Chapter 6—Health and Safety

41

FChapter 6—Health and Safety

ield work and firefighting areinherently dangerous. Wemust do all that we can toprevent illness and injuries,to treat them properly, and

to ensure the worker’s successfulreturn to work.

PreventionPrevention begins long before the fieldseason, with preparation, training, andattention to daily habits.

FitnessFit workers are less likely to be injured,and they lose less time when they areinjured. Debilitating back and repetitivetrauma problems are less common inworkers with adequate muscularfitness.

TrainingWorkers need to learn and practiceproper lifting techniques to avoid backproblems. Training in the efficient andeffective use of tools is also important.Workers should be cross-trained toreduce the likelihood of repetitivetrauma disorders. Simply changing jobsor tools now and then will reduce theisolated strains and trauma associatedwith certain tasks.

Work HardeningFeet, hands, backs, joints, and musclesneed to adjust to prolonged arduousfield work. Workers should come to thejob ready to work, and early trainingshould provide additional job-specificwork hardening. Blisters, sprains,strains, and muscle soreness areindications that more work hardening isneeded.

SafetySafety awareness and training are

F

Chapter 6—Health and Safety

42

BlistersBlisters are a major cause of dis-comfort and lost work time. Fric-tion separates skin layers andfluid accumulates. Avoid blistersby:

For feet• Fitting new boots (some

old-timers soak a new pairof boots and wear them untilthey dry out)

• Wear boots often before theseason starts

• Use petroleum jelly to lubri-cate potential hot spots

• Wear two pairs of socks ordouble-layer socks

• Use mole skin or a skin pro-tector to cover hot spots.

For hands• Harden your hands with light

work• Wear gloves that fit• Use mole skin or a skin pro-

tector to cover hot spots.

crew leaders and managers. Workersrespond to safety messages that arecommunicated by action and deed.

Protective EquipmentWorkers need to understand andappreciate the values and limitations ofprotective equipment, and becomeproficient in its use and care.

ErgonomicsErgonomics implies selecting the righttool for the job as well as the rightperson for the tool. Our studies showthat certain tools, such as the combitool, are more effective and lessfatiguing than the Pulaski, and thatsome workers are more capable withcertain tools. Field work andfirefighting in remote sites limit the useof power-assisted tools, so there is agreater need for worker fitness andskill with handtools.

Energy and HydrationWorkers are responsible formaintaining their energy and fluidintake. Supervisors can make food anddrink available, but individuals areresponsible for maintaining theireffectiveness and safety by adequateintake of energy and fluids. Failure todo so makes one a hazard to self andcoworkers. Supervisors shouldschedule fluid replacement every 30minutes during hot conditions.

Work and RestFatigue is a cause of accidents;adequate rest is the prime factor incontrolling fatigue. Breaks, both shortand long, are one defense againstfatigue. Sleep is another. To performwell at tough jobs like wildlandfirefighting, workers need to average 1hour of sleep for every 2 hours of work.This rest-to-work ratio means that a14-hour work shift is about as longcrews can work and still get the sleepand rest they need. The shift shouldallow time for eating, showering, andgetting ready for work. Sleepingconditions should be quiet, warm, anddry. Night crews need protection fromnoise, light, dust, and other conditionsthat interfere with restful sleep duringthe day.

WarmupWorkers, like athletes, need to warmup before strenuous effort. A gradualincrease in muscle and bodytemperatures improves metabolic andneuromuscular efficiency. Warmedmuscles and stretched tissues are lesssusceptible to injury, and stretchinghelps relieve soreness. So usestretching and a gradual transition towork to ease into the workday.

Injuries

No job is worth an injury, yet job-related injuries are common. Slips,trips, and falls are common in fieldwork. Firefighters experience ankle,knee, and back injuries. How can weprevent or limit these injuries? Thissection deals with the treatment andrehabilitation of injuries, and theworker’s safe and productive return towork.

TreatmentTreatment will depend on the natureand severity of the injury. Of course,serious injuries require medicalattention and treatment. For soft tissueinjuries that are not severe, theappropriate treatment will minimize theextent of the injury and ensure a quickand complete recovery. Most softtissue injuries are treated with RICESS(Rest, Ice, Compression, Elevation,Stabilization, Stretching). We will use asprained ankle to illustrate thetreatment (sprained ankles are unlikelyfor workers who wear good boots).

