Stephanie Griffin

Establishing a proactive safety and health risk management system in the fire service

BackgroundFormalized risk management (RM) is an internationally accepted process for reducing hazards in the workplace, with defined steps including hazard scoping, risk assessment, and implementation of controls, all within an iterative process. While required for all industry in the European Union and widely used elsewhere, the United States maintains a compliance-based regulatory structure, rather than one based on systematic, risk-based methodologies. Firefighting is a hazardous profession, with high injury, illness, and fatality rates compared with other occupations, and implementation of RM programs has the potential to greatly improve firefighter safety and health; however, no descriptions of RM implementation are in the peer-reviewed literature for the North American fire service.MethodsIn this paper we describe the steps used to design and implement the RM process in a moderately-sized fire department, with particular focus on prioritizing and managing injury hazards during patient transport, fireground, and physical exercise procedures. Hazard scoping and formalized risk assessments are described, in addition to the identification of participatory-led injury control strategies. Process evaluation methods were conducted to primarily assess the feasibility of voluntarily instituting the RM approach within the fire service setting.ResultsThe RM process was well accepted by the fire department and led to development of 45 hazard specific-interventions. Qualitative data documenting the implementation of the RM process revealed that participants emphasized the: value of the RM process, especially the participatory bottom-up approach; usefulness of the RM process for breaking down tasks to identify potential risks; and potential of RM for reducing firefighter injury.ConclusionsAs implemented, this risk-based approach used to identify and manage occupational hazards and risks was successful and is deemed feasible for U.S. (and other) fire services. While several barriers and challenges do exist in the implementation of any intervention such as this, recommendations for adopting the process are provided. Additional work will be performed to determine the effectiveness of select controls strategies that were implemented; however participants throughout the organizational structure perceived the RM process to be of high utility while researchers also found the process improved the awareness and engagement in actively enhancing worker safety and health.

Evaluation of a fitness intervention for new firefighters: injury reduction and economic benefits

Background Firefighting is a hazardous profession and firefighters suffer workplace injury at a higher rate than most US workers. Decreased physical fitness is associated with injury in firefighters. A physical fitness intervention was implemented among Tucson Fire Department recruit firefighters with the goals of decreasing injury and compensation claims frequency and costs during the recruit academy, and over the subsequent probationary year. Methods Department injury records were analysed and described by body part, injury type and mechanism of injury. Injury and workers’ compensation claims outcomes from the recruit academy initiation through the 12-month probationary period for the intervention recruit class were compared with controls from three historical classes. Results The majority of injuries were sprains and strains (65.4%), the most common mechanism of injury was acute overexertion (67.9%) and the lower extremity was the most commonly affected body region (61.7%). The intervention class experienced significantly fewer injuries overall and during the probationary year (p=0.009), filed fewer claims (p=0.028) and experienced claims cost savings of approximately US

Implementing risk management to reduce injuries in the U.S. Fire Service

33 000 (2013) from avoided injury and reduced claims costs. The estimated costs for programme implementation were

Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations

32 192 leading to a 1-year return on investment of 2.4%. Conclusions We observed reductions in injury occurrence and compensation costs among Probationary Firefighter Fitness (PFF-Fit) programme participants compared with historical controls. The initiation of the PFF-Fit programme has demonstrated promise in reducing injury and claims costs; however, continued research is needed to better understand the programmes potential effectiveness with additional recruit classes and carryover effects into the recruits career injury potential.

