Study identifies WTC evacuation risk factors

A study, funded by the Centers for Disease Control and Prevention and conducted by researchers at Columbia University’s Mailman School of Public Health, has identified some factors that affected evacuation from the World Trade Center (WTC) on September 11, 2001.

The key risk factors were associated with length of time to initiate evacuation, length of time to complete evacuation, and incidence of injury, according to a Mailman School release.

The study listed the following factors that delayed evacuation of the WTC:

  • a lack of awareness and experience in evacuation procedures;
  • making phone calls;
  • seeking co-workers;
  • personal concerns about one’s own ability (e.g., health and stamina) to descend the multiple flights of stairs;
  • workers waiting for supervisors’ permission to leave;
  • lack of appropriate footwear;
  • confusion about the locations of the staircases and where they ended; and
  • periodic congestion on stairs.

The study employed participatory action research (PAR) methodology to identify individual, organizational, and structural (environmental) barriers to safe and rapid evacuation. WTC evacuees, study investigators, and consultants with a wide range of expertise worked collaboratively to develop a set of recommendations to improve high-rise evacuation of business occupancies.

Among their recommendations were the following:

  • There is a need for a greater emphasis on emergency preparedness for high-rise workers, including mandatory training and drills, such as full-building evacuation drills.
  • Employees should keep comfortable footwear and emergency supplies at their desks.
  • “Emergency preparedness is a shared responsibility; therefore, it is important to encourage the development of a clear-cut emergency preparedness climate that is communicated to personnel.”

Line-of-Duty Deaths

January 24. Captain Richard Lynn Rhea, 60, Crawfordville (FL) Volunteer Fire Department: reportedly slipped on wet grass on the roadway shoulder while at the scene of a motor vehicle accident and contacted a live downed power line.

January 25. Firefighter Kyle Perkins, 45, Kilgore (TX) Fire Department: injuries sustained from falling eight stories from the bucket of a 95-foot rear-mount platform truck at a training exercise at the Fire Academy; incident is under investigation.

January 25. Firefighter Cory James Galloway, 23, Kilgore (TX) Fire Department: injuries sustained from falling eight stories from the bucket of a 95-foot rear-mount platform truck at a training exercise at the Fire Academy; incident is under investigation.

January 31. Firefighter-EMT Mark Bradley Davis, 25, Cape Vincent (NY) Volunteer Fire Department: wounds suffered from a high-powered rifle shot while on an EMS call.

February 1. Engineer William Gray Parsons, 58, Millers Creek (NC) Fire Department: apparent heart attack at the scene of a residential structure fire.

February 9. Chief Dean Walter Mathison, 63, Clayton-Winchester Fire Department, Larsen, WI: heart attack.

February 10. Firefighter Jeffrey Isbell, 33, Enterprise (AL) Fire Department: cause unknown.

February 16. Fire Police Captain Albert G. Eberle Jr., 74, Roslyn (PA) Fire Company: cardiac arrest.

Source: USFA Firefighters Memorial Database

FAA revises HEMS rules in face of increased crashes and fatalities

Responding to the increase in the number of crashes involving emergency medical services (EMS) helicopters, the Federal Aviation Administration (FAA) has revised its rules pertaining to helicopter emergency medical services (HEMS).

The revisions, according to the FAA’s Operations Specifications: A021. Helicopter Emergency Medical Services (HEMS) Operations, involve Instrument Flight Rules (IFR) and Visual Flight Rules (VFR) operations. View the full text of the changes in PDF files at www.faa.gov/.

The National Transportation Safety Board (NTSB) held a public hearing on the issue of HEMS safety in February to learn more about the challenges faced by HEMS and to help members determine ways to decrease accidents.

The Association of Air Medical Services (AAMS) was among those who testified at the hearing. In a press release, AAMS explained that “the hearing helped illuminate the reasons behind medical decisions for using medevac helicopters whenever a patient’s condition indicates the potential for serious illness or injury.”

During panel testimony, Dr. Jack Davidoff, president of the Air Medical Physician Association (AMPA), and Dr. Daniel Hankins, co-medical director of Mayo Clinic Medical Transport, noted that “physicians are obligated under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) to stabilize patients to the maximum of their ability and to assure continuation of a high level of medical care if transport to a tertiary-care facility is required.” The physicians also noted that EMTALA considerations are significant factors when deciding to transfer patients in rural and other underserved areas, which may lack specialty or tertiary-care centers, to other facilities.

