Problems of operation of positive pressure ventilators on the basis of surveys of Polish officers of the State Fire Service

Positive pressure ventilators (PPV) used by 97.7% of officers of the National Fire Service in Poland, are characterized by work that is not in line with the expectations of the firefighters. In order to improve the technical and operational features of these devices, a survey was conducted among 25,000 eligible firefighters, identifying the application of these devices, problems in use and expected development directions. A total of 682 officers voluntarily completed the survey. Based on their findings, it was determined that ventilators are most often used to smoke out buildings after or during a fire. Mentioned problems when using these devices were mainly noise (78.2%), exhaust emissions (68.5%), and impediments to mobility through the device's relatively heavy weight (40.2%). Other inconveniences were mentioned by less than 20% of firefighters. Polish firefighters expect the development of these devices mainly in terms of the above-mentioned features (noise reduction (81.7%) and reduction of the weight and size of the ventilators (about 50%)). Other expectations relate to the improvement of smoke removal in buildings: increasing the efficiency of smoke removal (46.4%) and efficiency regarding the rate of smoke removal in a building by increasing the size of the incoming airflow from the building's surroundings (33.2%). About 15% of firefighters expect changes in the operation of the ventilator itself, that is, an increase in the effective operating time (electric ventilators) and an increase in the device's uptime. The aim of the article is to identify the issues encountered during the operation and to indicate the expected direction of development for PPV by users. This information can be used by engineers to initiate new development work on these devices.

Characterization of fire investigators' polyaromatic hydrocarbon exposures using silicone wristbands

BACKGROUND

Exposures to polyaromatic hydrocarbons (PAHs) contribute to cancer in the fire service. Fire investigators are involved in evaluations of post-fire scenes. In the US, it is estimated that there are up to 9000 fire investigators, compared to approximately 1.1 million total firefighting personnel. This exploratory study contributes initial evidence of PAH exposures sustained by this understudied group using worn silicone passive samplers.

OBJECTIVES

Evaluate PAH exposures sustained by fire investigators at post-fire scenes using worn silicone passive samplers. Assess explanatory factors and health risks of PAH exposure at post-fire scenes.

METHODS

As part of a cross-sectional study design, silicone wristbands were distributed to 16 North Carolina fire investigators, including eight public, seven private, and one public and private. Wristbands were worn during 46 post-fire scene investigations. Fire investigators completed pre- and post-surveys providing sociodemographic, occupational, and post-fire scene characteristics. Solvent extracts from wristbands were analyzed via gas chromatography-mass spectrometry (GC-MS). Results were used to estimate vapor-phase PAH concentration in the air at post-fire scenes.

RESULTS

Fire investigations lasted an average of 148 minutes, standard deviation ± 93 minutes. A significant positive correlation (r=0.455, p<.001) was found between investigation duration and PAH concentrations on wristbands. Significantly greater time-normalized PAH exposures (p=0.039) were observed for investigations of newer post-fire scenes compared to older post-fire scenes. Regulatory airborne PAH exposure limits were exceeded in six investigations, based on exposure to estimated vapor-phase PAH concentrations in the air at post-fire scenes.

DISCUSSION

Higher levels of off-gassing and suspended particulates at younger post-fire scenes may explain greater PAH exposure. Weaker correlations are found between wristband PAH concentration and investigation duration at older post-fire scenes, suggesting reduction of off-gassing PAHs over time. Exceedances of regulatory PAH limits indicate a need for protection against vapor-phase contaminants, especially at more recent post-fire scenes.

Meta-Analysis of Incidence and Mortality of Firefighter Cancer: An Update on Emerging Science

BACKGROUND

Firefighters are faced with a broad range of toxic exposures during their work, including known and suspected carcinogens. The current study is an update to the previously published meta-analysis of cancer risk among firefighters by Soteriades and colleagues, and focuses on studies published from 2008 to 2020.

METHODS

A comprehensive search of the literature was conducted, including electronic databases and bibliographies of recently published papers. Analyses include stratification of studies conducted in the United States (US) versus other countries. Cancer incidence and mortality rates were compared to the relevant general population. Random effects models were used to calculate summary risk estimates and their 95% confidence intervals.

RESULTS

A total of 24 studies were included in the meta-analysis. Among the 42 cancer types covered, incidence was associated with firefighting in US samples for colon, kidney, large intestine, pleura, and prostate cancer, as well as malignant melanoma. There was an increased incidence of Hodgkin's Disease and malignant melanoma and a significantly lower risk of kidney cancer for non-US samples. Significant cancer mortality estimates for US samples included oral/buccal/mouth, other parts of the buccal cavity, pharynx, colon, esophagus, large intestine, lung, Non-Hodgkin's Lymphoma, pancreas, pleura, rectum, and soft tissue sarcoma. No cancer had a significantly higher rate of mortality among non-US samples.

CONCLUSIONS

The findings underscore the global cancer burden among firefighters, and indicate that geographically stratifying studies afford a more nuanced risk perspective. Further research should investigate why US firefighters exhibit higher cancer mortality rates compared to international counterparts.

The Tactical Athlete: Definitions, Cardiovascular Assessment, and Management, and "Fit for Duty" Standards

Tactical athletes are individuals in the military, law enforcement, and other professions whose occupations have significant physical fitness requirements coupled with the potential for exposure to life-threatening situations. Such exposures can have varied hemodynamic effects on the cardiovascular system. It is crucial that their clinical evaluation is inclusive of specific occupational requirements. Safety protocols regarding medical clearance are relatively more stringent for this population than for competitive athletes due to the increased impact to the tactical athlete, their team, and the population they aim to serve and protect should they experience a cardiovascular event on the job.

Using a Walking Test to Assess Firefighter Fitness

Tactical populations face increased risk on the job, and it is known that firefighters have high levels of cardiac-related death. Aerobic fitness is a modifiable cardiac risk factor, but many fire stations lack the proper equipment to easily assess aerobic fitness levels of their firefighters. Additionally, many fire stations lack wellness programs to hold firefighters accountable for maintaining their fitness levels.

Purpose

We assessed the validity of the submaximal 6-minute walk test (6MWT) as a measure of aerobic capacity compared to a maximal treadmill test and the submaximal Gerkin protocol.

Methods

Twenty-four firefighters (19 male, 5 female, 34.8 ± 9.7 years; 38.1 ± 3.6 kg·m-2) completed the 6MWT, the submaximal Gerkin protocol, and a maximal treadmill test. Data were analyzed with Bland-Altman plots and correlation analysis.

Results

We found equivalence between the 6MWT and directly measured VO2max and between the 6MWT and Gerkin protocol using Bland-Altman plots. In our cohort, the 6MWT underestimated VO2max (31.57 ml·kg-1·min-1) compared to directly measured VO2max (38.1 ml·kg-1·min-1) by 17% and to the Gerkin (40.48 ml·kg-1·min-1) by 22%.

Conclusion

Considering its equivalence, using the 6MWT could be a more accessible way to quantify aerobic capacity in firefighters. Despite underestimation, having an easy to administer protocol may encourage more fire stations to assess pre- and post- fitness levels regularly.

A systematic review and meta-analysis of musculoskeletal disorders among firefighters

INTRODUCTION

Due to the nature of their job, firefighters face many ergonomic risk factors and are exposed to several musculoskeletal disorders (MSDs). The aim of this systematic review and meta-analysis was to investigate the prevalence of MSDs among firefighters.

MATERIALS AND METHODS

This study was conducted based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The literature search was conducted in the databases of PubMed, Scopus, Web of Science, Science Direct, SID, ISC and Google Scholar without applying a time limitation until the end of July 2022. The random effects model was used for meta-analysis, and the I2 index was used to check heterogeneity among studies. The data were analyzed using STATA version 14 software.

RESULTS

The primary literature searches in the databases identified 1,291 articles, 26 of which were entered the meta-analysis stage after screening, study selection, and quality assessment, including 36,342 firefighters. Based on the results of a meta-analysis, the overall prevalence of MSDs among firefighters was 46.39% (95% CI: 32.45-60.32, I2 = 99.7%, P < 0.001). The prevalence of MSDs was also investigated at neck (18.36%), low back (34.32%), shoulder (18.68%), hands (7.43%), upper back (10.15%), knee (19.97%) and foot (6.66%).

CONCLUSION

Considering the relatively high prevalence of MSDs among firefighters and their higher exposition to specific job-related risk factors of MSDs compared to other professions, it is suggested to provide firefighters with appropriate training, implement ergonomic interventions, and regularly screen them to reduce MSDs.

