Firefighters at Risk for Coronary Heart Disease
The December 2008 issue of The Journal of the American Osteopathic Association (JAOA) reported on a study conducted to evaluate firefighters' cardiac risk factors as well as their motivation to resolve these risk factors. During a three month period, firefighters representing 79 departments serving Nassau and Suffolk counties in Long Island, NY, were asked to complete a 19 item questionnaire regarding their health habits, medical history, and demographics. The results show that resources and intervention programs should be assessed.
Today, there are more than 1 million firefighters in the United States. About 100 deaths occur each year, and about 45% of those are attributed to coronary heart disease. While firefighters tend to be selected based on their physical fitness, cardiovascular health does not necessarily play a dominant role in defining fitness, especially over time.
Even among firefighters who are apparently fit, the extreme physical demands of firefighting are still evident, especially in hot and smoky conditions. At a moment's notice, firefighters are called to respond to various alarms that require considerable demands on their bodies, some of which require working at near maximal heart rates for an extended time. Cardiovascular fitness is important not only to their own health and safety, but also the lives of other firefighters and victims in need of assistance or rescue.
In considering cardiovascular fitness, modifiable and non-modifiable cardiac risk factors exist. Non-modifiable risk factors include age, family history, and sex. Modifiable risk factors include cigarette smoking, high blood pressure, high cholesterol levels, obesity, physical inactivity, and diabetes. While firefighters can control the modifiable risk factors through diet, exercise, physician follow-up, and proper education about heart disease and its associated risk factors, the non-modifiable items predispose an individual to the risk of morbidity and mortality.
The National Fire Protection Agency (NFPA) sets standards regulating appropriate health and wellness programs and medical requirements for fire departments. While they recommend physical examinations be conducted every 3 years for persons aged 29 years or younger, every 2 years for persons aged 30 to 39 years, and every year for persons aged 40 years and older, individual choices should be made by each firefighter. There is nothing preventing a firefighter getting a physical examination annually under their own insurance, in order to get an assessment for potential risks.
This study was designed to evaluate firefighters' health, knowledge of cardiac risk factors, and motivation to resolve these risk factors and improve their healthcare maintenance. The full report on this study can be found in the JAOA, including the methods used and results. More can be learned about the American Osteopathic Association at www.do-online.org and www.osteopathic.org.
Healthcare Reimbursement Accounts:
To VEBA, or not to VEBA
One of the biggest issues facing public employees today is paying for health insurance and related medical expenses such as prescription drugs during retirement. With medical costs rising two to three times faster than inflation, employees are facing the reality of approaching retirement age without enough dollars to cover their medical expenses.
As a result, more and more employees who are eligible to retire are "job-locked"; they simply cannot afford to retire because of rising health care costs.
One of the ways that employees can help plan for these expenses is through an employer sponsored healthcare reimbursement account. One of the most common of these plans is a 501(c) 9, Voluntary Employees Beneficiary Association (VEBA) plan.
In a VEBA, contributions are made on a before-tax basis, meaning that they are not subject to state or federal income taxes, or employment taxes. That immediate tax savings helps you to accumulate more dollars to fund health insurance and medical expenses in retirement.
In order to qualify for the tax savings, IRS regulations require all members of your group to participate in the program, and be subject to the same contribution formula.
There are many potential sources for the contributions. In addition to ongoing contributions, a group may elect to contribute dollars from unused sick, vacation or compensatory time. Contributed on a regular basis, these dollars can grow to a meaningful account balance at retirement.
Once you separate service, depending on the contribution formula, you may withdraw funds from the VEBA for health insurance premiums, including long-term care insurance, and/or qualifying medical expenses not covered by your medical, dental or vision plans. Additionally, unused benefits are rolled over from year to year for future expenses.
The examples below are hypothetical examples of accumulations over time using different contribution sources. Calculations based on an annual salary of $36,000 and an assumed rate of return of 8%. Actual investment results will vary.
For additional information on this or other retirement related programs such as 457 deferred compensation plans, 401a defined contribution retirement plans, DROP accounts, IRA's and annuity withdrawal rollovers, please contact: Retirement Plan Advisors at 734-421-2212 or
Improper Setup of Aerial Ladders with a Locking Waterway May Put Fire Fighters at Risk
NIOSH recommends that all fire departments utilizing aerial ladder trucks with locking (pin-anchored, lever actuated, clamped) waterways immediately take the following actions to reduce the risk of fire fighters being struck by unsecured waterways or parts of the waterway:
- Ensure that Standard Operating Procedures (SOPs) and/or Guidelines (SOGs) on setting up multi-position waterways include steps to properly position the waterway and to inspect and verify that the locking mechanism (anchoring pin(s), lever, clamps, etc.) are properly installed and functioning as designed before pressurizing the waterway.
