Preventative Measures

Between 2000 and 2005, an average of 13 firefighters died every year in training-related incidents. Reported training-related injuries totaled more than 7,100 in 2005; however, the number of unreported injuries could be significant. Given those statistics, it’s no surprise the U.S. Fire Administration (USFA) identifies firefighter recruits, firefighters participating in training and firefighters conducting training as especially vulnerable to death and injury.

When did training get so risky? Rising injury rates for firefighter trainees and trainers occurred despite years of increasing emphasis on safety, more rigorous safety standards and major investments in personal protective equipment (PPE), fire simulators, burn buildings and other training technology. A USFA special report, “Trends and Hazards in Firefighter Training, 2003,” attributes many firefighter deaths and injuries during training to poor physical fitness and notes that heart attacks are the leading cause of death in training-related incidents. Firefighters who suffer a heart attack or stroke during training are more likely to die than survive, and those who do survive tend to face long-term health problems.

Ironically, the report also finds that a greater emphasis on physical training and exercise may be contributing to this trend, as firefighters adjust to the stress of more rigorous fitness-training programs. Trainers face a dilemma: More physically rigorous and realistic training is required to fully prepare firefighters for the dangers they face on the job, but those very requirements place trainees at significantly higher risk, especially when they are inexperienced and not at peak physical readiness.

The problem: Fire instructors and firefighters possess insufficient data on the physiological impact of real-time training scenarios on firefighters. Trainers and trainees in many cases do not even have baseline information about health and fitness that would help reduce many preventable injuries and deaths.

The solution: A recent study by the Center for Firefighter Safety Research and Development (CFSRD) at the University of Maryland at College Park, “Health and Safety Guidelines for Firefighter Training,” details guidelines for the health management of firefighters during training activities. Using a physiological analysis of more than 200 firefighters participating in strenuous training exercises, the CFSRD focused on overexertion, heat stress and recovery time after demanding training-related activity, assessing the physiologic effects of a variety of environmental conditions and the effects of operating in full PPE during various activities. Simulated firefighting activity in the high-temperature room of the structural burn buildings available at the Maryland Fire and Rescue Institute (MFRI) was also included in the study.

Study Specifics

The 200 firefighters who participated in the study were between 21 and 55 years of age and possessed a minimum of 3 years of firefighting experience; they also held Firefighter II certification.

Testing was conducted at the MFRI on 20 dates in 2005. Respiratory, cardiac and activity data was collected using the LifeShirt, a garment that features embedded sensors (see sidebar on p. 126 for a closer look at the LifeShirt). Researchers also monitored the firefighters’ core body temperature. To determine the hydration status of each participant, researchers also collected urine samples and measured participants’ urine specific gravity (USG).

Data was collected during standardized assessments and real training exercises conducted at the MFRI. In addition to the USG analysis, the standardized assessments included the Harvard Step Test. Subjects were instructed to stand quietly in front of the 50.8-cm (20″) step box for a 2-minute period to establish baseline cardiovascular function. On verbal command, subjects stepped on and off of the step box at a 30 step-per-minute pace for a 5-minute period or until exhaustion (defined as when the subject could not maintain the stepping rate for 15 seconds). Upon completion of the test, subjects were instructed to sit quietly on the step box for four minutes to obtain heart rate recovery data.

The fire training portion of the study involved one situational rest period where the resting (rapid intervention) team waited quietly in full turnout gear (including SCBA) and three working evolutions (a maze and first- and third-floor burn evolutions).

Recommendations

The study produced recommendations for instructors and firefighters, as well as for those who design and inspect training facilities. To implement the recommendations, however, certain minimum training standards must be adopted and enforced by the authority having jurisdiction (AHJ). Applicable standards include NFPA 1041: Fire Service Instructor Professional Qualifications; NFPA 1403: Standard on Live Fire Training Evolutions; and NFPA 1500: Standard on Fire Department Occupational Safety and Health Program.

