Line-of-duty deaths among U.S. firefighters: an analysis of fatality investigations

Attitudes and Beliefs of Wildland Firefighters Toward Occupational Health Services

CONTEXT

Wildland firefighters (WLFFs) are at an increased risk of health conditions, injuries, and illnesses related to sustained levels of intense physical activity. The purpose of this study was to identify and explore the current attitudes and beliefs of WLFFs regarding health services. Methods: We used consensual qualitative research design for this study. Participants engaged in an online, semistructured interview. Results: We identified four domains: (1) risk mitigation strategies, (2) culture of fire services, (3) access to health care services, and 4) identification of health care gap. Conclusions: Access to occupational health services for WLFFs is readily available in the form of emergency medical care. However, a lack of regular access to physical medicine and the continuation of care beyond acute treatment was apparent.

Muscle Damage, Inflammation, and Muscular Performance following the Physical Ability Test in Professional Firefighters

Proper monitoring of fatigue and muscular damage may be used to decrease the high levels of cardiovascular disease, overuse musculoskeletal injuries, and workers compensation claims within the profession of firefighting. The purpose of this study was to examine muscle damage, muscular fatigue, and inflammation responses following a typical firefighting shift. Twenty-four professional firefighters completed two Physical Ability Tests to standardize the tasks typically performed in a day of work, and to elicit similar physiological responses. Participants were then monitored for 48 h. Prior to, and 48 h following the Physical Ability Tests, participants were evaluated for changes in strength, power, range-of-motion, as well as blood markers including myoglobin and c-reactive protein. Following the Physical Ability Tests, significant differences in myoglobin (p < 0.05), grip strength (p < 0.05), vertical jump (p < 0.05), and sit-and-reach (p < 0.05) were observed. No difference in c-reactive protein was observed (p > 0.05). After 24 hours following a shift, firefighters exhibited decreased strength, power, and range-of-motion. This may lead to decreases in performance and an increased risk of injury.

Exploring the criteria and factors affecting firefighters' resilience: A qualitative study

PURPOSE

Firefighters are exposed to high levels of occupational risk factors, such as safety risks, chemical, ergonomic, and physical hazards that may jeopardize their lives. To overcome these hazards, firefighters must be physically, mentally, and personally fit to work. This study aimed to explore the criteria and factors affecting firefighters' resilience based on stakeholders' experiences.

METHODS

This qualitative study was carried out using conventional content analysis. In total, 21 face-to-face interviews were conducted by firefighters who were experienced in the field. The interviews were carried out from July 2019 to January 2020. The data were collected using 3 unstructured interviews and then resumed by 18 semi-structured interviews. Data analysis was done using Graneheim method.

RESULTS

The participants had more than 5 years of experience in the field of search and rescue. The extracted codes through data analysis were classified into 3 main categories (individual, organizational, and social factors), 9 sub-categories (mental, physical, occupational, managerial, colleagues-related, equipment-related, environmental, community-related, and family-related factors), as well as 19 sub-sub-categories and 570 codes.

CONCLUSION

Firefighters' personality, physical condition, behavior and psychological characteristics can affect their resilience along with organizational and management factors that play significant role in people's safety. Developing a tool for assessing resilience can help decision makers to have a real depict of firefighters' job qualifications.

Urinary Proteomics of Simulated Firefighting Tasks and Its Relation to Fitness Parameters

Firefighting rescues are high-hazard activities accompanied by uncertainty, urgency, and complexity. Knowledge of the metabolic characteristics during firefighting rescues is of great value. The purpose of this study was to explore the firefighting-induced physiological responses in greater depth. The urine samples of ten firefighters were collected before and after the simulated firefighting, and the proteins in urine samples were identified by the liquid chromatography–mass spectroscopy. Blood lactate and heart rate were measured. There were 360 proteins up-regulated and 265 proteins downregulated after this simulated firefighting. Changes in protein expression were significantly related to acute inflammatory responses, immune responses, complement activation, and oxidative stress. Beta-2-microglobulin (r = 0.76, p < 0.05) and von Willebrand factors (r = 0.81, p < 0.01) were positively correlated with heart rate during simulated firefighting, and carbonic anhydrase 1 (r = 0.67, p < 0.05) were positively correlated with blood lactate after simulated firefighting. These results illustrated that Beta-2-microglobulin, von Willebrand, and carbonic anhydrase 1 could be regarded as important indicators to evaluate exercise intensity for firefighters.

Weight management program for first responders: Feasibility study and lessons learned

BACKGROUND

Overweight and obesity are significant concerns for first responders (firefighters and emergency medical service providers).

OBJECTIVE

This pilot study examines the feasibility of a weight loss program for career first responders.

