Are We Taking Care Of Our Own?

At a minimum of once every two weeks, I get one of those dreaded e-mails distributed by the U.S. Fire Administration (USFA). It is the announcement of a firefighter death in the United States. The e-mail contains all the relevant information, including the firefighter's name, age, department and circumstances surrounding the death. I read each one of these. Read these often enough and you can almost predict what you are going to see as you scroll down to read the circumstances surrounding the death after you see the firefighter's age. Usually, the firefighter collapsed while performing some chore or did not feel well after returning from a call. Essentially, the firefighter had some type of coronary event.

A recent study conducted by researchers from the Harvard University School of Public Health looked at firefighter deaths and their link to coronary heart disease. In the study, the researchers looked at firefighter deaths between 1994 and 2004, with the exception of the deaths that occurred in New York City on Sept. 11, 2001.

Of the 1,144 firefighter line-of-duty deaths reported during that period, 449, or 39%, were attributed to coronary heart disease. The researchers' estimates show that firefighters spend just 1% to 5% of their time on fire suppression, yet that responsibility accounts for 32% of deaths from a coronary event. Therefore, the researchers concluded that the risk of a firefighter dying from a coronary event during fire suppression is 10 to 100 times greater than when a firefighter is performing non-emergency duties. The research also showed an increased risk during other emergency duties such responding to and from an alarm.

To those of us engaged in the business, this study comes as no surprise. Firefighting can be extremely physically demanding. It can involve heavy lifting, and maneuvering in awkward areas and positions while wearing heavy personal protective gear in a hot environment. This extreme physical exertion can lead to a heart attack. Numerous studies over the years have shown how extreme exertion can lead to heart attacks. The studies have run the gamut from snow shoveling to recreational exercise.

The results of this study validate what we already knew without looking at it on paper. Of any firefighter deaths you know of or have read about involving a coronary event, how many occurred on a scene and how many occurred with the firefighter sitting in a recliner? If you do not know, I recommend you go to the National Institute for Occupational Safety and Health (NIOSH) website and review the reports found there on firefighter deaths, or get on the USFA e-mail distribution that reports when each firefighter death occurs.

So what has your department done to take care of your own? Does your fire apparatus carry some form of defibrillation capability such as an automatic external defibrillation (AED) or a monitor/defibrillator? Key to surviving a cardiac arrest is rapid defibrillation. Studies have shown that the chances of surviving a cardiac arrest decrease by about 10% for each minute that goes by without defibrillation. The success rates in the casinos in Las Vegas from rapid defibrillation are outstanding since a security guard with an AED usually is at somebody's side shortly after he or she collapses.

Each piece of fire apparatus in the United States should have defibrillation capability. It should be as basic as hoses, ladders and SCBA. The defibrillation capability is not only essential for first responder calls, but also if a firefighter suffers a cardiac arrest while working on the fireground.

Second, does your department dispatch an ambulance to all working fires? If not, you should be. Whether it is your department ambulance or the ambulance service responsible for 911 in your community, it should be dispatched to the scene in the event a firefighter not only has a heart attack, but if is injured.

Waiting until a firefighter has a heart attack or is injured to call for the ambulance to the scene is putting the need for rapid treatment and transport way behind the curve. Once the ambulance arrives on the scene, its crew should report in and be prepared if something happens. Some smaller fire departments utilize their ambulance personnel who are firefighters in a fire suppression role once they reach the fireground. This should not preclude them from being able to respond to a firefighter who is down.

Are you rehabbing firefighters properly on the fireground? The National Fire Protection Association (NFPA) 1584 standard clearly outlines the standards for rehabbing firefighters on the fireground. NFPA 1584 has five main objectives: medical evaluation and treatment, food and fluid replenishment, relief from climatic conditions, rest and recovery, and member accountability. One option calls for personnel assigned to the ambulance that is dispatched to the scene to assume responsibility for the rehab group under the incident command system, instead of sitting in their ambulance.

Of course, the final thing your department should be doing is annual physical examinations and health/wellness programs. A 2005 study done by the NFPA showed that more than 70% of the fire departments in the United States lack fitness and health programs.

In recent years, the International Association of Fire Chiefs (IAFC) and International Association of Fire Fighters (IAFF) have joined together to produce the Fire Service Joint Labor Management Wellness/Fitness Initiative. The initiative is intended to be a positive individualized program that is not punitive and consists of five main components; medical, fitness, medical/fitness/injury rehabilitation, behavioral health, and data collection and recording. All component results are measured against the individual's previous examinations and assessments and not against any standard or norm.

We're real good at taking care of other people who call 911 and we're real good at giving nice firefighter funerals. We need to combine the two and take care of our people and give fewer funerals.

GARY LUDWIG, MS, EMT-P, a Firehouse contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 30 years of fire-rescue service experience. Ludwig is chairman of the EMS Section for the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally, and can be reached through his website at