Number of Instructors & Qualifications

• Instructors must comply with the standards in NFPA 1041: Fire Service Instructor Professional Qualifications.
• As a minimum requirement to lead a class, instructors should possess the requisite knowledge and skills for certification at the Instructor II level identified in NFPA 1041.
• The lead instructor will ensure the training involves a sufficient number of qualified instructors. In all practical evolutions, there should be enough instructors who meet the instructor requirements of NFPA 1041 to supervise all students in the class.
• During live-fire training evolutions, instructors must ensure a student-to-instructor ratio not greater than five to one (as required by NFPA 1403: Standard on Live Fire Training Evolutions). At a minimum, live-fire training requires an instructor in charge, an instructor with the primary hose team, an instructor with the backup team, two interior instructors to ready the fires and one safety officer. The complexity of the evolution will dictate whether more instructors are needed.

Training Facilities

• Facilities used for live-fire training must comply with NFPA 1403: Standard on Live Fire Training Evolutions.
• Training center burn buildings must be visually inspected before any live-fire training evolutions and any damage documented in accordance with the procedures established by the AHJ. If any damage to the burn building sufficient to affect the safety of participants is found, training must be suspended until appropriate repairs can be made.
• An engineer should conduct an annual evaluation of the structural integrity of the building; the condition of the structure behind the thermal lining should be evaluated once every five years.
• Instructors should test all equipment necessary for live-fire training evolutions before the evolution begins.

Safety Plan

• Before the beginning of any training evolution, and especially for live-fire training evolutions, instructors must develop a safety/training plan.
• Instructors will brief all participants on the plan, the evolutions to be conducted and the crew assignments.
• All participants will take part in a walkthrough of the facility prior to beginning any live-fire training, reviewing the building’s layout and evacuation provisions.
• The safety plan should detail the method of communication between the instructors and the safety officer, as well as an evacuation plan and signal. Instructors should demonstrate the signal for all trainees prior to beginning the training.
• The instructor-in-charge will ensure an adequate water supply and sufficiently staffed attack lines and backup lines. The necessary attack and backup lines shall be staffed and ready before the beginning of the evolution including the standard rapid intervention team (RIT). In addition, a charged attack line should be in position when the fire is ignited.
• All trainers and trainees must use the National Incident Management System (NIMS) for all live-fire training. The instructor-in-charge should assign personnel and document those assignments using a command chart. Personnel assignments should include instructor-in-charge, safety officer(s), RIT, crew assignments with instructor and reserve instructors, if available.
• During all evolutions in which a participant could become disoriented, lost or trapped, instructors must establish and follow a “point of entry” accountability system that tracks all personnel in the hazard zone. When a participant enters the hazard zone, they should be “logged in” using the recognized system and “logged out” upon their exit from the hazard zone. Instructors must pay close attention to the time trainees spend in the hazard zone and make provisions for a rescue should a participant become unable to exit on their own.
• All instructors and students in training evolutions must be held to a high standard of discipline, follow the designated training plan and direction from the instructor-in-charge and adhere to their assigned duty without “freelancing” of any kind.

Personal Protective Equipment

• Full PPE must be available to and required for all students participating in practical training evolutions.
• For live-fire training evolutions, participants must wear and use protective coats, trousers, hoods, footwear, helmets, gloves, SCBA and personal alarm devices meeting the appropriate NFPA standard (NFPA 1971: Standard on Protective Ensemble for Structural Fire Fighting, NFPA 1981: Standard on Open-Circuit Self-Contained Breathing Apparatus for the Fire Service and NFPA 1982: Standard on Personal Alert Safety Systems).

