Pneumonia and other hazards on the fireline

White Draw Fire, South Dakota
White Draw Fire, South Dakota, June, 2012.

(UPDATED at 4:24 p.m. PDT September 5, 2018)

The U.S. Fire Administration has designated the death of Erick Aarseth a line of duty death (LODD). The agency posted a notice on their web site that indicates Mr. Aarseth was released from the Horns Mountain Fire at 6 p.m. on August 27. The next day he was found unconscious in his apartment.

From the US Fire Administration:

“Firefighter II Eric Aarseth worked the Horns Mountain Fire in Washington on August 27 and was released at 6:00 p.m.  On August 28, Aarseth was found unresponsive at his home in Oregon. Reports indicate that Aarseth developed pneumonia which became septic. Aarseth was treated at Sacred Heart Medical Center in Springfield, Oregon, but was taken off life support on September 3 after suffering irreversible damage to his organs. Aarseth passed away early the following morning on September 4.

“Incident Location: Horns Mountain Fire near Northport, Washington (U.S. National Grid: 11U MQ 42732 18414 (DD: 48.916, -117.782))

“Department information
Miller Timber Services
PO Box 638
24745 Alsea Hwy.
Philomath, Oregon 97370

“Chief: President Lee Miller”


(Originally published at 12:59 p.m. PDT September 4, 2018)

Yesterday, September 3, 20-year-old Eric Aarseth passed away after he was found unconscious the day after he returned from a fire assignment.

His family said he returned home from the fire Monday August 27 and the next day was found unconscious in his apartment suffering from pneumonia. He was taken to a hospital but never woke up. KGW8 reported that he had vomited, obstructed his airway and developed sepsis. When it was discovered he was brain dead the family made the difficult decision to turn off the life support. He passed away Monday September 3.

The Centers for Disease Control reports that the incubation period of pneumococcal pneumonia is about 1 to 3 days. This makes it possible, or even likely, that Mr. Arseth was exposed to the conditions that led to the disease while still on the fire assignment or in travel status.  This could be a line of duty death, an LODD.

Mr. Aarseth was a member of a contractor’s hand crew fighting the Horns Mountain Fire in southern Washington. In July their crew was on the Garner Complex of Fires in southern Oregon.

Working on a hand crew is very hard work. It often means inadequate sleep, nutrition, and hygiene. An ongoing study of smokejumpers found that over the course of a season they lost muscle mass, added fat, their weight remained about the same, and often had impaired reaction time. A study we wrote about in February found firefighters’ exposure to smoke increases their disease risk. Depending on the type of work performed and the number of years of exposure, the increased risk can be 22 to 39 percent.

Wildland firefighters have enough to worry about from the fire itself, avoiding dangerous situations that could lead to being overrun by the fire, hit by a falling tree or rock, cut by a chain saw, exposed to toxic smoke, or being in a vehicle or helicopter accident. Trying to prevent something you can’t see that apparently can kill you in a matter of hours or days, like sepsis and pneumonia, is scarier than all of the above.

Thanks and a tip of the hat go out to Alex.
Typos or errors, report them HERE.

Study showed over a season smokejumpers lost muscle mass and often had impaired reaction time

Nine of them were monitored by University of Idaho researchers

firefighters wildfire smoke
Firefighters arrive at the White Tail Fire in South Dakota, March 8, 2017. Photo by Bill Gabbert.

This study conducted by researchers at the University of Idaho followed 9 smokejumpers over the course of a fire season. This is not a representative sample of wildland firefighters and the many different jobs they perform, but it is interesting nonetheless. This year they are monitoring 18 additional smokejumpers and hope to expand it to more firefighters in the future.


University of Idaho study looks at firefighter diet, sleep in an effort to curb impaired work

By Sara Zaske, U. of I. College of Natural Resources

Wildland firefighters are working long shifts this summer all across the West. And they are getting really tired.

Randy Brooks knows exactly how tired. The University of Idaho professor is closely tracking 18 smokejumpers with the help of advanced motion monitors that use an algorithmic fatigue model originally developed for the U.S. military.

This is not just an academic exercise — Brooks is aiming to save lives.

“Wildland firefighters need to be alert and vigilant of their surrounding situation because something could happen at any moment,” he said.

Both of Brooks’ sons fight fires. And the need for great situational awareness hit close to home in 2015 when a fire shifted directions on one of his sons.

It started with a late-night text — his son, Bo Brooks, let him know the crew was heading to work the next day on the Twisp fire in north central Washington. He was nervous because high winds were forecast.

