Category Archives: Emergency Services

Special Issue: Health Effects of 9/11: Fifteen Year Reports

Source: American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Articles include:
FDNY and 9/11: Clinical services and health outcomes in World Trade Center-exposed firefighters and EMS workers from 2001 to 2016
Source: Jennifer Yip, Mayris P. Webber, Rachel Zeig-Owens, Madeline Vossbrinck, Ankura Singh, Kerry Kelly and David J. Prezant, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Ten-year cancer incidence in rescue/recovery workers and civilians exposed to the September 11, 2001 terrorist attacks on the World Trade Center
Source: Jiehui Li, Robert M. Brackbill, Tim S. Liao, Baozhen Qiao, James E. Cone, Mark R. Farfel, James L. Hadler, Amy R. Kahn, Kevin J. Konty, Leslie T. Stayner and Steven D. Stellman, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Post-9/11 cancer incidence in World Trade Center-exposed New York City firefighters as compared to a pooled cohort of firefighters from San Francisco, Chicago and Philadelphia (9/11/2001-2009)
Source: William Moir, Rachel Zeig-Owens, Robert D. Daniels, Charles B. Hall, Mayris P. Webber, Nadia Jaber, James H. Yiin, Theresa Schwartz, Xiaoxue Liu, Madeline Vossbrinck, Kerry Kelly and David J. Prezant, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Impact of 9/11-related chronic conditions and PTSD comorbidity on early retirement and job loss among World Trade Center disaster rescue and recovery workers
Source: Shengchao Yu, Robert M. Brackbill, Sean Locke, Steven D. Stellman and Lisa M. Gargano, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Mental health status of World Trade Center tower survivors compared to other survivors a decade after the September 11, 2001 terrorist attacks
Source: Lisa M. Gargano, Angela Nguyen, Laura DiGrande and Robert M. Brackbill, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

The prevalence of metabolic syndrome among law enforcement officers who responded to the 9/11 World Trade Center attacks
Source: Jacqueline M. Moline, Mary Ann McLaughlin, Simonette T. Sawit, Cynara Maceda, Lori B. Croft, Martin E. Goldman, Mario J. Garcia, Rupa L. Iyengar and Mark Woodward, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

The association between body mass index and gastroesophageal reflux disease in the World Trade Center Health Program General Responder Cohort
Source: Nikolina Icitovic, Lynn C. Onyebeke, Sylvan Wallenstein, Christopher R. Dasaro, Denise Harrison, Jieying Jiang, Julia R. Kaplan, Roberto G. Lucchini, Benjamin J. Luft, Jacqueline M. Moline, Lakshmi Pendem, Moshe Shapiro, Iris G. Udasin, Andrew C. Todd and Susan L. Teitelbaum, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Isolated small airway reactivity during bronchoprovocation as a mechanism for respiratory symptoms in WTC dust-exposed community members
Source: Kenneth I. Berger, Samantha Kalish, Yongzhao Shao, Michael Marmor, Angeliki Kazeros, Beno W. Oppenheimer, Yinny Chan, Joan Reibman and Roberta M. Goldring, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Improvement in severe lower respiratory symptoms and small airway function in World Trade Center dust exposed community members
Source: Caralee Caplan-Shaw, Angeliki Kazeros, Deepak Pradhan, Kenneth Berger, Roberta Goldring, Sibo Zhao, Mengling Liu, Yongzhao Shao, Maria Elena Fernandez-Beros, Michael Marmor, Nomi Levy-Carrick, Rebecca Rosen, Lucia Ferri and Joan Reibman, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Biomarkers of patient intrinsic risk for upper and lower airway injury after exposure to the World Trade Center atrocity
Source: Rachel Zeig-Owens, Anna Nolan, Barbara Putman, Ankura Singh, David J. Prezant and Michael D. Weiden, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)
Asthma among Staten Island fresh kills landfill and barge workers following the September 11, 2001 World Trade Center terrorist attacks
Source: James E. Cone, Sukhminder Osahan, Christine C. Ekenga, Sara A. Miller-Archie, Steven D. Stellman, Monique Fairclough, Stephen M. Friedman and Mark R. Farfel, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Effect of asthma and PTSD on persistence and onset of gastroesophageal reflux symptoms among adults exposed to the September 11, 2001, terrorist attacks
Source: Jiehui Li, Robert M. Brackbill, Hannah T. Jordan, James E. Cone, Mark R. Farfel and Steven D. Stellman, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

