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  • NFORS: Using Technology to Document Firefighter Exposure to Carcinogens and IDLH Conditions

    (4 min read) Firefighters’ concerns have changed rapidly over the past decade.

    Big fire

    (4 min read) Firefighters’ concerns have changed rapidly over the past decade. We have always been focused on our personal readiness and the readiness of our equipment. Health concerns were more centric to strained backs from lifting LDH or perhaps a twisted ankle from a haphazard step while helping a patient down a narrow staircase.

    Big fire

    OSHA defines IDLH as: “an atmospheric concentration of any toxic, corrosive or asphyxiant substance that poses an immediate threat to life or would cause irreversible or delayed adverse health effects or would interfere with an individual's ability to escape from a dangerous atmosphere.” We may never have thought of as such, but airborne particulates and soot certainly fit this definition. It also goes without saying that there may be other atomized particles or chemicals that are in a concentration far above typical atmospheric conditions. These concentrations are highly variable depending on what was burning.

    These days, the “C” word – cancer – is seemingly uttered around every corner. In the past, our PPE was rarely decontaminated. If it was, it was not decontaminated properly according to today’s standards. It truly crept up on us and the activities we didn’t give a thought about are now the bane of our health.  Most states are passing cancer presumption laws and as a result we should be prepared to document our exposures accordingly. Thankfully, there is a standard available to assist us – the National Firefighter Operations Reporting System – or NFORS (www.nfors.org).

    Many departments have quickly adopted measures to combat the threat of cancer. Whether you are bagging your gear when you exit a structure fire, using wet wipes, or utilizing extra sets of gear, taking any combination of measures is better than none at all. Yet, the question remains as to how we document everything and how do we enforce such policies within the department? As mentioned earlier, the NFORS standard is a tool available to us.

    NFORS provides a free mobile application that can be downloaded on your smart phone and it is an excellent means of documentation according to the standard. At ZOLL, we also offer a mechanism for documenting exposures according to the NFORS standard, but we have gone a step further by allowing departments to directly link the exposure to an NFIRS incident that is already documented and report on the exposures alongside other data points. It is also possible to directly notify firefighters via email that they must complete an exposure report.

    “There is a lot of power behind having all of the data in one place rather than spread across several software systems.” – Chad Hurka, Product Manager | ZOLL emsCharts  

    Furthermore, enforcing the policies that we have set can be a challenge especially among more experienced personnel. Despite the inherent importance of following cancer policies, it is often difficult for firefighters to comply due to the obvious distractions of the job. For example, it may be your department policy to require all personnel to shower within one hour of smoke exposure. It is entirely possible to be dispatched to something else and it then becomes impossible to shower within the hour time period. The ZOLL NFORS implementation allows department officers to track which firefighters have not completed their exposure reports so that they can be reminded when such situations arise.

    Prevention is Better than Cure card with sky background

    Implementing exposure policies can be a daunting task if not properly disseminated from department leadership. There can also be financial challenges as some departments may not be able to afford additional sets of gear or proper gear washers. There are a few low-cost steps that a department can take to start down the path of doing more to protect personnel. An example of a low-cost strategy would include:

    1. Purchasing wet wipes and storing them on vehicles while training personnel to use them following responses.
    2. Brushing or hosing off gear following structure fire assignments.
    3. Particulate resistant hoods can be expensive, so depending on frequency it may be a better option to continue to utilize standard hoods and discard them after a response.
    4. Moving gear storage out of truck bays.
    5. Assigning “PPE free zones” in your station.
    6. Purchasing trash bags and bagging PPE prior to mounting the apparatus to begin to establish “clean cab” measures.
    7. Most importantly – training. Training can be cheap or free to educate personnel on hand washing and showering following responses.

    If cancer policies are completely new to you or your organization, or your department is gradually phasing in current S.O.P.s for cancer prevention, it is important to foster an atmosphere for building strong habits. In the cases of policy enforcement and/or habit creation, an electronic means of NFORS documentation is paramount. Consider the scenario where personnel are required to document exposures following each qualifying event. As personnel proceed through the documentation, it should trigger the proper thought processes within each of their minds and perhaps serve as a reminder. Repetition is key and as firefighters see the same questions repeatedly, it will become second nature for them to follow such procedures.

    All in all, firefighters know that cancer prevention and exposure mitigation are important. However, the push and pull of the job often presents scenarios where procedures are difficult to follow. The best hope for our profession to reverse the trend of cancer diagnoses is only possible through offering proper means of documentation and reinforcement of good habits. The tools are available to your department today, take advantage of them.


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