Missouri Valley Division Annual Conference A Required Stop on the Trail to Great Leadership 6/8/2012 1 Chief C. A. Haigh Hanover Park Fire Department

1Chief C. A. Haigh Hanover Park Fire Department

Missouri Valley Division

Annual Conference

A Required Stop on the Trail to Great Leadership

6/8/2012


Reducing Line of Duty Deaths:The Role of Research, Training &

Organizational Leadership6/8/2012


Contributing Authors

Denise L. Smith, Ph.D.

Professor and Chair of Exercise Science, Skidmore College Research Scientist, University of Illinois Fire Service Institute

Craig A. Haigh, M.S., CFO, EFO, MIFireE, NREMT-P

Fire Chief, Hanover Park (IL) Fire DepartmentField Staff Instructor, University of Illinois Fire Service Institute

Gavin Horn, Ph.D.

Director, Illinois Firefighter Life Safety Research CenterResearch Scientist, Department of Mechanical Science &

Engineering, University of Illinois

6/8/2012

Topics:

I. The Role of ResearchII. Case Study:

What the Research is Telling Us about the Physiologic Stress of Firefighting

Implementing Research into field operations – On Scene Rehab

Impact of Organizational Leadership

6/8/20124

Chief C. A. Haigh Hanover Park Fire

Department

Goal of Fire Service Research

Enhanced Knowledge

Changed Behavior

Training

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Department

The Process of Research Implementation

Enhanced Knowledge

Changed Behavior

Training

Support of LaborInternal Policy Development

Support of Fire Service Organizations (IAFC, IAFF, NVFC, USFA, NFFF, ICMA, IAAI, etc.)

Acceptance by standard setting/review organizations (NFPA, State Fire Marshal, OSHA, UL, NIOSH, etc.)

Research / Development / Manufacturing

Acceptance & buy in of Fire Administration (Fire Chiefs & Command Staff)Support of local

organizations (County Fire Associations, MABAS, etc.) Acceptance & buy in of

City/County/District Administration (i.e. City Managers)

Acceptance & buy In of Elected Officials and their willingness and ability to pay.

Cultural Change

6/8/20126


Department

Limitations of Local Departments to Implement Research Driven Change

1. Lack of visionary leadership.This is the way we have always done it…

2. Lack of strong labor / management relations.

3. Failure to maintain priorities:Be cautious of the swirling toilets and

washing wheels syndrome.

4. Lack of fire service support by elected officials and community.

5. Lack of financial resources.6/8/2012

7Chief C. A. Haigh Hanover Park Fire

Department

Fire Service Downfall

The Fire Service in general does a poor job of looking beyond the walls of our organizations to find workable solutions to complex problems. To successfully implement change that is driven by today’s research, departments must think globally and be willing to change tradition in order to address current concerns.

6/8/20128


Department

{

9

Physiological Impact of Heat Stress

Case Study

6/8/2012 Chief C. A. Haigh Hanover Park Fire

Department

Current Situation

Decreasing number of fire… Relatively unchanged number of

firefighter fatalities.

6/8/201210


Department

Cardiovascular Impact on LODD

Between 1995–2011:• 799 Firefighters died due to Cardiac or

Cerebrovascular Related Events. • 2011 -- 49• 2012 -- 17

• Cardiac or Cerebrovascular events account for approximately 50% - 60% of all annual line of duty deaths.

• An additional 700-1000 annual cardiac or cerebrovascular events occur that do not result in a LODD (810 in 2010).

6/8/201211


Department


Is it more than old out of shape firefighters? Is there something about firefighting that serves as the “trigger” for a cardiovascular event?

6/8/201212


Department


What do we know?

6/8/201213


Department

The job is getting harder…

• Increased BTU Production

• Changes in constructiono Light weight / open floor

space / energy efficient / green

• Require greater GPM to cool the BTU production.

• Decreased company staffing

• Protective equipment provides full encapsulation.

