Stephen N. Kales

Correlates of body mass index in hazardous materials firefighters.

We analyzed results from the medical examinations of 340 hazardous materials (HAZMAT) firefighters and observed the relationships between selected parameters and body mass index (BMI). Heights and weights were available for 98% of the subjects (333 of 340). The mean BMI was 28.9 +/- 4.1 kg/m2. Eighty-seven percent (290 of 333) of subjects were overweight (BMI > or = 25) and 34% (113 of 333) were obese (BMI > or = 30). Two percent (7 of 333) were morbidly obese (BMI > or = 39). For comparison purposes, we divided subjects into low (BMI < 27), medium (BMI 27 to < 30), and high (BMI > or = 30) BMI groups. The results demonstrated adverse associations between increasing BMI and resting blood pressures, forced vital capacity, alanine aminotransferase, aspartate aminotransferase, serum cholesterol, and overall morbidity scores. The high prevalence of overweight and obesity and the associated adverse health effects support the development and implementation of fitness-promotion programs for firefighters.

Injuries Caused by Hazardous Materials Accidents

STUDY OBJECTIVE To describe exposures that prehospital and ED personnel may encounter as a result of hazardous material incidents. METHODS Retrospective analysis of hazardous material incident reports from six district hazardous material teams in Massachusetts from their inception through May 1996. RESULTS The chemicals most frequently involved were various hydrocarbons and corrosive materials. Chlorine derivatives were involved in 18% of all incidents and 23% of all incidents resulting in victims. Victims were produced by 47 of 162 (29%) incidents. Respiratory exposures were the most frequent type of exposure and resulted in the largest number of victims transported to a hospital. Overall 24 of 26 (92%) incidents with chemical exposures resulted in symptomatic victims and 33 of 35 (94%) incidents produced victims requiring hospital transport. Respiratory symptoms were the most frequent, both in the number of incidents where they were observed and the total number of victims with symptoms. CONCLUSION Multiple victim transport to EDs from a single hazardous material incident is most likely to result from an inhalation exposure to a respiratory irritant. Information from descriptive studies should allow improved preparation for potential hazardous material victims.

Fitness for Duty Evaluations in Hazardous Materials Firefighters

We analyzed results from the medical examinations of 340 hazardous materials firefighters and applied various objective standards in simulated fitness for duty determinations. Ten percent had elevated blood pressures, 13% had far visual acuity worse than 20/30 in one or both eyes, and 38% had abnormal audiometry. The strictest standards for resting blood pressure and corrected visual acuity would have failed 2% and 1% of the cohort, respectively. For audiometry, 0%-5% of the cohort would have failed, depending on the hearing requirements set. The strictest hearing standard did not allow for corrective devices so that few failures would be reversible. Visual and audiometric testing and measurement of resting blood pressure all have significant clinical yields. Studies of simulated firefighting are needed to establish minimum hearing requirements and determine whether corrective devices can be worn safely during duty.

Medical surveillance of hazardous materials response fire fighters : A two-year prospective study

Hazardous materials releases can cause substantial morbidity and mortality, and an increasing number of communities have developed hazardous materials (HAZMAT) teams to deal with such incidents. Little is known, however, about the health effects of chemical accidents on HAZMAT team participants. Baseline and periodic medical surveillance of all 40 fire fighters from the Metrofire Haz-mat team was conducted in 1992/1993 and 1995, respectively. A database on incidents responded to by the team during the study period was also developed. From June 1990 through April 1995, the team responded to a total of 34 hazardous materials incidents. No injuries to HAZMAT team members were reported. Few biochemical abnormalities were observed, and those that were could not be linked to specific exposures or incidents. Four individuals had abnormal audiometry on both occasions. There was a trend toward a lower percent predicted FEV1 for the entire group on follow-up: 106 +/- 13% vs 105 +/- 12%, P = 0.07. For fire fighters older than age 35 (n = 21), the percent predicted FEV1 was significantly lower at follow-up: 108 +/- 12% vs 106 +/- 14%, P = 0.01. The results suggest significant noise exposure and exposure to pulmonary irritants, which support the use of baseline and periodic audiometry and spirometry. The potential utility of other laboratory testing is also discussed.

Lung cancer and occupational risk factors in Greece.

This study estimated the proportion of lung cancer in Greece that was attributable to occupational exposure. Two hundred eighty-two patients with lung cancer and 494 controls were interviewed about their socioeconomic characteristics, sex, age, and occupational, smoking, and residential histories. Each subject was classified as exposed or unexposed to known occupational lung carcinogens. Because of the small number of females exposed, only males were included in the multivariate analyses. When the occupationally exposed subjects were compared with the unexposed subjects and an adjustment for smoking was made, the relative risk for lung cancer was 2.9 (95% confidence interval, 1.95-4.31). If 5% to 10% of the Greek population were occupationally exposed, the attributable risk would be 9.9% to 16.6%, respectively. Occupational exposures conferred an additional risk that was approximately threefold that of smoking alone. Risks increased in a dose-response fashion with increasing cigarette consumption.

Interlaboratory comparisons of red blood cell cholinesterase activity

Comparisons of red blood cell cholinesterase values (AChE, EC 3.1.1.7) from different laboratories can be difficult. This study evaluated different methods of interlaboratory comparison. Eleven subjects gave triplicate samples for analysis by three commercial laboratories. Comparisons were made relative to the mid-point of each laboratory’s reference range (mid-range), and by transformation to Ellman assay activity in U/mL using published/derived conversion factors. To observe each laboratory’s reliability, four subjects submitted two additional duplicate samples to each laboratory. The mean intraspecimen variabilities were 3%, range 1%–8%; 4%, range 0–9%; and 13%, range 2%–24% for laboratories 1–3, respectively. The mean mid-range percent for laboratory 3 was substantially lower than the means for laboratories 1 and 2. Therefore, laboratory 3 values were adjusted based on the means for laboratories 1 and 2 and the mid-point suggested by laboratory 3’s assay kit. The mean AChE relative to these mid-points were 109%, 107%, and 107% for laboratories 1–3, respectively. Ellman activities were 19.0, 19.9 and 20.8 U/mL for laboratories 1–3, respectively. Intrasubject differences for both comparison methods showed agreement that approximated intraspecimen variabilities for each laboratory. Comparisons involving laboratory 3 showed the poorest agreement consistent with laboratory 3’s greater intraspecimen variation. AChE from different laboratories can be compared by both methods evaluated in this study. All comparisons are limited by the precision and reliability of the laboratories involved. Copyright