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UPMC studies best ways to cool off firefighters
A decent read. Thoughts?
http://www.post-gazette.com/pg/09187/982045-114.stm
UPMC studies best ways to cool off firefighters
Sudden cardiac arrest the leading cause of death in firefighters throughout the U.S.
Monday, July 06, 2009
By Jess Eagle, Pittsburgh Post-Gazette
After putting out a fire in a burning building tomorrow, groups of firefighters from across the county will sit in lawn chairs, put on special vests and get into air-conditioned cars.
They will be participating in a study of cooling equipment designed to reduce the risk of sudden cardiac arrests, the leading cause of death in firefighters nationwide.
The study, done by UPMC, will send groups of three or four participating firefighters into the Allegheny County Fire Academy's "Burn Building," which often is set ablaze for training simulations. After they put out the fire, participants will cool down using one of three techniques, known as rehabilitation.
David Hostler, one of the three UPMC doctors conducting the study, described the first technique as "a lawn chair you would bring to a soccer game," but with hollowed out spaces in the chair's arms for bags of water, which cool the forearms.
The next is a vest with piping that pumps water from a cooler into the tubing sewn into the vest. It is also used by NASCAR drivers to keep their body temperatures down during races.
The last technique, known as natural cooling, simply has participants sit or stand in air-conditioned vehicles.
Dr. Hostler, an assistant professor of emergency medicine at the University of Pittsburgh and director of the Emergency Responder Human Performance Lab, said most firefighters who experience cardiac arrest from overheating do so in the hours after putting out a fire.
Leaving a scene, most firefighters have body temperatures of 100 degrees or more. Dr. Hostler has seen some reach more than 103 degrees.
"It's not rare for people in their 20s and 30s to experience cardiac arrest with this job."
Though some fire departments in the area already use one of the three techniques, most use fans, Dr. Hostler said. And while fans work on cool days, they can be dangerous on hot days, actually raising a person's body temperature.
The Mt. Lebanon Fire Department uses both misting fans and the chairs with arm cooling. Chief Nicholas Sohyda said their procedures are rare for Allegheny County because they follow the National Fire Protection Association's standards.
"There's a lot of opinions, and I'm not exactly sure whose are the best," Chief Sohyda said. "There's even discussions whether you should drink cold water or room temperature water."
The department has two to four chairs, he said, and they only use them about once a month in the summer.
"We don't particularly go to that many fires here. They could probably use [the chairs] daily in the city of Pittsburgh, though," he said.
Under NFPA standards, firefighters must stay in a rehabilitation tent until their vital signs and blood pressure indicate that they are cool enough to continue. The NFPA also suggests annual physicals and stress tests, which the Mt. Lebanon department follows.
Firefighters in the county are required only to have a physical every two years, said Bob Full, chief of Allegheny County emergency services.
He added that he would like to see more departments adopting NFPA standards. The reason that some don't is the same reason that some are skeptical of new rehabilitation procedures.
"There's no downside except that it requires additional manpower. I would certainly like to see it implemented, but it really comes down to the individual departments," Chief Full said. "I know how noble and gallant they are, but at the same time, we have an aging work force in fire service."
Dr. Hostler has been a volunteer firefighter for more than 20 years. He currently volunteers at the Guyasuta Fire Department in O'Hara and has known friends in other departments who have died of cardiac arrest after leaving a scene.
"This is hard field to get money for," he said. "It's important to firefighters, but to other people it's not."
Tomorrow's simulation is the final phase of the doctors' two-year study. There is only one other academic study that has produced literature in the world, Dr. Hostler said. That study, done in Toronto, Canada, focused on firefighters' body temperatures on hot days only.
"There are no good guidance documents. ... We don't know which technique is superior over the other," Dr. Hostler said.
About 20 firefighters had signed up to participate in the study as of late last week, but Dr. Hostler said they're still recruiting more.
"I'm really looking forward to seeing the results," Chief Full said. "We will actually have solid information to make those informed policy and procedure changes down the road."
Once the study is done, the doctors hope their results, which will be posted for free online, will help fire departments across the country -- and even the world.
"If that rehab becomes more regimented in fire service, hopefully we can save lives," Dr. Hostler said.
Jess Eagle can be reached at jeagle@post-gazette.com or 412-263-1953.
First published on July 6, 2009 at 12:00 am
http://www.post-gazette.com/pg/09187/982045-114.stm
UPMC studies best ways to cool off firefighters
Sudden cardiac arrest the leading cause of death in firefighters throughout the U.S.
Monday, July 06, 2009
By Jess Eagle, Pittsburgh Post-Gazette
After putting out a fire in a burning building tomorrow, groups of firefighters from across the county will sit in lawn chairs, put on special vests and get into air-conditioned cars.