6/8/201214


Department

Personal Risk Factors for Cardiovascular

Problems

• Age• Gender• Family History• Diabetes• Hypertension• Smoking• High Cholesterol• Obesity• Lack of Exercise

6/8/201215


Department

Coupled with Heat Stress

• Work performed• Protective

Equipment• Thermal

Environment• Health Status• Fitness Level• Hydration Level

Disastrous potential exists.6/8/2012


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17

How do we reduce the impact of heat stress?

1. Personal physical fitness

2. Health screening 3. On-Scene

Rehabilitation


Department

18

On-Scene Rehabilitation

If Heat Stress is the likely causation of many detrimental physiologic

responses, why is rehab not a integral part of the fire service response?

Several Likely Reasons…


Department

Lack of rehab?

• Culture of Fire Service

• “Rehab is for Sissies”

• Undeveloped on-scene rehabilitation and support systems

• Lack of widespread research

• Why we do what we do?6/8/2012


Department

20

Field-based Research To Document the Stress of Firefighting

What do we know?


Department

Basic Statistics

• 1,148,100 FF (USFA, 2009)

• 335,950 career• 812,150 volunteers

• Firefighting is a Dangerous Occupation

• Injuries – 71,875 (2010)

• Fatalities – approx. 100 per year

• 50% - 60% due to sudden cardiac events

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Department

Reducing Injuries and Fatalities

• Prevent Fires, or detect earlier

• Optimal Staffing• Training• Safety Training

• Driving• Fireground• Attitudes, awareness

(cultural issues)• Personal Protective

Clothing• Improved Incident

Command• Fitness and Wellness

Programs• On-Scene Rehabilitation?

6/8/201222


Department

Sudden Cardiac DeathPrimary Cause of LODD

Hear Attack58%

Trauma17%

Burns8%

Asphyxiation6%

Other5%

Crush4%

Heat Exhaustion1%

CVA1%

Hear Attack Trauma Burns

Asphyxiation Other Crush

Heat Exhaustion CVA

NPFA Firefighter Deaths by Nature -- 2011

6/8/201223


Department

Despite reduction in total fires, fatalities due to cardiovascular issues

remain relatively unchanged.

USFA Firefighter Fatalities 1986-20096/8/2012


Department

Firefighter Deaths to Date by Nature of Injury -- 2012

Cardiac & Stroke: 53.1% Trauma: 37.5% Other: 6.3% Crushing: 3.1%

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Department

Num

be

r of F

irefi

gh

ter I

nju

rie

s

120,000

Figure 1 Total Firefighter Injuries by Year (1981-2010)

100,000

103,340

80,000

60,000 71,875

40,000

20,000

0

Source: NFPA Annual Survey of Fire Departments Year

for U.S. Fire Experience (1981-2010) From 1994 on, number of exposures was collected separately

Total Firefighter Injuries

6/8/201226


Department


Karter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2011

26%

22%

10%

5%

18%

7%

12%

Overexertion / StrainFall, Jump, SlipExposure (Fire Products, Haz Mat, Etc)Extreme WeatherOtherStruck by ObjectContact with Object

Distribution of Injuries

6/8/2012

Firefighter Injuries: Total injuries have reduced in hand

with total fires, yet leading causes (overexertion/strain & slips/falls) remain

relatively stable

2003 2004 2005 2006 2007 2008 20090

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

Total In-juriesSlip, Fall, JumpOverexer-tion/Strain

Karter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2009

6/8/201228

29

Is there a correlation between overexertion and strain and slips/trips/falls?


Department

30

Working Hypothesis

Slips, Trips, Falls Sudden Cardiac Events

Firefighting

Heat Stress

Fatigue Overexertion/Strain

Biomechanical Changes

CV/CoagulatoryChanges

Reduced SituationalAwareness

Disorientation, Entrapment,Poor decisions, and related

Injuries and Fatalities6/8/2012 Chief C. A. Haigh

Hanover Park Fire Department

Physiological/Psychological Stress of Firefighting

Probably the greatest stress ever imposed on the human cardiovascular system is the combination of exercise and hyperthermia. Together these stresses can present life-threatening challenges, especially in highly motivated athletes who drive themselves to extremes in hot environments.

