Carbon Monoxide: A Hazard to Fire Fighters

Carbon monoxide levels were measured in twenty-five fires in the city of Los Angeles to obtain information about fire fighters exposure to carbon monoxide. Levels as high as 3,000 ppm were observed for some fires. In general, when carbon monoxide levels were significantly elevated (> 100 ppm) the smoke was quite heavy and noxious, but in some cases the smoke was heavy and carbon monoxide levels were minimal. In two-story structures, the highest concentrations of carbon monoxide were found on the second-floor level and were usually (still elevated after the fire had been “knocked down” but was still smoldering. These data show that fire fighters are exposed to levels of carbon monoxide which could be a serious health hazard and may be related to the high incidence of heart disease in fire fighters.     

Fire fighters' exposure to carbon monoxide during Australian bushfires

Fatal entrapments of Australian bushfire fighters have led to suggestions that carbon monoxide (CO) poisoning could have contributed to these accidents by impairing the fire fighters' judgement. Carboxyhemoglobin saturation (COHb%) levels were assessed from alveolar CO levels in 24 fire fighters working with handtools and in 12 accompanying scientific observers, before and after fire fighting (duration 37-187 min) on 15 experimental bushfires. Carboxyhemoglobin levels increased on average by 0.7% per hour in the fire fighters and by 0.3% per hour in the observers. Nonsmoking fire fighters had lower COHb% after fires than the smokers had before fires. Estimates of environmental CO concentrations (including cigarette smoke) during the fires averaged 31 parts per million (ppm) for the smokers, 17 ppm for the nonsmoking crew members, and 11 ppm for the observers, none of whom smoked. The highest estimates of environmental CO arising solely from bushfire smoke were 40 to 50 ppm. Smokers were exposed to as much CO from their cigarettes as from bushfire smoke. Carboxyhemoglobin levels at the end of 8-hr fire fighting shifts, predicted from these levels of environmental CO, averaged about 5% (maximum 11%) in smokers and about 3% (maximum 7%) in nonsmokers. Acute levels of COHb% of this degree are not considered to have significant effects on health or performance. These results indicate that bushfire fighters are generally unlikely to experience hazardous levels of CO exposure.     

Reproductive hazards of fire fighting. I. Non-chemical hazards

Fire fighters are regularly exposed to chemical and non-chemical agents that have known or suspected adverse effects on reproductive health. Although chemical agents have received some attention, non-chemical hazards such as heat, noise, and physical exertion have only recently been examined for their reproductive effects. There is evidence that heat, noise, and physical exertion may affect various endpoints of reproductive health, including fertility, fetal loss, and growth parameters of the offspring. In particular, hyperthermia, a major fire fighting hazard, has been shown to impair male fertility and may also be teratogenic. Further study of the potential reproductive effects of this and other common non-chemical agents in the fire environment is needed to ensure the reproductive health of male and female fire fighters.     

Mortality and cancer incidence in stockholm fire fighters

Fire fighters are exposed to irritating, asphyxiating, and toxic gases and aerosols, to psychological stress, and to physically demanding work. Due to differences in fire fighting techniques, exposure conditions for fire fighters differ among different countries. The purpose of this investigation was to study cancer incidence and mortality in fire fighters who have been working with fire fighting methods used in Sweden from the beginning of this century onwards. All male fire fighters employed for at least 1 year in the City of Stockholm during 1931–1983 were traced, and an index of the number of fires fought was calculated for each individual. The mortality during 1951–1986 (among 1, 116 fire fighters) was lower than expected (SMR = 82; 95% confidence interval 72–91) compared with local mortality rates, with a low mortality in circulatory diseases, obstructive lung diseases, violent deaths, and suicides. The cancer incidence in 1958–1986 was equal to the expected (SMR = 100; 95% confidence interval 83–119). However, an excess of stomach cancer (18 observed vs. 9.37 expected: SMR = 192, 95% CI 114–304) was observed. There was also a tendency for higher incidence and mortality in stomach and brain cancer with increasing number of fires. There were four deaths from brain cancer compared to 0.8 expected (SMR = 496; 95% CI 135–1270) in the highest exposure category. Fire fighters are, however, not systematically exposed to known stomach or brain carcinogens, and the results need confirmation in further studies with extensive exposure evaluations. © 1994 Wiley-Liss, Inc.     