They will be participating in a study of cooling equipment designed to reduce the risk of sudden cardiac arrests, the leading cause of death in firefighters nationwide.
The study, done by UPMC, will send groups of three or four participating firefighters into the Allegheny County Fire Academy's "Burn Building," which often is set ablaze for training simulations. After they put out the fire, participants will cool down using one of three techniques, known as rehabilitation.
David Hostler, one of the three UPMC doctors conducting the study, described the first technique as "a lawn chair you would bring to a soccer game," but with hollowed out spaces in the chair's arms for bags of water, which cool the forearms.
The next is a vest with piping that pumps water from a cooler into the tubing sewn into the vest. It is also used by NASCAR drivers to keep their body temperatures down during races.
The last technique, known as natural cooling, simply has participants sit or stand in air-conditioned vehicles.
Dr. Hostler, an assistant professor of emergency medicine at the University of Pittsburgh and director of the Emergency Responder Human Performance Lab, said most firefighters who experience cardiac arrest from overheating do so in the hours after putting out a fire.
Leaving a scene, most firefighters have body temperatures of 100 degrees or more. Dr. Hostler has seen some reach more than 103 degrees.
"It's not rare for people in their 20s and 30s to experience cardiac arrest with this job."
Though some fire departments in the area already use one of the three techniques, most use fans, Dr. Hostler said. And while fans work on cool days, they can be dangerous on hot days, actually raising a person's body temperature.
The Mt. Lebanon Fire Department uses both misting fans and the chairs with arm cooling. Chief Nicholas Sohyda said their procedures are rare for Allegheny County because they follow the National Fire Protection Association's standards.
"There's a lot of opinions, and I'm not exactly sure whose are the best," Chief Sohyda said. "There's even discussions whether you should drink cold water or room temperature water."
The department has two to four chairs, he said, and they only use them about once a month in the summer.
"We don't particularly go to that many fires here. They could probably use [the chairs] daily in the city of Pittsburgh, though," he said.
Under NFPA standards, firefighters must stay in a rehabilitation tent until their vital signs and blood pressure indicate that they are cool enough to continue. The NFPA also suggests annual physicals and stress tests, which the Mt. Lebanon department follows.
Firefighters in the county are required only to have a physical every two years, said Bob Full, chief of Allegheny County emergency services.
He added that he would like to see more departments adopting NFPA standards. The reason that some don't is the same reason that some are skeptical of new rehabilitation procedures.
"There's no downside except that it requires additional manpower. I would certainly like to see it implemented, but it really comes down to the individual departments," Chief Full said. "I know how noble and gallant they are, but at the same time, we have an aging work force in fire service."
Dr. Hostler has been a volunteer firefighter for more than 20 years. He currently volunteers at the Guyasuta Fire Department in O'Hara and has known friends in other departments who have died of cardiac arrest after leaving a scene.
"This is hard field to get money for," he said. "It's important to firefighters, but to other people it's not."
Tomorrow's simulation is the final phase of the doctors' two-year study. There is only one other academic study that has produced literature in the world, Dr. Hostler said. That study, done in Toronto, Canada, focused on firefighters' body temperatures on hot days only.
"There are no good guidance documents. ... We don't know which technique is superior over the other," Dr. Hostler said.
About 20 firefighters had signed up to participate in the study as of late last week, but Dr. Hostler said they're still recruiting more.
"I'm really looking forward to seeing the results," Chief Full said. "We will actually have solid information to make those informed policy and procedure changes down the road."
Once the study is done, the doctors hope their results, which will be posted for free online, will help fire departments across the country -- and even the world.
"If that rehab becomes more regimented in fire service, hopefully we can save lives," Dr. Hostler said.
Jess Eagle can be reached at jeagle@post-gazette.com or 412-263-1953.
First published on July 6, 2009 at 12:00 am
Replies to This Discussion
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Permalink Reply by International 1582 Foundation on
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Alright, this is it; I am hoping I provoke thought in everyone who reads this, and I hope I am bombarded by emails from department Peer fitness Trainers, fire department physicians and firefighters arguing…hopefully, an intelligent point, but nevertheless upon reflecting on what you have read and processed. I hope you see my point. Before everyone reads this, I want everyone to know that I spent 30 years in the fire and EMS services before earning my doctorate; starting my journey with LA County Fire Department as an explorer when I was 15. I’ve been there and know the job!
