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Missouri Valley Division Annual Conference A Required Stop on the Trail to Great Leadership6/8/20121Chief C. A. Haigh Hanover Park Fire Department

Reducing Line of Duty Deaths:The Role of Research, Training & Organizational Leadership6/8/20122Chief C. A. Haigh Hanover Park Fire DepartmentContributing 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 DepartmentField Staff Instructor, University of Illinois Fire Service Institute

Gavin Horn, Ph.D.

Director, Illinois Firefighter Life Safety Research CenterResearch Scientist, Department of Mechanical Science & Engineering, University of Illinois6/8/20123Chief C. A. Haigh Hanover Park Fire DepartmentTopics:The Role of ResearchCase Study:What the Research is Telling Us about the Physiologic Stress of FirefightingImplementing Research into field operations On Scene RehabImpact of Organizational Leadership

6/8/20124Chief C. A. Haigh Hanover Park Fire DepartmentThe Process of Research ImplementationEnhanced KnowledgeChanged BehaviorTrainingSupport of LaborInternal Policy DevelopmentSupport of Fire Service Organizations (IAFC, IAFF, NVFC, USFA, NFFF, ICMA, IAAI, etc.)Acceptance by standard setting/review organizations (NFPA, State Fire Marshal, OSHA, UL, NIOSH, etc.)Research / Development / ManufacturingAcceptance & buy in of Fire Administration (Fire Chiefs & Command Staff)Support of local organizations (County Fire Associations, MABAS, etc.)Acceptance & buy in of City/County/District Administration (i.e. City Managers)Acceptance & buy In of Elected Officials and their willingness and ability to pay.Cultural Change6/8/20126Chief C. A. Haigh Hanover Park Fire DepartmentLimitations of Local Departments to Implement Research Driven ChangeLack of visionary leadership.This is the way we have always done itLack of strong labor / management relations.Failure to maintain priorities:Be cautious of the swirling toilets and washing wheels syndrome.Lack of fire service support by elected officials and community.Lack of financial resources.6/8/20127Chief C. A. Haigh Hanover Park Fire DepartmentFire Service DownfallThe 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 todays research, departments must think globally and be willing to change tradition in order to address current concerns. 6/8/20128Chief C. A. Haigh Hanover Park Fire DepartmentPhysiological Impact of Heat StressCase Study

6/8/20129Chief C. A. Haigh Hanover Park Fire Department{Current SituationDecreasing number of fire Relatively unchanged number of firefighter fatalities.6/8/201210Chief C. A. Haigh Hanover Park Fire DepartmentCardiovascular Impact on LODDBetween 19952011: 799 Firefighters died due to Cardiac or Cerebrovascular Related Events. 2011 -- 492012 -- 17Cardiac 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).

6/8/201211Chief C. A. Haigh Hanover Park Fire Department11This slide denotes the depth of the problem. Key points to emphasis:When we speak of cardiovascular incidents the phrase is an all inclusive term referencing any incident involving the heart, brain, lungs or vascular system. Therefore myocardial infarctions and cerebrovascular incidents are included under this category.Cardiovascular and cerebrovascular incidents account for approximately 1/4th of all firefighter injuries. Slips, trips and falls account for an additional 1/4th of injuries. Based on research conducted by Illinois Homeland Security Research Center, evidence exists to suggest a link exists between the physiologic response to heat stress and the bodies ability to maintain gait and balance.

Cardiovascular Impact on LODDIs it more than old out of shape firefighters? Is there something about firefighting that serves as the trigger for a cardiovascular event?6/8/201212Chief C. A. Haigh Hanover Park Fire DepartmentCardiovascular Impact on LODDWhat do we know?6/8/201213Chief C. A. Haigh Hanover Park Fire DepartmentThe job is getting harderIncreased BTU ProductionChanges in constructionLight weight / open floor space / energy efficient / greenRequire greater GPM to cool the BTU production.Decreased company staffingProtective equipment provides full encapsulation.

