This document summarizes research on occupational exposures and health risks faced by firefighters. It finds that while traumatic injuries are a risk, the leading causes of firefighter mortality in the US are medical issues like sudden cardiac death and certain cancers. Epidemiological studies show increased risks of these illnesses due to inhalation of toxic smoke particles and combustion byproducts during firefighting activities. Even with protective equipment, firefighters can absorb carcinogens through their skin and lungs. The risks remain even after fires are out during overhaul and salvage when respiratory protection is often not used. To better protect firefighter health and safety, the document argues for revised standards and protocols that address chronic long-term exposure risks, not just acute threats like burns or asphy
This document provides a summary of a full thickness third degree burn. It begins with an overview of burn injuries and classifications. It then describes the pathophysiology of a full thickness third degree burn, which destroys the epidermal and dermal layers of skin. Treatment includes wound care, pain management, antibiotics, and skin grafts. Nursing care focuses on preventing infection and maintaining skin integrity. The document ends with a personal story from the perspective of a nursing student who suffered a full thickness burn injury in a car accident, describing her physical and emotional struggles.
El documento describe los diferentes tipos y modelos de bases de datos, incluyendo bases de datos estáticas, dinámicas, jerárquicas, de red, relacionales, multidimensionales, orientadas a objetos, documentales y deductivas. Explica los componentes clave de una base de datos como tablas, registros, campos, claves primarias y relaciones entre tablas.
Awoti Akoi provides biographical details about himself including his full name, birthdate, parents' occupations, siblings' names and ages, best friend, schools attended, and favorite subjects. He describes a typical school day from waking up at 6 AM to doing homework and going to bed by 9:30 PM. Additionally, he notes where his extended family lives, his plans to attend the University of Connecticut to become an auditor, and how he wants to give back to his community in the future.
CLIQ offers electronic lock systems that provide flexible and secure access control through electronic keys that can be managed remotely. Their locks can be used for doors, cabinets, and other access points, installing easily without wiring. CLIQ customers include universities, industries, hospitals, and utility providers worldwide who benefit from the high security and flexibility of CLIQ's electronic lock systems.
This document discusses three types of conditional sentences in English grammar. The first conditional uses the present simple tense to talk about possible present or future events. The second conditional talks about hypothetical or unlikely situations using the past simple tense. The third conditional talks about hypothetical past events using the past perfect tense.
This short document promotes creating presentations using Haiku Deck, a tool for making slideshows. It encourages the reader to get started making their own Haiku Deck presentation and sharing it on SlideShare. In just one sentence, it pitches the idea of using Haiku Deck to easily create engaging slideshow presentations.
This document lists over 50 presentations given by Michael G. Kelly between 1978 and 2015 on topics related to vocational education, English as a second language, workforce development, and instructional leadership. The majority of presentations took place in Washington state and focused on boot camp instruction, quality instructional leadership, and developing skills in the marine industry. Kelly also presented frequently in the 1980s in Illinois on developing vocational education and materials for limited English proficiency students.
This document provides a summary of a full thickness third degree burn. It begins with an overview of burn injuries and classifications. It then describes the pathophysiology of a full thickness third degree burn, which destroys the epidermal and dermal layers of skin. Treatment includes wound care, pain management, antibiotics, and skin grafts. Nursing care focuses on preventing infection and maintaining skin integrity. The document ends with a personal story from the perspective of a nursing student who suffered a full thickness burn injury in a car accident, describing her physical and emotional struggles.
El documento describe los diferentes tipos y modelos de bases de datos, incluyendo bases de datos estáticas, dinámicas, jerárquicas, de red, relacionales, multidimensionales, orientadas a objetos, documentales y deductivas. Explica los componentes clave de una base de datos como tablas, registros, campos, claves primarias y relaciones entre tablas.
Awoti Akoi provides biographical details about himself including his full name, birthdate, parents' occupations, siblings' names and ages, best friend, schools attended, and favorite subjects. He describes a typical school day from waking up at 6 AM to doing homework and going to bed by 9:30 PM. Additionally, he notes where his extended family lives, his plans to attend the University of Connecticut to become an auditor, and how he wants to give back to his community in the future.
CLIQ offers electronic lock systems that provide flexible and secure access control through electronic keys that can be managed remotely. Their locks can be used for doors, cabinets, and other access points, installing easily without wiring. CLIQ customers include universities, industries, hospitals, and utility providers worldwide who benefit from the high security and flexibility of CLIQ's electronic lock systems.
This document discusses three types of conditional sentences in English grammar. The first conditional uses the present simple tense to talk about possible present or future events. The second conditional talks about hypothetical or unlikely situations using the past simple tense. The third conditional talks about hypothetical past events using the past perfect tense.
This short document promotes creating presentations using Haiku Deck, a tool for making slideshows. It encourages the reader to get started making their own Haiku Deck presentation and sharing it on SlideShare. In just one sentence, it pitches the idea of using Haiku Deck to easily create engaging slideshow presentations.
This document lists over 50 presentations given by Michael G. Kelly between 1978 and 2015 on topics related to vocational education, English as a second language, workforce development, and instructional leadership. The majority of presentations took place in Washington state and focused on boot camp instruction, quality instructional leadership, and developing skills in the marine industry. Kelly also presented frequently in the 1980s in Illinois on developing vocational education and materials for limited English proficiency students.
Cader draftprotocol literature review 4 abreiviated with changesRugshana Cader
This document discusses the Road to Health Chart (RtHC) used in South Africa to monitor children's growth and development. It notes that the oral health section of the RtHC is often overlooked. The RtHC was created to improve child health monitoring and the relationship between healthcare workers and parents. However, the oral health section is not well utilized as primary healthcare facilities often lack dental professionals. Childhood dental caries rates are high in South Africa, suggesting more needs to be done to address oral healthcare through policies and services. An integrated approach between medical and dental professionals could help identify oral health issues earlier.
Connect Magazine - July/August 2015 IssueAnna Dunn
Epworth By The Sea is a 100-acre retreat center located on St. Simons Island, Georgia that hosts 900 groups annually. It offers a safe and secure environment where guests can enjoy the natural beauty by walking the grounds or spending time in solitude. The property has a long history dating back to 1735 and blends the past and present through facilities like the oldest church on the island and newest lodge overlooking the river. Groups are drawn to activities like the ropes course and zip line where they can encourage each other through team building.
Pelican Grand Beach Resort in Fort Lauderdale, Florida underwent a multimillion dollar expansion to add two new oceanview ballrooms and rooftop spaces,
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document provides a selection of images taken in Digbeth, Birmingham. Photos were captured to document the area. Key sights and features of Digbeth in Birmingham are represented in the chosen photographs.
Pieter Nortje update Fitter with dual Diesel and Auto (1)Pieter Nortje
This document provides a summary of Pieter Nortje's personal and professional details. It includes his qualifications, languages spoken, driver's license, employment history spanning over 30 years working for various mining companies in South Africa and overseas, most recently as an underground mobile plant maintenance fitter in Rustenburg. It details the various mining equipment he has experience working on and maintaining across different roles.
Christopher Alan Reece has over 10 years of experience in education and international student services. He has a BA in History from Purdue University and a TEFL certificate from USTC. Currently, he works as an international credential evaluator and DSO at Ball State University where he processes applications, calculates GPAs, advises students, and handles visa paperwork. Previously, he taught English in China at the Nanjing School of Foreign Language and University of Science and Technology of China. He also has leadership experience as the co-founder and manager of the Purdue Fighting Game Club.
