FIP Investigation #1
Firefighter Suffered respiratory Arrest As A Result of Smoke Inhalation
To:
Division of Safety Research, National Institute for Occupational Safety and Health
From:
Firefighter Injury Project (FIP), New Jersey Department of Health (NJDOH)
Subject:
Firefighter Suffered Respiratory Arrest As A Result of Smoke Inhalation, Firefighter Injury Investigation #1
Summary
On November 26, 1996, a 33-year-old firefighter suffered respiratory arrest, which quickly progressed into cardiac arrest, while assisting in the search for the source of smoke in an abandoned industrial building. Two additional firefighters reported having respiratory complaints at the scene. A total of sixteen firefighters and two emergency medical service (EMS) workers were also evaluated at a hospital emergency room. The source of the smoke was smoldering copper wire insulation in a steel drum.
New Jersey Department of Health (NJDOH) Firefighter Injury Project (FIP) investigators concluded that in order to prevent similar incidents in the future, the following safety guidelines should be followed:
- Fire departments should ensure that self-contained breathing apparatus (SCBA) are worn whenever firefighters are engaged in interior structural firefighting, during emergency situations involving toxic substances, and during all phases of firefighting and overhaul.
- Firefighters should be routinely re-trained to be aware of the potential of encountering toxic materials in industrial buildings.
- Supervisory personnel must set the example by wearing their SCBA and should also enforce standard operating procedures.
Introduction
On November 27, 1996, NJDOH FIP personnel were notified of this work-related injury by a phone call from a representative with the New Jersey Department of Community Affairs (NJDCA), Division of Fire Safety. On December 4, 1996, FIP investigators accompanied a NJDCA investigator and a NJDOH, Public Employees Occupational Safety and Health (PEOSH) Program compliance officer on a joint inspection at the fire department headquarters.
The employer was a municipal paid fire department (with no volunteers) that covered a city-industrialized area of 8.5 square miles with a population of 140,800. The department's 250 firefighters were divided among seven fire stations. The department's command structure included 1 department chief, 6 deputy chiefs, and 13 battalion chiefs. The department answered 5,444 calls in 1995. Personnel assigned to fire suppression duties work a 42 hour week broken into 24 hour shifts, changing shifts at 8:00AM.
The department had an extensive written training program and a department training officer. Training for new recruits was provided by the city fire department which included a NJDCA approved "Firefighter 1" course. The NJDCA approved course is a minimum of 82 hours of classroom and hands-on instruction. Topics covered by the course include subjects such as common firefighter occupational injuries, SCBA use, and safety at fire scenes related to toxic gas and respiratory protection. In addition, firefighters were provided with specialized training in such areas as hazardous materials, employee right to know, firefighter strategy and tactics, and cardiopulmonary resuscitation (CPR).
Interviews were conducted with employer representatives and two firefighters (firefighter #1 and firefighter #2) who were injured at the scene. According to medical records, firefighter #1 had suffered respiratory arrest which progressed into cardiac arrest. He was a 33-year-old male firefighter who had been with the department since January 1996 (approximately eleven months). He attended the 90 hour "Firefighter #1" course prior to being assigned to active duty. He reportedly had no prior serious health conditions. Firefighter #2 was a 32-year old male with ten years of service. Firefighter #3, who also experienced respiratory distress at the scene, provided a written description of the incident. He was a 33-year old male with about five years of firefighting experience.
The SCBAs utilized by firefighter #1 and firefighter #2 were examined by the NJDCA investigator. FIP investigators were present during the interviews, photographed and visited the incident site, reviewed medical records, training records and department standard operating procedures (SOP).
Investigation
On November 26, 1996, a first fire alarm sounded at 2:46 p.m., in response to a report of smoke emanating from a building. The building was located in an old industrialized section of the city and was formerly a dye company which abandoned the building about five years prior to this incident. The brick and wood beam four story building covered an entire city block. One firefighter reported that the fire department had responded to other calls concerning this building in the past. At least one call to the building was caused by homeless people burning trash for warmth.
At the time of the incident, the weather was calm with a misty rain. On the first alarm, an engine and a ladder truck arrived simultaneously at 2:54p.m.. Several firefighters stated they had put on full turn-out gear at the station including their SCBA, letting their mask hang from their shoulders. The vehicles were staffed with a normal number of firefighters. Engines were staffed with one captain and four firefighters; ladder trucks were staffed with one captain and four or five firefighters. Upon arrival at the fire scene, it was found that the ground level doors closest to the smoke had sheets of plywood nailed over the doorways. Some of the firefighters attempted to forcibly remove the plywood. At the same time, another firefighter made entry into another ground level doorway, opened the plywood covered doorway from the inside, which allowed entry into the first level of the building. The firefighter who opened the doorway did not have his SCBA on. He reported feeling an acrid "bite" when he breathed in the smoke.
At this point, the firefighters entered the ground level of the building. They encountered a light white-gray smoke that was suspended about two feet from the ceiling. Visibility was generally good. No one, including the incident commander, was using a SCBA. After searching for the source of the smoke on the ground floor level, the firefighters were ordered to go up to the next level. As firefighter #1 ascended carrying a 1 3/4 inch hoseline up a ramp to the second level, he realized the smoke was getting heavier. He reported that he took off his helmet and put on his SCBA mask. At the top of the ramp he was ordered to wait by the incident commander. The smoke had become deep gray, heavier, and was four to five feet above the floor on this second level of the building. While waiting for further orders, he saw two fellow firefighters who appeared to be in distress. Firefighter # 1 reported seeing firefighter #2 pulling off his mask, and firefighter #3 sweating profusely and not wearing his mask. Both were at an open window trying to get fresh air to breathe. Firefighter #1 said he sensed something was wrong and removed his mask to talk with the two men in distress. Immediately he began to have difficulty breathing. He said it was "like something was pushing in on my chest." He held his mask to his face, which he thought made him feel worse, and ran down the ramp. He felt he couldn't breathe and had chest pain and pressure. When he got out of the building, he collapsed. No more than four minutes had elapsed since he entered the building.
