Motor performance as a determinant of medical rescue profession

Introduction 

Professional medical rescuer can work in the component parts of the integrated rescue system, in the sphere of premedical urgent health care, clinical health care in hospitals in casualty and emergency departments, intensive care units, critical care units, management of rescue health care, in the sphere of research, in education institutions, military health care units, fire squads and others units delivering life and health saving services. The bachelor study program “Medical Rescuer” focuses on training professional rescuers who are qualified and competent to provide urgent paramedical care and life-saving procedures.
The core subjects of the curriculum are focused on the theory and practice of the rescue health care. They include besides preclinical and biomedical disciplines, emergency and disaster medicine, rescue health care, fitness training, winter and summer practical courses, courses in cartography and topography and of self-protection training.
Emergency situations are usually unpredictable, quickly changing, and sometimes dangerous. By definition, “emergency services” implies a capability to transcend the challenges presented by either the victim or the perpetrator. An emergency should not create a second emergency for the responding public safety personnel (Davis et al., 1982).
Despite improvements in working skills, methods and equipment, rescue competence and safety depend on the physical capacity of the rescuers to meet the demands of the job. The physical fitness characteristics of firefighters, police officers, and armed service personnel are well documented. There are defined the criteria for required level of physical fitness and motor performance as well as for exercise programs to enhance and maintain optimal level of motor preparedness in these professions. In contrast, in Slovakia a relative lack of data is available describing the physical attributes of emergency medical service personnel. Up to this day, there have still not been defined key points for consolidation essential minimal requirements that concern optimal level of motor performance in candidates of professional rescue.
Stressors experienced by medical emergency personnel include high physical exertion during prolonged manual cardiopulmonary resuscitation, heavy lifting manoeuvres involved with patient transfer and mental strain associated with trauma situations and shiftwork (Bridgewater et al., 2000; Chapman et al., 2007). Emergency service personnel work both indoors and out, in all types of weather.  They are expected to perform their duties in a variety of potentially arduous situations, including remote mountainous terrains, water or mining rescue. They risk noise-induced hearing loss from sirens and may be exposed to disease such as hepatitis-B and AIDS, as well as violence from mentally unstable patients. The work is not only physically strenuous but can be stressful, sometimes involving life-or-death situations.
Hard work usually involves a high level of aerobic and muscular fitness. Those who meet the requirements are able to perform while maintaining a margin of safety and an ability to respond to emergencies. Those who lack these requirements are more likely to be injured, develop overuse injuries, incur workers´ compensation costs, and become ill and burden employee health plans.
Paramedics are constantly upgrading skills and knowledge, but employees in many physically demanding occupations refuse to submit to the documentation of the maintenance of work-related physical capabilities. Without annual tests or mandatory fitness programs with established benchmarks, employees in physically demanding occupations are certain to regress in fitness and gain fat at rates similar to those of the general population. According to Rodgers (1998) there is estimated a high prevalence of early retirement due to health problems among ambulance personnel.
It can be supposed that rescue tasks such as hoisting tasks, saving victims are related to factors such as stature, body mass, body fat, push-up scores, sit-up scores, total hand-grip strength, endurance (Williford et al., 1999). There were identified as a key physical components of the rescue tasks total body coordination, eye-hand coordination and total speed to be necessary for rescuers to successfully perform their duties (Considine et al., 1976). If the job requires lifting and dragging victims, tests of muscular strength and endurance may be highly correlated to performance. Muscular endurance test such as timed sit-ups, push–ups, and pull-ups are often part of the selection process or fitness assessment of law enforcement, public safety, and military personnel (Morrow et al., 2005, Hoffman, 2006). Ergonomic research demonstrated that the risk of back injury was not just a function of the demands of the materials-handling task, but also the physiological capacity (Wood & Zhu, 2006).
The purpose of this study is to describe and compare relevant indicators of motor performance of male and female rescuers.

Methodology

The research sample consisted of 36 professional medical rescuers (17 women and 19 men) employed in various emergency medical service departments in Slovakia. The mean age of male rescuers was 28.1 years and 31.6 years in female rescuers. The mean of practice years was 2.7 ± 1.9 years for men, varying from 1 to 8, and 5.1 ± 3.7 years for women, varying from 2 to 12.
The subjects were informed of the purpose of this study and the test procedures during special information sessions. For the study, the motor tests selected represent important physical capacities of occupationally competent medical rescuers. Physical fitness was measured using the EUROFIT test battery (Adam et al., 1988). This battery consists of 9 tests which measure the basic motor capacity of the subjects and 3 anthropometric parameters.
Body weight was measured with a precision of 0.5 kg. Stature was measured using Martin’s anthropometer with a precision of 0.1 cm. Skinfolds were measured using the Harpenden caliper with a precision of 0.1 mm. Then the sum of all 5 skinfolds was calculated.   
After the test session descriptive statistics (Mean, SD) were calculated for the groups of male and female rescuers respectively. Possible differences between the groups were explored using t-tests for independent samples. The significance level was set on p ≤ 0.05.