This document discusses hacking and ethical hacking. It provides an overview of hackers and different types of hackers such as black hat, white hat, and grey hat hackers. The history of hacking is explored beginning in the 1960s and the evolution of hacking with the rise of computers and the internet. The hacking process and techniques/tools used are addressed as well as advantages and disadvantages of ethical hacking. Different types of hackers like script kiddies are defined. Precautions against hacking and some famous hackers are also mentioned. The document provides references for further information.
Macy's Herald Square in New York is redesigning their store layout with a new center case-line called Dolce Rosa Excelsa to feature products and create additional shopping space by adding columns and vitrines throughout the store as well as more isle space.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Este documento clasifica las ecuaciones de segundo grado en completas e incompletas, y las completas en dos tipos dependiendo de si tienen o no solución real.
The document discusses the Data Transparency Lab, a community effort to increase transparency around how personal data is used online. It aims to reveal how personal data flows and is used, explore transparent data exchange models, and foster discussion through community involvement, research grants, and tools that help users understand their personal data usage. The goal is to make the web economy more trustworthy by empowering users through transparency.
This document discusses how wearable technology can enhance the hotel guest experience. It describes a system where guests check-in using their social media profiles linked to a smartwatch. The smartwatch allows keyless entry to their room and provides personalized recommendations and services throughout the stay. These include location-specific attractions on the TV, health and fitness advice from a smart scale, and immersive audiovisual experiences from a smart shower cap. Notifications are sent to the smartwatch upon departure to provide feedback and share the experience.
This document discusses functional and organic gastrointestinal disorders in children and adolescents. It begins by defining and classifying common organic disorders of the esophagus, stomach, duodenum, pancreas, and intestine seen in pediatric patients. These include gastroesophageal reflux disease, peptic ulcers, and inflammatory bowel diseases. The document then discusses the etiology, clinical manifestations, diagnosis, and treatment of these conditions in more detail. It also covers functional gastrointestinal disorders, which are defined as conditions with gastrointestinal symptoms that cannot be explained by structural abnormalities.
This document provides productivity hacks and discusses 5 facts about productivity. Fact #1 states that willpower is a muscle that needs to be exercised. Fact #2 says that multitasking is difficult for humans. Fact #3 notes that human memory is limited. Fact #4 acknowledges that humans have physical needs. The document concludes by advising the reader to be happy.
Early Grade Reading Activity Malawi (1)Sarah Bliss
This three-sentence summary provides an overview of the document:
The document evaluates the performance of the USAID/Malawi Early Grade Reading Activity (EGRA) which aimed to improve early grade reading instruction and learning outcomes in Malawi through four components: quality reading instruction, teaching and learning materials, parental and community involvement, and improving the policy environment. The evaluation assessed the implementation and effectiveness of EGRA between 2012-2015 through classroom observations, interviews, surveys and data collection in schools across three regions to determine the progress and impact of the activity. The report presents findings related to reading instruction practices, resource availability, community engagement, management and sustainability to draw conclusions on the successes and challenges of EGRA and provide recommendations.
Hugo Boss has launched its first women's fragrance under the Boss Orange brand called Boss Orange, featuring British actress Sienna Miller in its advertising campaign. The fragrance is a round, fruity floral centered around apple and peach with contrasting vanilla and woody notes. Christian Dior is adding a second fragrance to its travel-themed Escales de Dior collection inspired by Pondicherry, India called Escale à Pondichéry, created by in-house perfumer François Demachy. By Kilian is launching Back to Black, an unisex fragrance described as an olfactive aphrodisiac built around honey, fruity notes and wo
This chapter discusses the history of occupational safety and health for emergency services. It outlines key objectives which are to discuss the history of industry and emergency services safety programs, identify current safety issues through historical data, and describe efforts to address these issues. It then provides details on the safety risks and hazards faced by firefighters and EMS responders. Historical data on injuries and fatalities from organizations like NFPA and NIOSH is examined. The 16 Firefighter Life Safety Initiatives created in 2004 to prevent line-of-duty deaths are outlined. In conclusion, it notes that while injury and fatality rates have remained constant, continued prioritization of safety and evaluation of new programs is still needed.
A pandemic event is characterized by a disease spreading quickly and causing illness or death in a large number of people across a wide geographic area. During a pandemic, first responders must ensure they are vaccinated, trained, and equipped with proper protective equipment like respirators to control infection and protect themselves and the public. The P-100 respirator provides the highest level of protection against airborne particles carrying viruses and is recommended for first responders during a pandemic. However, supplies may not meet demand, so planning is needed to predict and stock needed quantities of disposable respirators.
Blast lung injury (BLI) is caused by the blast wave from high explosive detonations damaging the lungs. BLI can cause respiratory difficulty and hypoxia without obvious chest injuries. It is diagnosed clinically and may show a characteristic "butterfly" pattern on chest x-rays. Management of BLI involves supplemental oxygen, treatment of hemopneumothorax if present, and careful fluid management to avoid volume overload similar to pulmonary contusion. Outcomes of BLI can vary but many patients have normal exams and lung function after one year.
The document summarizes the key recommendations from the Hartford Consensus conference which brought together medical, law enforcement, and emergency response experts to discuss improving survival from active shooter events. The consensus recommends an integrated response using the acronym THREAT - Threat suppression, Hemorrhage control, Rapid extrication to safety, Assessment by medical providers, and Transport to definitive care. It emphasizes that early hemorrhage control, such as use of tourniquets, should be part of the law enforcement response and that all responders need training in basic hemorrhage control techniques to maximize survival from such events.
Cader draftprotocol literature review 4 abreiviated with changesRugshana Cader
This document discusses the Road to Health Chart (RtHC) used in South Africa to monitor children's growth and development. It notes that the oral health section of the RtHC is often overlooked. The RtHC was created to improve child health monitoring and the relationship between healthcare workers and parents. However, the oral health section is not well utilized as primary healthcare facilities often lack dental professionals. Childhood dental caries rates are high in South Africa, suggesting more needs to be done to address oral healthcare through policies and services. An integrated approach between medical and dental professionals could help identify oral health issues earlier.
Connect Magazine - July/August 2015 IssueAnna Dunn
Epworth By The Sea is a 100-acre retreat center located on St. Simons Island, Georgia that hosts 900 groups annually. It offers a safe and secure environment where guests can enjoy the natural beauty by walking the grounds or spending time in solitude. The property has a long history dating back to 1735 and blends the past and present through facilities like the oldest church on the island and newest lodge overlooking the river. Groups are drawn to activities like the ropes course and zip line where they can encourage each other through team building.
Pelican Grand Beach Resort in Fort Lauderdale, Florida underwent a multimillion dollar expansion to add two new oceanview ballrooms and rooftop spaces,
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
The document provides a selection of images taken in Digbeth, Birmingham. Photos were captured to document the area. Key sights and features of Digbeth in Birmingham are represented in the chosen photographs.
Pieter Nortje update Fitter with dual Diesel and Auto (1)Pieter Nortje
This document provides a summary of Pieter Nortje's personal and professional details. It includes his qualifications, languages spoken, driver's license, employment history spanning over 30 years working for various mining companies in South Africa and overseas, most recently as an underground mobile plant maintenance fitter in Rustenburg. It details the various mining equipment he has experience working on and maintaining across different roles.