Rest

Rest is used when necessary to relieveswelling and to allow treatment (ice,elevation). Otherwise some mobility isdesirable, so long as discomfort andswelling are controlled.

Ice

Ice (a cold pack, a frigid mountainstream, snow in a plastic bag) is thetreatment of choice for acute softtissue injury. Cold slows metabolism,reduces bleeding and swelling,reduces pain, and limits the extent ofinjury. Apply ice for 20 to 30 minutesseveral times a day for best results.Continue for several days or until theswelling and pain are gone.

Compression

An elastic wrap soaked in cold waterprovides compression and cooling

Chapter 6—Health and Safety

43

shortly after the injury. A dry wrapcontinues compression between coldtreatments.

Elevation

Elevation limits the edema andswelling that occur after an injury. Abadly swollen sprained ankle shouldbe elevated above the heart as muchas possible during the 24 hoursfollowing the injury.

Stabilization

Workers can use tape or anklesupports to stabilize the ankle.

Stretching

While stretching may be viewed aspart of rehabilitation, gentle stretchingmay begin shortly after the injury.Flexion and extension exercises canbe done while applying ice,compression, and elevation.

This simple treatment plan, if followedproperly, has a dramatic effect onrecovery time. Use ice as often aspossible in the first few days followingthe injury. Use compression to avoidswelling. Elevate the leg as necessaryto control swelling. When pain andswelling are controlled, stabilizing theankle allows a return to limited activityand rehabilitation.

RehabilitationSerious injuries should be rehabilitatedunder the guidance of an AthleticTrainer or Physical Therapist.Rehabilitation involves a progressiveprogram designed to regain musclestrength and endurance, range ofmotion, and full functional use. Theability to perform under field conditionsshould test the employee’s readinessto return to work. Physician approvalwill be required following recovery fromserious injuries.

Well-designed rehabilitation programsreturn workers to full activity in theshortest possible time. With physician

approval, workers may return to workwith the aid of protective taping orbracing. Leg, back, wrist, and otherbraces are becoming common in theworkplace, but there is little proof thatthey prevent new or recurring injuries.Braces are no substitute for training orrehabilitation. Workers should notreturn to work until they can do sosafely, without becoming a hazard tothemselves or to coworkers.

Return to WorkBefore the return to duty followingwork-related injuries, we insist onmedical clearance, but seldom specifyspecific performance criteria. As aminimum, workers should be able toperform the job-related test utilized inhiring. For example, a firefighter shouldbe able to pass the test used toestablish job-related work capacity.

This will demonstrate recovery fromthe injury as well as the fitness forduty. If no test is available for the jobclassification, demonstration of keyelements of the job will provide someassurance of job readiness. Becauseof the risk of subsequent injury,smokejumpers require a moredemanding test. Dr. Michael Schutte,an orthopedic surgeon and specialist insports medicine, has used a jumpingtest to evaluate a jumper’s readinessfor return to work.

Workers want to rejoin their crew andreturn to work as quickly as possible.Medical clearance and an appropriatefield evaluation will ensure readinessfor work without undue risk ofsubsequent injury.

Illness

Illnesses and related medicalconditions, such as allergies andasthma, also affect work capacity andthe quality of life. Prevention strategiesreduce the incidence of illness, andappropriate treatment reduces downtime and hastens return to duty.

PreventionPrevention of upper respiratory andother conditions includes avoidingexposure and maintaining immunefunction.

ExposureUpper respiratory infections occurmore frequently in group livingconditions, such as fire camps. Whenpossible, living conditions should allowprivacy and partial isolation. Workersshould not share water bottles, exceptin emergencies. And workers shouldavoid close contact with affectedfriends or family members (workerswith the potential for exposure to HIV,Hepatitis B, or Hantavirus must followappropriate precautions).

Chapter 6—Health and Safety

44

Neck CheckUse the “neck check” todecide if you should train orwork with an infection. If yoursymptoms are above theneck, stuffy nose, sneezing,scratchy throat, proceed withcaution. If you feel all right,you can continue at fullspeed. Postpone training orhard work, if possible, ifsymptoms are below theneck, including fever, achingmuscles, nausea, diarrhea.

Immune FunctionThe healthy immune system protectsthe body from viral and bacterialassaults. Maintain your immunesystem by controlling factors thatinfluence its function.