There is no doubt in my mind that Fire Rehab NFPA 1584, if employed correctly will save lives. What needs to be clearly stated, and no one seems to have the courage to say it…”if you are on medications to control your blood pressure you need to be taken off line, rehabilitated, retested, then if your cleared by a physician who is “informed” on the NFPA 1582 Standards to return to active firefighting; then you can return to the line”. Your life depends on it. LODD from sudden cardiac death, with the exception of “known defective mechanisms that can be contributed, such as hypertension caused by constricted renal arteries or type II diabetes caused by immune destruction of insulin secreting cells, are types of disorders affecting many firefighters, cops, and EMS professionals that don’t present to PCP with any diagnostic defective mechanism…termed “essential” (no known etiology…”don’t know why you have hypertension, but here, takes these medications!”). As with the fight or flight response, drugs to fix low level mechanisms that has no known defective mechanism is beneficial in the short-term, but as with chronic stress overload, what’s designed to help you survive can be harmful in the long-run.
Active firefighting is like NHL Hockey, the difference is the NHL hockey player, over a 60 minute period will only be on the ice for 15-20 minutes at 2-3 minute intervals. Why? NHL players are at 100% of their peak aerobic tolerance for the entire 2-3 minutes. 15-20 minutes for a firefighter in active firefighting is just one bottle, but its 700 degrees, your pulling around 70lbs of wet PPE and equipment, jockeying a hose, breathing air through an SCBA…coupled with the fact that your on a diuretic, beta blocker/ACE inhibitor.. Etc...Does that make good sense to you?
The physical requirement is mirrored between hockey players and firefighters, but firefighters sustain this mental and physical load for remarkably longer and sustained periods. The difference is, consistently, each year more than 40% of firefighters are dying in the line of duty, with a zero percent survival rate once in a ventricular tachydysrhythmia/fibrillation.
The theory behind the “homeostasis” model has contributed immeasurably to scientific medicine, and to criticize it seems absurd. Nevertheless, I am not criticizing it at all, but all scientific models encounter new facts that don’t fit, and this is the case for homeostasis. Several medical schools now are introducing a new model to med students because in physiology, evidence is now abundant that “set-points” such as a normal blood pressure of 120/80 mm hg is useless. Parameters are not constant…as is demonstrated by blood pressures and heart rate in fire rehab. Instead their variations, rather than signifying error, and what we know now, are apparently designed to reduce error. In firefighter occupational health major diseases are now rising in the numbers, at much younger ages of onset, such as essential hypertension, cancer and type II diabetes, whose cause the homeostasis model cannot explain. As written above, and for in contrast to the hypertension caused by constricted renal arteries, and NIDDM caused by the immune destruction of insulin secreting cells, these disorders are presenting to PCP with no defective mechanism. Treating firefighters with drugs to fix low level mechanism is beneficial in the short term, but to sustain a medication regime for long/lifetime for blood pressure maintenance for a physiological mechanisms that aren’t broke to begin with isn’t working out to well, as is clearly demonstrated year after year in LODD from sudden cardiac death.
The model I want to introduce to all of you is the “allostasis” model, which is translated literally to mean “stability through change.” The allostasis model takes virtually the opposite view of the homeostasis model. It suggests that the goal of biological regulation is not constancy, but rather fitness under natural selection. Fitness constrains regulation of such things as blood pH, BP, body temperature, etc. be efficient, which implies preventing errors and minimizing physiological cost that will eventually lead to “allostatic overload” and subsequent pathology if not shut off when no longer needed. Both needs are best accomplished by using prior knowledge (fighting fire) to predict physiological demand, and then adjusting all parameters to meet it (blood pressure while sleeping can drop to as low as 80/50 mm hg and active firefighters can jump up to 190/110 mm hg). Thus the allostasis model considers an unusual parameter value (i.e., active fire fighting body temp can be around 102 f), not as a failure to defend a set point (98.6 f), but as a response to neural signals to the brain that the body is too hot, and subsequent orders from the brain to began cooling measures.
The allostasis model attributes disease such as “essential” hypertension and type II NIDDM to sustained neural signals that arise from an unsatisfactory social interaction. Consequently, the allostasis model would redirect therapy away from manipulating low-level mechanisms, and towards improving higher levels to restore predictive fluctuations.
My goal is thought provocation, not argument. To learn methods of rapid cooling is essential to rehab, but what we need to be doing in concert with these types of studies, is to be better at prevention and rehabilitation. Maybe if we view firefighters as professional athletes our “department physicians” would do a better job at physician oversight, prevention and rehabilitation…firefighters save lives and that is not a game!
NOTE: Many of the above writing is abbreviated, and perhaps incomplete. If you would like to email me for more information, my email address is: rrobbins@international1582foundation.com
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Permalink Reply by Doug on
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Some follow up, including video.
http://kdka.com/local/Firefighter.Safety.UPMC.2.1074958.html
I still haven't seen the findings posted on the Pitt/University of Pittsburgh website.
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