Christopher Alan Reece has over 10 years of experience in education and international student services. He has a BA in History from Purdue University and a TEFL certificate from USTC. Currently, he works as an international credential evaluator and DSO at Ball State University where he processes applications, calculates GPAs, advises students, and handles visa paperwork. Previously, he taught English in China at the Nanjing School of Foreign Language and University of Science and Technology of China. He also has leadership experience as the co-founder and manager of the Purdue Fighting Game Club.
This document discusses hacking and ethical hacking. It provides an overview of hackers and different types of hackers such as black hat, white hat, and grey hat hackers. The history of hacking is explored beginning in the 1960s and the evolution of hacking with the rise of computers and the internet. The hacking process and techniques/tools used are addressed as well as advantages and disadvantages of ethical hacking. Different types of hackers like script kiddies are defined. Precautions against hacking and some famous hackers are also mentioned. The document provides references for further information.
Macy's Herald Square in New York is redesigning their store layout with a new center case-line called Dolce Rosa Excelsa to feature products and create additional shopping space by adding columns and vitrines throughout the store as well as more isle space.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Este documento clasifica las ecuaciones de segundo grado en completas e incompletas, y las completas en dos tipos dependiendo de si tienen o no solución real.
The document discusses the Data Transparency Lab, a community effort to increase transparency around how personal data is used online. It aims to reveal how personal data flows and is used, explore transparent data exchange models, and foster discussion through community involvement, research grants, and tools that help users understand their personal data usage. The goal is to make the web economy more trustworthy by empowering users through transparency.
This document discusses how wearable technology can enhance the hotel guest experience. It describes a system where guests check-in using their social media profiles linked to a smartwatch. The smartwatch allows keyless entry to their room and provides personalized recommendations and services throughout the stay. These include location-specific attractions on the TV, health and fitness advice from a smart scale, and immersive audiovisual experiences from a smart shower cap. Notifications are sent to the smartwatch upon departure to provide feedback and share the experience.
This document discusses functional and organic gastrointestinal disorders in children and adolescents. It begins by defining and classifying common organic disorders of the esophagus, stomach, duodenum, pancreas, and intestine seen in pediatric patients. These include gastroesophageal reflux disease, peptic ulcers, and inflammatory bowel diseases. The document then discusses the etiology, clinical manifestations, diagnosis, and treatment of these conditions in more detail. It also covers functional gastrointestinal disorders, which are defined as conditions with gastrointestinal symptoms that cannot be explained by structural abnormalities.
This document provides productivity hacks and discusses 5 facts about productivity. Fact #1 states that willpower is a muscle that needs to be exercised. Fact #2 says that multitasking is difficult for humans. Fact #3 notes that human memory is limited. Fact #4 acknowledges that humans have physical needs. The document concludes by advising the reader to be happy.
Early Grade Reading Activity Malawi (1)Sarah Bliss
This three-sentence summary provides an overview of the document:
The document evaluates the performance of the USAID/Malawi Early Grade Reading Activity (EGRA) which aimed to improve early grade reading instruction and learning outcomes in Malawi through four components: quality reading instruction, teaching and learning materials, parental and community involvement, and improving the policy environment. The evaluation assessed the implementation and effectiveness of EGRA between 2012-2015 through classroom observations, interviews, surveys and data collection in schools across three regions to determine the progress and impact of the activity. The report presents findings related to reading instruction practices, resource availability, community engagement, management and sustainability to draw conclusions on the successes and challenges of EGRA and provide recommendations.
Hugo Boss has launched its first women's fragrance under the Boss Orange brand called Boss Orange, featuring British actress Sienna Miller in its advertising campaign. The fragrance is a round, fruity floral centered around apple and peach with contrasting vanilla and woody notes. Christian Dior is adding a second fragrance to its travel-themed Escales de Dior collection inspired by Pondicherry, India called Escale à Pondichéry, created by in-house perfumer François Demachy. By Kilian is launching Back to Black, an unisex fragrance described as an olfactive aphrodisiac built around honey, fruity notes and wo
This chapter discusses the history of occupational safety and health for emergency services. It outlines key objectives which are to discuss the history of industry and emergency services safety programs, identify current safety issues through historical data, and describe efforts to address these issues. It then provides details on the safety risks and hazards faced by firefighters and EMS responders. Historical data on injuries and fatalities from organizations like NFPA and NIOSH is examined. The 16 Firefighter Life Safety Initiatives created in 2004 to prevent line-of-duty deaths are outlined. In conclusion, it notes that while injury and fatality rates have remained constant, continued prioritization of safety and evaluation of new programs is still needed.
A pandemic event is characterized by a disease spreading quickly and causing illness or death in a large number of people across a wide geographic area. During a pandemic, first responders must ensure they are vaccinated, trained, and equipped with proper protective equipment like respirators to control infection and protect themselves and the public. The P-100 respirator provides the highest level of protection against airborne particles carrying viruses and is recommended for first responders during a pandemic. However, supplies may not meet demand, so planning is needed to predict and stock needed quantities of disposable respirators.
Blast lung injury (BLI) is caused by the blast wave from high explosive detonations damaging the lungs. BLI can cause respiratory difficulty and hypoxia without obvious chest injuries. It is diagnosed clinically and may show a characteristic "butterfly" pattern on chest x-rays. Management of BLI involves supplemental oxygen, treatment of hemopneumothorax if present, and careful fluid management to avoid volume overload similar to pulmonary contusion. Outcomes of BLI can vary but many patients have normal exams and lung function after one year.
The document summarizes the key recommendations from the Hartford Consensus conference which brought together medical, law enforcement, and emergency response experts to discuss improving survival from active shooter events. The consensus recommends an integrated response using the acronym THREAT - Threat suppression, Hemorrhage control, Rapid extrication to safety, Assessment by medical providers, and Transport to definitive care. It emphasizes that early hemorrhage control, such as use of tourniquets, should be part of the law enforcement response and that all responders need training in basic hemorrhage control techniques to maximize survival from such events.
The document discusses emergency preparedness and disaster response. It outlines the objectives of being able to identify an all hazards plan, discuss the nurse's role in disaster planning, and discuss triage systems. It describes national preparedness efforts including establishing an all-hazards approach. It defines the nurses' role in disaster planning as being prepared personally and professionally, understanding triage systems, and responding according to their facility's emergency response plan and providing triage in the community. It discusses the triage system used in healthcare facilities and disasters which categorizes patients as red, yellow, green or black based on severity and need for care.
The Milton Fire Department has launched seven new initiatives to prevent firefighter injuries: 1) designating Incident Safety Officers, 2) participating in the "Everyone Goes Home" safety campaign, 3) enhancing Rapid Intervention Team training and equipment, 4) increasing training for high-risk operations, 5) providing safety-specific training opportunities, 6) formally establishing a Firefighter Rehabilitation Program, and 7) reviewing policies to ensure compliance with provincial guidelines. These initiatives aim to continuously improve health and safety and protect firefighters from preventable injuries.
Emergency Response To Multi Casualty IncidentsAshendu Pandey
This document discusses emergency response to multi-casualty incidents such as terrorist attacks involving explosives, chemical or biological agents. It emphasizes the importance of scene safety and security, identification of hazards, protective equipment, decontamination, triage, treatment and coordination between emergency response agencies through pre-planning and information sharing.
