Effects of Personal Protective Equipment in Chemical, Biological, Radiological and Nuclear Defense on Heart Rate and Heart Rate Variability of the Human Body
a narrative review
DOI:
https://doi.org/10.70545/ran.v10i15.13515Keywords:
Personal Protective Equipment, Chemical and Biological Defense, Heart Rate, Heart Rate Variability, Thermal StressAbstract
This study investigates the impacts of Personal Protective Equipment (PPE) used in biological, nuclear, chemical, and radiological defense (CBRN) on the heart rate (HR) and heart rate variability (HRV) of the human body. Studies analyzing the prolonged use of such equipment demonstrate a significant increase in thermal and physiological strain on exposed individuals. The literature review highlights that the encapsulation of PPE hinders heat dissipation, raising HR and reducing HRV, which may compromise workers' responsiveness and safety. Mitigation measures, such as cooling systems and adequate training, are discussed. In conclusion, we have identified that using PPE in DBNQR presents significant challenges to the safety and well-being of workers, compromising their physiological capacity for thermal regulation. Elevated heart rate (HR) and reduced heart rate variability (HRV) can negatively impact performance and increase the risk of heat-related collapse. Therefore, mitigating measures, such as cooling systems and adequate training, are relevant strategies to ensure the efficiency of the flight crew's mission.
Downloads
References
BEIN, T. Pathophysiologie und Management der Hitzeerkrankung. Medizinische Klinik, Intensivmedizin und Notfallmedizin, v. 119, n. 5, p. 373–380, 2024. Disponível em: https://link.springer.com/article/10.1007/s00063-023-01072-1, Acesso em: 23 maio 2025.
BLÜCHER GmbH. Instruction manual: CBRN protective coverall POLYPROTECT 12. Erkrath: Blücher GmbH, 2013. Disponível em: https://www.manualslib.com/manual/2063568/Blucher-Saratoga-Cbrn-Protective-Coverall.html?page=3. Acesso em: 21 maio 2025.
BOGERD, C. P.; LANGENBERG, J. P.; DENHARTOG, E. A. A novel adjustable concept for permeable gas/vapor protective clothing: Balancing protection and thermal strain. Annals of Work Exposures and Health, v. 62, n. 2, p. 232–242, 2018. Disponível em: https://doi.org/10.1093/annweh/wxx101. Acesso em: 10 maio 2025.
BAKER, L. B. Physiology of sweat gland function: The roles of sweating and sweat composition in human health. Temperature, v. 6, n. 3, p. 211–259, 2019. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC6773238/. Acesso em: 10 maio 2025.
BRASSER, P. Optimizing the protection against the physiological burden of CBRN clothing. International Journal of Occupational Safety and Ergonomics, v. 16, n. 2, p. 153–168, 2010. Disponível em: https://doi.org/10.1080/10803548.2010.11076836. Acesso em: 10 maio 2025.
BRASIL. Ministério da Defesa. Comando Da Aeronáutica. DCA 1-1/Vol II: Doutrina Básica da Força Aérea Brasileira - Volume 2. Brasília, 2020.
BRASIL. Ministério da Defesa. Comando Da Aeronáutica. DCA 1-6: Doutrina De Preparo E Emprego Da Fab Em Missões De Transporte Na Defesa Química, Biológica, Radiológica E Nuclear (DQBRN). Brasília, 2014.
BRASIL. Ministério da Defesa. Comando Da Aeronáutica. DCA 1-6: Doutrina De Defesa Biológica Nuclear Química e Radiológica (DBNQR). Brasília, 2024.
BRASIL. Ministério da Defesa. Comando da Aeronáutica. Instrução do Comando de Preparo sobre o Programa de Elevação Operacional nº 14C (INPREP/PEVOP/14C) - Programa de Elevação Operacional - PEVOP H-36. Brasília, 2022a.
BRASIL. Ministério da Defesa. Comando Da Aeronáutica. MCA 3-10: Manual do Facilitador de CRM (Corporate Resource Management) da Força Aérea Brasileira. Brasília, 2022b.
BRASIL. Ministério da Defesa. Comando Da Aeronáutica. NSCA 160-6: Evacuação Aeromédica (EVAM) e UTI-Aérea da Aeronáutica. Brasília, 2022c.
BRASIL. Ministério da Saúde. Ministério da Ciência, Tecnologia e Inovação. Ministério da Defesa. Nota Técnica conjunta. Estrutura de atendimento às ameaças, incidentes ou ataques de natureza química, biológica, radiológica e nuclear no período dos jogos Rio 2016. Brasília, 2016.
