“Preliminary findings show that one-third of firefighters had heart disease that is unrelated to traditional risk factors, such as high cholesterol. Those results are astounding and point at job duties and environment as the primary determinants for early death in our country’s first responders,” according to H. Robert Superko, MD, principal investigator in the Federal Emergency Management Agency-sponsored study of firefighters ages 40 and over. The study was conducted at Saint Joseph’s Hospital in Atlanta, Georgia. Dr. Superko is a recognized expert on the association between lipids, cholesterol, and advanced metabolic markers and heart disease. His comments, released in March, were contained in the preliminary findings of the world’s first study of first responders at risk of suffering sudden death or other significant cardiac events.
Three hundred firefighters in Gwinnett County, Georgia, participated in the study. They were selected for the study following an emotional report submitted by Chief Steve Rolader after the sudden death of one of his firefighters from cardiac arrest while fighting a house fire. “This man wasn’t the first firefighter in my department to die, but I wanted to do something to make it among the last,” Rolader says. The firefighter was 53 years old, in great physical shape, and had no known symptoms of heart disease, according to Rolader. The department has also lost several newly retired firefighters to sudden cardiac death.
Over the yearlong study, the volunteer participants underwent a comprehensive, scientific battery of sophisticated blood and imaging tests; a comprehensive genetic screen of more than a million genes, including newly identified KIF6 (statin responsiveness gene) and 9p21 (myocardial infarction gene); advanced phenotype (blood) and imaging analyses; and a diet and exercise review. The test results and explanations were presented to the groups; individual consultations followed. Complete statistical and comprehensive genetics results are expected this year.
One of the conclusions of the research study was that stress and psychological pressures related to the job, as well as diet, exercise issues, and inherent personalityinteracting with a genetic predisposition to heart diseaseprobably significantly impact the risk of heart attack in these first responders. The report cited several components of the emotional and psychological stress first responders experience: “being awakened from a dead sleep by a loud, shrieking siren several times during the night; responding through the rush of adrenaline; carrying a hundred pounds of equipment on your back; meeting people at the very worst possible moments in their lives every day, and responding to society’s most brutal moments from murders to car wrecks and death.” First responders’ mind-set and desire to help people, Dr. Superko adds, cause them “to bring a competitive nature to the job but also a profound desire to help and to do the best for others.”
In response to the growing awareness of the issues of diet and exercise, the Gwinnett Fire Department has instituted exercise programs within local firehouses, and the county reimburses department members for fitness club memberships. The department also educates firefighters on proper diet and nutrition one-on-one as well as through “lunch and learn” programs in the stationhouses. In addition, over the years, the traditional firehouse alarm in Gwinnett stations has been replaced with softer alarms and even-voiced prompts to awaken sleeping first responders.
As a result of the study, Saint Joseph’s Hospital and Dr. Superko’s research team implemented a two-month screening program for all Atlanta first responders (firefighters, police, and EMS), regardless of age, to provide them with some basic and advanced diagnostic tests at affordable prices. Several physicians are providing their services free of charge.
Rolader is hopeful that the results of this study will foster implementing similar programs across the country and that responders’ lives will be saved. Final study results are expected to be submitted for consideration at the annual American Heart Association meeting.
Line-of-Duty Deaths
February 19. Firefighter Timothy Nicholas, 26, Craigsville-Beaver-Cottle (C-B-C) Fire Department, Craigsville, WV: injuries sustained while operating at a mobile home fire.
February 19. Lieutenant Johnnie Hammons, 49, Craigsville-Beaver-Cottle (C-B-C) Fire Department, Craigsville, WV: injuries sustained while operating at a mobile home fire.
February 20. Firefighter John Adams, 45, Silver City Volunteer Fire Department, Jennings, OK: collapsed; cause of death unknown.
February 23. Firefighter Derek Edward North, 34, Stockton Fire Department, Lakeland, GA: injuries sustained when apparatus in which he was riding overturned while responding to a fire call.
February 25. Firefighter/EMT Ferdinando “Freddy” Pierno, 55, Martin County Fire Rescue, Stuart, FL: hepatitis C virus infection he contracted while on duty.
February 26. Firefighter/EMT Charles Myshrall, 67, North Coventry (CT) Volunteer Fire Department, Inc.: complications from surgery he underwent on February 3 for injuries sustained on January 30, when he slipped and fell on a resident’s driveway while on an EMS call.
February 27. Firefighter Michael J. Darrington, 45, Toledo (OH) Fire and Rescue: unknown.
March 4. Corporal Christopher Allen Dill, 43, Oklahoma City (OK) Fire Department: unknown.
Source: USFA Firefighters Memorial Database.
Gaines acting USFA administrator
Chief Glenn Gaines, a 37-year veteran of the fire service and former chief of the Fairfax (VA) Fire Department, has been appointed as the deputy assistant administrator and the acting U.S. fire administrator for the United States Fire Administration (USFA). Gaines began his career as a volunteer firefighter. His areas of expertise include training, prevention, operations, and administration. He was an instructor at the National Fire Academy and has had multiple articles and texts published within the fire service community. He helped to create and cultivate the Assistance to Firefighter and the SAFER grant programs.