Injuries on the fireground: risk factors for traumatic injuries among professional fire fighters

This case-control study within a metropolitan fire department evaluated the effect of self-contained breathing apparatus (SCBA) and other risk factors on three types of injury at the scene of a fire (smoke inhalation, burns, and falls). Data on 75 injured fire fighters and 144 controls came from telephone interviews and department records. The two sets of uninjured fire-fighter controls were matched to cases on incident (n = 72) or on job position and fire type and size (n = 72). Smoke inhalation cases were not significantly different from controls in SCBA use, cigarette smoking, previous fires in the shift, or injury history. Jobs with high risk of burns included nozzle operator, engine officer, and forcible-entry person in first-due companies (OR = 20.1). Other risk factors for burns were: basement origin of fire (OR = 10.2); prior fire-fighting training outside the present department (same fire: OR = 11.2; similar fire: OR = 3.9); and on-duty injury in the prior 12 months (same fire: OR = 4.3; similar fire: OR = 3.5). When other risk factors were considered, consistent SCBA use was associated with falls (same fire: OR = 11.8; similar fire: OR = 4.3) but not with burns. Risk of falls also was elevated among members of truck companies (OR = 17.7) and fire fighters without children (same fire: OR = 8.4; similar fire: OR = 7.4). On-duty injury in the past 12 months was associated with falls when one compared cases with similar-fire controls (OR = 5.5), but not with controls attending the same fire. Neither age nor experience was related to injury in this population.     

Reproductive hazards of fire fighting. II. Chemical hazards

Studies of the health of fire fighters have historically focused on non-malignant respiratory disease and cancer. More recently, concerns have surfaced about reproductive health effects in many areas of the workforce, including fire fighting. These concerns prompted this review of chemical exposures that may contribute to adverse reproductive health outcomes in male as well as female fire fighters. A review of the industrial hygiene literature was undertaken to identify agents commonly found in fire smoke. These agents were then examined for evidence of reproductive toxicity or mutagenicity/carcinogenicity. This profile of chemical agents and their reproductive toxicities permits a qualitative determination that fire fighters are exposed to potential reproductive toxicants as a part of their normal fire fighting duties. Considerations for mitigating these risks are also discussed.     

Reduced work tolerance associated with wearing protective clothing and respirators

This study examined worker tolerance and physiological responses to two levels of work while subjects wore various types of protective clothing and respirators. Nine healthy men (mean age = 24.8 years, weight = 75.3 kg, max VO2 = 44.6 mL/kg/min), experienced with the use of respirators, each performed a randomized series of eight experimental tests, each test scheduled to last 180 min. Work was performed on a motor-driven treadmill at a set walking speed and elevation indicative of either 30% (low work intensity) or 60% (high work intensity) of maximum work capacity for each individual. Four protective clothing ensembles were examined: light work clothing (LIGHT), light work clothing with SCBA (SCBA), firefighter's turnout gear with SCBA (FF) and chemical protective clothing with SCBA (CHEM). Physiological measurements included heart rate, skin and rectal temperature, and minute ventilation. Measurements were obtained every 2.5 min until test termination (tolerance time). If less than 180 min, tolerance time was defined by subjective or objective signs of near maximal stress. Mean tolerance times at the low work intensity were 167, 130, 26 and 73 min, respectively, for the LIGHT, SCBA, FF and CHEM ensembles. At the high intensity, mean tolerance times were 91, 23, 4 and 13 min, respectively. At the low work intensity, heart rate with SCBA rose very slowly during the tests and remained approximately 15 beats/min higher than the heart rate for subjects wearing the LIGHT ensemble. In contrast, heart rate with the FF and CHEM ensembles rose sharply and did not approach steady-state values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Concordance between rating of perceived exertion and function in persons with chronic,disabling back pain

Rating of perceived exertion (RPE), or the Borg scale, has been shown to be positively associated with physiologic effort in individuals undergoing cardiovascular assessment. This study examined the correlations between cardiovascular performance, psychosocial factors, and the RPE scale among 50 persons with chronic pain undergoing multidisciplinary assessment. The results indicated a significant negative association between fitness outcome measures (maximum VO₂ and endurance on bicycle), psychosocial measures, and age. With a mean maximum heart rate achieved on the exercise bicycle of 79.2% (SD = 8.3), there was no significant association between the highest rating of perceived exertion on the exercise bicycle test and percent of maximum heart rate. Percent of maximum heart rate was significantly related to self-reported pain and disability as well as age. These findings suggest that perceived exertion in this population is not highly correlated with physiologic effort, as other factors such as pain may influence effort ratings.     

