A Summary of Health Hazard Evaluations - Fire Scene Safety

A Summary of Health Hazard Evaluations:Issues Related to Occupational Exposure to

Fire Fighters, 1990 to 2001

DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and Prevention

National Institute for Occupational Safety and Health

January 2004

Hazard Evaluations and Technical Assistance Branchii

ORDERING INFORMATION

Individual Health Hazard Evaluations (HHEs) presented in this document may be requested byreferencing the HETA number listed. To receive these documents or other information aboutoccupational safety and health topics, contact the National Institute for Occupational Safetyand Health (NIOSH) at

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This document is in the public domain and may be freely copied or reprinted.

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DHHS (NIOSH) Publication No. 2004-115

FOREWORD

The Hazard Evaluations and Technical Assistance (HETA) Program responds to requests fromemployers, employees, employee representatives, other Federal agencies, and State and localagencies. Through a staff of industrial hygienists (IHs), engineers, occupational physicians,epidemiologists, other health professionals, and support personnel, the Hazard Evaluations andTechnical Assistance Branch (HETAB) collaborates with appropriate personnel in other divisionsof the National Institute for Occupational Safety and Health (NIOSH) to respond to approximately450 requests for assistance each year. The typical HETA response to a request for assistanceresults in (l) an evaluation of whether chemical, physical, biological, or other agents are hazardousas used or found in the workplace and (2) the development of recommendations for controlprocedures, improved work practices, and medical programs to reduce exposure levels andprevent adverse health effects. Health Hazard Evaluation (HHE) site visits are conducted if warranted,and interim and final reports are developed and distributed to employees, unions, management,and relevant State and Federal agencies. When the HETA request is from a Federal, State, orlocal agency for assistance in investigating another workplace, NIOSH provides only the technicalassistance (TA) requested and does not conduct a complete HHE. The results of individualevaluations may trigger wider studies of similar exposures in other settings or may stimulaterecommendations for implementation or modification of health standards. Approximately 12,000evaluations have been completed since the inception of the HETA Program in 1972.

Requests received by the HETA program often reflect widespread occupational problems, such asthe hazards of fire fighting. One-hundred and fifty-nine fire fighter-related HHEs were requested from1990 to 2001; the majority of the requests came from city and county fire departments, theInternational Association of Fire Fighters (IAFF), and the U.S. National Park Service (NPS). Thisdocument contains a summary of 30 HHEs related to fire fighting that involved a site visit between1990 and 2001, categorized by the focus. Of the 30 HHEs, 7 were related to respiratoryhealth effects and safety and health programs and procedures, 8 to diesel exhaust, 5 to forestfire fighting, 6 to chemical fires, 2 to communicable diseases, 1 to arsenic poisoning, and 1 toinspecting fire scenes at buildings with chromated copper arsenic (CCA)-treated lumber. UnlikeHHEs in the previous decade (1980–1989), not many fire-fighting HHEs were related to chemical fires(6 compared with 30), and none were related to noise exposure (0 compared with 9). In most cases,multiple exposures were investigated at the work site; generic as well as site-specific recom-mendations were always provided.

The purpose of this document is to amass the past decade of fire fighting HHEs in a concise formatfor easy reference and examination by NIOSH researchers, customers, and partners. Any individualreports or letters of interest can easily be requested. The scope and presentation of the indi-vidual HHEs vary based on the requesters' needs and the project officers' professional judgment.The editors of this document are not at liberty to change the overall findings of each HHEreport. The document is not meant to be a state-of-the-art review, but instead, it is intended toprovide general insight into the types of fire fighter HHE requests received, and HETAB's responseto them.

John Howard, M.D.DirectorNational Institute for Occupational Safety and Health

Centers for Disease Controland Prevention

Hazard Evaluations and Technical Assistance Branch iii

Hazard Evaluations and Technical Assistance Branchiv

CONTRIBUTORS

Prepared byBeth Donovan Reh, M.H.S.

EditorJane Weber, M.Ed.

Desktop Publishing and DesignDonna Pfirman

NIOSH Printing OfficePenelope Arthur

Web ProductionDavid WallDonna Pfirman

Contributing Project Officers on HealthHazard EvaluationsSteve BerardinelliLeo M. Blade, C.I.H.Mary Brown, D.V.M.Yvonne Boudreau, M.D.G.E. Burroughs, C.I.H.Calvin K. Cook, B.S. John Decker, M.S., C.I.H.Scott Deitchman, M.D., M.P.H.Alan Echt, M.P.H., C.I.H. Anne T. Fidler, Sc.D.Thomas K. Hodous, M.D.Brad Husberg, R.N., M.S.P.H.John E. Kelly, M.S. Max Kiefer, C.I.H.Gregory M. Kinnes, M.S., C.I.H. Steven W. Lenhart, C.I.H.Deanna Letts, R.N., M.S.Charles S. McCammon, Ph.D., C.I.H.Tim R. Merinar, M.S.Gary P. Noonan, M.P.A.Ted A. Pettit, M.S.Christopher M. Reh, M.S. Kevin Roegner, M.P.H.John Sheehy, Ph.D., C.I.H.Ruth A. Shults, R.N., M.P.H.Dwayne Smith, C.S.P.David C. Sylvain, M.S., C.I.H. Samuel Terry, B.S.Doug Trout, M.D. Nina Turner, Ph.D.

ABBREVIATIONS

ACGIH® American Conference of Governmental IndustrialHygienists

ATF Alcohol, Tobacco, and FirearmsATSDR Agency for Toxic Substances and

Disease Registry BLM Bureau of Land ManagementCAER Community Awareness and

Emergency ResponseCCA Chromated copper arsenicCDHS California Department of Health

ServicesCDPHE Colorado Department of Public

Health and EnvironmentCFK Coburn, Foster, Kane CI Confidence intervalCL Ceiling limitCNS Central nervous systemCO Carbon monoxideCO2 Carbon dioxideCOHb CarboxyhemoglobinCr VI Chromium VICVD Cardiovascular diseaseDOA U.S. Department of AgricultureDOI U.S. Department of the InteriorDSR Division of Safety Research EC Elemental carbonEKG ElectrocardiogramEMS Emergency medical servicesEPA U.S. Environmental Protection

AgencyFEF25-75 Mean forced expiratory flow

during the middle half of the FVCFEV1 Forced expiratory volume in

1 secondFEV1/FVC Ratio of FEV1 to FVCFFFI&PP Fire Fighters Fatality Inv. and

Prevention ProgramFS Forest service (DOA)FVC Forced vital capacityFY Fiscal yearGA General area (air sample)HBV Hepatitis B virusHCV Hepatitis C virusHETA Hazard Evaluations and

Technical Assistance

Hazard Evaluations and Technical Assistance Branch v

HETAB Hazard Evaluations andTechnical Assistance Branch

HHE Health hazard evaluationHIV Human immunodeficiency virusIAFF International Association of Fire

FightersICS Incident command systemIH Industrial hygiene or industrial

hygienistLOD Limit of detection (analytical

method) LOQ Limit of quantitation (analytical

method)MDC Minimum detectable concentra-

tion (the smallest amount of amaterial that can be reliablydetected). The MDC is calculatedby dividing the analytical limit ofdetection by a representative airvolume.

mg Milligramsmg/m3 Milligrams per cubic meter of airMQC Minimum quantifiable concentra-

tion (the smallest amount of amaterial that can be reliablymeasured). The MQC is calculatedby dividing the analytical LOQ bya representative air volume.

MSDS Material safety data sheetMSHA Mine Safety and Health

AdministrationMTBE Methyl t-butyl etherND Not detectedNFPA National Fire Protection

AssociationNIOSH National Institute for

Occupational Safety and HealthNPS National Park Service (DOI)NO Nitrogen oxideNO2 Nitrogen dioxideNOx Nitrogen oxides

NWCG National Wildfire CoordinatingGroup

OC Organic carbonOSHA Occupational Safety and Health

AdministrationPAHs Polycyclic aromatic hydrocarbonsPASS Personal alert safety system

devicePCB Polychlorinated biphenylsPBZ Personal breathing-zone (air

sample)PEL Permissible exposure limit

(OSHA)PFT Pulmonary function testsPPE Personal protective equipmentppm Parts (of a contaminant) per

million parts REL Recommended exposure limit

(NIOSH exposure criteria)RPM Respirable particulate matterRPNOR Respirable particulates not other-

wise regulatedSCBA Self-contained breathing apparatusSIC Standard industrial classificationSnCl4 Stannic chlorideSO2 Sulfur dioxideSOx Sulfur oxidesSOP Standard operating procedureTA Technical assistanceTB TuberculosisTLV® Threshold limit value (ACGIH®

exposure criteria)TST Tuberculin skin testTWA Time-weighted averageUSFS United States Forest ServiceVOCs Volatile organic compoundsµg/m3 Micrograms of contaminant per

cubic meter of air (a unit of concentration)

µm Micrometer

Hazard Evaluations and Technical Assistance Branch 1

BACKGROUND

Fire fighting continues to be one of themore hazardous industries in this country.1

The occupational environment for firefighters is somewhat unique: exposuresare varied, often high, and intermittent.They occur in circumstances of extremephysical and mental stress where theonly means of exposure control is self-contained breathing apparatus (SCBAs).Exposures can include smoke and particu-late matter, carbon monoxide (CO),nitrogen dioxide (NO2), hydrogen chloride,hydrogen cyanide, sulfur dioxide (SO2) /sulfuric acid, acrolein, formaldehyde andacetaldehyde, benzene and many otherorganic chemicals, and any chemicalsthat might be located at the fire scene.Many of these exposures cause acuteeffects, but others may cause chroniceffects, such as respiratory health effectsand decreased lung function from repeatedsmoke exposures or cancer from repeatedexposures to diesel exhaust, benzene,polycyclic aromatic hydrocarbons (PAHs),asbestos, or formaldehyde. A high potentialexists for burns, acute trauma, andmusculoskeletal injuries. Communicablediseases are becoming a major concern,especially blood-borne pathogens andtuberculosis (TB). Other health effectsassociated with fire fighters are cardio-vascular disease, reproductive hazards,hearing loss, and occupational stress. Adetailed summary of these exposuresand health effects can be found inOccupational Medicine: State of the ArtReviews: Fire Fighters' Safety andHealth.2

The 30 Health Hazard Evaluations (HHEs)summarized in this document are groupedinto the following six categories: 1. Respiratory health effects and safety and

health programs and procedures (7)2. Diesel exhaust exposures (8)3. Forest fire-fighting (5)4. Chemical diseases (6)5. Communicable diseases (2)6. Other (2)

Along with conducting fire-fighting HHEs,the Hazard Evaluations and Technical

Assistance Branch (HETAB) began a proj-ect under the Fire Fighter FatalityInvestigation and Prevention Program(FFFI&PP) during fiscal year (FY) 1998 toinvestigate line-of-duty cardiovascular fatali-ties suffered by fire fighters. Approximately45 fire fighters suffer fatal heart attackseach year, and NIOSH is investigating thesefatalities to generate hypotheses for preven-tion and intervention activities. Each inves-tigation includes an assessment of thephysiologic and psychologic demands ofthe job, workplace organization factors,and individual risk factors. Each investiga-tion results in a succinct report for theaffected fire department as well as thecountry's fire service and is included aspart of the larger annual report. From1998 to 2001, 62 investigative reports havebeen completed, with an additional 13pending completion. These reports havebeen distributed to more than 30,000 firedepartments representing more than 1 mil-lion fire fighters. They are also available onthe NIOSH fire fighter Web sitewww.cdc.gov/niosh/firehome.html. Onepeer-reviewed journal article has beenpublished, and seven presentations havebeen given at national meetings3. Finally,as an expert of cardiovascular disease(CVD) among those employed in the fireservice, one program member was invitedto become a member of the National FireProtection Association (NFPA) Standard1582, Medical Requirements of FireFighters and Information for FireDepartment Physicians.

SAFETY AAND HHEALTHPROGRAMS AAND PPROCEDURES

Seven HHEs are summarized below thatinvolved review of and recommendationsfor fire department safety and health pro-grams and procedures. Four of the HHEswere requested because of a fatality orsevere respiratory health effects, two oth-ers were requested specifically for reviewof department safety and health proce-dures, and one was requested because ofconcerns about psychologic changes andcardiac abnormalities possibly related tojob stress. All seven of these HHEs involvedsome or all of the recommendations that

Hazard Evaluations and Technical Assistance Branch2

have been published in the 1994 NIOSHAlert Preventing Injuries and Deaths ofFire Fighters.4 The Alert presents the cur-rent OSHA and MSHA Regulations, consen-sus standards, a case report, and recom-mendations for any fire department. Therecommendations from the Alert are pre-sented in the appendix of this document.

