Transcript Document

Missouri
Valley Division
Annual Conference
A Required Stop on the Trail to Great Leadership
Chief C. A. Haigh
Hanover Park Fire Department
Reducing Line of Duty Deaths:
The Role of Research, Training & Organizational
Leadership
Chief C. A. Haigh
Hanover Park Fire Department
Contributing Authors
Denise L. Smith, Ph.D.
Professor and Chair of Exercise Science, Skidmore College
Research Scientist, University of Illinois Fire Service Institute
Craig A. Haigh, M.S., CFO, EFO, MIFireE, NREMT-P
Fire Chief, Hanover Park (IL) Fire Department
Field Staff Instructor, University of Illinois Fire Service Institute
Gavin Horn, Ph.D.
Director, Illinois Firefighter Life Safety Research Center
Research Scientist, Department of Mechanical Science & Engineering, University
of Illinois
Chief C. A. Haigh
Hanover Park Fire Department
Topics:
I.
II.
The Role of Research
Case Study:



What the Research is Telling Us about the
Physiologic Stress of Firefighting
Implementing Research into field operations –
On Scene Rehab
Impact of Organizational Leadership
Chief C. A. Haigh
Hanover Park Fire Department
Goal of Fire Service
Research
Enhanced Knowledge
Training
Changed Behavior
Chief C. A. Haigh
Hanover Park Fire Department
Internal Policy
Development
Support of Labor
The Process of Research
Implementation
Acceptance by standard
setting/review organizations (NFPA,
State Fire Marshal, OSHA, UL,
NIOSH, etc.)
Enhanced Knowledge
Support of Fire Service
Organizations (IAFC, IAFF,
NVFC, USFA, NFFF,
ICMA, IAAI, etc.)
Research / Development / Manufacturing
Cultural Change
Acceptance & buy in of
Fire Administration (Fire
Chiefs & Command
Staff)
Support of local
organizations (County Fire
Associations, MABAS, etc.)
Training
Acceptance & buy In of
Elected Officials and
their willingness and
ability to pay.
Acceptance & buy in of
City/County/District
Administration (i.e. City
Managers)
Changed Behavior
Chief C. A. Haigh
Hanover Park Fire Department
Limitations of Local Departments to
Implement Research Driven
Change
1.
Lack of visionary leadership.
This is the way we have always done it…
2.
3.
Lack of strong labor / management relations.
Failure to maintain priorities:
Be cautious of the swirling toilets and washing
wheels syndrome.
4.
5.
Lack of fire service support by elected officials
and community.
Lack of financial resources.
Chief C. A. Haigh
Hanover Park Fire Department
Fire Service Downfall
The Fire Service in general does a poor job
of looking beyond the walls of our
organizations to find workable solutions
to complex problems. To successfully
implement change that is driven by
today’s research, departments must
think globally and be willing to change
tradition in order to address current
concerns.
Chief C. A. Haigh
Hanover Park Fire Department
Case Study
{
Physiological Impact
of Heat Stress
Chief C. A. Haigh
Hanover Park Fire Department
Current Situation
Decreasing number of fire…
Relatively unchanged number of
firefighter fatalities.
Chief C. A. Haigh
Hanover Park Fire Department
Cardiovascular Impact
on LODD
Between 1995–2011:
•
799 Firefighters died due to Cardiac or
Cerebrovascular Related Events.
•
•
•
•
2011 -- 49
2012 -- 17
Cardiac or Cerebrovascular events account for
approximately 50% - 60% of all annual line of duty
deaths.
An additional 700-1000 annual cardiac or
cerebrovascular events occur that do not result in a
LODD (810 in 2010).
Chief C. A. Haigh
Hanover Park Fire Department
Cardiovascular Impact
on LODD
Is it more than old out of shape
firefighters? Is there something
about firefighting that serves as the
“trigger” for a cardiovascular event?
Chief C. A. Haigh
Hanover Park Fire Department
Cardiovascular Impact
on LODD
What do we know?
Chief C. A. Haigh
Hanover Park Fire Department
The job is getting
harder…
•
•
Increased BTU Production
Changes in construction
o
•
•
•
Light weight / open floor
space / energy efficient /
green
Require greater GPM to
cool the BTU production.
Decreased company
staffing
Protective equipment
provides full
encapsulation.
Chief C. A. Haigh
Hanover Park Fire Department
Personal Risk Factors for
Cardiovascular Problems
•
•
•
•
•
•
•
•
•
Age
Gender
Family History
Diabetes
Hypertension
Smoking
High Cholesterol
Obesity
Lack of Exercise
Chief C. A. Haigh
Hanover Park Fire Department
Coupled with Heat
Stress
•
•
•
•
•
•
Work performed
Protective
Equipment
Thermal
Environment
Health Status
Fitness Level
Hydration Level
Disastrous potential exists.
