Tag: Pack Test

A firefighter in Indiana suffered a full cardiac arrest while taking the Work Capacity Test, or Pack Test, in March. Thankfully, as a result of the precautions that were in place, including the presence of an Automatic External Defibrillator (AED), there was a positive outcome.

Here is the text of an After Action Review.

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March 6, 2012

This AAR was prepared for Drew C. Daily, State Fire Coordinator for the Indiana Department of Natural Resources, Division of Forestry, Fire Control Headquarters by Stephen W. Creech (State Fire Coordinator Retired). Drew is serving as the Operations Section Chief for the Department of Homeland Security following the tornado events that took place on Friday, March 2, 2012. I was present during the medical emergency and Drew requested that I prepare this document.

After Action Review for Medical Emergency during Work Capacity Test

On Friday, March 2, 2012 the IDNR, Division of Forestry held one of their “Annual Refresher” training courses at Prophetstown State Park, Lafayette, Indiana. Due to impending severe weather the Work Capacity Test (WCT) scheduled immediately following the training was moved up to 0900 hours. Weather forecasts indicated that a severe line of strong thunderstorms were scheduled to move through the area at approximately 1030 hours. The course that was selected for the WCT had been accurately measured and marked and was a closed loop course. Participants completed their health screening questionnaire and they were checked by Drew Daily and Darren Bridges and signed. There were no indications that any of the participants suffered from any conditions that would preclude them from participation. The test was started at approximately 0915.

A lead vehicle was provided to guide participants through the course and the Emergency Medical Technician (EMTB) was in this vehicle. A trail vehicle was used to follow the final participant and was operated by one of the Prophetstown employees. The lead vehicle was equipped with an Emergency Warning System (EWS) and VHF mobile radio. The trail vehicle was only equipped with a VHF radio. The medic was also equipped with an 800 MHz portable radio and had contact with the ambulance service. Timers were provided and time splits were given at .5 mile increments. I was personally stationed at the 2.5 mile marker and had cleared all but a couple of participants when the medical emergency occurred.

Approximately 100-meters short of the 2.5 mile marker one of the participants suddenly fell forward and landed face down on the pavement. The medic was approximately 100-meters in front of the victim and was at the victim’s side within seconds. The medic assessed the situation and immediately called for assistance on the radio. The medic advised that the victim was in “full arrest”. Cardio Pulmonary Resuscitation was started immediately and 911 dispatch was notified via the 800 MHz radio. The medic hooked up an Automatic External Defibrillator (AED) and intubated the victim. The AED indicated that a “shock” was advised. Aid givers cleared the patient and the shock was administered. After the shock, CPR was resumed but we could not get a pulse nor was the victim breathing on his own. During the next several minutes (2 – 3 minutes) the AED analyzed the patient several times, but advised that a shock was not recommended. Just as we were getting ready to switch individuals providing CPR the patient seemed to involuntarily convulse a single time. Immediately following this episode the patient started to breathe on his own and a carotid pulse was detected. At this point we could still not get a radial pulse. The approximate time lapse from full cardiac arrest to now was 3 – 4 minutes.
Continue reading “Full cardiac arrest during Pack Test”

A recent study concluded that marathon runners suffered temporary damage to their hearts. It was a small sample size but of the 20 runners studied that ran in the 2008 Quebec City Marathon, 19 of them lost cardiac function in over half of the 17 segments of the heart. The good news is that when the runners were evaluated three months later their hearts had completely recovered.

There were at least two factors that affected the amount of damage to the heart function. The runners who were most fit, as measured by a VO2max test before the race, had the least damage. And dehydration was associated with greater damage.

Does this apply to wildland firefighters?

I am certainly no exercise physiologist, but I can’t help but wonder if any of this is applicable to wildland firefighters, for example working on a hot shot crew, performing extremely strenuous work for 8 to 16 hours. When a hot shot crew member is cutting fireline while carrying 20-30 pounds of gear thousands of feet above sea level, their heart rate is likely to be quite a bit above a resting heart rate. I have hiked up steep hills on fires when I was sure that my heart was working at close to its maximum capacity.

Between 1990 and 2006, 22% of the wildland fire fatalities were due to heart attacks. Training or testing can be hazardous or even fatal. According to the report “Wildland Firefighter Fatalities in the United States: 1990–2006” (NWCG 2007) 11 fire personnel died while preparing for or taking the work capacity test. Another died in 2007.