Supporting emergency service workers to cope with critical incidents that can lead to psychological burden at work - developing skills in the Post Critical Incident Seminar: a qualitative interview study

BACKGROUND

Emergency service workers face critical incidents causing psychological burden. This qualitative study investigates how attending a Post Critical Incident Seminar could affect the skills of emergency service workers to overcome incidents that can cause psychological burden at work and their consequences with the following research questions: (1) How did attending the Post Critical Incident Seminar impact the skills to overcome work incidents that can lead to psychological burden? and (2) How have these skills been manifested since attending the Post Critical Incident Seminar?

METHODS

The data consists of individual interviews with fifteen emergency services workers who attended a Post Critical Incident Seminar in April 2021 in Finland. The interviews were conducted six months after the Post Critical Incident Seminar and analysed using inductive content analysis.

RESULTS

The results of the first research question formed two main categories: improved performance abilities and improved self-regulation abilities. From the results of the second research question two main categories were created: new kind(s) of well-being and readiness to help. Several upper categories and sub-categories were discovered.

CONCLUSIONS

Based on the results, attending a Post Critical Incident Seminar may be effective in developing skills to overcome critical incidents that can lead to psychological burden. Further follow-up studies should investigate how acquired skills from the Post Critical Incident Seminar practically affect emergency service workers and their well-being in the longer term.

Assessing the association between probable posttraumatic stress disorder symptoms and quality of life among emergency service workers using path analysis

BACKGROUND

Emergency service workers have highly stressful occupations; the stressors encountered can contribute to the development of mental disorders such as depression, anxiety, and posttraumatic stress disorder (PTSD).

OBJECTIVE

The present study used a conceptual model and survey to identify variables influencing the association between probable PTSD and quality of life (QOL) in emergency service workers.

METHOD

PTSD was assessed using the Impact of Event Scale-Revised. QOL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey. Path analysis was used to determine whether stress-coping (Brief Coping Orientation to Problems Experienced [Brief COPE] scores), social support (Multidimensional Scale of Perceived Social Support [MSPSS] scores), and resilience (Connor-Davidson Resilience Scale scores) explain the association between probable PTSD and QOL among 220 emergency service workers in Japan.

RESULTS

Impact of Event Scale-Revised scores were significantly positively associated with Brief COPE Active coping scores and significantly negatively associated with MSPSS scores. Brief COPE Active coping and MSPSS scores were significantly positively associated with Connor-Davidson Resilience Scale scores, which were in turn significantly positively associated with Medical Outcomes Study 36-Item Short-Form Health Survey scores.

CONCLUSION

Active coping in response to stressful situations is important for maintaining good mental health among emergency service workers. Active coping and social support may strengthen resilience, and resilience may improve QOL. Screening for mental health and QOL should include simultaneous assessment of stress-coping, social support, and resilience. Although the findings of this cross-sectional study are important, it could not confirm a causal relationship between PTSD and QOL.

Implementation and use of a supraglottic airway device in the management of out-of-hospital cardiac arrest by firefighter first responders - A prospective feasibility study

Aim

We wanted to assess the implementation and use of a supraglottic airway (SGA) for on-call firefighter first responders in out-of-hospital cardiac arrest.

Methods

We trained 502 firefighter first responders, located at 35 fire stations in the South-East of Norway, in the use of SGA during cardiopulmonary resuscitation in adult out-of-hospital cardiac arrest. Training consisted of 45 minutes of theoretical and practical training in small groups.Primary outcome was successful ventilation with SGA assessed by both firefighter first responders and first paramedic arriving on-scene. Secondary outcomes included time expenditure and complications related to the procedure, evaluation of the training, and descriptive characteristics of the out-of-hospital cardiac arrest cases.

Results

An SGA was used by firefighter first responders in 23 out-of-hospital cardiac arrests, and successful ventilation was achieved in 20 (87%) cases. Air-leak was described in the three unsuccessful cases. The median procedural time was 30 seconds (IQR = 15-40), with no observed procedural complications. Firefighter first responders arrived in median time 9 minutes (IQR = 6-10 min) before the ambulance. They performed chest compressions on all patients and 6 (26%) of the patients received shock with semi-automatic external defibrillator. After training, all participants were able to successfully ventilate a manikin with the SGA. The cost of the SGA equipment for all fire stations was 3955 GBP.

Conclusion

Implementation of an SGA for firefighter first responders in out-of-hospital cardiac arrest management seems feasible, safe and can be introduced with limited amount of training and limited use of resources.

Physiological demands and physical performance determinants of a new firefighting simulation test

The study aimed to examine physiological responses of firefighters performing a firefighting simulation test (FST) and to determine the relationship between physical fitness parameters and FST performance. Aerobic fitness, muscular strength, muscular endurance, and anaerobic capabilities were evaluated in 37 firefighters (21-profesionals and 16-volunteers firefighters). Furthermore, participants carried out the FST during which we measured performance, respiratory gas exchange, heart rate (HR), perceived exertion and blood lactate concentrations. Males were significantly faster than females for all tasks of the FST (p < 0.01); however, final performance score (16.5 ± 2.9 and 14.5 ± 2.6 points for males and females, respectively), HR (94.0 ± 2.0% and 93.7 ± 2.3% of HRmax) and perceived exertion (8.1 ± 0.9 and 7.1 ± 1.3) were not significantly different. Prediction of FST performance by LASSO regression revealed a model that included mainly aerobic capacity and maximal strength. In conclusion, FST challenged both aerobic and anaerobic energy metabolisms for both males and females and requires various physiological abilities to perform. Practitioner Summary: For the safety of firefighters and victims, firefighters must meet minimum physical requirements. 37 firefighters performed physical tests and a new firefighting test implemented for the recruitment of firefighters in France. The results revealed that this test is strenuous and that performance is associated with cardiorespiratory fitness and muscular strength. Abbreviations: V̇O2: oxygen consumption; V̇CO2: carbon dioxyde production; V̇E: expired ventilation; RER: respiratory exchange ratio; FST: firefighting simulation test; MAS: maximal aerobic speed; HR: heart rate; RPE: rating of perceived exertion; MVC: maximum voluntary contraction; IMTP: isometric mid-thigh pull; TTE: time to exhaustion; Ppeak: peak power; Pmean: mean power; LASSO: least absolute shrinkage and selection operator; La-: blood lactate concentration.

Assessing Stress and Anxiety in Firefighters During the Coronavirus Disease-2019 Pandemic: A Comparative Adaptation of the Stress and Anxiety in the Viral Epidemic-9 Items and Stress and Anxiety in the Viral Epidemics-6 Items Scales

OBJECTIVE

This study assessed the reliability and validity of the Stress and Anxiety to Viral Epidemics-9 items (SAVE-9) and Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scales for measuring viral anxiety among firefighters during the coronavirus disease-2019 pandemic.

METHODS

An online survey was conducted among 304 firefighters assigned in Gyeonggi-do. The SAVE-9 scale, initially developed for healthcare workers, was adapted for firefighters. We compared it with the SAVE-6 scale designed for the general population among the firefighters sample. The confirmatory factor analysis (CFA) was conducted to explore the factor structure of both scales. Internal consistency reliability was checked using Cronbach's alpha and McDonald's omega. Convergent validity was assessed in accordance with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales.

RESULTS

The SAVE-9 scale demonstrated a Cronbach alpha of 0.880, while the SAVE-6 scale yielded an alpha of 0.874. CFA indicated good model fits for both SAVE-9 and SAVE-6 scales among firefighters sample. The SAVE-9 and SAVE-6 comparably measures viral anxiety of firefighters.

CONCLUSION

Both of the SAVE-9 and SAVE-6 scales are reliable and valid instruments for assessing viral anxiety among firefighters during the pandemic.

Local effects of printed logos and reflective striping fixed to firefighter clothing material packages under low radiation exposure

Notifications that related 1st degree burns to reflective striping and impermeable clothing elements did reach the investigators, while the mechanisms behind this phenomenon are still unclear. Material tests for thermal and evaporative resistance, and for heat transmission under dry and wet conditions at low radiation levels were done to evaluate the performance of protective clothing with and without printed logos or reflective striping. The results under the specified conditions showed reduction of heat loss capacity under impermeable elements from dry to wet conditions. Reflective surfaces, even when more impermeable, showed still lower heat transmission through the textile package than materials without striping under tested moisture and radiation combinations. It can be expected that the reported 1st degree burns were related to clothing design and tightness/fit rather than to reflective striping. However, due to the fine balance between clothing thermal and evaporative resistance, outer material emissivity, moisture quantity and location in clothing and applied radiation level, a different setup could lead to different results.