HETA 90�0205November 1990

Requester: UnionPurpose: To investigate conditions of aresidential fire during which two fire fight-ers diedKeywords: SIC 9224 (fire departments),fire-fighting, deaths, cyanide, smoke, CO,COHb, SCBA

Abstract: In January 1990, three professionalfire fighters combating a residential firebecame unconscious and were brought outof the structure in full cardiac arrest—onewas successfully resuscitated; two died.The IAFF contacted NIOSH in April, anda team (consisting of a physician, a respiratorspecialist, and an occupational safety andhealth specialist) conducted an investigationof the incident. No environmental sampleswere collected at the time of the fire, butarterial blood gas samples from the twodeceased fire fighters that were taken aftertheir arrival at the hospital showed COHblevels of 17% and 38%. Postmortem bloodcyanide tests were negative. A hazardousmaterials team from the county fire depart-ment had investigated the structure 3 hoursafter the fire and did not find any haz-ardous materials. The fire fighters were allwearing SCBAs, and an air sample of thesupplied breathing air was taken the morn-ing after the incident and determined to beof higher quality than was required. Themedical examiner's office said the cause ofdeath for both fire fighters was smokeinhalation based on the abundance of sootin the lower trachea, large mainstreambronchi, and smaller bronchiolar radicles.Given the evidence, NIOSH investigatorscould not make a definitive determinationof the actual cause of death but said thatCO was more likely the cause than cyanide

or an unknown toxin resulting fromcombustion. They also suggested that theexposure occurred in the structure and thatfor some unknown reason the fire fighters'SCBA units were probably not delivering airto the exclusion of outside air at somepoint. They recommended that in similarsituations grab samples of the atmosphereshould be collected immediately using agas-tight bag, blood samples should becollected as soon as possible, timesshould be documented accurately for anysample collection or significant event, andinvestigations such as this one should beconducted as soon as possible after theincident and should involve an IH to takesamples of suspect material.

HETA 90�0395�2121June 1991

Requester: UnionPurpose: To assess the safety and healthpractices of a county fire department afterthe death of an employeeKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, heat stress, heatstroke, mortality

Abstract: The IAFF asked NIOSH to assessthe safety and health practices of a countyfire department after a 25-year-old fire fight-er died of heat stroke while fighting abrush fire. NIOSH investigators toured thefire scene, conducted personal interviewswith 25 fire fighters and support personnel,and reviewed incident reports, incidentcommand procedures, and other documents.The deceased fire fighter and his captainhad advanced separate booster linesand fought the brush fire for approximately1 hour. The fire fighter then rested alone atthe engine while the captain reported tocommand. Upon arriving at the commandstation, the captain reported that the firefighter was in need of rehabilitation, thenentered rehabilitation himself. Over thenext few hours several individuals mistak-enly identified other fire fighters as thedowned fire fighter and assured the captainthat he had rested and was then reassigned.The fire fighter's body was discovered duringcleanup operations. On the basis of the


information obtained during this investi-gation, the NIOSH investigators concludedthat a preventable series of events precededthe fire fighter's death. Recommendationswere made for incident command and safetyprocedures, as well as medical monitoring,rehabilitation of fire fighters at fire scenes,and rehydration schedules.

HETA 93�0040�2315May 1993

Requester: ManagementPurpose: To evaluate the exposuresduring qualitative respirator fit testingusing irritant smokeKeywords: SIC 9224 (fire departments),fire-fighting, hydrogen chloride, irritantsmoke, respirator fit testing

Abstract: NIOSH conducted an HHE inresponse to a request from the fire chief ofa city fire department. The HHE requestwas received after four fire fightersreported experiencing either skin irritationor eye irritation as a result of qualitativerespirator fit tests using irritant smoke.Each of the 186 fire fighters from thedepartment were fit tested in 1992 whilewearing a SCBA (with nose cup) operatedin the pressure-demand mode. The fit-testingmethod involved puffing irritant smokefrom air flow indicator tubes into a testhood that encompassed the fire fighter'shead and the SCBA's facepiece. The tubescontained SnCl4, which reacts with ambienthumidity to liberate a white fume containinghydrochloric acid and tin compounds. Thehealth risks associated with the use of irritantsmoke were evaluated by (1) conductingparticle size analysis of the "smoke" emittedfrom air flow indicator tubes and (2) meas-uring the concentration of hydrogen chlorideproduced by these tubes. Count mediandiameters of the smoke ranged from0.33 µm to 0.63 µm with geometric standarddeviations ranging from 1.35 to 2.13.

Concentrations of hydrogen chloridemeasured without the hood in place ona day with low relative humidity (14%)ranged from <1 to 2,700 ppm. The highestconcentration measured inside the test

hood was also 2,700 ppm. Concentrationsof hydrogen chloride measured without thehood in place on a day with high relativehumidity (53%) ranged from 100 to11,900 ppm. The highest concentrationmeasured inside the test hood was14,400 ppm. Because fire-fighting activitiesfrequently occur in highly toxic atmospheresor those immediately dangerous to life orhealth, the use of a quantitative fit test wasrecommended. It was also recommendedthat they use the full facepiece air-purify-ing versions of the respirators. The samplingresults of this study suggested that highconcentrations of hydrogen chloride wereemitted from irritant smoke tubes and thatexposure to the fume produced by thesetubes should be considered a health risk.

HETA 94�0244�2431June 1994

Requester: UnionPurpose: To determine if the SCBA failedor contributed to the death of two firefighters, assess the accountability ofpersonnel utilizing SCBA in the hazardarea, and evaluate the training of commandand suppression personnelKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, death, self-con-tained breathing apparatus, SCBA

Abstract: NIOSH DSR received a requestfrom the IAFF who was investigating thecircumstances of the deaths of two firefighters. The IAFF requested technical assis-tance in determining if the SCBA failed orcontributed to the fire fighters' deaths,assessing the accountability of personnelutilizing SCBA in the hazard area, andevaluating the training of command andsuppression personnel. The investigationwas coordinated through the city firedepartment and consisted of four phases:(1) the interview of several fire fighters, firechiefs, union representatives, safety per-sonnel, fire investigators, and the directorof fire services, (2) the site visit to theeleven-story high-rise apartment buildinginvolved in the fire, (3) the review of res-pirator maintenance records of the firedepartment, and (4) the evaluation of


breathing apparatus (4 units) worn bythe first responders to the fire. NIOSHinvestigators identified several contributingfactors to this incident: (1) failure to followestablished departmental policies and proce-dures at the fire scene, (2) an inadequaterespirator maintenance program, (3) lack offire fighter accountability at the fire scene,and (4) lack of the use of PASS devices atthe fire scene.

HETA 94�0390�2822September 2000

Requester: UnionPurpose: To investigate concerns aboutpsychologic changes and cardiac abnormal-ities possibly related to job stress fromlong work hours, night work, sleep depriva-tion, and other job stressors in a city firedepartmentKeywords: SIC 9224 (fire protection), jobstress, cardiovascular disease, arrhythmia,anxiety, depressive symptoms, depression

Abstract: NIOSH received a request fromthe IAFF to investigate concerns aboutpsychologic changes and cardiac abnormal-ities possibly related to job stress fromlong work hours, night work, sleepdeprivation, and other job stressors in acity fire department. NIOSH investigatorsmet with department and IAFF representativesto discuss the HHE request, visited threefire stations, observed work practices andorganization, obtained EKG results fromannual physical examinations, and conduct-ed a health survey. Full-time departmentemployees filled out a questionnaire aboutpersonal characteristics, job history, med-ical history, cardiovascular symptoms, men-tal health (including depressive symptomsand anxiety), and job stress. For all studyparticipants, NIOSH investigators obtainedEKG results from the most recent annualphysical examinations. A NIOSH occupa-tional physician read the EKGs using stan-dard clinical criteria. Investigators did statis-tical modeling to learn whether job stres-sors were related to depressive symptoms,anxiety, and sinus arrhythmia.

Eighty-one percent (210/260) of the full-time employees participated in the ques-tionnaire survey, and 196 participants

from 10 fire stations were eligible to par-ticipate in the study. All but three partici-pants were male, and the majority (75%)were 30 to 40 years old. Most participantswere in one of the following four job titles:fire fighter (66 persons, 34%), fire fight-er/paramedic (31 persons, 16%), fire engi-neer (31 persons, 16%), and fire captain(30 persons, 15%). Because of the smallnumber of participants with any singlecondition other than sinus arrhythmia,investigators focused further analysis onthis finding. No meaningful linear relation-ship between sinus arrhythmia and any ofthe job stressors studied was found. Thus,the evaluation found neither severe psycho-logical problems nor a consistent patternof clinically significant cardiac arrhythmias.It did, however, find evidence that certainaspects of the job affected the psychologicwell-being of employees—uncertainty,disharmony, work effort, and involvementin specific critical incidents, including fireswith multiple burn victims and self-reportedhazardous materials exposure. Recommen-dations were offered to ensure that person-nel were receiving appropriate medicalsurveillance and to address concernsabout job stress.

HETA 95�0086March 1995

Requester: ManagementPurpose: To investigate a fire scene whereat least 40 fire personnel had experiencedrespiratory problems and injuries, to developrecommendations to prevent similarepisodes in the future, and to provideconsultation with The Johns HopkinsUniversity School of Hygiene and PublicHealth who was evaluating the affected firefightersKeywords: SIC 9224 (fire departments),carbon monoxide, CO, carbon dioxide,CO2, irritant gases, oxygen deficiency, pul-monary function tests, PFTs

Abstract: NIOSH was contacted, along withATSDR, the State Department of theEnvironment, and The Johns HopkinsUniversity School of Hygiene and PublicHealth, to investigate a fire scene where atleast 40 fire personnel had experienced


respiratory problems and injuries and todevelop recommendations to preventsimilar episodes in the future. Investigatorsdetermined that since the fire was notsuppressed for 6 hours, a significant smokeexposure was likely. Also, at least some ofthe SCBA air was contaminated with vehi-cle exhaust and gasoline fumes. Severalrecommendations were made, includingfollowing the guidelines in the NIOSH Alert:Preventing Injuries and Deaths of FireFighters and developing a respiratoryprotection program in accordance with theOSHA respiratory protection standard andNational Fire Protection Association 1404Standard for a Fire Department SCBAProgram.

HETA 97�0166�2726February 1999

Requester: UnionPurpose: To assess the incident responseprocedures used during a fire in a high-riseoffice building Keywords: SIC 9224 (fire departments),fire-fighting, fire fighters, incident commandsystem, ICS, self-contained breathingapparatus, SCBA, high-rise building

Abstract: NIOSH received a request for anHHE from the IAFF on behalf of fire fightersfrom a city fire department to assess theincident response procedures used duringa fire in a high-rise office building. The IAFFreported that more than 200 fire fightersand other response personnel wereinvolved in the incident. NIOSH investigatorsconducted a site visit to the fire departmentand held an opening conference withrepresentatives of the department andlocal union. Also, individual private interviewswere held with several fire fighters andother members of the department whoresponded to the incident. Several standardoperating procedures (SOPs) and other per-tinent records were obtained for review.Individual post-incident reports from theline commanders and several other firefighters were also requested and subse-quently reviewed. The fire departmentencountered several difficulties whileresponding to this fire. Fire suppression

activities were hampered because thebuilding was a high-rise and because ofproblems locating the fire because of thecomplex building layout. During theincident, there was confusion regardingactual command responsibility becausethe SOPs were apparently not followed.In addition, the department did not have aformal ICS in place to assist with managingan incident that required the response ofall their resources and mutual aid fromother fire departments. The SOP system,according to the information that wasreviewed, did not adequately address theseveral considerations specific to a high-rise situation. These situations includeexpanding the command structure toaccommodate the large number of firefighters typically required at major high-riseincidents, safety, support functions, lobbyand elevator control, and stairwell support.In addition, the issue of interagency coordi-nation or mutual aid command procedureswas only briefly mentioned in the SOPs.During the incident, the limitations in theSOPs and an apparent absence of anypreplanning for large-scale incidents resultedin a lack of fire fighter accountability, con-siderable confusion in the incident com-mand and staging areas, problems withthe communications system, logistical diffi-culties, and coordination problems withinthe department and with the respondingmutual aid units. In addition, the depart-ment's current system of equipping firefighters with SCBA led to a shortage. Eachdepartment fire fighter was assigned anSCBA mask while the fire apparatus wasequipped with a limited number of SCBAharnesses, air cylinders, and PASS devices.As a result, some fire fighters who respond-ed to the general alarm reportedly did nothave complete SCBAs to wear. Other prob-lems that were encountered included theequipment incompatibilities between theresponding department and the mutual aidunits, the dissemination of informationregarding the potential for exposure tohazardous materials such as asbestos andPCBs, and the lack of appropriate deconta-mination procedures. Investigators summa-rized the work practices as they affected thesituation and provided recommendations toimprove future responses.