Dr. Hankins also explained a transported patient’s being discharged from a hospital within 24 hours is “a poor measure of inappropriate utilization of helicopter emergency transport because in today’s health care system, patients with significant injuries or illnesses can be diagnosed, treated, stabilized, and ultimately discharged in 24 hours.”

The American College of Emergency Physicians (ACEP), in a press release, recommends that physicians oversee state EMS systems and that the physicians decide which patients should be air transported based on the patients’ best interest. It calls also for states’ developing EMS protocols and required accreditation for operating HEMS. Among other recommendations, the ACEP also suggested that the NTSB develop recommendations “to guide state governments in discharging their responsibilities to regulate facilities and ambulances, both air and ground, to achieve uniform best practices across states.”

Economic stimulus bill includes fire service-related funding

The American Recovery and Reinvestment Act of 2009, commonly referred to as economic stimulus legislation, contains funding for a variety of fire service-related items, according to the National Volunteer Fire Council (NVFC). Among the fire-service related provisions are the following:

  • $210 million for competitive grants for “modifying, upgrading, or constructing non-Federal fire stations.” The maximum grant size is capped at $15 million, and up to five percent of the appropriated funds may be used for grant administration.
  • The local matching requirement under the Staffing for Adequate Fire and Emergency Response (SAFER) grants for funds appropriated in FY 2009 and FY 2010 has been eliminated. Local governments previously had to match hiring grants at 10 percent in the first year of the grant, 20 percent in the second, 50 in the third, and 70 in the fourth.
  • The following was included for Wildland Fire Management: $15 million for hazardous fuels reduction, through the Bureau of Land Management; $500 million for Wildland Fire Management through the United States Forest Service, including $250 million for “hazardous fuels reduction, forest health protection, rehabilitation, and hazard mitigation activities on Federal lands”; and $250 million for “state and private forestry activities including hazardous fuels reduction, forest health, and ecosystem improvement activities on State and private lands.”

    Members to vote in June on NFPA 72® code level alarms for hearing impaired

    “Nearly half of subjects with mild to moderately severe hearing loss slept through code-mandated levels of the 3100-Hz smoke alarm signal, while nearly all participants woke up to the lower frequency 520-Hz square-wave signal,” according to National Fire Protection Association (NFPA)- and U.S. Fire Administration (USFA)-sponsored research.

    Members at the June NFPA meeting will have the opportunity to vote on the 2010 edition of NFPA 72®, National Fire Alarm Code.® “Many people are not aware of their hearing loss, and many who are aware do not act on their need for special alerting devices,” explains the NFPA. “Therefore, it is critical that the fire safety community improve the standards to protect these populations.”

    The proposed code includes language that would require 520-Hz square-wave smoke alarms in all commercial sleeping rooms and in residential bedrooms for people with hearing loss by 2014. This will give manufacturers time to develop new smoke alarms that meet the code.

    A smoke alarm that converts standard alarms into a 520-Hz square-wave tone at the bedside was expected to be made available shortly after press time; the device will be UL listed, according to the NFPA.

    CDC revises field triage guidelines for trauma patients

    The Centers for Disease Control and Prevention (CDC) published in its MMWR Reports and Recommendationsguidelines for ensuring that trauma patients with more severe injuries are taken to trauma centers designed to handle such injuries. The recommendations help to standardize decision making at the injury scene and also cover new technologies such as vehicle crash notification systems, which alert emergency services that a crash has occurred and automatically summon assistance. CDC and key experts in trauma care developed the guidelines.

    The report provides the rationale and development process for the revised 2006 Field Triage Decision Scheme: the National Trauma Triage Protocol for emergency medical service (EMS) providers. Previous CDC-funded research has shown that the risk of death for a severely injured person is 25 percent lower if the patient receives care at a Level 1 trauma center, which has additional resources specifically designed for care of severe trauma. Hence, decisions made at the injury scene are vital.

    The revised document also presents recommendations for “the right place and right time to best use crucial emergency care resources” and vehicle crash damage criteria that can help determine which patients may require care at a trauma center.

    The revisions were developed in collaboration with the American College of Surgeons Committee on Trauma with support from the National Highway Traffic Safety Administration (NHTSA). It was reviewed by the 36-member National Expert Panel on Field Triage, which included representatives from EMS, emergency medicine, trauma surgery, the automotive industry, public health, and several federal agencies. The Decision Scheme was endorsed by many professional organizations and associations and was included in the 2006 versions of the American College of Surgeons’ Resources for the Optimal Care of the Injured Patient and the National Association of Emergency Medical Technicians’ Prehospital Trauma Care Life Support manual for EMS practitioners.