Chief C. A. Haigh
Hanover Park Fire Department
How do we reduce the
impact of heat stress?
1. Personal physical fitness
2. Health screening
3. On-Scene Rehabilitation
Chief C. A. Haigh
Hanover Park Fire Department
On-Scene Rehabilitation
If Heat Stress is the likely causation of
many detrimental physiologic
responses, why is rehab not a integral
part of the fire service response?
Several Likely Reasons…
Chief C. A. Haigh
Hanover Park Fire Department
Lack of rehab?
•
Culture of Fire
Service
•
•
•
“Rehab is for Sissies”
Undeveloped onscene rehabilitation
and support systems
Lack of widespread
research
•
Why we do what we
do?
Chief C. A. Haigh
Hanover Park Fire Department
Field-based Research
To Document the Stress of Firefighting
What do we know?
Chief C. A. Haigh
Hanover Park Fire Department
Basic Statistics
•
1,148,100 FF (USFA, 2009)
•
•
•
335,950 career
812,150 volunteers
Firefighting is a
Dangerous Occupation
•
•
Injuries – 71,875 (2010)
Fatalities – approx. 100
per year
•
50% - 60% due to sudden
cardiac events
Chief C. A. Haigh
Hanover Park Fire Department
Reducing Injuries and
Fatalities
•
•
•
•
•
•
•
•
Prevent Fires, or detect
earlier
Optimal Staffing
Training
Safety Training
• Driving
• Fireground
• Attitudes, awareness
(cultural issues)
Personal Protective Clothing
Improved Incident
Command
Fitness and Wellness
Programs
On-Scene Rehabilitation?
Chief C. A. Haigh
Hanover Park Fire Department
Sudden Cardiac Death
Primary Cause of LODD
Other Crush
5% 4%
CVA
1%
Heat Exhaustion
1%
Asphyxiation
6%
Burns
8%
Hear Attack
58%
Trauma
17%
NPFA Firefighter Deaths by Nature -- 2011
Chief C. A. Haigh
Hanover Park Fire Department
Hear Attack
Trauma
Burns
Asphyxiation
Other
Crush
Heat Exhaustion
CVA
Despite reduction in total fires, fatalities
due to cardiovascular issues remain relatively
unchanged.
USFA Firefighter Fatalities 1986-2009
Chief C. A. Haigh
Hanover Park Fire Department
Firefighter Deaths to Date by
Nature of Injury -- 2012




Cardiac & Stroke:
Trauma:
Other:
Crushing:
Chief C. A. Haigh
Hanover Park Fire Department
53.1%
37.5%
6.3%
3.1%
Total Firefighter Injuries
Figure 1
Total Firefighter Injuries by Year (1981-2010)
120,000
103,340
Number of Firefighter Injuries
100,000
80,000
71,875
60,000
40,000
20,000
0
Source: NFPA Annual Survey of Fire Departments
for U.S. Fire Experience (1981-2010)
Year
From 1994 on, number of exposures was collected separately
Chief C. A. Haigh
Hanover Park Fire Department
Distribution of Injuries
Overexertion / Strain
12%
26%
7%
Fall, Jump, Slip
Exposure (Fire Products,
Haz Mat, Etc)
Extreme Weather
18%
Other
22%
Struck by Object
5%
10%
Contact with Object
Karter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2011
Chief C. A. Haigh
Hanover Park Fire Department
Firefighter Injuries:
Total injuries have reduced in hand with
total fires, yet leading causes
(overexertion/strain & slips/falls) remain
relatively stable
90,000
80,000
70,000
60,000
Total Injuries
50,000
40,000
Slip, Fall,
Jump
Overexertion
/Strain
30,000
20,000
10,000
0
2003
2004
2005
2006
Karter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2009
2007
2008
2009
Is there a correlation
between overexertion and
strain and slips/trips/falls?
Chief C. A. Haigh
Hanover Park Fire Department
Working Hypothesis
Firefighting
Heat Stress
Fatigue
Overexertion/
Strain
Biomechanical
CV/Coagulatory
Changes
Changes
Reduced Situational
Awareness
Slips, Trips, Falls
Sudden Cardiac Events
Disorientation, Entrapment,
Poor decisions, and related
Injuries and Fatalities
Chief C. A. Haigh
Hanover Park Fire Department
Physiological/Psychological Stress
of Firefighting
Probably the greatest stress ever imposed on the
human cardiovascular system is the combination
of exercise and hyperthermia. Together these
stresses can present life-threatening challenges,
especially in highly motivated athletes who
drive themselves to extremes in hot
environments.