DIESEL EXHAUSTEXPOSURES

Fire fighter exposures to diesel exhaustgenerally occur from trucks idling in theapparatus bays, which can allow exhaust toenter the offices and living quarters. EightHHEs were conducted between 1990 and2001 related to such exposure concerns.Recommendations were often for improvedgeneral dilution or local exhaust ventilationand for initiation of medical surveillancebecause of the nature of fire fighters' work.

Diesel exhaust is a complex mixtureconsisting of both gaseous and particulatefractions. The composition will vary greatlywith fuel and engine type, maintenance,tuning, and exhaust gas treatment.5,6

Gaseous constituents include CO2, CO,NO2, SOx, and hydrocarbons. The particulatefraction (soot) of diesel exhaust consistsof solid carbon cores produced duringcombustion and compounds deposited onthe particle cores through sorption andcondensation processes. More than 95% ofdiesel soot particles are less than 1µm.Up to 65% of the total particulate massmay be these adsorbed substances. Themajority of the adsorbed material isunburned fuel and oil, but trace levels ofcompounds such as PAHs are also present,some of which are carcinogenic.7 Anestimated 18,000 substances from thecombustion process can be adsorbed ontothe particle cores.7

Studies of rats and mice exposed todiesel emissions, especially the particulateportion, confirmed an association with lungtumors.7 Human epidemiology studies alsosuggest an association between occupationalexposure to whole diesel exhaust and lungcancer.7 In addition to the carcinogenic

potential, many other components of dieselexhaust have known toxic effects. Theseeffects include pulmonary irritation fromNOx, eye and mucous membrane irritationfrom SO2 and aldehyde compounds, andchemical asphyxiation from CO. Exposurecriteria have been established for some ofthese compounds; however, OSHA hasnot established a PEL for whole dieselexhaust emissions. ACGIH® has proposeda TWA TLV® of 0.02 mg/m3 for dieselexhaust, measured as elemental carbon(EC).8 On the basis of findings of carcino-genic responses in exposed rats and mice,NIOSH recommends that whole dieselexhaust be considered a potential occupa-tional carcinogen and that exposures bereduced to the lowest feasible concentra-tion.6 In addition to the carcinogenic effects,eye irritation and reversible pulmonaryfunction changes have been experienced byworkers exposed to diesel exhaust.7,9,10,11

Assessing workers' exposures to dieselexhaust is difficult because of the complexmakeup of the exhaust, uncertainty aboutwhich specific agent(s) may be responsiblefor the carcinogenic properties, and thepresence of other fine aerosols (such astobacco smoke particles). Measurements ofsome commonly found components of dieselexhaust have generally shown concentrationsto be well below established exposurecriteria. However, the use of EC holdspromise as a selective measure of dieselparticulate because the sampling andanalytical method has a low LOD, dieselparticulate contains a high percentage ofcarbon (80% to 90%), and there are fewinterferences. While the ACGIH® has pro-posed a TWA TLV® of 0.02 mg/m3 fordiesel exhaust, measured as EC, NIOSH iscontinuing to investigate its use as a sur-rogate index of the particulate fraction.12,13

Although neither NIOSH nor OSHA haveestablished numerical exposure limits,sampling for EC can provide informationfor assessing the effectiveness of dieselexhaust controls.



HETA 90�0396October 1990

Requester: GovernmentPurpose: To address concerns about firefighter exposures to diesel exhaust in theliving quarters and leukemiaKeywords: SIC 9224 (fire departments),fire-fighting, leukemia, diesel exhaust, SCBAtank air

Abstract: A NIOSH investigator conducteda walkthrough investigation of a fire depart-ment in response to a request from theFire Chief expressing concerns about dieselexhaust in the living quarters. The concernswere heightened after the recent death ofan employee from leukemia. A previousHHE had been conducted at this station in1982, and several changes had been madebased on the recommendations. Ventswere opened to supply fresh air to the livingquarters, the living quarters were underpositive pressure with respect to theapparatus floor, morning vehicle startswere no longer performed, vehicles wereparked outside for routine maintenance,the duct work was cleaned, a humidifierwas installed in the sleeping quarters, andregular maintenance was performed on thehumidifiers, furnace, and the air-handlingsystem. Since all of these changes hadbeen made, interviewed fire fighters statedthat they did not smell exhaust in the livingquarters, and air velocity measurementsshowed that air flowed from the livingquarters to the apparatus bay, the NIOSHinvestigator concluded that further testingwas not needed. Recommendations includedthe continuation of routine air-handlingsystem maintenance and the initiation of amedical surveillance program because ofthe nature of fire fighters' work.

HETA 92�0160�2360October 1993

Requester: JointPurpose: To evaluate exposure to dieselexhaust emissionsKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, diesel, elementalcarbon, benzene solubles, carbon monoxide,CO, nitrogen dioxide, NO2

Abstract: NIOSH conducted an HHE atthree engine houses of a city fire division inresponse to a joint request from theDivision of Fire and the local union toevaluate exposure to diesel exhaustemissions. Air samples for componentsof diesel exhaust emissions were collectedfrom the evening through early morning on2 days to evaluate exposures during atypically busy shift. NIOSH investigatorsvisited the engine houses a second timeto obtain data used to formulate theengineering control recommendations.PBZ air samples for EC, a surrogate fordiesel exhaust, were also collected. GA airsamples for EC, CO, benzene-solubles, andNO2 were collected at all three enginehouses. In addition, a GA air sample forEC was collected outside each enginehouse and away from sources of dieselemissions to measure the concentrationof ambient EC. In Engine House 1, PBZsamples for EC ranged from 14.1 to71.2 µg/m3. In Engine House 2, theyranged from 19.8 to 78.8 µg/m3. InEngine House 3, they ranged from 24.0 to60.5 µg/m3. The average background ECconcentration measured on the firstnight of sampling was 12.1 µg/m3, andthe average on the second night ofsampling was 8.4 µg/m3. With theexception of one measurement of 4.6 ppmof CO measured in the smoking room ofEngine House 2 on the first night of thesurvey, only trace amounts of CO weredetected in any of the other samples.During the 2 nights of sampling, benzene-solubles were only detected in onesample in Engine House 1 (on the secondnight in the large apparatus bay). This686-minute sample yielded a concentrationof 313 µg/m3. Since none of the vehicleswere moved on the second night, thesource of benzene-solubles in this samplewas not clear. Benzene-solubles measuredin Engine House 2 ranged from less thanthe LOD to 313 µg/m3. Sampling forbenzene-solubles in Engine House 3 didnot result in any concentrations in excessof the LOD for the method, 0.05 mg persample on either night. Since limitedepidemiological evidence suggests anassociation between occupational exposureto diesel exhaust emissions and lungcancer, engineering controls and work


practices to reduce the potential risk to firefighters from diesel exhaust emissionexposures were provided.

HETA 92�0225September 1992

Requester: ManagementPurpose: To determine the potentialexposure to diesel exhaust among para-medics at three hospital ambulance stations,one of which shares a building with a firedepartmentKeywords: SIC 8062 (hospitals), carbonmonoxide, nitrogen dioxide, nitric oxide

Abstract: A hospital Environmental Healthand Safety Manager requested an HHE todetermine the potential exposure to dieselexhaust among paramedics at three hospitalstations. One of the paramedic stationsshared a building with the fire station thathad installed a new ventilation system tocontrol diesel exhaust. The system consistedof a local exhaust hose that connecteddirectly to the vehicle exhaust pipe. Whenthe vehicle left the garage, the hose slidalong on a ceiling mounted track until itcontacted a stop and disengaged from theexhaust pipe. The connection had to bemanually reestablished when the vehiclereturned to the garage. EC samplingshowed that the new ventilation systemwas effective in reducing diesel exhaustexposures, and the NIOSH investigatorrecommended its use. The system did notaffect the concentrations of NOx, whichwere all very low. Similarly, CO concentrationswere low, except at the southside station,where concentrations ranged up to 13 ppm.The NIOSH investigator recommended thatthe CO source be determined—gas waterheater, ambulance, or other gasappliances—and then eradicated.

HETA 92�0384November 1990

Requester: ManagementPurpose: To assess exposures to dieselexhaust in seven fire stations with variedventilation systemsKeywords: SIC 9224 (fire departments),diesel fumes

Abstract: At the request of a city fire depart-ment, NIOSH investigators visited four of itsseven stations, two of which had addeddilution ventilation systems, which the firefighters had reported were inadequate forcontrolling diesel exhaust emissions. Theinvestigators measured dimensions and flowrates at each station and educated the firefighters about the different ways forcontrolling diesel emissions. They recom-mended the installation of tailpipe exhaustsystems and the improvement of severalwork practices, such as opening the garagedoors before starting the trucks, minimizingvehicle operation inside the station, andkeeping doors to other areas closed andproperly sealed. They also recommendedmaintaining the living and office areas at pos-itive pressure with respect to the garage andkeeping a record of health symptoms andnuisance complaints related to diesel emis-sions as an indicator of the need for futureimprovements.

HETA 97�0304�2695June 1998

Requester: EmployeePurpose: To assess diesel exhaustexposure at fire stations throughout thecityKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, diesel, elementalcarbon, nitrogen dioxide

Abstract: NIOSH received a request fromfire fighters of a city fire department to con-duct an HHE of diesel exhaust exposure atfire stations throughout the city. Healthconcerns included headaches and thepossible carcinogenic risk associated with


exposure to diesel exhaust. NIOSH investi-gators conducted an IH evaluation at twofire stations. Environmental monitoring wasconducted for components of dieselexhaust including NO, NO2, EC, andmiscellaneous hydrocarbons. PBZ and GAair samples were collected for EC at eachstation. Area samples were collected in thekitchen, apparatus bay, and in the firefighters' sleeping quarters. Additionally, onebackground EC sample was collected out-side of each station as a comparativemeasure. Exhaust ventilation flow rateswere also measured to estimate airchanges per hour in apparatus bays. ECwas ND in all of the samples collected atstation 5 on either night, indicating that theEC concentration for all area and PBZsamples (including background) was lessthan 4 µg/m3. Five of the 12 (42%) ECsamples collected at station 8 weregreater than background. These includedtwo area samples collected in the apparatusbay and three PBZ samples. The highestEC concentration of 16 µg/m3 was measuredin the apparatus bay. Concentrations ofNO2 and NO in the stations were belowexposure limits for these chemicals. Onlylow levels of contaminants were detected ateach station by qualitative organic vaporscreening. Compounds detected includedtoluene, isooctane, benzene, C6–C16aliphatic hydrocarbons, MTBE, hexyleneglycol, trimethylbenzenes, and naph-thalenes. Air concentrations on the thermaldesorption tubes were estimated to beless than 0.5 µg for any single component(less than 0.07 ppm, based on the minimumsample volume). Analyses of charcoaltubes for benzene, toluene, and xylenesidentified trace (<0.07 ppm) quantities ofxylenes in two samples and did not detectbenzene or toluene in any samples. Thesamples in which xylene was detected werecollected during a 62-minute samplingperiod while the rescue unit left andreturned to the station. Exposure toindividual constituents of diesel exhaustwas below respective NIOSH RELs at bothstations, indicating that under the samplingconditions, these constituents should notpose a significant health hazard. Dieselexhaust in station 8 was confined to theapparatus bay. Three factors could becredited for the low diesel exhaust concen-

trations at the time of the evaluation. First,the newer engines operated more efficientlyand, consequently, generated cleanerexhaust than the older engines theyreplaced. Second, during the survey,stations 5 and 8 may have responded tofewer than the typical number of calls.Third, the ventilation is effectively removingexhaust from the bays. Recommendationswere made that could further reduce dieselexhaust exposure.

