Firefighter Health and Safety Research Presentation for web

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Slide 1: 

Jim Brown, PhD, Director Firefighter Health & Safety Research Program Indiana University School of KinesiologyGary Coons, EFO, CFPE, CFI, & Founder Firefighters with Parkinson’s Disease Foundation Richard Nass, PhD, Associate Professor Department of Pharmacology and Toxicology Center for Environmental Health - Stark Neuroscience Research Institute Indiana University School of Medicine

Gary Coons Story : 

Gary Coons Story Gary Coons was a career firefighter for 15 years before being medically pensioned with a line-of-duty injury. In 2005, he went through a series of surgeries to repair his shoulder and back damage related to his line-of-duty injuries. During this time, his wife stated that she started noticing symptoms related to an overall slowness in his demeanor, leg tremors while at rest, blank stares, and stooped over walking. At the same time he was aware of an increased stiffness and pain in his shoulder and lower extremities, smaller hand writing, and soft speaking. They both related these symptoms to his injuries and sought medical help from multiple physicians over a two year period. The doctors offered therapies to mitigate the symptoms and did not relate these complications to a more complex neurological disease.

Gary Coons Story Continued : 

Gary Coons Story Continued Within this two year period, the symptoms were getting worse and his right arm and hand started to tremor, he was stuttering, and developed impaired fine motor dexterity and coordination. They then decided to seek out a neurologist, who conducted several test and medication trials over 6 months resulting in a diagnosis of early onset Parkinson’s Disease at the age of 33

Gary Coons’ Life Sentence with Parkinson’s Disease : 

Gary Coons’ Life Sentence with Parkinson’s Disease When my brain feels that I am awake Neurons fire off and it is hard telling what I will be able to control and not control. People with Parkinson’s Disease Live for the moment, we are not sure what the next moment will bring. My feet are curled in and cramped due to what is called Dystonia most morings. Medications Requip Azliect Tramadol Diazepam Co-Q 10 Propranolol - Inderal Artane Gary Coons: “This disease might have changed my life, but it will not take my life.”

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Are American firefighters being poisoned unknowingly during the performance of their fire suppression and rescue duties? Recent findings illustrate that firefighters are in fact frequently be exposed, sometimes unknowingly, to a dangerous toxins like: Cyanide, low level to high level Carbon Monoxide, N-Hexane, Toluene, any many others. How many times have firefighters seen their colleagues on building roofs ventilating in heavy smoke or performing overhaul functions in smoldering fire debris without self-contained breathing apparatus (SCBA)?

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Fire Fighters are regularly exposed to burning chemicals and other toxins. There are 70,000 toxic substances on file with the Environmental Protection Agency (EPA) in the United States. In reality, when these substances burn together, there are 70 million possible combinations that are created in a fire. Routinely, exposures to these burning and non-burning toxins occur during the “Overhaul” phase of a fire or Hazardous Materials Incident.

Parkinson’s Disease : 

Parkinson’s Disease Neurotoxic chemicals are suspected of causing apoptosis or cell suicide in the substantia nigra (where dopamine is produced), a form of cell death in which cells shrink and disappear permanently. The chances of anyone having early onset Parkinson's Disease at this age are less than 1 in 100,000, making it a rare medical disorder, and therefore more likely to be the result of “unusual circumstances.” A toxic exposure is one of the “unusual circumstances” that can trigger Parkinson’s Disease.

Research on Prevalence : 

Research on Prevalence A study conducted by the Neurotoxin Institute indicated that Parkinson's Disease was significantly more common in fire fighters than in the general population. This was demonstrated by a finding of 3-4 cases per 1,000 in the general population compared to 30 Parkinson's cases per 1,000 firefighters. Minerbo GM, Jankovic J. Prevalence of Parkinson's disease among firefighters. Presented at the 42nd Annual Meeting of the AAN, Miami, 5/4/90, Neurology (Suppl. 1) 1990;40:348.

