App State senior Skylar Bovine, a kinesiology major from Greensboro, right, uses a portable metabolic system to assess Boone Fire Department Engineer John Edmisten as part of grant-funded App State research spearheaded by Dr. Carolina Smith, professor of kinesiology, and conducted in collaboration with NC State. The research project calculates firefighters’ energy expenditure during specific occupational tasks to assess their energy use and workloads and compares their cardiovascular and thermoregulatory responses to different personal protective equipment, or turnout gear. Photo by Chase Reynolds
BOONE, N.C. — Firefighters face enough uncertainty during a blaze without having to question the performance reliability of their turnout gear, or personal protective equipment (PPE). To ensure next-generation PPE meets rigorous safety and performance standards, Appalachian State University researcher Dr. Caroline Smith is putting both gear and firefighters in the hot seat — in the field and in specially designed lab spaces at the Beaver College of Health Sciences.
Smith serves as a co-principal investigator on the research project, which is led by PI Dr. R. Bryan Ormond, associate professor in the Wilson College of Textiles at North Carolina State University and director of the college’s Milliken Textile Protection and Comfort Center. The project was recently funded with $1.5 million from the Federal Emergency Management Agency’s Fire Prevention and Safety Grant Program.
Their respective research teams are investigating how human physiology responds to the gear’s newly engineered moisture barriers, which are designed to reduce the amount of harmful liquids and bloodborne pathogens that come in contact with firefighters’ skin. The new barriers, introduced last year, are free of polytetrafluoroethylene — a “forever chemical” that persists in the environment, accumulates in the body and has been linked to higher cancer rates among firefighters.
App State students and lab assistants Samantha Mitchell, a senior nutrition and foods-dietetics major from Charlotte, right, and Charlotte Willis, a kinesiology graduate student from Winston-Salem, center, use a portable metabolic system to assess exhaled oxygen and carbon monoxide by Boone Fire Department Engineer Tyler McNeil. This work is part of grant-funded App State research spearheaded by Dr. Carolina Smith, professor of kinesiology, and conducted in collaboration with NC State to test whether new moisture barriers in firefighter turnout gear prevent overheating — a key factor in reducing firefighters’ risk of heat stroke and cardiac events. Photo by Chase Reynolds
Some gear manufacturers have already incorporated the changes to comply with new National Fire Protection Association standards and state-level bans on forever chemicals (or per- and polyfluoroalkyl substances), which affects millions of firefighters. However, limited real-world data exists on how the new layers release moisture and heat and affect the body’s ability to cool itself in extreme fireground conditions, according to Smith.
“With changes to the moisture barrier potentially altering the thermal management, firefighters may potentially be under more thermal and cardiovascular strain. In short, if they are hotter, their hearts end up working harder,” explained Smith, a professor in the Department of Kinesiology. “So if these guys get hotter and they’re under strain, that’s a problem and they need to be aware of that.”
With cardiac events responsible for 45% of firefighter fatalities each year, according to the Centers for Disease Control and Prevention, it is critical to evaluate whether the gear reduces evaporative cooling and raises core body temperature, heart rate and dehydration — factors that significantly increase firefighters’ risk of heat stroke and cardiac events.
App State kinesiology graduate student and lab assistant Charlotte Willis, left, connects Boone Fire Department Capt. Jereme Daniels to the gas sampling line of a portable metabolic system during lab testing in the environmental chamber housed in App State’s Beaver College of Health Sciences. Photo by Chase Reynolds
Dr. Caroline Smith, App State professor of kinesiology, center, explains blood pressure and other physiological measurements to Genesis Santos, of Calypso, a senior chemistry major who is a member of App State’s Environmental Physiology Research Group, left, during testing on Samantha Mitchell, a senior nutrition and foods-dietetics major from Charlotte. Photo by Chase Reynolds
Over several months, six firefighters from Boone and 12 from the Raleigh area will serve as volunteer test subjects, assisting researchers with the evaluation of different moisture barrier designs provided by multiple gear manufacturers.
The rigorous series of tests are set to take place in both field settings and an environmental chamber at the Beaver College of Health Sciences’ Environmental and Occupational Physiology Laboratory, where temperatures can reach 105 degrees. These environments are ideal for testing heat stress, Smith said. She will conduct the initial phase of testing in the field, at local fire halls, where firefighters will be monitored while performing physical tasks such as swinging hammers, dragging hoses and climbing to assess their physiological responses to working intensively in the new gear.
