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To the Editor:
Firefighters have an elevated risk of injuries compared with other occupational groups.1 These injuries may occur during fireground operations, other on duty operations, responding/returning from an accident, training activities, and nonfire emergency incidents.2 In 2014, there were over 1.1 million career and volunteer firefighters in the United States (US).3 That same year, an estimated 63,350 injuries among firefighters occurred in the line of duty.2 According to the National Fire Protection Association, the most common causes of injuries among firefighters are fall, jump, or slip (29%) followed by overexertion or strain (25%), contact with object (11%), exposure to fire products (9%), struck by an object (6%), extreme weather (3%), exposure to chemicals or radiation (3%), and other (14%).2
Firefighters may be particularly at risk of exposure to potentially hazardous substances. They are often first to arrive at an emergency event and may be exposed before exposure hazards have been identified. Also, firefighters’ gear may not protect them from exposures to all substances.4 Exposures to potentially hazardous substances account for a small proportion of the total injuries to firefighters.5–7 Studies describing the sort of potentially hazardous substances firefighter encounter and the outcome of such exposures are limited.
The Texas Poison Center Network (TPCN) is a telephone consultation service that assists in the management of potentially adverse exposures to a wide variety of exposures, including those related to occupation or workplace. The TPCN consists of the six poison centers that together service the entire state, which has a current population of over 25 million. According to the US Department of Labor, Bureau of Labor Statistics, in May 2015, Texas had 27,890 employed firefighters, second only to California.8 This does not include the number of volunteer firefighters in the state.
During 2003 to 2015, the TPCN received 202 calls about firefighter exposures to potentially hazardous substances. These exposures occurred in 158 separate events—141 involving a single firefighter and 17 involving multiple firefighters (61 or 30.2% of total firefighters). The most common substances were pesticides (n = 57, 28%), chemicals (n = 46, 23%), hydrocarbons (n = 40, 20%), and fumes/gases/vapors (n = 34, 17%).
For the 136 firefighters with a known age, the mean age was 35 years (range 17 to 68 years). Males accounted for 194 (96%) of the patients. The majority (n = 195, 97%) of the exposures were unintentional. The most frequent exposure routes were inhalation (n = 130, 64%), dermal contact (n = 44, 22%), ocular (n = 32, 16%), and ingestion (n = 23, 11%).
The management site was 118 (58%) already at or en route to a health care facility, 63 (31%) on site, and 17 (8%) referred to a health care facility. The exposure was considered to be serious in 46 (23%) of the cases.
These data suggest that relatively few firefighter exposures to potentially hazardous substances were reported to the TPCN. The reported exposures most often involved pesticides, chemicals, hydrocarbons, and fumes or gases and occurred by inhalation followed by dermal contact, ocular, and ingestion. Although most of the exposures were not serious, the patients tended to be managed at a health care facility. In an effort to reduce the exposures to potentially hazardous substances among firefighters, efforts might be made to ensure that firefighters are educated regarding the various sorts of exposure hazards they might encounter. Although firefighters already consult with poison centers for the management of potentially hazardous exposures to themselves as well as others, it may be useful to explore closer working relationships between the poison centers and firefighters.
1. Leigh JP, Miller TR. Ranking occupations based upon the costs of job-related injuries and diseases. J Occup Environ Med
2. Haynes HJ, Molis JL. U.S. Firefighter Injuries: 2014. National Fire Protection Association, Quincy, Massachusetts, US, 2015. Available at: http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/the-fire-service/fatalities-and-injuries/firefighter-injuries-in-the-united-states
. Accessed August 24, 2016.
3. Haynes HJ, Stein GP. U.S. Fire Department Profile: 2014. National Fire Protection Association, Quincy, Massachusetts, US, 2016. Available at: http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/the-fire-service/administration/us-fire-department-profile
. Accessed August 24, 2016.
4. Calvert GM, Barnett M, Mehler LN, et al. Acute pesticide-related illness among emergency responders, 1993-2002. Am J Ind Med
5. Britton C, Lynch CF, Ramirez M, Torner J, Buresh C, Peek-Asa C. Epidemiology of injuries to wildland firefighters. Am J Emerg Med
6. Poplin GS, Harris RB, Pollack KM, Peate WF, Burgess JL. Beyond the fireground: injuries in the fire service. Inj Prev
7. Hong O, Chin DL, Phelps S, Feld J, Vogel S. Occupational injuries, duty status, and factors associated with injuries among firefighters. Workplace Health Saf
8. Bureau of Labor Statistics. Occupational Employment Statistics. Occupational Employment and Wages, May 2015. 33-2011 Firefighters. United States Department of Labor, 2016. Available at: http://www.bls.gov/oes/current/oes332011.htm
. Accessed August 24, 2016.