Mortality of a municipal-worker cohort: IV. Fire fighters

Morbidity and mortality studies of fire fighters have produced varied and inconsistent findings regarding the potential chronic effects of fire fighting including respiratory disease, cardiovascular disease, and cancer. The mortality experience of 1,867 white male fire fighters who were employed for the City of Buffalo a minimum of five years with at least one year as a fire fighter was studied. Vital status was determined for 99% of the cohort, resulting in 470 observed deaths. The fire fighter cohort was characteristic of a healthy worker population. All-cause mortality was close to the expected standardized mortality ratio (SMR) = 95, and significantly lower than expected mortality was seen for all external causes (SMR = 67)--in particular, for suicide (SMR = 21) and respiratory diseases (SMR = 48). Significantly elevated SMRs were found for benign neoplasms (SMR = 417), cancer of the colon (SMR = 183), and cancer of the bladder (SMR = 286). Cause-specific mortality is presented by number of years employed, calendar year of death, year of hire, and latency. Cancer mortality was significantly higher in the long-term fire fighters, and risk of mortality from all malignant neoplasms tended to increase with increasing latency. Patterns in risk of mortality among fire fighters for cancers of the bladder, colon, and brain are intriguing. Additional follow-up of this cohort and initiation of cancer morbidity studies would be helpful in further clarifying the potential long-term effects of fire fighting on cancer risk.     

A longitudinal study of pulmonary function in fire fighters

Pulmonary function changes among fire fighters were evaluated by re-examining 632 Baltimore city fire fighters six to ten years after a baseline examination. Spirometry was used to determine forced expiratory volume in 1 second (FEV1). Information about exposures was obtained by questionnaire and by combining data from fire department records regarding the number of fires fought by fire fighting units with individual work histories. Men who never wore a mask while extinguishing fires experienced a 1.7 times greater rate of FEV1 decline than mask wearers. Men with ammonia exposure experienced a rate of decline 1.7 times greater than non-exposed men. Neither length of time spent in exposed jobs nor number of responses were associated with the rate of decline. Active fire fighters experienced a rate of decline 2.5 times greater than those who had retired or resigned. Some effects differed between men who were able to perform repeatable pulmonary function tests and those who were not.     

Occupational exposures in California wildland fire fighting.

Industrial hygiene measurement of exposures to wildland fire fighters was conducted in northern California during three consecutive fire seasons (1986-1989) in conjunction with three separate health effects studies. Chemicals that were monitored included carbon monoxide, total and respirable particulates, polyaromatic hydrocarbons (PAHs), crystalline silica, aldehydes, and benzene. Measurements were taken at both wildland fires and prescribed (planned) burns. A variety of collection methods were employed--colorimetric detector tubes and a CO monitor were used for direct-reading area measurements; colorimetric diffusion tubes, filter cassettes, sorbent tubes, and passive vapor monitors were used for determining personal time-weighted average exposures. A new screening method (National Institute for Occupational Safety and Health Method 2539) was used to identify the presence of specific aldehydes. Results show that wildland fire fighters may at times be exposed to concentrations of carbon monoxide, total or respirable particulates, or silica at levels near or higher than recommended occupational exposure limits, although group means were generally well below the limits. Time-weighted average formaldehyde levels, measured in a few instances above 0.37 mg/m3 (0.3 ppm), indicate a potential for formaldehyde-induced eye or respiratory irritation under these conditions. Certain characteristics of the work such as high altitude, temperature, and breathing rate; extended work shifts; and additional off-shift exposures suggest that adjustment of 8-hr exposure limits may be necessary to provide adequate protection. In part, because of the rigors of performing industrial hygiene measurements under fire fighting conditions, data are limited and could not be considered representative of the full range of exposures fire fighters may encounter.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mandatory exercise and heart disease risk in fire fighters

Summary After undergoing initial assessments of percentage of body fat (% fat), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and maximal oxygen consumption (VO₂Max), a group of 24 paid male fire fighters (mean age, 30.1 ± 7.7 years) began a mandatory exercise program. The physiological variables mentioned above were assessed once a year for the subsequent 5 years. A repeated-measures multivariate analysis of variance followed by univariate post hoc techniques showed a minimal but statistically significant improvement in % fat (–1.43% ± 0.66%) and TG (–27.54 ± 10.44 mg/dl) over the 5-year period. Significant differences in TC, HDL-C, LDL-C, and VO₂Max were noted over the years, but their magnitudes were small and no pattern was demonstrated. Each of the 5-year means for TC, LDL-C, % fat, and VO₂Max were outside the desirable ranges. We concluded that mandatory exercise programs do not significantly alter the risk factor status or the aerobic fitness levels of fire fighters and that a significant number of the latter demonstrate a higher than average risk for cardiovascular disease.     

Clinimetric quality of the fire fighting simulation test as part of the Dutch fire fighters Workers' Health Surveillance

Background  

Clinimetric data for the fire fighting simulation test (FFST), a new test proposed for the Workers' Health Surveillance (WHS) of Dutch fire fighters, were evaluated.     

