Dallas (TX) Fire Department responds to Ebola patient

Emergency medical service (EMS) crews of the Dallas (TX) Fire Department responded to the first confirmed case of Ebola reported in the United States. The EMS providers are members of the International Association of Fire Fighters (IAFF) Local 58. They treated and transported the Ebola patient to the hospital at the end of September; he died in early October. According to the IAFF Web site, the EMS members were taken off duty with pay and were under continuous medical observation at their homes at press time.

The IAFF is urging every affiliate to conduct a “safety stand down” in the department to review all infectious exposure policies, procedures, and guidelines. The assessment should cover also whether the department is prepared to respond to and care for patients with possible symptoms of the Ebola virus: Is there enough equipment? Are the members trained to respond safely to worst-case scenarios involving potential Ebola exposures?

Lessons Learned

The Ebola case in Dallas and its evolving consequences have yielded some valuable lessons learned for EMS responders and their departments. According to President of IAFF Dallas Local 58 Doug Dickerson, the Dallas paramedics were to have been under observation for at least three weeks (one week after press time) after contact with the infected patient. Dickerson stressed, however, that the paramedics say they were not in contact with the patient’s bodily fluids. He said family members met the responders outside the home and told them the patient may have had Ebola. The paramedics donned protective masks and gloves before entering the house, administered an IV, and transported him to the hospital. They alerted hospital officials of the patient’s symptoms and possible exposure to Ebola. After the hospital run was concluded, the EMS responders decontaminated the ambulance according to protocol. See “Ebola Resources and Safety Training for Firefighters” at http://bit.ly/10onnIh.

On the National Front

The Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security’s Customs & Border Protection (CBP) introduced additional procedures for screening travelers entering the United States from Guinea, Liberia, and Sierra Leone, where the Ebola virus has been a serious health problem. Five airports were selected because they receive more than 90 percent of the passengers from these countries. The airports are New York’s JFK International Airport, Washington-Dulles, Newark, Chicago-O’Hare, and Atlanta international airports.

“CBP personnel will continue to observe all travelers entering the United States for general overt signs of illnesses at all U.S. ports of entry and these expanded screening measures will provide an additional layer of protection to help ensure the risk of Ebola in the United States is minimized,” said Secretary of Homeland Security Jeh Johnson. The CDC is sending additional staff to each of the five airports.

These new measures complement the exit screening protocols used in the affected West African countries. Since the beginning of August, the CDC has been working with airlines, airports, ministries of health, and other partners to develop exit screening and travel restrictions in Ebola-affected countries.

All outbound passengers are screened for Ebola symptoms in the affected countries. In the past two months since exit screening began in the three countries, of 36,000 people screened, 77 people were denied boarding a flight because of the screening results but none of them were diagnosed, according to the CDC. Exit screening at airports remains the principal means of keeping travelers from the affected countries from spreading Ebola to other nations. These nations have asked for, and continue to receive, assistance in strengthening exit screening, notes the CDC.

In October, President Obama announced that Ron Klain would be coordinating the administration’s Ebola response. Klain had served as chief of staff to Vice President Joe Biden and former Vice President Al Gore.

Update: A doctor who returned home from treating Ebola patients in Guinea was admitted to a New York City hospital on October 23 with a fever. He tested positive for the disease.

Fallen Firefighters Memorial Weekend: October 11–12, 2014

One hundred seven firefighters who died in the line of duty during the previous year and those lost in the Yarnell, Arizona, fire were honored during the October 10-12 Memorial Weekend hosted by the National Fallen Firefighters Foundation (NFFF) on the campus of the National Emergency Training Center in Emmitsburg, Maryland. On Saturday morning, the family and friends of the most recent fallen firefighters met with survivors of firefighters lost in previous years. Among the activities included in the schedule of weekend activities was the survivors’ recording of memories of their loved ones through the Foundation’s Hero Tributes and a candlelight service at the Memorial. Charles LaBella, father of Jeremy LaBella, who gave his life in 2007, lit the Remembrance Candle.

