If you have not been outside lately, then let me tell you this. Summer is here! And “man, it’s a hot one, like seven inches from the midday sun,” as Carlos Santana and Rob Thomas once lyricized in “Smooth.”
Haven’t we all felt that kind of heat before? We are out with our family or friends, having fun in the sun without a care in the world. And then suddenly, it hits. You don’t feel well and are really hot — more so than normal hot based on your activities. You feel lightheaded, your muscles start to cramp, and you even notice that you may not be sweating anymore. Before you know it, you are in the middle of a full-blown heat emergency.
What makes a heat emergency like this even more of a concern is that we are in the “heat business.” We respond daily to structure fires, wildland fires and hazmat incidents that all require specialized clothing to keep us from getting harmed. All the while, these protective garments zap our strength in the form of sweat and dehydration. And if we do not properly address these issues before, during and after the emergency scene, then we can become a fire service casualty in the form of an injury or even a fatality. The same is true for hands-on training.
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So what can we do to make sure that our members do not become fireground or training ground casualties?
Know the signs
First things first, understand exactly what constitutes a heat-related illness or injury. According to NIOSH, these illnesses or injuries, also known as “heat-related stress,” include a series of conditions that occur when the body is unable to properly cool itself. This can range from mild stress (heat rash) to critical and/or life-threatening stress (heat stroke).
When a body’s internal temperature heats up to an unhealthy level, a heat emergency occurs. Some signs of an oncoming heat emergency can include:
- Thirst
- Nausea
- Less frequent or discoloration urination
- Dry or hot skin, mouth or mucous membranes
- Confusion
- Dizziness
- Rapid breathing and heart rate
Your emergency medical training, whether American Red Cross First Aid or National Registry Paramedic, prepares you to identify and treat these heat stresses, not only in others but also yourself.
Keep in mind that these symptoms of heat illnesses exist on a scale from bad to worse. Symptoms like loss of thirst or nausea serve as signs of a heat stress emergency. That is why it is important to continuously stay hydrated throughout the day.
The power of hydration
So again, why is hydration important? Much like an automobile, proper fluids keep your body from overheating. Give your body the hydration it needs just like you maintain your radiator fluid to keep your vehicle from overheating. Water is your best option — yes, better than sports drinks. Furthermore, sodas and energy drinks can be the worst options for maintaining hydration.
A person should consume at least 64 ounces of water each day, or 8 full glasses. And at an emergency scene or during HOT, your goal is to match your intake of water with your output of sweat, per NFPA 1580: Standard for Emergency Responder Occupational Health and Wellness. Science shows that you can lose one to four cups of water through sweat, just on a normal hot day, even without your fireground or training ground activities.
As a firefighter, we could see these health challenges occur at any incident, but it’s no surprise that we tend to be more susceptible to their impact as the ambient temperature rises. Heavy, non-breathing PPE, intense work periods and work environments, and limited rest and hydration/rehydration breaks are all contributing factors. You must therefore constantly prepare your body for these external environmental conditions that complicate your service delivery during these hot summer months.
This preparation comes in the form of hydration and exercise. A firefighter who is in good physical health, which includes being properly hydrated, can more safely navigate the various emergency situations they are called to tackle than an out-of-shape firefighter.
Tip: During the summer months, try to gradually acclimate to the outside temperatures where you are expected to operate.
HOT emergencies
Heat-stress emergencies do not just happen at an incident; they can occur during routine training exercises. If they are not properly planned and continuously monitored, heat-stress emergencies can result in firefighter fatalities.
According to NFPA 1580, Chapter 22 – Rehabilitation: Incident Scene and Training (NFPA 1584), training staff for these types of emergencies should include the following:
Pre-training preparation
Firefighter training involves the same stresses and strains that are found during any emergency. These training events then require you to be in top shape if you are expected to operate in HOT environments. It is therefore important that firefighters participating in HOT training first have a complete an NFPA 1580 physical. This will quickly show whether a firefighter should not only be operating in this training environment, but also at an emergency scene.
Training staff should make sure that on the day of the training there is plenty of water for rehydration. Studies show that room temperature water is better for hydration than cold water. Regardless, water and not electrolyte replacements should be the first stop for rehydration during these training events. Trainees should also be encouraged to prehydrate the day of their HOT training, as though they would on their shift days. Getting ahead of the heat stress is what the goal should be.
