Firefighter deaths from cardiovascular events (Part 1 of 2)

I. Introduction

Coronary artery disease (CAD) in firefighters is due to a combination of workplace factors and personal factors such Diabetes mellitus, hypertension, smoking, elevated blood cholesterol (HDL-C), obesity, and a lack of exercise (AHA, 2007). Although not as widely known, firefighters are also exposed to factors in the workplace which are also associated with adverse cardiac outcomes.

II. Cardiovascular effects associated with smoke

Think back to your first fire academy class. You learned that smoke is a combination of heated gases, vapors, and particulate matter. It is also important to remember that the composition of smoke is determined not only by its fuel source, but also by fire conditions such as oxygen availability and temperature (Kulig, 1991). While hundreds of decomposition products can be found, two gases with known cardiovascular effects are carbon monoxide and hydrogen cyanide.

Carbon monoxide (CO)

Carbon monoxide - a product of incomplete combustion - is present in virtually all fire environments. One thing I think many of us are guilty of overlooking is the fact that high CO levels are usually still present during the overhaul phase of an operation and, to make that situation worse, it is during this phase of the operation that many firefighter's remove their self-contained breathing apparatus (SCBA). When CO is inhaled, it disrupts the transport of (and intracellular use of) oxygen which can result in a myocardial injury.

Hydrogen cyanide (HCN)

Hydrogen cyanide is formed due to the incomplete combustion of substances which contain both carbon and nitrogen (e.g. paper, cotton, and wool). It has frequently been detected in residential structure fires in levels that exceed established exposure limits. Like CO, hydrogen cyanide disrupts the intracellular use of oxygen resulting in intracellular hypoxia with cardiac manifestations.

Particulate matter

It's a well-known fact that firefighters are exposed to particulate matter contained in the smoke from a structure fire. (For those who might be reading this blog and not be associated with the fire service, particulate matter is the "sum of all solid and liquid particles in air many of which are hazardous". Studies conducted in the general population have indicated that particulate matter, as a component of air pollution, has adverse cardiovascular effect. For example, short-term exposure to particulate matter has been shown to trigger heart attacks particularly in persons with pre-existing heart disease.

III. Why are we at higher risk

It is a well-known fact that sleep plays a vital role in helping our body recover from fatigue, illness, and stress. Without it, our metabolic rate begins to decrease resulting in weight gain. A firefighter's "internal biological clock"is often disrupted numerous times during a shift making it difficult to regulate the sleep-wake system.  In addition, researcher's at Boston Hospital and Medical Center have determined that prolonged sleep restriction combined with circadian rhythm disruption can be a contributing factor to an increased risk for diabetes.

Electrocardiogram (ECG) tracing shows coronary
heart disease

As if that wasn't bad enough, the University of Chicago conducted research that shows a direct link between sleeping (or the lack of it) and a increased risk of cerebrovascular accident (stroke), myocardial infarction (MI), and congestive heart failure (CHF). According to their findings, an individual who sleeps more than eight (8) hours a night or less than six (6) hours a night has a significantly higher chance of experiencing chest pain or angina and developing Coronary heart disease.

As a firefighter, we are exposed to traumatic stress almost every shift. If we work thirty (30) years that stress will take a toll on our body both physically and mentally. Researchers at the University of California - San Francisco  (UC San Francisco) have found that these exposures over the course of a lifetime will experience an increase in inflammation in their body even if they don't develop Post-Traumatic Stress Disorder (PTSD). These increased levels of inflammation also tend to put the person at a greater risk of having an MI. Intervention strategies to combat this stress, such as exercise, yoga, and other health-related activities should be integrated at the start of a firefighter's career.

IV. Conclusion

Chicago Engine 29 operates at an early morning
warehouse fire.

Firefighting in and of itself is a physically demanding job and will eventually break even the healthiest body down. According to a study performed at the Illinois Fire Service Institute (IFSI), just three (3) hours of prolonged firefighting stiffens arteries and impairs function of the heart in young, healthy male firefighters. This same phenomena is seen in both heavy powerlifters and marathon runners. This means firefighters who do not value the importance of physical fitness are at a greater risk of exhibiting several factors of cardiovascular disease including being overweight and becoming hypertensive.

