Firefighter Resilience Assessment Using a Structured Approach
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Firefighter Resilience Assessment Using a Structured Approach by Khyati Vyas A thesis submitted to the School of Graduate and Postdoctoral Studies in partial fulfillment of the requirements for the degree of Master of Health Science in Health Informatics Faculty of Health Sciences Ontario Tech University Oshawa, Ontario, Canada December, 2019 © Khyati Vyas, 2019 THESIS EXAMINATION INFORMATION Submitted by: Khyati Vyas Master of Health Science in Health Informatics Thesis title: Firefighter Resilience Assessment Using a Structured Approach An oral defense of this thesis took place on December 13, 2019 in front of the following examining committee: Examining Committee: Chair of Examining Committee DR. PAUL YIELDER Research Supervisor DR. CAROLYN MCGREGOR AM Examining Committee Member DR. MICHAEL WILLIAMS-BELL Thesis Examiner DR. GRACE VINCENT The above committee determined that the thesis is acceptable in form and content and that a satisfactory knowledge of the field covered by the thesis was demonstrated by the candidate during an oral examination. A signed copy of the Certificate of Approval is available from the School of Graduate and Postdoctoral Studies. ii ABSTRACT This thesis proposes a resilience assessment model to assess the physiological changes experienced during a simulated firefighting environment. Currently, a resilience assessment model that measures the response to job stressors does not exist. The model provides a mechanism to measure the level of progress or decline experienced by public safety personnel, while exposed to job-related stressors. The research design for the model includes analysis of heart rate and electrocardiogram-based RR intervals at baseline and during the training activity. The model was applied to a case study that involved an extreme heat (50° C) search and rescue training task for pre-service firefighters (mean age of 21 years and a standard deviation of 4.6 years with 20% female). The performance of the female participants revealed a 54% higher standard deviation of normal R-R interval (SDNN) score compared to male participants. Furthermore, the average of the mean heart rate (HR) for males was 18% higher than the females. The SDNN for 93% (39) of males was less than 100ms as compared to the female SDNN where only 22% (2) of participants fell below 100 ms. Applying the model revealed female participants to be more resilient than their male counterparts. Prior studies have not addressed biological sex differences in their studies and this needs to be further explored. Implementation of the resilience assessment model to assess and improve the effectiveness of resilience training programs could benefit firefighters by reducing the incidence of PTSD, depression and workplace injuries. Keywords: occupational stress; firefighters; heart rate variability; public safety personnel; resilience iii CO-AUTHORSHIP STATEMENT The thesis includes a paper co-authored with research supervisor, Dr. Carolyn McGregor who contributed by providing feedback and supervision. The Use of Heart Rate for the Assessment of Firefighter Resilience: A Literature Review (Vyas & McGregor, 2018). iv AUTHOR’S DECLARATION I hereby declare that this thesis consists of original work of which I have authored. This is a true copy of the thesis, including any required final revisions, as accepted by my examiners. I authorize the University of Ontario Institute of Technology to lend this thesis to other institutions or individuals for the purpose of scholarly research. I further authorize University of Ontario Institute of Technology to reproduce this thesis by photocopying or by other means, in total or in part, at the request of other institutions or individuals for the purpose of scholarly research. I understand that my thesis will be made electronically available to the public. The research work in this thesis that was performed in compliance with the regulations of Ontario Tech’s Research Ethics Board/Animal Care Committee under REB Certificate #14783 and Durham College Research Ethics Board under REB Certificate #156-1718. KHYATI VYAS v STATEMENT OF CONTRIBUTIONS 1 The work described in Chapter 4 was performed at the in climatic chambers of Ontario Tech University’s ACE Facility, Oshawa, using the Hexoskin smart wearable device for data acquisition in a pre-firefighting simulated environment supervised by Dr. Michael Williams-Bell and Dr. Carolyn McGregor. I was responsible for downloading and analyzing data in my computer. 2 Part of the work described in Chapter 2 has been published as: Vyas, K., McGregor, C., 2018, “The Use of Heart Rate for the Assessment of Firefighter Resilience: a Literature Review”, 2nd IEEE Life Sciences Conference, Montreal, Canada, 259-262, doi: 10.1109/LSC.2018.8572095 I performed the majority of the literature review, finding articles relevant to the context, and writing of the document. vi ACKNOWLEDGEMENTS I would first like to thank my thesis advisor Dr. Carolyn McGregor from the Faculty of Business and IT at Ontario Tech University. She provided me confidence and courage in pursuing my goals and guided me during this journey. She consistently allowed this paper to be my own work but steered me in the right direction whenever she thought I needed it. I would also like to thank Dr. Michael Williams-Bell who was involved in this research work. His prior research work to make firefighting a safer occupation has always inspired me to work harder and remain constantly driven to accomplishing this thesis work. I would also like to acknowledge all the members of our Health Informatics lab in SIRC. They provided motivation when the times I was trying to find solutions to my research questions. Catherine Inibhunu (Ph.D. © of Computer science) from FBIT at Ontario Tech University who provided advice on the constructive research and Meg Thavakugathasalin as the second reader of this thesis, and I am gratefully indebted to her very valuable comments on this thesis. Additionally, I would like to thank the Financial Aid Office of Ontario Tech University for providing financial support during a semester through the TD Bank Financial Group Graduate Scholarship. Finally, I must express my very profound gratitude to my friends and everyone that provided me with unfailing support and continuous encouragement throughout my years of study and through the process of researching and writing this thesis. This accomplishment would not have been possible without them. Thank you. vii TABLE OF CONTENTS ABSTRACT ..................................................................................................................iii CO-AUTHORSHIP STATEMENT ............................................................................. iv AUTHOR’S DECLARATION ...................................................................................... v STATEMENT OF CONTRIBUTIONS ....................................................................... vi ACKNOWLEDGEMENTS ........................................................................................ vii TABLE OF CONTENTS ........................................................................................... viii LIST OF TABLES ........................................................................................................ x LIST OF FIGURES...................................................................................................... xi LIST OF ABBREVIATIONS AND SYMBOLS ........................................................ xii Chapter 1. Introduction .............................................................................................. 1 1.1 Background ............................................................................................................ 1 1.1.1 Physiological Signal Monitoring ................................................................ 3 1.2 Mental Health in the Firefighter Population ............................................................ 4 1.1.2 Resilience Training .................................................................................... 7 1.1.3 Application of Resilience Assessment Techniques ..................................... 8 1.1.4 Research Motivations ............................................................................... 10 1.1.5 Structure of Resilience Assessment Model ............................................... 10 1.1.6 Research Methods .................................................................................... 11 1.1.7 Thesis Structure ....................................................................................... 14 Chapter 2. Literature Review................................................................................... 16 2.1 Introduction ......................................................................................................... 16 2.1.1 Method..................................................................................................... 16 2.2 Physical Demands of Firefighter Population ......................................................... 17 2.1.2 Cardiovascular Disease in the Firefighter Population ................................ 19 2.1.3 Prior work for Resilience in the Firefighter Population ............................. 21 2.1.4 Resilience in other Public Safety Personnel Population ............................ 24 2.1.5 Sample Size & Demographic Characteristics ............................................ 29 2.1.6 Heart Rate Responses ............................................................................... 30