Active training operations
As with pre-training perorations, hydration is the key to not becoming a casualty. Remember that your objective is to replace your amount of sweat by drinking water. During the actual training event, make sure that evolutions are broken into small segments in order to take frequent breaks. The total combined heat from the ambient temperature and PPE will quickly reduce your stamina during these HOT evolutions regardless if it involves actual fire. It is also important for the training staff to set up cooling stations by using fans, canopy shade and other active cooling methods. (Our department uses KoreKooler chairs, which are very effective.) Each trainee should open or remove their PPE in order for their body heat to be released with cool air blowing across their perspired clothing. Cool, shaded spots will also help the training staff to review the activities just completed.
Post-training activities
Again, hydrate, hydrate, hydrate — or in this case, rehydrate. Make sure that, if needed, medical care is provided for anyone who exhibits signs of an oncoming heat emergency. Trainees should quickly be removed to an air-conditioned location. This should help their condition. If it doesn’t, advise on-scene medical units that they are not getting any better, then make sure they are transported to the nearest medical facility per your fire department’s requirements. Also, conducting post-training activity medical monitoring as you would do during a HOT emergency will assure the trainees and the trainers that everyone is returning to the pre-training health conditions.
Following HOT training, the training staff should complete a debriefing with all the instructors to talk about what went right, what went wrong, and what should be done differently. Most importantly, if any heat-related emergency occurred during these events, these should be studied in detail to see what changes should occur.
Free-flowing resources
Like any good fire department operation, we should have planned for this time of year. (Remember, summer happens every June for those of us in the Northern Hemisphere!) Our policies and procedures should already be in motion for our fireground and fire training rehabilitation programs. And these policies and procedures should be based on the science established and reported in several documents geared toward firefighter safety, health, survival and wellness.
Groups like the U.S. Fire Administration (USFA), the National Volunteer Fire Council (NVFC), the National Fire Protection Association (NFPA), the International Association of Fire Chiefs (IAFC), the International Association of Fire Fighters, and the National Fallen Firefighters Foundation (NFFF) have all dug deep into the subject of occupational heat-related injuries and their prevention. Additionally, government agencies like the Centers for Disease Control and Prevention (CDC), the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) have vast resources at your disposal to address the prevention of heat emergencies. There are also world-renowned fire service scholars such as Dr. Denise Smith, Dr. Gavin Horn, Dr. Sara Jahnke and Dr. Brittany Hollerbach, who have studied and shared how to prevent heat emergencies in your fire department, as well as a litany of scholarly information available on preventing these fire service casualties. Your job as a department leader is to disseminate this information to your members. (See additional resources below.)
Final thoughts
You know it’s hot outside. You also know that we go to “heat events” just about every time we answer the bell. This is not the time to be caught off guard by a heat stress event in your fire department. It squarely falls on your shoulders to take care of your crews so they can take care of the people we are sworn to protect. Remember, your most valuable resource in your agency is your personnel. Make sure you don’t let anything, especially if it is preventable, happen to them.
Stay safe!
REFERENCES
- Risk for heat-related illness among wildland firefighters: job tasks and core body temperature change, Occupational and Environmental Medicine 2020; 77 433-438, by Molly R. West, et al.
- Frequency of firefighters’ heat-related illness and its association with removing personal protective equipment and working hours, Industrial Health 2019, by Siyeon Kim, et al.
- Core temperature and heart rate response to repeated bouts of firefighting activities, Ergonomics 2013, by Gavin P. Horn et al.
- Do Older Firefighters Show Long-Term Adaptations to Work in the Heat? Journal of Occupational and Environmental Hygiene 2013, 10(12), 705–715, by Wright, H. E., et al.
- Firefighter Fatalities and Injuries: The Role of Heat Stress and PPE, Kinesiology and Community Health, by Denise L. Smith, Gavin P. Horn, Eric Goldstein and Steven J Petruzzello.
- Firefighter Incident Rehabilitation: Interpreting Heart Rate Responses, Prehospital Emergency Care 2015, by Denise L. Smith, PhD, Jeannie M. Haller, MS , Ron Benedict, MS & Lori Moore-Merrell, PhD.
- Medical Monitoring During Firefighter Incident Scene Rehabilitation. Prehospital Emergency Care 2016, by David A. Barr, Craig A. Haigh, Jeannie M. Haller & Denise L. Smith.
- “Health & Wellness: The Energy Drink Issue,” Firehouse Magazine, by Sara Jahnke and Christopher Kaipust.
