Recently I had a Q&A session with Alex (Sandy) MacQuarrie, Ph.D., to gain insight into his work with the Hexoskin™ Smart Garment and how it’s used in his research. Hexoskin™ and Astroskin are garment-based platforms that combine ECG, respiratory, pulse oximetry, temperature, and accelerometry sensors.
About Sandy MacQuarrie
Alex (Sandy) MacQuarrie is a registered paramedic and Senior Lecturer in the Griffith University School of Medicine and Dentistry, teaching in the Paramedicine program. Griffith University is located close to Surfer’s Paradise on the Gold Coast, Queensland, Australia. Originally from Prince Edward Island, Canada, Sandy has had an interesting career in emergency services, including over 25 years as a paramedic in rural, offshore, and urban environments as well as a flight paramedic. Sandy has a Bachelor of Science, Master of Business Administration and completed his Ph.D. in 2019.
Sandy’s research focuses on paramedic health status and its effect on job performance. Key to the data collection was the innovative use of wearable technology, specifically the Hexoskin™ biometric garment. This technology was used by paramedics while they responded to emergency callouts as part of the Ph.D. project done in conjunction with the New South Wales Ambulance Service. Data cleaning and analysis were completed using VivoSense® software. In a novel approach, Sandy obtained call type and time stamps for all the calls the paramedics attended and were able to incorporate them into VivoSense®. The result was a second-by-second look at how a paramedic responds to almost every type of call, from a routine transfer to a cardiac arrest.
Current research focuses on stress and resilience, incorporating Heart Rate Variability (HRV) as a measure of paramedic wellness, ensuring these health care providers are fit for duty. Here's what Sandy had to say about his current research:
Your research is focused on the health and wellbeing of the paramedic and first responder communities. Which particular health challenges do these groups face as a result of their stressful work?
- Stress resulting from chronic exposure to traumatic events
- Poor sleep quality associated with shift work; for example, some individuals working 24-hour shifts
- The high risk of using unhealthy practices as a potential coping strategy
We know paramedics have an intermittently physically, mentally, and emotionally challenging job. This is different from the general population and has a different effect on them that needs attention through research.
This is a highly physically active group. What are the challenges in monitoring these individuals on a physiologic level?
The best monitoring solutions we have found are garment-based sensors, for example, the Hexoskin™ and Astroskin platforms. In these commercially available garments, a variety of sensors are integrated directly into the clothing. Snug-fitting clothing most importantly stabilizes the sensors even during intense activity and ensures that they stay in the correct positions relative to the skin surface. Of course, this may be a limiting factor also as the clothing must fit the person exactly to ensure correct placement. As mentioned in the previous answer, the level of demand varies greatly both within and between shifts. There is a real sense of the “unknown” in terms of what a paramedic will face on a daily basis. Other advantages of long-term monitoring with garment-based sensors are the ability to understand the metabolic and physical activity demands and how they affect the paramedic.
What types of physiologic measures are you most interested?
Overall measures of activity, using accelerometry, cardiac measures, like HRV and respiratory measures made using inductive plethysmography bands, sleep measures using pulse-oximetry, and the other measures listed in combination together. Also interested in energy expenditure (as mentioned above). I am developing an interest in how the role of health status (for example, diminished measures like extremely high BMI) will impact the measures of HR, HRV, RR, and sleep. Fatigue is also high on the list of research interests. Operating an ambulance with high fatigue levels could be disastrous. We need to be able to use all these measures to establish and link to the development of fatigue. As importantly, we need to have interventions to address.
Which tools do you use to analyze all of these signals?
HRV analysis with a focus on non-linear measures (i.e., Poincare plots) as well as time and frequency domains, actigraphy is important, especially over long periods of time (an entire shift, for example). We recently looked at paramedic actigraphy compared to a mannikin accelerometer to see if we could correlate the two. Interestingly, we also saw a direct decrease in CPR quality over time, with the paramedics increasing HR. We need to do much more work in this area.
Does your research have implications for health management in other populations?
I would say yes. I am currently involved in research projects involving Early Childhood ™Educators, Paramedicine students and am always looking for more ways to deploy the Hexoskin™ and VivoSense® combination. The more we know about the physiological responses, especially in combination with understanding the impact of health status on those responses, the better we can all look after our own health.