- Properly train and practice the correct method of securing waterways and verifying they are secured (per manufacturer's recommendations).
NIOSH is currently investigating an April 8, 2008 fire fighter line-of-duty-death that illustrates that adhering to manufacturer recommended setup procedures for aerial ladder operations is paramount to ensuring fire fighter safety.
Preliminary findings in this investigation suggest that some equipment designs do not provide secondary stops for the waterway on aerial ladders. Thus, failure to properly secure the waterway in the proper position can lead to catastrophic waterway failure and possible serious or fatal injury to fire fighters working in the area. The pin-anchored waterway design involved in this particular investigation is not limited to a single model or apparatus manufacturer. NIOSH is aware of at least 7 similar incidents that occurred in Delaware, Michigan, New Jersey, Texas, Virginia and Ontario without serious injury. Newer aerial ladder trucks may incorporate different types of anchoring mechanisms and/or a more fail-safe design but proper set up still needs to be verified before operation.
Circumstances of incident under investigation by NIOSH. On April 8, 2008, a volunteer Deputy Fire Chief (the Incident Commander) was killed when struck by a motorized water monitor and 30 feet of aluminum pipe that was "launched" off an elevated aerial ladder at a fire at an industrial manufacturing plant in Pennsylvania. The truck was normally transported in the "rescue mode" with the monitor pinned to the second section of ladder so that the waterway would not be in the way if the ladder was set up for rescue operations. At the incident scene, when the waterway was pressurized, the monitor and its support bracket, along with the last 30-foot section of pipe were "launched" off the aerial ladder by the force of the water pressure in the pipe. The monitor flew approximately 75 feet and fell, striking the Incident Commander on the head, killing him instantly. After the incident, the anchor pin was found on the ground, in front of the truck's cab. The waterway did not include any secondary mechanical stops to prevent the separation of the water monitor in the event the anchoring pin was not properly seated. The NIOSH Fire Fighter Fatality Investigation and Prevention Program is currently investigating this incident and a full report will be available at a later date.
NIOSH would like to bring this information to the attention of all U.S. fire departments and fire fighters who operate or work around aerial ladder trucks with locking (pin-anchored, lever actuated, clamped) waterways so that future occurrences of waterway monitor "launches" or the unexpected movement of the waterway monitor can be prevented. If secondary mechanical stops are present, the unexpected impact of the waterway monitor against the mechanical stop could cause structural damage to the aerial ladder and jeopardize the safety of any fire fighter standing on the aerial ladder. While not a contributing factor in the fatal incident, NIOSH reminds fire departments to comply with relevant federal regulations and NFPA standards for fire apparatus inspections and certification.
Fire Fighters Denied On-Duty Death Benefits
More than three years after the enactment of a law granting federal benefits to families of fire fighters, police officers, and EMT's who die of heart attacks and strokes on the job, not a dollar has been paid. The U.S. Justice Department has denied all 34 claims that have been decided, and has yet to act on more than 200 others.
The Hometown Heroes Act of 2003 stated that heart attacks and strokes on the job should be presumed to be line-of-duty deaths, making survivors eligible for federal benefits. A spokeswoman for the Department of Justice said the delays are caused by the complexity of the cases, not by any disagreement with the intent of the law.
The denials come to light as a new study published in the New England Journal of Medicine found that fire fighters are at much higher risk of heart attacks when fighting fires or responding to alarms. They face up to 100 times their normal risk of heart attack while working at a fire.
At least some of the denials were based on the Justice Department judgment that some of the duties the fire fighters were performing at the time of their deaths did not meet the law's requirement of "non-routine strenuous activity." Examples are a fire fighter who returned home after carrying fire hose at a training session who collapsed and died that afternoon, and a fire chief that died at home after directing traffic for more than an hour at a major intersection in the Texas heat.
The Justice Department rules for the program say that the program requires the fire fighter to be involved in a situation that would:
- Pose, or appear to pose, "significant dangers, threats or hazards (or reasonable foreseeable risks thereof), not faced by similarly situated members of the public in the ordinary course, and;
- "provoke, cause, or occasion an unusually high level of alarm, fear, or anxiety.
The Harvard study of 449 heart attack deaths among fire fighters nationwide found that 32 percent died when they were involved in fire suppression or other activity at a fire. But less stressful duties were associated with higher than expected risk of heart attack as well: 13 percent occurred while responding to an alarm; 17 percent in returning from an alarm; 13 percent in physical training; 9 percent in emergency medical services and other non-fire emergencies; and 15 percent in a fire station or while performing non-emergency duties.