HETA 98�0152�2729March 1999

Requester: GovernmentPurpose: To conduct an evaluation ofdiesel exhaust exposure at a city PublicSafety BuildingKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, diesel, elementalcarbon, nitrogen dioxide

Abstract: NIOSH received an HHE requestfrom a State Department of Labor to con-duct an evaluation of diesel exhaust expo-sure at a city Public Safety Building. Therequest indicated that fire and police per-sonnel were exposed to diesel exhaustfrom fire apparatus. Asthmatic bronchitiswas listed as a health problem resultingfrom this exposure. NIOSH conducted an IHevaluation that included air sampling for ECand NO2. With the exception of the 199-minute EC sample collected in the appara-tus bay (0.009 mg/m3), EC concentrationswere below the MDC throughout the build-ing. An NO2 concentration of 0.086 ppmwas measured over a 189-minute periodin the apparatus bay. TWA NO2 sampling inother areas of the building revealed con-centrations below the MQC. Direct-read(grab) measurements, however, appear toindicate that higher NO2 concentrations(peak concentrations) may occur in theapparatus bays during very brief periodswhen vehicles are entering or returning.It seemed likely that the concentrationof diesel exhaust and its constituentcompounds in the building varied,depending upon the operating conditions(e.g., engine temperature, tune-up condition,etc.), the type and size of engine, and the


length of time that an engine ran in or nearthe building. Weather conditions may havealso affected indoor concentrations of dieselexhaust by changing the pressure differentialbetween the apparatus bay and other partsof the building, thus driving contaminantsinto occupied indoor areas. Althoughexposure to individual constituents ofdiesel exhaust was below respective NIOSHRELs, complaints of diesel exhaust in thebuilding were likely to reoccur as long asdiesel-powered emergency vehicles werepresent and fire and police staffs occupiedadjacent offices and living areas.Investigators suggested that engineeringcontrols be considered to alleviate comfortand health concerns, especially amongpersons who were more sensitive to thepresence of diesel exhaust, such asasthmatics.

HETA 99�0094April 1999

Requester: UnionPurpose: To assess exposures to CO anddiesel exhaust in a local fire departmentKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, diesel exhaust,carbon monoxide

Abstract: A NIOSH investigator conducteda site visit along with a State Departmentof Labor representative, who had receiveda request for assistance from a local firedepartment concerning CO exposuresfrom the oil furnace and diesel exhaustexposures from the fire trucks. The firedepartment dispatch center, day room,and apparatus bays were housed in anaddition to the town offices building.Employees reported that the oil furnacehad intermittent ignition problems thatcaused the furnace to release smoke andCO into the building. Six of the seven fireapparatus were diesel-powered, and theapparatus bays were not equipped with anylocal exhaust ventilation. Investigators

observed pressure differentials betweendifferent areas in the fire station and con-ducted air sampling during four responsesimulations. Negligible air exchangebetween the bays and adjacent day roomoccurred, but the air flow in the suspendedceiling above the Board of Health office wasfrom the apparatus bays. The highest COconcentrations were measured duringsimulated responses; a 20-minute TWA of39 ppm was measured in the bays, andthe peak was 108 ppm. The 20-minuteCO concentrations in the adjacent dayroom and Board of Health office were 10 ppmand 4 ppm, respectively, with peaks of12 ppm and 6 ppm. An hour and a halfafter the simulations concluded, measura-ble concentrations of CO were still in theserooms. Concentrations of NOx were esti-mated to be 6 ppm in the apparatus baysand 1.5 ppm in the day room at the con-clusion of all four simulations. It wasnoted that a few of the trucks had airleaks which prevented the brakes fromreleasing immediately upon startup. Thisresulted in an extra minute or so of dieselexhaust release in the bays. Also, a diesel-powered emergency generator that wasused weekly was located a few feet from theback of the building. The State provideddata indicating that the indoor CO2 con-centrations were in the range of 800 to900 ppm, showing inadequate ventilationand that other indoor contaminants mayalso build-up. Several recommendationswere made to reduce the migration ofdiesel exhaust into the other areas of thebuilding, such as minimizing idling times,performing regular engine tune-ups, repair-ing air leaks in the brake systems, keepingdoors closed and properly sealed, main-taining a positive pressure differential withrespect to the bay, scheduling generatorweekly start-ups during periods when thebuilding is unoccupied, and inspecting andmaintaining the furnace. If these efforts wereineffective, then tailpipe exhaust ventilationsystems could be added.


HETA 99�0266�2850May 2001

Requester: ManagementPurpose: To evaluate the effectiveness ofnew diesel exhaust filtration controlsKeywords: SIC 9224 (fire protection),diesel exhaust control, fire stations, ceramicfilters, elemental carbon

Abstract: NIOSH received an HHE requestfrom a fire department that was planning toinstall diesel exhaust filtration systems onsome of their apparatus and wanted NIOSHto evaluate the effectiveness of the controls.In response to the request, NIOSH conductedpre- and post-control evaluations of dieselexhaust in two fire stations. The pre-con-trol evaluations were conducted onNovember 8–11, 1999. Samples werecollected to characterize contaminantconcentrations at the fire stations, and toprovide base-line data for determining theeffectiveness of the ceramic exhaust filtersat controlling these contaminants. Airborneconcentrations of EC, SO2, NO, NO2, andVOCs were measured. After the ceramicfilters were installed on the engines, afollow-up evaluation was conducted onMarch 14–17, 2000, to determine thecontrol's effectiveness in reducing dieselsoot (measured as EC) in the fire stations.

In the initial survey, only trace concentra-tions of EC were measured in PBZ samplesat each station. Concentrations of EC inthe living quarters of each station weremostly in the ND to trace range as well.The 12 EC area samples collected in theapparatus bay of each station had meanconcentrations of 6.1 µg/m3 in station 3,and 15.6 µg/m3 in station 5. SO2 was notdetected in any spot samples collected inthe apparatus bay of either station. Thisindicates that the concentration of SO2 inthe bay did not exceed 0.1 ppm as theapparatus entered and departed the station.NO concentrations in the apparatus bay ofboth stations were all below the MDC. Thisindicates that all concentrations were

below 0.5 ppm as an 8-hour TWA, which iswell below the current evaluation criteria.Low concentrations of several organicchemicals were identified. Identifiedchemicals included methyl t-butyl ether,C4–C7 alkanes, benzene, toluene, andxylenes. Concentrations of benzene andxylene were quantified and were well belowcurrent exposure criteria.

In the post-control evaluation, EC was notdetected on 12 of 16 area samples collectedin the bay of station 3. Four area sampleshad a trace amount of EC, indicating thatEC concentrations in the bay were betweenthe MDC of 1.3 µg/m3 and the MQC of5.1 µg/m3. EC was not detected on 11 of16 area samples collected during thepost-control sampling campaign at station 5.Trace concentrations of EC were detectedin four area samples, indicating that ECconcentrations for these samples rangedfrom 1.3 to 5.1 µg/m3. A significant reduc-tion in geometric mean EC concentrationsin the apparatus bay of both stations wasevident in the data. The reductions were76% in station 3 and 91% in station 5.

Thus, the NIOSH environmental assess-ment of diesel exhaust in two fire stationsfound that concentrations of diesel exhaustgas-phase components were low prior tothe installation of engineering controls.Personal exposures to diesel exhaustparticulate-phase components in these twofire stations were also low because thequantities of EC generated were moderateand because fire fighters and paramedicsdid not spend very much time in theapparatus bay. However, geometric meanconcentrations of EC in the two bays werereduced by 76% and 91% after the ceramicdiesel exhaust filters were installed. NIOSHresearchers conclude that, in stations withpull-through apparatus bays, the ceramic fil-ters are effective at reducing the emission ofdiesel soot. Recommendations were madefor maintaining positive pressure in the livingquarters relative to the bay and for a moreformalized means of training and informationexchange about engineering controls, shouldthey be installed at other stations.


FOREST FFIRE-FFIGHTING

NIOSH conducted five HHEs related to forestfire-fighting between 1990 and 1999. Eachyear, an estimated 80,000 wildland firefighters fight approximately 70,000 forestfires that burn an average of 2 million acresof forested land. Forest fire smoke containsa wide variety of toxic components, manyof which are pulmonary irritants, includingparticulates, formaldehyde, acetaldehyde,acrolein furfural, SO2, and acids. Wildlandfire fighters may be exposed to smoke forlong, uninterrupted periods. They typicallywork 12 hours per day, 6–7 days per week.The crew is usually transported by groundor air to and from staging areas. The dura-tion of time that a fire fighter spends in trav-el during one shift can range from minutesto hours. After arriving at the staging area,crews may spend up to several hours hik-ing before initiating line construction.

There are two distinct classifications ofwildland fires—prescribed and wildfire. Aprescribed fire is designated as such whenit is in the "prescription" of the burn. Theprescription includes a specific geographicarea and predetermined burning properties,such as flame height and fuel consumption.Conversely, a wildfire is a wildland fire thatis outside of prescription. Although thestrategies used to fight forest fires can varydramatically, the techniques used from onefire to another are basically the same. Firesuppression relies on removing one or moreof the three requirements of a fire: oxygen,fuel, and heat. For an uncontrolled fire,suppression efforts focus on removing thevegetation, which is the fuel for the fire.Procedures that remove heat and oxygenare relied on during the mop-up stage. Firefighters use hand tools to remove vegeta-tion, thus forming containment lines (alsocalled firelines). When firelines are con-structed adjacent to the fire, it is referred toas direct attack line construction. When theyare constructed at a distance from the fire,it is referred to as indirect attack. Whiledirect attack generally requires less time tocontrol the fire, it usually requires person-nel working nearer the heat and smoke. Air

attacks, i.e., the dropping of water or fireretardant from various types of aircraft, areused to slow the progress of the fire and toextinguish spot fires. To remove fuels fromareas ahead of the advancing fire, or toaffect the direction or spread of the wildfire,unburned areas of land may be ignitedintentionally within prescription. This isreferred to as burning out or backfiring.Once the fire is controlled, fire fightersbegin mop-up activities that includeextinguising the fire completely with theuse of hand tools, chain saws, dirt, andwater and may involve digging up smolderingstumps, roots, and mineral soil and fellingburning snags (a standing dead tree).

During suppression activities, a fire fightertypically wear Nomex™ pants and shirt,Vibrae-soled boots, hard hat, goggles, andleather gloves. (Nomex is a flame resistant,chemically treated material.) Some firefighters also tie a bandanna across theirnose and mouth in an attempt at respiratoryprotection. Fire-fighting crews involved inbuilding a fireline by hand consist ofapproximately 20 crew members (typically3 sawyers, 3 swampers who assist thesawyers, and the rest fire fighters who areequipped with hand tools). These crews areclassified as either Type I or Type II crews.Type I crews, also referred to as "hotshots,"are highly trained crews used primarily inhand fireline construction in direct attack.Type II crews are also used in hand firelineconstruction but are primarily relied on formop-up activities. In 1987, smoke inhalationaccounted for 38% of all reported injuriesand illnesses among all fire fighters inCalifornia. A CDHS study of 94 wildland firefighters engaged in the Klamath NationalForest fires of 1987 found that 76% reportedthree respiratory symptoms (i.e., cough,wheezing, or shortness of breath). Duringthe 1988 Yellowstone fires, 40% of theapproximately 30,000 medical visits madeby wildland fire fighters were for respiratoryproblems. This information suggests thatwildland fire fighters experience significantrates of acute smoke inhalation. Many ofthe recommendations involved improvedrespiratory protection and/or respiratorysymptom surveillance, as well as medicalsurveillance.


