Firefighters endure strenuous conditions to volunteer

PUNXSUTAWNEY — It has been a long, hot summer for everyone, especially those who work outdoors. But there is a certain group that must deal with heat and dehydration issues throughout the year: Firefighters.
Firefighting is a tough job, work so physically intense that it demands every ounce of energy a firefighter can muster. Sometimes, it takes a toll.

Statistics from the Pennsylvania Department of Health/Bureau of EMS show that most firefighter injuries are caused by physical stress resulting from prolonged exposure to heat, not from injuries incurred at the scene, which is why the Department of Health implemented new protocols in the local area for EMS as of July 1.

Ed Mann, Pennsylvania State Fire commissioner, said that firefighter rehab, which has been utilized in most metropolitan areas, is finally starting to catch on in other parts of the state.

"There are some areas of the state where firefighter rehab has been going on for the last ten years," he said.

Mann said firefighter rehab has received more attention because there is now a national standard included in the Pennsylvania EMS protocol.

"When you consider that the No. 1 cause of firefighter line-of-duty deaths is due to heart attacks because of sudden cardiac arrest, if I can bring you out of that environment, and an EMS crew takes your vital signs and finds something irregular, I've just prevented a line-of-duty death," he said.

Mann said in the Harrisburg area, where he lives, there's an ambulance service that has been doing firefighter rehab for more than 10 years.

One of the things that EMS will do is come to each fire station and record baseline vital signs for firefighters in a computer. That way, if EMS is at a fire scene somewhere, crews are taking vital signs and have some kind of a baseline information to compare it to.

Mann said an ambulance service takes each candidate's baseline vital signs for anyone who comes to the state Fire Academy for the residential burn program on the first or second day of class.

"If they pick up on any problems with your baseline vital signs that day that can't be cleared up with a medical doctor, we send them home," he said.

"I know of an individual who came out of the burn building during a training session and went to rehab," Mann said. "The paramedic said, 'There's something wrong with your heart rate; there's something amiss with it.’ He went to the emergency room, and they did an EKG and found out that he had a problem with his heart rhythm that he never knew he had."

Mann said in a study dealing with firefighter stress, the U.S. Coast Guard reported that during interior firefighting operations, a firefighter's body core temperature often reaches 104 degrees Farenheit.
Since 1994, the fire service has been averaging between 90 and 105 deaths per year. Heart attacks and strokes still account for the largest number of line-of-duty deaths.

While the total number of deaths has generally been declining, the percentage of deaths due to heart attacks and stroke have actually risen.

According to the NFPA, these heart attacks and strokes are almost always due to stress and overexertion.

Todd Peace, chief of the Big Run Area Volunteer Fire Department, said with the large number of major fires his department fought this past year — especially during the summer — he has had to utilize firefighter rehabilitation. With the summer heat and fatigue factor alone, he has also had paramedics and EMTs setting up actual rehab areas with fans and chairs.

Donnie Haines, supervisor of Jefferson County EMS, said with the new state protocols that went into effect July 1, there's more for his EMS crews to monitor at a fire scene.

Chuck Cressley, manager of Jefferson County EMS, said everyone worries about football players practicing and playing games during the summer and into the fall, but they only wear a fraction of the gear that firefighters will wear when battling an interior fire.

"In most cases, the football players are younger and in better shape than a firefighter is," he said.

Haines said the volunteers EMS workers pull from fires are not always in the best of condition.

"The activity levels that a firefighter endures during fire ground activity is one of the most difficult stressors that a person can put on their bodies," Cressley said, adding that EMS is on-scene at a fire or accident for patient care.

Haines said EMS hasn't encountered any firefighters who've refused to have their vitals checked or go through rehab.

"I think all of the department chiefs in Jefferson County are pretty much on board with the latest protocols," he said. "Whoever is in command at a fire scene, they direct firefighters that they must go through rehab and have their vital signs checked, or they'll have to sit out the rest of the time."

Cressley said it becomes a difficult situation for volunteer companies that have a limited number of personnel to work with, and firefighters are not permitted to recycle back in to help fight the fire.

Haines said EMS is seeing more mutual aid fire companies called to fire scenes in order to have proper rehab and be able to step in for those who do not recycle back in.

Cressley said there was recently a large fire at a manufacturing plant in the Delaware Water Gap in Lehigh Valley, where more than 60 departments were called to the scene to help fight the huge blaze, mainly due to firefighter rehab.

The fire occurred during the hottest portion of the summer, and some of the firefighters had to sit out for several hours before they could be rotated back in due to dehydration, Cressley said, adding there are many unknown factors that EMS has to deal with during rehab.

"A firefighter may have an unknown cardiac disease that may cause a cascading event to occur while someone is battling a fire," Haines said, and that the initial stressor can trigger many underlying conditions.
Cressley said something else that could come out of the new protocols is that EMS might require some more assistance at the scene.

"As busy as we are at times, to implement this new protocol, we may in fact have to call immediate response groups to help us monitor department members who are involved with fire ground operations," he said, adding that it's conceivable that even at a rural fire, there could be 100 firefighters on the scene of a fire throughout the year.
"For one EMS crew to oversee the condition of that many firefighters is pretty unreasonable," Cressley said. "I'm not sure that with the introduction of this new protocol, fire services will have to have a specific rehab unit county-wide or within a fire company to be dispatched to a scene for firefighter rehab."

Haines said the Falls Creek Volunteer Fire Company has a specific rehab trailer that will transport all of the necessary elements, including fans and folding chairs.

The Internet has played a major role in bringing about these changes as more groups are networking, which allows for more discussion of the issues such as firefighter rehab, Cressley said.

Paul Hense, Punxsutawney Fire Department chief, said at every structure fire, an area for rehab has to be established when the department first arrives on scene.

"We work closely with the ambulance service, and the area should be set up far enough from the scene that it's close, but in the general area where someone can relax and not be in the smoke and be well ventilated," he said, adding that the Punxsutawney Salvation Army has received a canteen truck that will serve refreshments from the truck for firefighters at the scene.

Capt. Keith Jache, Punxsutawney Salvation Army said this is something that has been growing since he arrived in Punxsy.

Jache said the corps will go out to a fire scene, day or night, to serve refreshments, especially cold bottles of water, to help with firefighter rehab.

"We began this ministry with just a van transporting beverages and snacks, and I was able to obtain a canteen truck through the Salvation Army headquarters," Jache said, adding that he discovered there was quite a need for this service along with assistance from the American Red Cross.

Hense said just standing around at a scene wearing bunker gear wears a firefighter out.

"If I have firefighters staging at the scene, many times, I'll tell them to take some of the gear off so they can keep cool until they're needed," he said. "The accountability system our department has implemented is part of the firefighter rehab system."

Hense said that each Punxsy firefighter has two tags bearing his or her name, and each firefighter must turn the tag in to an accountability officer when he or she enters a structure to fight the fire and tag out when going to rehab or returning to the staging area.

"We will lose more people to heart attacks than we ever do to injuries at the fire scene," he said. "That is considered a firefighter death, even if that person went to the scene, went back to the station and had a heart attack an hour later from the stress of firefighting."

Hense said that firefighter rehab will continue year-round, even during the winter when they have the opposite problem, with firefighters suffering from the cold temperatures and frostbite.