BUTLER, C. et al. Current clinical concepts: Heat tolerance testing. Journal of athletic training, v. 58, n. 2, p. 84–90, 2023. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC10072087/. Acesso em: 10 maio 2025.
CHEUNG, S. S.; MCLELLAN, T. M. Influence of hydration status and fluid replacement on heat tolerance while wearing NBC protective clothing. European journal of applied physiology and occupational physiology, v. 77, n. 1–2, p. 139–148, 1998. Disponível em: https://link.springer.com/article/10.1007/s004210050312. Acesso em: 19 maio 2025.
FORÇA AÉREA BRASILEIRA. A FAB e o combate à pandemia de COVID-19 em 2021. Disponível em: https://www.fab.mil.br/noticias/mostra/38481/OPERA%C3%87%C3%83O%20COVID-19%20-%20A%20FAB%20e%20o%20combate%20%C3%A0%20pandemia%20de%20COVID-19%20em%202021. Acesso em: 20 maio 2025.
GODSMARK, C. N. et al. Moisture vapour permeable gloves extend thermal endurance and safe work time more than other similarly permeable chemical-biological ancillary protective items. Ergonomics, v. 61, n. 12, p. 1635–1645, 2018. Disponível em: https://doi.org/10.1080/00140139.2018.1503726. Acesso em: 19 maio 2025.
HAVENITH, G.; DEN HARTOG, E.; MARTINI, S. Heat stress in chemical protective clothing: porosity and vapour resistance. Ergonomics, v. 54, n. 5, p. 497–507, 2011. Disponível em: https://doi.org/10.1080/00140139.2011.558638. Acesso em: 19 maio 2025.
HOUSE, J. R. et al. Testing the effectiveness of techniques for reducing heat strain in Royal Navy nuclear, biological and chemical cleansing stations’ teams. Journal of the Royal Naval Medical Service, v. 89, n. 1, p. 27–34, 2003. Disponível em: https://pubmed.ncbi.nlm.nih.gov/14655424/ . Acesso em: 19 maio 2025.
HOUSE, J. R.; HOLMES, C.; ALLSOPP, A. J. Prevention of heat strain by immersing the hands and forearms in water. Journal of the Royal Naval Medical Service, v. 83, n. 1, p. 26–30, 1997. Disponível em: https://pubmed.ncbi.nlm.nih.gov/9282438/. Acesso em: 19 maio 2025.
JOVANOVIC, D. et al. Physiological tolerance to uncompensated heat stress in soldiers: Effects of various types of body cooling systems. Vojnosanitetski pregled. Military-medical and pharmaceutical review, v. 71, n. 3, p. 259–264, 2014. Disponível em: https://doiserbia.nb.rs/Article.aspx?ID=0042-84501300045J. Acesso em: 19 maio 2025.
KENNY, G. P. et al. Ice cooling vest on tolerance for exercise under uncompensable heat stress. Journal of Occupational and Environmental Hygiene, v. 8, n. 8, p. 484–491, 2011. Disponível em: https://doi.org/10.1080/15459624.2011.596043. Acesso em: 23 maio 2025.
KHOMENOK, G. A. et al. Hand immersion in cold water alleviating physiological strain and increasing tolerance to uncompensable heat stress. European journal of applied physiology, v. 104, n. 2, p. 303–309, 2008. Disponível em: https://link.springer.com/article/10.1007/s00421-008-0693-y. Acesso em: 7 jun. 2025.
KLOMPMAKER, J. O. et al. Long-term exposure to summer specific humidity and cardiovascular disease hospitalizations in the US Medicare population. Environment international, v. 179, n. 108182, p. 108182, 2023. Disponível em: https://www.sciencedirect.com/science/article/pii/S0160412023004555?via%3Dihub. Acesso em: 7 jun. 2025.
LATZKA, W. A. et al. Hyperhydration: tolerance and cardiovascular effects during uncompensable exercise-heat stress. Journal of applied physiology (Bethesda, Md.: 1985), v. 84, n. 6, p. 1858–1864, 1998. Disponível em: https://doi.org/10.1152/jappl.1998.84.6.1858. Acesso em: 7 jun. 2025.
MACDONALD, R. C. et al. Consideration of the importance of measuring thermal discomfort in biomedical research. Trends in molecular medicine, v. 29, n. 8, p. 589–598, 2023. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC10619709/. Acesso em: 12 junho 2025.
MALEY, M. J. et al. Extending work tolerance time in the heat in protective ensembles with pre- and per-cooling methods. Applied Ergonomics, v. 85, p. 103064, 2020. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0003687018306379?via%3Dihub. Acesso em: 12 jun. 2025.