Occupational noise exposure and hearing loss in fire fighters assigned to airport fire stations.

The National Institute for Occupational Safety and Health (NIOSH) was requested to conduct a health hazard evaluation (HHE) at a large metropolitan fire department. The request concerned the hearing levels and noise exposures of fire fighters who were assigned to two fire stations serving the international airport. There was concern that these fire fighters were at a greater risk of accruing hearing loss than fire fighters located at other fire stations because of the addition of aircraft noise to their occupational noise exposures. The city also requested that NIOSH investigate other fire stations, not influenced by the airport, for noise exposures and hearing ability among a larger population of the fire fighters. NIOSH investigators conducted noise surveys at five fire stations and examined the hearing ability of 197 fire fighters. The noise surveys consisted of personal noise dosimetry on fire fighters assigned to the fire station for the entire 24-hr tour of duty over 2 consecutive days at each of the five stations. A NIOSH investigator accompanied the fire fighters on their vehicle to log response times and activities. The audiometric examinations were pure-tone, air conduction tests administered according to the Occupational Safety and Health Administration's (OSHA's) hearing conservation amendment. The noise dosimetry results revealed time-weighted averages (TWAs) that ranged from 60 to 82 dBA. However, the levels encountered during Code 3 responses (warning lights, sirens, and air horns) reached 109 dBA for a 1-min time period. The audiometric results showed that the average fire fighter exhibited a characteristic noise-induced permanent threshold shift.(ABSTRACT TRUNCATED AT 250 WORDS)     

Is testicular cancer an occupational disease of fire fighters?*

BACKGROUND: A previous investigation showed an increased risk of testicular cancer among fire fighters in Wellington City, New Zealand, during the 1980s. Other studies of fire fighters had not identified testicular cancer as an occupational disease. METHODS: This was an historical cohort study of mortality and cancer incidence in all paid New Zealand fire fighters, from 1977 to 1995. RESULTS: The only cancer for which this study provided evidence of an increased risk was testicular cancer, even after excluding cases from the previous investigation. The standardized incidence ratio for 1990-96 was 3.0 (95% confidence interval: 1.3-5.90). There was no evidence that fire fighters were at increased risk from any particular cause of death. CONCLUSIONS: This study confirmed that New Zealand fire fighters are at increased risk of testicular cancer, although the reason is unknown. Other incidence studies of cancer in fire fighters are needed to confirm this finding.     

The physical demands of electrical utilities work in North America

We assessed the physical demands associated with electrical utilities work in North America and how they influence the level of thermal and cardiovascular strain experienced. Three common job categories were monitored as they are normally performed in thirty-two electrical utility workers: (i) Ground Work (n = 11), (ii) Bucket Work (n = 9), and (iii) Manual Pole Work (n = 12). Video analysis was performed to determine the proportion of the work monitoring period (duration: 187 ± 104 min) spent at different levels of physical effort (i.e., rest as well as light, moderate and heavy effort). Core and skin temperatures as well as heart rate were measured continuously. On average, workers spent 35.9 ± 15.9, 36.8 ± 17.8, 24.7 ± 12.8, and 2.6 ± 3.3% of the work period at rest and performing work classified as light, moderate, and heavy physical effort, respectively. Moreover, a greater proportion of the work period was spent performing heavy work in Ground Work (1.6 ± 1.4%) relative to Bucket Work (0.0 ± 0.0%; P<0.01) and in Manual Pole Climbing (5.5 ± 3.6%) in comparison to both other work job (both P≤0.03). Furthermore, the proportion of time spent during work classified as heavy physical effort was positively correlated to the mean (r = 0.51, P<0.01) and peak (r = 0.42, P = 0.02) core temperatures achieved during the work period as well as the mean heart rate response (presented as a percentage of heart rate reserve; r = 0.40, P = 0.03). Finally, mean and peak core temperatures and mean heart rate responses increased from the first to the second half of the work shift; however, no differences in the proportion of the work spent at the different intensity classifications were observed. We show that Manual Pole Work is associated with greater levels of physical effort compared to Ground or Bucket Work. Moreover, we suggest that the proportion of time spent performing work classified as heavy physical exertion is related to the level of thermal and cardiovascular strain experienced and that workers may not be employing self-pacing as a strategy to manage their level of physiological strain.     