248 Epigenetic changes in firefighters

INTRODUCTION Risk management, a proactive process to identify and mitigate potential injury risks and implement control strategies, was used to reduce the risk of occupational injury in a fire department. The objective of this research was to study the implementation of the risk management process for future replication. A second objective was to document changes in fire personnels knowledge, attitudes, and behaviors related to the selected control strategies that were implemented as part of the risk management process. METHOD A number of control strategies identified through the risk management process were implemented over a 2-year period beginning in January 2011. Approximately 450 fire personnel completed each of the three cross-sectional surveys that were administered throughout the implementation periods. Fire personnel were asked about their awareness, knowledge, and use of the control strategies. RESULTS Fire personnel were generally aware of the control strategies that were implemented. Visual reminders (e.g., signage) were noted as effective by fire personnel who noticed them. Barriers to use of specific control strategies such as new procedures on the fireground or new lifting equipment for patient transfer included lack of knowledge of the new protocols, lack of awareness/access to/availability of the new equipment, and limited training on its use. Implementation challenges were noted, which limited self-reported adherence to the control strategies. CONCLUSIONS Fire personnel generally recognized the potential for various control strategies to manage risk and improve their health and safety; however, implementation challenges limited the effectiveness of certain control strategies. The study findings support the importance of effective implementation to achieve the desired impacts of control strategies for improving health and safety. PRACTICAL APPLICATIONS Employees must be aware of, have knowledge about, and receive training in safety and health interventions in order to adopt desired behaviors.

515 Use of urinary biomarkers and bioassays to evaluate chemical exposure and activation of cancer pathways in firefighters

BackgroundEmergency service vehicle crashes (ESVCs) are a leading cause of death in the United States fire service. Risk management (RM) is a proactive process for identifying occupational risks and reducing hazards and unwanted events through an iterative process of scoping hazards, risk assessment, and implementing controls. We describe the process, outputs, and lessons learned from the application of a proactive RM process to reduce ESVCs in US fire departments.MethodsThree fire departments representative of urban, suburban, and rural geographies, participated in a facilitated RM process delivered through focus groups and stakeholder discussion. Crash reports from department databases were reviewed to characterize the context, circumstances, hazards and risks of ESVCs. Identified risks were ranked using a risk matrix that considered risk likelihood and severity. Department-specific control measures were selected based on group consensus. Interviews, and focus groups were used to assess acceptability and utility of the RM process and perceived facilitators and barriers of implementation.ResultsThree to six RM meetings were conducted at each fire department. There were 7.4 crashes per 100 personnel in the urban department and 10.5 per 100 personnel in the suburban department; the rural department experienced zero crashes. All departments identified emergency response, backing, on scene struck by, driver distraction, vehicle/road visibility, and driver training as high or medium concerns. Additional high priority risks varied by department; the urban department prioritized turning and rear ending crashes; the suburban firefighters prioritized inclement weather/road environment and low visibility related crashes; and the rural volunteer fire department prioritized exiting station, vehicle failure, and inclement weather/road environment related incidents. Selected controls included new policies and standard operating procedures to reduce emergency response, cameras to enhance driver visibility while backing, and increased training frequency and enhanced training. The RM process was generally acceptable to department participants and considered useful. All departments reported that the focused and systematic analysis of crashes was particularly helpful. Implementation of controls was a commonly cited challenge.ConclusionsProactive RM of ESVCs in three US fire departments was positively received and supported the establishment of interventions tailored to each department’s needs and priorities.

Efficacy of a proactive health and safety risk management system in the fire service

Introduction Firefighters are exposed to carcinogens and have elevated cancer rates. Cancer may be caused by activation of oncogenes or inhibition of tumour suppressor genes, such as through alterations in microRNA (miRNA) concentrations and DNA methylation. We hypothesised that occupational exposures in firefighters would lead to epigenetic changes associated with activation of cancer pathways and increased cancer risk. We designed this study to compare epigenetic changes in incumbent firefighters and new recruits. Methods At the time of subject selection, the study population consisted of 119 incumbents and 70 recruits. From this group, 108 subjects were randomly selected for miRNA analysis and 96 for DNA methylation analysis, both evenly divided among incumbents and recruits. Only non-smoker male firefighters were included in the final comparison. MiRNAs and DNA methylation were measured with the nCounter Human v3 miRNA expression assay with over 828 miRNAs and the Illumina MethylationEPIC 850 k chips, respectively. Result After adjusting for age and BMI, miR-1260a, miR-145–5 p, miR-181c-5p, miR-331–3 p, miR-361–5 p, and miR584–3 p were significantly downregulated in incumbent firefighters. MiR-208b-5p, miR-30e-3p, and miR-486–3 p were significantly overexpressed in incumbents. Controlling the genome-wide false discovery rate at 5%, 22 CpGs were annotated to promoter regions of a gene and were hypermethylated in the incumbents including YIPF6, HELB, SYT5 and DVL2. Discussion MiR-181c-5p, miR-145–5 p, and miR-584–3 p are involved in tumour suppression. MiR-30e-3p is upregulated in skin cancer and is a poor prognostic factor in lung cancer. Co-amplification of the YIPF6 gene with the androgen receptor may stimulate prostate tumour progression. Aberrant activation of HELB reduces genomic stability, a hallmark of cancer. SYT may have a novel function in breast cancer. DVL2 is a part of the Wnt signalling pathway involved in multiple cancers. These epigenetic biomarkers of carcinogenic exposure in firefighters should be further evaluated in larger studies.