Environmental and occupational disorders are an important aspect of clinical medicine. Physicians, employers, employees, and the general public need to be aware of epidemiological and clinical findings of these disorders and how to treat and prevent them. Environmental pulmonary diseases result from inhalation of various pollutants and the lungs are continually exposed. Pathologic processes can involve the airways, interstitium, and pleurae. Guidelines for diagnosing an occupational lung disorder include exposure to a known hazardous agent, appropriate latency between exposure and symptoms, symptoms consistent with the exposure-related disorder, and no other more likely explanation for signs and symptoms. Prevention focuses on reducing exposure through administrative controls, engineering controls, product substitution, and respiratory protection.
Considerations of the Ebola Outbreak, Haddon's Matrix and Reason's Swiss Chee...Wes Chapman
In 1970, Dr. William Haddon wrote a brilliant editorial that changed forever how we evaluate accidents and other failures in complex systems. The paper was titled, On the Escape of Tigers: An Ecological Note, and it looked at accidents through an etiological rather than descriptive approach. The work was immediately applied to automotive and aviation safety, beginning the enormous reduction in accidents in both fields that continues to this day. In 1990, Dr. James T. Reason published his first work on the role of barriers to sequential failure, and how they fail in truly catastrophic accidents. Together, their combined work forms the basis for much of the best practice for risk mitigation in the automotive, airline, oil & gas and healthcare industries. In this article, I take a look at the failed efforts to control the Ebola outbreak relative to the concepts of Drs. Haddon and Reason.
The document discusses the key players and publications that guide incident safety officers (ISOs). The National Fire Protection Agency (NFPA), Occupational Safety and Health Administration (OSHA), National Institute of Occupational Safety and Health (NIOSH), and Department of Homeland Security (DHS) are the main players that develop regulations, codes, standards, and guides. Publications like NFPA 1500 and 1521, OSHA regulations, and NIOSH reports provide standards and recommendations to help ISOs perform their duties safely and prevent firefighter injuries and deaths.
This document summarizes a presentation about occupational health risks for aging workers related to chemical, physical, and infectious exposures. It discusses how aging workers have increased susceptibility to certain exposures due to normal age-related physiological changes. It covers specific chemical exposures of concern, physical risks from noise and heat, and infectious disease susceptibility. It recommends steps for industries to take to manage risks, such as engineering and administrative controls, medical surveillance, and personal protective equipment programs tailored to older workers' needs.
Exposure assessment for occupational epidemiology part 1Retired
The aim of this lecture is to provide an introduction to occupational exposures and the strategies used in epidemiological studies to assess exposure of subjects.
Occupational hazards and risk management in nursing practice outlines various workplace hazards nurses may face and strategies for managing risks. It discusses physical, biological, chemical, organizational, and psychological hazards. It also covers classification of hazards, causes and safety measures, risk management, ergonomics, fire safety, and concludes that adequate safety precautions are needed to prevent injuries and ensure a safe work environment for nurses and patients.
Occupational hazard is a hazard experienced in the workplace, it can encompass many types of hazards, including chemical hazards, biological hazards (biohazards), psychosocial hazards, and physical hazards.
In other words, occupational hazard explains the risks of illnesses or accidents in the workplace. An occupational hazard is something unpleasant that a person experiences or suffers as a result of doing their job. Some dictionaries say that the term also includes hazards that people experience as a result of working on their hobbies.
Occupational hazard as a term signifies both long-term and short-term risks associated with the workplace environment and is a field of study within occupational safety and health and public health. Short term risks may include physical injury, while long-term risks may be increased risk of developing cancer or heart disease.
1. The document discusses temperature management after cardiac arrest. It recommends mild therapeutic hypothermia (MTH) to 32-34°C for 12-24 hours to protect the brain from global ischemia after cardiac arrest and resuscitation based on evidence from randomized control trials.
2. However, a recent randomized trial found no difference in outcomes between cooling patients to 33°C versus 36°C. The key is to avoid hyperthermia in patients after cardiac arrest rather than aiming for a specific target temperature.
3. MTH is not superior to target temperature management of 36°C and is associated with side effects like coagulopathy, so the current recommendation is to avoid hyperthermia rather than aiming for
This document proposes a thesis on training first responders to recognize and respond to biological threats. It discusses how biological agents can rapidly spread if detection is slow. While technologies like BioShield filters exist, manual collection and testing means delays in detection. The document examines past biological incidents like the 1918 Spanish Flu and 1995 Tokyo subway sarin attack to show the importance of early detection. It argues that educating first responders on production methods and symptoms can speed up detection before an outbreak spreads. Using military resources could provide training without significant additional costs.
Role of Emergency Physicians During CBRNE Attack - The Malaysian ContextChew Keng Sheng
This document discusses the role of emergency physicians in responding to CBRNE (chemical, biological, radiological, nuclear, and explosive) attacks. It begins by defining key terms like disaster, mass casualty incidents, and terrorism. It then reviews lessons learned from past terrorist attacks involving weapons of mass destruction. Early detection of biological attacks can be aided by syndromic surveillance of emergency department visits. The document outlines recommended preparedness criteria for emergency departments. Finally, it describes the "seven Ds" that define an emergency physician's role in disaster response: detection, declaration, defense, decontamination, delegation, drugs, and disposition.
This document summarizes the epidemiology, causes, management, and pathophysiology of thermal burn injuries. Some key points:
- Thermal burns are a major cause of death and disability worldwide, especially in those under 40. The average burn patient is 24 years old with 19% total body surface area burned.
- Most burns are preventable and caused by carelessness, while others result from smoking, alcohol, hot substances (2/3 of cases), and fire/flame (1/4 of cases). Major determinants of mortality include organ failure, infection, burn extent, and age/sex.
- Initial burn management focuses on stabilizing respiration, fluid resuscitation, and infection prevention
1. Occupational Exposures in the Fire Service 1
Occupational Exposures in the Fire Service
A Review of Exposure and Epidemiological Data
Jonathan D. Skube
Western Kentucky University
2. Occupational Exposures in the Fire Service 2
Abstract
In the U.S. there are nearly a million firefighters, representing a large workforce that is
exposed to tremendous stressors. In a review of the leading causes of mortality for
firefighters in the U.S., we find both the causes and nature of injury are due to medical
reasons other than trauma. Since investigators first began studying firefighter mortality,
sudden cardiac death has predominated as the largest proportion of on-duty deaths by
cause. Epidemiological studies suggest there is also an increased risk of specific cancers
associated with firefighting as an occupation. Additionally, more recent exposure studies
have shown a variety of combustion byproducts formed by structural fires include
substances known to also contribute to both cancer and cardiovascular disorders. These
substances include microscopic, respirable particles that are essentially invisible to the
eye yet are increased in airborne concentration as fire-suppression activities continue.
Inhalation exposures during fire-suppression are most likely to occur when self-contained
breathing apparatus is not worn. Furthermore, combustion byproducts are found to enter
the body through both dermal and inhalation routes of exposure even while structural-
firefighters’ ensemble is worn, with uptake noted by an increase in the body burden of
carcinogens after exposure. In conclusion, this review of firefighters’ epidemiological
and exposure data may provide evidence that compliance with conventional personal
protection ensembles during all fire-suppression activities are merely minimal exposure
reduction strategies. Lack of respiratory protection during salvage and overhaul
continue to represent a common, yet preventable, cause of potentially life-threatening
exposures. The fire service should be addressed as an occupation where every fire-
suppression activity represents a work environment with specific occupational hazards.