Short-term effects of air pollutant exposure on small airway dysfunction, spirometry, health-related quality of life, and inflammatory biomarkers in wildland firefighters: a pilot study

Clinical Trials Registry: Study ID: TCTR20200828005.

Lack of compensation for COVID-19-related overtime work and its association with burnout among EMS providers in Korea

OBJECTIVES

This study examined the association between lack of compensation for COVID-19-related overtime work (LCCOW) and burnout among emergency medical service (EMS) providers in Seoul, Korea.

METHODS

We conducted a cross-sectional survey of 693 EMS providers in Seoul, Korea. Participants were classified into 3 groups according to their experience of coronavirus disease 2019 (COVID-19)-related overtime work and LCCOW: (1) "did not experience," (2) "experienced and was compensated," and (3) "experienced and was not compensated." Burnout was measured using the Korean version of the Copenhagen Burnout Inventory, which has 3 subdomains: personal burnout (PB), work-related burnout (WRB), and citizen-related burnout (CRB). Multiple linear regression was applied to examine whether LCCOW was associated with burnout after adjusting for potential confounders.

RESULTS

In total, 74.2% of participants experienced COVID-19-related overtime work, and 14.6% of those who worked overtime experienced LCCOW. COVID-19-related overtime work showed a statistically non-significant association with burnout. However, the association differed by LCCOW. Compared to the "did not experience" group, the "experienced and was not compensated" group was associated with PB (β=10.519; 95% confidence interval [CI], 3.455 to 17.584), WRB (β=10.339; 95% CI, 3.398 to 17.280), and CRB (β=12.290; 95% CI, 6.900 to 17.680), whereas no association was observed for the "experienced and was compensated" group. Furthermore, an analysis restricted to EMS providers who worked overtime due to COVID-19 showed that LCCOW was associated with PB (β=7.970; 95% CI, 1.064 to 14.876), WRB (β=7.276; 95% CI, 0.270 to 14.283), and CRB (β=10.000; 95% CI, 3.435 to 16.565).

CONCLUSIONS

This study suggests that LCCOW could be critical in worsening burnout among EMS providers who worked overtime due to COVID-19.

Firefighting and Cancer: A Meta-analysis of Cohort Studies in the Context of Cancer Hazard Identification

Objective

We performed a meta-analysis of epidemiological results for the association between occupational exposure as a firefighter and cancer as part of the broader evidence synthesis work of the IARCMonographs program.

Methods

A systematic literature search was conducted to identify cohort studies of firefighters followed for cancer incidence and mortality. Studies were evaluated for the influence of key biases on results. Random-effects meta-analysis models were used to estimate the association between ever-employment and duration of employment as a firefighter and risk of 12 selected cancers. The impact of bias was explored in sensitivity analyses.

Results

Among the 16 included cancer incidence studies, the estimated meta-rate ratio, 95% confidence interval (CI), and heterogeneity statistic (I2) for ever-employment as a career firefighter compared mostly to general populations were 1.58 (1.14-2.20, 8%) for mesothelioma, 1.16 (1.08-1.26, 0%) for bladder cancer, 1.21 (1.12-1.32, 81%) for prostate cancer, 1.37 (1.03-1.82, 56%) for testicular cancer, 1.19 (1.07-1.32, 37%) for colon cancer, 1.36 (1.15-1.62, 83%) for melanoma, 1.12 (1.01-1.25, 0%) for non-Hodgkin lymphoma, 1.28 (1.02-1.61, 40%) for thyroid cancer, and 1.09 (0.92-1.29, 55%) for kidney cancer. Ever-employment as a firefighter was not positively associated with lung, nervous system, or stomach cancer. Results for mesothelioma and bladder cancer exhibited low heterogeneity and were largely robust across sensitivity analyses.

Conclusions

There is epidemiological evidence to support a causal relationship between occupational exposure as a firefighter and certain cancers. Challenges persist in the body of evidence related to the quality of exposure assessment, confounding, and medical surveillance bias.

Workers' compensation injury claims among firefighters in Ohio, 2001-2017

BACKGROUND

Firefighters are at high risk for nonfatal and fatal occupational injuries. While some past research has quantified firefighter injuries using various data sources, Ohio workers' compensation injury claims data largely have not been used.

METHODS

Public and private firefighter claims, including volunteer and career firefighters, from Ohio's workers' compensation data for 2001-2017 were identified based on occupational classification codes and manual review of the occupation title and injury description. The task during injury (firefighting, patient care, training, other/unknown, etc.) was manually coded based on the injury description. Injury claim counts and proportions were described across claim type (medical-only or lost-time), worker demographics, task during injury, injury events, and principal diagnoses.

RESULTS

33,069 firefighter claims were identified and included. Most claims were medical-only (66.28%, <8 days away from work) and involved males (93.81%) aged 25-54 years (86.54%). While the task during injury could not be categorized for many narratives (45.96%), the largest percentage that could be categorized occurred during firefighting (20.48%) and patient care (17.60%). The most common injury events were overexertion involving outside sources (31.33%) and struck by objects or equipment (12.68%). The most frequent principal diagnoses were back, lower extremity, and upper extremity sprains (16.02%, 14.46%, and 11.98%, respectively).

CONCLUSIONS

This study provides a preliminary basis for the development of focused firefighter injury prevention programming and training. Obtaining denominator data, enabling rate calculation, would strengthen the risk characterization. Based on the current data, prevention efforts focusing on the most frequent injury events and diagnoses may be warranted.

An analysis of suicides among first responders ─ Findings from the National Violent Death Reporting System, 2015-2017

INTRODUCTION

First responders, including law enforcement officers (LEOs), firefighters, emergency medical services (EMS) clinicians, and public safety telecommunicators, face unique occupational stressors and may be at elevated risk for suicide. This study characterized suicides among first responders and identifies potential opportunities for additional data collection.

METHODS

Using suicides identified from the three most recent years of National Violent Death Reporting System data with industry and occupation codes from the NIOSH Industry and Occupation Computerized Coding System (2015-2017), decedents were categorized as first responders or non-first responders based on usual occupation. Chi-square tests were used to evaluate differences in sociodemographic and suicide circumstances between first and non-first responders.

RESULTS

First responder decedents made up 1% of all suicides. Over half of first responders (58%) were LEOs, 21% were firefighters, 18% were EMS clinicians, and 2% were public safety telecommunicators. Compared to non-first responder decedents, more first responders served in the military (23% vs. 11%) and used a firearm as the method of injury (69% vs. 44%). Among first responder decedents for whom circumstances were known, intimate partner problems, job problems, and physical health problems were most frequent. Some common risk factors for suicide (history of suicidal thoughts, previous suicide attempt, alcohol/substance abuse problem) were significantly lower among first responders. Selected sociodemographics and characteristics were compared across first responder occupations. Compared to firefighters and EMS clinicians, LEO decedents had slightly lower percentages of depressed mood, mental health problems, history of suicidal thoughts, and history of suicide attempts.

CONCLUSIONS

While this analysis provides a small glimpse into some of these stressors, more detailed research may help inform future suicide prevention efforts and interventions.

PRACTICAL APPLICATION

Understanding stressors and their relation to suicide and suicidal behaviors can facilitate suicide prevention among this critical workforce.

Face-to-face with scorching wildfire: potential toxicant exposure and the health risks of smoke for wildland firefighters at the wildland-urban interface

As wildfire risks have elevated due to climate change, the health risks that toxicants from fire smoke pose to wildland firefighters have been exacerbated. Recently, the International Agency for Research on Cancer (IARC) has reclassified wildland firefighters' occupational exposure as carcinogenic to humans (Group 1). Wildfire smoke contributes to an increased risk of cancer and cardiovascular disease, yet wildland firefighters have inadequate respiratory protection. The economic cost of wildland fires has risen concurrently, as illustrated by the appropriation of $45 billion for wildfire management over FYs 2011-2020 by the U.S. Congress. Occupational epidemiological studies of wildland firefighters are crucial for minimizing health risks; however, they must account for the mixture of exposures in wildfire smoke. This review focuses on four aspects of wildland firefighters' health risks at the wildland-urban interface: 1) economic costs and health impact, 2) respiratory protection, 3) multipollutant mixtures, and 4) proactive management of wildfires.

Inflammatory profiles, gut microbiome, and kidney function are impacted after high-fidelity firefighter training

BACKGROUND

Firefighters are frequently exposed to high temperatures, environmental toxicants, and strenuous physical demands. The health impacts of these occupational exposures on processes including inflammation and kidney function as well as on the gut microbiota are poorly understood. A firefighter training course may provide a controlled environment to assess these health risks.