Additional information: Firefighter deaths from cardiovascular events, Heart disease and firefighters

References

American Heart Association (AHA) [2007]. Risk factors and coronary artery disease. Retrieved on September 19, 2017 from http://www.americanheart.org/presenter. jhtml?identifier=4726

Hofman, John (September, 2012). Heart disease and firefighters: how and why? Retrieved on September 28, 2017 from http://www.fireengineering.com/articles/2012/09/heart-disease-and-firefighters-how-and-why.html

Kulig, K. [1991]. Cyanide antidotes and fire technology. New Eng J Med 325:1801-1802

September is National Preparedness Month

It wasn't until earlier this morning when I was on Facebook that I remembered that September is also National Preparedness Month. I thought on how I could do my part to raise awareness of preparedness and I thought the best avenue would be to address preparedness and the disabled. That being said, "Lets do this".

The first step in preparing for an emergency is to consider how it will affect you as an individual (emphasis added). The first step in doing this is to realize that you might have to fend for yourself for up to three (3) days without access to disaster assistance, a medical facility, or even a drug store. With that in mind, you (and your family) need to consider what resources you utilize on a daily basis and what you would do if there is a limited supply or none at all

I. Prepare an emergency kit

Example of a room modified for
sheltering-in-place

Think first about the basics -- food, water, and clean air and any other life-saving supplies needed to maintain health, safety, and independence. Disaster preparedness experts - such as the American Red Cross - recommend having two versions of these basics: 1) A kit that contains the basics you would need to "shelter in place" (preferably in a interior room of your house or apartment with few or no windows) for up to 72 hours; 2) A light weight, smaller version of the kit (referred to as a "go kit") that you can take with you if it becomes necessary to evacuate your home.

II. Make a plan

The reality of a disaster is that it will likely prevent your from having access to the everyday conveniences to which we have become accustomed. If you have a "support network" that helps you on a daily basis, make a list of their names and how you can contact them during an emergency. It's also important to consider the mode of transportation that you use on a daily basis; what alternative modes will be available if there is a weather-related emergency (such as an snow storm) or a disaster. When planning for a disaster, it is imperative to take into consideration specialized equipment (such as mobility aids) that you are dependent on day-to-day. What would you do if these were not available? In the nutshell, for every aspect of your day-to-day life, you should have an alternate way to accomplish this.


For additional information: Preparing makes sense (PDF)

Do they not understand sometimes?

Link to newspaper story: Fire Chief arrested as PD officer allows structure to burn

We often joke about a our colleagues in the police department not understanding what we do, but the article above points out there might be more truth to the statement than we are willing to admit. Earlier this week in Cannelton, Indianna, Fire Chief Christopher Herzog was arrested by a CIPD officer who felt that his authority was "being threatened".  According to Indianna media outlets, Ryan Foertsch was on the scene (dressed in plain clothes) and attempting to smash open a window. Chief Herzog stopped him and was promptly arrested for "interfering with an officer" or some such manufactured charge. It didn't stop there, however, as Foertsch (and other CIPD officers) stated "We are in charge of this scene now" and ordered fire personnel to leave the scene. Perhaps those officers should be reminded that the National Incident Management System says unequivocably that the first-arriving fire personnel on a scene are the ones in command of the incident -- not the police. Because of their actions, the home was for all purposes destroyed.

As one newspaper article on the incident stated . . .

 "It seems that officer Foertsch was more concerned with his own ego and perceived authority than he was with saving lives, which is a dangerous consequence of giving some people unlimited power"

Following the northern Arizona wildfires

Being a college sophomore studying both Fire science and Emergency Management, I have spent the last few days monitoring the northern Arizona wildfire. The human-caused fire has been burning since last Tuesday (May 20) and currently covers 21 square-miles (Associated Press, 2014). Containment is currently estimated at 25% although a spokesman stated "It will still be a lot of work to be done before those numbers will increase significantly".