METHODS

Participants were career first responders with BMI≥30 and interest in losing weight. Baseline height, weight, and body composition using dual x-ray absorptiometry, Pittsburgh Sleep Quality Index (PSQI), and a Functional Movement Screen (FMS) with follow-up weight and body composition were assessed. A 10-week weight loss program used evidence-based lifestyle goals (encouraged increasing activity levels, using tailored calorie goals, following the DASH diet, tracking with a phone app) and weekly in-person sessions with a student coach-in-training who reviewed weight and tracking information.

RESULTS

Participants (N = 10) were 39.0±9.9 years old with a BMI of 35.6±4.7 kg/m2. There were significant reductions in weight -4.8±2.3 kg and percent body fat -3.9±1.7%. All participants had a PSQI score >5 indicating poor quality of sleep. Nine participants had FMS scores ≤14 indicating increased risk of injury.

CONCLUSION

The use of commercially available apps with support from a student coach-in-training and evidence-based weight loss recommendations is a feasible approach to support career firefighters in their weight loss efforts.

Safety specific transformational leadership, safety motivation and personal protective equipment use among firefighters

Personal protective equipment (PPE) use, although normally the last line of preferred hazard control, is vital to protecting firefighters. It is vital that research identify factors that positively influence firefighter behaviors associated with PPE use. Data were collected from 742 career firefighters working for metropolitan fire departments in both the eastern and western United States. Structural equation modeling was used to assess the hypothesized model and relationships between safety-specific transformational leadership, safety motivation and effective use of personal protective equipment. Safety-specific transformational leadership was positively associated with firefighter safety motivation and safety motivation was positively associated with personal protective equipment use. There was also a significant direct relationship between safety-specific transformational leadership and personal protective equipment use. Transformational leadership has not been an emphasis in the fire service because of its hierarchical structure and paramilitary-like traditions. Current fire service stakeholders have called for changes in leadership strategies and the overall culture within the fire service. This research provides additional evidence that safety-specific transformational leadership can bolster safety motivation among firefighters and can result in enhanced safety performance, including the proper and effective use of personal protective equipment.

Heart Rate Variability and Accelerometry as Classification Tools for Monitoring Perceived Stress Levels-A Pilot Study on Firefighters

Chronic stress is the main cause of health problems in high-risk jobs. Wearable sensors can become an ecologically valid method of stress level assessment in real-life applications. We sought to determine a non-invasive technique for objective stress monitoring. Data were collected from firefighters during 24-h shifts using sensor belts equipped with a dry-lead electrocardiograph (ECG) and a three-axial accelerometer. Levels of stress experienced during fire incidents were evaluated via a brief self-assessment questionnaire. Types of physical activity were distinguished basing on accelerometer readings, and heart rate variability (HRV) time series were segmented accordingly into corresponding fragments. Those segments were classified as stress/no-stress conditions. Receiver Operating Characteristic (ROC) analysis showed true positive classification as stress condition for 15% of incidents (while maintaining almost zero False Positive Rate), which parallels the amount of truly stressful incidents reported in the questionnaires. These results show a firm correspondence between the perceived stress level and physiological data. Psychophysiological measurements are reliable indicators of stress even in ecological settings and appear promising for chronic stress monitoring in high-risk jobs, such as firefighting.

A pilot survey of Southeastern firefighters: Safety practices, use of protective gear, and injury

INTRO

There were over 60 firefighter line of duty deaths and roughly 30,000 injuries in the United States in 2016. Modern thermoprotective gear has reduced the risks firefighters face from both thermal and inhalation injury, but must be used properly to be effective. The purpose of this study is to examine gear use and associated injury in firefighters.

METHODS

Surveys were distributed with questions about demographics, gear usage, and maintenance practices. If previously injured, firefighters described the injury, treatment, and recovery.

RESULTS

Of the 50 surveys distributed, 37 were returned (72%). A majority of respondents (70%) reported wearing incomplete gear. Those who reported injury were more likely to have omitted gear (81% vs 45%). For all respondents, the items most commonly omitted were hood (58%), gloves (22%), and earflaps (22%). Regular cleaning of gear was not practiced by 39% of burned respondents and 46% had not had their gear sized within 2 years. Serious burns were reported by 41% of respondents. Mean burn size was 7% total body surface area (TBSA), and 11% reported self-treating their burns, including 63.5% who continued to work despite suffering a 2nd or 3rd degree burn injury. Only 17% were treated at a burn center, and this group missed anywhere from two shifts to 8 months of work.