Stress

Excessive, prolonged exposure toevents and conditions perceivedas stressful causes the release ofhormones that depress immunefunction. Avoid exposure and learnstrategies for stress management(relaxation, meditation).Remember, stress is in the eye ofthe beholder. Follow two rules ofstress management:

• Don’t sweat the small stuff,and

• It’s all small stuff!

Nutrition

A healthy diet helps to maintainimmune function (Chapter 4).

Fatigue

Exhaustion increases theincidence of upper respiratoryinfections. Maintain fitness, ensureenergy intake, take frequentbreaks, and get adequate sleep toavoid excessive fatigue.

Environment

Smoke from cigarettes, forestfires, wood stoves, and otherforms of occupational andenvironmental pollution can lowernatural defense mechanisms.

TreatmentThe common cold is an upperrespiratory infection caused by one ofmany viruses. While colds are hard toavoid, you can help by washing hands,keeping hands away from the face,and avoiding overfatigue and closecontact with those who havesymptoms. The cold usually lastsabout 1 week. Prolonged upperrespiratory problems may indicate

secondary bacterial infection or allergicrhinitis. It is probably not necessary tolimit work for those with upperrespiratory infections, unless thecondition is accompanied by fever,muscle pains, or symptoms ofsystemic infection.

More serious respiratory problemssuch as bronchitis and pneumoniarequire medical treatment and rest, asdo viral hepatitis and infectiousmononucleosis. Systemic infectionsimpair strength, endurance,coordination, and concentration. Hardwork could slow recovery andpredispose the worker to injury.

Return to WorkFollowing a short illness resulting inabsence from work, the employee mayreturn to duty under these conditions:

• Physician approval (if needed)

• Absence of fever for 24 hourswithout use of antifever drugs(such as aspirin).

After a prolonged illness a workershould follow a gradual transition to fullwork activity, or be reassigned to lessarduous duties until work capacity isregained.

SummaryThe best way to avoid illness is topractice prevention and to maintain ahealthy immune system. This meanswashing hands before meals, drinkingfrom your own water bottle, eatingimmune friendly foods, gettingadequate rest, and managing stress.Of course it helps to come to work fit,rested, and ready for the demands ofthe job.

MedicalConsiderations

Reproductive RisksWildland firefighters and field workersface many hazards in the conduct oftheir duties. Among these hazards arepotential reproductive risks, such asexposure to toxic chemicals, heat, andother factors that can threatensomeone’s ability to conceive or bear ahealthy child. These potential risksaffect both men and women.

SmokeWhile exposure to cigarette smoke hasbeen linked to low birth weights,spontaneous abortion, still birth,preterm birth, and cleft palate, there islittle information concerning the risks ofexposure to toxic chemicals at levelsmeasured in the breathing zone ofwildland firefighters. Carbon monoxidehas the potential to affect thedeveloping fetus, but cigarettesmokers are regularly exposed tolevels of CO that are several timesabove those occasionally experiencedby firefighters.

HeatThere is concern about exposure toextreme heat, which has been linked tomale infertility and possibly to birthdefects in the offspring of exposedmothers. Although maternal illnesswith prolonged high fever has been

Chapter 6—Health and Safety

45

associated with birth defects, saunastudies and case studies of pregnantrunners have not revealed birthdifficulties or defects. In fact, theopposite has been true for those whoremain active during pregnancy. Andwhile wildland firefighting has thepotential for heat stress, studies havenot indicated severe heat problems,especially when firefighters are fit,acclimatized, and hydrated. The lowhumidity and air movement of theburning season enhance evaporativeand convective cooling, and lower therisk of heat stress.

Pregnant women who are physicallycapable of performing the duties of theposition may, at their discretion,remain in active duty (U.S. SupremeCourt, UAW v. Johnson Controls,1991). While it is not the obligation ofthe employer to protect the fetus, theemployer may be able to assign theworker to less hazardous duties uponreceipt of a request. Workers who arepregnant, breast feeding, or attemptingto conceive should consult theirphysician if they are concerned aboutthe reproductive risks of firesuppression or other duties. Pregnantfirefighters who, on the advice of aphysician, cannot continue working inany capacity, should request leave inaccordance with existing pregnancy orother leave policies of the agencyhaving jurisdiction.