3. Occupational Exposures in the Fire Service 3
1. Introduction of the Research Topic
1.1 Occupational Exposures in Firefighting
Since the findings of Sir Percival Pott (1744-1788), we have found associations between
occupational exposure to incomplete combustion byproducts and adverse health events
(Richards & Bourgeois, 2014). Since then, environmental and industrial standards have
been established based on scientific discovery and used to make occupations safer by
decreasing the exposure and subsequent risk of an associated illness. However, current
standard operating procedures (SOPs) in the firefighting industry are mainly focused on
the use of structural firefighter's gear as they relate to those working an “active fire” with
visible flames and billowing smoke or in a hazardous materials incident. These
occupational settings describe what we consider an Immediately Dangerous to Life and
Health (IDLH) atmosphere. Until recently, there has been a gross underestimation of the
health impacts that cause firefighter morbidity and mortality, and on atypical firefighter
working environments when compared to fixed-settings in general industry. Minimal
information has been available regarding firefighter exposures during overhaul, the phase
in fire-suppression when firefighters search for hidden fire inside attics, ceilings, and
walls. Additionally, salvage is conducted in an attempt to preserve property. Both
phases are often conducted without the same respiratory protection afforded during the
knockdown phase of an active fire response and any attempted rescue of victims
(Bolsted-Johnson et al., 2000).
Ongoing research is finding more and more constant, insidious threats from both this
work environment and from continuous exposures retained on equipment and especially
on structural firefighters’ protective clothing. Commonly referred to as “bunker” or
“turnout” gear, it serves both as the industry standard and iconic ensemble of a structural
firefighter. Studies suggest there is an apparent lack of any uniform administrative
controls concerning the use of Personal Protective Equipment (PPE), namely, turnout
gear and SCBA. Until recently, the majority of past studies have characterized firefighter
exposures during the knockdown phase, when maximum personal protection is most
often utilized. Lapses in the use of PPE, particularly SCBA, most routinely occur during
lengthy exposure settings that follow active-fire “knockdown”, the phase in fire-
suppression in which the majority of the incident is mitigated. These studies have
indicated that even the act of donning and doffing contaminated PPE can lead to
inhalation of toxic and carcinogenic substances and to the spread of contaminants in the
firehouse (Fent et al., 2014). With nearly 1 million full and part-time firefighters in the
U.S., new research-based regulation and department-based occupational oversight on the
firefighting industry is warranted.
1.2 Current Efforts in Firefighters’ Occupational Health
Since its inception 40 years ago, the National Fire Protection Agency (NFPA) has sought
to primarily protect firefighters against the Immediately Dangerous to Life and Health
(IDLH) atmospheres, in accordance with Occupation Safety and Health Administration
(OSHA) standards (2015). An IDLH atmosphere is defined by the National Institutes for
4. Occupational Exposures in the Fire Service 4
Occupational Safety and Health (NIOSH) as an atmospheric concentration of any “toxic,
corrosive or asphyxiating substance that poses an immediate threat to life or would cause
irreversible or delayed adverse health effects or would interfere with an individual's
ability to escape from a dangerous atmosphere” (NIOSH, 1994). Since visible flames
and the acutely toxic and heated gasses produced in a fire represent both the most
destructive and acutely hazardous components of a structural fire, IDLH atmosphere,
thermal injuries, and mechanical stressors are at the forefront of industry standards on
firefighter health and safety. However, with the majority of firefighters being well-
trained against immediate threats and thereby preventing life-threatening injuries, there is
apparent lack of training and education towards protecting themselves and each other
against insidious, chronic threats to health that predominate the nature and causes of this
occupation’s mortality rates.
1.3 Firefighter Line of Duty Deaths
According to the NFPA (2015), an on-duty fatality includes “any injury sustained in the
line of duty that proves fatal, any illness that was incurred as a result of actions while on
duty that proves fatal, and fatal mishaps involving non- emergency occupational hazards
that occur while on duty” (Fahy, LeBlanc & Molis, 2015). Commonly referred to as Line
of Duty Deaths (LODDs), these are recorded as incidents when signs and symptoms
occur during firefighting activities, training, or either when enroute or coming back from
a response. Additionally, any illness or injury with initial onset of symptoms and
manifestation during such activities can also been categorized as on-duty fatalities. As an
example, chest pain encountered while on-scene and any subsequent manifestation to a
fatal acute myocardial infarction (AMI) can be included as a case where death is delayed
considerably, even for days.
1.4 Line of Duty Deaths
1.4.1 Sudden Cardiac Death
In a study by the National Fire Protection Agency (NFPA), of the 1,006 total on-duty
firefighter deaths recorded between 1995 and 2005, 440 were attributed to sudden cardiac
death (Fahy, 2005). Of these 440, 155 (35.2 percent) included those who experienced
cardiac symptoms during fire ground operations, with only 3 of them reportedly due to
acute inhalation of smoke. 1 of the 3 acute smoke-related deaths occurred at a “wildland”
(forest) fire setting, where firefighters are not expected, nor commonly equipped, to use
self-contained breathing apparatus (SCBA). The other 2 deaths were at structure fires
where one of the victims was reported to have been using SCBA while stretching a hose
line, a physically strenuous activity, where the face piece may have been dislodged. The
suspected effect of this vigorous activity resulted in the inhalation of toxic gasses either
prior to or while being rescued. The next largest percentage of the 440 cardiac deaths,
111 (25.2%) involved firefighters responding to, or returning from, alarms. Of these
firefighters, 52 were responding to incidents while 59 were returning or had returned
from a response when they appeared to have signs and symptoms of a cardiac event,
constituting a LODD (Fahy, 2005).
5. Occupational Exposures in the Fire Service 5
1.4.2 Recent Trends in Sudden Cardiac Death
In a more recent study of firefighters in the United States, of the 64 firefighter deaths in
2014, 58% alone were considered related to overexertion, stress and other medical issues,
with 35 of the 37 deaths in this category caused by sudden cardiac death (Fahy, Leblanc
& Molis, 2015). One of these deaths was attributed to an acute ischemic brain incident,
otherwise known as a stroke. Strokes are also designated as a cardiovascular event
because it involves the cardiovascular system. As a whole, sudden cardiac death
accounts for 56% of the total deaths during 2014. Sudden cardiac death rates were higher
for firefighters over the age of 40, constituting more than 2/3 of the total cases (Fahy,
2005).
1.5 Cancer Morbidity and Mortality from Firefighting
As stated by Daniels et al. (2014), most studies have simply examined mortality, but not
cancer incidence, among relatively few firefighters, with subjects recruited from a single
fire department. As of now, instances of fatal cancers possibly resulting from exposure to
firefighting operations are not on the list of on-duty deaths, with numerous discrepancies
noted by the International Association of Fire Fighters (IAFF) in the cancer risk
assessment processes currently used by the National League of Cities (IAFF, 2009).
However, we should expect that this might change in light of studies showing exposure
and quantifiable body burden to both known and suspected carcinogenic substances after
firefighting operations (Fent et al, 2014; Pleil, Stiegel, & Fent, 2014). Shift work, intense
training, and mandatory overnight stays in firehouses, along with high intensity work
during firefighting activities, are viewed as accepted stressors of the trade. However, in
addition to high levels of both physical and emotional stress, it has been recognized by
the IAFF that short and long-term exposure to chemicals and infectious disease are
causes of death and occupational disease disability that might be prevented (IAFF, 2008).
