Wednesday, June 11, 2014

Wild World of Exposure Risk in Firefighting & EMS

Wild World of Exposure Risk in Firefighting & EMS
By Alan Perry


There are accepted inherent risk to firefighting and EMS that all providers in the industry should understand when they sign up. Fire will be hot, people and events can be very unpredictable, we know this and accept this as well as the injury and illnesses that can occur over the course of a career in this industry. These risks should be managed and reduced to the greatest extent possible given our limited knowledge of the full constellation of circumstances that contribute to both physical and mental harm to our providers. We are constantly improving our awareness of these processes and adapt and train in methods to reduce risk where it is possible. Cancer, heart attacks and physical trauma will still claim the lives and health of our comrades. We will still suffer strains, sprains, hearing loss and depression as a normal consequence of our professional choice. Can we improve these circumstances by changing the things we personally have control over? I think so.

We have a duty to ourselves, our co-workers and our families to take safety and health seriously. This means taking a personal stand in keeping your activities as safe and healthful as possible, as well as identifying & correcting health and safety concerns when we find them. These concerns need to be communicated and thoughtful solutions found within our organizations working cooperatively with all stakeholders. Do not depend on state or Federal law to protect you, merely complying with the law does little to minimize the risks and certainly does not cover every possible one that we encounter. Chief Officers need to evaluate compliance with existing regulations and SOP’s to assure that all members are following the guidelines meant to protect them. If compliance rates are low try to determine if there are obstacles or unreasonable requirements that make it difficult or inconvenient to do so. Unreasonable and half-hearted requirements will lead to low compliance and increased injury and illness among your people.


My gut feeling is that health and safety programs rely too heavily on mandates, are not easy and seamless for the user, and are not promoted with any degree of enthusiasm within public safety organizations. This leads to an atmosphere of apathy and poor compliance. Add to that a general lack of personal responsibility, and/or awareness of our own circumstances, and assumptions that we are already doing all that can be done and you can see how ineffective things can be. To test the theory, I took a walk around several facilities in my area and made a mental note of some reasonable concerns in four 
major areas; cancer, heart attacks, traumatic injury and hearing loss.

Cancer

Cancer rates are significantly higher in emergency services when compared to the general population. Public Safety workers who develop lung cancer and/or heart diseases are generally have the cause attributed to exposure to products of combustion and diesel exhaust. What about the other forms of cancer? What about all the other toxic products we are exposed too? We have policies and recommendations that discourage carrying turnout gear in personal vehicles due to exposure concerns, but we place the same gear at our feet when we are riding around in the fire truck. We have policy and recommendations for washing turnout gear, but we have no spare gear to use or recovery time dedicated to cleaning it after a fire. These are two examples of the disconnect between policy and practice that do little to reduce exposure. Add too that our own self-exposure to cleaners, fuel, and tobacco and non-fire air-borne pollutants creates a recipe for tragedy. Cavicide and other germicidal products in particular are an example that may present an significant incidental risk over time to all  providers, the label clearly states to avoid contact with the skin, repeated exposure may lead to damage of the thymus- an important immune system organ responsible for maturing and selecting T-cells.T-cells are responsible for the control of abnormal cell development like cancer.

Heart attacks
Cardiac events are another prime source of injury and death in emergency services. They are attributable to levels of physical fitness and dehydration primarily. Physical fitness is a no-brainer provided you attain it in a responsible manner. A good work out routine will promote flexibility, endurance and strength equally and not push the body to exhaustion or failure.We self-ingest caffeine, energy drinks and protein supplements in our efforts to remain awake and enhance our physical and mental performance; at what cost? Caffeine is a diuretic; it virtually guarantees a state of dehydration. Both caffeine and other substances present in energy drinks override the body’s protective mechanisms and can/do push your heart beyond its ability, occasionally causing chest pain and/or arrhythmia. Protein supplements require proper hydration to prevent kidney damage, in  firefighting or any high heat, high stress situation you can easily cause yourself permanent damage, or even death when using these supplements while on duty.

Traumatic Injury
Most injuries do not occur on the fire ground. Look around your station; you will find wires, cables, rope, hose, wet floors, oily spots, and occasionally clutter both in the station and the apparatus bay. All of these can contribute to a slip or fall that will at a minimum embarrass you and could potentially cause a career ending injury. Examine your apparatus design; are the steps at a reasonable height? Could the height from the cab to the ground be reduced? Are there adequate hand holds? What if you are carrying gear? Are your driving habits in-line with the driving policy? Is your driving policy reasonable given that emergency response does not improve response times appreciably? Is the risk of having an accident, injuring or killing a civilian(s) and/or a crew member(s) worth it? Lift with good technique and body mechanics, don’t forget to stretch, warm-up and exercise moderately. A large number of workplace injuries have occurred while doing PT. Isn't that ironic?

Hearing Loss

A federal Q-siren produces 123 decibels of sound pressure, according to most sources this is enough to cause immediate pain and permanent hearing loss within seconds, add a 140 decibel air horn too that mix and you create a dangerous situation for both your crew and the general public without substantial hearing protection. You have hearing protection on the engine. That is good, what about the medic and the other response vehicles? Does the guy in the convertible trapped in traffic in front of you have any protection? Does the small child playing in their yard? Warning devices are only one concern, there are many others; chain saws, power tools, PPV fans and pump panels are all dangerous too. Hearing loss occurs from brief exposure to intense sound pressure as well as routine exposure to levels as low as 90 decibels, that is the ambient sound pressure inside an engine or medic just driving down the road normally.

Conclusion

A genuinely effective health and safety program is one that is supported with spirit throughout the organization. These programs fit seamlessly into the workflow within the organization and are supported with unimpeded access to the correct resources. Event reporting is unfiltered, honest, and thoroughly documented with the objective of determining causality and circumstances to prevent future occurrences. Members of the organization recognize the importance of personal accountability for actions affecting their health and safety and that of others. The Recipe: Leadership Commitment, Engineering Controls, Education, Ease of use + Attitude.

Be Safe,
Alan

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