Unless this is your first time reading this column, you are pretty much aware that we feel that among the best ways to minimize injury and death to firefighters is through a system that uses policy development, validation, classroom and hands-on training, training verification, testing, policy enforcement, evaluation and regular updating. It goes full circle to ensure that risks that must be taken, such as at a fire, are taken with firefighter and civilian survival as the focus. While fire officers must have discretion, in some cases and based on conditions, to make needed adjustments, a successful department is one that is built upon "realistic" standard operating orders and policies (less discretionary) and standard operating guidelines, which are a bit more discretionary.
Please note the important difference between policy as opposed to guidelines. Policy, you generally must do. Guidelines are direction with user discretion. An example would be that if it is your department's policy for all members to wear self-contained breathing apparatus (SCBA) in or near immediately dangerous to life or health (IDLH) environments, you will do that. No one is particularly interested in what you think at the moment. As the saying goes, "just do it."
When we think about standard operating policies, we usually think about the more dramatic ones such as training, driving, operating at a fire, engines stretching and flowing hoselines, truck companies searching — situations like that. But all standard operating policies are critical, not just the dramatic ones. We just normally don't think about the less dramatic ones. And in many cases, the "less dramatic" ones may fall through the cracks and be missed. Sometimes, they are ignored. And sometimes, they are not ignored — and they lead directly to the saving of a firefighter's life.
We thank Fire/EMS Lieutenant (ret.) Jeff Chandler of the Prince George's County, MD, Fire/EMS Department for his sobering close-call story this month. Additionally, we thank Prince George's County Fire Chief Eugene A. Jones and Acting Lieutenant Colonel Steven L. Hess for their support and cooperation in the sharing of this information.
While this month's close-call story may not be as dramatic as some we have written, it certainly is to those it immediately affects. As firefighter line-of-duty death statistics go, this story is much more likely to affect you, as a firefighter, than any other kind of line-of-duty death, so read on.
Fire/EMS Lieutenant (ret.) Jeff Chandler, Prince George's County Fire/EMS Department:
I am a 47-year-old firefighter lieutenant who had a profound experience while participating in my fire department physical in the spring of 2009. I am now retired, but feel strongly that my story should be told through Firehouse® Magazine Close Calls.
I have always been active in sports and worked hard to stay in good physical shape to perform as best I can as a firefighter. With a career spanning 22-plus years and while still serving in the Prince George's County Fire/EMS Department, I encountering a serious health issue that caused me to retire.
The story begins with my shift on April 15, 2009. Like any other shift in that particular station, we were very busy. The normal call volume for our crews in that station range from 40 to 50 calls per shift. At about 8 P.M., a box alarm was sounded for a hotel fire at 3131 Branch Ave. We arrived to find heavy smoke showing from a second-floor window. After the incident ended, I noticed that I was a more tired than normal, but didn't think anything of it. At the time, I did not know that April 15, 2009, would be the last shift I would ever work with my crew and for the Prince George's County Fire/EMS Department.
On April 17, 2009, I reported for my annual required fire department physical, which had been scheduled about one month earlier. After completing the first phase of the physical, I moved to the treadmill stress test. The staff asked me to continue the test so they could further evaluate the EKG readings at a higher heart rate. After completing the stress test, my nurse asked me how I was feeling. I replied that I felt fine and at no point did I experience chest pain or anything abnormal.
The cardiologist said that my EKG readings were abnormal and that he would like to perform a nuclear stress test to eliminate the possibility of any false-positive interpretation. The nuclear stress test was completed the next day and it revealed a blockage. I was immediately scheduled for cardiac catheterization the following morning. The cardiac catheterization exposed five blockages, of which two were 100% blocked involving the left anterior descending artery, and three smaller, partially blocked coronary arteries.
Once this was discovered, the cardiologist brought my family in and explained there was a possibility that a triple bypass needed to be performed, but he was going to first attempt to place cardiac stints in the needed areas. After about an hour, he was successful in placing two of the stints, but I needed to return in two weeks so he could place three more. The cardiologist, knowing I was in the fire service, informed my family and I that not only did the fire department physical exam save my life, but that I most likely would not have survived another one or two months without the cardiac problems being detected.
On May 1, 2009, I had my second catheterization completed to place the remaining three stints. During this second procedure, my blood pressure dropped and I had the unique experience of going into cardiac arrest. A balloon pump and medication were used to stabilize me. With some great work by my doctor and the staff, the stints were placed and I am here to pass along the importance of getting your annual physical.
In closing, I would like to explain that my required departmental annual physical saved my life. Thank you for allowing me the opportunity to tell my story to others, especially those in the fire service.
Comments by Chief Goldfeder and others regarding this month's close call.
It's no secret that firefighters are dying on the job from preventable cardiovascular conditions. Sudden cardiac death represents the most common cause of a firefighter line-of-duty death. Below are recommendations to minimize the risk of injury and death to firefighters from cardiovascular events. According to nearly all fire service organizations, these measures can drastically reduce risk, so fire departments should take the following steps to reduce on-duty heart attacks and other sudden cardiovascular events:
• Provide policy-driven medical evaluations to ensure that firefighter candidates and members are capable of performing job tasks with minimal risk of sudden incapacitation
• Ensure that physicians conducting medical evaluations are knowledgeable about the physical demands of firefighting, the essential tasks of firefighting and the consensus guidelines developed by the fire service
• Implement a comprehensive wellness/fitness program for firefighters to reduce risk factors for cardiovascular disease and improve cardiovascular capacity
• Control exposure to carbon monoxide and other fire contaminants through proper management of the fire scene and proper use of respiratory protection
• Ensure adequate staffing levels for operations to prevent over-exertion
• Provide on-scene rehabilitation to monitor vital signs for indication of excessive cardiovascular strain and to cool and hydrate firefighters
• Implement a comprehensive hearing-conservation program
We are certainly glad that Lieutenant Chandler is alive and well to tell his story, and we appreciate him doing so. Unfortunately, so many firefighters are at high risk of experiencing what he did, but are not provided the opportunity to get a physical for a variety of reasons. Or they simply choose to not take advantage of the opportunity. Numerous resources are available to firefighters and chiefs, including:
Also, check out The Fire Service Joint Labor Management Wellness/Fitness Initiative through your International Association of Fire Fighters (IAFF) or International Association of Fire Chiefs (IAFC) contacts.
WILLIAM GOLDFEDER, EFO, a Firehouse® contributing editor, is a 33-year veteran of the fire service. He is a deputy chief with the Loveland-Symmes Fire Department in Ohio, an ISO Class 2 and CAAS-accredited department. Goldfeder has been a chief officer since 1982, has served on numerous IAFC and NFPA committees, and is a past commissioner with the Commission on Fire Accreditation International. He is a graduate of the Executive Fire Officer Program at the National Fire Academy and is an active writer, speaker and instructor on fire service operational issues. Goldfeder and Gordon Graham host the free and noncommercial firefighter safety and survival website www.FirefighterCloseCalls.com. Goldfeder may be contacted at BillyG@FirefighterCloseCalls.com.