Missouri Valley Division Annual Conference

1. Missouri Valley Division Annual Conference A Required Stop on the Trail to Great Leadership Chief C. A. Haigh Hanover Park Fire Department

2. Reducing Line of Duty Deaths: The Role of Research, Training & Organizational Leadership Chief C. A. Haigh Hanover Park Fire Department

3. 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 Contributing Authors Chief C. A. Haigh Hanover Park Fire Department

4. Topics: • 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

5. Goal of Fire Service Research Enhanced Knowledge Training Changed Behavior Chief C. A. Haigh Hanover Park Fire Department

6. Acceptance by standard setting/review organizations (NFPA, State Fire Marshal, OSHA, UL, NIOSH, etc.) Research / Development / Manufacturing Acceptance & 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. Internal Policy Development Support of Labor The Process of Research Implementation Enhanced Knowledge Cultural Change Support of Fire Service Organizations (IAFC, IAFF, NVFC, USFA, NFFF, ICMA, IAAI, etc.) Training Changed Behavior Chief C. A. Haigh Hanover Park Fire Department

7. Limitations of Local Departments to Implement Research Driven Change • Lack of visionary leadership. This is the way we have always done it… • Lack 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. Chief C. A. Haigh Hanover Park Fire Department

8. 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

9. Case Study Physiological Impact of Heat Stress Chief C. A. Haigh Hanover Park Fire Department

10. Current Situation Decreasing number of fire… Relatively unchanged number of firefighter fatalities. Chief C. A. Haigh Hanover Park Fire Department

11. 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

12. 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

13. Cardiovascular Impact on LODD What do we know? Chief C. A. Haigh Hanover Park Fire Department

14. The job is getting harder… • Increased BTU Production • Changes in construction • 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

15. 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

16. 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

17. Personal physical fitness Health screening On-Scene Rehabilitation How do we reduce the impact of heat stress? Chief C. A. Haigh Hanover Park Fire Department

18. If Heat Stress is the likely causation of many detrimental physiologic responses, why is rehab not a integral part of the fire service response? On-Scene Rehabilitation Several Likely Reasons… Chief C. A. Haigh Hanover Park Fire Department

19. Lack of rehab? • Culture of Fire Service • “Rehab is for Sissies” • Undeveloped on-scene rehabilitation and support systems • Lack of widespread research • Why we do what we do? Chief C. A. Haigh Hanover Park Fire Department

20. What do we know? Field-based Research To Document the Stress of Firefighting Chief C. A. Haigh Hanover Park Fire Department

21. 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

22. 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

23. Sudden Cardiac DeathPrimary Cause of LODD Chief C. A. Haigh Hanover Park Fire Department NPFA Firefighter Deaths by Nature -- 2011

24. 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

25. Firefighter Deaths to Date by Nature of Injury -- 2012 • Cardiac & Stroke: 53.1% • Trauma: 37.5% • Other: 6.3% • Crushing: 3.1% Chief C. A. Haigh Hanover Park Fire Department

26. Total Firefighter Injuries Chief C. A. Haigh Hanover Park Fire Department

27. Distribution of Injuries Karter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2011 Chief C. A. Haigh Hanover Park Fire Department

28. Firefighter Injuries: Total injuries have reduced in hand with total fires, yet leading causes (overexertion/strain & slips/falls) remain relatively stable Karter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2009

29. Is there a correlation between overexertion and strain and slips/trips/falls? Chief C. A. Haigh Hanover Park Fire Department

30. Slips, Trips, Falls Sudden Cardiac Events Working Hypothesis Firefighting Heat Stress Fatigue Overexertion/ Strain Biomechanical Changes CV/Coagulatory Changes Reduced Situational Awareness Disorientation, Entrapment, Poor decisions, and related Injuries and Fatalities Chief C. A. Haigh Hanover Park Fire Department

31. 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

32. Simplified Schematic of Possible Causes of Heart Attack in FF Perfuse sweating Increased Body Temperature Activation of SNS Decreased Plasma volume Increased viscosity Changes in HR and BP Altered Electrolytes Circulatory Shock Arrhythmias Clot Formation Plaque Disruption Heart Attack Chief C. A. Haigh Hanover Park Fire Department

33. 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 Denise L. Smith, PhD Skidmore College

34. Study Cycle drills drills drills Rehab Rc1 Rc2 ~ 8min ~ 8 min ~ 8 min = measurement period Denise L. Smith, PhD Skidmore College

35. Heart Rate Response * * * * p < .05 vs rest Denise L. Smith, PhD Skidmore College

36. Stroke Volume Response # # p <.05 vs T1 Denise L. Smith, PhD Skidmore College

37. Stroke Volume Response # Take home message: Push Fluids # p <.05 vs T1 Denise L. Smith, PhD Skidmore College

38. Changes in Core Temperature Denise L. Smith, PhD Skidmore College

39. Changes in Core Temperature Take home message: Provide Cooling Denise L. Smith, PhD Skidmore College

40. Effect of Firefighting on Coagulation Factors (N=10; Mean ± SD) VariablePrePost 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) 243.9 (20.8) † Antithromin III (%) 109.7 (4.9) 116.8 (6.9) * (Fibrinogen & Antithromin III: Factors in Blood Clotting) *p<0.001 † p < 0.05 Denise L. Smith, PhD Skidmore College

41. a Pre Post Post 90’ a significantly (p <.05) different pre and post 90’ Denise L. Smith, PhD Skidmore College

42. a c a significantly (p < .05) different pre and post90 c significantly (p < .05) different pre and post 90’ Denise L. Smith, PhD Skidmore College

43. Impact of Rehab Denise L. Smith, PhD Skidmore College

44. Implementation of an Effective Rehabilitation Program NFPA 1584 On-Scene Rehabilitation Chief C. A. Haigh Hanover Park Fire Department

45. 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

46. 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

47. 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

48. 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

49. 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

50. 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