Is it chemical or CO poisoning?
It was a Friday afternoon during the Christmas holiday week. Things were pretty quiet in the industrial park, as many businesses gave employees the week off. Our department got dispatched on a code one (ambulance request) to an industrial building for a person passed out. Whenever we respond to an industrial site, we consider the potential for chemical exposure.
When we arrived on the scene, we were met by company representatives, who stated the patient had been working all day with sodium nitrite, which is ground into a fine dust. We were given the material safety data sheet (MSDS) and checked the medical information. The patient was conscious but complaining of headache, dizziness, difficulty breathing, weakness, and vision problems. All of the symptoms that the patient was experiencing were the same as those listed on the MSDS for overexposure to sodium nitrite. There was a language barrier with the patient, and he was not very alert, so it was difficult to determine if he was wearing his protective mask as required while working with the chemical.
There were only a few other workers in the building at the time, and no one else was complaining of any problems. The patient’s clothing, which had a lot of the powder on it, was removed and patient decon performed because the sodium nitrite is also a material that is absorbed through the skin. Once the patient was at the hospital, blood work was done as a standard part of patient care. The doctor then called us to say that the level of carbon monoxide in the patient’s blood was 26 percent. The patient had been treated with 100 percent oxygen for about an hour before this reading was done, and his levels were much higher when we first saw him.
At this point, we immediately went back to the building to check for carbon monoxide levels. The company owner stated that the building did not use gas heat because of the dust; all the heat was supplied by hot water from the boiler. Our quint entered the area where the employee was working; the area had readings of more than 300 ppm. The building was ventilated. The boiler turned out to be the source of the high CO. Several other employees working in the area, which was near the boiler room, were evaluated for CO levels; all of their readings came up high, although no one else had complained about symptoms.
The lesson here is simple: Carbon monoxide poisoning presents symptoms with which we all need to be familiar. Sometimes, like in this case, the symptoms can be similar to those of a chemical exposure. Almost all fire departments carry meters to check for levels of carbon monoxide, and it takes only a few extra minutes. Whenever you respond to a medical call in which the patient displays the symptoms associated with carbon monoxide poisoning, check the levels of CO in the building. We often assume that it can only be a carbon monoxide problem if we have several patients. People often experience symptoms at various levels; some are more susceptible to CO exposure than others. Using the CO meter will determine a possible cause of the patient’s condition and help to prevent others from becoming ill later.
John Guglielmo
Lieutenant
Elk Grove Village (IL) Fire Department
More focus on #1 firefighter killer
Regarding “Reducing the Firefighter Injury and Death Rates, Parts 1 and 2” (January and February 2003 Roundtable), I wish firefighters, fire departments, and the fire service as a whole would put more focus into what is really killing our firefighters: heart attack or heart-related problems and lack of overall firefighter fitness. The 10-year study conducted by the National Fire Protection Association was just released and, no big surprise, 44 percent of all firefighter deaths were related to heart problems, then asphyxiation, and then some type of trauma accident. This 44 percent does not take into account the number of firefighters who may have been put on permanent or partial disability because of a heart- or stress-related problem.
My question is, “What are you doing to prevent yourself from adding to this 44 percent statistic?” or “What is your fire department doing to promote awareness of the true #1 killer of firefighters?” As a fire service, we have developed rapid intervention teams, incident command systems, better accountability systems (some very high tech), PARs, emergency evacuation procedures, better and more efficient lightweight personal protective equipment such as SCBAs and turnout gear, thermal imaging cameras, safer fire apparatus, NFPA 1710/1720 standards, two-in/two-out laws, and the list goes on and on.
Don’t get me wrong: These are all excellent programs for our overall safety; as a safety officer, I’m for every one of them. Look at how much time and energy it took to develop these safety programs, but it seems to me that as a fire service nobody really wants to put as much time and effort into what is really killing firefighters—our health and overall fitness. We all know what the #1 killer is year in and year out, but we don’t want to do anything about it, or so it seems.
I understand that it may be difficult for some fire departments to implement a wellness program for their firefighters because of budget constraints and logistics. I know my department has finally come to some type of agreement between our administration and union to develop some type of wellness program for all members; this was really a sticky issue and was highly debated. Our firefighters had many concerns—for example, whether a member would lose his job if he failed the fitness standard or couldn’t get to the level the department set. We had to educate our firefighters that this was not a standard but a wellness program for our members’ overall health and fitness.
For 2003, all members will go through a personal baseline fitness evaluation; the only ones who will know the results will be the firefighter and the fitness evaluator. Confidentiality will be paramount throughout the program. The records, kept in our health plan office, will be used the first year for statistical purposes only, to compile a firefighter fitness index and see where we are as a department in regard to our overall fitness level. The fitness evaluation program we have in place is an excellent program geared toward firefighting duties; the firefighters get a copy of the results and something to go by as a baseline for their overall fitness improvement. This program measures several aspects of a member’s fitness level and was developed by the U.S. Air Force for its firefighters. A committee consisting of union and fire administration representatives will review the results of the program only to evaluate the overall wellness of the department as a whole and to determine the effectiveness of the program.