CONCLUSIONS

Firefighters risk injury by omitting gear and not adhering to National Fire Protection Association (NFPA) guidelines on gear sizing, maintenance, and station wear. Firefighters also frequently self-treat serious burns despite unique considerations regarding re-injury. National trends related to gear use and injury risk should be studied further, and standards should be developed for ensuring safe return to work.

Multi-level safety climate associations with safety behaviors in the fire service

INTRODUCTION

Limited research associated with safety climate has been completed within the fire service. Given this dearth of information, the present study sought to identify a valid and reliable measure of safety climate at both the workgroup and organizational levels within the fire service.

METHODS

Researchers surveyed 994 firefighters in two large metropolitan fire departments. Preliminary analyses including psychometrics, confirmatory factor analyses, and shared perception analyses were completed. A linear mixed model analysis was then completed to assess the relationships between workgroup safety climate, organizational safety climate, and safety behaviors, including both safety compliance and safety citizenship behaviors.

RESULTS

Measures of safety climate at the workgroup (WGSC) and organizational levels (OSC) were derived. WGSC factors include supervisor support (α = 0.92), vertical cohesion (α = 0.89), and horizontal cohesion (α = 0.94). OSC factors include management commitment (α = 0.91), safety programs/policies (α = 0.89), perceived fairness (α = 0.86) and incident command (α = 0.90). Confirmatory factor analyses confirmed our multi-factor models were a good fit to the data. The linear mixed model analysis found that WGSC positively predicted safety compliance behavior (B = 0.13, p < .001) and safety citizenship behavior (B = 0.22, p < .001) and OSC positively predicted safety compliance behavior (B = 0.16, p < .001) and safety citizenship behavior (B = 0.15, p < .001).

CONCLUSIONS

This work presents reliable and valid measures of both workgroup and organizational safety climate, which have positive relationships with safety behavior outcomes. Practical application: The measures, which were developed through an extensive multi-method process, provide a means for researchers and practitioners to assess safety climate in the fire service and provides guidance for future safety climate research, including informing intervention research, which could potentially bolster safety climate and enhance safety in the fire service.

A Case Study of Fishbone Sequential Diagram Application and ADREP Taxonomy Codification in Conventional ATM Incident Investigation

This paper aims to present the application of a fishbone sequential diagram in air traffic management (ATM) incident investigations performing as a key connection between safety occurrence analysis methodology (SOAM) and accident/incident data reporting (ADREP) approaches. SOAM analysis is focused on organizational cause detection; nevertheless, this detection of individual causes from a complete incident scenario presents a complex analysis, and even more, the chronological relationship between causes, which is lacking in SOAM, should be tracked for post-investigation analysis. The conventional fishbone diagram is useful for failure cause classification; however, we consider that this technique can also show its potential to establish temporal dependencies between causes, which are categorized and registered with ADREP taxonomy for future database creation. A loss of separation incident that occurred in the Edmonton area (Canada) is used as a case study to illustrate this methodology as well as the whole analysis process.

Firefighter Fatalities: Crude Mortality Rates and Risk Factors for Line of Duty Injury and Death

The United States Fire Administration (USFA) provides high-quality data for firefighter deaths (FFDs), but until now these data have not been analyzed for temporal trends. This analysis explores FFDs between 1990 and 2016 to determine high-risk groups for outreach and training. Mortality rates were calculated using USFA information compared against the total number of deaths per year. Rates were compared between 1990-2009 (early period) and 2010-2016 (recent period). Multinomial logistic regression was used to determine predictors of death in firefighters (FFs) by age group (≤45 and >45 years old) and by work status (career vs volunteer). Analysis of 3159 FFDs revealed a decline in crude-rate mortality between 1990-2009 and 2010-2016 (47.4 vs 35 FF deaths per million, P < .0001). FFs of ≤45 years old were less likely to die in the 2010s than in the 1990s-2000s (13.7 vs 24.7 FF deaths per million, P = .0002). Trauma-related deaths decreased (13.1 vs 8.1, P = .0003), whereas CV-related deaths remained constant (19.4 vs 19.5, P = .24). Regression analysis determined that volunteer FFs were more likely to die from burns (OR 1.7, CI: 1.2-2.4, P < .0001) and trauma (OR 1.8, CI: 1.5-2.2, P < .0001) than career FFs. Younger FFs were also more likely to die from burns (OR 10.4, CI: 6.9-15.6, P < .0001) and trauma (OR 6.5, CI: 5.4-7.8, P < .0001). Although overall FFDs were lower after 2010, younger and volunteer FFs saw an increase in burn and trauma-related mortality. Cardiovascular-related fatalities were consistent throughout the study. Future research should continue to make use of high-standard data to track FFDs and efficacy of interventions.