METHODS

Basic health measures, stool, and blood samples were obtained from 24 firefighters participating in a one-week, heat-intensive training course. Indicators of inflammation, gut permeability, kidney health, and stool microbiota composition were measured before and after the training course in 18 participants. Urine specific gravity was measured before and after a heat-intensive training day to evaluate dehydration.

RESULTS

The majority of firefighters in this cohort were categorized as hypertensive and experienced multiple heat-related illness symptoms during the training week and dehydration after the heat-intensive training day. While plasma IL-1β, CXCL8, and NGAL decreased over the training week, other indicators of inflammation and acute kidney injury increased, and estimated kidney function declined. Microbiota composition shifted over the course of the training week, with changes in Peptostreptococcus anaerobius and Streptococcus.

CONCLUSIONS

This pilot study conducted in a controlled field setting suggests that the occupational environment of firefighters may increase their risk for systemic inflammation and kidney disease.

Military field training exercise with prolonged physical activity and sleep restriction causes hormonal imbalance in firefighter cadets

PURPOSE

To evaluate the impact of the "Search and rescue" field military training exercise (SR_FTX) on hormonal modulation and identify their possible correlation with physical and cognitive performance.

METHODS

An observational (before and after) study was carried out, with male firefighters cadets (n = 42; age = 23[22;27] years) undergoing a nine-day military exercise (SR_FTX). The Countermovement jump (physical performance), the Stroop test (cognitive alertness), and blood tests for testosterone, cortisol, GH, and IGF-1 were applied. Wilcoxon for paired samples and Spearman's correlation tests were used.

RESULTS

Testosterone (751.10 [559.10;882.8] vs. 108.40 [80.12;156.40] ng/dL) and IGF-1 (217.5 [180;239.30] vs. 105 [93;129] ng/mL) significantly decreased while GH (0.10 [0.06;0.18] vs. 1.10 [0.58;2.28] ng/mL) and cortisol (9.60 [8.20;11.55] vs. 15.55 [12.28;18.98] ug/dL) significantly increased. Physical performance (31.2 [30.04;35.4] vs. 21.49 [19,02;23,59] cm) and cognitive alertness were significantly worse after SR_FTX (Congruent task: 1,78 (0183) vs. 1,56 (0185) response/s and incongruous task: 1,23 (0191) vs. 1,02 (0207) response/s). The physical performance showed a strong correlation with testosterone (rho = 0.694) and regular correlations with both IGF-1 (rho = 0.598) and cortisol (rho = - 0.580). The Stroop test presented weak correlations with GH (rho = - 0.350) and cortisol (rho = - 0.361).

CONCLUSION

SR_FTX negatively impacted hormonal modulation, physical and cognitive performance. These findings could help commanders decide to replace the employed firefighters in a real mission more frequently. Also, if the real scenario allows, they could think about providing better work conditions, such as improving caloric intake and rest periods, to preserve the military performance and health.

Effects of liquid cooling garment on physiological and psychological strain of firefighter in hot and warm environments

This study aimed to explore the effects of a liquid cooling garment on the physiological and psychological strains of firefighters. Twelve participants wearing firefighting protective equipment with the liquid cooling garment (LCG group) and without the liquid cooling garment (CON group) were recruited to conduct human trials in a climate chamber. During the trials, physiological parameters (mean skin temperature (T_sk), core temperature (T_c), and heart rate (HR)) and psychological parameters (thermal sensation vote (TSV), thermal comfort vote (TCV), and rating of perceived exertion (RPE)) were measured continuously. The heat storage, sweating loss, physiological strain index (PSI), and perceptual strain index (PeSI) were calculated. The results indicated that the liquid cooling garment decreased the mean skin temperature (maximum value of 0.62 °C), scapula skin temperature (maximum value of 1.90 °C), sweating loss (26%), and PSI (0.95 scales) with a significant difference (p < 0.05) at some time points when compared with the CON group. Moreover, the liquid cooling garment had little influence (p > 0.05) on core temperature, heart rate, TSV, TCV, RPE, and PeSI. The association analysis indicated that psychological strain had the potential to predict physiological heat strain with an R² value of 0.86 between the PeSI and PSI. This study offers insights into the evaluation of cooling system performance, the design of next-generation cooling systems, and the improvement of firefighters' benefits.

Relationship between Body Mass Index and Health and Occupational Performance among Law Enforcement Officers, Firefighters, and Military Personnel: A Systematic Review

The prevalence of overweight and obesity among tactical populations is estimated at 70%-75%, which may negatively impact health and performance. The relationship between BMI and health and performance is well established among the general population, however, literature on such relationships among tactical populations has yet to be reviewed and evaluated. The purpose of this study was to systematically review available literature on the relationship between BMI and health and occupational performance among law enforcement officer, firefighters, and military personnel. After reviewing the literature, 27 articles were included. Nine studies found BMI was positively associated with cardiovascular disease (CVD) risk factors. Studies involving BMI and cancer were lacking. One study found BMI was positively associated with type 2 diabetes (T2DM) risk. Five studies on occupational/physical performance and 12 studies on injury found a higher BMI was often indicative of decreased performance and increased risk of injury in general, but protective against stress fractures. Overall, higher BMI was often associated with negative health and performance outcomes among tactical populations, especially when beyond the overweight classification. Public health practitioners should focus efforts on improving nutrition and physical activity to promote a healthy BMI among these individuals.

Exposure Risks and Potential Control Measures for a Fire Behavior Lab Training Structure: Part B. Chemical Gas Concentrations

Firefighters' or instructors' exposure to airborne chemicals during live-fire training may depend on fuels being burned, fuel orientation and participants' location within the structure. This study was designed to evaluate the impact of different control measures on exposure risk to combustion byproducts during fire dynamics training where fuel packages are mounted at or near the ceiling. These measures included substitution of training fuels (low density wood fiberboard, oriented strand board (OSB), pallets, particle board, plywood) and adoption of engineering controls such as changing the location of the instructor and students using the structure. Experiments were conducted for two different training durations: the typical six ventilation cycle (6-cycle) and a shorter three ventilation cycle (3-cycle) with a subset of training fuels. In Part A of this series, we characterized the fire dynamics within the structure, including the ability of each fuel to provide an environment that achieves the training objectives. Here, in Part B, airborne chemical concentrations are reported at the location where fire instructors would typically be operating. We hypothesized that utilizing a training fuel package with solid wood pallets would result in lower concentrations of airborne contaminants at the rear instructor location than wood-based sheet products containing additional resins and/or waxes. In the 6-cycle experiments (at the rear instructor location), OSB-fueled fires produced the highest median concentrations of benzene and 1,3 butadiene, plywood-fueled fires produced the highest total polycyclic aromatic hydrocarbon (PAH) concentrations, particle board-fueled fires produced the highest methyl isocyanate concentrations, and pallet-fueled fires produced the highest hydrogen chloride concentrations. All fuels other than particle board produced similarly high levels of formaldehyde at the rear instructor location. The OSB fuel package created the most consistent fire dynamics over 6-cycles, while fiberboard resulted in consistent fire dynamics only for the first three cycles. In the follow-on 3-cycle experiment, PAH, benzene, and aldehyde concentrations were similar for the OSB and fiberboard-fueled fires. Air sampling did not identify any clear differences between training fires from burning solid wood pallets and those that incorporate wood-based sheet products for this commonly employed fuel arrangement with fuels mounted high in the compartment. However, it was found that exposure can be reduced by moving firefighters and instructors lower in the compartment and/or by moving the instructor in charge of ventilation from the rear of the structure (where highest concentrations were consistently measured) to an outside position.

Biological monitoring for exposure assessment of volatile organic compounds by Korean firefighters at the fire site

The VOCs and metabolites in urine for exposed VOCs were evaluated for firefighters who participated in the actual fire fighting to determine whether firefighters were exposed to hazardous chemicals, which is the basic data on cancer risk of firefighters. When the fire extinguishing time is long, the concentration of benzene, PHEMA, and toluene among VOCs and metabolites in the case of fire suppression, rescue, and fire investigation work, which is estimated that the exposure of hazardous substances generated from the fire site at the time of fire suppression was large, significantly increased. In the case where the number of urination is 2 or less, the concentration of TZCA, toluene, and benzene among VOCs and metabolites was significantly increased compared to the number of urinating more than 2 times. In the concentration of VOCs and metabolites in urine corrected with creatinine, the concentrations of toluene and PHEMA in urine were significantly higher. The concentration of PHEMA in urine was higher in the group who participated in the fire suppression for more than 11 hours (long time) than the group who participated in the fire suppression for a short time.

