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Effects of heat exposure and ice slurry ingestion on risk-taking behavior in healthcare workers

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ALHADAD, SHARIFAH BADRIYAH, PONAMPALAM, R, LIM, LOUISA SI XIAN, LOW, IVAN CHERH CHIET, KSHITIJ, RAHALKAR, ABDUL KARIM, AZIZ BIN, SALAMOON, ZAMSHEK BIN, MARIMUTHU, YOGARAJAH S/O +1 more·2024·Medicine & Science in Sports & Exercise
DOI 10.1249/mss.0000000000003486PMC PMC11419282
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Abstract

Purpose: Healthcare workers (HCWs) wearing personal protective equipment (PPE) experience physiological strain that can impair motor and psychological functions, potentially affecting patient care. We assessed the effects of heat exposure on maximal strength and risk-taking behavior among PPE-wearing HCWs and the efficacy of ice slurry to alleviate adverse effects. Methods: Seventeen HCWS completed two experimental trials in a crossover design, consuming 5 g·kg −1 of body mass of ambient drink (AMB) or ice slurry (ICE) before donning PPE and undergoing 2 h of simulated decontamination exercise (wet-bulb globe temperature (WBGT): 25.9°C ± 0.8°C, PPE microenvironment WBGT: 29.1°C ± 2.1°C). Body core temperature ( T c ), heart rate (HR), chest skin temperature ( T sk ), ratings of perceived exertion (RPE), thermal sensation (RTS), maximal voluntary contraction (MVC), risk-taking behavior (balloon analogue risk-taking task (BART)), and salivary cortisol were assessed. Results: Predrinking to postdrinking ∆ T c was greater in ICE (−0.2°C ± 0.1°C) than AMB (−0.0°C ± 0.1°C, P = 0.003). Post-drinking RTS was lower in ICE (2.7 ± 1.2) than AMB (4.1 ± 0.4, P < 0.001). ICE and AMB had similar T c and HR (both P > 0.05), but T sk was lower in ICE than AMB ( P = 0.049). A lower MVC (30.3 ± 6.7 vs 27.4 ± 4.9 kg, P = 0.001) and higher BART-adjusted total pump count (472 ± 170 vs 615 ± 174 pumps, P = 0.017) was observed pretrial to posttrial in AMB but absent in ICE (both P > 0.05). Salivary cortisol was similar between trials ( P = 0.42). Conclusions: Heat-exposed PPE-wearing HCWs had impaired maximal strength and elevated risk-taking behavior. This may increase the risk of avoidable workplace accidents that can jeopardize HCWs and patient care. Ice slurry ingestion alleviated these heat-related impairments, suggesting its potential as an ergogenic aid.

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  • Heightened impulsivity and risk-taking behaviours are driven by warmer temperatures, leading to increased work errors.

    “Heightened impulsivity and risk-taking behaviours are driven by warmer temperatures, leading to increased work errors.10,11”

    From Influence of habitual physical activity on cognitive performance of healthy young adults after passive heat exposure (2026) · cites this paper as [11]

    The Discussion (page unavailable) reports increased risk-taking in healthcare workers after simulated activity in the heat. It describes skin-temperature elevations as a possible contributor, rather than establishing that warmer temperatures drove the change. The paper did not establish heightened impulsivity or increased work errors; the Discussion presents workplace errors as a potential consequence of risk-taking. (LLM, conf=0.88)

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Authors
ALHADAD, S. B., PONAMPALAM, R., LIM, L. S. X., LOW, I. C. C., KSHITIJ, R., ABDUL KARIM, A. B., SALAMOON, Z. B., MARIMUTHU, Y. S., & LEE, J. K. W.
Affiliations
  • National University of Singapore (SG)
  • Singapore General Hospital (SG)
  • Department of Emergency Medicine, Singapore General Hospital, SINGAPORE
Corresponding author
ALHADAD, SHARIFAH BADRIYAH
ORCID
Venue
Medicine & Science in Sports & Exercise
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2024-05-15
Volume
56
Issue
10
Pages
2016-2025
ISSN
  • 0195-9131 (ISSN-L)
  • 1530-0315
DOI
10.1249/mss.0000000000003486
PMC
PMC11419282
OpenAlex
W4398145610
Cited by
4
References
3
Citations by year
2026: 3 · 2025: 1
FWCI
1.03
Type
journal article
Language
en
Open access
Licence
Locations
  • Medicine & Science in Sports & Exercise (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Thermoregulation and physiological responses
  • Life Sciences › Agricultural and Biological Sciences › Animal Science and Zoology › Effects of Environmental Stressors on Livestock
  • Physical Sciences › Materials Science › Polymers and Plastics › Textile materials and evaluations
Keywords
heat exposure, ice slurry ingestion, risk-taking, healthcare workers, personal protective equipment, maximal strength, core body temperature, thermal sensation, Balloon Analogue Risk Task, salivary cortisol, occupational accidents, heat stress countermeasures, wet bulb globe temperature, rating of perceived exertion, heart rate, psychological performance
MeSH terms
Personal Protective Equipment, Adult, Body Temperature, Physical Exertion, Female, Health Personnel, Heart Rate, Hot Temperature, Humans, Hydrocortisone, Ice, Male, Risk-Taking, Saliva, Skin Temperature, Thermosensing, Occupational Exposure, Cross-Over Studies, Muscle Strength, Young Adult

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