Hydrogen Cyanide : 

Hydrogen Cyanide Toxicity varies with chemical form. Hydrogen cyanide (HCN) gas at concentrations of 130 ppm can be fatal within an hour. OSHA permissible exposure levels are 10 ppm as an 8-hour time-weighted average.

Carbon Monoxide : 

Carbon Monoxide CO poisoning actually very complex. CO binds to hemoglobin with an affinity ~ 250 times that of oxygen. The combination of CO and hemoglobin is called carboxyhemoglobin (CO-Hb).

Carbon Monoxide : 

Carbon Monoxide 46-year-old woman with chronic exposure to CO. CO-Hb = 46% Immediate cause of death: ventricular fibrillation due to cardiac hypoxia. CO Normal

MANGANESE : 

MANGANESE Overexposure to Mn can cause the neurological disorder Parkinsonism, and has been implicated as an environmental toxicant that may contribute to the development of PD. Both disorders share a number of clinical and pathophysiological features that includes motor deficits, DA neuronal damage, and mitochondria dysfunction, which suggests that there may be overlapping modalities and molecular pathways that contribute to the pathologies.

Essential Records Could Mean Life or Death for First Responders : 

Essential Records Could Mean Life or Death for First Responders When Capt. Ed Stahley turned green after battling an industrial fire in 1987 in his hometown of Kitchener, Ontario, his colleagues joked that he looked like Kermit the Frog. But firefighter the joke turned deadly when Stahley died of liver cancer in 1990. Within seven years, 23 of the 69 firefighters who responded to the Kitchener blaze developed cancer or Parkinson's disease. "The firefighters," said The Ottawa Citizen, "had no idea what was burning" when they arrived at the plant that manufactured floral foam. First responders depend on accurate information -- much of it contained in essential records -- to protect their health and lives during disaster response. Subject :23 of 69 Firefighters Developed Cancer or Parkinson's Disease - Floral Foam Fire :For more information about the Horticultural Fire

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Environmental Pollution of Foods Spills & Water Exposures (neurotoxic chemicals and micro-organisms) Head Trauma Agricultural Chemicals and Pesticides PCBs Airborne Contaminants Neurotoxic – Trauma PD Risks are common in firefighter’s life • Neurotoxic Chemicals • Neurotropic Viruses • Ionizing Radiation Environments contain physical and material hazards that intensify or modulate risks to firefighter health & performance

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Neurotoxin Exposure Trauma Parkinson’s Prevention Treatment Research Initiative (NETPPTRI) Firefighters with Parkinson’s Disease Telemedicine and Advanced Technology Research Support of adding firefighters to the:

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Focused Research on Firefighters NETPPTRI research identifies effects of operational hazards and provides the basis for strategies to sustain and enhance health and performance. Firefighting Mission Oriented PARKINSON’S Treatment Oriented Research to: Maintain or improve Health & performance In operational and training environments Research to: Improve quality of life, Halt progression of the disease, & advance a cure

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The fire service are firmly rooted in the principles and practices of risk management beginning with a thorough risk assessment of the communities they serve. The risk management approach also drives and shapes all fire department operations, practices and policies. As with the communities they serve fire departments use their risk analysis related to their personnel to minimize risk and optimize safety and health. Fire departments are continually looking for and deploying technologies to improve firefighter performance and safety including the use of a personal protective equipment and enhanced “on-scene” management practices.

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Fire departments have been paying considerable attention over the last 30 years to the immediate and long-term impacts of firefighting to health and welfare of firefighters. The evidence continues to point to exposures of firefighters on emergency incidents as a prime cause of early death, chronic illness and increased incidence of health problems such as heart/lung and neurological disease.

Problem Statement : 

Problem Statement Firefighters may be at risk for neurodegenerative diseases from occupational exposures to psychological stress, toxic industrial and agricultural chemicals, chemical threat agents, head injury, and even radiofrequency radiation. Parkinson’s Disease (PD), as a particularly relevant disorder induced by a variety of environmental exposures, is a central focus of the research program. Is there something about firefighting that causes or promotes the development of neurological disease? Although we cannot answer definitively yet, the answer is almost assuredly, yes!