A Socio-Ecological Approach to Mitigating Wildfire Vulnerability in the Wildland Urban Interface: A Case Study from the 2017 Thomas Fire

Wildfire disasters are one of the many consequences of increasing wildfire activities globally, and much effort has been made to identify strategies and actions for reducing human vulnerability to wildfire. While many individual homeowners and communities have enacted such strategies, the number subjected to a subsequent wildfire is considerably lower. Furthermore, there has been limited documentation on how mitigation strategies impact wildfire outcomes across the socio-ecological spectrum. Here we present a case report documenting wildfire vulnerability mitigation strategies undertaken by the community of Montecito, California, and how such strategies addressed exposure, sensitivity, and adaptive capacity. We utilize geospatial data, recorded interviews, and program documentation to synthesize how those strategies subsequently impacted the advance of the 2017 Thomas Fire on the community of Montecito under extreme fire danger conditions. Despite the extreme wind conditions and interviewee estimates of potentially hundreds of homes being consumed, only seven primary residences were destroyed by the Thomas Fire, and firefighters indicated that pre-fire mitigation activities played a clear, central role in the outcomes observed. This supports prior findings that community partnerships between agencies and citizens are critical for identifying and implementing place-based solutions to reducing wildfire vulnerability.

Summary of recommendations from the National Institute for Occupational Safety and Health Fire Fighter Fatality Investigation and Prevention Program, 2006-2014

INTRODUCTION

The NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) conducts independent investigations of selected fire fighter line-of-duty deaths (LODD) and offers recommendations to prevent similar deaths. The purpose of the current study was to provide information on more recent FFFIPP recommendations and to determine if recommendations have changed over time.

METHODS

Fatality investigations completed from 2006 to 2014 were selected for this study with recommendations being assigned into twelve major categories when possible. The most frequently occurring recommendations were then rank ordered overall and then by medical and traumatic fire fighter LODD.

RESULTS

There were 1,067 total recommendations made in the published fire fighter investigative reports for both medical and trauma-related fire fighter fatalities for the period 2006-2014. Of these, 784 (73%) could be placed within one of the 12 categories noted previously. The top 10 recommendation categories overall were: 1. Medical screening, 2. Fitness and wellness program, 3. Training, 4. Medical clearance, 5. Standard Operating Procedures/Standard Operating Guidelines (SOPs/SOGs), 6. Incident command, 7. Strategy and tactics, 8. Communications, 9. Personal protective equipment and 10. Staffing.

CONCLUSIONS

The leading recommendations from the NIOSH FFFIPP medical investigations between 2006 and 2014 did not change compared to those made between 1998 and 2005, with the exception of the addition of "medical clearance for duty". There were changes for the traumatic injury leading recommendations for 2006-2014, with the major change being "training", which was the leading FFFIPP recommendation for traumatic injuries for this time period. Practical applications: The intent of the FFFIPP is to influence fire departments and fire fighters to critically assess and evaluate situations/circumstances similar to those identified by NIOSH investigations and implement the recommendations offered to prevent additional fire fighter fatalities.

Assessment of confined space entry and rescue training for aircraft rescue and fire fighting (ARFF) members in the United States

INTRODUCTION

Fire and emergency service workers, including Aircraft Rescue and Fire Fighting members, may be called on to perform confined space entry and rescue operations. The purpose of the present study was to develop a comprehensive and valid understanding of the present state of confined space entry and rescue training effectiveness and resultant compliance or use of best practices among trained Aircraft Rescue and Fire Fighting personnel.

METHOD

The study used a convergent, parallel mixed-methods approach. Qualitative data (n = 20) were collected via semi-structured interviews at four locations. Data were coded, analyzed and super-ordinate and sub-ordinate themes were derived. Quantitative data (n = 158) from Aircraft Rescue and Fire Fighting members were analyzed.

RESULTS

Interviewees believed there is a lack of standardization in training, but believed training should not be completed in the same format every time. Several participants (50%) desired more realistic training. Other concerns were associated with staffing, personal readiness, and resource adequacy. With regard to survey outcomes, most respondents reported that their organizations completed confined space training (69.8%), but only 55.3% indicated this training was conducted as a full-scale exercise and nearly 40% indicated that rescue practice was not performed despite standards mandating annual rescue practice. Following training, 55.4% indicated training evaluation information was not presented.

CONCLUSIONS

Participants mostly agreed their training effectively addressed OSHA requirements, such as how to test the atmosphere, the need for and use of personal protective equipment, how to identify pertinent permit information and methods to retrieve victims in limited space. Some gaps exist between current training practices and established training requirements and standards.