    With additional funding from NHTSA, the CDC is developing a companion educational initiative for local EMS medical directors, state EMS directors, public health officials, and EMS providers. Tailored to meet the needs of their communities, the package will include a user’s guide, poster, and pocket card of the Decision Scheme, a slide presentation for use in training, and the MMWR article that includes continuing education opportunities.

    Information and free downloads are available from the CDC at www.cdc.gov/FieldTriageFor a complete copy of the MMWR report, visit www.cdc.gov/mmwr.

    NFPA report: Eight people die in home fires daily in the U.S.

    In February, the National Fire Protection Association (NFPA) issued its Home Structure Fires report. The report covered one- and two-family dwellings and apartments.

    According to the report, 399,000 home fires were reported in the United States in 2007, and 2,865 people died in home fires—on average, eight people every day.

    In addition, the following findings were reported:

    • Home fires accounted for 84 percent of all civilian fire deaths and caused 13,600 injuries.
    • Direct property damage was estimated at $7.4 billion.
    • For the 2003-2006 four-year period, the following findings apply:
      —Cooking equipment was the leading cause of fires, civilian fire injuries, and unreported fires.
      —About 41 percent of reported home fires began in the kitchen or cooking area.
      —Smoking was the leading cause of civilian home structure fire deaths.
      —Heating ranked second in home structure fire deaths overall and was the leading cause of fire-related deaths in one- and two-family dwellings.
      —Almost two-thirds of home fire deaths occurred in homes without working smoke alarms.
      —More than half (53 percent) of people killed in home fires were in the room or area of origin when the fire started.

    National 9-1-1 Office to establish 9-1-1 technical assistance center

    The National E9-1-1 Implementation Coordination Office’s Technical Assistance Center (TAC), which will be available mid-2009, will assist emergency 9-1-1 centers and 9-1-1 authorities in promoting and enhancing efforts for deploying advanced 9-1-1 capabilities and improving the receiving and processing of 9-1-1 calls and data, the Office said in a press release. L. Robert Kimball & Associates (Kimball) and a team of 9-1-1 experts, including the National Emergency Number Association, will lead the center.

    The TAC will also serve as an information clearinghouse for resources related to 9-1-1 and emergency services. A searchable Web site will enable users to post detailed questions to 9-1-1 subject matter experts.

    USFA and NVFC revise Health and Wellness Guide for volunteer firefighters

    The revised Health and Wellness Guide for the Volunteer Fire and Emergency Services addresses fitness, flexibility, strength training, diet, smoking cessation, and other areas that impact firefighters’ health. “The partnership between the U.S. Fire Administration (USFA) and the National Volunteer Fire Council (NVFC) to improve the health and wellness of the volunteer fire service will support reducing the primary cause of on-duty deaths in the volunteer fire service—heart attack and stress,” notes Acting Assistant Administrator Dr. Denis Onieal. The document also explains how volunteer fire departments can enhance compliance with appropriate National Fire Protection Association (NFPA) firefighter health and safety standards such as NFPA 1583, Health Related Fitness Programs for Fire Fighters. Download the guide at www.usfa.dhs.gov/downloads/pdf/publications/fa_321.pdf/.

    NHTSA posts National EMS Education Standards

    The National Highway Traffic Safety Administration’s (NHTSA) Office of EMS has posted the final National EMS Education Standards (NEMSES) on its Web site, www.EMS.gov/. The corresponding Instructional Guidelines for Emergency Medical Responder, Emergency Medical Technician, Advanced EMT, and Paramedic are also posted.

    NIOSH releases firefighter fatality investigation report

    The National Institute for Occupational Safety and Health (NIOSH) report F2007-18, “Nine career fire fighters die in rapid fire progression at commercial furniture showroom—South Carolina,” June 18, 2007, is now available at http://www.cdc.gov/niosh/fire/reports/face200718.html/.

    FDA warns of potential hazards of improper use of skin-numbing products

    The U.S. Food and Drug Administration (FDA) warns that topical anesthetics were reported to have caused adverse events and two deaths. Available over the counter and by prescription, the products contain anesthetic drugs such as lidocaine, tetracaine, benzocaine, and prilocaine in a cream, ointment, or gel.

    The products, absorbed by the skin, can cause irregular heartbeat, seizures, breathing difficulties, coma, or death if used improperly. The products have been used to lessen pain in procedures such as skin treatments and laser hair removal.

    The FDA says anyone considering using a topical anesthetic before a procedure should consult with a health care professional first. For additional information, go to the FDA Web site at www.fda.gov/.

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