Using Focus Groups to Identify Nutrition Education Needs and Implementation Strategies for the Wildland Firefighter.

OBJECTIVES: The aims of the study are to describe the current state, identify topics of importance, and suggest implementation strategies for tailored nutrition education for the WLFFs. METHODS: Focus groups were conducted and survey data was collected to gather qualitative and quantitative data from a sample of WLFFs. Constant comparative strategy was used to generate themes from transcripts. RESULTS: Wildland firefighters showed interest in early-introduced, multimodal, and specific nutrition education tailored to the demands of the WLFF. CONCLUSIONS: Study findings provide nutrition topics of interest and importance to WLFFs and may be used to develop educational materials.

The Wildland Firefighter Exposure and Health Effect (WFFEHE) Study: Rationale, Design, and Methods of a Repeated-Measures Study.

The wildland firefighter exposure and health effect (WFFEHE) study was a 2-year repeated-measures study to investigate occupational exposures and acute and subacute health effects among wildland firefighters. This manuscript describes the study rationale, design, methods, limitations, challenges, and lessons learned. The WFFEHE cohort included fire personnel ages 18-57 from six federal wildland firefighting crews in Colorado and Idaho during the 2018 and 2019 fire seasons. All wildland firefighters employed by the recruited crews were invited to participate in the study at preseason and postseason study intervals. In 2019, one of the crews also participated in a 3-day midseason study interval where workplace exposures and pre/postshift measurements were collected while at a wildland fire incident. Study components assessed cardiovascular health, pulmonary function and inflammation, kidney function, workplace exposures, and noise-induced hearing loss. Measurements included self-reported risk factors and symptoms collected through questionnaires; serum and urine biomarkers of exposure, effect, and inflammation; pulmonary function; platelet function and arterial stiffness; and audiometric testing. Throughout the study, 154 wildland firefighters participated in at least one study interval, while 144 participated in two or more study interval. This study was completed by the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health through a collaborative effort with the U.S. Department of Agriculture Forest Service, Department of the Interior National Park Service, and Skidmore College. Conducting research in the wildfire environment came with many challenges including collecting study data with study participants with changing work schedules and conducting study protocols safely and operating laboratory equipment in remote field locations. Forthcoming WFFEHE study results will contribute to the scientific evidence regarding occupational risk factors and exposures that can impact wildland firefighter health over a season and across two wildland fire seasons. This research is anticipated to lead to the development of preventive measures and policies aimed at reducing risk for wildland firefighters and aid in identifying future research needs for the wildland fire community.

Nutrient Intake of Wildland Firefighters During Arduous Wildfire Suppression: Macronutrient and Micronutrient Consumption.

Wildland firefighters (WLFFs) perform in adverse environments making rapid adjustments to dietary needs. The National Mobile Food Services (NMFS) contract details WLFF dietary provisions on wildfire incidents. OBJECTIVE: Determine the nutrient content of food and drink provided to and consumed by WLFFs under the NMFS contract. METHODS: Individual (n = 122) dietary provisions and consumption was recorded during 1 workday. Nutritional analysis of items provided was compared with consumption and the recommended dietary allowance (RDA). RESULTS: WLFFs consumed significantly (P < 0.05) fewer macronutrients than provided for calories, protein, and fat. Provided and consumed micronutrients were below the RDA for vitamins D and E, magnesium, and manganese. CONCLUSION: Most dietary recommendations were met by NMFS provisions. Next steps include WLFF nutrition education to improve consumption and contract revisions to meet micronutrient recommendations.

Exposure to Particulate Matter and Estimation of Volatile Organic Compounds across Wildland Firefighter Job Tasks.

