Preventing
Hearing Loss
By
Becky Sherek, RN/EMT-Northern Health and Fitness Plus
Noise induced hearing and inner ear damage to firefighters (and to
emergency service workers) has been documented for many years. Firefighting has
many scenarios that involve high levels of noise exposure including sirens,
diesel engines, air horns, power saws, and power ventilators. This occupational
damage is commonly manifested by hearing loss that gets worse with the passing
of time for the individual. The Federal Emergency Management Agency (FEMA) and
the United States Fire Administration (USFA) with the International Association
of Firefighters (IAFF) has produced a document entitled, “Fire & Emergency
Service Hearing Conservation Program Manual”. This document recognizes the
dangers of noise induced trauma to the hearing system and outlines a program to
reduce and/or prevent the occupational noise induced damage associated with the
above mentioned sources.
Firefighters and other emergency personnel are often exposed to decibels
well over 100(acceptable noise level is not to exceed 90 decibels for an 8-hour
period). The action level is 85 decibels, which is the level where a hearing
conservation program must be offered to employees. A rule of thumb is that if
you have to shout to talk to a coworker to be heard 3 feet away by a person with
normal hearing, then regular exposure to the noise will be potentially damaging
to your hearing. Continued exposure to more than 85 decibels of noise may cause
gradual but permanent damage to hearing. Hearing loss is accelerated by louder
noises. Noise can also hamper job performance, increase fatigue, and cause
irritability.
Many people do not become aware of their hearing loss until it is too
late to avoid permanent damage. Northern Health & Fitness Plus can help your
department institute a hearing protection program by providing audiometric
screening to your employees. A successful hearing protection program benefits
both the employee and the employer. Employees are spared disabling hearing loss
and may experience less fatigue and better health in general. Employers benefit
from reduced medical expenses and worker compensation costs.
Fire department officials who are concerned about possible hearing loss and instituting a hearing protection program are encouraged to call Northern Health & Fitness Plus at (218) 744-2133.
When firefighters respond to an emergency in sub-zero temperatures, they
need to keep a number of things in mind.
More than anything else, they need to be aware of the impact of weather
conditions on personal safety. They
need to use this awareness in order to remain safe throughout the entire
operation, whether it’s a structure fire, vehicle extrication call or high
angle rescue.
The human body can do little to adapt to a cold environment. Cold,
wetness and wind challenge the body to maintain core temperatures above 35* C
(94* F). The selection of clothing is the single most important variable that
fire personnel can use to achieve acceptable levels of thermo regulation. The
key aims of dressing appropriately can be remembered by the abbreviated letters-
VIP: ventilation
to selectively control heat storage and loss by adjusting clothing, insulation
to control heat escape through conduction, and protection against wind and rain, which greatly accelerate heat
loss.
The layer next to the skin should have the warmth and wicking ability
which is referred to as the under layer. Adequate insulation and the ability to
selectively ventilate are by far the most important characteristics of the next
layer, which is the insulation layer. Wind and moisture can be serious
challenges to thermo regulation, so protection against the elements and
selective ventilation are the most important functions of the protective outer
layer.
Firefighters should take the time to select the appropriate clothing that
is needed to protect themselves when working in these conditions. It is worthy
to mention that the additional weight of clothing and other gear used to protect
against the environment adds to the energy requirement of the body to work
effectively. When the body gets exhausted due to lack of energy stores and
if the firefighter has been standing around after being physically active, the
body becomes fatigued. This
puts the firefighter at risk, along with other fire department members.
What does all this mean when the alarm comes in during the cold winter months? The challenge of the incident or fire is not the only concern. Cold weather firefighting requires an understanding and respect for its impact, potential, and demands, and the ultimate consideration for personal safety. Being prepared to maintain near normal body temperature, to conserve body energy stores, and to lose body heat to the extent that sweating is minimal should be the ultimate goal whenever a firefighter is called to do his or her duty in sub-zero temperatures.
Confused about the fit testing requirement in the OSHA Respiratory Protection Standard (CFR 1910.134)? This standard requires that before any firefighter uses any respirator with a tight fitting face-piece, which covers the self contained breathing apparatus (SCBA), the firefighter must be fit tested with the same make, model, style, and size respirator that he or she will be wearing. In addition, firefighters must be fit tested on an annual basis. Another requirement says that fit testing must be performed whenever the firefighter’s physical condition could affect respirator fit. This would include such things as scarring, dental changes, cosmetic surgery, or an obvious change in body weight. A medical evaluation must be completed prior to fit testing to ensure fire fighter is medically and physically able to wear a respirator.