6/8/201214Chief C. A. Haigh Hanover Park Fire DepartmentPersonal Risk Factors for Cardiovascular ProblemsAgeGenderFamily HistoryDiabetesHypertensionSmokingHigh CholesterolObesityLack of Exercise

6/8/201215Chief C. A. Haigh Hanover Park Fire DepartmentCoupled with Heat StressWork performedProtective EquipmentThermal EnvironmentHealth StatusFitness LevelHydration Level

Disastrous potential exists.6/8/201216Chief C. A. Haigh Hanover Park Fire DepartmentHow do we reduce the impact of heat stress?Personal physical fitnessHealth screening On-Scene Rehabilitation6/8/201217Chief C. A. Haigh Hanover Park Fire Department

On-Scene RehabilitationIf 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 Reasons6/8/201218Chief C. A. Haigh Hanover Park Fire DepartmentLack of rehab?Culture of Fire ServiceRehab is for SissiesUndeveloped on-scene rehabilitation and support systemsLack of widespread researchWhy we do what we do?

6/8/201219Chief C. A. Haigh Hanover Park Fire DepartmentField-based Research To Document the Stress of Firefighting

What do we know?6/8/201220Chief C. A. Haigh Hanover Park Fire DepartmentBasic Statistics1,148,100 FF (USFA, 2009)335,950 career812,150 volunteersFirefighting is a Dangerous OccupationInjuries 71,875 (2010)Fatalities approx. 100 per year 50% - 60% due to sudden cardiac events

6/8/201221Chief C. A. Haigh Hanover Park Fire DepartmentReducing Injuries and FatalitiesPrevent Fires, or detect earlierOptimal StaffingTrainingSafety TrainingDrivingFiregroundAttitudes, awareness (cultural issues)Personal Protective ClothingImproved Incident CommandFitness and Wellness ProgramsOn-Scene Rehabilitation?

6/8/201222Chief C. A. Haigh Hanover Park Fire DepartmentSudden Cardiac DeathPrimary Cause of LODDNPFA Firefighter Deaths by Nature -- 20116/8/201223Chief C. A. Haigh Hanover Park Fire DepartmentDespite reduction in total fires, fatalities due to cardiovascular issues remain relatively unchanged.

USFA Firefighter Fatalities 1986-20096/8/201224Chief C. A. Haigh Hanover Park Fire DepartmentFirefighter Deaths to Date by Nature of Injury -- 2012Cardiac & Stroke:53.1%Trauma:37.5%Other:6.3%Crushing:3.1%6/8/201225Chief C. A. Haigh Hanover Park Fire Department

Total Firefighter Injuries6/8/201226Chief C. A. Haigh Hanover Park Fire DepartmentKarter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2011 Distribution of Injuries6/8/201227Chief C. A. Haigh Hanover Park Fire DepartmentFirefighter Injuries: Total injuries have reduced in hand with total fires, yet leading causes (overexertion/strain & slips/falls) remain relatively stableKarter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2009 6/8/201228Is there a correlation between overexertion and strain and slips/trips/falls?6/8/201229Chief C. A. Haigh Hanover Park Fire DepartmentWorking Hypothesis

Slips, Trips, FallsSudden Cardiac Events

FirefightingHeat StressFatigueOverexertion/StrainBiomechanical ChangesCV/CoagulatoryChangesReduced SituationalAwarenessDisorientation, Entrapment,Poor decisions, and relatedInjuries and Fatalities6/8/201230Chief C. A. Haigh Hanover Park Fire DepartmentPhysiological/Psychological Stress of FirefightingProbably 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

6/8/201231Chief C. A. Haigh Hanover Park Fire DepartmentSimplified Schematic of Possible Causes of Heart Attack in FFHeart AttackCirculatory ShockArrhythmias

Clot FormationPlaqueDisruptionPerfuse sweatingDecreasedPlasma volumeAlteredElectrolytesIncreased viscosityChanges in HR and BPIncreased Body TemperatureActivation of SNS6/8/201232Chief C. A. Haigh Hanover Park Fire Department6/8/2012

Firefighting TasksDummy dragCarry and discharge extinguisherHose pullWood chopping

U of I Study: Response of Firefighters following short-term strenuous firefighting activities

33Denise L. Smith, PhD Skidmore College336/8/2012Study Cycledrillsdrillsdrills~ 8min~ 8 min~ 8 minRehabRc1Rc2= measurement period

34Denise L. Smith, PhD Skidmore College346/8/2012Heart Rate Response

**** p < .05 vs rest35Denise L. Smith, PhD Skidmore College356/8/2012Stroke Volume Response

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