1.5.1 Cancer Rates for Firefighters versus the U.S. General Population
According to LeMasters et al., (2006), in a meta-analysis and systematic review of 32
types of cancer, previous findings of an elevated risk for multiple myeloma were
confirmed to exist among firefighters with a summary risk estimate (SRE) calculated
from existing statistical data. The SRE were calculated after meta-relative risk ratios
were performed on each of the cancer types, with both hypotheses for homogeneity
validated with fixed-effects modeling calculated and verified by SAS statistical software
in a three-part statistical summary, with measures incorporated to control for bias. In
conclusion, the researchers estimated a probable cancer risk of multiple myelomas with
an SRE of 1.53 with a 95% confidence interval (CI) of 1.21-1.94. In addition to eight
cancers possibly associated with firefighting, a probable association with other cancers,
including both non-Hodgkin lymphoma and cancers of the prostate were identified, with
SREs of 1.28 and 1.51, respectively. Testicular cancer had the highest relative risk (RR)
of any cancer identified with firefighting, indicated with a SRE of 2.02 (CI = 1.30-3.13)
(LeMasters et al, 2006).
6. Occupational Exposures in the Fire Service 6
The results of a study on firefighter exposures and cancer rates by Daniels et al. (2014),
provide additional evidence of a relation between known carcinogens, exposures by
firefighters, and cancer, with findings of excess malignant mesothelioma (SMR 2.00,
95% CI), indicating a twofold increase in mortality from this disease when compared to
the general U.S. population. According to Virta (2006), worldwide asbestos production
and use rose rapidly from 573,728 metric tons in the 1940s to 3,493,800 in 1970. This
fact illustrates the tremendous potential for firefighter exposure to asbestos and
subsequent disease manifestation from exposure during incidents involving buildings
constructed over that time period. This represents a specific workplace hazard generally
minimized for most occupations since the use of asbestos became highly regulated in the
1970s (Fritschi & Glass, 2014). This knowledge is critical to the firefighting industry,
given that asbestos, found in older building where it is integrated into insulating and
fireproofing materials such as concrete, shingles, and around pipes, does not normally
represent an inhalation hazard (Daniels et al., 2014). However, given the nature of
firefighting, any exposures may likely occur during operations in demolished buildings
when asbestos containing materials become damaged and their fibers become airborne.
During this scenario, asbestos fibers may present both inhalation hazards in the air of the
fire-suppression setting and then directly from contaminated structural firefighters gear.
Other diseases recognized to be specific to the respiratory route of exposure are lung
cancers and chronic obstructive pulmonary disease (COPD). These are of interest
because inhalation to the causative agents is considered the major pathway for exposures
during firefighting operations. Additionally, there is evidence of chronic and acute
inflammatory respiratory effects in firefighters. These short-term and chronic exposures
are hypothesized to be linked to the development of cancer (Daniels et al., 2014).
2. Human Exposure to Combustion By-Products
2.1 Environmental Hazards and Public Health Effects
In addition, the World Health Organization (WHO) has established an association
between air pollution and heart health disease, contributing to an estimated 40% of
ischemic heart disease, 40% of strokes, 11% of chronic obstructive pulmonary disease
(COPD), and 6% of lung cancers (World Health Organization, 2014). Additionally,
Jung, Su, & Liang (2015) found an association between indoor air pollutant exposure
with high blood pressure and increased heart rates in subjects according to body mass
index, a suspected factor for heart disease. The study also measured the levels of carbon
dioxide, total volatile organic compounds (VOCs) and PM2.5, two components of a
smoldering fire to which firefighters are certainly exposed. Additionally, in an exposure
and risk assessment performed by Rezadeh Azari et al. (2012), calculated levels of VOCs
in petroleum fuels, included known and/or suspected carcinogens and aromatic toxicants
such as benzene, toluene, ethylbenzene, and xylene (BTEX). Such compounds have been
characterized as being present in aerosol form in both structural fires and during
petroleum fuel loading operations. In the study, the researchers concluded that specific
biomarkers for BTEX compounds were found to accumulate in the bodies of exposed
workers after conducting the loading of petroleum fuel tanker trucks (Rezadeh Azari et
al., 2012).
7. Occupational Exposures in the Fire Service 7
2.1.1 Health Effects of Volatile Organic Compound (VOC) Exposure
As we now understand, solid or liquid inhalable combustion by-products that enter the
smallest functional components of the human lung consist of aerosolized particles and
other constituents of aerosols that make up smoke. These components include particulate
matter, oxides, volatile organic compounds (VOCs), including potentially toxic and
carcinogenic chemicals and elements (Richards & Bourgois, 2014). Regarding perhaps
the most widely known of the VOCs for its cancer causing properties in the
environmental and occupational environment, benzene is a highly volatile hydrocarbon
that consists of a single, 6-carbon aromatic ring. In a study by Portengen et al. (2015),
even at low levels of benzene exposure, researchers were able to detect increased risk of
lymphopoietic disorders during epidemiological investigations of benzene exposure.
This association was found using a statistical model for calculating exposure levels of
subjects from factories that were part of a nested case-cohort study of benzene exposed
workers (Portengen et al., 2015). This modeling framework enabled us to deal with the
data complexities generally found in studies using historical exposure data in a
comprehensive way and we therefore expect to be able to investigate effects at relatively
low exposure levels, such as those found during sampling as we assess chronic exposures
of firefighters.
2.1.2 Health Effects of Particulate Matter
In population health studies, industrialized nations have gained awareness of associations
between increases in the concentration of airborne combustion by-products and a
corresponding increase in adverse human health effects. In particular, urbanized centers
have become centers of environmental health research into the effects of particulate
matter on human health. Of special importance, particulate matter with an average
aerodynamic diameter equal to or less than 2.5 micrometers (PM2.5) has been implicated
in both respiratory and cardiovascular diseases, including strokes, heart disease, and
cancer, due to its ability to enter and carry compounds and elements to the smallest
regions of the human respiratory system (Richards & Bourgois, 2014). As one of the
most polluted cities in the world, Beijing has observed various adverse health
consequences from airborne contaminants, including PM2.5, which has resulted in both
increases in respiratory disease incidence and severity, with excessive hospital
admissions correlated with increased airborne concentration of these pollutants (Xiong et
al., 2015). In a study by Lee, Coull, Kloog, & Schwartz (2015) on the acute effects of
inhalation particulate matter, 10 mcg/m3
increase in PM2.5 was associated with a 1.56%
increase in daily deaths, with increases in cardiovascular disease showing the highest
effect estimate. Orru et al. (2009) found a relationship between the airborne
concentration of fine particulate matter and cardiovascular events, leading to both an
increased number of hospitalizations and premature deaths, as indicated by a decrease in
life expectancy of as much as an estimated 13 years.
8. Occupational Exposures in the Fire Service 8
2.2 Occupational Hazards and Health Effects from Firefighting
According to the NFPA, there were 346,000 career firefighters and 783,000 volunteer
firefighters in the USA between 2012 and 2013; any number of which were exposed to a
potential variety of chemicals and particulates during fire suppression, including
components of incomplete combustion that can exist in both particle and gas phase
(Karter & Stein, 2013). According to Feairheller (2015), high blood pressure,
cardiovascular disease (CVD), and obesity are global health problems and are a large
concern for firefighters, with the leading cause of death among firefighters being cardiac-
related. These threats to health, while at the center stage in our nation’s public health
view, may be of great concern to first responders and especially firefighters, as they face
austere and dangerous environments daily. However, such obvious threats as injury or
death from building collapse, inhalation of acutely toxic smoke, and burns are most
predominantly the concern among firefighters since first being addressed on a national
scale with the release of the first and most predominant NFPA publication on safety,
NFPA 1950. While such publications serve as essential components to the field,
immediate threats to life safety overwhelmingly have had the spotlight over firefighter
long-term health and wellbeing (Feairheller, 2015).
