLD and CON. None of the other vascular function tests indicated endothelial dysfunction. However, NFCI perceived their extremities to be colder and more uncomfortable/painful than the controls.

Background Deep body temperature is a critical indicator of heat strain. However, direct measures are often invasive, costly, and difficult to implement in the field. This study assessed the agreement between deep body temperature estimated from heart rate and that measured directly during repeated work bouts while wearing explosive ordnance disposal (EOD) protective clothing and during recovery. Methods Eight males completed three work and recovery periods across two separate days. Work consisted of treadmill walking on a 1% incline at 2.5, 4.0, or 5.5 km/h, in a random order, wearing EOD protective clothing. Ambient temperature and relative humidity were maintained at 24 °C and 50% [Wet bulb globe temperature (WBGT) (20.9 ± 1.2) °C] or 32 °C and 60% [WBGT (29.0 ± 0.2) °C] on the separate days, respectively. Heart rate and gastrointestinal temperature (T GI ) were monitored continuously, and deep body temperature was also estimated from heart rate (ECTemp). Results The overall systematic bias between T GI and ECTemp was 0.01 °C with 95% limits of agreement (LoA) of ±0.64 °C and a root mean square error of 0.32 °C. The average error statistics among participants showed no significant differences in error between the exercise and recovery periods or the environmental conditions. At T GI levels of (37.0–37.5) °C, (37.5–38.0) °C, (38.0–38.5) °C, and > 38.5 °C, the systematic bias and ± 95% LoA were (0.08 ± 0.58) °C, (− 0.02 ± 0.69) °C, (− 0.07 ± 0.63) °C, and (− 0.32 ± 0.56) °C, respectively. Conclusions The findings demonstrate acceptable validity of the ECTemp up to 38.5 °C. Conducting work within an ECTemp limit of 38.4 °C, in conditions similar to the present study, would protect the majority of personnel from an excessive elevation in deep body temperature (> 39.0 °C).

Despite extensive documentation directed specifically toward mitigating thermal strain of first responders, we wished to ascertain the degree to which first responders applied cooling strategies, and what opinions are held by the various agencies/departments within the United States. An internet-based survey of first responders was distributed to the International Association of Fire Chiefs, International Association of Fire Firefighters, National Bomb Squad Advisory Board and the USA Interagency Board and their subsequent departments and branches. Individual first responder departments were questioned regarding the use of pre-, concurrent, post-cooling, types of methods employed, and/or reasons why they had not incorporated various methods in first responder deployment. Completed surveys were collected from 119 unique de-identified departments, including those working in law enforcement (29%), as firefighters (29%), EOD (28%) and HAZMAT technicians (15%). One-hundred and eighteen departments (99%) reported heat strain/illness to be a risk to employee safety during occupational duties. The percentage of departments with at least one case of heat illness in the previous year were as follows: fire (39%) HAZMAT (23%), EOD (20%) and law enforcement (18%). Post-cooling was the scheduled cooling method implemented the most (63%). Fire departments were significantly more likely to use post-cooling, as well as combine two types of scheduled cooling compared to other departments. Importantly, 25% of all departments surveyed provided no cooling whatsoever. The greatest barriers to personnel cooling were as followsavailability, cost, logistics, and knowledge. Our findings could aid in a better understanding of current practices and perceptions of heat illness and injury prevention in United States first responders.

The primary aim of this study was to assess the accuracy of an infrared camera and that of a skin thermistor, both commercially available. The study aimed to assess the agreement over a wide range of skin temperatures following cold exposure. MethodsFifty-two males placed their right hand in a thin plastic bag and immersed it in 8 °C water for 30 minutes whilst seated in an air temperature of 30 °C. Following hand immersion, participants removed the bag and rested their hand at heart level for ten minutes. Index finger skin temperature (Tsk) was measured with a thermistor, affixed to the finger pad, and an infrared camera measured 1 cm distally to the thermistor.Agreement between the infrared camera and thermistor was assessed by mean difference (infrared camera minus thermistor) and 95 % limits of agreement analysis, accounting for the repeated measures over time. The clinically significant threshold for Tsk differences was set at ±0.5 °C and limits of agreement ±1 °C. ResultsAs an average across all time points, the infrared camera recorded Tsk 1.80 (SD 1.16) °C warmer than the thermistor, with 95 % limits of agreement ranging from -0.46 °C to 4.07 °C. 3 ConclusionCollectively, the results show the infrared camera overestimated Tsk at every time point following local cooling. Further, measurement of finger Tsk from the infrared camera consistently fell outside the acceptable level of agreement (i.e. mean difference exceeding ±0.5 °C). Considering these results, infrared cameras may overestimate peripheral Tsk following cold exposure and clinicians and practitioners should, therefore, adjust their risk/withdrawal criteria accordingly.

ObjectiveThe present study aimed to compare a range of cooling methods possibly utilised by occupational workers, focusing on their effect on body temperature, perception and manual dexterity.MethodsTen male participants completed eight trials involving 30 min of seated rest followed by 30 min of cooling or control of no cooling (CON) (34°C, 58% relative humidity). The cooling methods utilised were: ice cooling vest (CV0), phase change cooling vest melting at 14°C (CV14), evaporative cooling vest (CVEV), arm immersion in 10°C water (AI), portable water-perfused suit (WPS), heliox inhalation (HE) and ice slushy ingestion (SL). Immediately before and after cooling, participants were assessed for fine (Purdue pegboard task) and gross (grip and pinch strength) manual dexterity. Rectal and skin temperature, as well as thermal sensation and comfort, were monitored throughout.ResultsCompared with CON, SL was the only method to reduce rectal temperature (P = 0.012). All externally applied cooling methods reduced skin temperature (P<0.05), though CV0 resulted in the lowest skin temperature versus other cooling methods. Participants felt cooler with CV0, CV14, WPS, AI and SL (P<0.05). AI significantly impaired Purdue pegboard performance (P = 0.001), but did not affect grip or pinch strength (P>0.05).ConclusionThe present study observed that ice ingestion or ice applied to the skin produced the greatest effect on rectal and skin temperature, respectively. AI should not be utilised if workers require subsequent fine manual dexterity. These results will help inform future studies investigating appropriate pre-cooling methods for the occupational worker.