PRACTICAL APPLICATIONS

Aircraft Rescue and Fire Fighting organizations need to bolster aspects of their training, particularly with regard to standardizing training efforts, practicing rescues, providing evaluation feedback and written materials and providing adequate resources.

The "Warm Zone" Cases: Environmental Monitoring Immediately Outside the Fire Incident Response Arena by Firefighters

Hazardous work zones (i.e., hot, warm, and cold) are typically established by emergency response teams during hazardous materials (HAZMAT) calls but less consistently for fire responses to segment personnel and response activities in the immediate geographic area around the fire. Despite national guidelines, studies have documented the inconsistent use of respiratory protective equipment by firefighters at the fire scene. In this case-series report, we describe warm zone gas levels using multigas detectors across five independent fire incident responses all occurring in a large South Florida fire department. Multigas detector data collected at each fire response indicate the presence of sustained levels of volatile organic compounds in the “warm zone” of each fire event. These cases suggest that firefighters should not only implement strategies for multigas detector use within the warm zone but also include respiratory protection to provide adequate safety from toxic exposures in the warm zone.

Nonfatal Injuries to Firefighters Treated in U.S. Emergency Departments, 2003-2014

INTRODUCTION

Several studies of nonfatal firefighter injuries have been conducted but are limited by the inclusion criteria used and coverage. The aim of this study was to enhance current knowledge by providing national estimates of nonfatal injuries to firefighters treated in U.S. emergency departments.

METHODS

Nonfatal injuries from 2003 through 2014 were extracted from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work). NEISS-Work captures nonfatal occupational injuries, illnesses, and exposures treated in a sample of U.S. emergency departments. Nonfatal injury rates were calculated based on NEISS-Work counts (numerator) and counts from the National Fire Protection Association (denominator). Data were analyzed from 2016 through 2017.

RESULTS

Between 2003 and 2014, an estimated 351,800 firefighters were treated in emergency departments for nonfatal injuries. The overall rate was 260 injuries per 10,000 firefighters. Career firefighters had an annual rate of 699 injuries per 10,000 firefighters; volunteers had a rate of 39 injuries per 10,000 firefighters. Leading injury events were fires and explosions (36%) and overexertion and bodily reactions (20%). A majority (38%) of injuries occurred during firefighting activities, 7% occurred during training, and 7% occurred during patient care. Sprains and strains accounted for the largest proportion of injuries in all three of these activities: 28% firefighting activities, 32% training, and 36% patient care.

CONCLUSIONS

The results demonstrate that nonfatal injuries for firefighters remained high throughout the study period. The predominance of sprains and strains in all firefighting activities suggests the need for additional research and prevention needs in areas of improved fitness, safer body postures and movements, and situational awareness.

Impact of work pressure, work stress and work-family conflict on firefighter burnout

Little research has explored burnout and its causes in the American fire service. Data were collected from career firefighters in the southeastern United States (n = 208) to explore these relationships. A hierarchical regression model was tested to examine predictors of burnout including sociodemographic characteristics (model 1), work pressure (model 2), work stress and work-family conflict (model 3) and interaction terms (model 4). The main findings suggest that perceived work stress and work-family conflict emerged as the significant predictors of burnout (both p < .001). Interventions and programs aimed at these predictors could potentially curtail burnout among firefighters.

Safety climate and firefighting: Focus group results

BACKGROUND

Firefighting is a hazardous occupation and there have been numerous calls for fundamental changes in how fire service organizations approach safety and balance safety with other operational priorities. These calls, however, have yielded little systematic research.

METHODS

As part of a larger project to develop and test a model of safety climate for the fire service, focus groups were used to identify potentially important dimensions of safety climate pertinent to firefighting.

RESULTS

Analyses revealed nine overarching themes. Competency/professionalism, physical/psychological readiness, and that positive traits sometimes produce negative consequences were themes at the individual level; cohesion and supervisor leadership/support at the workgroup level; and politics/bureaucracy, resources, leadership, and hiring/promotion at the organizational level. A multi-level perspective seems appropriate for examining safety climate in firefighting.

CONCLUSIONS

Safety climate in firefighting appears to be multi-dimensional and some dimensions prominent in the general safety climate literature also seem relevant to firefighting. These results also suggest that the fire service may be undergoing transitions encompassing mission, personnel, and its fundamental approach to safety and risk.

PRACTICAL APPLICATIONS

These results help point the way to the development of safety climate measures specific to firefighting and to interventions for improving safety performance.

A conceptual safety-oriented job demands and resources model for the fire service

Purpose

The purpose of this paper is to develop and present a safety-oriented job demands-resources (JD-R) model that supports the notion that excessive job demands in the fire service, when not controlled or countered, may increase firefighter burnout and diminish firefighter safety.