Practical guidance for firefighter applicants preparing for cardiorespiratory fitness testing: a secondary analysis of self-reported physical activity levels

Adequate cardiorespiratory fitness is critical for firefighters since an insufficient level of fitness threatens the integrity of their operations and could be dangerous for their lives. In fact, the leading cause of mortality for on-duty firefighters is not injury but sudden cardiac death. Therefore, to mitigate these risks, potential firefighter recruits are often required to perform a graded exercise test to determine their cardiorespiratory fitness as part of the recruitment process. However, there are currently limited data available to prospective firefighters on the amounts and types of exercises needed to be successful in the graded exercise test, commonly known as a V̇O_2max test. Physiological parameters for the current secondary analysis were collected on firefighter applicants who performed the graded exercise test where 72% were successful and 28% were unsuccessful to meet the minimum standard set at 42.5 ml kg^-1 min^-1. Prior to their test, applicants were asked to describe their exercise training routine by indicating the number of minutes per week spent exercising. Activities were then divided into one of two categories: endurance exercise or strength and power exercise training. The total exercise training describes the sum of all activities performed each week. The sum of endurance exercise activities and the sum of strength and power exercise activities were compared between the successful and the unsuccessful groups and results showed that successful applicants had a higher training volume and performed more endurance exercise training as compared to unsuccessful applicants. Therefore, practical recommendations related to exercise training regime are presented for firefighter applicants to embrace as guidance to prepare for their graded exercise test as part of their recruitment process.

Characterizing firefighter's exposure to over 130 SVOCs using silicone wristbands: A pilot study comparing on-duty and off-duty exposures

Firefighters are occupationally exposed to an array of hazardous chemicals, and these exposures have been linked to the higher rates of some cancer in firefighters. However, additional research that characterizes firefighters' exposure is needed to fully elucidate the impacts on health risks. In this pilot study, we used silicone wristbands to quantify off-duty and on-duty chemical exposures experienced by 20 firefighters in Durham, North Carolina. By using each firefighter's off-duty wristband to represent individual baseline exposures, we assessed occupation-related exposures (i.e. on-duty exposures). We also investigated the influence of responding to a fire event while on-duty. In total, 134 chemicals were quantified using both GC-MS and LC-MS/MS targeted methods. Seventy-one chemicals were detected in at least 50% of all silicone wristbands, including 7 PFAS, which to our knowledge, have not been reported in wristbands previously. Of these, phthalates were generally measured at the highest concentrations, followed by brominated flame retardants (BFRs) and organophosphate esters (OPEs). PFAS were measured at lower concentrations overall, but firefighter PFOS exposures while on-duty and responding to fires were 2.5 times higher than off-duty exposures. Exposure to polycyclic aromatic hydrocarbons (PAH), BFRs, and some OPEs were occupationally associated, with firefighters experiencing 0.5 to 8.5 times higher exposure while on-duty as compared to off-duty. PAH exposures were also higher for firefighters who respond to a fire than those who did not while on-duty. Additional research with a larger population of firefighters that builds upon this pilot investigation may further pinpoint exposure sources that may contribute to firefighters' risk for cancer, such as those from firefighter gear or directly from fires. This research demonstrates the utility of using silicone wristbands to quantify occupational exposure in firefighters and the ability to disentangle exposures that may be specific to fire events as opposed to other sources that firefighters might experience.

Firefighter Occupational Cancer Risk: Starting the Conversation

This study was conducted to determine if an educational session would increase the firefighter's knowledge of their occupational cancer risk and increase their motivation and confidence to have a conversation with their primary care provider (PCP) in regard to their occupational cancer risk. This study was an exploratory descriptive interventional pilot study. Firefighters self-reported using a pre-/post-educational intervention survey. Results were analyzed using a paired t test in IBM SPSS Version 23 to compare the pre-/post-test mean scores. There were statistically significant differences noted in the mean scores of the pre-/post-interventional survey tool. It seems an educational intervention can motivate and increase the firefighter's confidence to have a conversation with their PCP in regard to their occupational cancer risk. Firefighter perceptions of their "lived" care experience at the PCP level shared during study sessions also contributed to some key conclusions. These conclusions lead to the development of an informational wallet card for the firefighter to use as a conversational tool during a visit with their PCP. Motivating firefighters to have a conversation with their PCP in regard to their occupational cancer risk could potentially increase firefighter occupational cancer awareness at the PCP level and result in earlier detection of cancers in firefighters leading to decreased firefighter cancer mortality rates. Increasing informed firefighter conversations at the PCP level in regard to their occupational cancer risk could potentially increase appropriate cancer prevention guidance and earlier cancer screenings at the primary care level.

Firefighters' feet: Differences by sex and weight-bearing

Firefighters have reported their protective boots to be bulky and ill-fitting, which they believe restrict the lower body movement on the unpredictable fireground. This study used 3D foot scanning to compare the shape of firefighters' feet to the general population, the shape of female firefighters' feet to males, and the impact of the heavy fire gear on foot shape. The results found the foot breadth of firefighters was larger than the general population and the feet of female firefighters were slimmer than males. Furthermore, it revealed that the feet of firefighters became longer, wider, and flatter when bearing the weight of fire gear. Protective boots should be designed based on the foot shape and dimensions of the actual population, with consideration of sex differences and the impact of weight-bearing for their safety.

Firefighter exposures to potential endocrine disrupting chemicals measured by military-style silicone dog tags

Studies suggest that exposure to potential endocrine disrupting chemicals (pEDCs) may contribute to adverse health outcomes, but pEDC exposures among firefighters have not been fully characterized. Previously, we demonstrated the military-style silicone dog tag as a personal passive sampling device for assessing polycyclic aromatic hydrocarbon exposures among structural firefighters. This follow-up analysis examined the pEDC exposures based on department call volume, duty shift, and questionnaire variables. Structural firefighters (n = 56) were from one high and one low fire call volume department (Kansas City, MO metropolitan area) and wore separate dog tags while on- and off-duty (n_dogtags = 110). The targeted 1530 analyte semi-quantitative screening method was conducted using gas chromatography mass spectrometry (n_pEDCs = 433). A total of 47 pEDCs were detected, and several less-frequently-detected pEDCs (<75%) were more commonly detected in off- compared to on-duty dog tags (conditional logistic regression). Of the 11 phthalates and fragrances detected most frequently (>75%), off-duty pEDC concentrations were strongly correlated (r = 0.31-0.82, p < 0.05), suggesting co-applications of phthalates and fragrances in consumer products. Questionnaire variables of "regular use of conventional cleaning products" and "fireplace in the home" were associated with select elevated pEDC concentrations by duty shift (paired t-test). This suggested researchers should include detailed questions about consumer product use and home environment when examining personal pEDC exposures.

Consensus on tasks to be included in a return to work assessment for a UK firefighter following an injury: an online Delphi study

OBJECTIVE

The aim was to provide a consensus tasks needed to be included in a return to work assessment for operational firefighters.

METHODS

A two round online Delphi study was conducted with twenty-four participants including firefighters, service fitness advisers and occupational health managers. A consensus was set at 70% agreement. In round one, participants completed an online survey relating to tasks to be included during a return to work assessment for firefighters following an injury. Round two was an online consensus meeting to discuss the tasks where consensus was not achieved.

RESULTS

A consensus was reached for ten of the thirteen tasks, including the number of repetitions required when lifting a light portable pump and climbing a ladder. A consensus was reached for the total distance equipment which should be carried. This included carrying a ladder, a hose and a light portable pump.

CONCLUSIONS

This study has provided a consensus for tasks to be included when assessing a firefighter for return to work. Further research is needed to understand how to use this assessment optimally.

The efficacy of a lifting strap as an ergonomic intervention for EMS providers: Does it make it easier to raise a supine patient to an upright sitting posture?

Patient handling related musculoskeletal injuries are prevalent among Emergency Medical Service (EMS) providers. The first step in many patient handling situations is where a supine patient on the floor is brought to a sitting position. This study investigated whether a strap, placed under the patient's torso and long enough that EMS providers can perform the patient raising task in a standing posture, reduced muscular effort. Fifteen participants raised a simulated patient, with the help of an assistant, using the strap method and a traditional method (grasping the shoulders) in an open area, a restricted space, and in a bathtub. Torso postures improved in all location conditions when using the strap. The muscle activation data showed mixed results. While EMG responses from the latissimus dorsi muscles were reduced, EMG activity of the erector spinae muscles increased when the strap was used. Perceived effort assessments supported the use of the strap.