During this time, two EMS units had also responded to the fire scene: one basic life support unit and one advanced life support unit. EMTs immediately began to work on firefighter #1 after he collapsed at 3:08 p.m.. Oxygen was administered, but his condition rapidly deteriorated. According to the EMS medical reports, his respiratory distress quickly escalated into respiratory arrest which progressed into cardiac arrest. He was intubated, given drugs intravenously, and CPR. There was spontaneous resumption of his heart beat two minutes later. He was taken to a local general hospital where he was kept in the intensive care unit for 24 hours and then released.
Firefighter #2 had also entered the building without using his SCBA until he encountered smoke going up the ramp to the second level. Before he went on air, he was having trouble breathing. He continued into the building for a few minutes when he became nauseated and pulled off his mask for fear of vomiting into the mask. It was at this point that firefighter #1 saw him in distress. Firefighter #2 went to an open window to get some fresh air and then exited the building where his condition improved. EMTs evaluated his condition and sent him to a hospital emergency room for further evaluation. He was subsequently released.
Firefighter #3 did not use his SCBA until he encountered moderate smoke. When he was told that the fire in a barrel was extinguished and the smoke began to lift, he took off his mask. As he walked deeper into the building, he began to have respiratory difficulties and a burning sensation in his throat, according to the EMS report. Oxygen was administered at the scene and on route to the local hospital emergency room where he was treated and subsequently released.
EMS workers evaluated all emergency response personnel for anoxia (oxygen deficiency) and lung sounds at the scene. Out of the thirty-four firefighters on the scene, eighteen were sent to the emergency room at a local hospital emergency room for further evaluation, and were subsequently released. This included two emergency medical service workers who complained of a burning sensation on their hands after removing firefighter #1's boots.
The source of the smoke was a thirty gallon steel drum that contained smoldering copper wire coated with insulation. Burning off the insulation is a method used to reclaim the copper in order to sell it. It appears that inhalation of toxic substances produced from the smoldering insulation caused the firefighters injuries. Polyvinyl chloride (PVC) is commonly used for wire insulation. Hydrogen chloride is frequently generated in fires involving PVCs which when inhaled dissolves on the moist mucous membranes to form hydrochloric acid, a corrosive irritant. Exposure to hydrogen chloride can cause burning of the eyes and throat and may produce edema of the glottis, acute bronchitis, pulmonary edema and death.
The NJDCA investigator inspected the SCBA units used by firefighters #1 and #2. He concluded that little or no air was used based on the amount of air remaining in their tanks.
Recommendations and Discussion
Recommendation #1:
Fire departments should ensure that SCBA's are worn whenever firefighters are engaged in interior structural firefighting, during emergency situations involving toxic substances, and during all phases of firefighting and overhaul.
Discussion: None of the firefighters entered the building using their SCBAs. Some firefighters did not turn on their SCBAs until encountering moderate smoke, and then they removed their masks when the smoke was subsiding. The department had a SOP requiring the use of SCBA's for interior fires.
All firefighters must assume that the atmosphere inside smokey/burning buildings are immediately dangerous to life or health (IDLH). Even after the fire is under control, high concentrations of toxic substances may be present. It is important that firefighters use their SCBAs unless the incident commander advises them that it is safe to discontinue their use. These hazards are addressed in the New Jersey Public Employees Occupational Safety and Health, Standards for Firefighters, N.J.A.C. 12:100-10.10(c) which requires that SCBAs be worn at all times while engaged in interior structural firefighting, during emergency situations involving toxic substances, and during all phases of firefighting and overhaul.
Recommendation #2:
Firefighters should be routinely re-trained to be aware of the potential of encountering toxic materials in industrial buildings.
Discussion: There is always the potential of encountering toxic substances in occupied and abandoned industrial sites. This building had been abandoned approximately five years prior to this incident and was clearly labeled on the side of the a building as a dye house.
Recommendation #3:
Supervisory personnel must set the example by wearing their SCBAs and they should enforce standard operating procedures.
Discussion:SCBAs were not utilized by superiors when entering the smoky building. This sets a poor example to firefighters who go through extensive training in respiratory protection in the Firefighter I training course. The department's SOP for the use of respiratory protection should be enforced for all firefighters involved in all phases of firefighting and overhaul while engaged in interior structural firefighting.
References
- Firefighting in New Jersey Hazards and Methods of Control: Occupational Health Service, New Jersey Department of Health, June 1983.
- Guidelines for the Emergency Management of Firefighters: Occupational Health Service, New Jersey Department of Health, December 1992.
Attachments
- Hydrogen Chloride: New Jersey Department of Health, Hazardous Substance Fact Sheet; NJDOH, Right to Know Program, CN 368, Trenton, NJ.
- NIOSH Fire Fighter Health Hazard Evaluations: International Association of Fire Fighters, Department of Occupational Health and Safety.
- Request for Assistance in Preventing Injuries and Deaths of Fire Fighters, Alert: Centers for Disease Control and Prevention, September 1994.