Design/methodology/approach

The approach for the present project includes a review of the JD-R literature and the presentation of a conceptual model specific to fire service organizations.

Findings

A conceptual model, relevant to fire service organizations was derived. The model argues that excessive job demands associated with workload, physical demands, emotional demands, and complexity can result in burnout if not controlled or countered. Safety-specific resources, including recovery, support, safety-specific transformational leadership and safety climate are theorized to buffer these effects and are suggested to enhance firefighter engagement. These effects are argued then to improve firefighter safety. Ultimately, the findings will help guide future research, intervention projects and workplace safety and health management programs and initiatives.

Originality/value

This paper and conceptual model extends the application of the JD-R model to fire service organizations. Further, the conceptual model supports the application of safety-specific job resources vs more traditional job resources as a means to enhance firefighter safety.

Factors Implicated in Safety-related Firefighter Fatalities

Firefighting is wrought with risk, as 80-100 firefighters (FFs) die on the job each year in the United States. Many of the fatalities have been analyzed by the National Institute for Occupational Safety and Health (NIOSH) to determine contributing factors. The purpose of this study is to determine variables that put FFs at risk for potentially preventable workplace mortality such as use of personal protective equipment (PPE), seat belts, and appropriate training/fitness/clearance for duty. The NIOSH FF Fatality Database reports from 2009 to 2014 were analyzed. Data including age, gender, years on the job, weather, other calls on the same shift, and department type were compared between FFs who employed PPE, seat belts, or wellness/fitness and those who did not. A second group of FFs was determined by NIOSH to have inexperience, lack of training, or inappropriate clearance for duty implicated in their fatalities. Comparisons for the second group were between those whose department used training and safety-related standard operating protocols and those who did not. In 84/176 deaths, PPE/seat belts/fitness was implicated in the fatality. Lack of PPE was more likely on clear days (P = .03) but less likely on cloudy and windy days (P < .001). These FFs dying with lack of PPE had more time on the job in a single department, 18 vs 13 years (P = .03), and more time in a volunteer department, 17 vs 8 years (P < .01). Being deployed on another call during the same shift was associated with lack of PPE-34 vs 16% of those who had not been on another call (P = .005). Lack of training, experience, or medical clearance was implicated in fatalities for 100/176 FFs. FFs who worked in departments that lacked standard operating protocols for respirator fit testing, PPE, fitness testing, rapid intervention, medical clearance, safety/distress alarms, vehicle maintenance, or incident command were statistically more likely to have lack of experience/training/clearance implicated in the fatality. Good weather during a call and more years on the job, particularly in a volunteer department, are associated with FF mortality related to unsafe practices. These factors might create an air of complacency that puts FFs at risk for safety-related omissions. Having been on a recent call may create distraction or fatigue that puts FF at risk during subsequent calls. Lack of key safety-related protocols appears to put FFs at risk of mortality, and the risk may be increasing over time. Further study and prevention efforts from multidisciplinary groups are needed to better understand and combat this problem.

Line of duty firefighter fatalities: an evolving trend over time

Between 1990 and 2012, 2775 firefighters were killed in the line of duty. Myocardial infarction (MI) was responsible for approximately 40% of these mortalities, followed by mechanical trauma, asphyxiation, and burns. Protective gear, safety awareness, medical care, and the age of the workforce have evolved since 1990, possibly affecting the nature of mortality during this 22-year time period. The purpose of this study is to determine whether the causes of firefighter mortality have changed over time to allow a targeted focus in prevention efforts. The U.S. Fire Administration fatality database was queried for all-cause on-duty mortality between 1990 to 2000 and 2002 to 2012. The year 2001 was excluded due to inability to eliminate the 347 deaths that occurred on September 11. Data collected included age range at the time of fatality (exact age not included in report), type of duty (on-scene fire, responding, training, and returning), incident type (structure fire, motor vehicle crash, etc), and nature of fatality (MI, trauma, asphyxiation, cerebrovascular accident [CVA], and burns). Data were compared between the two time periods with a χ test. Between 1990 and 2000, 1140 firefighters sustained a fatal injury while on duty, and 1174 were killed during 2002 to 2012. MI has increased from 43% to 46.5% of deaths (P = .012) between the 2 decades. CVA has increased from 1.6% to 3.7% of deaths (P = .002). Asphyxiation has decreased from 12.1% to 7.9% (P = .003) and burns have decreased from 7.7% to 3.9% (P = .0004). Electrocution is down from 1.8% to 0.5% (P = .004). Death from trauma was unchanged (27.8 to 29.6%, P = .12). The percentage of fatalities of firefighters over age 40 years has increased from 52% to 65% (P = .0001). Fatality by sex was constant at 3% female. Fatalities during training have increased from 7.3% to 11.2% of deaths (P = .00001). The nature of firefighter mortality has evolved over time. In the current decade, line-of-duty mortality is more likely to occur during training. Mortality from burns, asphyxiation, and electrocution has decreased; but death from MI and CVA has increased, particularly in older firefighters. Outreach and education should be targeted toward vehicle safety, welfare during training, and cardiovascular disease prevention in the firefighter population.