This is a huge first step in the right direction for our department; I’m just happy we finally have something in place. We have plenty of time and workout equipment in the station to help us try to get to our optimal fitness level.
We all know firefighting is one of the most stressful and physically demanding professions. Why is it that we can put so much time and energy into implementing RIT and procedures but can’t do more to lower this 44 percent statistic? I know motivating someone to make more healthful life choices or improve overall fitness and health is not that easy; it takes a big personal commitment and change of lifestyle. If you are going to do this line of work, you owe it to yourself, your family, and your fellow firefighters.
We can go from 0 to 60 at the drop of a tone; that’s a lot of stress on our bodies before we even get to the fire scene to perform all the needed strenuous duties.
Firefighters should look at this 44 percent statistic a little more seriously and put just as much time and energy into reducing it as they do inventing all these other standards and practices. We need to do whatever it takes to lower that statistic. Our job is dangerous enough.
Ronald Kay
Lieutenant, Safety Bureau
Toledo (OH) Department of Fire and Rescue
Officer belongs behind nozzleman
In the December 2002 Letters to the Editor, John Van Etten wrote he believed the captain should be on the nozzle and taking the “lead” at fires. I strongly disagree with this concept. I believe it is important for the captain, lieutenant, or whoever is the ranking person to be behind the nozzleman. It is vitally important for someone to be constantly sizing up what the fire is doing, if the situation is changing, and what needs to be done next. The person on the end of the nozzle is not the one to be doing that. His attention is usually on the fire and not what is going on around him. This is why the officer, who is usually a seasoned firefighter, needs to be backing up the nozzleman and not vice versa. A “good” officer will take this position knowing he has a lot more to do than “put the white stuff on the red stuff.”
Donnie Glenn
Sherman, Texas
Inform community of risks of inadequate staffing
I read with great interest the interview with William Goldfeder, battalion chief, Loveland-Symmes (OH) Fire Department, in the July 2002 Burning Issues column. I thought his argument “weak training + weak staffing = disaster in waiting” to be well reasoned. As a member of a suburban volunteer department, I have long believed in the argument that fires in residential and commercial buildings must be fought the same way no matter what the community’s size. In a smaller community such as mine, an additional effort must be made to place all necessary resources (personnel and equipment) on the fireground on a timely basis to provide full service to the fire department’s customers.
Therefore, I read with equal interest Chief Dwight Van Zanen’s letter in the December 2002 Letters to the Editor. Van Zanen argues against a national minimum standard for deployment of personnel on a fireground and argues that the local community is in the best position to decide what level of service it is willing to provide to the community. In conclusion, he argues that firefighters do not die on the fireground because an insufficient number of personnel arrived at the emergency. Instead, he claims that firefighters die because fire officers attempt to fight fires when it is unjustified. Zanen believes that the job of the fire officer, with insufficient personnel, is simply to protect exposures and personnel. It is not the officer’s job to blame politicians when bad things happen.
If a community cannot or will not make the necessary arrangements to put a sufficient number of personnel on the fireground to perform efficient and safe interior operations, the incident commander should be realistic in what he can accomplish (the protection of exposures, maybe) and should not place any troops at risk. Of course, that will result in most buildings being lost, but that is the choice the community has made in analyzing the level of protection that it will provide/pay for. However, the chief must make sure that the community makes an informed choice when it allocates the resources. The chief must tell taxpayers what level of service they will receive with a first-due alarm assignment of five firefighters. Unfortunately, it is the chief who often misleads the public by assuring the residents that all is well and that in this locality two firefighters on a rig are sufficient because 70 percent of the calls are for EMS. Has he informed the community leaders what will occur (or should occur) when a structure fire is reported in the community? Probably not. Chiefs fail to do so out of self-preservation, the inability to control overinflated egos, or the inability to truly recognize known risks.
It is time chiefs woke up and started looking out for the members by informing the community of the known risks of inadequate staffing and training; if the community chooses not to listen, then the chief must not place the troops at risk and must stand up to community politicians when the building is lost. Worse yet, the chief must be willing to tell the politician that the fire department will not be able to safely rescue trapped occupants and fight fires in any residential building in town because of the inadequate resources on hand. The chief must be willing to stand by this decision after the politicians have weighed the potential benefit vs. costs in analyzing the resource allocation.
If you believe that a chief will adequately inform the community leaders and the public regarding the potential risks of inadequate staffing, if you believe that by following a choice to not provide the recommended staffing and resource levels a chief officer will never place firefighters at risk (or firefighters will not place themselves at risk) to save civilian lives, then Van Zanen’s position makes sense. However, I would rather be in the position to aggressively fight the fire and save lives by making the necessary arrangements in advance to place an adequate number of fire suppression personnel on the fireground. If my community is not willing to do it alone, there is no reason communities cannot plan and work together to reduce the risks to both the firefighters and those we protect.
David C. Comstock Jr.
Chief
Western Reserve Joint Fire District
Poland, Ohio
