News in Brief

First responders honored with new postage stamp

The U.S. Postal Service is honoring firefighters, law enforcement officers, emergency medical services professionals, and other emergency personnel with the Honoring First Responders Forever stamp. The first-day-of-issue ceremony was held recently at the Aerial Fire Depot and Smokejumper Center in Missoula, Montana, home to the nation’s largest training center for firefighters who parachute into remote areas of national forests to combat wildfires. Artist Brian Stauffer worked with art director and designer Antonio Alcalá and designer Ricky Altizer to create the stamp.New airway tube ups cardiac arrest survival rate

According to the National Institutes of Health (NIH), a change in the breathing tube emergency medical services (EMS) workers use when treating victims of sudden cardiac arrest can save “more than 10,000 lives every year.”

“During resuscitation, opening the airway and having proper access is a key factor for survival of a person who goes into cardiac arrest outside of a hospital,” says George Sopko, M.D., M.P.H., co-author of the study and program director in the National Heart, Lung, and Blood Institute (NHLBI), part of the NIH. The study, the Pragmatic Airway Resuscitation Trial, was a multicenter research study conducted by the Resuscitation Outcomes Consortium (https://bit.ly/2QKNuEm).

The study was the largest of its kind to test oxygen delivery methods used by firefighters, EMS providers, and paramedics and the first to show that the method of airway intervention can positively affect patient survival rates. The findings were published online in the Journal of the American Medical Association.

EMS providers treat the majority of the 400,000 out-of-hospital cardiac arrests each year. For more than three decades, their standard-of-care technique for resuscitation has been endotracheal intubation—inserting a plastic tube into the trachea to maintain an open airway. But, notes Henry E. Wang, M.D., the study’s lead author and professor and vice chair for research in the Department of Emergency Medicine at McGovern Medical School at The University of Texas Health Science Center at Houston, “Intubation in these severe and stressful prehospital settings is very difficult and fraught with errors.” The new laryngeal tubes are easier to use.

The study compared survival rates among 3,000 adults with cardiac arrest treated by paramedic crews from 27 EMS agencies in Birmingham, Alabama; Dallas-Fort Worth; Milwaukee; Pittsburgh; and Portland, Oregon. Overall, patients in the laryngeal tube group had significantly better outcomes: 18.3 percent of patients survived three days in the hospital and 10.8 percent survived to reach hospital discharge. For the group with traditional endotracheal intubation, the survival numbers were 15.4 and 8.1 percent, respectively. Also, the proportion of patients surviving with good brain function was higher in the laryngeal tube group.

H.E. Wang, et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs. Endotracheal Intubation on 72-Hour Survival in Adults with Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. (link is external) Journal of the American Medical Association. August 28, 2018. DOI: 10.1001/jama.2018.7044 https://jamanetwork.com/journals/jama/article-abstract/2698491.

Firefighters who die of cardiac arrest: heart disease common

“Firefighters who died from cardiac arrest were much more likely than those who died of other causes to show signs of both atherosclerotic and hypertensive heart disease at autopsy,” according to new research in Journal of the American Heart Association.

To understand which heart diseases affect firefighters who die of cardiac arrest, this study looked at autopsy reports for firefighters who had died in the line of duty. Results showed that the most common diseases were narrowed arteries, or coronary artery disease, and structural abnormalities. These abnormalities included an enlarged heart (cardiomegaly) and increased wall thickness (hypertrophy) of the heart’s primary chamber for pumping blood, or left ventricle.

“Firefighters face many dangers, but the greatest risk is from underlying cardiovascular disease in combination with the physiological strain that the work places on the firefighter,” says study lead author Denise L. Smith, Ph.D., Tisch Distinguished Professor and director of the First Responder Health and Safety Laboratory at Skidmore College in Saratoga Springs, New York. “Medical screening is necessary to establish that a firefighter is healthy enough to do this strenuous work.”

The researchers looked at autopsy records for U.S. male firefighters who died on duty between 1999 and 2014. Of 627 total deaths, 276 resulted from cardiac arrest and 351 from trauma. At the time of death, the firefighters were between 18 and 65 years old.

Smith notes: “Since cardiac arrest often is the first sign of underlying heart disease, screening and treatment for common heart diseases are critical. Historically, screening has focused more on risk factors for coronary artery disease. While this screening remains essential, it is important that clinicians also consider testing to identify an enlarged heart and increased wall thickness.”

The study results may have been affected by limitations that included differences in autopsy descriptions of heart disease, the use of a cutoff weight for an enlarged heart, and lack of information about other risk factors such as smoking and high blood pressure.

The American Heart Association recommends lifestyle changes known as Life’s Simple 7® to control the risk factors for heart disease: manage blood pressure, control cholesterol, reduce blood sugar, get active, eat better, lose weight, and stop smoking.

Denise L. Smith, Jeannie M. Haller, Maria Korre, Patricia C. Fehling, Konstantina Sampani, Luiz Guilherme Grossi Porto, Costas A. Christophi, Stefanos N. Kales. “Pathoanatomic Findings Associated with Duty‐Related Cardiac Death in US Firefighters: A Case–Control Study.” Journal of the American Heart Association, 2018; DOI: 10.1161/JAHA.118.009446.

American Heart Association. “Heart disease common among firefighters who die of cardiac arrest.” ScienceDaily, 5 September 2018. <www.sciencedaily.com/releases/2018/09/180905083922.htm>.

IAFF holds Fallen Fire Fighter Memorial Service

International Association of Fire Fighters (IAFF) members from across the United States and Canada joined the grieving families of firefighters lost in the line of duty at the IAFF Fallen Fire Fighter Memorial held recently in Colorado Springs, Colorado. The names of 271 firefighters who have died in the line of duty from trauma or occupational illness will be etched on the granite Wall of Honor. Of these 271 firefighters whose names will be added in 2018, 211 succumbed to fire service-related cancers; 19 died from work-related cancers linked to toxic exposures at Ground Zero, the site of the September 11 attacks on the World Trade Center; and two were diagnosed with job-related post-traumatic stress disorder and died of suicide.