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HHE Report No. HETA-2018-0154-3361, Evaluation of Rhabdomyolysis and Heat Stroke in Structural Firefighter Cadets

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HHE Report No. HETA-2018-0154-3361, Evaluation of Rhabdomyolysis and Heat Stroke in Structural Firefighter Cadets Evaluation of Rhabdomyolysis and Heat Stroke in Structural Firefighter Cadets HHE Report No. 2018-0154-3361 November 2019 Authors: Judith Eisenberg, MD, MS Jessica F. Li, MSPH Karl D. Feldmann, MS, CIH Desktop Publisher: Jennifer Tyrawski Editor: Cheryl Hamilton Logistics: Donnie Booher, Kevin Moore Medical Field Assistance: Nonita Dhirar Data Support: Hannah Echt Keywords: North American Industry Classification System (NAICS) 922160 (Fire Protection), Structural Firefighter Training, Structural Firefighter Cadet Course, Heat, Heat-Related Illness, Heat Stroke, Rhabdomyolysis, Texas Disclaimer The Health Hazard Evaluation Program investigates possible health hazards in the workplace under the authority of the Occupational Safety and Health Act of 1970 [29 USC 669a(6)]. The Health Hazard Evaluation Program also provides, upon request, technical assistance to federal, state, and local agencies to investigate occupational health hazards and to prevent occupational disease or injury. Regulations guiding the Program can be found in Title 42, Code of Federal Regulations, Part 85; Requests for Health Hazard Evaluations [42 CFR Part 85]. Availability of Report Copies of this report have been sent to the employer, employees, and union at the plant. The state and local health departments and the Occupational Safety and Health Administration Regional Office have also received a copy. This report is not copyrighted and may be freely reproduced. Recommended Citation NIOSH [2019]. Evaluation of rhabdomyolysis and heat stroke in structural firefighter cadets. By Eisenberg J, Li JF, Feldmann KD. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health Hazard Evaluation Report 2018-0154-3361, https://www.cdc.gov/niosh/hhe/reports/pdfs/2018-0154-3361.pdf. Table of Contents Main Report Introduction ....................................................................................................................................................... 1 Our Approach ................................................................................................................................................... 1 Our Key Findings .............................................................................................................................................. 2 Our Recommendations .................................................................................................................................... 3 Supporting Technical Information Section A: Background Information ......................................................................................................... A-1 Incident Summary .................................................................................................................................... A-1 Training Facility and Course Information ............................................................................................ A-1 Section B: Methods, Results, and Discussion .......................................................................................... B-1 Methods: Review of the Incident From June 2018 ............................................................................. B-1 Results: Review of the Incident From June 2018 ................................................................................ B-2 Methods: Additional Document Review .............................................................................................. B-3 Results: Additional Document Review ................................................................................................. B-3 Methods: Environmental Conditions During Site Visit ..................................................................... B-5 Results: Environmental Conditions During Site Visit ........................................................................ B-5 Other Observations ................................................................................................................................. B-6 Methods: Knowledge Assessment ......................................................................................................... B-7 Results: Knowledge Assessment ............................................................................................................ B-7 Methods: Cadet Admissions Process Review ....................................................................................... B-8 Results: Cadet Admissions Process Review ......................................................................................... B-8 Discussion ................................................................................................................................................. B-8 Limitations ............................................................................................................................................... B-13 Conclusions ............................................................................................................................................. B-13 Section C: Tables .......................................................................................................................................... C-1 Section D: Occupational Exposure Limits ............................................................................................... D-1 Heat Stress ................................................................................................................................................ D-2 Heat Strain ................................................................................................................................................ D-3 Acclimatization ........................................................................................................................................ D-4 Rhabdomyolysis ....................................................................................................................................... D-4 Section E: Heat Stroke and Rhabdomyolysis Knowledge Assessment ................................................ E-1 Section F: References.................................................................................................................................... F-1 This page left intentionally blank Introduction Request A representative of a city-operated structural firefighter cadet training program requested a health hazard evaluation concerning heat-related (HRI) illness and rhabdomyolysis among cadets. The request was prompted by the death of one cadet and the hospitalization of another in the same class for heat stroke and rhabdomyolysis. Both cadets became ill on the first day of the training course. Workplace Cadet training consisted of the following components: • Indoor classroom lectures • Indoor and outdoor physical fitness activities (e.g., weight training, group and individual running, group and individual exercises) • Outdoor firefighter task-based exercises (e.g., using firefighting tools, victim rescue, live-fire suppression) At the time of our evaluation, the cadet course was six months long, and class sizes ranged from 30 to 80 cadets. Classes trained cadets 8 to 10 hours a day, 5 days a week. The facility conducted classes year-round and may train two classes concurrently. All cadets were required to pass the state-administered emergency medical technician and certified firefighter exam before graduating from the academy. The city-operated firefighter training facility was co-located with the police training facility on a multibuilding, multiacre site. Firefighter training facilities (e.g., weight room, fire tower, etc.) were open and available after hours for cadet and all training facility staff to use. To learn more about the workplace, go to Section A in the Supporting Technical Information Our Approach We visited the firefighter cadet training facility for two days in August 2018, which were Days 36 and 37 of the 126th cadet training course. During this site visit, we completed the following activities: • Met with training course management, instructors, and support staff, including the medical director, exercise physiologists, and the workers’ compensation claims manager. • Reviewed written facility policies, incident reports, workers’ compensation claims, and medical records. • Observed cadet outdoor physical fitness activities and firefighter task-based training exercises. 1 • Recorded environmental conditions and estimated metabolic effort expended during outside activates and exercises. • Administered a knowledge assessment on HRI and rhabdomyolysis to all Class 126 cadets and instructors present on the second day of the site visit. To learn more about our methods, go to Section B in the Supporting Technical Information Our Key Findings Cadets and instructors were at increased risk for rhabdomyolysis and heat-related illness • Firefighting exercises and physical fitness training regimens often involve activities which can increase risk for rhabdomyolysis and HRI. • Instructors often participated in cadet exercises as safety officers and to encourage cadet efforts. • A knowledge assessment completed by cadets and instructors identified that additional training is needed on both conditions to increase early recognition and reduce modifiable risk factors. The facility’s heat stress management program could be improved • The heat stress management program lacked important components including: o Guidelines on how to assess outdoor
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