Psychosocial barriers and facilitators for a successful return to work following injury within firefighters

Objective

The aim was to explore firefighter’s experiences during their recovery from injury. Focused specifically on exploring perceived psychosocial barriers and facilitators firefighters faced during recovery and return to work.

Methods

Semi-structured interviews were used to provide an in-depth understanding of the firefighter’s experiences. The semi-structured interviews were informed by a topic guide. The topic guide focused on five main themes, (1) overall experience of returning to operational duties following an injury, (2) perceived barriers experienced during their return to work, (3) perceived facilitators experienced during their return to work, (4) confidence in participating in physical activity following injury and (5) where they felt areas of improvement could be made with the return to work process. Thematic analysis of the data collected was undertaken using The Framework Method.

Results

Two main themes were sought after transcription: barriers and facilitators. From these, nine subthemes were identified (1) communication, (2) confidence in physical activity participation, (3) modified duties, (4) physiotherapy, (5) return to operational duties, (6) support, (7) inconsistency, (8) use of station gyms, (9) detachment from the watch.

Conclusions

Consideration should be made for the consistency of procedures followed during an individual’s return to work following an injury. Further research is needed to understand if the themes identified in this study are the same for other fire services. Further research is also needed to understand how the findings may be best implemented within the fire service.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01712-z.

The Interaction of Inflammatory Markers and Alcohol-Use on Cognitive Function in Korean Male Firefighters

OBJECTIVE

Cognitive functions have been shown to become impaired due to alcoholism. Recently, neuroinflammation gained attention for playing a role in the neurotoxic effect of alcohol. However, there is limited data on the relationship between alcohol and cognitive function, based on the mechanism of inflammation. This study examined whether the interaction between alcohol use and pro-inflammatory biomarkers is related to cognitive function in Korean male firefighters.

METHODS

A total of 474 firefighters were assessed for alcohol-related problems using CAGE, cognitive functions, and pro-inflammatory biomarkers (CRP, IL-6, TNF-α). Sequential multiple regression analyses were conducted to determine if inflammatory markers moderate the relationship between alcohol use and cognitive function.

RESULTS

Only a decreased attentional function was associated with the interaction of alcohol use and inflammatory markers, after controlling for age, sex, body mass index, lipid profiles, smoking, depression, fatigue, self-reported hypertension, diabetes, and musculoskeletal problems.

CONCLUSION

This study revealed that the interaction between alcohol use and inflammation is related to attentional function in Korean male firefighters. Additionally, this cross-sectional study suggests that diminishing attention, related to alcohol use, may be based on the mechanism of inflammation.

Lead contamination among Paris Fire Brigade firefighters who fought the Notre Dame Cathedral fire in Paris

BACKGROUND

On 15th April 2019, the fire at Notre Dame Cathedral, Paris, resulted in the melting of 410 tons of lead. Four hundred fourteen Paris firefighters were involved. For the purpose of preventive medicine, the level of lead contamination among the firefighters was assessed. This study objectives' were to describe the blood lead levels (BLLs) in the firefighters, to study the influence of some parameters such as the function of firefighters and the decrease in BLLs during the follow-up investigations.

METHODS

The emission of 138 kg of melted lead from the roof and spire of the Notre Dame Cathedral during the fire was estimated by the National Institute for Industrial Environment and Risks. Three categories were defined according to the estimated levels of external lead exposure and fire proximity: high (category 1, n = 170), medium (category 2, n = 151), and low (category 3, n = 93). Two to three weeks after the fire, blood samples to assess the BLLs were taken from firefighters in category 1 (N = 164) and from every female firefighter in category 1 and 2 (N = 4). When the BLL was above 50 μg/L (95th percentile of reference range concentrations for a sample of the French population), it was checked again at one month later (N = 31) and then, if still above 50 μg/L, at six months later (N = 10).

RESULTS

The geometric mean of initial blood lead level was 31.5 μg/L (CI 95% [27.7-35.9]; Min-Max: 7.0-307.6 μg/L). Twenty-five percent (n = 42) of initial BLLs were above 50 μg/L, versus 10% (n = 16) at 1 month, and 2% (n = 3) at 6 months. The French binding biological BLL limit value (400 μg/L for men and 300 μg/L for women was never exceeded and all BLLs decreased over time. BLLs varied according to the function occupied during the extinguishing of the fire: operators', officers' and those of unknown function. BLLs were significantly higher compared to drivers reflecting their lower distance to fire and fume.

CONCLUSIONS

The fire at Notre Dame Cathedral, Paris, resulted in moderate lead contamination among firefighters. Individual and collective protection measures probably helped to limit the contamination. Nevertheless, an effort could be made to improve the working conditions by rethinking the respiratory protection.

Heart rate response to alarm tones in firefighters

OBJECTIVE

To examine cardiovascular responses to medical (MED) and fire (FIRE) alarm tones in firefighters.

METHODS

Heart rate was collected throughout 24-h shifts (N = 41). Call logs were utilized post hoc to identify heart rate at the time the alarm sounded (TIME_TONE), peak heart rate following the alarm (TIME_PEAK), and heart rate at the time of station departure (TIME_DEPART) for MED and FIRE calls. A 2X3 (TONE x TIME) split-plot mixed-model repeated-measures analysis of variance (ANOVA) and least significant differences tests examined the influence of tone type on heart rate, expressed as a percent of age estimated maximum. Bivariate Pearson correlations examined the relationship between body mass index (BMI) and TIME_PEAK and TIME_DEPART. An alpha of 0.05 determined statistical significance and Bonferroni Corrections were applied to post hoc comparisons (p < 0.017).

RESULTS

Follow-up analyses for the significant 2 × 3 repeated-measures ANOVA (p = 0.035) indicated differences in heart rate for MED (p < 0.001) and FIRE (p < 0.001) where TIME_TONE < TIME_PEAK, TIME_TONE < TIME_DEPART, and TIME_PEAK > TIME_DEPART. There was a non-significant simple effect of time for MED and FIRE at TIME_TONE (p = 0.259), but significant effects of tone type where FIRE > MED at TIME_PEAK (p < 0.001) and TIME_DEPART (p = 0.002). There was a significant small positive relationship between BMI and TIME_PEAK (p = 0.002) and TIME_DEPART (p < 0.001) for MED only.

CONCLUSIONS

Alarms increased heart rates to a greater extent in FIRE than MED calls. Higher BMI was related to greater heart rate responses in MED but was unrelated to FIRE response.

An epidemiologic study of suicide among firefighters: Findings from the National Violent Death Reporting System, 2003 - 2017

Suicide is a significant concern among fire service due to high rates of suicide behaviors. The aim of this study was to describe suicides among firefighters using national suicide death data. Data from the National Violent Death Reporting System for 722 firefighters and 192,430 non-firefighters were analyzed to compare sociodemographics and risk factors between firefighter and non-firefighter decedents; and among firefighters based on suicide means. A greater proportion of firefighter decedents died by firearm compared to non-firefighters. Firefighter decedents were less likely to have been diagnosed with depression, but more likely to have been diagnosed with post-traumatic stress disorder compared to non-firefighters. A greater percentage of firefighter decedents had a relationship or physical health problem prior to death, but a lower percentage had a history of suicide thoughts/attempts. Among firefighter decedents, multivariate analysis showed physical health problems and disclosing suicide intent predicted death by firearm. Greater awareness of risk factors, reduced access to lethal means, and ensuring access to behavioral health services may aide in decreasing suicide mortality in this population. These findings should be interpreted with caution due to limitations concerning report accuracy, generalizability, small female sample size, and inclusion of data only for lethal suicide attempts.

Evaluation of silicone-based wristbands as passive sampling systems using PAHs as an exposure proxy for carcinogen monitoring in firefighters: Evidence from the firefighter cancer initiative

Compared to the general population, firefighters are known to sustain greater levels of exposure to hazardous compounds, despite their personal protective equipment, also known as turnout gear. Among the most significant toxins that firefighters are chronically exposed to are polycyclic aromatic hydrocarbons (PAHs). Additionally, firefighters have also been noted to exhibit an increased incidence of certain types of cancer. Considering a probable link between exposure to PAHs and increased rates of cancer in the fire service, we aim to document ambient chemical concentrations in the firefighter work environment. Our strategy involves the use of silicone-based wristbands that have the capacity to passively sorb PAHs. To determine if wristbands can serve as an effective chemical monitoring device for the fire service, silicone wristbands were pilot-tested as personal sampling devices for work environment risk monitoring in active-duty firefighters. Recovered wristbands underwent multiple extraction steps, followed by GC-MS analysis to demonstrate their efficacy in monitoring PAHs in the firefighter environment. Initial findings from all wristband samples taken from firefighters showed multiple exposures to various PAHs of concern for the health of the firefighters when in a fire environment. In addition to PAH monitoring, we examined known and potential sources of PAH contamination in their work environment. To that end, profiles of elevated PAH concentrations were documented at various fire stations throughout South Florida, for individual firefighters both during station duties and active fire response.

