Perception or reality: Can thermal perceptions inform management of firefighters in the heat?

Accurately assessing the physiological status of firefighters during work in the heat is critical to ensuring their safety. Evaluating core temperatures (T_c) in the field is problematic due to cost and limitations in technology and accuracy. As such, fire services rely on individual perceptions of wellbeing. The present study aimed to establish whether perceptual responses measured using the perceptual strain index (PeSI), calculated from rate of perceived exertion (RPE) and thermal sensation (TS), could reliably predict the physiological strain (PSI) encountered by experienced firefighters working in a hot environment. We conducted two firefighting simulations (set-pace and self-paced) in a purposefully built heat chamber (100 ± 5°C) comprised of two 20-min periods separated by a 10-min recovery outside the chamber. Physiological strain was measured via heart rate (HR) and gastrointestinal temperature (T_gi) and compared with PeSI at 5-min intervals. To evaluate the predictive ability of the PeSI for PSI, mean differences and the 95% limits of agreement (LOA) were established, along with correlation coefficients at each 5-min interval. Moderately significant correlations occurred in the second work bout of the self-paced trial only (10 min: r = 0.335, 15 min: r = 0.498, 20 min r = 0.439) with no other correlations observed at any other time during either trial or during the rest periods. Bland-Altman analysis revealed mean differences of -0.74 ± 2.70 (self-paced) and +0.04 ± 2.04 (set-paced) between PeSI and PSI with the 95% LOA being -4.77 to 3.28 (self-paced) and -4.01 to 2.01 (set-paced). The wide LOA and lack of correlations observed between perceptual and physiological strain in both self-paced and set-paced work trials indicate that PeSI is not sufficiently reliable as a sole measure of wellbeing for firefighters working in the heat. Hence, we recommend that fire services prioritise the development of reliable and effective monitoring tools for use in the field.