Wildland firefighters are exposed to smoke-containing particulate matter (PM) and volatile organic compounds (VOCs) while suppressing wildfires. From 2015 to 2017, the U.S. Forest Service conducted a field study collecting breathing zone measurements of PM4 (particulate matter with aerodynamic diameter ≤4 µm) on wildland firefighters from different crew types and while performing various fire suppression tasks on wildfires. Emission ratios of VOC (parts per billion; ppb): PM1 (particulate matter with aerodynamic diameter ≤1 µm; mg/m3) were calculated using data from a separate field study conducted in summer 2018, the Western Wildfire Experiment for Cloud Chemistry, Aerosol Absorption, and Nitrogen (WE-CAN) Campaign. These emission ratios were used to estimate wildland firefighter exposure to acrolein, benzene, and formaldehyde. Results of this field sampling campaign reported that exposure to PM4 and VOC varied across wildland firefighter crew type and job task. Type 1 crews had greater exposures to both PM4 and VOCs than type 2 or type 2 initial attack crews, and wildland firefighters performing direct suppression had statistically higher exposures than those performing staging and other tasks (mean differences = 0.82 and 0.75 mg/m3; 95% confidence intervals = 0.38-1.26 and 0.41-1.08 mg/m3, respectively). Of the 81 personal exposure samples collected, 19% of measured PM4 exposures exceeded the recommended National Wildland Fire Coordinating Group occupational exposure limit (0.7 mg/m3). Wildland fire management should continue to find strategies to reduce smoke exposures for wildland firefighters.

Carbon monoxide exposures in wildland firefighters in the United States and targets for exposure reduction.

BACKGROUND: Every year thousands of wildland firefighters (WFFs) work to suppress wildfires to protect public safety, health, and property. Although much effort has been put toward mitigating air pollutant exposures for the public and WFFs, the current burden in this worker population is unclear as are the most effective exposure reduction strategies. OBJECTIVE: Quantify fireline carbon monoxide (CO) exposures in WFFs and identify predictors of exposures. METHODS: We collected 1-min breathing zone CO measurements on 246 WFFs assigned to fires between 2015 and 2017. We used generalized estimating equations to evaluate predictors of CO exposure. RESULTS: Approximately 5% of WFFs had fireline CO exposure means exceeding the National Wildfire Coordinating Group's occupational exposure limit of 16 ppm. Relative to operational breaks, direct suppression-related job tasks were associated with 56% (95% CI: 47%, 65%) higher geometric mean CO concentrations, adjusted for incident type, crew type, and fire location. WFF perception of smoke exposure was a strong predictor of measured CO exposure. SIGNIFICANCE: Specific job tasks related to direct suppression and WFF perceptions of smoke exposure are potential opportunities for targeted interventions aimed at minimizing exposure to smoke.

Workshift Changes in Hydration Status During Wildfire Suppression.

OBJECTIVE: Document wildland firefighters (WLFFs) hydration status during a singular workshift (13.7 ±â€Š1.4 hours). METHODS: WLFF researchers documented real-time WLFF (n = 71) urine metrics and fluid consumption. Body weight and blood samples (n = 25) were also collected. Two-tailed dependent t tests determined statistical significance (P < 0.05). RESULTS: Body weight significantly decreased (-0.3 ±â€Š1.1%, P > 0.05). Fluid consumption totaled 6.2 ±â€Š2.3 L including food and 5.0 ±â€Š2.1 L without food. Morning versus afternoon urine frequency (2.6 ±â€Š1.3, 3.1 ±â€Š1.9 voids), urine volume (1.2 ±â€Š0.7, 1.3 ±â€Š0.8 L), urine volume per void (440 ±â€Š157, 397 ±â€Š142 mL), and urine specific gravity (1.010 ±â€Š0.007, 1.010 ±â€Š0.007) were not significantly different (P > 0.05). Pre- to post-workshift serum chloride (103.2 ±â€Š1.9, 101.4 ±â€Š1.7 mM) and blood glucose (5.2 ±â€Š0.4, 4.5 ±â€Š0.7 mM) significantly decreased (P < 0.05), while serum sodium (141.5 ±â€Š2.4, 140.8 ±â€Š2.0 mM) and serum potassium (4.3 ±â€Š0.3, 4.2 ±â€Š0.3 mM) remained stable (P > 0.05). CONCLUSIONS: WLFFs can ingest fluid and food amounts that maintain workshift euhydration and electrolyte status.

Evaluation of Environmental Conditions on Self-Selected Work and Heat Stress in Wildland Firefighting.

