title: The impact of fire suppression tasks on firefighter hydration: a critical review with consideration of the utility of reported hydration measures.
abstract: BACKGROUND
  Firefighting is a highly stressful occupation with unique physical challenges, apparel and environments that increase the potential for dehydration. Dehydration leaves the firefighter at risk of harm to their health, safety and performance. The purpose of this review was to critically analyse the current literature investigating the impact of fighting 'live' fires on firefighter hydration.
  
  
  METHODS
  A systematic search was performed of four electronic databases for relevant published studies investigating the impact of live fire suppression on firefighter hydration. Study eligibility was assessed using strict inclusion and exclusion criteria. The included studies were critically appraised using the Downs and Black protocol and graded according to the Kennelly grading system.
  
  
  RESULTS
  Ten studies met the eligibility criteria for this review. The average score for methodological quality was 55 %, ranging from 50 % ('fair' quality) to 61 % ('good' quality) with a 'substantial agreement' between raters (k= .772). Wildfire suppression was considered in five studies and structural fire suppression in five studies. Results varied across the studies, reflecting variations in outcome measures, hydration protocols and interventions. Three studies reported significant indicators of dehydration resulting from structural fire suppression, while two studies found mixed results, with some measures indicating dehydration and other measures an unchanged hydration status. Three studies found non-significant changes in hydration resulting from wildfire firefighting and two studies found significant improvements in markers of hydration. Ad libitum fluid intake was a common factor across the studies finding no, or less severe, dehydration.
  
  
  CONCLUSIONS
  The evidence confirms that structural and wildfire firefighting can cause dehydration. Ad libitum drinking may be sufficient to maintain hydration in many wildfire environments but possibly not during intense, longer duration, hot structural fire operations. Future high quality research better quantifying the effects of these influences on the degree of dehydration is required to inform policies and procedures that ensure firefighter health and safety.
authors.affiliation: Faculty of Health Sciences and Medicine, Bond Institute of Health and Sport, Bond University, Gold Coast, QLD 4226 Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Walker
authors.affiliation: Tactical Research Unit, Bond University, Gold Coast, QLD 4226 Australia.
authors.forename: Rodney
authors.initials: R
authors.lastname: Pope
authors.affiliation: Tactical Research Unit, Bond University, Gold Coast, QLD 4226 Australia.
authors.forename: Robin Marc
authors.initials: RM
authors.lastname: Orr
keywords: Dehydration; Firefighting; Rural fire; Structural fire; Wildland fire