I first heard about the fire from a long-time friend who lives in Sedona and started searching on Broadcastify to see if I could hear scanner traffic about the fire. Since then - at least during the daytime - I've listened to the Northern Arizona Wildland Agencies feed as they work to control the fire that is burning around Oak Creek Canyon between Sedona and Flagstaff. The fire has necessitated the closing of Slide Rock State Park.

Fire Managers said their primary goals are to protect an estimated 300 structures threatened by the flames in Oak Creek Canyon, preventing the flames from pushing into the communities of Forest Highlands and Kachina Village located east of the fire, and minimize potential flooding that could occur. Thus far, no homes have been destroyed by the fire.

Bibliography

Associated Press. (2014, May 26). Officials say northern Arizona wildfire 25 percent contained. Retrieved from Fox News: http://www.foxnews.com/us/2014/05/26/northern-arizona-wildfire-grows-but-officials-say-firefighters-making-progress/

Cross-training firefighters as code inspectors

Last night I was working on the discussion board for my Principles of Emergency Services class and I decided to try something new: I enlisted the "voices of experience" by posting the question on Facebook and asking my friends to respond. I want to thank Jerry Michael Allen (Deputy Chief, Brunswick Fire Department), David J. Bullard (Lieutenant,  Columbia County Fire/Rescue Department), Robert J. Duncan (Firefighter, Bradley County Fire/Rescue Department), David Harris (Chief, Mountain Park Fire Department (Ret.)), and Jeff Williamson (Captain, Johns Creek Fire Department for their invaluable input. Here is my discussion board:

Since I know in the past cross-training has been something of a “hot button” topic, I decided to post this question on Facebook to get the thoughts of both current and retired firefighters on my friend’s list. As I suspected I got mixed reviews with some coming out in favor and some opposed. Honestly, I think I have to agree with the mindset of being opposed because, from my experience, department’s that utilize cross-trained personnel tend to have problems with both areas of duty not receiving equal attention. Consider the responsibilities that are already placed on the plate of Firefighter/Medic’s and then add the following duties if they are also responsible for inspection/code enforcement: 1) the design of fire safe assemblies and systems; 2) Review of plans; 3) Inspection of fire safety equipment; and 4) Public education in fire prevention just to name a few responsibilities (Klinoff, 2012). Surprisingly, the strongest opposition did not come from line personnel, but from chief officers – one active and one retired. Explained Deputy Chief Michael Allen of the Brunswick, Georgia Fire Department: “a firefighter doing code enforcement is a bad idea. If a firefighter does all the things expected along with EMS First Responder and all the special ops they shouldn't have time to do other peoples jobs,” (Allen, 2013).

In the interest of fairness, I did some on-line research and found a blog entitled “The Pros and Cons of Cross-Training” written by Mr. Hoyt Mann. In the blog he presented both the pros and cons associated with cross-training (Mann, 2009):

 

Pro	Con
Possible to transfer ideas from one area of responsibility to another	Jack of all Trades is master of none. A limit of two (2) areas to support is probably best.
Keeps you fresh	Burn-out can occur if you are asked to switch back and forth too often or too quickly.
May keep you from being laid off	No time to catch up on reports or other paperwork.
If management is in your future, knowing more than one could be useful	Tends to be more stressful

 

In conclusion, I will leave you with the opinion of retired Mountain Park (GA) Fire Chief David Harris: “If you are at a station which has hardly any calls it would be OK. They had us doing that for a while at FCFD #2's and we were never able to complete the task in our first alarm territory. We were also out of position and or late responding many times because of it,”  

Reference

Allen, M. (2013, September 22). Would you support the idea of cross-training your local firefighters to perform inspection/code enforcement roles? What are the “pros” and “cons” to this idea? [Online forum comment]. Retrieved from https://www.facebook.com/wtlittle Retrieved: September 22, 2013

Harris, D. (2013, September 22). Would you support the idea of cross-training your local firefighters to perform inspection/code enforcement roles? What are the “pros” and “cons” to this idea? [Online forum comment]. Retrieved from https://www.facebook.com/wtlittle  Retrieved: September 22, 2013

Klinoff, R. (2012). Introduction to fire protection. (4th ed., p. 322). Clifton Park, NY: Cengage Learning. DOI: www.cengage.com/ Retrieved: September 22, 2013