L. Rowell, 1986

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Department

Simplified Schematic of Possible Causes of Heart

Attack in FF

Heart Attack

Circulatory Shock

Arrhythmias Clot Formation

PlaqueDisruption

Perfuse sweating

DecreasedPlasma volume

AlteredElectrolytes

Increased viscosity

Changes in HR and BP

Increased Body Temperature

Activation of SNS

6/8/201232


Department

6/8/2012

Firefighting TasksDummy dragCarry and discharge extinguisherHose pullWood chopping

U of I Study: Response of Firefighters following short-term strenuous firefighting

activities

33Denise L. Smith, PhD Skidmore College

6/8/2012

Study Cycle

drills drills drills

~ 8min ~ 8 min ~ 8 min

Rehab Rc1 Rc2

= measurement period


6/8/2012

Heart Rate Response

0

50

100

150

200

Rest 1st Trial 2nd Trial 3rd Trial

HR (bpm)

* * *

* p < .05 vs rest35Denise L. Smith, PhD

Skidmore College

6/8/2012

Stroke Volume Response

0

20

40

60

80

100


SV (ml)

#

# p <.05 vs T136Denise L. Smith, PhD

Skidmore College

6/8/2012

Stroke Volume Response

0

20

40

60

80

100


SV (ml)

#

# p <.05 vs T1

Take home message:

Push Fluids


6/8/2012

Changes in Core Temperature

36

36.5

37

37.5

38

38.5

39

Pre Trial 1 Trial 2 Trial 3 10 minrec

Trectal


6/8/2012

Changes in Core Temperature

36

36.5

37

37.5

38

38.5

39

Pre Trial 1 Trial 2 Trial 3 10 minrec

TrectalTake home message:

Provide Cooling


6/8/2012

Effect of Firefighting on Coagulation Factors (N=10; Mean ± SD)

Variable Pre PostPlatelets (x103/uL) 236.6 (48.2) 290.37 (83.4) *

Prothrombin Time (s) 10.18 (0.6) 10.13 (0.6)

Activated Partial Thrombopastin Time (s) 25.2 (2.3) 25.5 (2.7)

Fibrinogen (mg/dL) corrected 254.5 (17.2) 243.9 (20.8) †

Antithromin III (%) 109.7 (4.9) 116.8 (6.9) *

(Fibrinogen & Antithromin III: Factors in Blood Clotting)

* p<0.001

† p < 0.0540Denise L. Smith, PhD

Skidmore College

6/8/2012

Effects of Simulated Fire-Fighting Stress on Plasma Volume Shifts

-16

-14

-12

-10

-8

-6

-4

-2

0

2

4

Ch

ang

e in

Pla

sma

Vo

lum

e (%

)

Pre Post Post 90’

a

a significantly (p <.05) different pre and post 90’ 41Denise L. Smith, PhD Skidmore College

6/8/2012

Effects of Simulated Fire-Fighting Stress on Glucose

40

60

80

100

120

140

160

Pre Post Post 90'

mg

/dL

a

c

a significantly (p < .05) different pre and post 90c significantly (p < .05) different pre and post 90’ 42Denise L. Smith, PhD

Skidmore College

43

Impact of Rehab

Physiological Responses

Rehab

Firefighting

Muscular/Metabolic Fatigue

DehydrationHeat Stress

Cardiovascular Strain•HR, BP•Blood Clotting

•Rest/Recovery•Nutrition

Fluid Replacement

•Cooling•Climatic Relief•Medical Monitoring

•Rest•Cooling•Fluid Replacement•Medical Monitoring

6/8/2012 Denise L. Smith, PhD Skidmore College


Implementation of an Effective Rehabilitation Program

NFPA 1584 On-Scene Rehabilitation

6/8/2012

The Role of Rehab

Rehab when implemented properly can reduce the detrimental effects of heat stress and lesson the potential for a cardiovascular/cerebrovascular incident as well as heat related illnesses.

The Question: How to do this with limited human and financial resources?

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6/8/2012

How, when, and by whom?

• How many of us have available staffing to dedicate to rehab?

• At what point is rehab established:

• When the crews look tired?

• After 2 SCBA bottles?• When the weather is

especially hot or cold?• As part of the initial

response assignment or specific alarm level?


Department

How, when, and by whom?