The next day, Brooks got a phone call instead of his typical text.

“My son called me at 4 in the afternoon,” Brooks said. “I knew something was wrong because they usually just text me to let me know they were all right.”

Randy BrooksThis time everything was not all right. The winds kicked up suddenly, and the fire crew had to “bug out” – run out of an area as quickly and efficiently as possible. Not all of them made it. Three firefighters died and another was badly burned.

After the tragedy, some members of the team quit firefighting. Bo Brooks stayed on but wanted things to change: “He said ‘Dad you’re a forestry researcher — is there anything you can do to help us?’” Randy Brooks said.

So Brooks, who works in U of I’s College of Natural Resources, and Callie Collins, a doctoral student in environmental science, conducted a survey of more than 400 wildland firefighters. The majority indicated that the main contributors to accidents in fire operations were inadequate sleep and fatigue, both mental and physical.

The researchers followed the survey with a pilot study of nine firefighters to closely assess sleep, fatigue and body composition.

They outfitted the smokejumpers, firefighters who parachute from planes to battle wildland fires in remote areas, with Readibands — motion monitors made by Fatigue Science that keep detailed data on sleep and activity. The data was then analyzed using the algorithm model developed by the U.S. Army Research Laboratory to obtain an “alertness score,” which quantifies the wearers’ reaction times and relative accident risk.

In the pilot study, Brooks and Collins found firefighters spent more than 42 percent of one month working in impaired conditions with reaction times slowed by as much as 34 to 100 percent – equivalent to having a blood-alcohol concentration of 0.05 to 0.11 or higher. That’s on the cusp of the legal limit for driving at 0.08.

Professor Randy Brooks wearing a Fatigue Fitness Readiband holds a tablet that is monitoring the alertness scores of 18 wildland firefighters currently in the field.

The researchers also had the firefighters’ body composition measured, before and after the fire season, and looked at their hydration and diet. Despite their high level of physical activity, the smokejumpers maintained their weight but gained fat over the summer — and lost muscle mass.

Brooks and Collins believe this may be because of the quality of their diet, which is high in carbohydrates and sugar and lower in protein and healthy fats like those found in eggs, nuts and fish. They hope to test that hypothesis in future studies.

Always a challenging profession, wildland firefighting has become even more difficult in recent years as the wildfire season in the West continues to grow in intensity and duration – today the fire season is about 30 days longer than it was three decades ago.

“It’s like they used to be running a 100-yard dash 30 years ago and now they’re running a marathon with the longer fire seasons,” Brooks said.

And if they are running a firefighting marathon, he argues, the crews may need to eat and drink like elite athletes do as well.

This summer, Brooks doubled the sample size of his pilot study to 18 smokejumpers. He wants to expand the project further in the future, and nearly 200 firefighters have volunteered to participate in his studies. His research was only limited by the expense of the motion trackers, which cost close to $1,000 each at the start of the study.

Still, Brooks hopes whatever data he gathers will help make this dangerous profession safer.

“I think we need a paradigm shift in the way we think about fighting wildfires at all cost and place a greater emphasis on personal safety over protecting resources,” Brooks said. “Trees grow back, homes can be rebuilt, but lives can’t be replaced.”




New rhabdomyolysis resources for firefighters

If left untreated, severe rhabdo may be fatal or result in permanent disability.

Too many wildland firefighters have suffered from rhabdomyolysis (often referred to as rhabdo) in recent years. In some cases they could have been treated much earlier if the victims and those around them had recognized the symptoms.

Rhabdo informationFirefighting, both structural and wildland, involves tasks in environments that place fire fighters at increased risk for this condition. Rhabdo is a breakdown of muscle tissue that releases proteins and electrolytes into the blood stream and can cause heart and kidney damage. If left untreated, severe rhabdo may be fatal or result in permanent disability. Heat exposure and intense physical effort are just two of many known risk factors for rhabdo.

NIOSH has developed two sets of factsheets and wallet cards—one for structural firefighters and their healthcare providers and another for wildland firefighters and their healthcare providers—to increase awareness about the signs and symptoms of rhabdomyolysis and help fire fighters get early treatment to prevent more serious medical problems.