Safety Officers

• During any live-fire training evolution, a qualified, experienced safety officer must be appointed and present for the duration of the evolution.
• The instructor-in-charge or the safety officer may designate additional safety personnel to monitor conditions and participants within the structure.
• All safety personnel are expected to be trained and knowledgeable in safe firefighting operations and all features of the burn building being used.
• The responsibilities of the safety officer, and subordinate safety personnel, are to prevent unsafe acts and eliminate unsafe conditions. In all cases, the safety officer must have the authority to intervene and control any unsafe operations, including suspending all operations until sufficient measures are taken to ensure the safety of participants.
• Students must be able to stop training at any point without retribution. Allowing them to stop training gives them the ability to improve at their own pace. This is not to say that students will be allowed to deviate from the minimum standard; they will still be required to meet the minimum established standard for successful completion of the class.

Environmental Conditions

• Training instructors should monitor weather conditions and adjust or cancel related activities as conditions warrant.
• Environmental conditions have a significant impact on an individual’s physiological response to physical activity. Trainers should use the heat and wind chill indices developed by the National Weather Service to determine extreme heat and cold conditions. They should use weather information local to the class site, as conditions can vary greatly even over a relatively small geographic area.
• Outside training activities requiring physical activity or full PPE shall not be conducted when the heat index reaches more than 110 degrees F. Instructors must remember that full PPE may add 10 degrees to the heat index value, and factors such as age and physical condition of individual students may affect susceptibility to heat disorders.
• When the heat index is between 100 degrees and 110 degrees F, conditions may be considered hazardous, and instructors should consider canceling or modifying the training activity. Other factors such as the time of day and type of activity may influence the instructor’s decision.
• Wind chill factors may vary depending on the training location’s proximity to wind barriers. Frostbite is possible at temperatures less than 0 degrees F and temperatures are considered dangerous at 20 degrees F.
• Outside training activities should not be conducted when the wind chill factor is less than 20 degrees F, unless the following conditions are met: Students are properly dressed for an appropriate cold-weather activity; the cold weather will not affect the safe and proper function of tools, equipment and apparatus; an adequate supply of warm liquids and/or food is available at the training site; strenuous physical activity is monitored and limited to 15-20 minutes; and a heated indoor rehabilitation area is available close by.
• Instructors must exercise additional caution when conducting outside training activities in temperatures where climbing/walking surfaces are subject to freezing and may create a slip hazard.
• Other weather-related conditions-including high winds, snow or snow on the ground, ice, sleet, hail, rain, lightning, thunderstorm or tornado warnings-may also warrant the cancellation or modification of outdoor training.

Medical Evaluation

• All departments must conduct medical evaluations in accordance with NFPA 1582: Comprehensive Occupational Medical Program for Fire Departments as a baseline for surveillance and annually thereafter on all individuals engaged in firefighter emergency functions.

Medical & Fitness Screening

• Fire training academies should use the seven-question Physical Activity Readiness Questionnaire (PAR-Q) to screen students prior to participation in firefighter emergency training evolutions (see sidebar below).
• Fire training academies should conduct a two-fold fitness screening on all individuals prior to participation in firefighter emergency training:

1. Calculation of the trainee’s Body Mass Index (BMI). The results of this study indicate that BMI correlates with physiological response to training evolutions. BMI is calculated using the following formula:
   BMI = Weight in lbs. x 703 / Height in inches²
   
   Anyone with a BMI greater than 25 is classified as overweight and anyone with a BMI greater than 30 is classified as obese.
2. Calculation of the individual’s sub-maximal estimation of aerobic fitness using the Harvard Step Test (described in the Study Specifics section on p. 123) or an equivalent test. The total number of heart beats are counted between 1 and 1.5 minutes after finishing, between 2 and 2.5 minutes and between 3 and 3.5 minutes. The firefighter’s fitness index (FI) is determined by the following equation: FI = (100 x test duration in seconds) x (2 x Total Heart Beats in the Recovery Period). The chart below indicates the level of fitness that corresponds to the fitness index.àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿ Fitness Levelàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿àƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚ƒàƒƒà‚ƒàƒ‚à‚ƒàƒƒà‚‚àƒ‚à‚‚àƒƒà‚ƒàƒ‚à‚‚àƒƒà‚‚àƒ‚à‚¿ Fitness Index
   Excellent >90
   Good 80-89
   High Average 65-79
   Low Average 55-64
   Poor <55