HETA 90�0365�2415April 1994

Requester: GovernmentPurpose: To characterize exposures andevaluate possible respiratory effects amongforest fire fightersKeywords: SIC 0851 (forestry services),forest fire-fighting, carbon monoxide, sulfurdioxide, extended work shifts, lung functiontests, breath analysis, carboxyhemoglobin,respiratory symptoms, central nervous sys-tem symptoms

Abstract: NIOSH received an HHE requestfrom the NPS to characterize exposuresand evaluate possible respiratory effectsamong forest fire fighters at the Arch RockFire in Yosemite National Park, California.On August 15–16, 1990, NIOSH conductedIH and medical surveys on fire fightersbelonging to three fire-fighting crews (twoType I and one Type II). The IH surveymeasured forest fire fighters' exposures toCO, SO2, NO2, RPM, PAHs, VOCs, aldehy-des, and acid gases. Also, samples of newand old bandannas (frequently used asrespiratory protection by the forest firefighter) were submitted for scanningelectron microscopic analysis to measurethe pore size of the fabric. The medicalsurvey evaluated cross-shift changes inlung function, CO levels in exhaled breath(to estimate the COHb level), and irritant,respiratory, or CNS symptoms during oneworkshift.

The average CO and SO2 exposure concen-trations measured in the breathing zone ofthe Pike Forest Hot Shots (fire fighters inthe Pike forest) were 18.3 and 1.4 ppm,respectively. All CO measurements werebelow the NIOSH REL, the OSHA PEL, andthe ACGIH® TLV®; however, one of six airsamples for SO2 was above the NIOSH RELof 2.0 ppm. The CO breathing zone exposureconcentrations in the Plumas Forest HotShots averaged 3.9 ppm, and the averagebreathing zone exposure level for SO2

was 1.4 ppm, with one of the five airsamples above the NIOSH REL of 2.0 ppm.NO2 was ND in the ten TWA air samplescollected in the fire fighters breathingzones. The 35 ppm CO standard may not

be appropriate for forest fire fighters. Indeveloping the REL for CO, NIOSH used theCFK equation to determine the CO exposurelevel that would result in a COHb level lessthan 5% in most workers. Some of thevariables (length of workshift, level of workactivity, and altitude) used by NIOSH in theCFK equation were adjusted by the NIOSHinvestigators in this report to betterdescribe the forest fire fighter's workenvironment. Using these new variables,the CFK equation predicts that a 5% COHblevel would be reached at an exposureconcentration of 21 ppm. Ten (30%) of thePike Hot Shots and none of the Plumas HotShots had exposures in excess of 21 ppm.Low airborne concentrations of particulate-bound acenaphthene, anthracene, andnaphthalene, and gaseous acenaphthene,anthracene, fluoranthene, andbenzo(b)fluoranthene were measured inthe breathing zones of the fire fighters. Inaddition, low airborne concentrations ofthe following aldehydes and other VOCswere measured in the fire fighters' breath-ing zones: acetaldehyde, formaldehyde,acrolein, furfural, benzene, toluene, xylene,and total hydrocarbon compounds. Theconcentrations of hydrochloric acid,sulfuric acid, and hydrofluoric acidmeasured in the air samples for acidgases were also considered to be low.The exposure levels for RPM were belowthe OSHA PEL for RPNOR of 5 mg/m3.However, the OSHA PEL for RPNOR may notbe applicable when evaluating exposuresto this particulate matter since the dustcontains particulate-bound PAHs. Scanningelectron microscope pictures of the newand old bandanna samples demonstratedthat the rectangular pore size of the fabricexceeded 100 µm in both length andwidth, which would allow both respirableand inhalable particles to pass throughthe fabric and to enter the workersrespiratory tract.

Overall, the mean cross-shift changes inlung function for the 21 participants wereas follows: -0.7% FVC, -1.2% FEV1, -0.4%FEF25-75, and -1.4% FEV1/FVC. The Type Icrews had larger declines than the Type IIcrew in all spirometric values, and thosefor FVC, FEV1, and FEV1/FVC were significantat the level of P=0.05 although each


changed by 3% or less. The Type II crewhad small cross-shift declines in FEV1,FEV1/FVC, and FEF25-75, none of whichwere statistically significant at the level ofP=0.05. The magnitude of the cross-shiftdeclines in lung function did not appear toincrease with self-reported increases inexposure. Overall the mean cross-shiftincrease in estimated COHb% was 1.4%(95% CI: 1.1%, 1.7%). Cross-shift increasein COHb% was not observed with increasingself-reported exposure to smoke. Cross-shift symptom data were available on 10participants from the Type II crew. Themost frequent respiratory symptomdeveloped during the shift was noseirritation; the most frequent CNS symptomwas headache. The occurrence of respiratoryor CNS symptoms was not associated withself-reported degree of exposure, but thevalidity of these findings is limited by thesmall number of fire fighters evaluated andself-estimates of exposure.

The NIOSH investigators concluded thata potential health hazard existed fromexposure to CO and SO2 at the Arch RockForest Fires in Yosemite National Park.Their conclusion was based on the threeCO exposure concentrations above theadjusted guideline of 21 ppm and 2 of11 exposure concentrations for SO2

above the NIOSH REL of 2.0 ppm. Therewas limited evidence of acute changes inlung function associated with activities ofType I crew members. Recommendationswere made for respiratory protection and fora respiratory surveillance program to furtherexamine the effects of forest fire-fighting onlung function.

HETA 91�0152�2140September 1991

Requester: GovernmentPurpose: To determine whether wildlandfire fighters incurred cross-season changesin lung function and respiratory symptomsKeywords: SIC 0851 (forestry services),forest fire-fighting, lung function tests,spirometry, respiratory symptoms

Abstract: NIOSH received an HHE requestfrom the NPS to evaluate the health effectsof forest fire smoke exposure among wild-land fire fighters. In response to thisrequest, NIOSH investigators conducted amedical survey of wildland fire fightersbelonging to 6 hot shot crews in the NPSand the FS on June 11–15 and onSeptember 24–28, 1990. The surveywas conducted to determine whether wild-land fire fighters incurred cross-seasonchanges in lung function and respiratorysymptoms during the 1990 fire season.During June 11–15, 1990, spirometrywas performed and a questionnaireadministered to 105 pre-season studyparticipants (representing six hot shotcrews) to establish a pre-season base-line. Post-season data were collectedSeptember 24–28, 1990, 15 weeks afterbaseline, on 78 individuals, representing74% of the pre-season participants. All78 individuals completed a post-seasonquestionnaire and were retested byspirometry. The 6 crews were divided into3 exposure categories (low, medium, high)on the basis of the total number of hoursof fighting fires weighted by a visual estimateof the intensity of smoke at each fire.Overall, the mean cross-season changesfor lung function for the 78 participantswere -0.5% (95% CI: -1.1%, 0.2%) FEV1,0.2% (95% CI: -0.5%, 0.9%) FVC, -2.3%(95% CI: -4.2%,-0.5%) FEF25-75, and -0.5%(95% CI: -1.0%, -0.1%) FEV1/FVC. Dose-related decreases in FEF25-75 and FEV1/FVCwere observed with higher exposure (testfor linearity: P=0.08 and P=0.16, respective-ly). Respiratory symptom prevalence did notincrease significantly cross-seasonally andwere not associated with exposure. Thevalidity and applicability of these findingsmay be limited by several factors,including sample size, selection biases, anda nonrepresentative fire season. On thebasis of this investigation, the NIOSHinvestigators concluded that there waslimited evidence suggesting that forest fire-fighting results in cross-season changes inlung function. A respiratory surveillanceprogram was recommended to examine thelong-term effects of forest fire-fighting onlung function.


HETA 91�0312�2185March 1992

Requester: GovernmentPurpose: To collect information about thepotential health effects from fire fighter'sexposure to smoke during fire suppressionactivities at wildland firesKeywords: SIC 0851 (forestry services),forest fire-fighting, carbon monoxide, sulfurdioxide, particulate matter

Abstract: NIOSH received an HHE requestfrom the NPS. The purpose of the requestwas to collect information about the poten-tial health effects from fire fighter's expo-sure to smoke during fire suppressionactivities at wildland fires. IH data were col-lected from July 20-22, 1991, during theThompson Creek Fire in Gallatin NationalForest. PBZ air samples were collected forCO, SO2, aldehydes, RPM and respirablecrystalline silica. The CO exposure levelsranged from ND to 17 ppm; these levelsare below the evaluation criteria used byNIOSH, OSHA, and ACGIH®. SO2 concentra-tions ranged from 0.6 to 3.0 ppm. Three ofthe 26 PBZ samples were above the evalua-tion criteria of 2.0 ppm used by NIOSH,OSHA, and ACGIH® for an 8-hour TWA.Aldehyde concentrations were an order ofmagnitude or more below the evaluationcriteria used by OSHA and ACGIH®. NIOSHconsiders acetaldehyde and formaldehydeto be potential occupational carcinogensand therefore recommends that exposuresbe reduced to the lowest feasible level. Ofthe 14 samples analyzed for respirable sili-ca, one sample was above the OSHA andACGIH® evaluation criteria for quartz.NIOSH considers silica to be a potentialoccupational carcinogen and therefore rec-ommends that exposures be reduced tothe lowest feasible level. The IH data col-lected during this survey suggested that apotential health hazard from SO2 exposureexisted during fire suppression activities.

HETA 92�0045�2260October 1992

Requester: GovernmentPurpose: To characterize fire fighters'exposures to chemical contaminants duringwildland fire suppression operationsKeywords: SIC 0851 (forestry services),forest fire-fighting, carbon monoxide, sul-fur dioxide, aldehydes, volatile organiccompounds, crystalline silica, benzene

Abstract: NIOSH received an HHE requestfrom the NPS. The purpose of the HHE wasto characterize fire fighters' exposures tochemical contaminants during fire suppres-sion operations. IH data were collected onNovember 3–4, 1991, during the GauleyMountain Fire at the New River GorgeNational River in West Virginia. PBZ and GAair samples were collected to measure air-borne concentrations of CO, SO2, aldehy-des, VOCs, RPM, crystalline silica, benzene-solubles, and PAHs. Eight-hour TWA expo-sures ranged up to 9 ppm for both CO andSO2 with average exposures of 4 and 2ppm, respectively. CO exposures were wellbelow the NIOSH REL of 35 ppm. Twenty-three of the 40 PBZ measurements of SO2

exposures were at or above the NIOSHREL of 2 ppm. Formaldehyde concentra-tions ranged up to 0.10 ppm. NIOSH con-siders formaldehyde to be a potentialoccupational carcinogen and recommendsthat exposures be reduced to the lowestfeasible level. Air concentrations of otheraldehydes detected (acetaldehyde, acrolein,and furfural) were below the MQC. VOCswere ND. Air concentrations of RPM rangedup to 1.5 mg/m3. Silica was ND. Air concen-trations of benzene solubles ranged up to0.67 mg/m3; however, PAHs were ND onthese samples. Air concentrations of naph-thalene measured from the tube portionof the PAH samples ranged up to 6.1 µg/m3.This is well below the NIOSH REL of 50 mg/m3.Concentrations of other PAHs were belowthe MQC. Results indicated that fire fighterswere overexposed to SO2 during wildfiresuppression activities. Recommendationsfor reducing SO2 exposures and forfuture collection of exposure data wereprovided.


HETA 98�0173�2872March 2000

Requester: GovernmentPurpose: To field-test a wildland fire fightersmoke exposure management and monitor-ing program outlined in earlier NationalWildfire Coordinating Group sponsoredresearchKeywords: SIC Code 0851 (forestry services)Wildland fire fighter, carbon monoxide, CO,State health department, ColoradoDepartment of Public Health andEnvironment, CDPHE, National WildfireCoordinating Group, NWCG, United StatesForestry Service, USFS, Department ofInterior, DOI, Bureau of Land Management,BLM

Abstract: NIOSH received a request from aState Department of Public Health andEnvironment to assist in a project to beconducted in cooperation with USFS andBLM personnel. The goal of the project wasto field-test the implementation of a wild-land fire-fighter smoke exposure manage-ment and monitoring program outlined inearlier NWCG sponsored research. TheDepartment also hoped to provide furtherexposure data related to fuels in areas ofthe United States, other than the PacificNorthwest where much of the previous datahad been collected. The Department askedNIOSH to train fire fighters in the use of COdosimeters during wildland fires, and toassist in data collection when the USFS andBLM conducted fire-fighting activities duringthe 1998 fire season. Four crews of wild-land fire fighters were equipped with COmonitors, related equipment for calibrationand data transfer, and training for twopeople from each crew in the use of themonitors. The fire fighters monitored COexposures from 0 to 176 hours (depend-ing upon the crew) during the fire sea-son. During 8 of the 41 monitoring periods,CO exposure concentrations exceededthe NIOSH REL of 200 ppm. During 10 ofthe 41 sessions, measured CO concentra-tions exceeded the ACGIH® excursionlimit of 125 ppm. TWA exposures were allwithin current occupational exposure lim-its. During 2 of the 41 periods (each 480

minutes in length), CO exposure concen-trations of 21 and 22 ppm were measured.These exposures approach the ACGIH®TLV® of 25 ppm. The data collected inthis evaluation indicated that wildland firefighters may be exposed to CO concentra-tions in excess of recommendedceiling/excursion limits during as much as25% of their fire-fighting efforts. This proj-ect showed that managers and safety offi-cers could establish exposure monitoringand control programs to aid in the reduc-tion of fire fighter exposures to smoke com-ponents, given the proper financial andadministrative support. Several issues need-ed further evaluation before such programscould be optimally effective. These issuesincluded availability of equipment and train-ing; consistent documentation of monitoringconditions among fire fighters; a writtensmoke exposure management plan contain-ing a response strategy when CO monitorsshould alarm; health surveillance programs;and training and tactics to minimize expo-sures.

