Missouri Valley Division Annual Conference A Required Stop on the Trail to Great Leadership 6/8/2012...
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Transcript of Missouri Valley Division Annual Conference A Required Stop on the Trail to Great Leadership 6/8/2012...
1Chief C. A. Haigh Hanover Park Fire Department
Missouri Valley Division
Annual Conference
A Required Stop on the Trail to Great Leadership
6/8/2012
2Chief C. A. Haigh Hanover Park Fire Department
Reducing Line of Duty Deaths:The Role of Research, Training &
Organizational Leadership6/8/2012
3Chief C. A. Haigh Hanover Park Fire Department
Contributing Authors
Denise L. Smith, Ph.D.
Professor and Chair of Exercise Science, Skidmore College Research Scientist, University of Illinois Fire Service Institute
Craig A. Haigh, M.S., CFO, EFO, MIFireE, NREMT-P
Fire Chief, Hanover Park (IL) Fire DepartmentField Staff Instructor, University of Illinois Fire Service Institute
Gavin Horn, Ph.D.
Director, Illinois Firefighter Life Safety Research CenterResearch Scientist, Department of Mechanical Science &
Engineering, University of Illinois
6/8/2012
Topics:
I. The Role of ResearchII. Case Study:
What the Research is Telling Us about the Physiologic Stress of Firefighting
Implementing Research into field operations – On Scene Rehab
Impact of Organizational Leadership
6/8/20124
Chief C. A. Haigh Hanover Park Fire
Department
Goal of Fire Service Research
Enhanced Knowledge
Changed Behavior
Training
6/8/20125
Chief C. A. Haigh Hanover Park Fire
Department
The Process of Research Implementation
Enhanced Knowledge
Changed Behavior
Training
Support of LaborInternal Policy Development
Support of Fire Service Organizations (IAFC, IAFF, NVFC, USFA, NFFF, ICMA, IAAI, etc.)
Acceptance by standard setting/review organizations (NFPA, State Fire Marshal, OSHA, UL, NIOSH, etc.)
Research / Development / Manufacturing
Acceptance & buy in of Fire Administration (Fire Chiefs & Command Staff)Support of local
organizations (County Fire Associations, MABAS, etc.) Acceptance & buy in of
City/County/District Administration (i.e. City Managers)
Acceptance & buy In of Elected Officials and their willingness and ability to pay.
Cultural Change
6/8/20126
Chief C. A. Haigh Hanover Park Fire
Department
Limitations of Local Departments to Implement Research Driven Change
1. Lack of visionary leadership.This is the way we have always done it…
2. Lack of strong labor / management relations.
3. Failure to maintain priorities:Be cautious of the swirling toilets and
washing wheels syndrome.
4. Lack of fire service support by elected officials and community.
5. Lack of financial resources.6/8/2012
7Chief C. A. Haigh Hanover Park Fire
Department
Fire Service Downfall
The Fire Service in general does a poor job of looking beyond the walls of our organizations to find workable solutions to complex problems. To successfully implement change that is driven by today’s research, departments must think globally and be willing to change tradition in order to address current concerns.
6/8/20128
Chief C. A. Haigh Hanover Park Fire
Department
{
9
Physiological Impact of Heat Stress
Case Study
6/8/2012 Chief C. A. Haigh Hanover Park Fire
Department
Current Situation
Decreasing number of fire… Relatively unchanged number of
firefighter fatalities.
6/8/201210
Chief C. A. Haigh Hanover Park Fire
Department
Cardiovascular Impact on LODD
Between 1995–2011:• 799 Firefighters died due to Cardiac or
Cerebrovascular Related Events. • 2011 -- 49• 2012 -- 17
• Cardiac or Cerebrovascular events account for approximately 50% - 60% of all annual line of duty deaths.
• An additional 700-1000 annual cardiac or cerebrovascular events occur that do not result in a LODD (810 in 2010).
6/8/201211
Chief C. A. Haigh Hanover Park Fire
Department
Cardiovascular Impact on LODD
Is it more than old out of shape firefighters? Is there something about firefighting that serves as the “trigger” for a cardiovascular event?
6/8/201212
Chief C. A. Haigh Hanover Park Fire
Department
Cardiovascular Impact on LODD
What do we know?
6/8/201213
Chief C. A. Haigh Hanover Park Fire
Department
The job is getting harder…
• Increased BTU Production
• Changes in constructiono Light weight / open floor
space / energy efficient / green
• Require greater GPM to cool the BTU production.
• Decreased company staffing
• Protective equipment provides full encapsulation.