Physiological responses to the wearing of fire fighter's turnout gear with neoprene and GORE-TEX barrier liners

This study examined the physiological effects of performing moderate and high intensity work while wearing fire fighter's turnout gear with either a neoprene or GORE-TEX barrier liner. Eight healthy men, experienced with the use of respirators and protective clothing, each performed moderate and high intensity treadmill exercise (44% and 71% of maximum work capacity) in a double-blind study at 27.6 degrees C (50% RH) while wearing complete fire fighter's turnout gear (weighing 23 kg) with either a neoprene or GORE-TEX barrier liner. Physiological measurements obtained included minute ventilation, heart rate, skin temperature, rectal temperature and sweat rate. Subjective evaluations of perceived exertion, comfort, clothing breathability, temperature and perspiration also were obtained. Tests were terminated (tolerance time) when objective or subjective signs of near maximal stress were observed (i.e., 90% of the maximum heart rate, rectal temperature of 39 degrees C, dizziness, etc.). Mean tolerance times for the moderate intensity exercise were 27.4 (+/- 7.3 S.D.) and 30.9 (+/- 7.9) min, respectively, for the neoprene and GORE-TEX barrier liners and at the high intensity were 7.2 (+/- 2.1) and 7.5 (+/- 2.3) min, respectively. Analysis of variance indicated that significant differences caused by liner were observed in skin temperature (0.6 degrees C higher with the neoprene ensemble). No significant differences caused by liner were seen in tolerance time, heart rate, sweat rate or subjective ratings.(ABSTRACT TRUNCATED AT 250 WORDS)     

Congenital anomalies among the offspring of fire fighters

A case-control study has been conducted to determine the association between employment as a fire fighter and congenital heart defects among the offspring. Cases were fathers of all children born between 1979 and 1986 in Ontario, Canada, who were diagnosed with a cardiac congenital anomaly during the first year of life (n = 9340). Matched controls (n = 9340), defined as fathers whose child did not have a congenital anomaly, were randomly selected from the Ontario birth certificate file. In order to identify those fathers who had been employed as a fire fighter, the cases and controls were linked to a cohort of Metropolitan Toronto fire fighters. Eleven cases and nine controls worked as fire fighters, giving an odds ratio of 1.22 (95 percent confidence interval 0.46–3.33). This study had sufficient power to detect the level of risk reported in one previous study; however, these results do not support a hypothesis of elevated risk of cardiac congenital anomalies among the offspring of fire fighters. © 1996 Wiley-Liss, Inc.     

Aging and the fitness of fire fighters: the complex issues involved in abolishing mandatory retirement ages.

This study presents an assessment of the cardiorespiratory health and physical fitness of fire fighters of different ages with the aim of addressing several questions currently being debated on a national level. These include how fire fighters differ across age groups in their health and physical fitness, and what would be the impact on the existing work force of implementing minimum fitness standards as an alternative to mandatory retirement ages. Fire fighters aged 20-65 years were found to be similar in their cardiorespiratory health and physical fitness to the sedentary segment of the general population of the same age. Particularly worrisome, however, is the low maximal aerobic capacity (31, 28, 26 ml/kg/min), high percent body fat (26, 29, 30), and high resting blood pressure (136/86, 140/90, 143/93 mm Hg) observed in the 40-45-, 50-55-, and 60-65-year-old fire fighters, respectively. In fact, 66%, 83%, and 93% of the fire fighters in these three age groups, respectively, fall below the lowest published recommendations for maximal aerobic capacity in this profession. These data underscore the need to establish minimum health and physical performance standards for fire fighters and demonstrate the profound impact such minimum standards will have on the existing work force.     

Effect of variable carbohydrate intake on exercise performance in female endurance cyclists

This study measured the effect of variable carbohydrate intake on time to exhaustion, variations in heart rate (HR), respiratory exchange ratio (RER), and rating of perceived exertion (RPE) in female endurance cyclists during an exercise trial. Subjects were 11 eumenorrheic women with maximal oxygen consumption (VO2max) 60.1 +/- 5.1 ml/kg who habitually cycled at least 100 miles per week. In a crossover design, each woman was randomly assigned to a eucaloric diet providing 8, 5, or 3 g of CHO/kg of body weight. Subjects cycled at least 100 miles while adhering to the diet for 6 days. The exercise trial was performed on the 7th day, consisting of a 60 min cycle at 70% VO2max, followed by an increase in intensity to 90% VO2max until the intensity could no longer be maintained. Results indicated no difference in mean time to exhaustion, heart rate, or RPE. RER increased over time-elapsed (F = 40.4, p < .001) and across diets (F = 6.1, p = .015). CONCLUSIONS: Female endurance cyclists did not experience a difference in time to exhaustion, HR, or RPE with different levels of CHO intake during an endurance trial. RER varied with diet at submaximal intensities. Further research is needed to determine the optimal level of CHO intake for this population.