L. Rowell, 1986
Chief C. A. Haigh
Hanover Park Fire Department
Simplified Schematic of Possible
Causes of Heart Attack in FF
Perfuse
sweating
Decreased
Plasma volume
Circulatory
Shock
Increased Body
Temperature
Altered
Electrolytes
Arrhythmias
Activation of
SNS
Increased
viscosity
Clot
Formation
Heart Attack
Chief C. A. Haigh
Hanover Park Fire Department
Changes in
HR and BP
Plaque
Disruption
U of I Study:
Response of Firefighters following
short-term strenuous firefighting
activities
Firefighting Tasks
Dummy drag
Carry and discharge
extinguisher
Hose pull
Wood chopping
6/8/2012
Denise L. Smith, PhD
Skidmore College
33
Study Cycle
drills
drills
drills
Rehab
~ 8min ~ 8 min
Rc1
Rc2
~ 8 min
= measurement period
6/8/2012
Denise L. Smith, PhD
Skidmore College
34
Heart Rate Response
*
200
*
*
150
100
HR (bpm)
50
0
Rest
1st Trial
2nd Trial
3rd Trial
* p < .05 vs rest
6/8/2012
Denise L. Smith, PhD
Skidmore College
35
Stroke Volume Response
100
#
80
60
SV (ml)
40
20
0
Rest
1st Trial
2nd Trial
3rd Trial
# p <.05 vs T1
6/8/2012
Denise L. Smith, PhD
Skidmore College
36
Stroke Volume Response
100
#
80
60
Take home message:
SV (ml)
40
20
0
Push Fluids
Rest
1st Trial
2nd Trial
3rd Trial
# p <.05 vs T1
6/8/2012
Denise L. Smith, PhD
Skidmore College
37
Changes in Core
Temperature
39
38.5
38
37.5
Trectal
37
36.5
36
Pre
6/8/2012
Trial 1
Trial 2
Trial 3
Denise L. Smith, PhD
Skidmore College
10 min
rec
38
Changes in Core
Temperature
39
38.5
38
Take home message:
37.5
Trectal
37
36.5
36
Provide Cooling
Pre
6/8/2012
Trial 1
Trial 2
Trial 3
Denise L. Smith, PhD
Skidmore College
10 min
rec
39
Effect of Firefighting on Coagulation
Factors (N=10; Mean ± SD)
Variable
Pre
Post
Platelets (x103/uL)
236.6 (48.2)
290.37 (83.4) *
Prothrombin Time (s)
10.18 (0.6)
10.13 (0.6)
Activated Partial
Thrombopastin Time (s)
25.2 (2.3)
25.5 (2.7)
Fibrinogen (mg/dL) corrected
254.5 (17.2)
Antithromin III (%)
109.7 (4.9)
243.9 (20.8) †
116.8 (6.9) *
(Fibrinogen & Antithromin III: Factors in Blood Clotting)
*
†
p<0.001
p<
6/8/2012
0.05
Denise L. Smith, PhD
Skidmore College
40
Effects of Simulated Fire-Fighting Stress on Plasma
Volume Shifts
a
Change in Plasma Volume (%)
4
2
0
-2
-4
-6
-8
-10
-12
-14
-16
Pre
a
Post
Denise
L. Smith,
significantly (p <.05) different pre and
post
90’ PhD
6/8/2012
Skidmore College
Post 90’
41
Effects of Simulated Fire-Fighting Stress on
Glucose
a
160
140
mg/dL
120
c
100
80
60
40
a
Pre
Post
significantly (p < .05) different pre and post 90
c significantly (p < .05) different pre and post 90’
Denise L. Smith, PhD
6/8/2012
Skidmore College
Post 90'
42
Impact of Rehab
Firefighting
Physiological
Responses
Rehab
Muscular/
Metabolic
Fatigue
•Rest/Recovery
•Nutrition
Dehydration
Fluid
Replacement
Denise L. Smith, PhD
Skidmore College
Heat
Stress
•Cooling
•Climatic Relief
•Medical
Monitoring
Cardiovascular Strain
•HR, BP
•Blood Clotting
•Rest
•Cooling
•Fluid Replacement
•Medical Monitoring
Implementation of an Effective
Rehabilitation Program
NFPA 1584 On-Scene Rehabilitation
Chief C. A. Haigh
Hanover Park Fire Department
The Role of Rehab
Rehab when implemented properly can
reduce the detrimental effects of heat
stress and lesson the potential for a
cardiovascular/cerebrovascular incident
as well as heat related illnesses.
The Question: How to do this with
limited human and financial resources?
Chief C. A. Haigh
Hanover Park Fire Department
How, when, and by whom?
•
•
How many of us have
available staffing to
dedicate to rehab?
At what point is rehab
established:
•
•
•
•
When the crews look
tired?
After 2 SCBA bottles?
When the weather is
especially hot or cold?
As part of the initial
response assignment or
specific alarm level?
Chief C. A. Haigh
Hanover Park Fire Department
How, when, and by whom?