Stressors and coping strategies of U.K. firefighters during on-duty incidents

Operational response by firefighters requires an abrupt change from rest to near-maximal physical effort and incorporates almost instant stress management that must be made during extreme heat, limited time and partial information, yet little is known about the coping strategies incorporated to manage the physiological and psychological demands associated with this environment. A sample of 22 UK firefighters took part in focus groups identifying frequently used coping techniques based upon problem-focused and emotion-focused coping methods. Findings suggest problem-orientated coping comprised half of the total coping strategies quoted by participants, with a third of responses being categorized as emotion-focused methods, and 17% were considered to be both problem-focused and emotion-focused techniques. Responses indicate problem-focused methods are often utilized en route to the incident, and at the early stages of operational tasks. Emotion-focused responses are more common during periods of fatigue and exhaustion and post-incident, and problem-focused and emotion-focused techniques were found post-incident, although there was often an overlap between methods and they perhaps should not be treated as three distinct stages. The importance of peer support and potential benefits to firefighter well-being and operational performance are discussed.

Firefighter safety: rampant unsafe practices as documented in mainstream media

More than 30,000 firefighters are injured on the fireground each year. Literature suggests that injury often occurs when protective gear is not used properly. According to firefighters, failure to correctly wear protective equipment occurs for several reasons: (1) gear not used because of haste, (2) cumbersome gear can sometimes interfere with performance, and (3) cultural factors. The purpose of this study is to quantify improper gear and tactic use in a publicly available, online video repository in order to better understand unsafe firefighting. This was an Institutional Review Board-exempt study of public video records. A search for "fire fighting videos" was conducted at YouTube (www.youtube.com). The first 50 videos that contained volunteer or career firefighters at work fighting fires were selected evaluated for appropriate use of personal protective equipment and for safe behavior. The videos were evaluated by two highly experienced professional firefighters. Of the 50 videos reviewed, 25 (50%) demonstrated violations of firefighting safety principles. Of the unsafe videos, 21 (42%) displayed firefighters improperly using gear, while the other 4 (8%) were related to unsound tactics. The most common problem was failure to wear or properly secure a self-contained breathing apparatus when appropriate (14 videos or 28%). The second most common failure was lack of helmet, hood, or approved gloves (11 videos or 22%). In conclusion, firefighting as documented on YouTube is often unsafe because of failure to properly use personal protective equipment. Half of the videos reviewed contained unsafe practices. With such a shockingly high rate of unsafe firefighting, the profession is in need of additional education and reform. In response to this epidemic, a multidisciplinary educational program has been developed to improve firefighter awareness of gear limitations and burn injury risk. Effectiveness of educational programs should be documented in additional prospective studies.

Sudden cardiac death among firefighters ≤45 years of age in the United States

Sudden cardiac death (SCD) is the leading cause of death in firefighters. Although on-duty SCD usually occurs in older victims almost exclusively because of coronary heart disease, no studies have examined causation across the career span. In the present retrospective case-control study, cases of SCD in young (aged ≤45 years) firefighters from the National Institute for Occupational Safety and Health fatality investigations (n = 87) were compared with 2 age- and gender-matched control groups: occupationally active firefighters (n = 915) and noncardiac traumatic firefighter fatalities (n = 56). Of the SCD cases, 63% were obese and 67% had a coronary heart disease-related cause of death. The SCD victims had much heavier hearts (522 ± 102 g) than noncardiac fatality controls (400 ± 91 g, p <0.001). Cardiomegaly (heart weight >450 g) was found in 66% of the SCD victims and conveyed a fivefold increase (95% confidence interval [CI] 1.93 to 12.4) in SCD risk. Furthermore, hypertension, including cases with left ventricular hypertrophy, increased SCD risk by 12-fold (95% CI 6.23 to 22.3) after multivariate adjustment. A history of cardiovascular disease and smoking were also independently associated with elevated SCD risk (odds ratio 6.89, 95% CI 2.87 to 16.5; and odds ratio 3.53, 95% CI 1.87 to 6.65, respectively). In conclusion, SCD in young firefighters is primarily related to preventable lifestyle factors. Obesity entry standards, smoking bans, and improved screening and/or wellness program are potential strategies to reduce SCD in younger firefighters.

