The Effect of Breathwork on Physiological Stress Regulation and Performance in Emergency Responders: An Experimental Controlled Simulation Trial

From a previous study, 15 paramedicine students from the Breathwork group and 15 paramedicine students from the control group will be selected to don Hexoskin apparatus and participate in stressful immersive simulations. Hexoskin apparatus will measure heart rate (HR), respiratory rate (RR), and heart rate variability (HRV) during fully immersive stressful simulations such as a simulated paediatric cardiac arrest. The paramedicine students (n=30), they will undergo identical acutely stressful one-day scenarios designed by their university staff. Performance will be independently judged as an additional outcome. Participation in the previous study ACTRN12625000101482 is a key inclusion criterion. The Hexoskin smart shirt is a wearable biometric monitoring garment designed to collect real-time physiological data including heart rate, respiratory rate, and HRV. Participants will wear the Hexoskin shirt beneath their uniform for the duration of each simulation. The garment connects to a companion device worn at the waist and transmits data wirelessly to a secure database for analysis. Participants will wear the device for approximately 10 minutes pre-simulation (rest period), throughout the simulation (~20 minutes), and for a 10-minute post-simulation cool-down period. The intervention group will be instructed in the A52 Method (aka “Little A Method”) of breathwork: a daily 10-minute session involving slow, diaphragmatic nasal breathing with a 5-second inhale, 5-second exhale, and 2-second pause (hold), performed while seated and relaxed. The intervention group members will be asked to practice the A52 Method frequently (i.e. twice per day), 7 days leading up to the simulation task. Simulation: Each participant will participate in one simulation that will last upto 20 minutes. The participant will enter the simulation by themselves and participate in a scenario such as a paediatric arrest. Participants will wear the Hexoskin for 10 minutes pre-simulation (rest baseline), during the simulation, and for 10 minutes post-simulation (recovery period). No separate rest protocol is administered outside these time points. Simulations will be conducted by senior paramedic educators trained in high-fidelity simulation delivery. Simulations will be observed through two way glass. This study builds upon the trial registered under ACTRN12625000101482.