CHEMICAL FFIRES

In the 1980s, approximately 30 HHEs wereconducted because of chemical fires, manyof which involved electrical transformers. Inthe 1990s, only six such HHEs were done,and none involved transformers. Exposuresand potential health effects will vary witheach type of chemical fire, so a standardrecommendation has been that fire fight-ers have special training and SOPs for haz-ardous materials responses.


Requester: UnionPurpose: To assess the safety and healthpractices used during a response to a fireat an illegal dump siteKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, methylene chlo-ride, dump fire

Abstract: NIOSH received an HHE requestfrom the IAFF to assess the safety andhealth practices used during a response to


a fire at an illegal dump site. The IAFFreported that more than 300 fire fightersand other response personnel wereinvolved in the incident and that approxi-mately 90 had reported chemical exposureinjuries. In response to this request, NIOSHinvestigators conducted a site visit to thecity fire department. Several meetings wereheld with representatives from several ofthe responding agencies, and a tour of thefire scene was conducted. Incident reports,air sampling results, medical records, andother pertinent reports from the respondingagencies were reviewed. A copy of the ICSwas also obtained for review. In addition,the EPA collected and analyzed samples offire fighter turnout gear to address deconta-mination issues. The results of this analysiswere provided to NIOSH for review. The firesuppression activities during this incidentwere hampered by high winds and severaldirectional wind shifts. During the incident,several fire fighters reportedly did not weartheir SCBA or depleted their supply of aircylinders. Air monitoring performed by theState Department of EnvironmentalProtection during the incident indicatedthat methylene chloride may have beenpresent in the smoke plume at concentra-tions reaching 400 ppm. Numerous firefighters were treated on-site by theresponding EMS for dizziness, mucosalirritation, and elevated blood pressure.EMS personnel also noted abnormalitiesamong several fire fighters on the field car-diac monitors. According to the EMSrecords, 171 fire fighters were transportedto 8 area hospitals, and 3 were eventuallyadmitted. However, the fire departmentreport stated that 68 fire fighters receivedincident-related injuries. Representativesfrom the responding agencies indicatedthat there were several instances of coordi-nation and communication difficulties.These difficulties led to confusion concerningincident classification (debris fire or haz-ardous materials incident) and commandstructure (single versus unified). Otherproblems encountered included theexchange of information between respondingagencies, the use of SCBAs by the firefighters, the delegation of authority todeputies in areas such as incident safety,and the establishment of a staging area.The EPA analyzed the fire fighter turnout

gear for the presence of metals, pesticides,herbicides, PCBs, dioxins, and PAHs.This analysis was performed to addressdecontamination issues; however, theresults were inconclusive. On the basisof the information obtained during thisinvestigation, the NIOSH investigators wereunable to determine a definitive environ-mental cause for the adverse health effectsexperienced by numerous fire fightersduring this incident, even though possibleacute exposures to methylene chloride mayhave been a contributing factor. However,several limitations regarding the applicationof incident command and safety proce-dures were identified. Recommendationsregarding these procedures were presentedin the report.

HETA 91�0230�2543November 1995

Requester: UnionPurpose: To evaluate the safety and healthpractices followed by county and city firedepartments in response to a chlorine leakfrom a nearby chlor alkali plantKeywords: SIC 9224 (fire departments),fire fighters, chlorine, respiratory symp-toms, police, incident command system,health effects, self-contained breathingapparatus

Abstract: NIOSH received a request for anHHE from the IAFF on behalf of membersof a county and a city fire department. Firefighters in these departments responded toa chlorine leak at a chlor alkali plant locat-ed just outside the city limits. The IAFFreported that several fire fighters whoresponded to this incident had developedrespiratory symptoms that they attributedto chlorine exposure. Three weeks after theincident, NIOSH investigators held jointmeetings with representatives from themanagement of both fire departments,the city, and the two IAFF local unions. Inaddition, separate meetings were conductedwith representatives of the county healthdistrict and the chemical plant. Privateinterviews were conducted with 10 city firefighters and the physicians who treated firefighters during and after the incident.


Information from these meetings, variousrecords, and interviews were used to recon-struct events and procedures used duringthe incident response and to reviewincident medical care and fire fightersymptoms. According to availablerecords, approximately 200 fire fighterswere involved in the response to thisemergency. Eleven fire fighters were hospi-talized or held for observation, and severalothers were reportedly injured by exposureto the chlorine. Many of the fire fighterscomplained of skin irritation and respiratorydifficulty, even though they were wearingSCBAs and structural fire fighter's protectiveclothing. Although a CAER plan had previ-ously been devised by the chemical manu-facturers at the industrial complex wherethe plant was located and the local emer-gency response units, this plan was report-edly not activated. Air monitoring per-formed by the county health district indi-cated that chlorine concentrations duringthe incident ranged from less than 0.2 to17 ppm. Because of the weather condi-tions, the chlorine plume was unpre-dictable, and the command post had to berelocated on four occasions.

Representatives from the responding agenciesindicated several instances of coordinationand communication difficulties. Reportedconcerns and problems encountered duringthe incident response included delays inthe response of the hazardous materialsteams, deployment and use of appropriatePPE, lack of a common communicationsfrequency for all participating agencies,and lack of appropriate decontaminationprocedures.

Six months following the chlorine leak,150 medical questionnaires were sent bymail to the involved police and fire depart-ments for completion by workers potential-ly exposed during the incident. NIOSHreceived a total of 59 completed question-naires: 42 from fire fighters and 17 fromindividuals other than fire fighters. Most firefighters responding to the questionnairereported inhaling chlorine gas, even thoughmost used respirators during the incident.Symptoms included coughing, tightness inthe chest, wheezing, tearing eyes, sorethroat, or headache after exposure to chlo-

rine. Among the questionnaire respon-dents, symptom occurrence and severitywere greatest among those stationed at theleak site. The duration of symptoms alsoappeared to increase with proximity to thechlorine leak. Symptom resolution wasfaster among respondents who wore respi-rators, which may suggest that the intensityof exposure experienced, the personal per-ception of respirator need, and improperrespirator use were related to symptomduration. Several fire fighters who respond-ed to this incident experienced adversehealth effects from chlorine gas exposure,including hospitalization and persistentrespiratory symptoms. Many of the firefighters complained of skin irritation andrespiratory difficulty, even though they hadworn SCBAs and their structural fire fight-er's protective gear. The questionnaire dataindicated that the duration and severity ofrespiratory symptoms tended to increasewith the proximity to the leak site, despitethe use of respirators. However, the lowresponse rate to the questionnaire surveyand potential selection biases limited theability to further generalize the question-naire data. Possible explanations for theoccurrence of symptoms included theimproper fit of, or delays in donning of,respiratory protection and the use of struc-tural fire-fighter’s protective gear instead ofappropriate chemical protective clothing.Recommendations regarding the appropriatekind of response to this type of incidentwere made.


Requester: EmployeePurpose: To investigate the circumstancesof a hazardous materials incident thatoccurred at a correctional instituteKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, chlorine, haz-ardous materials

Abstract: NIOSH DSR received a requestfrom employees to investigate the circum-stances of a hazardous materials incidentthat occurred at a correctional institute thatoperates a chemical plant on its grounds.


The local fire department had been calledto respond to a vapor cloud that resultedfrom improper mixing and storage of pow-dered laundry bleach. The fire fightersrequested technical assistance from NIOSHin reviewing both general and specificissues relating to this hazardous materialsemergency response, especially regardingICS, personnel training, chemical protectiveclothing, trained and equipped backup per-sonnel, medical evaluations, and deconta-mination procedures. NIOSH recommendedthat when chemicals are being measuredand mixed at the chemical plant, the facili-ty manager or a supervisor should alwaysbe present, that the fire department shoulddevelop written SOPs for hazardous materi-als responses, that fire fighters should bekept up-to-date for hazardous materialsresponses, and that fire fighters shouldreceive routine medical evaluations.

HETA 97�0034�2683April 1998

Requester: Joint Union and ManagementPurpose: To review fire suppression andoverhaul activities, evaluate the overallincident command structure, and investigatechemical exposures and injuries experiencedby fire fighters during a chemical ware-house fireKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, industrial fire,chemical fire, chemical warehouse, incidentcommand system, ICS, health effects, self-contained breathing apparatus, SCBA, PPE,contamination, overhaul

Abstract: NIOSH received an HHE requestfrom the local IAFF on behalf of 78 firefighters involved in a chemical warehousefire. Fire fighters dispatched to the firescene experienced chemical exposuresand injuries. NIOSH was asked to providetechnical assistance in reviewing the cir-cumstances surrounding fire suppressionand overhaul activities, to evaluate theoverall incident command structure, and toinvestigate chemical exposures and injuriesexperienced by the fire fighters. Recordswere reviewed for 19 fire fighters who expe-rienced acute health effects during and

after fire suppression; these health effectsincluded frequent headaches, chemicalburns, irritation on face and hands, nosebleeds, cough, and a metallic taste in themouth. Injuries experienced by two otherfire fighters included a fractured pelvis anda concussion. Numerous reports and notesfrom the fire department's safety andhealth office, the Fire Investigation Unit, thelocal health department, and a local hospi-tal were collected and later reviewed. Somefire fighters were interviewed (confidential-ly) in person and others were interviewedby telephone to gather additional details ofthe incident. Deficiencies that contributedto injuries and illnesses were identified.Response activities, including medical careand monitoring, were reviewed to recon-struct events both during and after thefire incident. On the basis of the informa-tion obtained and reviewed, NIOSH investi-gators concluded that a variety of acutesymptoms experienced by fire fighters wereassociated with occupational exposures inthe course of fire suppression. Skin irritationtemporarily associated with the use ofequipment previously used at the chemi-cal fire could be due to residual chemicalcontamination of the equipment.Recommendations were offered toaddress safety and health deficiencies ofthe overall ICS and activities and toimprove the medical evaluation system forthe fire fighters.


Requester: UnionPurpose: To assess the incident responseprocedures followed during a fire in arefuse waste-to-energy facilityKeywords: SIC 9224 (fire protection), firefighters, incident command system, ICS,self-contained breathing apparatus, SCBA

Abstract: NIOSH received a request from IAFFto assess the incident response proceduresfollowed during a fire in a refuse waste-to-energy facility. On December 17, 1998, theresponding fire department received areport of a fire in the refuse pit of a refusewaste-to-energy facility. The fire was


declared a hazardous materials incident asinformation became known that the firehad involved chlorine bleach cleanerwhich, according to the product's MSDS,would liberate chlorine and phosgene asdecomposition products. Fire fighters usedthe plant's showering facilities for deconta-mination purposes before all of the 37responding fire fighters were sent to areahospitals for evaluation. The IAFF indicatedthat several of the fire fighters respondingto the incident were subsequently hospital-ized due to smoke and chlorine gas inhala-tion. NIOSH investigators conducted a sitevisit in April 1999, and again in June 1999.NIOSH personnel conducted private inter-views with several fire fighters whoresponded to the incident and reviewedseveral incident-related records, includingthe department's SOPs and medicalrecords. Self-administered questionnaireswere distributed to fire fighters who werenot present on the days of the NIOSHinvestigation. In addition to the medicalinterviews and questionnaires, medicalrecords were reviewed from five hospitalswhere the fire fighters received medicalcare, and from the occupational medicineprovider. NIOSH investigators also visitedthe refuse waste-to-energy facility.