Northern Health & Fitness Plus can assist you in facilitating a medical evaluation for firefighters, plus we can help you with the yearly fit testing requirements. In fit testing, we use one of two procedures, qualitative (Irritant Smoke or Saccharin) or quantitative CNP (Controlled Negative Pressure) methods. Northern Health and Fitness Plus recently purchased the Fit Tester 3000 that utilizes the scientifically proven and patented Controlled Negative Pressure Technology, which directly measures leakage.
If your department also operates an ambulance service, your N95 respirator will also have to be fit tested. Emergency medical response personnel use N95 respirators when transporting patients in a closed vehicle, with suspected or confirmed infectious tuberculosis or the recent concern for SARS.
If you have questions about annual fit testing or medical clearance evaluations, you can contact Northern Health and Fitness Plus at (218) 744-2133.
Past Articles
Making a commitment to health and fitness in 2004
Firefighters are exposed to disproportionately high rates of fatalities, injuries, and illness. A commitment to health and fitness can mean the difference between life and death for them or the people they are trying to help. With the New Year here, every one of us should make fitness part of a comprehensive wellness, a philosophy that emphasizes the total health and well being through the active prevention of illness and injury. Pursuing wellness is no different than pursuing any goal, except that it may be the most important one you ever make.
The need for fitness in the fire service is tremendous because of the physical, mental, and emotional stress of the job. According to Pynes (2001), statistics have determined that firefighters die nine years of their peers because of the nature of the service. This is a very scary thought to me. Firefighters not only have lower life expectancy, but also suffer from a greater risk of heart attack. Normally, the risk of a heart attack is twice as high for an unfit person as for a fit person, and for people who do not take regular exercise this increases sharply after age 40. For those in good physical condition, the risk remains at a constant low level for the next 20 to 25 years after 40.
How can fire departments instill health and safety attitudes in their members? They must take a proactive approach. The Medical Clearance Evaluation Standard can be one means that a fire service can use to detect a physical problem of a firefighter that may otherwise go unnoticed. Statistically, a large percentage of line-of-duty deaths are attributed to “stress.” Some of the precursors to heart attacks and strokes can be detected by medical examinations. I believe that with the completion of medical evaluations and the empowerment with some education throughout the year in future articles of the Fire- Wire, we can fine-tune the most important piece of firefighting and rescue equipment-a firefighter’s body.Winter
Hypothermia:
A Firefighters Risk
By
Becky Sherek, RN/EMT
Northern
Health and Fitness Plus
With
winter here, it is time to prepare for the problems that go along with it. One
of the biggest concerns, especially in our region, is exposure to cold.
Firefighters
may suffer injury from potential adverse effects of overexposure to the cold.
These exposures may occur when firefighters are exposed to low temperatures,
wind and /or moisture for significant time periods. A person’s normal body
temperature is approximately 98.6 degrees Fahrenheit. The body is usually very
good at maintaining this, but when the body loses heat due to exposure to the
cold, the following conditions can develop.
These cold stress symptoms can be displayed as either frostbite or
hypothermia.
Frostbite: A cold –induced condition by the formation of ice crystals in exposed body parts. It occurs when extremities such as hands, feet, ears, and nose are exposed to cold for extended periods of time. Superficial frostbite is characterized by grey or yellowish patches on the affected areas. Deep frostbite is characterized by waxy and pale skin, the affected parts feel cold, hard and solid which may turn blue or purple upon thawing.
Hypothermia:
Hypothermia literally means “low temperature” and is diagnosed when an
individual’s body core temperature falls below 95 degrees Fahrenheit. A cold
induced condition which results from over cooling the body due to excessive loss
of body heat. Symptoms of hypothermia include shivering, confusion, numbness,
drowsiness, dizziness, impaired vision and judgment and loss of coordination.
It is important to manage cold stress by modifying work practices during
emergency operations according to environmental conditions. These measures are
recommended:
*Wear multiple layers of light, loose-fitting clothing
* Pay particular attention to protecting feet, hands, face and head
* Report any cold-stress-related symptoms in themselves or their
co-workers
* To perform at the highest level, firefighters must remain hydrated and refuel their energy with food. Yes, I said hydrated which means drinking at least 64 ounces of water daily. Northern Health & Fitness Plus’s goal is to promote the importance of firefighter safety by instilling the need to keep your body hydrated. Your body is like an engine, if you don’t keep it fully hydrated it’s not going to work at peak efficiency or, in the worse case it may not perform at all.