Mann, H. (2009, January 12). [Web log message]. Retrieved from http://www.phaseware.com/PhaseWare-Files-blog/bid/12379/The-Pros-and-Cons-of-Cross-Training-in-the-support-center-not-the-gym  Retrieved: September 22, 2013

Farewell to a hero

By Rhonda Cook

The Atlanta Journal-Constitution
(Published: 09/08/2013)

Retired Judge Arthur Kaplan -- who sat on the bench by day and trolled metro Atlanta’s streets at night as a volunteer EMT -- died Friday after a long illness. He was 84. Before he retired a decade ago, the long-time Atlanta Municipal Court judge and former Fulton County magistrate was honored by the Secret Service, trained thousands of law enforcement officers in emergency rescue and on a few occasions personally treated wounded officers even as shots were being fired.

He appeared on the television shows To Tell the Truth and he was featured on This Is Your Life. Newsweek Magazine included the judge on its list 100 "unsung heroes" of America in 1986, and People magazine wrote about his unusual “hobby". Judge Kaplan was recognized for receiving more Red Cross Certificates of Merit for Lifesaving than anyone else in the nation.

“Judge Kaplan was a man of absolute integrity,” said Georgia Bureau of Investigation Director Vernon Keenan. “He was a war hero and he was a hero to men and women in Georgia law enforcement. He trained thousands of police officers in first aid, specifically in how to treat gunshot wounds. On several occasions, he went in, under fire, to rescue wounded police officers.”

Judge Kaplan died at 1 a.m. at Hospice Atlanta, where he had been for 12 weeks, according to his family.

Judge Kaplan, a Navy frogman during World War II, was in five Pacific island invasions and he survived the sinking of a ship. He was awarded a Naval Commendation for Meritorious Service for helping doctors care for injured sailors under fire at the battle of Okinawa.

After the war he was faced with deciding between two loves -- medicine and the law. He got a law degree from John Marshall Law School while also training as a medic at Grady Memorial Hospital, which led to decades as a volunteer paramedic. He has taught his lifesaving techniques to officers and Secret Service and FBI agents as well as some probation violators who would appear before him in court. “He just loved medicine and he just loved this city,” said one of his daughters, Gwinnett Judge Debra Turner.

Cobb County Public Safety Director Mickey Lloyd once told a story about Judge Kaplan coming to his aid when, as a young Atlanta police officer, Lloyd was hit by a taxicab, "When I opened my eyes the first thing I saw was the sincere and serious face of Judge Arthur Kaplan looking down at me, saying ‘You're going to be all right, son,' " Lloyd said in a previous AJC article. One of his most dramatic rescues was in 1975 when he was first to respond to a report that an officer in DeKalb County had been shot twice and the gunman was still shooting. Returning fire with his own revolver, the judge dragged the officer to safety. One of his shots struck the gunman's pistol and disabled it but the attacker continued shooting with a shotgun while Kaplan began emergency treatment on the wounded officer. After taking care of the officer, Judge Kaplan also treated the gunman who was shot 14 times by officers arriving at the scene. The officer and the gunman both survived their wounds. In 1983, Judge Kaplan heard on his police radio that an officer had been shot in the face by a barricaded gunman. Even as the gunfire continued, the judge provided emergency first aid to officer J.E. Burke and then helped move him to an ambulance. Four years later, marshals summoned the judge to the sidewalk outside the Fulton State Courthouse because a child had stopped breathing. The judge revived the child with mouth-to- mouth resuscitation. "One of the most beautiful things in the world is to see someone breathe again,” Judge Kaplan said  at the time. And in 2003, Judge Kaplan received the U.S. Secret Service Director's Award -- the agency's highest honor – for voluntarily training agents for 35 years. “The Atlanta area has lost one of its greatest volunteers and heroes,” said a former law clerk, Noal Solomon. “It didn’t matter who you were or what your background was – if you needed help, Judge Kaplan was there.”

Judge Kaplan is survived by his wife of 63 years, Frances; a son, Dr. Ron Kaplan; two daughters, Turner and Shelley Wisely; their spouses and eight grandchildren. The family asks that in lieu of flowers,  donations be made the Hospice Atlanta or the Atlanta Police Foundation.