6/8/201214
Chief C. A. Haigh Hanover Park Fire
Department
Personal Risk Factors for Cardiovascular
Problems
• Age• Gender• Family History• Diabetes• Hypertension• Smoking• High Cholesterol• Obesity• Lack of Exercise
6/8/201215
Chief C. A. Haigh Hanover Park Fire
Department
Coupled with Heat Stress
• Work performed• Protective
Equipment• Thermal
Environment• Health Status• Fitness Level• Hydration Level
Disastrous potential exists.6/8/2012
16Chief C. A. Haigh Hanover Park Fire
Department
17
How do we reduce the impact of heat stress?
1. Personal physical fitness
2. Health screening 3. On-Scene
Rehabilitation
6/8/2012 Chief C. A. Haigh Hanover Park Fire
Department
18
On-Scene Rehabilitation
If Heat Stress is the likely causation of many detrimental physiologic
responses, why is rehab not a integral part of the fire service response?
Several Likely Reasons…
6/8/2012 Chief C. A. Haigh Hanover Park Fire
Department
Lack of rehab?
• Culture of Fire Service
• “Rehab is for Sissies”
• Undeveloped on-scene rehabilitation and support systems
• Lack of widespread research
• Why we do what we do?6/8/2012
19Chief C. A. Haigh Hanover Park Fire
Department
20
Field-based Research To Document the Stress of Firefighting
What do we know?
6/8/2012 Chief C. A. Haigh Hanover Park Fire
Department
Basic Statistics
• 1,148,100 FF (USFA, 2009)
• 335,950 career• 812,150 volunteers
• Firefighting is a Dangerous Occupation
• Injuries – 71,875 (2010)
• Fatalities – approx. 100 per year
• 50% - 60% due to sudden cardiac events
6/8/201221
Chief C. A. Haigh Hanover Park Fire
Department
Reducing Injuries and Fatalities
• Prevent Fires, or detect earlier
• Optimal Staffing• Training• Safety Training
• Driving• Fireground• Attitudes, awareness
(cultural issues)• Personal Protective
Clothing• Improved Incident
Command• Fitness and Wellness
Programs• On-Scene Rehabilitation?
6/8/201222
Chief C. A. Haigh Hanover Park Fire
Department
Sudden Cardiac DeathPrimary Cause of LODD
Hear Attack58%
Trauma17%
Burns8%
Asphyxiation6%
Other5%
Crush4%
Heat Exhaustion1%
CVA1%
Hear Attack Trauma Burns
Asphyxiation Other Crush
Heat Exhaustion CVA
NPFA Firefighter Deaths by Nature -- 2011
6/8/201223
Chief C. A. Haigh Hanover Park Fire
Department
Despite reduction in total fires, fatalities due to cardiovascular issues
remain relatively unchanged.
USFA Firefighter Fatalities 1986-20096/8/2012
24Chief C. A. Haigh Hanover Park Fire
Department
Firefighter Deaths to Date by Nature of Injury -- 2012
Cardiac & Stroke: 53.1% Trauma: 37.5% Other: 6.3% Crushing: 3.1%
6/8/201225
Chief C. A. Haigh Hanover Park Fire
Department
Num
be
r of F
irefi
gh
ter I
nju
rie
s
120,000
Figure 1 Total Firefighter Injuries by Year (1981-2010)
100,000
103,340
80,000
60,000 71,875
40,000
20,000
0
Source: NFPA Annual Survey of Fire Departments Year
for U.S. Fire Experience (1981-2010) From 1994 on, number of exposures was collected separately
Total Firefighter Injuries
6/8/201226
Chief C. A. Haigh Hanover Park Fire
Department
27Chief C. A. Haigh Hanover Park Fire Department
Karter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2011
26%
22%
10%
5%
18%
7%
12%
Overexertion / StrainFall, Jump, SlipExposure (Fire Products, Haz Mat, Etc)Extreme WeatherOtherStruck by ObjectContact with Object
Distribution of Injuries
6/8/2012
Firefighter Injuries: Total injuries have reduced in hand
with total fires, yet leading causes (overexertion/strain & slips/falls) remain
relatively stable
2003 2004 2005 2006 2007 2008 20090
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
Total In-juriesSlip, Fall, JumpOverexer-tion/Strain
Karter, M.J., Patterns of Firefighter Fireground Injuries, NFPA 2009
6/8/201228
29
Is there a correlation between overexertion and strain and slips/trips/falls?
6/8/2012 Chief C. A. Haigh Hanover Park Fire
Department
30
Working Hypothesis
Slips, Trips, Falls Sudden Cardiac Events
Firefighting
Heat Stress
Fatigue Overexertion/Strain
Biomechanical Changes
CV/CoagulatoryChanges
Reduced SituationalAwareness
Disorientation, Entrapment,Poor decisions, and related
Injuries and Fatalities6/8/2012 Chief C. A. Haigh
Hanover Park Fire Department
Physiological/Psychological Stress of Firefighting
Probably the greatest stress ever imposed on the human cardiovascular system is the combination of exercise and hyperthermia. Together these stresses can present life-threatening challenges, especially in highly motivated athletes who drive themselves to extremes in hot environments.