(See
article on dehydration below)
Cold
weather firefighting is unlike any incident alarm response that may be attended
in summer, it requires an understanding and respect for its impact, potential,
and demands, and the ultimate consideration for personnel safety.
Summer
Avoiding
Heat Related Emergencies
With
the hot days of summer upon us, firefighters should not overlook the hazard they
face at every incident they respond to, hear.
Dehydration, drinking less water than the body needs is the major cause
of heat-related illnesses. As I
mentioned in the last issue of the Fire Wire, water is a firefighter’s best
friend. As emergency workers, we
have a tendency to push ourselves further than we should, that just the nature
of the job, but at the same time we must be aware of the warning signs so we do
not become victims during these situations.
Because of high temperatures and humidity, firefighters become very
susceptible to dehydration, heat exhaustion and heat stroke.
To
prevent heat illness, firefighters should exercise regularly to improve their
ability to acclimatize to heated conditions, hydrate with water (not coffee,
tea, soda) prior to and after fires, and when removed to a nearby safe area for
resting, they should immediately remove bunker gear, helmets and hoods so that
body temperatures can be lowered. Studies
have shown that body temperature continues to rise if you continue to wear your
bunker gear and other equipment. The best defense against heat-induced
conditions is to understand what causes it and to recognize the signs and
symptoms.
Dehydration:
Thirst, irritability, nausea and weakness occur with 5% loss of body water, only
2 ½ quarts for a 150-pound person. A
10% loss will cause headache, dizziness, inability to walk and tingling
sensations in the arms and legs. At
a 15% loss, the tongue becomes swollen, vision can dim, numb sensations occur on
the skin and urination may be painful. Any
greater loss can lead to death.
Heat
Exhaustion: The most common form of heat related illness is heat exhaustion.
If not treated, in can continue on to become heat stroke, a
life-threatening emergency. Heat
exhaustion is the overheating of the body temperature that does not cause
permanent damage, while heat stroke can permanently disable or kill the victim.
Symptoms such as dizziness, sweating, dry mouth, headache, weakness;
fatigue, clammy skin and unstable gait are displayed.
Other indicators include muscle cramps and a weak and rapid pulse.
Heat exhaustion takes time to develop.
Heat
Stroke: Heat stroke strikes suddenly with little warning.
Signs of heat stroke include a very high temperature (104 degrees F. or
higher) and skin that is hot, dry and read.
During heat stroke, sweating stops and deep breathing with a fast pulse
is followed by shallow breathing and a weak pulse. Pupils become dilated, speech may be incoherent and confusion
or delirium or even hallucinations and convulsions may occur.
As I said before, in order for firefighters to perform at their highest
level, they must remain hydrated and refuel their energy with food to prevent
serious injury or death due to heat related illness.
Water,
A Firefighter’s Best Friend
By
Becky Sherek, EMT/RN
Dehydration is a major concern for members of the fire service
or anyone who works out. The
body is like an engine, if you don’t keep it cool, it’s not going to
work at peak efficiency. In the worse case, it may not perform at all.
A firefighter with compromised mental and/or physical
capabilities presents an obvious threat to himself and the safety of the
crew. Dehydration will be
the result of the body trying to regulate its temperature naturally, if
there are available fluids to replace what is lost.
Serious dehydration can lead to heat exhaustion and a life
threatening condition known and heat stroke.
Firefighters don’t when they’re going to receive an
alarm therefore consuming 64+ ounces of water a day on a regular basis
is the way to combat dehydration. In
addition to being fully hydrated during the day, it’s imperative that
firefighters aggressively re-hydrate on the scene and following
firefighting activities. Studies
have founds that firefighters had to consume 1.7 liters of water to
replace the fluids lost during 17 minutes of firefighting activity.
Now is the time to prepare your body before the call
comes. Remember that
practicing these principles of hydration can keep us all safe and
healthier on the fireground and to help ensure a safe return.
·
Drink 64 ounces of water a day
·
Don’t wait until you’re thirsty to drink
·
Don’t stop once your thirst is quenched
·
Caffinated drinks and soft drinks tend to
exacerbate more dehydration
·
Isotonic sport drinks with over 10% carbohydrates
have a tendency to slow down the uptake of water and electrolytes
·
Drink cold water
·
The size of the bottle mouth contributes to the
amount of fluid consumed
Can you squirt or can you
gulp?