Slide 21: 

Direction towards the Future Design prospective studies to ID molecular markers for identification of at-risk individuals within Public Safety. Everyone has a Predisposition. As to what that is, research is still being completed. Predisposition among individuals loads the gun, the exposure or lack life style change can pull the trigger. Develop and disseminate accessible, validated, diagnostic tools for determination of at risk individuals in Public Safety. Right now we can’t control what is burning and being produced (or in others the trials we face), we can control how we will protect our self from having the triggered pulled on us. Develop procedures to correlate environmental impacts with epigenetic control mechanisms for better protection.

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I

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C. elegans: A Model Dopamine Neuronal System for PD Biochemistry and Neurotoxins On the cellular and molecular level, the dopamine neurons of C. elegans recapitulate the characteristics of mammalian dopamine neurons. But unlike vertebrates, which contain tens of thousands of dopamine neurons in the mid brain, the hermaphroditic C. elegans organism contains only eight dopamine neurons, thereby simplifying a wide array of investigations.

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Research Application PARKINSON’S RESEARCH ENVIRONMENTAL EXPOSURES EARLY DIAGNOSIS AND PROGNOSIS METHODS NEUROPROTECTANTS AND TREATMENTS Determine Risk for Disease and Progression of the Disease Exploit Symptom Mechanisms for Early Diagnostic Markers Identify and Validate Neuroprotectants, Therapeutics & Ways to Reduce or Remove Symptom Effects FIREFIGHTING APPLICATIONS CRITERIA AND METHODS FOR OPERATIONAL RISK ASSESSMENT EARLY DETECTION METHODS FOR THREATS TO PERFORMANCE TREATMENTS FOR NEUROLOGICAL INJURY AND PREVENTIVE METHODS

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RESEARCH PROGRAM GOALS The primary goal of the research program is to establish essential fire ground monitoring practices as well as develop guidelines for the use of the self contained breathing apparatus (SCBA) to prevent fire ground toxic gas exposure. To reach these long term goals, we propose a series of research studies that will culminate in the development of new standards and guidelines for monitoring the fire ground gas environment as well as firefighters on scene.

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Program Phase 1: Pilot Study The goal of the pilot study program is to develop protocols necessary to effectively monitor a fire event. Utilizing local assists (Carmel and Indianapolis Fire Departments); we are able to test data collection methodologies during acquired structures burns. Program Phase 2: Investigation and Validation of fire ground monitoring technology The goal of this portion of the program is to investigate currently available technologies for the monitoring of fire ground air quality. In addition, we will be looking at technologies currently (and soon to be) available for the detection of neurotoxins within the human body. Although it is the goal of the program to help prevent exposure and uptake of toxic gases by firefighters, it is essential that we are able to detect environmental and blood levels to evaluate preventative strategies.

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Program Phase 3: Fire Scene gas evolution survey This tightly controlled program phase will involve the construction of test structures which will be burned to measure the evolution and movement of toxic gases in and around a burning structure. Using the protocols and technologies developed in earlier work, this study phase will involve the quantification of off gassed compounds and the tracking of these combustion products on the fire ground. This portion of the study will form the basis of real world fire scene monitoring guidelines. Program Phase 4: Real World practices The final experimental phase of the study will move to the street. By accompanying Indianapolis Fire Department companies to fire scenes, we will test our newly developed protocols for monitoring fire scenes and firefighters. Program Phase 5: Information Dissemination An essential element for this work will be the dissemination of study-derived information to the fire service. We will utilize multiple media forms (audio, video, print, web sites etc) to distribute this information to the fire service.

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Prevention and Early Intervention Strategies Intervention at the company level is most effective for development of Good, Better, Best Paradigm shift for safer work environments Personal Protective Gear and SCBA Exercise – Rock Steady Boxing NEUROPROTECTION Lifestyle effects (eating, smoking, and etc.) Fire Scene Best Practices On scene monitoring of toxins What Toxins did we monitor before taking Off the SCBAs? Lessons Learned INTERVENTION STRATEGIES

Slide 30: 

THANK YOU!

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