In a study by Fent et al. (2015), there was a measured >5 fold increases in mean
concentrations of styrene, benzene, 1,4-dichlorobenzene, acetone, and cyclohexane in the
burn site collected after a controlled burn, when compared to background atmospheric
concentrations. In addition, the researchers measured >2 fold increases in mean breath
concentrations of benzene, toluene, and styrene after the burns when compared to pre-
exposure samples. In conclusion, it was found that BTEX compounds “off-gassing” from
firefighters' used PPE and in firefighters' post-burn exhaled breath were significantly
correlated (Fent et al., 2015). Additionally, Trasande et al. (2015), found that polycyclic
aromatic hydrocarbons (PAH), commonly are produced by incomplete combustion
processes, have been associated with oxidant stress as well as insulin resistance and
hypertension in adults. By providing direct toxicological information into some of the
occupational risk factors for heart disease, it may be equally critical to protect from
obvious examples of acute hazards as it is to understand how firefighters’ personal
protective equipment (PPE) affects cardiovascular responses as risks to as long-term
health.
3. Protection Against Exposure and Physical Stressors
3.1 Firefighting Industry Standards – Turnout Gear
The NFPA, while responsible for producing a library of PPE standards for the fire
service, is also responsible for setting the industry standards that provide atmospheric
protection for the body of first responders during firefighting and hazardous materials
operations. NFPA 1971 details specifications and uses for PPE ensembles for structural
firefighting (NFPA, 2013). Turnout gear, most characteristic of firefighting operations,
consists of a jacket and pant set, with at least an abrasion and heat resistant outer layer, a
water-resistant yet vapor-permeable middle inner layer, and an additional heat-resistant
9. Occupational Exposures in the Fire Service 9
liner. The design of the suits is to allow for maximum thermal and physical hazard
protection and dexterity during any active-fire response, with materials technology that
allows the liquid barrier layer to keep firefighters dry from water but to allow for gaseous
perspiration to leave the suit. For such reasons, turnout gear is not to be used for
response to Chemical, Biological, Radiological, or Nuclear (CBRN) threats (NFPA,
2013).
3.2 Turnout Gear versus Vapor-Protective Ensembles
Turnout gear, in its most predominantly implemented forms, is neither impervious to
vaporous hazards nor dermal exposures to soot and chemicals that may come in direct
contact with skin, as obvious gaps exist between the suit, the gloves, and the SCBA face-
piece (NFPA, 2013). This comes despite built-in features that include a thumb loop and
cuffing between the sleeve and any removable gloves worn. Additionally, there is the
incorporation of a separate thermal protective hood that is worn over the facemask seal
and under the collar of the jacket. Despite the seemingly comprehensive coverage of this
ensemble design, these areas can become quickly compromised during stressful incidents
where flesh may be directly exposed the surrounding environment. In contrast, the
standards for structural and proximity firefighting vary significantly from the NFPA 1991
Standard on Vapor-Protective Ensamples for Hazardous Materials Emergencies, which
details the Level A ensemble – a fully-encapsulating, one-piece suit that provides the
maximum barrier from both liquid and aerosolized hazards (NFPA, 2005). This suit type
is in direct contrast with turnout-gear as any suspected gaps that would allow even vapor
penetration are taped or otherwise sealed according to manufacturers’ instructions. Like
turnout gear, Level A suits are also worn in conjunction with SCBA. However, the
vapor-barrier enable provides essentially no thermal protection and cannot be used in
firefighting operations where flame hazards exist or are likely to occur. This becomes one
of the main disadvantage to the Level A suit as perspiration readily accumulates in the
suit, often limiting visibility. Additionally, lack of thermal protection and vapor
permeability make both heat stress and cold weather effects more likely than those
wearing turnout gear (NFPA, 2005).
3.2.1 Protective Limitations of Turnout Gear
Testing of firefighters for the presence of toxicants (clinical biomarkers) by taking
samples of exhaled breath for lab analysis, is suggested as a suitable method for assessing
systemic dermal exposure in a simple and non-invasive manner, when we assume that
SCBA, when worn during operations, is fully effective during firefighting operations
(Fent et al, 2014). According to Kirk et al. (2011), combustion science investigators
researching the gaseous components of structural fires found that aromatic hydrocarbons,
common components of incomplete combustion, may penetrate turnout gear and come in
direct contact with skin (Fent et al, 2014). In addition, samples of firefighter face and
neck wipes taken after “controlled burns” of household fires were found to contain a
number of Polyaromatic Hydrocarbons (PAHs) and single ring organic compounds,
several of which are known to have carcinogenic activity. Additionally, Baxter et al.
10. Occupational Exposures in the Fire Service 10
(2014), found both benzene and benzofluoranthene, category 1 and category 2
carcinogens, in overhaul air from samples taken during controlled burn trials (Baxter et
al., 2014; NIOSH, 2015). While Pleil, Stiegel, & Fent (2014) assumed that SCBA
protects the user from the majority of inhaled hydrocarbons, any changes in the exhaled
profile of combustion products, including an increase in post-exposure bio-assessment for
both single ring and poly aromatic hydrocarbons found, can be attributed to dermal
exposures from gas and particle penetration through the turnout gear.
3.3 Self-Contained Breathing Apparatus and Limitations
As assumed by the aforementioned study by Pleil, Stiegel, & Fent (2014), SCBA, which
is afforded the maximum Protection Factor (PF) by the National Institute for
Occupational Safety and Health (NIOSH) of any respiratory protection device, should
keep the respiratory tract protected by maintaining positive pressure between the seal of
the mask and the face of operator under normal exertion levels. However, according to a
study of firefighters’ use of SCBA during various physical activities by Burgess &
Crutchfield (1995), under higher levels of physical stress, firefighters could “over-
breathe” SCBA, causing a break between the skin and full facemask of the operator
(Pleil, Stiegel, & Fent, 2014). The results of the break between the facemask and
operator was the inhalation of the surrounding atmosphere, thereby confirming the
potential for inhalation of any toxic and/or carcinogenic aerosols contained therein to
enter the users’ respiratory tract. This was found to be due to overcoming the allotted
rate and amount of supplied air at a given time (Fent et al., 2014). Thus, for every
firefighter that encounters excessive exertion levels, it may be assumed that there is
potential for a significant toxic and/or carcinogenic inhalation exposure to occur in other
than “normal levels of exertion” (Burgess & Crutchfield, 1995).