In a study done to evaluate the physical effects of taking the Pack Test and the old Step Test, the mean heart rates measured were 144 and 135, respectively. The study concluded that taking the Pack Test requires subjects to perform at approximately 65% of maximal effort. There are definitely times when a firefighter is working harder on the fire line than when they are taking the Pack Test.

A marathon lasts about 3 to 5+ hours. A typical heart rate for a marathon runner is about 140.

I’m not saying that working on a hot shot crew is like running a marathon, but you have to wonder if any of the findings in the study are applicable to firefighters.

Hydration

Since hydration was associated with greater temporary damage to the heart, this might be one more reason why wildland firefighters, especially those assigned to large fires and working long shifts, should pay even more attention to staying hydrated. A firefighter can only carry 1-2 gallons of drinking water, so the Operations and Logistics sections on fires should proactively resupply crews working in remote locations water throughout their shift. Even if it means using helicopters and sling loads to stage water ahead of the crews.

Thankfully, we are a lot smarter about this than we used to be. When I first started on the El Cariso Hot Shots in 1970, we were not allowed to drink water while cutting practice fire line. The water we carried in our fire gear while training was “fire water” and could only be consumed when on an actual fire. We had to wait, usually several hours, until we hiked back to our trucks to get a sip of water. And it was uphill both ways!

The moral of the story

Drink! Drink! Drink! Oh, and be fit, too.

You have read about Brian Sharkey of the Missoula Technology and Development Center (MTDC)) previously on Wildfire Today, most recently when the IAWF presented to him their Wildland Fire Safety Award.

Here is an excerpt from an article in the Missoulian:

When Brian Sharkey arrived in Montana back in 1964, he’d never been west of Harrisburg, Pa.

“I was just eager to come West and one thing led to another,” Sharkey said.

His eagerness to migrate west, as well as a timely job opening, served as the beginning of a career spanning more than four decades, studying what he calls “human energy expenditure in the workplace” – mainly pertaining to wildland firefighters.

Last month, the International Association of Wildland Fire awarded Sharkey the 2009 Wildland Safety Award for his work and research over the last 45 years. Sharkey, a fire and aviation project leader for the U.S. Forest Service’s Missoula Technology and Development Center, has studied the physiological stressors and needs of firefighters battling wildfire.

That work provided information for firefighters, and even soldiers, in subjects ranging from which ergonomic tools to use to how much rest a worker needs.

Sharkey, formerly an exercise physiology professor at the University of Montana, spent numerous summers gathering data and studying firefighters in the field. Despite working closely with firefighters, Sharkey and his fellow researchers made a point not to interfere.

“When we send people to collect (the data), we know exactly how not to get in the way,” Sharkey said.

In addition, he prefers that his fellow field workers are able to endure physical strain.

“Everybody who’s working in these projects either has experience as a firefighter or endurance athlete,” Sharkey said, himself a distance runner and ski marathoner.

Sharkey hopes the recognition from the award will help expand the research program between the Missoula Technology and Development Center and UM, as well as provide for projects in the future.

“We’ve now got really good folks at the university who are interested in this kind of work,” Sharkey said. “I think we’ve got it set up where that program will continue.”

However, the reporter, or perhaps the person that gave him the information, got the dates wrong in this excerpt:

[Leslie] Anderson also cited Sharkey’s instrumental role in developing the Work Capacity Test, a test used to determine a firefighter’s level of fitness.

Ken Frederick, public affairs specialist for the National Interagency Fire Center in Boise, remembers when the WCT replaced the “step test” in the early 1980s as the standard physical fitness examination.

According to Frederick, the Work Capacity Test, which involves walking three miles with a 45-pound pack within 45 minutes, much more closely mimics a real-life situation for a firefighter than climbing steps.

“It’s a lot more accurate in terms of what a firefighter actually does,” Frederick said.

The Step Test, which was developed by Swedish doctor Per-Olaf Astrand in the 50s, was brought to the the five federal land mangement agencies by Brian Sharkey and others from the MTDC in 1975.  The Step Test was replaced in 1998 by the Work Capacity Test, commonly known as the pack test.

Thanks Dick and Kelly