INTRODUCTION: The purpose of this study was to evaluate heat stress occurring in wildfire management activities with variable environmental conditions. METHODS: Direct observation and real-time wireless physiological monitoring allowed for weather and physiological metrics, including heart rate, core temperature (Tc), skin temperature, and physiological strain index (PSI), of male (n=193) and female (n=28) wildland firefighters (WLFFs) to be recorded during wildfire management activities. Accelerometry data were used to categorize intensity level of activity. RESULTS: Ambient temperature and relative humidity values were used to compute the heat index (HI; n=3891 h) and divided into quartiles (Q1: 13.3-25.1°C; Q2: 25.2-26.4°C; Q3: 26.5-28.9°C; Q4: 29.0-49.1°C). Activity levels remained relatively constant across all HI quartiles. The percentage of time spent performing moderate/vigorous activities was lowest during the hotter Q4 (Q1: 3%; Q2: 2%; Q3: 2%; Q4: 1%). Heart rate, Tc, PSI, and skin temperature associations with HI varied by resource type. Sixty-one percent of WLFFs (n=134) experienced a Tc ≥38.0°C, and 50% of WLFFs (n=111) experienced a PSI ≥6.0. CONCLUSIONS: Heat stress was prevalent as WLFFs performed job tasks of varying intensities in all ambient conditions. Spontaneous bouts of arduous labor, duration of work shifts, and other occupation characteristics present the possibility for substantial durations of hyperthermia, although no heat-related injuries occurred in this study. Despite chronic exposure to rugged sloped terrain, load carriage, and environmental conditions, self-regulation and individual attention to managing work:rest appears to be the primary management strategy in mitigating excessive accumulation of body heat in this occupation.

Wildland firefighter exposure to smoke and COVID-19: A new risk on the fire line.

Throughout the United States, wildland firefighters respond to wildfires, performing arduous work in remote locations. Wildfire incidents can be an ideal environment for the transmission of infectious diseases, particularly for wildland firefighters who congregate in work and living settings. In this review, we examine how exposure to wildfire smoke can contribute to an increased likelihood of SARS-CoV-2 infection and severity of coronavirus disease (COVID-19). Human exposure to particulate matter (PM), a component of wildfire smoke, has been associated with oxidative stress and inflammatory responses; increasing the likelihood for adverse respiratory symptomology and pathology. In multiple epidemiological studies, wildfire smoke exposure has been associated with acute lower respiratory infections, such as bronchitis and pneumonia. Co-occurrence of SARS-CoV-2 infection and wildfire smoke inhalation may present an increased risk for COVID-19 illness in wildland firefighters due to PM based transport of SARS CoV-2 virus and up-regulation of angiotensin-converting enzyme II (ACE-2) (i.e. ACE-2 functions as a trans-membrane receptor, allowing the SARS-CoV-2 virus to gain entry into the epithelial cell). Wildfire smoke exposure may also increase risk for more severe COVID-19 illness such as cytokine release syndrome, hypotension, and acute respiratory distress syndrome (ARDS). Current infection control measures, including social distancing, wearing cloth masks, frequent cleaning and disinfecting of surfaces, frequent hand washing, and daily screening for COVID-19 symptoms are very important measures to reduce infections and severe health outcomes. Exposure to wildfire smoke may introduce additive or even multiplicative risk for SARS-CoV-2 infection and severity of disease in wildland firefighters. Thus, additional mitigative measures may be needed to prevent the co-occurrence of wildfire smoke exposure and SARS-CoV-2 infection.

Total Energy Intake and Self-Selected Macronutrient Distribution During Wildland Fire Suppression.

INTRODUCTION: Wildland firefighters (WLFF) work long hours in extreme environments, resulting in high daily total energy expenditure. Increasing work-shift eating episodes and/or providing rations that promote convenient eating has shown augmented self-selected work output, as has regular carbohydrate (CHO) consumption. It remains unclear how current WLFF feeding strategies compare to more frequent nutrient delivery. Our aim was to determine WLFFs' self-selected field total energy intake (TEI), composition, and feeding patterns during wildland fire suppression shifts. METHODS: WLFF were deployed to fire incidents across the United States throughout the 2018 fire season. Preshift food inventories collected at basecamp provided item-specific nutrient content (kilocalories, CHO, fat, protein). Work shift consumption (TEI, feeding frequency, episodic composition) was monitored in real time by field researchers on fireline via observational data capture using mobile tablets. Shift work output was also quantified via actigraph accelerometry. RESULTS: Eighty-six WLFF (27.5±6.4 y; 16 female, 70 male) worked 14.0±1.1 h shifts, with a TEI of 6.3±2.5 MJ (1494±592 kcal) (51±10, 37±9, 13±4% for CHO, fat, and protein, respectively). WLFF averaged 4.3±1.6 eating episodes (1.4±1.3 MJ [345±306 kcal] and 44±38 g CHO·episode-1). WLFF who consumed >20 kcal·kg-1 averaged less sedentary activity than those consuming <16 kcal·kg-1. Data are presented as mean±SD. CONCLUSIONS: Not including fire camp meals (breakfast, dinner), the present work-shift TEI approximates 33% of previously determined WLFF total energy expenditure and demonstrates that current WLFF consumption patterns may not deliver adequate nutrients for occupational demands.

