Improvements in tactics and operations, sudden cardiovascular events (heart attacks and strokes) remain the top cause of firefighter line-of-duty deaths (LODDs). Recognizing this tragic statistic, the USFA established goals to decrease LODDs by 25% in 5 years and 50% in 10 years. These commendable targets create a primary national objective to develop a breakthrough in ensuring the health and safety of the emergency responder community. This breakthrough requires a state-of-the-art approach that combines medical science with technological innovations.
In response to this national challenge, the U.S. Department of Homeland Security, Science and Technology Directorate, has created the Physiological Health Assessment System for Emergency Responders (PHASER). The mission of the PHASER program is to empower emergency responders to embrace advancing technologies and medical understanding in order to increase their safety and to enhance wellness initiatives that are already recommended or in place.
A key component of this effort is to develop a practical way to monitor firefighters’ physiological status, such as heart rate, breathing rate and motion.
Who’s Involved?
The responsibility for PHASER was awarded to the University of California Los Angeles (UCLA), where the program is led by experts from the David Geffen School of Medicine (Program Director Christopher Cooper, MD, and Associate Director Thomas Storer, MD) and the Henry Samueli School of Engineering and Applied Science (Program Coordinator Maxim Batalin, PhD). The UCLA team works with a consortium of leading academic, industry and government partners, drawing on the expertise of Skidmore College (Denise Smith, PhD), with its long history of research with firefighters; the NASA Centers, which have extensive experience with astronaut-monitoring systems (David Kao, PhD at Ames Research Center and Todd Schlegel, MD, at Johnson Space Center); and Zephyr Technologies and other industry partners that develop physiological-status monitoring products. The PHASER team is advised by Fire Chief (Ret.) Bruce Varner, who also chairs the NFPA committee on Electronic Safety Equipment for Fire and Emergency Services.
Many organizations are concerned with firefighter cardiovascular-related deaths, including the IAFF, IAFC, National Volunteer Fire Council, USFA, FEMA, DHS, National Fallen Firefighters Foundation, National Institute for Occupational Safety and Health and NFPA. These organizations fund research programs and publish guidelines and initiatives. Importantly, PHASER is not a replacement for any of the existing wellness/fitness initiatives; rather, it was developed to enhance these programs and to add exciting new opportunities for monitoring firefighters and other emergency responders, with the aim of reducing risk factors.
Prioritizing Risks
To understand how to mitigate risks that contribute to cardiovascular events in firefighters, we must first identify those risks. Accordingly, the first part of the PHASER program resulted in the development of a “Compendium of Risk Factor Analysis.” This scientific document includes a comprehensive evaluation of published literature in 17 risk categories with prioritization within and between categories. Each risk factor was assessed using a “level of evidence” approach; possibilities for mitigating the risk were also explored. Currently, the PHASER team is working on a second version of this comprehensive analysis.
PHASER-Net
Equipped with an understanding of the prevalence and seriousness of all risks, PHASER then aims to select and evaluate physiological sensors through laboratory and field-based experimentation, combining the experience of the PHASER team in medical science and engineering. The PHASER team is currently focused on the development and deployment of PHASER-Net, a low-cost, networked system for individualized emergency responder physiological monitoring and risk mitigation.
The goals of PHASER-Net are to support secure physiological data acquisition and analysis at various points of opportunity, such as during baseline assessment, training, fire suppression, search and rescue operations, and rehabilitation, as well as to provide individualized feedback and guidance toward the reduction of risk to participating emergency responders.
PHASER-Net employs a set of wireless physiological monitors and leverages low-cost, durable smartphone platforms via a PHASER-Net app (a mobile application interface) for secure data acquisition, processing and interaction with the emergency responder. The data from the smartphones is then uploaded via a secure network interface to the emergency responder portal (ERP), a secure server system located at UCLA, where the data is archived, processed and made available to individual emergency responders via password-protected personal Web pages. The system has been demonstrated to work on the fireground, and it is also suitable for wearing for long periods.
It’s important to note that the data collection and analysis by the PHASER-Net system is strictly confidential, governed by the university regulations that relate to the protection of human research subjects and overseen by the UCLA Institutional Review Board. This process ensures the utmost confidentiality and privacy for the individual firefighter.
At present, the PHASER-Net system consists of the Android mobile phone app and ERP (see photo, p. 66). The app supports the acquisition of physiological data during several firefighter activities, such as standardized treadmill testing (Wellness/Fitness Initiative, or WFI), aerobic or strength training, fire drill/training, fire suppression, search and rescue, and rehabilitation. The app acquires physiological data wirelessly (Bluetooth) from a chest strap (Bioharness by Zephyr Technology) worn by the emergency responder, which provides measurements of heart rate, 2-lead electrocardiogram (ECG), breathing frequency and motion via an accelerometer.
The app automates the WFI treadmill test, enabling emergency responders to perform self-evaluations of physical fitness via estimated aerobic capacity (VO2 max) in a standard, low-cost approach, while complying with established WFI safety conditions.
The accumulated physiological data is then packaged and securely transferred to the PHASER-Net ERP for archiving and processing. An individualized report is generated for every participating emergency responder.
Next Steps
The developmental stages of PHASER-Net were undertaken at the Redondo Beach (Calif.) Fire Department, in collaboration with Chief Robert Rappaport. As of spring 2012, PHASER-Net has been deployed during live-fire training exercises at the North Las Vegas Fire Department (under the supervision of FireRescue Editor-in-Chief/Assistant Fire Chief Tim Sendelbach) and will also be deployed at the Glendale (Ariz.) Fire Department (under the supervision of Deputy Chief Patty Frey) and at the Phoenix Fire Department (under the supervision of Deputy Chief Tim Smith).
We anticipate that continuing governmental support of the program will enable the program to expand to other fire departments across the country. During the ongoing development and refinement of PHASER-Net, the PHASER team will work in close partnership with participating fire departments to further define the key parameters for physiological evaluation, risk identification, operational assessment, intervention and guidance. Our goal is to add physiological sensors for the measurement and tracking of blood pressure, body composition, spirometry, pulse oximetry, fasting glucose and lipid profile. Participating fire departments might choose to incorporate an “advanced ECG” system developed in collaboration with Dr. Todd Schlegel from NASA.
The PHASER team feels privileged to have the opportunity to work with our nation’s firefighters and will continue to develop close collaborations to enhance the wellbeing and safety of all emergency responders who place their own lives at risk in protecting others.