Environmental hazards at large-scale catastrophic events
“Firefighters normally worry about putting water on fires,” says Chief Pat Sullivan, from Gulfport, Mississippi. “Until a few years ago, we were never concerned that the water we’re drinking or cooking with could be contaminated. Public health can help us plan on things we hadn’t thought about, advise us about problems we’re facing, and problems we may face in the next 12 hours. Then those events don’t become another emergencythey become another part of the operation that needs to be addressed.”
Sullivan is referring to emergency responders’ need to consider environmental factorsthose underlying factors that may instantly affect a scene and adversely impact operations especially during the initial response to emergency incidents. “You do yourself a disservice when you provide contaminated food and water to your own emergency personnel,” Sullivan explains. “Public Health is a tool that is underutilized. Incident commanders, fire personnel, law enforcement, and others in command roles need this course [see below]. They will understand that this is a tool that will help them do their job and make the incident go more smoothly.”
According to the Centers for Disease Control and Prevention (CDC), “There is no current national, comprehensive, standardized education and training program in emergency preparedness and response for environmental health specialists.” To fill this gap, the CDC and the Center for Domestic Preparedness (CDP) in Anniston, Alabama, recently partnered to develop the Environmental Health Training in Emergency Response (EHTER) course program. The introductory course will be held at the CDP. The CDC explains that the program’s objective is to develop “a uniform training program that will benefit health practitioners and emergency responders who are first on the scene.”
Plans include conducting four pilot courses at the CDP over the next few months before the course officially joins the CDP lineup. The CDC will oversee course delivery and continue to develop the class, in partnership with the CDP.
The Department of Homeland Security’s Federal Emergency Management Agency will pay expenses for state, local, and tribal emergency responders to attend the three-day presentation. Round-trip air and ground transportation, lodging, and meals will be provided at no cost to responders, their agency, or jurisdiction.
Additional information is at http://cdp.dhs.gov/, or call (866) 213-9553.
Proposed legislation to study consensus standards
U.S. Sen. Sherrod Brown (OH) and Rep. Ed Perlmutter (CO) introduced the Firefighter Fatality Reduction Act of 2009 in March. This legislation would direct the secretary of Homeland Security to conduct a survey to determine the level of compliance with national voluntary consensus standards and to determine if there are any existing barriers that may prevent those standards from being met. Sen. Joe Lieberman (CT), chairman of the Senate Homeland Security and Governmental Affairs committee, cosponsored the bill.
The Firefighter Fatality Reduction Act calls for the creation of a Task Force to Enhance Firefighter Safety that will develop a plan to increase and promote compliance with the national consensus standards. It would require the DHS to determine the rate of compliance with standards for safe operations, staffing, training, and fitness among career, volunteer, and combination fire departments. The DHS would form the task force, which would survey the nation’s fire departments. The bill would not mandate federal oversight of local fire departments but would explore how the federal government should best promote firefighter safety standards and assist fire departments with compliance. Brown and Perlmutter introduced similar companion bills in the 110th Congress.
Zonisamide product labeling to reflect acidosis risk
Treatment with Zonisamide (marketed as Zonegran and as generics), an adjunctive therapy for partial seizures in adults with epilepsy, can cause metabolic acidosis in some patients, according to updated clinical data. The U.S. Food and Drug Administration (FDA) notified healthcare professionals of this finding. Patients with predisposing conditions or therapies may be at greater risk for developing metabolic acidosis, and younger patients appear to be at higher risk for more frequent and more severe zonisamide-induced metabolic acidosis. The FDA recommends that healthcare professionals measure serum bicarbonate before starting treatment with zonisamide, and also periodically during treatment, even in the absence of symptoms. The FDA is working with the makers of zonisamide to revise the product labeling to reflect this new safety information. A 2009 safety summary is at the MedWatch Web site http://www.fda.gov/medwatch/safety/2009/safety09.htm#Zonisamide/.
NIOSH issues firefighter fatality investigation reports
The National Institute for Occupational Safety and Health (NIOSH) has recently released the following firefighter line-of-duty fatality investigation reports:
- F2008-20, May 6, 2007; “Volunteer fire fighter dies while performing exterior fire suppression at a large machine shed fireIllinois”; http://www.cdc.gov/niosh/fire/reports/face200820.html/.
- F2008-12, April 8, 2008; “Volunteer deputy fire chief dies when struck by motorized water monitor that “launched” off aerial ladder truckPennsylvania; http://www.cdc.gov/niosh/fire/reports/face200812.html.
- F2002-22, Revision, September 26, 2001; “Fire fighter suffers fatal heart attack at fire at his residenceFlorida; http://www.cdc.gov/niosh/fire/reports/face200222.html/.
