Research is an integral part of medicine. Whenever a new drug or piece of equipment is developed, scientists have to examine whether it works, whether it is safe and whether it is better than other current treatments available. This process can take years.
In EMS, this same process has been slow to trickle down. There are plenty of examples of treatments used in the field that simply did not pan out because they did not improve patient survival. Examples include the Medical Anti-Shock Trousers, large boluses of IV fluids for trauma, and high dose epinephrine in cardiac arrest.
These are all examples of care that we once thought were the standard – they simply had to be done. But later we found that not only did they not help, in some cases they did harm. We have a motto in medicine: "Primum non nocere," which translates to "First, do no harm." (I know what you're thinking: "Isn't that cute, the docs have a motto.")
The fact that emergency services has not embraced research is starting to change. Let's look at an example.
If you go to a fire convention and walk the exhibit floor, you will be confronted with many different products designed to improve fire rehab. Questions you need to ask include, "Will this product help my department? Does it do what it advertises?" and "Is it cost effective?" Research helps to answer at least the first two. The third is often more difficult.
A rehab study(1) comparing active and passive cooling devices for firefighters was published in the past few months in the official journal of the National Association of EMS Physicians. David Hostler and associates at the University of Pittsburgh examined a number of products that claim that they can help us provide firefighter rehab. They had 18 individuals do the following:
• Wear full turnout gear and air packs in a 95 F lab • Perform a 50 minute simulated firefighting activity, on a treadmill • Rest for 20 minutes • Utilize a tool or method for cooling (this is what was being studied) • Perform a second 50 minute simulated activity • Answer questions about what product felt the best
They also studied the core body temperature (how fast it recovered, how much it recovered), heart rate and body weight.
The specific tools were:
• A forearm/hand immersion device (cold water) • A cooling fan • An ice water hand cooling device • An IV of very cold (40 F) normal saline • Passive cooling (simply a 75 F room, gear off) • An ice water perfused cooling vest
A complete description of the activities and how they studied the participants is way beyond the scope of this article, but I believe they did the best they could in simulating the duties a firefighter performs at a working fire.
So, which product or method do you think did a better job?
Surprisingly, after looking at all the numbers and data, no one product did that much better than the other. With all devices, the firefighter is eventually cooled down. Cold IV fluids worked a bit faster, but the pain and expense of the supplies is a drawback. Some required a significant amount of ice water. Others were bulky and only able to cool one firefighter at a time.
Which device felt better to the participants?
After interviewing the firefighters, the majority chose the simple fan. A product that is available to every department right now in terms of a ventilation fan. And, if a mister is used, it likely would work even better, according to other research studies done. This device can cool multiple firefighters, and as more firefighters come to the scene, so do more trucks, which have more fans.
So what does this mean to you and your department? You can go out and spend a lot of money to purchase various cooling devices that are being marketed, and they will work just fine. In general, they do what they advertise and claim they do. But if your department is strapped for cash, and wants to take care of its staff, the ventilation fans will work well. If you add wet towels around the neck, they can work even better.
Of course I think the best tool is you. Someone who cares enough to be reading this and other websites about how to protect your fellow firefighters. Someone who recognizes the need for rehab and when to have it available. All of the expensive equipment is worthless if the firefighter comes and gets a bottle of water and heads right back into the heat, or if it is on a special truck that never makes it to the scene.
I am glad these products are available, but I am also glad that we as emergency responders are not accepting them at face value. The fact that researchers like those at the University of Pittsburgh are examining them helps not only in the selection of a device or method, but also helps us learn so much about the physical demands of firefighting and how to protect the health of firefighters. So hats off to Pitt.
End notes (1) Hostler, D. et al. Comparison of Active Cooling Devices with Passive Cooling for Rehabilitation of Firefighters Performing Exercise in Thermal Protective Clothing: A report from the Fireground Rehab Evaluation [FIRE] Trial. Prehospital Emergency Care 2010; 14:300-309
About the author
The Albert Einstein Medical Center. The Albert Einstein Medical Center is a teaching hospital offering a full range of advanced health services to the Philadelphia community and beyond. The center has more than 600 primary care doctors and specialists on staff, with an additional 1,200 affiliated physicians. The Department of Emergency Medicine at the center has staff trained in emergency medical services, special operations medicine, and disaster management. David Jaslow, director of the Division of EMS and Disaster Medicine at the center, and his team will offer a variety of columns on fireground medical operations. Ken Lavelle is an attending physician at Albert Einstein, and previously spent 14 years working as a firefighter and EMS provider. He serves as medical director for several agencies in Pennsylvania and New Jersey.
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