4. Exposures Encountered during Fire Suppression Activities
4.1 Dermal Exposures during Firefighting
The composition of structural firefighters PPE typically includes layers that are easily
permeated by aerosolized particles, as they are meant to reduce thermal and physical
hazards while providing liquid-resistant, yet breathable protection, by allowing for gas
exchange. Until recently, only a few studies have explored dermal exposure and
absorption of combustion products in firefighters (Fent et al., 2014). During a study of
dermal absorption of aromatic hydrocarbons by both firefighters and fuel workers, the
authors concluded that there was significant increases in breath concentrations of benzene
that were consistent with levels of contaminant accumulated on the face and neck –
portions of the body only protected by a thin fabric hood, despite the use of appropriate
respiratory protection, including SCBA, for firefighters in the study (Pleil, Stiegel, &
Fent, 2014). This study was representative of real-world scenarios whereby firefighters
and fuel-workers both wore job appropriate PPE. In an attempt to limit the inhalation
route of exposure during the live-fire study, participating firefighters wore SCBA
throughout operations and stayed upwind of the site after doffing ensemble at a distance
of at least 30 meters from the structure. The authors of the study conclude that while
11. Occupational Exposures in the Fire Service 11
controlling for inhalation exposure as best as possible, exposure to environmental smoke
from premature removal of SCBA and transfer of PAHs from contaminated gear to the
skin were potential confounders of the study. In conclusion, it was found that firefighters
wearing full protective ensembles have systemic uptake of PAHs and other aromatic
hydrocarbons, with the neck being the primary site of exposure (figure 1). Thus, further
study on hood design, turnout gear doffing, decontamination methods, and growing
awareness of firefighters’ dermal absorption during fire responses are warranted (Pleil,
Stiegel, & Fent, 2014).
Figure 1: Pre and Post-Exposure Breath Concentration of Select Hydrocarbons for
Firefighters and U.S. Air Force Fuel Workers
Referenced from: Pleil, Stiegel, & Fent, 2014
4.2 Inhalation Exposures during Fire Suppression Activities
In a study by Baxter et al. (2010), fine particulate matter was measured in 7 different
scale scenarios, including 90 minutes prior to ignition, during initial fire ignition, initial
fire-suppression (knockdown), and during salvage and overhaul. The researchers found
that ultrafine particulate matter (<1 micrometer in diameter) were generated at high
number densities relative to background values, beginning at the knockdown and even
more so at the overhaul stages. In all scenarios, including automobile fires and differing
residential setups, ultrafine particulate matter was found to comprise greater than 99% of
the total particulate matter measured using a wide range particle spectrometer (figure 2).
While not visible to the naked eye, it is hypothesized that ultrafine particles generated
during knockdown and overhaul may give firefighters a false sense of security and easily
lead to doffing of SCBA prematurely. Exposure to ultrafine particulate matter is
12. Occupational Exposures in the Fire Service 12
suspected to contribute to the incidence of both cardiovascular disease and sudden
cardiac death. During physical examinations, clinical changes in both spirometry and
other lung permeability parameters in firefighters noted as not wearing SCBA during
overhaul have been documented (Baxter et al., 2010).
Figure 2: Particulate Matter Sampled during Fire Suppression Activities
Referenced from: Baxter et al., 2010
4.3 Mixed Inhalation/Dermal Uptake of VOCs during Fire Suppression
In summary of a study of firefighters by Fent et al. (2014), after controlling for inhalation
route of entry by continued use of SCBA during doffing of structural firefighters
equipment, the authors noted that after finding for clinical biomarkers, it was concluded
that the PAHs most likely entered firefighters’ bodies through their skin. In a subsequent
study by Fent et al. (2015), there was a measured >5 fold increases in mean
concentrations of styrene, benzene, 1,4-dichlorobenzene, acetone, and cyclohexane in the
burn site collected following a controlled burn, when compared to background levels. In
support of both dermal and inhalation routes of exposure as significant to the uptake of
VOCs, a subsequent study of the dermal route of exposure concluded that a more than
two-fold increase in mean breath concentrations of benzene, toluene, and styrene were
present in samples taken from firefighters after the burns, when compared to pre-
exposure samples. In addition, the concentrations of BTEX chemicals measured off-
gassing from firefighters' used PPE and in firefighters' post-burn exhaled breath were
significantly correlated. In this case, the authors conceded that although previous studies
have suggested a single route of exposure to be the culprit for the majority of systemic
contaminants, firefighters might have absorbed these substances through both the dermal
and (to a lesser extent) inhalation routes during firefighting and from off-gassing of
contaminated tools, equipment, and PPE after fire-suppression operations (Fent et al.,
2015).
4.4 Exposures in the Firehouse
In addition to exposures during fire-suppression activities, it has been found that the
firehouse contributes to airborne contamination in the firefighters’ living environment. In
13. Occupational Exposures in the Fire Service 13
an exposure study of particulate matter comparing both fire-suppression sites and
firehouses, both environments were found to contain significant airborne contamination
of particulate matter and other combustion byproducts. In a typical firefighting shift, 24
hours constitutes the typical timeframe that a crew works, with 48 hours between shifts.
The result is that exposures in the workplace, to include the firehouse, may involve a
more continuous exposure of occupational exposures, well beyond the timeframes that
NIOSH and the Occupational Safety and Health Administration (OSHA) standards make
provisions for, based on typical 8 and 10-hour workdays. This makes the estimation of
both recommended and regulatory limits of exposure to contaminants difficult, with gross
underestimation of workplace exposures of particular concern. The results of the study by
Baxter et al. (2014) conclude that detectable exposures to particulate matter in the
respirable range contaminate both the sites where firefighting activities occur and
additionally in parts of the firehouse where cooking, dining, storage, training, and other
work activities commonly take place. Contaminated areas inside the firehouse include
vehicle-bays, sleeping quarters, and kitchens where air samples containing both PM2.5
and submicron particles were found (figure 3). Furthermore, the researchers found
PAHs, including naphthalene, present in 2 out of 3 firehouses where samples were taken
(Baxter et al, 2014). Therefore, in addition to airborne exposure, toxic and/or
carcinogenic substances may also be present in the food and drink preparation areas,
providing the potential for the ingestion route of exposure from the food the firefighters
consume while on duty.
Figure 3: Fine Particle Concentration in the Firehouse over Time of Day
Referenced from: Baxter et al, 2014.#
5. Conclusion
As a series of future steps, illustrated by Fent et al. (2014), adherence to wearing full
protective ensembles, research on further study designs on PPE including redesign of fire
-resistant hoods, and methods of decontamination as well as ways to otherwise limit
firefighters’ dermal absorption of toxic and/or carcinogenic substances, are all minimal
steps to reduce the frequency, extent, and duration of future exposures in this occupation.
New NFPA standards for turnout gear include specifics on cleaning and maintaining
14. Occupational Exposures in the Fire Service 14
existing gear prior to and following exposure to fire and combustion byproducts, as both
SCBA and PPE are noted to be both critical to the job and an important part of a
firefighter’s protection against exposure to carcinogens (NFPA, 2015). However, the
responsibility for compliance lies with both individual departments and firefighters to
ensure PPE and SCBA are maintained and cleaned as recommended by the NFPA. In
light of recent research and exposure data that illustrates the insidious hazards we now
recognize as threats to both life and health, it is their responsibility to ensure that SCBA
is worn during all fire-suppression phases, including salvage and overhaul. Additionally,
firefighters should be made aware of the potential for inhalation exposure when doffing
and traveling in confined vehicles with contaminated PPE and take measures to minimize
this exposure pathway (Fent et al., 2015). As we have observed more information on
toxic and/or carcinogenic substances encountered during and after fire-suppression, the
industry should seek to improve administrative controls through compliance with
firefighters’ protection against exposure to toxic and carcinogenic substances with the
implementation and take initiatives to continually strive for the development of new PPE.
Finally, fire departments should invest in the components of workplace hazard reduction
and utilize industrial hygienists, occupational health physicians, and other environmental
health and safety personnel for monitoring of contaminants in both fire-suppression sites
and the firehouse.
15. Occupational Exposures in the Fire Service 15
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during fire suppression – is it an important contributory factor for coronary heart
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