Risk Management Interventions to Reduce Injuries and Maximize Economic Benefits in U.S. Mining

Introduction Cancer is a leading cause of fire service morbidity and mortality. Measurement of urinary polycyclic aromatic hydrocarbons (PAHs), a group which includes known carcinogens, provides a means of evaluating absorption from all exposure routes. Activation of the aryl hydrocarbon receptor (AhR) and p53 pathways is associated with cancer, and their evaluation through in vitro urinary bioassays provides measures of toxicity of the chemical mixtures to which firefighters are exposed. Methods Urine was collected at baseline and two hours after responding to fires in 80 Tucson firefighters. Urine contaminants were de-conjugated using β-Glucuronidase and extracted using Focus Solid Phase Extraction (SPE) cartridges. Quantification of hydroxylated PAH (PAH-OH) target analytes was conducted with GC-MS/MS. In addition, the urinary extracts were evaluated using AhR and p53 in vitro bioassays. Results Compared to baseline, structural firefighting was associated with an increase in urinary PAH-OH concentrations. Increased concentrations were also found in training fires when self-contained breathing apparatus (SCBA) were used assiduously, suggesting a primary route of dermal exposure in that setting. Contrary to expectations, engineers (vehicle drivers) also demonstrated increased urinary PAH-OH concentrations, which was felt to be due to inhalation exposure as they generally did not wear SCBA. AhR and p53 activation occurred in general with higher concentrations of PAH-OHs in the urine, but extent of activation was not highly correlated with any single urinary PAH-OH marker. Conclusion Among firefighters, urinary PAH-OH concentrations increase in both entry teams and engineers. The route and extent of dermal and inhalation exposure vary with the specific job task at the fireground. AhR and p53 in vitro bioassays demonstrate activation of cancer pathways following occupational exposure in firefighters.

Indicators of hearing protection use: self-report and researcher observation.

BackgroundThis study evaluated the efficacy of a fire department proactive risk management program aimed at reducing firefighter injuries and their associated costs.MethodsInjury data were collected for the intervention fire department and a contemporary control department. Workers’ compensation claim frequency and costs were analyzed for the intervention fire department only. Total, exercise, patient transport, and fireground operations injury rates were calculated for both fire departments.ResultsThere was a post-intervention average annual reduction in injuries (13%), workers’ compensation injury claims (30%) and claims costs (21%). Median monthly injury rates comparing the post-intervention to the pre-intervention period did not show statistically significant changes in either the intervention or control fire department.ConclusionsReduced workers’ compensation claims and costs were observed following the risk management intervention, but changes in injury rates were not statistically significant.

Enhanced Surveillance of Heat-Related Illness in Pinal County

Objective: Risk management (RM) is a cyclical process of identifying and ranking risks, implementing controls, and evaluating their effectiveness. This study aims to identify effective RM interventions in the U.S. mining industry. Methods: RM interventions were identified in four companies representing metal, aggregate, and coal mining sectors. Injury rates were determined using Mine Safety and Health Administration (MSHA) data and changes in injury rates identified through change point analysis. Program implementation costs and associated changes in injury costs were evaluated for select interventions. Results: Six of 20 RM interventions were associated with a decline in all injuries and one with a reduction in lost-time injuries, all with a positive return on investment. Conclusion: Reductions in injuries and associated costs were observed following implementation of a limited number of specific RM interventions.