Hydration

• The results of the study indicate dehydration has a significant impact on the physiological response to the stresses of firefighting. Therefore, trainers must provide instructions to participants prior to and during training to encourage proper hydration.
• Training academies should consider using the USG measures from this study as a means to identify dehydrated individuals upon arrival for training. In the absence of this test, trainers must assume that participants arrive dehydrated and actively take measures to avoid severe dehydration once training begins.
• Firefighters regularly lose 2 or more liters of sweat during strenuous firefighting activities. Under most circumstances firefighters begin sweating as soon as they don PPE and continue to sweat even after the training evolution is completed. Trainers must provide adequate water on site, and students should begin hydrating upon arrival and throughout the training day.
• Participants should drink 2-4 oz. of water every 20 minutes during training.

Medical Monitoring/Rehabilitation

• Training academies must adhere to NFPA 1584: Recommended Practice on the Rehabilitation of Members Operating at Incident Scene Operations and Training Exercises.
• Effective rehabilitation should include medical monitoring, including the rate of perceived exertion (RPE), heart rate, blood pressure and temperature. In the future, real-time, detailed physiologic monitoring may be more available and cost-effective.
• In the absence of continuous real-time monitoring, personnel trained to evaluate vital signs should conduct periodic medical monitoring and assess firefighters’ level of distress from hyper or hypothermia and cardiorespiratory compromise.
• Students should be provided a shaded rest area. It is essential that firefighters remove their PPE in warm weather. The use of wet towels around the head and neck, fans and water misting fans are all helpful in the cooling process if an air conditioned space is not readily available.
• Cold conditions provide a challenge as well. Students should be instructed to bring dry socks, gloves and sweatshirts to minimize the risks of hypothermia following the hyperthermic experience of the fire training evolution. Note: Even in cold temperatures firefighters will lose water during evolutions and must rehydrate following the recommendations above.
• During rest periods, instructors must encourage students to sit down and allow their bodies to recover. Training should observe a work/rest ratio of 10 minutes of self-rehabilitation after 30 minutes of SCBA use or 20 minutes of intense work. A 20-minute rehabilitation period is recommended after two 30-minute SCBA bottles, one 45-60-minute SCBA bottle, 40 minutes of intense work or operation within encapsulating chemical protective clothing.

Fuel Load & Exposure

• Training academies should only use fuels with known burning characteristics that are controllable and appropriate to the design of the burn building, and only in quantities needed to create the desired fire size.
• Instructors should not use flammable and combustible liquids for live-fire training evolutions in structures. The combination of wooden pallets and excelsior wood fibers adequately simulates actual firefighting conditions without placing students and instructors at unnecessary risk for injury.
• The results of this study indicate that the fuel loads used in most training evolutions were safe, but at the upper limits of what would be considered appropriate for the length of exposure required to complete the evolution.
• Ceiling temperatures in the burn room should generally not exceed 900 degrees F. At higher temperatures, helmet delamination was witnessed and the integrity of the protective eye shield was compromised.
• Trainees should be limited to no more than 4 minutes of exposure in the burn room prior to extinguishment of the fire. Longer exposure times can increase the risk of thermal illness or injury.

Conclusion

“Health and Safety Guidelines for Firefighter Training” establishes a baseline of factual information regarding the physiological effects of firefighter training. This will in turn lead to more research on this topic and on the behavioral aspects of firefighter training that tend to cause injuries and death. Our duty now: to implement the recommendations from this study in each and every fire department throughout the United States.

Full copies of the research report can be downloaded from the MFRI Web site at www.mfri.org.