MedicalExaminationThe American College of SportsMedicine recommends a medicalexamination for persons over 40 yearsof age, for those with heart diseaserisk factors, and for those who havebeen sedentary before a majorincrease in activity. For many others, asimple health screening questionnaireprovides assurance of the readiness toengage in training, work, or a job-related work capacity test. PAR-Q is ahealth screening questionnaire

designed to identify that small numberof individuals who should seek medicaladvice before involvement in moderateactivity. A ‘no’ answer to seven simplehealth questions indicates suitabilityfor involvement in an exercise test ormoderately vigorous aerobic andmuscular fitness training. PAR-Q wasdeveloped and validated by theCanadian Society for ExercisePhysiology. Use of the questionnairesubstantially reduces the risk of takingexercise tests or training for apparentlyhealthy adults. Candidates for fitnesstraining, firefighting, or field workshould complete the PAR-Q beforetaking a work capacity test or begin-ning strenuous training (page 42).

Over 40?If you are over 40 years of age, haveone or more heart disease risk factors(smoking, high blood pressure,elevated cholesterol), and have beeninactive, your physician may recom-mend an ECG-monitored exercise test.A progressive treadmill test (stresstest) determines functional capacityand cardiovascular health. To estimateaerobic fitness the test must proceedto an endpoint determined by fatigue,discomfort, or other indicators (ECG,blood pressure). The prediction ofaerobic fitness (VO2 max) is not valid ifthe individual holds the railing to sup-port their body weight during the test.

Chapter 6—Health and Safety

46

Chapter 6—Health and Safety

47

Warning Signs

Here are some points to consider ifsymptoms or warning signs appearduring exercise testing, training, orwork.

Group 1These can be remedied withoutmedical consultation. Report them ifthey occur frequently.

Side stitch . This muscle spasm(intercostal or diaphragm) may berelieved by sitting, leaning forward, andpushing abdominal organs against thediaphragm. The side stitch usuallydisappears as training progresses andfitness improves.

Breathlessness that lasts more thana few minutes after exercise stops.Train at lower edge of the heart ratetraining zone or use the talk test (youshould be able to carry on aconversation during aerobic exercise).

Nausea or vomiting during or afterexercise. After eating, wait severalhours before exercise. Do moderateexercise and extend the cool-down.

Prolonged fatigue the day afterexercise, or insomnia. Reduceintensity and gradually increase thelevel of exercise.

Group 2Try the suggested remedy; if it doesn’thelp, consult your physician.

Arthritic flareup during or soon afterexercise. Rest, use ice, and aspirin oribuprofen. Resume exercise gradually.Use cross training to reduce repetitivetrauma.

Rapid heart rate during or 5 to 10minutes after vigorous exercise. Keeprate at lower end of training zone andincrease slowly. Avoid exercising in theheat.

Wheezing and phlegm during orsoon after exercise. Use a gradualwarmup, reduce exercise intensity,avoid cold, dry air or use a mask towarm cold air; try swimming.

Group 3If any of these occur, stop exercise.Consult your physician beforeresuming exercise.

Pain or pressure in the middle ofthe chest or in the arm or throat,precipitated by exercise or occurringafter exercise.

Abnormal heart action during orsoon after exercise. Irregular pulse,fluttering, palpitations in chest, suddenburst of rapid heart beats, sudden dropin heart rate.

Dizziness , light-headedness, suddenloss of coordination, confusion, coldsweat, glassy stare, pallor, blueness,or fainting. Stop exercise; sit with headbetween legs or lie down with feetelevated.

Things to Avoid

In addition to the precautions alreadynoted, there are some other things toavoid in training.

Sudden vigorous exercise withoutwarmup can cause ECG abnormalities.A warmup and cool-down reduce thelikelihood of cardiac complications.

Downhill running . Called a “crimeagainst the body” by an experiencedcrew leader, running down steepgrades increases impact forces andthe risk of chronic knee problems.While uphill hiking or running is goodfor training, you should minimize theamount of downhill running. Hike or jogslowly on the downhills.

Straight leg situps don’t helpstomach muscles and they can

aggravate the back. Do bent kneecrunches or curl-ups with the armsfolded across the chest.

Full squats with weights canaggravate knee problems. Use legpress machines or squats with aspotter, but don’t go much beyond a 90degree knee bend.