Risk for heat-related illness among wildland firefighters: job tasks and core body temperature change.

OBJECTIVES: In order to make recommendations to protect wildland firefighters (WLFFs) from heat-related illness, the role physical exertion plays on core body temperature (Tc) in the work environment needs to be considered. We aimed to estimate the association of time-varying job tasks with differing exertion levels on change in Tc, among WLFFs engaged in fire management activities, while controlling for ambient conditions and individual characteristics. In addition, we examined whether duration of tasks modified the relationship between task and change in Tc. METHODS: We used data from The Wildland Firefighter Heat Related Illness study, a repeated measures study with individual-level data on 301 WLFFs from 2013 to 2016. Job tasks over one full shift were recorded and categorised into four levels (sedentary, light, moderate and high) based on estimated exertion levels. Tc was measured every 15 s using an ingestible sensor and personal monitors measured ambient conditions. The analysis used generalised estimating equations with an autoregressive correlation structure. RESULTS: We found statistically significant associations between job tasks with increased physical demand and increases in Tc. When compared with sedentary tasks, the estimated increases in Tc for light, moderate and high activity tasks of average duration were 0.07°C (95% CI 0.02 to 0.11°C), 0.19°C (95% CI 0.15 to 0.23) and 0.44°C (95% CI 0.39 to 0.49°C), respectively. In addition, we found evidence of interaction between task type and duration. CONCLUSIONS: This study supports the hypothesis that occupational exposure to physical exertion increases Tc, highlighting the need to update recommendations to protect WLFFs from heat-related illness.

Wildland firefighter smoke exposure and risk of lung cancer and cardiovascular disease mortality.

Wildland firefighters are exposed to wood smoke, which contains hazardous air pollutants, by suppressing thousands of wildfires across the U. S. each year. We estimated the relative risk of lung cancer and cardiovascular disease mortality from existing PM2.5 exposure-response relationships using measured PM4 concentrations from smoke and breathing rates from wildland firefighter field studies across different exposure scenarios. To estimate the relative risk of lung cancer (LC) and cardiovascular disease (CVD) mortality from exposure to PM2.5 from smoke, we used an existing exposure-response (ER) relationship. We estimated the daily dose of wildfire smoke PM2.5 from measured concentrations of PM4, estimated wildland firefighter breathing rates, daily shift duration (hours per day) and frequency of exposure (fire days per year and career duration). Firefighters who worked 49 days per year were exposed to a daily dose of PM4 that ranged from 0.15 mg to 0.74 mg for a 5- and 25-year career, respectively. The daily dose for firefighters working 98 days per year of PM4 ranged from 0.30 mg to 1.49 mg. Across all exposure scenarios (49 and 98 fire days per year) and career durations (5-25 years), we estimated that wildland firefighters were at an increased risk of LC (8 percent to 43 percent) and CVD (16 percent to 30 percent) mortality. This unique approach assessed long term health risks for wildland firefighters and demonstrated that wildland firefighters have an increased risk of lung cancer and cardiovascular disease mortality.

Metabolic Demand of Hiking in Wildland Firefighting.

INTRODUCTION: The objective of this study was to document characteristics of hiking during wildland firefighter (WLFF) training and wildfire suppression. For the first time, the overall physical demands during wildland firefighting were evaluated in the field using global positioning systems coupled with wireless physiological monitoring and load carriage prediction models. METHODS: Male (n=116) and female (n=15) interagency hotshot crew and type II WLFFs on wildfires volunteered for this direct observation study. Participants' heart rate, internal temperature, speed, and elevation gain were monitored throughout training and during wildfire suppression. The Pandolf and Santee equations were used to predict metabolic rate to estimate oxygen consumption of uphill and downhill hiking. RESULTS: Equipment weight varied by crew type (type II: 24±9 kg and interagency hotshot crew: 28±6 kg; P<0.05). Grade of terrain was steepest during training hikes, and ingress hikes were statistically different from egress and training hikes (ingress: 4±9%, shift: 4±9%, egress: 1±8%, training hikes: 10±9%; P<0.01). Estimated oxygen consumption was highest during ingress hikes and was significantly different from all other hike types on fire assignments (ingress: 22±12, shift: 19±12, egress: 19±12 mL·kg-1·min-1; P=0.01). Oxygen consumption was higher during training hikes (34±14 mL·kg-1·min-1) than during job-related hikes (P<0.01). CONCLUSIONS: The greatest metabolic demand during wildfire assignments occurred during ingress hikes. On average, this was close to the estimated metabolic demand of the job qualification arduous pack test. However, greater metabolic demand occurred for periods during both shift (on the job) and training hikes. These data quantify the demands associated with actual wildland performance of WLFFs and can help define future work capacity testing and training procedures.