The medical survey showed that most firefighters at the scene experienced somedegree of acute upper respiratory tractirritation, and many experienced lowerrespiratory tract irritation as well. Fifteenhad persistent symptoms at 24 hours, and13 had symptoms at the time of the NIOSHinvestigation. Based on the combustion ofchlorine-containing cleaner, the fire fighters'exposures probably consisted primarily ofirritant gases, such as chlorine and nitrogentrichloride. Medical records revealed thatthe treating physicians were aware that thefire fighters were exposed to chemicals at afire and were concerned about the inhalationof toxic fumes and smoke. However, neitherfire fighters nor treating physicians knewwhat specific toxins were present. Thesymptoms of the fire fighters were consis-tent in the different hospitals; however, thediagnostic tests performed differed. Theuniversity-based hospital performed themost diagnostic tests on the fire fighters.The other hospitals performed fewer tests,

but this did not appear to result in agreater rate of adverse health outcomes.

The elements leading to the fire fighterexposures were complex and multi-factorialin nature. Clearly, fire fighters didencounter exposures to irritant gasses atthe scene. The responding fire departmentapproached the incident in fire mode, whenin fact, a hazardous materials responseapproach would have been more appropri-ate. Most fire fighters suffered irritantsymptoms that were the result of expo-sures to irritant gases. For those fire fight-ers who had recovered at the time of theNIOSH investigation or did not developsymptoms, it was unlikely that the exposurewould result in further health problems.Those who developed more significantrespiratory symptoms were being furtherevaluated by health care providers. Severalrecommendations were offered for improvingfire fighter health and safety, including rec-ommendations for better integration of firefighter medical surveillance informationwith acute care occupational medicineproviders, better PPE usage, and filling gapsin the hazardous materials response plan.

HETA 2001�0043�2844May 2001

Requester: UnionPurpose: To assess the incident responseprocedures followed during a response to aplastics recycling plantKeywords: SIC 9224 (fire protection), firefighters, plastics fire, plastic, burning carpet,burning nylon, incident command system,rehabilitation, rehab, respiratory arrest,mucous membrane irritation, respiratorysymptoms, constitutional symptoms

Abstract: NIOSH received a request to con-duct an HHE at a city fire department thathad to respond to a plastics recycling plantfire on October 1, 2000. On December11–14, 2000, NIOSH investigators traveledto the site to conduct an incident and med-ical evaluation. The incident evaluation con-sisted of surveying the remaining structuresat the fire ground, examining departmentpolicies and procedures, interviewing fire


fighters who responded to the incident, andreviewing the following records: (1)department incident reports and witnessstatements, (2) the Bureau of Alcohol,Tobacco, and Firearms report, and (3)MSDSs of the primary fuel sources. Themedical evaluation consisted of the follow-ing: (1) interviewing fire fighters whoresponded to the incident, (2) discussingthe current health and safety programwith the fire department's EmergencyMedical Services Director, (3) reviewingthe "first report of injury" forms associat-ed with this incident, (4) reviewinginjury reports from the on-sceneRehabilitation unit, (5) reviewing theresponding ambulance and medical chartfrom the one hospitalized fire fighter, and(6) reviewing exposure monitoring conduct-ed two days after the fire. The investigationrevealed the following problems during thefire: staffing shortages, communicationproblems (radios not working and missedinformation), material shortages in theRehabilitation area (air bottles and fluids),procedural deficiencies, lack of a pre-inci-dent plan, and lax observance andenforcement of SCBA use. One fire fightersuffered a life-threatening emergency(unresponsive, elevated blood pressure,rapid shallow respirations, and sinustachycardia) and other fire fighters reportedmucous membrane irritation and respiratorysymptoms consistent with, but not specificfor, exposure to burning plastic. Other thanone critical case and three less criticalcases, no other fire fighters reported per-sistent symptoms.

A combination of communication problems,staffing and material shortages, and planningand procedural deficiencies, put the healthand safety of fire fighters at risk. One firefighter suffered a life-threatening emergencyand other fire fighters reported mucousmembrane irritation and respiratorysymptoms consistent with exposure tosmoke and burning plastic. It cannot bedetermined if any long-term health effectswill result from smoke exposure at thisparticular fire. Mandatory annual medicalevaluations and periodic medical examina-tions should be implemented for the entiredepartment. Analysis of this data over timemay allow the department to determine

whether this or other large fires are asso-ciated with adverse long-term healtheffects.

COMMUNICABLE DDISEASES

Fire fighters are now often cross-trained asfirst-responders and emergency medicaltechnicians, and communicable diseaseshave become a prominent concern in thefire service. In the past decade, NIOSH con-ducted two HHEs related to fire fighters anda communicable disease. Bloodbornepathogens, particularly HCV, and TB are themost significant concerns, but fire fightershave the potential to be exposed to anycommunicable disease. Because of thenature of emergency response, typicalengineering controls are not applicable.Therefore, proper work practices andprevention strategies must be identifiedand instituted. Guidance for determiningthese strategies can be found on the OSHAand CDC websites (www.osha.gov andwww.cdc.gov) in the various documentsrelated to TB, HIV, HBV, HCV, bloodbornepathogens, and health care personnel.

Because emergency and public-safetyemployees work in environments thatprovide inherently unpredictable risks ofexposures to bloodborne pathogens, generalinfection control procedures should beadapted to these work situations. Sinceexposures are unpredictable, protectivemeasures may be warranted in situationsthat initially do not appear to present risk.Emergency and public-safety workers performtheir duties in the community underextremely variable conditions; thus, controlmeasures that are simple and uniformacross all situations have the greatest likeli-hood of worker compliance. Occupationalexposures should be considered urgentmedical concerns to ensure timely adminis-tration of postexposure prophylaxis if it isindicated. A broader overview of themodes of transmission of TB, HIV, HCV,and HBV is included in the documents listedin association with the above mentionedwebsites (www.osha.gov and www.cdc.gov).

An "emergency medical service" workermay include paramedics, fire fighters, emer-


gency medical technicians, advanced lifesupport personnel, and others performingmedical services in the field. The followingrecommendations for an emergencyresponse program were prepared based oninformation from the above listed references.

1. The program should cover all employeeswho could be reasonably anticipated,as the result of job duties, to contactblood or other potentially infectiousmaterials. Potentially infectious materialsinclude semen, vaginal secretions,cerebrospinal fluid, synovial fluid,pleural fluid, pericardial fluid, peritonealfluid, amniotic fluid, any body fluidvisibly contaminated with blood, and allbody fluids in situations where it is difficult or impossible to differentiatebetween body fluids.

2. The program should include a writtenplan that identifies tasks, procedures,and job classifications in which occupa-tional exposure to potentially infectiousmaterial occurs—without regard topersonal protective clothing andequipment. The written plan shouldaddress all aspects of the emergencymedical services infectious diseaseprogram. The plan must be accessibleto employees and employee representa-tives. The employer should review andupdate the plan at least annually—more often if necessary to accommo-date changes or recommendationsfrom appropriate agencies.

A work practices program should beestablished that includes SOPs for allactivities having the potential for expo-sure. Once these SOPs are developed,initial and periodic worker educationprograms to assure familiarity with workpractices should be provided to poten-tially exposed workers. No workershould engage in such tasks oractivities before receiving trainingpertaining to the SOPs, work practices,and protective equipment required forthat task.

3. The program should mandate universalprecautions (all persons should beassumed to be infectious for blood-borne pathogens), emphasizing

engineering and work practice controls. Washing of the skin following exposureto potentially infectious material shouldbe stressed; the program shouldinclude provision of facilities or equip-ment to be used for washing andensure that employees use them follow-ing exposure to potentially infectiousmaterial. The program should includeprocedures used to prevent needle-sticks, minimize splashing and sprayingof potentially infectious material, andensure appropriate disinfection ordisposal of contaminated clothing orequipment.

a. As a part of the program, the Cityshould provide, at no cost, andrequire employees to use, appropriatePPE such as gloves, gowns, masks,mouthpieces, and resuscitation bags.

b. All work activities should be classi-fied into one of three categories ofpotential exposure: (i) activities withdirect contact with blood or otherbody fluids to which universalprecautions apply, (ii) activitiesusually performed without exposureto potentially infectious material, butexposure may occur in emergency,and (iii) activities that do not entailexposure to blood or other potentiallyinfectious material. Employers shouldmake protective equipment availableto all workers when they are engagedin Category I or II activities.

c. Regarding personal protective orother equipment, the programshould do the following: (i) include aplan for cleaning or disposal of equip-ment or clothing that has come intocontact with blood or other potentiallyinfectious materials, identifying themethod of decontamination (ifappropriate) to be used, (ii) specifymethods for disposing of contami-nated sharps, and (iii) include a planfor use of appropriately labeledcontainers for potentially infec-tious material.

4. The program should make TB testingand HBV vaccination available to allemployees who have occupational


exposure to potentially infectiousmaterial. For personnel at ongoingrisk for exposure to blood or otherpotentially infectious material, followcurrent recommendations for postvac-cination screening.

5. The program should include a currentplan for post-exposure evaluation andfollow-up for all employees who havehad an exposure incident. Occupationalexposures should be considered urgentmedical concerns to ensure timelyadministration of postexposureprophylaxis. Studies by CDC havesuggested that the recommended HIVpost-exposure prophylaxis, whendetermined to be appropriate by aqualified physician, is most effectivewhen started within 2 hours of exposure.Employers with employees at risk ofexposure should have protocols thatpromote prompt reporting and facilitateaccess to post-exposure care. An algo-rithm is provided in CDC guidelines toguide clinicians and exposed workers indeciding when to consider post-exposure prophylaxis.

6. All laboratory tests should be conductedby an accredited laboratory at no costto the employee.

7. All laboratory tests and diagnosesshould remain confidential. That is,medical care providers should informthe Fire Department of any necessaryaccommodations or work restrictionsbut not specific test results or diagnoses.

8. The program should include trainingconcerning all aspects of the emer-gency medical services infectiousdisease program. Training shouldinclude general discussion on TB,bloodborne diseases, and their trans-mission; the written exposure controlplan; engineering and work practicecontrols; PPE; HBV vaccine; response toemergencies involving blood; how tohandle exposure incidents; the post-exposure evaluation and follow-upprogram; and signs/labels/color-codingto alert persons to potentially infectiousmaterial. There should be opportunity

for questions and answers, and thetrainer should be knowledgeable in thesubject matter.

9. The program should require that medicalrecords for each employee with occupa-tional exposure be kept according toany standards that may apply by law forthat jurisdiction, or for the duration ofemployment plus 30 years, whicheveris longer. The records should be keptin a confidential manner. Medicalrecords should be made available to thesubject employee or anyone with writtenconsent of the employee. They are notroutinely available to the employer.Training records should be maintainedfor 3 years.

HETA 95�0072March 1996

Requester: UnionPurpose: To assess the potential occupa-tional risk of TB to fire fighters in a city firedepartmentKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, Mycobacteriumtuberculosis, tuberculosis, TB, tuberculinskin test, TST

Abstract: The IAFF requested an HHE toassess the potential occupational risk of TBto fire fighters in a city fire departmentwhere 135 of 1,112 (12%) had a positiveTST between January 1990 and November1994. Since only active TB cases, not posi-tive TSTs, are reported to State healthdepartments, a background TST prevalencewas not available for the city. NIOSH inves-tigators could not determine the extent ofthe risk of occupationally acquired TBinfection among the city fire departmentpersonnel for several reasons, including thelack of a two-step TST upon first employ-ment, the lack of documentation ofnegative reaction sizes, discrepancies in atleast two employee's results, and the firedepartment's different definition of a con-version. However, it was noted that the TBprevention program had greatly improved inthe past year. Although the department's


respiratory policy was consistent with theOSHA respiratory protection standard, itrelied on individual fire fighters to deter-mine whether a situation warranted respiratoruse. Fire fighters generally did not have aclear idea of a patient's TB status, andsome were reportedly resistant to respira-tor use because of discomfort andimpaired communication with the patient.Also, no current ventilation criteria forambulances that addressed the issue ofinfectious disease transmission existed.The NIOSH investigator provided many rec-ommendations to improve the TB testingand prevention program, includingstrengthening the TB testing program,assuring effective employee training,and providing effective respiratory protec-tion procedures.