L. Rowell, 1986
6/8/201231
Chief C. A. Haigh Hanover Park Fire
Department
Simplified Schematic of Possible Causes of Heart
Attack in FF
Heart Attack
Circulatory Shock
Arrhythmias Clot Formation
PlaqueDisruption
Perfuse sweating
DecreasedPlasma volume
AlteredElectrolytes
Increased viscosity
Changes in HR and BP
Increased Body Temperature
Activation of SNS
6/8/201232
Chief C. A. Haigh Hanover Park Fire
Department
6/8/2012
Firefighting TasksDummy dragCarry and discharge extinguisherHose pullWood chopping
U of I Study: Response of Firefighters following short-term strenuous firefighting
activities
33Denise L. Smith, PhD Skidmore College
6/8/2012
Study Cycle
drills drills drills
~ 8min ~ 8 min ~ 8 min
Rehab Rc1 Rc2
= measurement period
34Denise L. Smith, PhD Skidmore College
6/8/2012
Heart Rate Response
0
50
100
150
200
Rest 1st Trial 2nd Trial 3rd Trial
HR (bpm)
* * *
* p < .05 vs rest35Denise L. Smith, PhD
Skidmore College
6/8/2012
Stroke Volume Response
0
20
40
60
80
100
Rest 1st Trial 2nd Trial 3rd Trial
SV (ml)
#
# p <.05 vs T136Denise L. Smith, PhD
Skidmore College
6/8/2012
Stroke Volume Response
0
20
40
60
80
100
Rest 1st Trial 2nd Trial 3rd Trial
SV (ml)
#
# p <.05 vs T1
Take home message:
Push Fluids
37Denise L. Smith, PhD Skidmore College
6/8/2012
Changes in Core Temperature
36
36.5
37
37.5
38
38.5
39
Pre Trial 1 Trial 2 Trial 3 10 minrec
Trectal
38Denise L. Smith, PhD Skidmore College
6/8/2012
Changes in Core Temperature
36
36.5
37
37.5
38
38.5
39
Pre Trial 1 Trial 2 Trial 3 10 minrec
TrectalTake home message:
Provide Cooling
39Denise L. Smith, PhD Skidmore College
6/8/2012
Effect of Firefighting on Coagulation Factors (N=10; Mean ± SD)
Variable Pre PostPlatelets (x103/uL) 236.6 (48.2) 290.37 (83.4) *
Prothrombin Time (s) 10.18 (0.6) 10.13 (0.6)
Activated Partial Thrombopastin Time (s) 25.2 (2.3) 25.5 (2.7)
Fibrinogen (mg/dL) corrected 254.5 (17.2) 243.9 (20.8) †
Antithromin III (%) 109.7 (4.9) 116.8 (6.9) *
(Fibrinogen & Antithromin III: Factors in Blood Clotting)
* p<0.001
† p < 0.0540Denise L. Smith, PhD
Skidmore College
6/8/2012
Effects of Simulated Fire-Fighting Stress on Plasma Volume Shifts
-16
-14
-12
-10
-8
-6
-4
-2
0
2
4
Ch
ang
e in
Pla
sma
Vo
lum
e (%
)
Pre Post Post 90’
a
a significantly (p <.05) different pre and post 90’ 41Denise L. Smith, PhD Skidmore College
6/8/2012
Effects of Simulated Fire-Fighting Stress on Glucose
40
60
80
100
120
140
160
Pre Post Post 90'
mg
/dL
a
c
a significantly (p < .05) different pre and post 90c significantly (p < .05) different pre and post 90’ 42Denise L. Smith, PhD
Skidmore College
43
Impact of Rehab
Physiological Responses
Rehab
Firefighting
Muscular/Metabolic Fatigue
DehydrationHeat Stress
Cardiovascular Strain•HR, BP•Blood Clotting
•Rest/Recovery•Nutrition
Fluid Replacement
•Cooling•Climatic Relief•Medical Monitoring
•Rest•Cooling•Fluid Replacement•Medical Monitoring
6/8/2012 Denise L. Smith, PhD Skidmore College
44Chief C. A. Haigh Hanover Park Fire Department
Implementation of an Effective Rehabilitation Program
NFPA 1584 On-Scene Rehabilitation
6/8/2012
The Role of Rehab
Rehab when implemented properly can reduce the detrimental effects of heat stress and lesson the potential for a cardiovascular/cerebrovascular incident as well as heat related illnesses.
The Question: How to do this with limited human and financial resources?
6/8/201245
Chief C. A. Haigh Hanover Park Fire
Department
6/8/2012
How, when, and by whom?
• How many of us have available staffing to dedicate to rehab?
• At what point is rehab established:
• When the crews look tired?
