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Saving their own; Local agencies strive to curb heart attacks

By Erika Pedroza | Published Wednesday, February 20, 2013

Firefighters – volunteer and career alike – believe the heart of fire service lies in prevention and preparation.

But the highly-strenuous nature of the job can take a toll on the hearts of those who perform it.

EQUIPPED - Wise Regional Health System's director of radiology, John Neal, who is also the Paradise fire chief, was instrumental in obtaining the donation of an AED to every local department. Departments also receive an AED from the county. "Those AEDs are kept on the trucks that respond to medical emergencies, not on the trucks that are used for fires, accidents, rescue, etc.," he said. "Carrying that logic forward, heart attack is the No. 1 killer of firefighters, and very few of (those) heart attacks occur on medical calls. Therefore, when firefighters die, we are not equipped to save our own." Submitted photo

EQUIPPED – Wise Regional Health System’s director of radiology, John Neal, who is also the Paradise fire chief, was instrumental in obtaining the donation of an AED to every local department. Departments also receive an AED from the county. “Those AEDs are kept on the trucks that respond to medical emergencies, not on the trucks that are used for fires, accidents, rescue, etc.,” he said. “Carrying that logic forward, heart attack is the No. 1 killer of firefighters, and very few of (those) heart attacks occur on medical calls. Therefore, when firefighters die, we are not equipped to save our own.” Submitted photo

According to a report compiled by the U.S. Fire Administration, 48 firefighters across the country died due to heart attacks in 2011, and a preliminary report indicates there were 34 last year. Fortunately, none of those were in Wise County. Although Paradise Fire Chief John Neal attributes that mostly to “luck,” he does not discount the measures taken by county departments and their supporters.

firefighter-fatalitiesPrevention and preparation drive their efforts and protocols on all levels – whether it’s community education programs on proper smoke detector installation or personnel management such as required workouts.

Because some personnel are paid, the Decatur department holds an advantage over volunteer-based brigades in being able to mandate and monitor adherence to guidelines, which essentially facilitates “prevention.”

Decatur fire volunteers and career firefighters are required to work out – whether in the station’s in-house facility or via workout videos like P90x or Insanity – for an hour-and-a-half during each shift they work, depending on the volume of calls for service.

“If you take a normal person and put them in firefighting mode, their stress level doubles,” Captain Nate Mara said. “Working out, eating right and being fit and getting an appropriate amount of rest helps with that stress.

“As firefighters, we try to stay hydrated 24/7. Even on my days off, I’ll drink plenty of water,” he continued. “On a summer day, we know we have to drink our two gallons of water, that way when we get the hot call in the middle of the afternoon, we’re ready to go.”

For volunteer departments, like the one John Neal heads in Paradise, it is more difficult to stress such measures.

“In a perfect world, every firefighter would uphold the same physical standard,” he said. “But the reality is that the paid firefighters do because it is their job and you can mandate a certain fitness. On volunteer forces, you wind up with plumbers and fencebuilders and truck drivers and housewives and X-ray technicians – all sorts of other vocations that aren’t firefighters. Unfortunately, it’s not going to happen.

Neal added there aren’t many volunteer firefighters who maintain a health and diet conducive to high levels of exertion on a periodic basis, as called for on the job.

“There’s a whole lot of sitting around followed by two hours of very hard work fighting a house fire or uprighting an overturned vehicle, followed by more sitting around,” he said.

With prevention efforts limited by resources, Neal instead hones in on preparation.

“We take firefighters of all abilities and health levels and fitness abilities because we don’t want to turn anyone away,” he said. “We tailor the assignments given to each firefighter based on their particular abilities and health level. We may have a strong interior firefighter in one guy and another guy who brings out drinks to other firefighters. We have to go with their skill level, but we also factor in fitness and health.”

HEARTFELT DONATION - Wise Regional Health System donated an automated external defibrillator to each of the county's fire departments last December. Each donation is valued at $2,200 for the device, pads for adults, pads for pediatric patients, a hard storage case, training manuals and spare adults pads. Submitted photo

HEARTFELT DONATION – Wise Regional Health System donated an automated external defibrillator to each of the county’s fire departments last December. Each donation is valued at $2,200 for the device, pads for adults, pads for pediatric patients, a hard storage case, training manuals and spare adults pads. Submitted photo

In addition, Neal, who is the director of radiology at Wise Regional Health System in Decatur, was instrumental in securing the donation of an Automated External Defibrilator (AED) to each of the county’s fire departments from the hospital. (The Rhome Volunteer Fire Support Brigade also gave Rhome VFD $2,000 for an AED in September.)

“Anytime the heart stops, whether it be from heart attack or traumatic injury, an AED is used to provide a counter-shock to try to get the heart going again,” Neal said. “It works the same as any other defibrillator; it just takes the human error out so that the lay-person not trained to interpret EKGs and heart rhythms can use it. The computer inside the AED does the interpreting for you and makes the decision – is it a shockable rhythm or is it not shockable? If it is a shockable rhythm and you are advised to shock, all you do is press a little button. It takes the human element out and makes it usable by a relatively untrained person.”

The success rate depends on timing.

“The sooner we can get it on and deliver the shock, the much greater the success rate,” Neal said. “Timing is everything.”

AEDs cost about $2,200 for the device, pads for adults, pads for pediatric patients, a hard storage base, training manuals and spare pads. And although the devices generally last a long time, its add-ons have a very short lifespan.

A battery, which costs about $400, must be replaced after being used on one patient or every two to three years (depending on the manufacturer’s recommendation), even if it hasn’t been used. Defibrillator “smart” pads cost $80 to $100 a piece.

Because there are only three medic stations in the county, the fire departments serve as the first responders to medical calls in their respective jurisdictions. As part of the contract, Wise County Emergency Medical Services (through county commissioners) provides each entity with one AED.

“Most fire departments keep the AED on the apparatus they take to medical calls,” Neal said. “That apparatus is generally not the same piece of equipment taken when responding to car accidents, house fires, grass fires – and the level of stress apparent in those situations is not natural.”

Of the 48 heart attack deaths mentioned in the U.S. Fire Administration report on 2011 firefighter fatalities, eight occurred on the scene of a fire and five during training. The others fell into “incident” categories, which were not specified as a fire, car accident, etc. But the report went on to outline the strenuous physical demand of the job.

“Sometimes, firefighters are not in the physical shape to do whatever the department may be called to do, and they wind up as the patient, and the equipment needed to rescusitate them is not available,” Neal said. “Having this second AED allows us to be there for our own. Heart attack is the No. 1 killer of firefighters.”

According to a preliminary report on 2012 firefighter fatalities, heart attack was the cause of 41 percent of those deaths; trauma, 32.5; crushed, 4.8; cerebrovascular, 3.6; and heat exhaustian and asphyxiation each 1.2.

“People started noticing the number of firefighter fatalities related to cardiac issues,” Mara said. “I’ve only been a firefighter for a few years, but since I became a fireman, there have been a lot of changes. At first, it wasn’t really in the forefront of everyone’s thoughts. Now it’s something you hear almost daily – fitness and wellness.”

Mara also praised the rehab services Wise County medics provide at the scene of fires and wrecks.

“They play a part to ensure our firefighters stay hydrated and cool down,” he said. “They are a vital part in the chain.”

Alongside the Decatur Fire Department logo, the words “To Help People” outline the mantra of its members and, likely, the members of the remaining county departments.

‘People’ includes their own.

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