Some 5,000 attended the memorial service on Sunday morning. Pipes and drums provided the backdrop for the service, when the families were greeted by honor guards and fire service escorts. A bronze plaque bearing the names of the firefighter honorees was unveiled. “From this day on, all who visit this Memorial will see the names of your firefighters,” said Chief Dennis Compton, chairman of the NFFF board of directors. “They will know that each name represents a loved family member, friend, and coworker who died while bravely serving their communities. They will think of you-the survivors.”

President Obama told the attendees by way of a videotaped message: “This memorial is a testament to the indelible mark that all our fallen firefighters have left on the soul of our nation. Their love of country, their love for each other, their unyielding bravery and commitment to service represent what’s best about America.”

Congressman Steny Hoyer of Maryland, keynote speaker, noted: “We must always remember that when a firefighter loses his or her life on the line, it is not only the family members who have suffered a loss but the entire community that firefighter served and strengthened.” Hoyer represented the bi-partisan Congressional Fire Services Caucus. Other speakers included U.S. Fire Administrator Ernie Mitchell, U.S. FEMA Administrator Craig Fugate, and Mayor Donald Briggs.

Ceremonies also included the reading of the name of each firefighter honoree from the Roll of Honor. Survivors were given a flag that had flown over the U.S. Capitol and the Memorial, a personalized badge, and a red rose. You can view the Candlelight Service and the Memorial Service video at vistaworldlink.comNFFF.

For the first time this year, the weekend agenda included the Congressional Flag Presentation Ceremony, coordinated through the joint efforts of the Congressional Fire Services Caucus, the CFSI, and the NFFF. Bill Webb, CFSI executive director and NFFF vice chairman, served as the master of ceremonies. Days before the event, 107 flags flew above the Capitol Dome. These flags were then presented on Sunday to the survivors of the 107 brave men and women whose names were added to the Memorial.

The ceremony was attended by Congressman David Reichert (WA), chairman of the CFSC, who spoke at the Flag Presentation Ceremony, and his fellow House caucus co-chairmen: Congressmen Hoyer, Peter King (NY), and Bill Pascrell Jr. (NJ).

NFPA has Community Risk Reduction standard

The National Fire Protection Association (NFPA) Standards Council has approved a request from the Vision 20/20 project to establish a standard for Community Risk Assessments and Reduction plans. Jurisdictions will be able to use the standard as a guide when developing and implementing a Community Risk Reduction plan that entails preparing a community risk profile and allocating resources to minimize risks. The standard is expected to be available in two years.

According to the NFPA, interest in Community Risk Reduction is growing in the United States. It cites the International Association of Fire Chiefs (IAFC) strategic planning platform, which “recognizes the need for the fire service to embrace an integrated approach to community risk reduction,” and inclusion of the concept in part of the National Fire Academy curriculum. In addition, the NFPA notes that the concept is supported by the Institution of Fire Engineers and “a growing number of fire service leaders nationwide.”

The NFPA adds that its 1730 standard requires that the fire prevention organization perform a Community Risk Reduction plan (see the draft http://www.nfpa.org/1730“>NFPA 1730, Standard on Organization and Deployment of Fire Prevention Inspection and Code Enforcement, Plan Review, Investigation, and Public Education Operations to the Public).

U. of Arizona receives $1.4 million for safety research

The University of Arizona Mel and Enid Zuckerman College of Public Health (UA) will lead a research project with fire departments in four states to study vehicle crashes and injuries in the fire service.

UA was awarded a three-year grant of $1.4 million from the Federal Emergency Management Agency (FEMA) Assistance to Firefighters Grants (AFG) program. The project will involve implementing and evaluating risk-management processes with the Chicago (IL) Fire Department, Prince William County (VA) Department of Fire and Rescue, and Stayton (OR) Fire District. The Seattle (WA) Fire Department will provide training consultation.

Among the approaches being contemplated for controlling vehicle accidents are improved driver training and vehicle data recorders (a “black box” for vehicles). “One of the exciting things we’ll be doing is using vehicle operation data, things like engine speed, acceleration and braking events to assess driver safety. Since vehicle data recorders are relatively new in the fire service, we’ll be one of the first to study how we can effectively use them to improve driver training and reduce vehicle incidents,” explains Jeff Burgess, MD, MPH, associate dean for research at UA, principal investigator on the project.