• After 2 SCBA bottles?• When the weather is
especially hot or cold?• As part of the initial
response assignment or specific alarm level?
46Chief C. A. Haigh Hanover Park Fire
Department
How, when, and by whom?
• Who is assigned the task of rehab:
• EMS• Additional fire
companies• Support Organizations
• What supplies & equipment are supplied by the rehab crew?
• What training do they have in providing rehab?
6/8/201247
Chief C. A. Haigh Hanover Park Fire
Department
48Chief C. A. Haigh Hanover Park Fire Department
6/8/2012
Leadership is Critical
• Safety is a cultural value that needs to be represented at all levels of the organization and must be established by those in command.
• Boards, Managers, and Chief Officers must embrace methods for reducing the 50% - 60% LODD and the 700+ duty related cardiac events.
• Comprehensive medical exams and wellness programs (NFPA 1582 – Standard on Comprehensive Occupational Medical Programs for Fire Departments).
• Mandatory physical fitness programs• Strict operating guidelines for usage of SCBA, PPE,
Incident Command and sound operational practices.• On-scene rehab programs
If the Chief Officers and Community Leadership does not
value firefighter safety, the personnel won’t!
6/8/2012
Cost of Firefighting Injuries/LODD
• Average of 80,000 annual firefighter injuries (~5,000 Burn Injuries)
• Estimated Annual Cost ~ $8 bil/year
• Average cost per injury is $74,000
“The Economic Consequences of FF Injuries and Their Prevention, Tridata Corp., 2005. NIST GCR – 05-874
49Chief C. A. Haigh Hanover Park Fire
Department
6/8/2012
In-house Lesson: Hanover Park Fire Department
• 5-Year average shows HPFD companies responding to 73 structural fires annually.
• 50 Firefighter injury reports filed (emergency incidents, training, medical exposures).
• 1998: A line of duty M.I. resulted in a firefighter disability.
• Injuries generated 22,649 hours of work comp sick leave:
• Costing greater than $170k in workers compensation.
• Greater than $600K in overtime for backfill
50Chief C. A. Haigh Hanover Park Fire
Department
51Chief C. A. Haigh Hanover Park Fire Department
Financial ImpactVillage of Hanover
Park
2008 2009 2010 2011Work Comp. Losses
$17,217 $19,188 $18,642 $383,847
6/8/2012
Prior to 2008:Average Department Workers Compensation Losses $127,000
Chief C. A. Haigh Hanover Park Fire Department
52
Partnerships are the Key
Most of us don’t have enough personnel to
effectively handle the incident let
alone manage the rehab, therefore
developing partnerships with
those who are willing and able to assist us is the key.
6/8/2012
6/8/2012
Partnership Opportunities
• Utilize CERT to develop a volunteer response team (Fire Corps) trained and equipped to provide on-scene rehab services.
53Chief C. A. Haigh Hanover Park Fire
Department
6/8/2012
Fire Corps
• Consists of 17 volunteers• Pager alerted• Respond on the initial alarm
to all reported structure fires• The team operates a
decommissioned ambulance outfitted with rehab equipment and supplies.
• Training• Basic CERT • Specialized training on
how to provide rehab conducted through IFSI.
• On-scene partnered with paramedics who conduct medical assessments while Fire Corps members provide hydration, cooling and nourishment.
54Chief C. A. Haigh Hanover Park Fire
Department
6/8/2012
Components of Rehab
1. Rest and Recovery2. Relief from incident
and environmental conditions
3. Rehydration4. Nourishment5. Medical Monitoring6. Operate within the
established accountability system
55Chief C. A. Haigh Hanover Park Fire
Department
6/8/2012
Equipment Inventory
• Chairs• Fans or misting systems• Awnings or Tents• Towels• Heaters• Floodlights• Dry gloves, socks and
sweatshirts• Water and Sports Drinks• Basic Food Supplies• EMS Equipment:
• AED• RAD 57 Monitor
56Chief C. A. Haigh Hanover Park Fire
Department
Field Participation in Research
The purpose of this study was to document the vital signs of firefighters upon entering a fire ground / emergency incident rehabilitation
division and to track the changes that occurred during the medical monitoring period.
6/8/201257
Chief C. A. Haigh Hanover Park Fire
Department
Chief C. A. Haigh Hanover Park Fire Department
58
Take Home Message:Research / Fire Service
Partnership
• Fire Service Change needs to be driven by research.
• Research needs to be driven based on Fire Service concerns.
• It takes courage to change the status quo and find solutions to difficult problems with limited human and financial resources.
6/8/2012
596/8/2012 Chief C. A. Haigh
Hanover Park Fire Department
Does it seem like our recruits are getting younger
and younger?
Let’s make the Fire Service a safer career for the next generation.
60Chief C. A. Haigh Hanover Park Fire Department
6/8/2012