Table 1. List of the EUROFIT (Adam et al., 1988) tests and anthropometric measures

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RESULTS

The descriptive statistics (Mean, SD and t-values) of the examined groups are presented in Table 2. The study revealed that male rescuers perform significantly better in agility, strength and endurance parameters. It is obviously related to their significantly higher level of body stature and mass. Significantly higher body weight and heigh were observed in the group of male rescuers. On the other hand, in female rescuers significantly higher level of body fat was observed. Concerning the women employment in paramedic career these are probably important points that should be taken into account. Level of frequency speed of an arm is also represented by a better performance of male rescuer. There is no important difference observed between male and female rescuers concerning static balance and joint flexibility of a trunk. We presume that flexibility as well as other coordination tests should become important parts of regular diagnostics for physically demanding profession to recognize differences between men and women in more details.

Table 2. Descriptive statistics, t-values of motor abilities in male and female rescuers

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The motor components which are involved in this study have not been very extensively investigated in previous studies. The tests most used in employment issues are strength and aerobic endurance; speed, flexibility and balance tests are used less often (Wood & Zhu, 2006). However, further research is needed to ascertain the relation of particular condition and coordination indicators and job tasks and to determine the necessity of including such parameters in future physical testing and development of specific fitness programs.

Discussion 

The physical inequalities between males and females are well documented. On average the strength superiority of men over women for the upper body is 50 % and for the lower body 30 %, women have usually a higher percentage of body fat (Davies et al., 2008). Our results indicate very similar trends.
Much of the early preemployment testing focused on cognitive abilities, but with the rise in women seeking employment in physically demanding and male-dominated jobs, the need of testing increased (Wood & Zhu, 2006). Increased physical demands of this profession must be taken into account regarding the number of female candidates of this profession as well as the number of women having already been executed this job (Claessens et al., 2003; Miller et al., 1993). Should job or fitness standards be absolute – that is, the same for all employees – or relative to age and gender? Sharkey and Davis (2008) argue that those performing the same job should meet the same standard, regardless of gender or age. On the other hand, it is stated that gender and age are important factors, which should be taken into account.
An aerobic fitness declines with age, even when people remain active. Fitness declines rapidly in a regular population, and body fat levels double during a typical 20-year career. With this physical decline comes a high rate of heart disease, which, surprisingly, is viewed as a job-related disability. Taxpayers deserve the best public servants available, and incumbents deserve to remain healthy and fit for the job. The solution is to test recruits and follow up with an annual performance evaluation, coupled with a job-related physical maintenance fitness program (Sharkey & Davis, 2008). The rescuers within our study referred that their employers did not provide them any kind of health or job-related fitness program, entry or annual fitness testing. It is likely that the motivation of the rescuers for regular training is rather low.
During normal ambulance rescue duties, body fat may prove to be a more important physiological variable than aerobic capacity. While many tasks are completed below maximal aerobic levels (cardiopulmonary resuscitation, patient handling, etc), increased levels of body fat may lead to an increase in the relative intensity of such activities (Chapman et al., 2007). Physical training can be used as a preventive or rehabilitative tool in occupational settings. Training can also prevent mismatches between physical capabilities and job demands and decrease incidences of injury-related absenteeism. Rescue requires strenuous effort at sporadic intervals, and it is unlikely that the physical demands of work and the job rescue will be of sufficient frequency to provide adequate training to maintain, let alone increase, physical fitness (stewart et al., 2008). Our study results of the body fat level correspond to some extent with Davis et al. (1982). The authors stated, that the performance is more influenced by the increasing percentage of body fat than by the increasing age. Overweight, and especially obesity, is a limiting factor not only for performance of the rescue tasks but also for the health of the rescuers.
During normal ambulance rescue duties, body fat may prove to be a more important physiological variable than aerobic capacity. While many tasks are completed below maximal aerobic levels (cardiopulmonary resuscitation, patient handling, etc), increased levels of body fat may lead to an increase in the relative intensity of such activities (Chapman et al., 2007).

Conclusions 

Despite improvements in working skills, methods and equipment, rescue competence and safety depend to large extent on their physical dispositions to meet the demands of the profession. In addition, range of duties has widened in recent years. Partial scientific studies determining the kinetic particularities of individual professions enable to particularize and improve profession’s profile and undergraduate preparation.
The physical profile provides a more in depth estimation of the job requirements. Knowledge of actual physical readiness of rescuers should be presented with the purpose to promote and support employee health and safety, to enhance physical, emotional and health and improve social competency. It should initiate discussion about assessment within the broad range of physically and/or psychologically demanding occupations. It is an important step in the development of a comprehensive employee health program, entry-level testing, health education and health-related fitness, periodic evaluations of work capacity.

Acknowledgments

This research was supported by the Grant Academy of the Slovak Republic no.1/0424/08 awarded to the authors.