****

As I sit here monitoring the mass casualty incident / shooting at the Washington, DC Navy Yard I know with a certainty, had it occurred in Atlanta, Judge Kaplan would have been there because that was what he did. It didn't matter to him that he was a volunteer, he would be right there side-by-side with the paid EMS and fire personnel, and police officers. Often, as Ms. Cook's article points out, he would go about and beyond the call of duty aiding shooting victims even as the gunfire still rang out around him. Not only that, but he served as an inspiration to many - including myself - to enter the EMS field and tirelessly serve others. Thank you Judge Kaplan!

Are we getting sloppy?

West, Texas fertilizer plant explosion aftermath

The unusually high occurrence of incidents that have resulted in multiple Line of Duty Deaths (LODDs) makes me wonder: are we getting sloppy or is it just coincidence? Since I am not a big believer in coincidence, which is defined as "happening without planning; the fact of happening by chance," (emphasis added), then it must be we are tending to get sloppy. Mind you, I am in no way saying that all departments are getting sloppy, just that it is the only way my mind can comprehend it. According to the U.S. Fire Administration (USFA) (United States Fire Administration, 2013) there have been 77 firefighter deaths-to-date during 2013; that compares with 83 for all of 2012. According to the 2012 provisional report from the USFA the occurrence of fatalities broke down as follows: volunteer firefighters - 40 (accounting for 49.4% of the total); career firefighters - 30 (accounting for 30% of the total); wildland firefighters (contract) - 3 (accounting for 3.7% of the total); wildland firefighters (full-time) - 2 (accounting for 2.5% of the total); paid-on-call firefighters - 2 (accounting for 2.5% of the total); wildland firefighters (part-time) - 2 (accounting for 2.5% of the total); part-time firefighters (paid) - 1 (accounting for 1.2% of the total); and industrial firefighter - 1 (accounting for 1.2% of the total).

Surprisingly - given the number of multi-fatality incidents - the most frequent cause of LODDs was heart attack with 40 reported (accounting for 49.4% of the total) Other causes - in descending order - included: trauma with 24 occurrences reported (accounting for 29.6% of the total); asphyxiation with five (5) occurrences (accounting for 6.2% of the total); other (non-specified) with four (4) occurrences (accounting for 4.9% of the total); cerebrovascular accident (CVA) with three (3) occurrences (accounting for 3.7% of the total); crushing injury with two (2) occurrences (accounting for 2.5% of the total); violence (non-specified) with two (2) reported (accounting for 2.5% of the total); and heat exhaustion with one (1) occurrence (accounting for 1.2% of the total).

EKG tracing

Have you ever stopped to wonder we, as firefighters, have a higher occurrence of heart attack?  According to Dr. James Howard writing in the National Institute of Safety and Health's (NIOSH) Science Blog, it is a combination of both personal and workplace factors (Howard, 2013). Personal factors include: 1) age; 2) gender; 3) family history of heart disease; 4) pre-existing diabetes mellitus; 5) hypertension; 6) smoking; 7) elevated cholesterol; 8) obesity; and 9) lack of exercise. Add to those these additional workplace factor and you have the proverbial "perfect storm" to cause a heart attack: 1) exposure to fire smoke (it contains carbon monoxide, hydrogen cyanide, and particulates); 2) heat stress; 3) noise; and 4) shift work. There are some steps fire service personnel can take to decrease their risk of heart attack such as pre-placement medical evaluations for new hires. This serves two purposes: 1) it provides a baseline assessment of the person's overall health; and 2) encourage participation in a comprehensive wellness/fitness program. Additional he recommends reducing exposure to fire-related smoke and doing our best to ensure our stations are a smoke-free environment.

Reference

Fire Administration, U. S. (2013, January 07). Us fire administration releases 2012 firefighter fatality statistics. Retrieved from http://www.usfa.fema.gov/media/press/2013releases/010713a.shtm Retrieved: September 3, 2013

Howard, J. (2013, November 01). [Web log message]. Retrieved from http://blogs.cdc.gov/niosh-science-blog/2007/11/01/fire/ Retrieved: September 3, 2013