NIOSH Recommendations in the Wake of Junior Volunteer Firefighter Death
A tragic accident, which claimed the life of a 17-year-old female volunteer junior firefighter after the tanker truck she was riding in went off a narrow one-lane bridge in Alabama has resulted in a number of recommendations by NIOSH investigators:
- Ensure that fire fighters are always seated in an approved riding position any time the fire apparatus is in motion • Ensure that all fire apparatus are equipped with seat belts and that fire fighters always wear seatbelts
- Ensure that tankers are operated at a safe and reasonable speed
- Provide initial and refresher training (at least twice annually) to driver/operators as often as necessary for the safe operation of fire tankers
- Develop and enforce written policies, procedures, and/or guidelines that identify the permissible and non-permissible tasks and activities of junior fire fighters
- Establish an effective preventive maintenance program for all fire apparatus
- Establish and develop written standard operating procedures for all fire fighting operations
- Avoid using former fuel trucks as water tankers, if at all possible
- Consider developing a State-endorsed junior fire fighter program that addresses the tasks that minors are permitted to perform in the fire service
- Consider requiring vehicle safety inspections for fire apparatus
The tanker was enroute to a structure fire and failed to negotiate a sharp curve at the approach to the bridge. The tanker crashed through the bridge's guardrail and landed upside down below the bridge. The driver and two other fire fighters riding in the tanker were injured in the incident. The victim was extricated by emergency personnel and pronounced dead at the scene.
Source: NIOSH Newsletter April 11, 2007
Guidelines can help communities prepare for terrorism
As the Homeland Security Office builds a national plan to protect the American public from terrorism, here are some ideas that you can pass along to businesses, agriculture and infrastructure organizations in your community to help them take steps now to prepare for terrorism and other disasters.
Any organization or business can become more secure by implementing measures on this list.
First, do the Hazard Assessment, at least a draft of an organizational emergency plan and a determination of what equipment and facilities will be used in emergencies. These products will guide your deliberations on what training is needed by your personnel e-mail - http://riskcenter.doe.gov/whatisrisk/index.cfm.
Encourage employees to enroll in FEMA and other emergency management courses
Determine what elements of your situation are unique and/or not covered in the already available courses.
Conduct the Community Emergency Response Teams (CERT) Course at your site (see the CERT material listed on the emergency management courses page at http://www.fema.gov/emi/index.htm).
Key steps/considerations include:
- Discuss an overview of the hazards that may threaten your facility. Neighboring businesses should also be considered in case a disaster spreads from your facility to theirs or from their facility to yours.
- Protective action decisions for each hazard and the method of implementing these decisions - to include assembly points and in-place protection procedures.
- Alert and notification procedures - to include the meaning of various warning signals, fan out charts, and mobilization procedures.
- Concept of operations to include:
- Organization structure
- assignment of responsibilities
- how to deal with specific emergencies
- what to report and to whom
- sequence of "first response" actions, such as what to do in case of fire - sound alarm, use an extinguisher, leave the vicinity, etc.
- Identification, location and use of emergency equipment such as showers, eyewashes, portable fire extinguisher, and respirators.
- Shutdown routines and emergency shutdown procedures.
- Demonstrations of emergency equipment with hands-on experience - how to use and how not to use eyewashes, safety masks (for example, check filter inserts before using), portable extinguishers, etc.
- If your organization has limited or no medical capability, encourage your employees, especially those with emergency response assignments, to take courses in emergency health care and first-aid. Many hospitals, volunteer ambulance corps, the American Red Cross, and various community organizations teach first-aid skills.
- Conduct sessions at least annually or when:
- Employees are hired
- Evacuation wardens, shelter managers and others with special assignments
- New equipment, materials or procedures are introduced
- Procedures are updated or revised
- Exercises show that employee performance must be improved
- In the process of planning and developing the emergency plan, you have identified the hazards and the actions that need to be taken during an emergency. Cross-check the hazard assessment and written procedures with your course of instruction to make certain nothing has been overlooked.
- The general training should be provided on a recurring basis and should cover all possible circumstances that may affect life safety as well as the aspects critical to property and production protection.
Design your training so that: 1). every employee will react automatically in an emergency; and 2). all employees assigned emergency response tasks know their responsibilities and have the skills to do the job.
Personnel should also have a thorough understanding of the entire emergency plan and how they fit into it. To accomplish this, the training program should integrate each segment of training with the overall plan.