Pa. rehab study looks at firefighter cooling devices

By Jess Eagle
Pittsburgh Post-Gazette

ALLEGHENY COUNTY, Pa. — After putting out a fire in a burning building tomorrow, groups of firefighters from across the county will sit in lawn chairs, put on special vests and get into air-conditioned cars.

They will be participating in a study of cooling equipment designed to reduce the risk of sudden cardiac arrests, the leading cause of death in firefighters nationwide.

The study, done by UPMC, will send groups of three or four participating firefighters into the Allegheny County Fire Academy's "Burn Building," which often is set ablaze for training simulations. After they put out the fire, participants will cool down using one of three techniques, known as rehabilitation.

David Hostler, one of the three UPMC doctors conducting the study, described the first technique as "a lawn chair you would bring to a soccer game," but with hollowed out spaces in the chair's arms for bags of water, which cool the forearms.

The next is a vest with piping that pumps water from a cooler into the tubing sewn into the vest. It is also used by NASCAR drivers to keep their body temperatures down during races.

The last technique, known as natural cooling, simply has participants sit or stand in air-conditioned vehicles.

Dr. Hostler, an assistant professor of emergency medicine at the University of Pittsburgh and director of the Emergency Responder Human Performance Lab, said most firefighters who experience cardiac arrest from overheating do so in the hours after putting out a fire.

Leaving a scene, most firefighters have body temperatures of 100 degrees or more. Dr. Hostler has seen some reach more than 103 degrees.

"It's not rare for people in their 20s and 30s to experience cardiac arrest with this job."

Though some fire departments in the area already use one of the three techniques, most use fans, Dr. Hostler said. And while fans work on cool days, they can be dangerous on hot days, actually raising a person's body temperature.

NFPA standards
The Mt. Lebanon Fire Department uses both misting fans and the chairs with arm cooling. Chief Nicholas Sohyda said their procedures are rare for Allegheny County because they follow the National Fire Protection Association's standards.

"There's a lot of opinions, and I'm not exactly sure whose are the best," Chief Sohyda said. "There's even discussions whether you should drink cold water or room temperature water."

The department has two to four chairs, he said, and they only use them about once a month in the summer.

"We don't particularly go to that many fires here. They could probably use [the chairs] daily in the city of Pittsburgh, though," he said.

Under NFPA standards, firefighters must stay in a rehabilitation tent until their vital signs and blood pressure indicate that they are cool enough to continue. The NFPA also suggests annual physicals and stress tests, which the Mt. Lebanon department follows.

Firefighters in the county are required only to have a physical every two years, said Bob Full, chief of Allegheny County emergency services.

He added that he would like to see more departments adopting NFPA standards. The reason that some don't is the same reason that some are skeptical of new rehabilitation procedures.

"There's no downside except that it requires additional manpower. I would certainly like to see it implemented, but it really comes down to the individual departments," Chief Full said. "I know how noble and gallant they are, but at the same time, we have an aging work force in fire service."

Dr. Hostler has been a volunteer firefighter for more than 20 years. He currently volunteers at the Guyasuta Fire Department in O'Hara and has known friends in other departments who have died of cardiac arrest after leaving a scene.

"This is hard field to get money for," he said. "It's important to firefighters, but to other people it's not."

Final phase
Tomorrow's simulation is the final phase of the doctors' two-year study. There is only one other academic study that has produced literature in the world, Dr. Hostler said. That study, done in Toronto, Canada, focused on firefighters' body temperatures on hot days only.

"There are no good guidance documents. ... We don't know which technique is superior over the other," Dr. Hostler said.

About 20 firefighters had signed up to participate in the study as of late last week, but Dr. Hostler said they're still recruiting more.

"I'm really looking forward to seeing the results," Chief Full said. "We will actually have solid information to make those informed policy and procedure changes down the road."

Once the study is done, the doctors hope their results, which will be posted for free online, will help fire departments across the country and even the world.

"If that rehab becomes more regimented in fire service, hopefully we can save lives," Dr. Hostler said.

Copyright 2009 P.G. Publishing Co.

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