MCARDLE, W.; KATCH, I.; KATCH, L. Fisiologia do Exercício: Nutrição, Energia e Desenvolvimento Humano. 8. ed. Rio de Janeiro: Guanabara Koogan, 2016.
MCLELLAN, T. M.; AOYAGI, Y. Heat strain in protective clothing following hot-wet or hot-dry heat acclimation. Canadian journal of applied physiology, v. 21, n. 2, p. 90–108, 1996. Disponível em: https://cdnsciencepub.com/doi/10.1139/h96-009. Acesso em: 12 jun. 2025.
MCLELLAN, T. M.; CHEUNG, S. S. Impact of fluid replacement on heat storage while wearing protective clothing. Ergonomics, v. 43, n. 12, p. 2020–2030, 2000. Disponível em: https://doi.org/10.1080/00140130050201454. Acesso em: 19 jun. 2025.
NORTH ATLANTIC TREATY ORGANIZATION (NATO). ATP-65 - The effect of wearing NBC individual protection equipment on individual and unit performance during military operations. NATO Standardization Agency (NSA), 2004.
PÉRIARD, J. D.; et al. Exercise under heat stress: thermoregulation, hydration, performance implications, and mitigation strategies. Physiological reviews, v. 101, n. 4, p. 1873–1979, 2021. Disponível em: https:// https://journals.physiology.org/doi/full/10.1152/physrev.00038.2020. Acesso em: 12 jun. 2025.
POWERS, S.; HOWLEY, E. Fisiologia do Exercício: teoria e aplicação ao condicionamento e ao desempenho. 8. ed. Barueri: Manole, 2014.
QUEIROGA, M. M. V. O Sistema de Defesa Biológica, Nuclear, Química E Radiológica E A Contribuição Para A Pronta Resposta Da Força Aérea Brasileira. Escola Superior de Guerra. Rio de Janeiro, 2022. Disponível em: https://repositorio.esg.br/bitstream/123456789/1618/1/CAEPE.59%20TCC%20VC.pdf. Acesso em 26 fev. 2026.
RICHMOND, V. L. et al. Insulated skin temperature as a measure of core body temperature for individuals wearing CBRN protective clothing. Physiological measurement, v. 34, n. 11, p. 1531–1543, 2013. Disponível em: https://iopscience.iop.org/article/10.1088/0967-3334/34/11/1531. Acesso em: 29 jun. 2025.
RUBENSTEIN, C. D. et al. Fluid replacement advice during work in fully encapsulated impermeable chemical protective suits. Journal of occupational and environmental hygiene, v. 14, n. 6, p. 448–455, 2017. Disponível em: https://doi.org/10.1080/15459624.2017.1296230. Acesso em: 29 jun. 2025.
SAVIOLI, G. et al. Heat-related illness in emergency and critical care: Recommendations for recognition and management with medico-legal considerations. Biomedicines, v. 10, n. 10, p. 2542, 2022. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC9599879/. Acesso em: 2 jun. 2025.
SEO, Y. et al. Effects of 5-Day Heat Acclimation on Workers Wearing Personal Protective Clothing. Journal of Exercise and Nutrition, v.1, n.1, 2018. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC10194072/. Acesso em: 12 jun. 2025.
SOARES, A. B. F. Variabilidade da Frequência Cardíaca em Pilotos Militares Durante a Atividade Aérea: Uma Revisão de Escopo. 2024, 98 p. Dissertação (Mestrado em Desempenho Humano Operacional) - Universidade da Força Aérea, Brasil, 2024.
THORNTON, R.; BROWN, G. A.; REDMAN, P. J. The effect of the UK aircrew chemical defence assembly on thermal strain. Aviation, space, and environmental medicine, v. 56, n. 3, p. 208–211, 1985. Disponível em: https://pubmed.ncbi.nlm.nih.gov/3985899/. Acesso em: 12 jun. 2025.
YOKOTA, M.; KARIS, A. J.; THARION, W. J. Thermal-work strain in law enforcement personnel during chemical, biological, radiological, and nuclear (CBRN) training. International Journal of Occupational and Environmental Health, v. 20, n. 2, p. 126–133, 2014. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC4060587/. Acesso em: 29 jun. 2025.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sra. Laura Cabral Cruz Lopes da Silveira Andrade, Sra. Paula Morisco de Sá, Sr. Vinicius de Oliveira Damasceno (Autor)
This work is licensed under a Creative Commons Attribution 4.0 International License.