Stress, burnout and diminished safety behaviors: An argument for Total Worker Health® approaches in the fire service

INTRODUCTION

Firefighting is stressful work, which can result in burnout. Burnout is a safety concern as it can negatively impact safety outcomes. These impacts are not fully understood within the fire service. Further, the fire service needs support that safety strategies are needed to protect and promote the health and wellbeing of firefighters.

METHODS

Structural equation modeling was completed to examine a hypothesized model that linked stress and burnout to diminished safety behavior outcomes among a sample of career firefighters.

RESULTS

Findings support a full mediation model. Firefighter stress perceptions were positively associated with burnout and burnout was negatively associated with safety compliance behavior, personal protective equipment behavior, safe work practices, and safety citizenship behavior.

CONCLUSIONS

These results illustrate the negative impact of health impairment on firefighter safety behaviors. Practical Applications: These outcomes suggest that interventions aimed at protecting and promotion firefighter health are needed. Total Worker Health® (TWH) approaches may provide the framework for these interventions.

Discovery of firefighter chemical exposures using military-style silicone dog tags

Occupational chemical hazards in the fire service are hypothesized to play a role in increased cancer risk, and reliable sampling technologies are necessary for conducting firefighter chemical exposure assessments. This study presents the military-style dog tag as a new configuration of silicone passive sampling device to sample individual firefighters' exposures at one high and one low fire call volume department in the Kansas City, Missouri metropolitan area. The recruited firefighters (n = 56) wore separate dog tags to assess on- and off-duty exposures (n_dogtags = 110), for a total of 30 24 h shifts. Using a 63 PAH method (GC-MS/MS), the tags detected 45 unique PAHs, of which 18 have not been previously reported as firefighting exposures. PAH concentrations were higher for on- compared to off-duty tags (0.25 < Cohen's d ≤ 0.80) and for the high compared to the low fire call volume department (0.25 ≤ d < 0.70). Using a 1530 analyte screening method (GC-MS), di-n-butyl phthalate, diisobutyl phthalate, guaiacol, and DEET were commonly detected analytes. The number of fire attacks a firefighter participated in was more strongly correlated with PAH concentrations than firefighter rank or years in the fire service. This suggested that quantitative data should be employed for firefighter exposure assessments, rather than surrogate measures. Because several detected analytes are listed as possible carcinogens, future firefighter exposure studies should consider evaluating complex mixtures to assess individual health risks.

Moving FOCUS - The Fire Service Organizational Culture of Safety survey - From research to practice

INTRODUCTION

FOCUS, the Fire Service Organizational Culture of Safety survey, has evolved from a research to practice enterprise within the United States fire and rescue service. The FOCUS tool was developed through a FEMA Assistance to Firefighters Research & Development grant. Then it moved to practice in the field. To date over 35,000 firefighters have participated. A current FEMA Fire Prevention & Safety grant can support FOCUS assessment in up to 1,000 fire departments, with the potential of nearly 120,000 respondents. With each funding cycle, the goal of the FOCUS program is to grow and measure its research to practice impact.

METHODS

We describe how FOCUS safety culture results are disseminated to fire service stakeholders. By utilizing customized reports and a training curriculum we demonstrate how FOCUS is moving research to practice by: (1) illustrating how survey results can be delivered effectively to practitioners, (2) providing examples of how fire departments are using results, and (3) sharing the reactions of the fire service to the FOCUS instrument, reports, and our flagship data training curriculum - Culture Camp. Results' Conclusions: Qualitative and quantitative data are analyzed to demonstrate the impact and acceptance of the FOCUS report and Culture Camps. Stakeholders reflect on the report and the experience of having quantitative safety culture data. Culture Camps are evaluated qualitatively and quantitatively using a matching game exercise, pre/post-test, a fire department teach back, and a Qualtrics evaluation. Practical Applications: Traditionally, the fire service has focused on reducing negative safety outcomes. FOCUS is helping shift their attention further upstream in the prevention pathway through the measurement of important organizational outcomes. The research to practice evolution of the FOCUS program may hold utility for other occupational groups when considering how to steadily move occupational health and safety research to practice in the field for measurable impact.

Pain intensity, alcohol use motives, and alcohol use among firefighters: The moderating role of pain-related anxiety

Firefighters are an understudied population that reports high rates of alcohol use and hazardous drinking. Pain, which is also commonly experienced by firefighters, may be associated with alcohol use and alcohol use motives, as research among the general population suggests that pain is associated with coping-oriented drinking. Pain-related anxiety, reflecting a tendency to respond to pain with anxiety or fear, may link pain to coping-oriented drinking among firefighters. Therefore, the current study examined the moderating role of pain-related anxiety on the association between pain intensity and alcohol use motives as well as alcohol use severity. The sample was comprised of 189 (M_age = 40.33, SD = 9.97, 89.9% male) firefighters. Results from the current study supported a significant moderation effect of pain-related anxiety on the association between pain intensity and alcohol use coping motives, whereby the association between pain intensity and coping motives was stronger for those with high compared to low pain-related anxiety. No significant moderation effects were documented for social, enhancement, or conformity motives; and no significant moderation effect was found for alcohol use severity. These results highlighted the potential importance of pain intensity and pain-related anxiety in coping-oriented alcohol use among firefighters.

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.

Moderated Mediation Effect of Mindfulness on the Relationship Between Muscular Skeletal Disease, Job Stress, and Turnover Among Korean Firefighters

Background

This study investigated the effect of increased job stress, caused by musculoskeletal disease (MSD) among firefighters, on a firefighter's intention to leave the profession, henceforth referred to as “turnover intention,” and verified the moderating effect of mindfulness on such a relationship.

Methods

A survey involving a total of 549 Korean male firefighters as participants was conducted herein, and the following results were obtained: the mediation effect of the MSD to turnover intention through job stress was confirmed, and the indirect effect of job stress was verified.

Results

We verified the moderated mediation effect of mindfulness on the relation:MSD, job stress, and turnover intention. The conditional indirect effect for middle and high levels of mindfulness is significant.

Conclusion

The result of this study is supported by proofs of the relationship between a firefighter's MSD, job stress, and turnover intention, and these case studies reveal the moderated mediation effect of dispositional mindfulness.

Prevalence and implications of gambling problems among firefighters

Firefighting is a high-risk occupation that accounts for vulnerability to a range of mental health problems and addictive behaviours. However, no research has addressed whether this vulnerability extends to gambling problems, and the aim of this study was thus to provide new data on frequency and implications of such problems in this occupational context. The sample consisted of n = 566 career and retained firefighters who participated in a cross-sectional survey of an Australian metropolitan fire service. The Problem Gambling Severity Index (PGSI) was used to operationalise both clinically significant levels of problem gambling (PGSI ≥ 5), and 'at-risk' gambling (PGSI 1-4); alongside measures of major depression (PHQ-9), anxiety (GAD-7), Posttraumatic Stress Disorder (PCL-5) and alcohol problems (AUDIT), as well as other addictive behaviours, wellbeing and psychosocial issues. Results indicated 12.3% of firefighters that reported any gambling problems across a continuum of severity (PGSI ≥ 1), including 2.3% that were problems gamblers, and 10.0% reporting at-risk gambling. The weighted prevalence of problem gambling was comparable to other significant mental health conditions including depression and PTSD, while the rate of any gambling problems was high relative to other addictive behaviours. Gambling problems were associated with poor mental health and wellbeing, but not psychosocial indicators (e.g., financial difficulties). The findings suggest that gambling problems across a spectrum of severity may be significant yet hidden issues among emergency service workers, and thus require increased recognition and responses at the organisational level.

Exploring prevention and mitigation strategies to reduce the health impacts of occupational exposure to wildfires for wildland firefighters and related personnel: protocol of a scoping study

BACKGROUND

With an increase in wildfire activity across the globe and growing numbers of personnel involved each year, it is necessary to explore the health impacts of occupational exposure to wildfires and the practices and policies that can be implemented to mitigate these effects. The aim of this work is to (1) identify the impact occupational exposure to wildfires has on health outcomes including physical, mental, and social wellbeing; (2) examine the characteristics and effectiveness of mitigation strategies or policies to reduce negative health impacts as reported by current literature and reports; and (3) develop a program of research to address and understand the health impacts of occupational exposure to wildfires based on gaps in the literature and stakeholder priorities.