Civilian fire fatalities up, according to fire marshals
More civilian fire deaths occurred during January 2009 than in January 2008, according to information provided by the National Association of State Fire Marshals. Based on the number of fire deaths that occurred in 28 states in January 2009, there were at least 173 fatalities during January 2009 as opposed to 131 in January 2008. In addition, the number of civilians who died in fires that caused three or more fatalities increased to 82 in 2009 vs. 42 in 2008 and 51 in 2007. Almost two-thirds of those killed in 2009 were children, according to information compiled by writer-tech.com.
Fires across the country kill on the average of nine people each day (one every 153 minutes) and injure thousands. In 2007, the latest year for which statistics are available, 3,430 people were killed in fires and 17,675 were injured. More than 80 percent of the civilian deaths occurred in their homes.
A number of organizations have joined to increase the effort to raise the nation’s awareness of fire safety. Among them are the following: the American Fire Sprinkler Association, Common Voices, the Congressional Fire Services Institute, Fire Team USA, the Home Safety Council, the Institution of Fire EngineersUSA Branch, the International Association of Black Professional Fire Fighters, the International Association of Fire Chiefs, the International Code Council, the International Fire Marshals Association, the Metropolitan Fire Chiefs Association, the National Association of State Fire Marshals, the National Electrical Manufacturers Association, the National Fire Sprinkler Association, the National Volunteer Fire Council, the People’s Burn Foundation, the Phoenix Society for Burn Survivors, the Society of Fire Protection Engineers, Underwriters Laboratories, and the United States Fire Administration.
Wildland fire skills “Gap” courses now available
The United States Fire Administration (USFA) is offering wildland fire skills Gap courses for structural firefighters. The USFA’s National Preparedness Network (PREPnet) has produced a Webcast that explains the requirements, availability, and distribution of these newly packaged Gap course materials. The Webcast, Crosswalk: Bridging the Skills Gap, is available for viewing anytime at www.usfa.dhs.gov/fireservice/subjects/wildfire/gap_courses.shtm/.
The Gap courses are based on the Wildland Training for Structural Firefighters Skills Crosswalk. The Crosswalk effort, led by USFA in partnership with the National Wildfire Coordinating Group (NWCG) and the International Association of Fire Chiefs, identified parallel technical competencies between structural firefighters and officers [National Fire Protection Association (NFPA) Standard 1001 and 1021] or equivalent with those of four NWCG positions: Firefighter Type 2 (FFT2), Firefighter Type 1 (FFT1), Engine Boss Single Resource (ENGB), and Strike Team Leader Engine (STEN). The Crosswalk also identified wildland skills and knowledge that qualified and experienced firefighters would not already have acquired through their structural firefighting training, such as specific wildland fire tactical concepts and wildland fire behavior. The learning modules address these gaps. Each Gap course is composed entirely of NWCG training material pulled into specific courses.
Visit www.usfa.dhs.gov/fireservice/subjects/wildfire/ for more information.
Potential problem with batteries in AED Plus
ZOLL Medical has announced that problems can arise with the Duracell lithium 123 batteries that have been in its AED Plus defibrillators for more than four years. Even though the battery indicator shows that the batteries still have sufficient power, (i.e., the green check is showing), the AED may not be able to communicate with the batteries and draw down sufficient power to allow a shock to be delivered to a person in ventricular fibrillation (VF).
ZOLL recommends two immediate solutions: (1) Change the batteries immediately if the current batteries were installed more than three years ago, and then change the batteries every three years (instead of the previously recommended five years). (2) Install newly developed software that will prevent this problem from occurring.
Detailed information is at www.zollaedplusbatteryhelp.com/. Owners may also contact ZOLL Technical Support at (800) 348-9011 or (978) 421-9460. ZOLL urges all Initial Life Support Foundation (ILSF-Announce@ilsl.info) affiliates who have helped clients, institutions, or organizations to purchase a ZOLL AED Plus through ZOLL’s PAD Support Program to alert the owners of these units regarding this potential problem and the immediate actions needed to correct or prevent it.
CLASS 1 RECALLS: MEDICAL DEVICES
• Covidien Inc., Shiley 3.OPED Cuffless Pediatric Tracheostomy tube. Complaints have been received about difficulty in inserting the device used to place the tracheostomy tube into the windpipe (obturator) and/or a suction tube (catheter) into the tracheostomy tube. This problem may require that the tracheostomy tube be removed and replaced. Contact the company at (800) 635-5267. Lot numbers involved were manufactured from July 7, 2008, through December 9, 2008, and were distributed from July 24, 2008, through December 23, 2008. The company’s press release is at www.nellcor.com/legal/prodnotices.aspx/. Lot numbers and additional information are at www.fda.gov/cdrh/recalls/recall-011409.html/. The recall was initiated January 14, 2009.
• Baxter Healthcare Corp. Colleague Single-and Triple-Channel Volumetric Infusion Pumps. The company identified software and battery usage failures that result in a delay in or interruption of infusion that may cause serious injury or death. The products involved were manufactured and distributed from February 1997 through December 2008. Contact the company at (800) 843-7867. The recall was initiated January 23, 2009. Lot numbers and additional information are at www.fda.gov/cdrh/recalls/recall-012309.html/.