Wildland firefighter deaths in the United States: A comparison of existing surveillance systems.

Wildland fire fighting is a high-risk occupation requiring considerable physical and psychological demands. Multiple agencies publish fatality summaries for wildland firefighters; however, the reported number and types vary. At least five different surveillance systems capture deaths, each with varying case definitions and case inclusion/exclusion criteria. Four are population-level systems and one is case-based. System differences create challenges to accurately characterize fatalities. Data within each of the five surveillance systems were examined to better understand the types of wildland firefighter data collected, to assess each system's utility in characterizing wildland firefighter fatalities, and to determine each system's potential to inform prevention strategies. To describe similarities and differences in how data were recorded and characterized, wildland fire deaths for three of the population-based systems were matched and individual fatalities across systems were compared. Between 2001 and 2012, 247 unique deaths were captured among the systems; 73% of these were captured in all three systems. Most common causes of death in all systems were associated with aviation, vehicles, medical events, and entrapments/burnovers. The data show that, although the three systems often report similar annual summary statistics, events captured in each system vary each year depending on the types of events that the system is designed to track, such as inclusion/exclusion of fatalities associated with the Hometown Heroes Survivor Benefits Act of 2003. The overarching and central goal of each system is to collect accurate and timely information to improve wildland firefighter safety and health. Each system is unique and has varying inclusion and exclusion criteria for capturing and tracking different subsets of wildland firefighter tasks and duties. Use of a common case definition and better descriptions and interpretations of the data and the results would help to more accurately characterize wildland firefighter traumatic injuries and illnesses, lessen the likelihood for misinterpretation of wildland firefighter fatality data, and assist with defining the true occupational injury burden within this high-risk population.

Core-temperature sensor ingestion timing and measurement variability.

CONTEXT: Telemetric core-temperature monitoring is becoming more widely used as a noninvasive means of monitoring core temperature during athletic events. OBJECTIVE: To determine the effects of sensor ingestion timing on serial measures of core temperature during continuous exercise. DESIGN: Crossover study. SETTING: Outdoor dirt track at an average ambient temperature of 4.4°C ± 4.1°C and relative humidity of 74.1% ± 11.0%. PATIENTS OR OTHER PARTICIPANTS: Seven healthy, active participants (3 men, 4 women; age  =  27.0 ± 7.5 years, height  =  172.9 ± 6.8 cm, body mass  =  67.5 ± 6.1 kg, percentage body fat  =  12.7% ± 6.9%, peak oxygen uptake [Vo(2peak)]  =  54.4 ± 6.9 mL•kg⁻¹â€¢min⁻¹) completed the study. INTERVENTION(S): Participants completed a 45-minute exercise trial at approximately 70% Vo(2peak). They consumed core-temperature sensors at 24 hours (P1) and 40 minutes (P2) before exercise. MAIN OUTCOME MEASURE(S): Core temperature was recorded continuously (1-minute intervals) using a wireless data logger worn by the participants. All data were analyzed using a 2-way repeated-measures analysis of variance (trial × time), Pearson product moment correlation, and Bland-Altman plot. RESULTS: Fifteen comparisons were made between P1 and P2. The main effect of time indicated an increase in core temperature compared with the initial temperature. However, we did not find a main effect for trial or a trial × time interaction, indicating no differences in core temperature between the sensors (P1  =  38.3°C ± 0.2°C, P2  =  38.3°C ± 0.4°C). CONCLUSIONS: We found no differences in the temperature recordings between the 2 sensors. These results suggest that assumed sensor location (upper or lower gastrointestinal tract) does not appreciably alter the transmission of reliable and repeatable measures of core temperature during continuous running in the cold.