Working Inside the Firehouse

Cardiovascular disease (CVD) is the most common cause of on-duty death among U.S. firefighters among whom volunteers comprise 71% of the fire service. We sought to understand CVD risk among volunteer firefighters and to develop a CVD intervention based on their input. To accomplish these aims, we conducted a series of focus groups with volunteer firefighters and firefighters who serve with volunteers in Maryland. We conducted two additional focus groups with fire service leaders. Ninety-eight people participated in 15 focus groups. Participants discussed health and wellness, stress and the demanding nature of the volunteer fire service, and the challenges associated with healthy eating. They talked about food in the firehouse and the lack of quick, healthy, satisfying, and affordable food. Several suggestions for interventions to improve the food environment and firefighters’ ability to choose and prepare healthy meals and snacks emerged. An intervention reflecting the participants’ recommendations resulted. The way volunteer firefighters understand health and wellness and the specific factors that influence their food intake are valuable insights for addressing CVD risks in this population. To our knowledge, this is the first study that systematically brings firefighters into the process of developing an intervention to reduce CVD risk among this high-risk population.

Aged garlic extract and coenzyme Q10 have favorable effect on inflammatory markers and coronary atherosclerosis progression: A randomized clinical trial

Background:

Aged garlic extract (AGE) and coenzyme Q10 (CoQ10) have been shown to affect multiple cardiovascular risk factors. The current study evaluates the effect of AGE combined with CoQ10 on inflammatory markers and progression of coronary atherosclerosis compared with placebo.

Methods and Results:

In this placebo-controlled, double-blind, randomized trial, 65 intermediate risk firefighters (age 55 ± 6 years) were treated with a placebo capsule or a capsule containing AGE and CoQ10 (AGE+CoQ10, 1200 and 120 mg, respectively) daily for 1 year. All participants underwent coronary artery calcium (CAC) scanning and C-reactive protein (CRP) at baseline and at 12 months. At 1 year, mean CAC progression was significantly lower in AGE+CoQ10 (32 ± 6 vs. 58 ± 8, P = 0.01) than placebo. Similarly, CRP were significantly decreased in AGE+CoQ10 compared with placebo (-0.12 ± 0.24 vs. 0.91 ± 0.56 mg/L, P < 0.05). After adjustment for age, gender, conventional cardiac risk factors, and statin therapy, AGE+CoQ10 was associated with 3.99 fold (95% 1.3–12.2, P = 0.01) lack of CAC progression compared with the placebo.

Conclusion:

AGE+CoQ10 are associated with beneficial effects on inflammatory markers and reduced progression of coronary atherosclerosis.

Beneficial effects of aged garlic extract and coenzyme Q10 on vascular elasticity and endothelial function: the FAITH randomized clinical trial

OBJECTIVE

Aged garlic extract (AGE) is associated with a significant decrease in atherosclerotic plaque progression and endothelial function improvement. Similarly, coenzyme Q10 (CoQ10) has significant beneficial effects on endothelial function. A stressful lifestyle is a well-known risk factor for the presence and progression of atherosclerosis. This study investigated the effect of AGE plus CoQ10 on vascular elasticity measured by pulse-wave velocity (PWV) and endothelial function measured by digital thermal monitoring (DTM) in firefighters.

METHODS

Sixty-five Los-Angeles County firefighters who met the eligibility criteria were enrolled in this placebo-controlled, double-blinded randomized trial. The firefighters were randomized to four tablets of AGE (300 mg/tablet) plus CoQ10 (30 mg/tablet) or placebo. The participants underwent quarterly visits and 1-year follow-up. PWV and DTM were measured at baseline and at the 1-year follow-up.

RESULTS

There were no significant differences in age, cardiovascular risk factors, PWV, and DTM between the AGE/CoQ10 and placebo groups at baseline (P > 0.5). At 1-y, PWV and DTM significantly improved in the AGE/CoQ10 compared with the placebo group (P < 0.05). After an adjustment for cardiovascular risk factors and statin therapy, the mean decrease in vascular stiffness (PWV) was 1.21 m/s in the AGE/CoQ10 compared with the placebo group (P = 0.005). Similarly, the mean increase in the area under the temperature curve, the DTM index of endothelial function, was 31.3 in the AGE/CoQ10 compared with the placebo group (P = 0.01).

CONCLUSION

The combination of AGE and CoQ10 was independently associated with significant beneficial effects on vascular elasticity and endothelial function in firefighters with high occupational stress, highlighting the important role of AGE and CoQ10 in atherosclerotic prevention of such individuals.