Physiological Monitoring for Firefighters

There is increasing awareness at all levels of the fire service that we need to seriously address the causes of line-of-duty deaths (LODDs) and disabilities. With nearly half of LODDs over the past decade due to stress and overexertion, it is obvious that this is the most important problem to tackle if we are to make a difference. But how?

Virtually every major organization in the fire service, including the International Association of Fire Fighters (IAFF), International Association of Fire Chiefs (IAFC) and National Volunteer Fire Council (NVFC) has gotten behind the need to promote fitness among firefighters. And there is widespread agreement within the fire service and the medical community that this is a critical piece of the puzzle.

Less well promoted is the need for medical screening both for new recruits and on an annual basis for firefighters. Heart disease is rampant in the general population and the fire service is no exception. Although there is a segment of firefighters who just don't want to know, departments that have made medical screening available all have stories of firefighters that have been "saved" by such screening. For "bang for the buck," medical screening is tough to beat.

But even with these pieces in place, firefighters are exposed to enormous levels of stress and overexertion, particularly during the period between alarm, suppression and return from a fire call. In fact, 62% of all LODDs occur during this relatively short part of the average firefighter's day. When you do the math, the odds of a fatal cardiac event is up to 100 times greater during fire suppression than non-emergency duty. Does this get your attention?

So, is there a way to monitor the physiology of firefighters in real time to signal when they are at risk? First of all, you can forget about a system that would predict when a firefighter is about to have a heart attack. Even if you are hooked up in a hospital bed in the ICU to every piece of medical diagnostic equipment made, you can't predict it before it happens. But that doesn't mean we shouldn't pursue technology that can identify stress and overexertion during emergency operations.

That's the hope of two fire departments on opposite coasts — Oxnard, CA, and Boston, MA — that have been participating in a recent study led by Skidmore College. The two-year study is being funded by the Federal Emergency Management Agency (FEMA) through the Assistance to Firefighters Grant/Fire Prevention and Safety program to describe cardiovascular responses to alarms and firefighting activities and to identify differences in recovery based on individual factors such as fitness levels, age and body composition.

In the first phase of the study completed last year, 33 members of the Oxnard Fire Department wore a Physiological Status Monitoring undershirt for their entire 24-hour shift for a period of four months. And 24 firefighters from the Boston Fire Department just wrapped up the second phase of the project also wearing these shirts for their full shifts for four months. Altogether, that's over 60 million heartbeats that will be analyzed by the researchers to better understand the cardiovascular strain of firefighting.

Participating in this study was not a cakewalk for these firefighters. Early prototypes of the shirts were far less than ideal, changing shirts and laundering them every day was a pain, and data downloads, activity logs and call logs needed to be maintained daily. And the inevitable problems needed to be worked through. But the firefighters put up with the hassle because they felt that they were making an important contribution to the development of technology and data that would make a difference for all firefighters.

So, back to the technology. What is it, what can it do now and what does it need to do to be effective?