As part of the tests, firefighters swallow telemetry pills — ingestible sensors that use radio technology to transmit core body temperature in real time. Smith and a team of student researchers also measure the firefighters’ heart rate, skin temperature, sweat loss and gas exchange (oxygen use and carbon dioxide production) to calculate their metabolic rate (how hard they’re working). Additionally, the team is examining the impact of heat on cognitive functioning.
“If you get very hot and if you’re at risk of heat illness, your cognitive function can change, and that can be dangerous if your decision-making changes in an emergency situation,” Smith said.
App State researchers apply a respirator mask on Boone Fire Department Engineer Tyler McNeil to test his physiological responses to the new turnout gear. Photo by Chase Reynolds
The initiative, including work at NC State, is an interdisciplinary effort that draws on physiology, chemistry, textile expertise, cognitive expertise and biostatistics, Smith explained. Her student researchers will assist with subject recruitment, testing and data analysis. They will also help produce educational material on gear capabilities, limitations and potential health considerations.
The App State–NC State research team includes Smith, Ormond, co-PI Dr. Emily Griffith, professor of the practice in NC State’s Department of Statistics, and investigator Dr. Samantha DuBois, assistant professor in App State’s Department of Kinesiology.
“By quantifying physiological impacts, this project will provide data-driven guidelines for turnout gear selection, ensuring alternatives do not increase cardiovascular and thermal strain beyond acceptable limits,” Ormond explained. “It is imperative that an unbiased and scientifically driven assessment of these new materials be completed as expeditiously as possible to ensure that firefighters are aware of any critical differences, educated on their impacts and acclimated to how their new gear performs and feels prior to wearing it in an emergency response.”
Smith’s broader research examines carcinogen exposure routes, including dermal absorption, particularly in occupational settings. In the lab and in the field with firefighters, Smith’s work has involved placing catheters under the skin to measure the amount of chemicals entering the body. Her novel approaches to understanding contaminant exposure, including intradermal microdialysis, help shed light on the magnitude and time course of exposure through the skin. By pairing this with laser Doppler flowmetry, she can assess the acute effects of these contaminants on skin blood flow and thermoregulation (the body’s internal process for maintaining a safe temperature). Understanding how much and where contaminants are absorbed may help inform decontamination procedures, Smith said, emphasizing that the overall goal for this project is to improve firefighter health and safety.
What do you think?
Share your feedback on this story.
About the Department of Kinesiology
The Department of Kinesiology at Appalachian State University, housed in the Beaver College of Health Sciences, blends scientific rigor with practical experience across the undergraduate and graduate levels, offering the Bachelor of Science in Kinesiology and the Master of Science in Kinesiology, along with an undergraduate minor in kinesiology. The programs’ innovative curricula prepare students for dynamic careers in health, fitness, performance and sport — shaping the next generation of evidence-driven professionals. Learn more at https://phes.appstate.edu/kinesiology.
About the Beaver College of Health Sciences
Appalachian State University’s Beaver College of Health Sciences (BCHS), opened in 2010, is transforming the health and quality of life for the communities it serves through interprofessional collaboration and innovation in teaching, scholarship, service and clinical outreach. The college enrolls more than 3,600 students and offers 10 undergraduate degree programs, nine graduate degree programs and four certificates across seven departments: Kinesiology, Nursing, Nutrition and Health Care Management, Public Health, Recreation Management and Physical Education, Rehabilitation Sciences, and Social Work. The college’s academic programs are located in the Holmes Convocation Center on App State’s main campus and the Levine Hall of Health Sciences, a state-of-the-art, 203,000-square-foot facility that is the cornerstone of Boone’s Wellness District. In addition, the college supports the Appalachian Institute for Health and Wellness and has collaborative partnerships with the Wake Forest University School of Medicine’s Physician Assistant Program, UNC Health Appalachian and numerous other health agencies. Learn more at https://healthsciences.appstate.edu.
About Appalachian State University
As a premier public institution, Appalachian State University prepares students to lead purposeful lives. App State is one of 17 campuses in the University of North Carolina System, with a national reputation for innovative teaching and opening access to a high-quality, cost-effective education. The university enrolls more than 21,000 students, has a low student-to-faculty ratio and offers more than 150 undergraduate and 80 graduate majors at its Boone and Hickory campuses and through App State Online. Learn more at https://www.appstate.edu.
![How NCInnovation Is Rethinking Economic Development in North Carolina [faculty featured]](/_images/_posts/2026/02/rethinking-economic-development-600x400.jpg)