METHODS

This scoping study will be conducted in two phases: (1) scoping literature review and (2) modified Delphi process. The literature review will follow a methodologically rigorous scoping review approach that includes (a) identifying the research question (and protocol development), (b) identifying literature (an iterative process), (c) selecting relevant studies, (d) extracting data into tables, and (e) synthesizing, summarizing, and reporting results. Alongside this, a modified Delphi process will be conducted to define priorities for wildland fire occupational health research. A partnership with the British Columbia (BC) Wildfire Service will enable exploring the appropriateness of identified mitigation strategies and health risks for the BC context.

DISCUSSION

This two-phase approach will provide an in-depth review of the literature of the health impacts of occupational exposure to wildfires and identify mitigation strategies or policies implemented to protect workers and reduce negative health impacts. It is anticipated that these findings may provide recommendations for "quick wins" or initial action that can be implemented within the BC context to reduce negative health outcomes, and inform gaps in context-specific research that needs to be addressed through a strategic, collaborative research program over the next 5 years.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework osf.io/ugz4.

Firefighters' absorption of PAHs and VOCs during controlled residential fires by job assignment and fire attack tactic

To better understand the absorption of combustion byproducts during firefighting, we performed biological monitoring (breath and urine) on firefighters who responded to controlled residential fires and examined the results by job assignment and fire attack tactic. Urine was analyzed for metabolites of polycyclic aromatic hydrocarbons (PAHs) and breath was analyzed for volatile organic compounds (VOCs) including benzene. Median concentrations of PAH metabolites in urine increased from pre-firefighting to 3-h post firefighting for all job assignments. This change was greatest for firefighters assigned to attack and search with 2.3, 5.6, 3.9, and 1.4-fold median increases in pyrene, phenanthrene, naphthalene, and fluorene metabolites. Median exhaled breath concentrations of benzene increased 2-fold for attack and search firefighters (p < 0.01) and 1.4-fold for outside vent firefighters (p = 0.02). Compared to interior attack, transitional attack resulted in 50% less uptake of pyrene (p = 0.09), 36% less uptake phenanthrene (p = 0.052), and 20% less uptake of fluorene (p < 0.01). Dermal absorption likely contributed to firefighters' exposures in this study. Firefighters' exposures will vary by job assignment and can be reduced by employing a transitional fire attack when feasible.

Descriptive analysis of prevalence and medical expenses of cancer, cardio-cerebrovascular disease, psychiatric disease, and musculoskeletal disease in Korean firefighters

Background

Firefighters are exposed to many dangerous working conditions. Many studies have identified the risk of disease for firefighters, but only a few studies have addressed the medical expenses of firefighters, which represents a concrete scale of disease. Our purpose in this study was to determine the medical expenditures of firefighters to assess the overall scale of disease in Korea. We focused on cancer, mental disorders, cardio-cerebrovascular disease, and musculoskeletal disease, the prevalence of which was expected to be high in firefighters.

Methods

This study utilized National Health Insurance Service data. We targeted firefighters, police officers, and government officials. We classified disease based on the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes. We compared prevalence by the age-standardized prevalence rate, considering standard distribution of the population. Medical expenditure of disease was defined as outpatient fees, hospitalization fees, and drug costs. Total medical expenditures were calculated by the sum of those 3 categories.

Results

The age-standardized prevalence of cancer, mental disorders, and cardiovascular disease in firefighters was slightly higher than or similar to that of government officials and police officers (no significant difference). However, medical expenditures for stomach cancer, mental disorders, and most cardio-cerebrovascular diseases were higher in firefighters than in others. In particular, firefighters spent 12 times more money for ischemic heart disease than did government officials. Of musculoskeletal diseases, lumbar disc disorder had the highest expenditures among firefighters.

Conclusions

The age-standardized prevalence of most of diseases of firefighters was not as high as in the other groups, but the medical expenses of firefighters were much higher than those of government officials and police officers.

Heart Rate Responses during Simulated Fire Ground Scenarios among Full-Time Firefighters

Simulated fire ground scenarios (SFGS) provide firefighters with an opportunity to maintain skills, receive feedback, and optimize performance. Although there is extensive research on heart rate (HR) changes in the firefighter population, few examine the differences between positions. Firefighters are primarily responsible for fire suppression and control (23), officers for emergency operations and organizational management, paramedics for providing on-scene emergency medical care, and drivers are responsible for driving the fire apparatus. Utilizing HR analysis to quantify the physical demands of SFGS among firefighting crews by position. Sixty-seven male (age: 38.97 ± 9.17; ht: 177.99 ± 6.45 cm. wt: 88.83 ± 13.55 kg) firefighters (FF) participated in this investigation. FF crews performed two SFGS involving the suppression and control of a structural fire. Participants were outfitted with heart rate (HR) monitors and average heart rate (HRavg) and maximum heart rate (HRmax) data were collected for each of the two SFGS. Significant differences were observed for Age (P = 0.01), APMHR (P = 0.01), HRmax1 (P = 0.04), and HRmax2 (P = 0.04) in which firefighters had higher values for Age-predicted maximal heart rate (APMHR), HRmax1, HRmax2 compared to the officers. SFGS can be very physically demanding events that may elicit maximal or near maximal HR responses regardless of position. Based on the metabolic demands of these events and the individual firefighter's capabilities, this information can be used to develop resistance training and conditioning programs that optimize performance at maximal or near maximal heart rates.

Validity assessment of self-reported smoking status in firefighters using the urine cotinine test

BACKGROUND

In firefighters, smoking management is important because they are exposed to various harmful substances in their occupational environment. Accurate surveys of smoking status are essential to control tobacco use. The main disadvantage of self-report questionnaires, which are commonly used for investigating smoking status, is the possibility that the subjects' response are invalid. If the validity of firefighters' answers on smoking questionnaires is not adequate, different methods will be needed for investigating smoking status in firefighters.

METHODS

This study was conducted on 445 male firefighters from 9 fire stations in Daegu (the city in South Korea) who visited a medical institution for medical checkup in 2016. The urine cotinine test strip (DCT-102; CLIAwaived Inc., cut-off value = 200 ng/mL) was used to classify the actual smoking status and to assess the validity of self-reported smoking status on questionnaires. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the smoking questionnaires were analyzed. Subjects testing positive in the urine cotinine test (assumed the actual current smokers) were selected. The frequency at which actual current smokers were misclassified as current non-smokers by the questionnaire was calculated. Subjects' characteristics were analyzed for possible association with any discrepancy between self-reported smoking status and urine cotinine test results.

RESULTS

The smoking rates among firefighters surveyed using the smoking questionnaire and the urine cotinine test were 22.47% and 51.24%, respectively. Of the all subjects, 29.66% (n = 132) were misclassified. The sensitivity of the smoking questionnaire was 42.98%, the specificity was 99.08%, the PPV was 98.00%, and the NPV was 62.32%. In the 228 subjects classified as current actual smokers by the urine cotinine test, 57.02% (n = 130) were misclassified on the questionnaire. The misclassification rate increased with age. The degree of misclassification also increased when subjects had a history of disease.

CONCLUSIONS

In present study, the validity of the smoking questionnaire for firefighters was not suitable for investigating smoking status due to low sensitivity. To increase the validity of smoking status monitoring in firefighters, consideration of the various factors like survey environment, subjects' characteristics, and occupational factors is needed.

A biomechanical evaluation of potential ergonomic solutions for use by firefighter and EMS providers when lifting heavy patients in their homes

Firefighters and EMS providers continue to be challenged when lifting heavy patients in their homes. This study investigated the biomechanical efficacy of four devices that could be used by two-person teams when lifting patients from the floor, from a reclining chair, or from a Simulated Inflatable Seat at chair height. Fourteen firefighter-paramedics, working in two-person teams, were instrumented with motion capture and electromyographic sensors. The Binder Lift™, the Simple Strap, and the Slip Preventer were used to lift patient actors, and were compared to current lifting methods. Postural data and the peak dynamic spine shear forces at the L5/S1 level were reduced when using the Simple Strap, the Binder Lift, and the Simulated Inflatable Seat. The Slip Preventer reduced spine flexion when the Binder Lift was not used. In summary, the tested devices can potentially reduce the biomechanical loads experienced by EMS providers as they lift and move patients.