Neck circles and the backover (lyingon back, legs go over head to touchfloor) may be stressful for those at riskfor neck injury.

Standing toe touch . This stretchcan aggravate the lower back whenthe touch is done with straight legs.Use a seated stretch with the kneesslightly bent.

Chapter 6—Health and Safety

48

Exercise Problems

Minor exercise problems should beviewed as symptoms. Here are somecommon problems and some possiblesolutions.

Blisters can be prevented withproperly fitted shoes, good socks (twopairs or a double layer pair), andlubrication. They can be treated withmoleskin or a skin replacementproduct.

Soreness can be minimized withwarmup and stretching, gradualprogression, and avoidance of ballistic(fast) or eccentric (lowering heavyweight) movements. Delayed onsetmuscle soreness occurs a day or moreafter vigorous effort (especiallyeccentric contractions, as in downhillrunning). Stretching and anti-inflammatory agents such as ibuprofenrelieve the discomfort, but only timeeliminates the problem.

Muscle Cramps are powerfulinvoluntary contractions that may becaused by dehydration, electrolyteimbalance (sodium, potassium,calcium), or both. Avoid cramps withadequate warmup and fluid andelectrolyte replacement. Relievecramps by stretching the crampedmuscle.

Bone bruises on the feet can beavoided with careful foot placement,running on soft surfaces, and goodfootwear. Treatment includes ice,padding, and cross training to allowrecovery.

Shin splints or pain on the front ofthe shin have many possible causes.Prevention includes gradual changesin training intensity or distance,running on softer surfaces, goodfootwear, stretching, and strengtheningexercises. Rest, ice, taping, and a heelpad are sometimes effectivetreatments. A persistent point of paincould indicate a stress fracture.Persistent diffuse pain could signal an

anterior compartment syndrome. Seean athletic trainer or sports medicinespecialist.

Knee pain could be due to a numberof factors, including improperfootstrike, worn shoes, or alignmentproblems. Use rest, ice, and anti-inflammatory agents (aspirin,ibuprofen) to reduce discomfort.Resume activity with new footwear. Ifproblems persist, see a podiatrist. Ifthe problem is an old injury withassociated arthritis, try rest, ice, andanti-inflammatory agents to reduce thepain. Resume activity with exercises tostrengthen thigh muscles (weightlifting, bicycling). If the problempersists, see a sports medicinespecialist for bracing or other options.

Lower back pain can be due to poorposture, inactivity, lack of flexibility,and weak abdominal and backmuscles. Prevention involves attentionto each of the possible causes andproper lifting technique. Treatment

involves rest, but only until acute painsubsides, followed by a gradual returnto activity. See page 74 for backexercises.

Crew BossesWhen crews report for duty at the startof the season, plan time for job-specificwork hardening. Schedule training andproject activities that prepare workersfor the job and the environmentalconditions. Gradually increase workrate and duration. Take frequentbreaks and use the time to provideinstructions on tool use. Change toolsoften to avoid fatigue and to cross trainworkers. Watch for signs of overuseinjuries, heat stress, or other earlyseason problems. Use this time todevelop good habits, including safetyawareness, hydration, and nutrition, andto build crew morale, cohesion, andteamwork. Work hardening is a physicaland psychological process that buildsthe toughness needed to be an effectivemember of a productive crew.

Chapter 6—Health and Safety

49

Work Hardening

Work hardening is a gradualprogression of work-specific activitiesdesigned to bring you to the job readyto deliver a good day’s work. Whilefitness training provides thefoundation, it is no substitute forjob-specific work hardening. Aerobicand muscular fitness training increasethe strength of tendons, ligaments andconnective tissue. Work hardening

ensures that the muscles andconnective tissues used on the job aretough and ready to go. Feet are work-hardened when you hike and work inthe boots you’ll use in the field. Hikeup and down hills and on sidehills, atthe pace you’ll use on the job. Dosome extended hikes with a loadedpack to prepare the back andshoulders for carrying loads. Test legsand boots on steep uphill climbs.

If you will be building fireline, you willneed to do some work with a tool likethe Pulaski. There is no substitute toprepare trunk and upper body musclesfor prolonged work in the positiondemanded by hand tools. This workwill also toughen your hands so youwon’t get blisters the first day on thejob. Come to the job hardened andready to go, but be prepared to treatblisters and other problems thatdiminish performance.