Other members of the research team include Keshia Pollack, PhD, Johns Hopkins Bloomberg School of Public Health; Dustin French, PhD, Northwestern University; and co-investigators Stephanie Griffin, PhD, CIH, and Chengcheng Hu, PhD, from UA. All of the investigators have collaborated on other National Institute for Occupational Safety and Health (NIOSH)-funded risk-management studies with the Tucson Fire Department. The complete release is at http://publichealth.arizona.edu/news/2014/ua-receives-14-million-firefighter-safety-research.

PTSD and respiratory illness: problems of 9/11 responders

According to the findings from research conducted over the past several years at Stony Brook Medicine’s World Trade Center Health Program, as many as 60 percent of 9/11 World Trade Center (WTC) responders continue to experience clinically significant symptoms of post-traumatic stress disorder (PTSD) and lower respiratory illness.

According to Benjamin Luft, MD, medical director of the program, and Edmund D. Pellegrino, professor of medicine, the two conditions (co-morbidities) so often coexist in this patient community that they can be thought of as one ailment-“a signature illness of WTC responders.” They explain that this “illness” increases their disability and complicates long-term medical monitoring and care.

According to Dr. Luft, even though more than 10 years have passed since 9/11, the connection between mental and physical illnesses among responders appears stronger. “This connection,” he explains, “raises important questions about the mechanisms underlying the PTSD and respiratory illness relationship. The next step in our research is to determine how co-morbid physical and mental conditions impact the progression of clinical disease and genetic changes in these responders.”

Dr. Luft and his colleagues in the Departments of Medicine and Psychiatry, Drs. Evelyn Bromet, Adam Gonzalez, and Roman Kotov, are working on five new research projects to evaluate the extent of mental and physical illness in hundreds of responders. The goal is to identify a causal pathway that links the two diseases so biomarkers that can be targets for diagnosis and treatment can be identified.

Over the next two years, the WTC Health Program will receive approximately $4 million in funding from the National Institute for Occupational Safety and Health and the Centers for Disease Control and Prevention to carry out this research.

Additional information is at http://sb.cc.stonybrook.edu/news/general/140910wtc.php and at Psychological Medicine

NFPA National Wildfire Community Preparedness Day

National Wildfire Community Preparedness Day (Wildfire Preparedness Day) is scheduled for Saturday, May 2, 2015. The National Fire Protection Association, sponsor of the event, is urging communities across the United States to participate in local mitigation projects that will help to reduce the risk of wildfire damage to homes and neighborhoods.

The NFPA notes that more than 100 projects were undertaken on the first Wildfire Preparedness Day last year. Projects can include a short time commitment up to an entire day project by individuals, families, or groups. Example of projects include hosting a chipping day, distributing wildfire safety information to neighbors, and organizing brush cleanup. Some project ideas and additional information are available at http://www.nfpa.org/wildfirepreparednessday.

NVFC adopts position on freelancing, self-dispatching

At the 2014 meeting of its board of directors, the National Volunteer Fire Council (NVFC) unanimously adopted the following position regarding self-dispatching (responding to a scene without prior authorization) and freelancing (being authorized to respond to a scene but responding outside the scope of incident command and/or failing to check in with the command structure) of individuals or departments; the document was developed by the NVFC’s Health, Safety, and Training Committee, which worked with the Department of Justice. The NVFC is urging fire departments to adopt this position (see below).

NVFC Position on Freelancing and Self-Dispatching:

The National Volunteer Fire Council (NVFC) supports the leadership role of incident commanders in regard to incident management during emergencies. The NVFC opposes freelancing or self-dispatching, as it can lead to miscommunication, causing safety and health issues for firefighters, first responders, and citizens. Firefighters must have the legal authority and responsibility to engage in the suppression of fire at a scene and acting in the line of duty for eligibility purposes under the Public Safety Officers’ Benefits (PSOB) Program. The NVFC strongly encourages fire department leadership to take an active role in communicating this position to every firefighter and first responder.

The NVFC will partner with the North American Fire Training Directors, the U.S. Fire Administration, and other training entities to emphasize the freelance and self-dispatch position and will promote and provide sample mutual-aid agreements.