Firefighting is a highly dangerous occupation, but it is indispensable and can even be prestigious. The emergency-response services enjoy both public admiration for acts of bravery and criticism due to injury and death in the line of duty. Their work involves intermittent exposure to extreme physical and psychological stress on the job, and they are also exposed to serious chemical, biological and physical hazards, to a degree unusual in the modern workforce. The acute hazards of firefighting, primarily trauma, thermal injury and smoke inhalation, are obvious.
The risks and occupational hazards for firefighters are a grey area for emergency-response services, government, private and research agencies. Occupational hazards can include both short-term and long-term risks associated with the workplace environment and is a field of study within occupational health and safety, and public health. There might be any number of excuses, including other priorities, lack of awareness, non-availability of funds, and hurdles to implementing protective measures, but first we need to create awareness for a clear understanding about what risks exist, whether these are acceptable and how they might be controlled.
Occupational hazards can encompass physical hazards – such as a fall or trip, cut injury, road accident, heat stroke, burn injury and handling of high-pressure firefighting equipment – as well as diseases including respiratory, cancer, cardiovascular, chronic lung, neurological/sensory, exposure to various toxic and carcinogenic chemicals, toxic gases, fumes, dusts, radiological hazards, biological, psychosocial, musculoskeletal (lower back pain, osteoarthritis).
Behavioural disorders can occur due to working prolonged duty hours or lack of leave, which leads to mental stress and an impact on family life.
Exposure hazards are due to lack of available personnel protection equipment (PPE), proper decontamination processes and regular medical checks for early detection of diseases.
The above risks can be controlled by the following hierarchic process: elimination (physically removing the hazard), substitution (replacing the hazard), engineering controls (changing the way people work) and PPE. Each and every risk and occupational hazard encountered during firefighting and rescue operations should be mapped, based on leadership, past incidents and investigations. Recommendations with preventive action plans should be published and online tracking mechanisms made available in the public domain for feedback for continual improvement. We need to create awareness of the risks and occupational hazards of firefighters, and conduct studies on occupation hazards, ergonomics, stress management, behaviour disorders, chronic diseases and early cancer detection to create a prevention programme which leverages the latest technologies.
Potential reasons for on-duty cardiac-related deaths: Heart rate goes up with alarms and sirens, and combines with the physical stress of wearing 50+ lbs of protective equipment while working at near maximal heart rates. Heat stress and fluid loss can cause decreased cardiac output even with increased pulse. PPE reduces environmental toxic exposure but does not eliminate all toxins.
Cardiovascular disease risk factors: 45 years plus, hypertension, smoking, previous diagnosis of coronary heart disease, diabetes, hyper cholesterol.
Cancer risk: Firefighters are twice, sometimes three times, as likely to develop testicular or skin cancer and leukaemia. Brain cancer in firefighters with 20 years’ experience is so common in Ontario, Canada that it is recognized as a workplace injury and victims are automatically compensated – at least 15 studies show a statistical link between brain cancer and firefighting. Elevated mortality risks due to brain tumours, lymphatic cancers, bladder and kidney cancers, and soft tissue sarcomas have been observed, and the overall risk of cancer among firefighters in Florida was found to be significantly higher when compared to the general population. There are also significant mortality risks due to respiratory cancer and skin cancer, which may not appear until later in life.
Immediate actions that may reduce cancer risks: Use of self-contained breathing apparatus set throughout operations; use of wet wipes to remove soot from head, neck, jaw, throat, under arms and hands immediately and while still on scene; change clothes and wash them immediately after fire, shower thoroughly after a fire and do not take contaminated clothes and PPE home, nor store them in a vehicle; decontamination of fire appliance interior after a fire; keep PPE out of living and sleeping quarters; stop using tobacco products. In addition, the importance of annual medical examinations cannot be overstated as early detection and treatment are essential for increasing survival rates.
During an incident, atmospheric risks such as carbon monoxide, toxic chemicals and other unburnt particle hazards can be mitigated by mechanical ventilation, HVAC, positive/negative pressure, hydraulic and smoke management by exhaust fans and lowers and so on.
Symptoms of heat exhaustion: fainting, profuse sweating, headache, tingling in the extremities, pallor (ashen colour of the face), dyspnoea (shortness of breath), nausea and vomiting.
Heat stress management: The most important measures are to minimize heat/radiation/chemical exposure levels by rotation of firefighter crew engaged in emergencies, identify basic heat-stress terms and concepts and the sources of heat exposure that affect firefighters, understand the added impact of PPE on heat stress, understand the effects of heat stress on the human body, understand the role of adaptation to environmental conditions and how they may benefit firefighters, identify and treat the symptoms of minor heat injuries and illnesses, identify and treat the symptoms of heat exhaustion, identify and treat the symptoms of heat stroke and various methods for avoiding heat-related injuries, and conduct simulator-based live firefighting training.
Treatment for heat exhaustion: Elevate the patient’s legs and remove them away from the heat to a cool place. Water and/or salt replacement should be given, using intravenous methods if required, followed by continuous monitoring of the patient’s condition in the field and then evaluation of their electrolyte status at a hospital. Recovery from heat exhaustion is usually rapid but an immediate return to duty is not advisable.
Proper hydration: This is the most critical factor in preventing heat injury. Water must be replaced, both during exercise periods and at emergency scenes; thirst should not be relied upon to stimulate drinking. Cool water and cups must be readily available at both exercise areas and emergency scenes and drinking must be encouraged.
Psychological effects of heat stress: Heat-acclimatized firefighters will not be affected as quickly as those who are not acclimatized. Heat stress reduces mental performance, slows reaction and decision times meaning that tasks requiring attention to detail, concentration and short-term memory may be more difficult. Routine tasks are performed more slowly, and errors are more common. Dehydration greater than 2% of body weight will adversely affect mental function of simple tasks.
Physical fitness: Strenuous training drills create a risk of coronary-heart-disease deaths for firefighters who lack physical fitness, and most fire departments now have a system of regular exercise.
Physical exercise: Daily exercise is a good idea, with at least 3–4 sessions of combined cardio fitness and weight training a week. Speak to a medical professional before starting a programme if not already exercising.
Meditation: During the Thailand cave rescue, meditation led by a coach helped the boys survive the terrifying ordeal. The team were then trapped in the cave for more than two weeks before they were led to safety by rescue divers.
Completed Physical Ability Test (CPAT): We have been inspired by the USA and Canada emergency-response services and developed in-house simulators for physical ability and professional fitness assessments or endurance tests to ensure continual professional fitness. In India, firefighters are usually selected on their physical statistics and their athletic performance, but the functional tasks necessary to perform during an actual emergency are not tested.
Common activities involving ergonomic hazards: High-rise fires, ventilation and overhaul procedures, hose-laying operations, ladder work, forcible entry, extrications, extended procedures, hose rolling, carrying heavy equipment, physical exertion and so on.