Firefighter Fatalities and Injuries: The Role of Heat Stress and PPE

Study Documents Cardiovascular Risk Factors Among Firefighters A recent research-and-development meeting hosted by the Federal Emergency Management Agency (FEMA) in Washington, DC, highlighted a large number of research projects funded by Fire...


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Study Documents Cardiovascular Risk Factors Among Firefighters

A recent research-and-development meeting hosted by the Federal Emergency Management Agency (FEMA) in Washington, DC, highlighted a large number of research projects funded by Fire Prevention and Safety Grants awarded under the Assistance to Firefighters Grant Program. The room was filled with a distinguished group of Ph.D.s and MDs that shared a common goal - making firefighting safer. And though much of this research may take several years to yield practical results, there were also presentations on completed projects that could provide valuable guidance to firefighters right now.

One of these projects, Cardiovascular and Biomechanical Responses to Firefighting and PPE, presented by Denise Smith and Gavin Horn of the University of Illinois Fire Service Institute, provides a review of the known research and new and important findings and recommendations. In plain English, this project studied how heat stress may be a common causal factor in both firefighter heart attacks (the leading cause of on-duty deaths) and slip, trip and fall accidents (the largest portion of fireground injuries).

One part of this study documented laboratory-based cardiovascular risk factors among a large cohort of firefighters and investigated the effects of different personal protective equipment (PPE) configurations on physiological and biomechanical responses to live-fire firefighting activities. Study participants included 122 male firefighters from across the state of Illinois with a wide range of firefighting experience. The group was nearly equally divided between career and volunteer firefighters. The participants were relatively young (their mean age was 29.5 years), were free of known cardiovascular disease or balance/gait impairment and were not taking medications for hypertension or high cholesterol. Participants engaged in 18 minutes of firefighting activity in a burn tower that contained live fire. Temperatures were maintained at approximately 100 degrees Fahrenheit and 170ºF at the floor and waist level, respectively. Firefighting activities included repeated work-rest cycles, with firefighters doing stair climbing, forcible entry, search and rescue, and a simulated hose pull.

Major Findings

  • A large percentage of the firefighters who participated were overweight or obese based on body mass index (BMI) measures.
  • A large percentage of these firefighters were pre-hypertensive or hypertensive.
  • Eighteen minutes of simulated firefighting activity causes significant physiological disruption including an increase of heart rate (75 beats per minute) and an increase of core temperature (1.2°F).
  • The simulated firefighting activities caused a significant increase in platelet numbers and a significant increase of platelet activation (resulting in faster clot formation).
  • Firefighting activity resulted in an increased level of coagulation (increased factor VIII activity and PF1.2) and significant changes in clot breakdown (fibrinolysis).
  • PPE configuration had no significant effect on physiological, perceptual, blood chemistry or coagulatory responses to short-term firefighting activity.
  • Donning of firefighting PPE caused significant detriments in gait and balance parameters regardless of which configuration of PPE was worn.
  • Enhanced PPE had a smaller detrimental effect on some gait parameters than the standard PPE.
  • Eighteen minutes of simulated firefighting activity had negligible further effects on gait and balance parameters compared with the effect of donning firefighting PPE.

Recommendations

Most importantly, this study offers recommendations for the fire service that are found in a careful review of the literature, supported by this research and aimed at reducing fatalities and injuries on the fireground. These recommendations address medical readiness for duty, physical fitness requirements, on-scene rehabilitation and hydration strategies, and personal protective equipment.

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