• Who is assigned the task of rehab:

• EMS• Additional fire

companies• Support Organizations

• What supplies & equipment are supplied by the rehab crew?

• What training do they have in providing rehab?

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6/8/2012

Leadership is Critical

• Safety is a cultural value that needs to be represented at all levels of the organization and must be established by those in command.

• Boards, Managers, and Chief Officers must embrace methods for reducing the 50% - 60% LODD and the 700+ duty related cardiac events.

• Comprehensive medical exams and wellness programs (NFPA 1582 – Standard on Comprehensive Occupational Medical Programs for Fire Departments).

• Mandatory physical fitness programs• Strict operating guidelines for usage of SCBA, PPE,

Incident Command and sound operational practices.• On-scene rehab programs

If the Chief Officers and Community Leadership does not

value firefighter safety, the personnel won’t!

6/8/2012

Cost of Firefighting Injuries/LODD

• Average of 80,000 annual firefighter injuries (~5,000 Burn Injuries)

• Estimated Annual Cost ~ $8 bil/year

• Average cost per injury is $74,000

“The Economic Consequences of FF Injuries and Their Prevention, Tridata Corp., 2005. NIST GCR – 05-874


Department

6/8/2012

In-house Lesson: Hanover Park Fire Department

• 5-Year average shows HPFD companies responding to 73 structural fires annually.

• 50 Firefighter injury reports filed (emergency incidents, training, medical exposures).

• 1998: A line of duty M.I. resulted in a firefighter disability.

• Injuries generated 22,649 hours of work comp sick leave:

• Costing greater than $170k in workers compensation.

• Greater than $600K in overtime for backfill


Department


Financial ImpactVillage of Hanover

Park

2008 2009 2010 2011Work Comp. Losses

$17,217 $19,188 $18,642 $383,847

6/8/2012

Prior to 2008:Average Department Workers Compensation Losses $127,000

Chief C. A. Haigh Hanover Park Fire Department

52

Partnerships are the Key

Most of us don’t have enough personnel to

effectively handle the incident let

alone manage the rehab, therefore

developing partnerships with

those who are willing and able to assist us is the key.

6/8/2012

6/8/2012

Partnership Opportunities

• Utilize CERT to develop a volunteer response team (Fire Corps) trained and equipped to provide on-scene rehab services.


Department

6/8/2012

Fire Corps

• Consists of 17 volunteers• Pager alerted• Respond on the initial alarm

to all reported structure fires• The team operates a

decommissioned ambulance outfitted with rehab equipment and supplies.

• Training• Basic CERT • Specialized training on

how to provide rehab conducted through IFSI.

• On-scene partnered with paramedics who conduct medical assessments while Fire Corps members provide hydration, cooling and nourishment.


Department

6/8/2012

Components of Rehab

1. Rest and Recovery2. Relief from incident

and environmental conditions

3. Rehydration4. Nourishment5. Medical Monitoring6. Operate within the

established accountability system


Department

6/8/2012

Equipment Inventory

• Chairs• Fans or misting systems• Awnings or Tents• Towels• Heaters• Floodlights• Dry gloves, socks and

sweatshirts• Water and Sports Drinks• Basic Food Supplies• EMS Equipment:

• AED• RAD 57 Monitor


Department

Field Participation in Research

The purpose of this study was to document the vital signs of firefighters upon entering a fire ground / emergency incident rehabilitation

division and to track the changes that occurred during the medical monitoring period.

6/8/201257


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Chief C. A. Haigh Hanover Park Fire Department

58

Take Home Message:Research / Fire Service

Partnership

• Fire Service Change needs to be driven by research.

• Research needs to be driven based on Fire Service concerns.

• It takes courage to change the status quo and find solutions to difficult problems with limited human and financial resources.

6/8/2012

596/8/2012 Chief C. A. Haigh

Hanover Park Fire Department

Does it seem like our recruits are getting younger

and younger?

Let’s make the Fire Service a safer career for the next generation.


6/8/2012

Documents

Missouri Valley Division Annual Conference A Required Stop on the Trail to Great Leadership 6/8/2012 1 Chief C. A. Haigh Hanover Park Fire Department