Factsheets for wildland firefighters and their healthcare providers:

What Wildland Fire Fighters Need to Know about Rhabdomyolysis

Rhabdomyolysis in Wildland Fire Fighters: A Patient Population at Risk

Wallet cards for wildland fire fighters

 

Factsheets for structural firefighters and their healthcare providers:

What Structural Fire Fighters Need to Know about Rhabdomyolysis

Rhabdomyolysis in Structural Fire Fighters: A Patient Population at Risk

Wallet cards for structural fire fighters

Thanks and a tip of the hat go out to Bryan.
Typos or errors, report them HERE.

Seeking firefighters to help with research about physical and mental health

It was just a week ago that we published an article about evaluating the health of wildland firefighters and about how difficult it has been to get good data.

Now YOU may be able to help.

Current and former wildland firefighters- please consider participating in an important research project about wildland firefighters’ physical and mental health. We need research like this to understand and document the unique health risks that wildland firefighters experience. This ANONYMOUS study was developed at the University of Montana by a wildland firefighter to improve wildland firefighters’ health and safety. It is being funded by the Fallen Firefighter Foundation.

As a token of appreciation for participating in this study, the first 600 participants will be offered a $5 Amazon.com gift card code, provided by the National Fallen Firefighters Foundation. The success of this study depends on participation.

More information.

Inadequate sleep can help explain high rates of suicide and cardiac events among firefighters

Studies indicate sleep deprivation increases susceptibility to cancer, cardiac disease, and post-traumatic stress disorder.

Firefighters sleep wildfire
USFS photo.

An article by Eric Saylors at Medium.com emphasizes how important sleep is to firefighters.

He reports that one study found men kept awake between 10 p.m. and 3 a.m. showed a 70 percent reduction of cancer-fighting immune cells known as “natural killers” after one night. These cells detect and control early signs of cancer. The data in the study indicates that even a modest disturbance of sleep produces a reduction of natural immune responses.

Below are excerpts from Mr. Saylor’s article, which also draws information from several other researchers:

“Lack of quality sleep could explain why cardiac events are common in firefighters, regardless of fitness programs. ”

“Rosaline Cartwright, professor of psychology in neuroscience, explains the mind needs sleep to processes stressful events. Without sleep the brain cannot decouple the memory of tragic events and the physiological response. Essentially, if you can’t sleep on it, you can’t get over it. This explains a new epidemic in the fire service; firefighter suicide.”

“Cartwright’s research suggests the mind needs dreams followed by REM sleep and to process upsetting experiences. In other words, you have to recreate tough experiences in your dreams so your mind can break them down. Without the combination of REM sleep and dreams, memories of traumatic events remain fresh in the person’s mind. As a result, a firefighter who is sleep deprived accumulates traumatic events like a trash can that is never emptied.”

“Contributing to cancer, cardiac events, and PTSD, lack of sleep may be the greatest cause of firefighter deaths.”

Eric Saylors is an instructor, author, pilot, consultant, and 3rd gen firefighter with a Masters degree in security studies from the Naval Post Graduate School.

Study shows firefighters’ exposure to smoke increases disease risk

Depending on the type of work performed and the number of years of exposure, the increased risk can be 22 to 39 percent.

Above: Smoky conditions on the Legion Lake Fire in Custer State Park in South Dakota, December 12, 2017. Photo by Bill Gabbert.

Originally published at 6:02 p.m. MT, February 6, 2018.

After collecting data from wildland firefighters in the field, a group of researchers concluded that firefighters’ exposure to smoke can increase the risk of mortality from lung cancer, ischemic heart disease, and cardiovascular disease. In this first section we cover what is in vegetation fire smoke, and after that we have details about the additional mortality risk faced by firefighters who can’t help but breathe the toxic substances.

What is in the air that firefighters breathe?

There have been many studies about smoke dating back to the 1988 NIOSH project at the fires in Yellowstone National Park. Most of them confirmed that yes, wildland firefighters ARE exposed to smoke and in most cases they quantified the amount.

In 2004 Timothy E. Reinhardt and Roger D. Ottmar  found a witches’ brew of methyl ethyl bad stuff that firefighters are breathing. All of these are hazardous to your health:

  • Aldehydes (volatile organic compounds); can cause immediate irritation of the eyes, nose, and throat, and inhalation can cause inflammation of the lungs. Short-term effects include cough, shortness of breath, and chest pain. The most abundant aldehyde in smoke is formaldehyde. When formaldehyde enters the body, it is converted to formic acid, which also is toxic.
  • Sulfur dioxide (SO²); causes severe irritation of the eyes, skin, upper respiratory tract, and mucous membranes, and also can cause bronchoconstriction. It forms sulfuric acid in the presence of water vapor and has been shown to damage the airways of humans.
  • Carbon monoxide (CO); As CO is inhaled it displaces O2 as it attaches to red blood cells and forms COHb. COHb reduces the ability of the blood to carry oxygen and causes hypoxia (a condition in which the body does not receive sufficient oxygen). Due to their strenuous work, wildland firefighters often have increased respiratory rates, which will increase the amount of CO being inhaled when smoke is present. COHb has a half-life (the time it takes half of the COHb to dissipate from the body) of about 5 hours. Symptoms of CO exposure include headaches, dizziness, nausea, loss of mental acuity, and fatigue. Prolonged, high exposure can cause confusion and loss of consciousness
  • Particulate matter; Respirable particulates are a major concern as they can be inhaled into the deeper recesses of the lungs, the alveolar region. These particles carry absorbed and condensed toxicants into the lungs
  • Acrolein; may increase the possibility of respiratory infections. It can cause irritation of the nose, throat, and lungs. Long-term effects can include chronic respiratory irritation and permanent loss of lung function if exposure occurs over many years.
  • Benzene; can cause headaches, dizziness, nausea, confusion, and respiratory tract irritation. Although the human body can often recover and repair damage caused by irritants, prolonged exposure from extended work shifts and poorly ventilated fire camps can overwhelm the ability to repair damage to genes and deoxyribonucleic acid (DNA).
  • Crystalline silica; can cause silicosis, a noncancerous lung disease that affects lung function. But OSHA classifies it as a carcinogen.
  • Intermediate chemicals; have been shown to cause a variety of health problems including bronchopulmonary carcinogenesis, fibrogenesis, pulmonary injury, respiratory distress, chronic obstructive pulmonary disease (COPD), and inflammation.

One of the more recent research efforts, from 2009 to 2012, was led by George Broyles of the U.S. Forest Service, National Technology and Development Program, in Boise, Idaho. They collected data in 11 fuel models in 17 states on initial attack, prescribed burns, and large project fires. The group measured carbon monoxide (CO) with electronic datalogging dosimeters and particulate matter using air pumps and filters.

carbon monoxide exposure firefighters
Data from the 2009-2012 wildland firefighter study led by George Broyles. “TWA” stands for Time Weighted Average. CO is carbon monoxide. OEL is Occupational Exposure Limits.

Monitoring carbon monoxide (CO) can be important, and is also fairly easy to do and not terribly expensive. Researchers have found that it can be a surrogate for the primary irritants of concern in wildland smoke near the combustion source. If CO is present, it’s almost certain that the smorgasbord of nasty stuff is in the air.

wildfire smoke monitoring firefighters
Jon Richert displays the various devices the National Technology Development Center research crews use to measure the amount of smoke firefighters deal with during wildfire suppression. This equipment was used in 2016 in a different but similar study than the one described in this article.
Diffusion tube
Diffusion tube.

Electronic CO monitors are available for $100 to $300. Another option is the little disposable CO monitors called diffusion tubes. With the holder they are about the size of a dry erase marker. Many are made by Drager, and for eight hours can record the cumulative CO. You can’t get an instantaneous reading, but the total hourly exposure can be monitored. They cost about $13 each. If one or two people on the crew carry them it can provide a heads up if the air quality is really bad.

What are the health effects of smoke exposure on a wildland fire?

Employers in most if not all workplaces are required to minimize hazards and provide a safe working environment. But of course it is impossible to totally eliminate all risks to firefighters. A cynic might assume that leadership in the wildland fire community may be hesitant to ask the question if they don’t want to hear the answer.

In spite of numerous studies confirming that yes, there is smoke where wildland firefighters work, there has been little in the literature that quantifies the effects on a person’s health. A new study published in August, 2017 contains a preliminary analysis addressing that question.

It is titled Wildland Fire Smoke Health Effects on Wildland Firefighters and the Public – Final Report to the Joint Fire Science Program. The authors are Joe Domitrovich, George Broyles, Roger D. Ottmar, Timothy E. Reinhardt, Luke P. Naeher, Michael T. Kleinman, Kathleen M. Navarro, Christopher E. Mackay, and Olorunfemi Adetona.

They used the field data collected in the 2009 to 2012 George Broyles study to extrapolate the physical and health effects on humans. The authors actually came up with numbers that indicate firefighters’ relative mortality risk for lung cancer, ischemic heart disease, and cardiovascular disease.
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