HETA 2000�0056September 2000

Requester: UnionPurpose: To assess the potential occupa-tional risk of HCV infection among fire fight-ers in a city fire departmentKeywords: SIC 9224 (fire departments),fire-fighting, fire fighters, hepatitis C, HCV,first responders, emergency medical per-sonnel, bloodborne pathogens

Abstract: The IAFF requested an HHE toassess the potential occupational risk ofHCV infection among fire fighters in a cityfire department. NIOSH investigators spokewith several union and city representatives,reviewed the fire department health andsafety records pertaining to infectiousdiseases, provided information fromcurrent literature and guidelines, and maderecommendations for updating the currentcommunicable disease program.Specific needs for such a program wereoutlined as in the introduction to this section.

OTHER

HETA 91�0370January 1992

Requester: UnionPurpose: To determine if there was anoccupational source of arsenic to which firefighters may be exposedKeywords: SIC 9224 (fire departments),arsenic

Abstract: An IAFF local requested an HHEto determine if the diagnosis of arsenic poi-soning in one fire fighter could be work-related. The NIOSH investigator (1) collect-ed background information and surfacewipe samples at the fire station and fromthe fire fighter's personal turnout gear, (2) visually inspected the fire stations, (3) interviewed the affected fire fighter, theanalytical laboratory that detected theexcess levels of arsenic, and the diagnosingphysician, and (4) obtained the most recentwater quality analysis from the city. Noarsenic sources were identified, and noarsenic was detected except for traceamounts on a wooden work bench, whichcould have originated from a variety ofsources, including treated lumber orpesticides. Since fire-fighting is not con-sidered an occupation that poses a risk ofoverexposure to arsenic and no exposuresources were identified, the NIOSH investi-gator recommended additional biologicalmonitoring to differentiate between dietaryand environmental arsenic.


HETA 99�0299January 2001

Requester: GovernmentPurpose: To provide technical assistancein evaluating potential exposure to com-bustion emissions among fire investigatorswho inspect fire scenes at buildings withCCA-treated lumber as part of theirconstructionKeywords: SIC 9224 (fire departments),arsenic, copper, chromium, chromatedcopper arsenic, CCA, treated lumber

Abstract: The Bureau of Alcohol, Tobacco,and Firearms (ATF) requested technicalassistance in evaluating potential exposureto combustion emissions among fireinvestigators who inspect fire scenes atbuildings with CCA-treated lumber as partof their construction. A fire department'sresponse to a fire usually involves threephases: suppression, overhaul, and investi-gation. After a fire fighter suppression crewhas extinguished the fire and ventilated thestructure, an overhaul crew searches forhidden fire in walls or ceilings to make surethe fire has been completely extinguished.Fire scene investigators then examine thestructure to determine the origin and causeof the fire. Typically, the same fire fighterswho suppress the fire also perform theoverhaul. Also, fire investigators aresometimes involved in the overhaul phaseto help ensure the preservation of evidence.

Combustion products typically present atfire scenes include CO, hydrogen cyanide,NOx, aldehydes, and particulates. Whilesuppression crews typically use SCBAs toprotect against respiratory hazards, manydepartments do not require their use duringoverhaul. Fire investigators rarely userespirators even though a considerableamount of smoldering debris may bepresent. CCA-treated wood is usedextensively in outdoor construction ofdecks, porches, railings, playgrounds, etc.In Hawaii, CCA-treated lumber is also usedfor interior residential and businessconstruction because of large populationsof termites in the tropical climate.Particulates containing copper, chromium,

and arsenic are emitted when CCA-treatedwood is burned.

Investigators from NIOSH and the Bureauof ATF conducted an evaluation of potentialfire fighter exposure to CCA combustionemissions. The study was conductedduring a controlled burn at a residencewith simulated CCA interior construction inconjunction with a previously scheduledATF training activity in Kinston, NorthCarolina. The structure was an 825 ft2

single family, one-story, wood frameresidence. In one 8-ft x 9-ft bedroom, fourwalls were constructed using a total of12 CCA-treated 2X4s, and six sheets ofCCA-treated ½-inch plywood. Labels on thewood indicated it was treated in October1998, by New South Inc., Conway, SouthCarolina. A small amount of leftoverCCA-treated wood was placed on a stuffedrecliner along with some straw in a cornerof the bedroom. Five to seven minutesafter the straw was ignited, the fire spreadto some foam padding under the livingroom carpet and caused the living room toflash over. The local Fire Department SafetyOfficer allowed the test bedroom to burnfor two or three minutes after the livingroom flashed over before deciding that heneeded to send in the first suppressioncrew to prevent losing the building. TheCCA-treated wood test burn was the first of4 test burns scheduled for the building.Further evaluation of CCA combustionemissions was attempted in Hawaii. An ATFinvestigator was equipped with air samplingequipment in the hopes of obtainingexposure data from actual fire scenes thatmay involve CCA-treated wood. However,because of a low number of residentialfires during the study period and problemswith the air sampling equipment, no use-able air samples were collected.

PBZ total particulate concentrationsranged from 37 to 320 mg/m3 for thesuppression and overhaul crews. Thesefire fighters wore SCBA respiratory protec-tion. The investigators were exposed to0.6 and 1.5 mg/m3 of total particulateduring their 15-minute exposure period.The OSHA 8-hour PEL for "particulates nototherwise regulated" is 15 mg/m3. Traceamounts of copper were found in one sup-


pression crew air sample, and traceamounts of chromium VI were found in thePBZ air samples of one overhaul fire fighterand one investigator. Trace levels are abovethe LOD but below the LOQ, therefore,they should be considered approximatevalues. The NIOSH 8-hour RELs for cop-per fume and Cr VI are 0.1 mg/m3 and0.001 mg/m3, respectively. Soot from thecharred CCA-treated wood contained3,500 ppm of arsenic, 5,800 ppm oftotal chromium, 2.3 ppm of Cr VI, and3,900 ppm of copper. Soot from theuntreated wood contained less than 9 ppmof arsenic, less than 2 ppm of totalchromium, approximately 0.01 ppm ofCr VI, and 4.2 ppm of copper.

The environmental sampling conductedduring this investigation indicated thatexposure to CCA contaminants among fireinvestigators did not exceed the relevantevaluation criteria. However, these resultscannot be considered representative ofpotential exposures that may be encoun-tered by investigators in actual fire scenes.The test fire in this study was quicklyextinguished and the CCA-treated woodwas not burned as extensively as what mayoccur in other situations. Also, the investi-gators' duration of exposure was shorterwith less debris being moved than the workthat often occurs at typical fire scenes.Considering the high levels of arsenic andchromium found in the bulk samples, andthe high exposure to respirable dust foundamong fire investigators during a previousNIOSH study, it was possible that exposureto airborne CCA contaminants could bemuch higher during actual fire scenes.People have been severely poisoned afterburning CCA-treated wood for indoorheating. Health problems involved theeyes, respiratory system, central nervoussystem, gastrointestinal tract, blood,reproductive system, skin, and hair.Exposure to arsenic pentoxide was thoughtto be the compound primarily responsiblefor most of the health problems. A previousNIOSH HHE documented the potential forfire investigators to also be exposed toaldehydes, cyanide, organic vapors, acids,and polynuclear aromatic hydrocarbons.Recommendations for respiratory protectionand a respiratory protection program were

provided, as well as for improving ventilationwhenever possible.

APPENDIX

In the NIOSH Alert: Preventing Injuriesand Deaths of Fire Fighters, NIOSHrecommends that fire departments take thefollowing precautions to protect fire fightersfrom injury and death:

1. Establish and implement an incident management system with written SOPs for all fire fighters. The system shouldinclude a well-coordinated approach to the emergency, accountability of all firefighters, and provisions for their overall safety at the scene of the emergency.

2. Develop and implement a writtenrespirator maintenance program for allrespiratory protective equipment usedby fire fighters. Establish service and maintenance procedures and rigidlyenforce them to provide respirators thatare dependable and are constantlyevaluated, tested, and maintained.

3. Establish and implement a system ofaccountability that will enable the commander at the scene of theemergency to account for the locationand function of each company or unitat the scene. Also use a standardpersonnel identification system thatcan rapidly account for each depart-ment member at the scene.

4. Employ a buddy system whenever firefighters wear SCBAs.

5. Provide PASS devices and ensure that firefighters wear and activate them whenthey are involved in fire-fighting, rescue,or other hazardous duties.

6. Encourage municipalities to review andamend their elevator and life safetycodes to require fire fighter control forall elevators with a total travel distancegreater than 25 feet.

7. Guard against heat stress and othermedical emergencies at the fire scene;provide cool water supplies, rest areas,and access to emergency medicalpersonnel.

NIOSH also recommends that the fire fight-ers take the following precautions to protectthemselves from injury and death:

1. Follow all established policies andprocedures.

2. Wear and activate your PASS device atthe scene of every emergency.

3. Wear the appropriate protective clothingand equipment (including your SCBA)at all incidents where hazardousatmospheres might be encountered.

4. Check your SCBA to assure that it is inworking order and has been properlymaintained.

5. Drink fluids frequently and be aware ofsigns of heat stress.

REFERENCES

1. Reichelt PA, Conrad KM [1995].Musculoskeletal injury: ergonomics andphysical fitness in fire fighters. In: Orris P,Melius J, Duffy RM, eds. Occupational med-icine: state of the art reviews: fire fighters'safety and health. Vol. 10, No. 4.Philadelphia, PA: Hanley & Belfus, Inc.,October-December, p. 735.

2. Orris P, Melius J, Duffy RM, eds. [1995].Occupational medicine: state of the artreviews: fire fighters' safety and health. Vol.10, No. 4. Philadelphia, PA: Hanley &Belfus, Inc., October-December.

3. Balwin TN (2001). Basement fires: A lethaltrap. American Fire Journal 12-16.

4. NIOSH.[1994]. NIOSH Alert: Request forAssistance in Preventing Injuries andDeaths of Fire Fighters. Cincinnati, OH:U.S. Department of Health and HumanServices, Public Health Service, Centers forDisease Control and Prevention, NationalInstitute for Occupational Safety andHealth, DHHS (NIOSH) Publication No. 94-125.

5. ILO [1983]. Todradze C, Diesel engines,underground use of. In: Encyclopedia ofoccupational health and safety. Vol. I/a-k.Geneva, Switzerland: International LabourOffice.

6. NIOSH [1988]. Current intelligence bulletin50: carcinogenic effects of exposure todiesel exhaust. Cincinnati, OH: U.S.Department of Health and HumanServices, Public Health Service, Centers forDisease Control, National Institute forOccupational Safety and Health, DHHS(NIOSH) Publication No. 88-116.

7. Garshick E, Schenker MB, Munoz A, SegalM, Smith TJ, Woskie SR, Hammond SK,Speizer FE [1987]. A case-control study oflung cancer and diesel exhaust exposurein railroad workers. Am Rev Respir Dis135(6):1242-1248.

8. ACGIH [2001]. Threshold limit values andbiological exposure indices for chemicalsubstances and physical agents, dieselexhaust (measured as elemental carbon).Cincinnati, OH: American Conference ofGovernmental Industrial Hygienists.

9. Gamble J, Jones W, Mishall S [1987].Epidemiological-environmental study ofdiesel bus garage workers: acute effects ofNO2 and respirable particulate on the res-piratory system. Env Res 42(1):201-214.

10. Reger R, Hancock J [1980]. Coal minersexposed to diesel exhaust emissions. In:Rom W, Archer V, eds. Health implicationsof new energy technologies. Ann Arbor, MI:Ann Arbor Science Publishers, Inc., pp.212-231.

11. Ulfvarson U, Alexandersson R [1990].Reduction in adverse effect on pulmonaryfunction after exposure to filtered dieselexhaust. Am J Ind Med 17(3):341-347.

12. Birch, ME, Cary, RA [1996]. Elemental car-bon-based method for monitoring occupa-tional exposures to particulate dieselexhaust. Aerosol Sci Technol 25:221-241.

13. Zaebst D, Clapp D, Blade L, Marlow D,Steenland K, Hornung R, Scheutzle D,Butler J [1991]. Quantitative determinationof trucking industry workers' exposure todiesel exhaust particles. Am Ind Hyg AssocJ 52(12):529-541.


A Summary of Health Hazard Evaluations - Fire Scene Safety

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