•
Who is assigned the task
of rehab:
•
•
•
•
•
EMS
Additional fire companies
Support Organizations
What supplies &
equipment are supplied
by the rehab crew?
What training do they
have in providing
rehab?
Chief C. A. Haigh
Hanover Park Fire Department
If the Chief Officers and Community
Leadership does not value firefighter
safety, the personnel won’t!
•
•
Safety is a cultural value that needs to be represented at all levels
of the organization and must be established by those in
command.
Boards, Managers, and Chief Officers must embrace methods for
reducing the 50% - 60% LODD and the 700+ duty related cardiac
events.
•
•
•
Comprehensive medical exams and wellness programs (NFPA 1582 –
Standard on Comprehensive Occupational Medical Programs for
Fire Departments).
Mandatory physical fitness programs
Strict operating guidelines for usage of SCBA, PPE, Incident
Command and sound operational practices.
On-scene rehab programs
Leadership is Critical
•
Chief C. A. Haigh
Hanover Park Fire Department
Cost of Firefighting Injuries/LODD
•
•
Average of 80,000
annual firefighter
injuries (~5,000 Burn
Injuries)
Estimated Annual Cost
~ $8 bil/year
•
Average cost per injury is
$74,000
“The Economic Consequences of FF Injuries and Their Prevention, Tridata Corp.,
2005. NIST GCR – 05-874
Chief C. A. Haigh
Hanover Park Fire Department
In-house Lesson:
Hanover Park Fire Department
•
•
5-Year average shows HPFD
companies responding to 73
structural fires annually.
50 Firefighter injury reports filed
(emergency incidents, training,
medical exposures).
•
•
1998: A line of duty M.I. resulted
in a firefighter disability.
Injuries generated 22,649 hours
of work comp sick leave:
•
•
Costing greater than $170k in
workers compensation.
Greater than $600K in overtime
for backfill
Chief C. A. Haigh
Hanover Park Fire Department
Financial Impact
Village of Hanover Park
Prior to 2008:
Average Department Workers Compensation Losses $127,000
2008
Work
Comp.
Losses
$17,217
2009
$19,188
Chief C. A. Haigh
Hanover Park Fire Department
2010
$18,642
2011
$383,847
Partnerships are the
Key
Most of us don’t have
enough personnel to
effectively handle
the incident let alone
manage the rehab,
therefore developing
partnerships with
those who are
willing and able to
assist us is the key.
Chief C. A. Haigh
Hanover Park Fire Department
Partnership
Opportunities
•
6/8/2012
Utilize CERT to
develop a volunteer
response team (Fire
Corps) trained and
equipped to provide
on-scene rehab
services.
Chief C. A. Haigh
Hanover Park Fire Department
Fire Corps
•
•
•
•
•
•
6/8/2012
Consists of 17 volunteers
Pager alerted
Respond on the initial alarm to
all reported structure fires
The team operates a
decommissioned ambulance
outfitted with rehab equipment
and supplies.
Training
•
Basic CERT
•
Specialized training on how
to provide rehab conducted
through IFSI.
On-scene partnered with
paramedics who conduct
medical assessments while Fire
Corps members provide
hydration, cooling and
nourishment.
Chief C. A. Haigh
Hanover Park Fire Department
Components of Rehab
1.
2.
3.
4.
5.
6.
Rest and Recovery
Relief from incident
and environmental
conditions
Rehydration
Nourishment
Medical Monitoring
Operate within the
established
accountability system
Chief C. A. Haigh
Hanover Park Fire Department
Equipment Inventory
•
•
•
•
•
•
•
•
•
•
Chairs
Fans or misting systems
Awnings or Tents
Towels
Heaters
Floodlights
Dry gloves, socks and
sweatshirts
Water and Sports Drinks
Basic Food Supplies
EMS Equipment:
•
•
AED
RAD 57 Monitor
Chief C. A. Haigh
Hanover Park Fire Department
Field Participation in
Research
The purpose of this study was to document the vital
signs of firefighters upon entering a fire ground /
emergency incident rehabilitation division and to track
the changes that occurred during the medical
monitoring period.
6/8/2012
Chief C. A. Haigh
Hanover Park Fire Department
Take Home Message:
Research / Fire Service
Partnership
•
•
•
6/8/2012
Fire Service Change needs to be driven
by research.
Research needs to be driven based on Fire
Service concerns.
It takes courage to change the status quo
and find solutions to difficult problems
with limited human and financial
resources.
Chief C. A. Haigh
Hanover Park Fire Department
Does it seem like our recruits are
getting younger and younger?
Let’s make the Fire Service a safer career for the next generation.
Chief C. A. Haigh
Hanover Park Fire Department
6/8/2012
Chief C. A. Haigh Hanover Park
Fire Department