Sex differences in asthma and gastroesophageal reflux disease incidence among the World Trade Center Health Program General Responder Cohort
Source: Jieying Jiang, Nikolina Icitovic, Michael A. Crane, Christopher R. Dasaro, Julia R. Kaplan, Roberto G. Lucchini, Benjamin J. Luft, Jacqueline M. Moline, Lakshmi Pendem, Moshe Shapiro, Iris G. Udasin, Andrew C. Todd and Susan L. Teitelbaum, American Journal of Industrial Medicine, Volume 59 no. 9, September 2016
(subscription required)

24-hour work shifts, sedentary work, and obesity in male firefighters

Source: BongKyoo Choi, Marnie Dobson, Peter Schnall, and Javier Garcia-Rivas, American Journal of Industrial Medicine, Volume 59 Issue 6, June 2016
(subscription required)

From the abstract:
Background: Little is known about the occupational risk factors for obesity in US firefighters.
Methods: 308 male California firefighters, who participated in a work and obesity project, were chosen. Working conditions were measured with a firefighter-specific occupational health questionnaire. Adiposity was clinically assessed using body mass index (BMI), waist circumference (WC), and body fat percent.
Results: In a multivariate analysis, the prevalence of obesity by all measures was significantly higher in the firefighters who reported seventeen to twenty-one shifts than those who reported eight to eleven shifts in the past month. Prolonged sedentary work was also a risk factor for obesity by BMI. Furthermore, there was a linear dose-response relationship of obesity by BMI and WC with the number of 24-hr shifts and sedentary work.
Conclusions: Many additional 24-hr shifts and prolonged sedentary work substantially increased the risk for obesity in male firefighters.

Mortality among World Trade Center rescue and recovery workers, 2002–2011

Source: Cheryl R. Stein, Sylvan Wallenstein, Moshe Shapiro, Dana Hashim, Jacqueline M. Moline, Iris Udasin, Michael A. Crane, Benjamin J. Luft, Roberto G. Lucchini and William L. Holden, American Journal of Industrial Medicine, Early View, Article first published online: January 4, 2016
(subscription required)

From the abstract:
Background: Rescue and recovery workers responding to the 2001 collapse of the World Trade Center (WTC) sustained exposures to toxic chemicals and have elevated rates of multiple morbidities.

Methods: Using data from the World Trade Center Health Program and the National Death Index for 2002–2011, we examined standardized mortality ratios (SMR) and proportional cancer mortality ratios (PCMR) with indirect standardization for age, sex, race, and calendar year to the U.S. general population, as well as associations between WTC-related environmental exposures and all-cause mortality.

Results: We identified 330 deaths among 28,918 responders. No cause-specific SMRs were meaningfully elevated. PCMRs were elevated for neoplasms of lymphatic and hematopoietic tissue. Mortality hazard ratios showed no linear trend with exposure.

Conclusions: Consistent with a healthy worker effect, all-cause mortality among responders was not elevated. There was no clear association between intensity and duration of exposure and mortality. Surveillance is needed to monitor the proportionally higher cancer mortality attributed to lymphatic/hematopoietic neoplasms

Cancer in World Trade Center responders: Findings from multiple cohorts and options for future study

Source: Paolo Boffetta, Rachel Zeig-Owens, Sylvan Wallenstein, Jiehui Li, Robert Brackbill, James Cone, Mark Farfel, William Holden, Roberto Lucchini, Mayris P. Webber, David Prezant and Steven D. Stellman, American Journal of Industrial Medicine, Early View, Article first published online: January 4, 2016
(subscription required)

From the abstract:
Background: Three longitudinal studies of cancer incidence in varied populations of World Trade Center responders have been conducted.

Methods: We compared the design and results of the three studies.

Results: Separate analyses of these cohorts revealed excess cancer incidence in responders for all cancers combined and for cancers of the thyroid and prostate. Methodological dissimilarities included recruitment strategies, source of cohort members, demographic characteristics, overlap between cohorts, assessment of WTC and other occupational exposures and confounders, methods and duration of follow-up, approaches for statistical analysis, and latency analyses.

Conclusions: The presence of three cohorts strengthens the effort of identifying and quantifying the cancer risk; the heterogeneity in design might increase sensitivity to the identification of cancers potentially associated with exposure. The presence and magnitude of an increased cancer risk remains to be fully elucidated. Continued long-term follow up with minimal longitudinal dropout is crucial to achieve this goal.

Expecting the unexpected: A mixed methods study of violence to EMS responders in an urban fire department

Source: Jennifer A. Taylor, Brittany Barnes, Andrea L. Davis, Jasmine Wright, Shannon Widman and Michael LeVasseur, American Journal of Industrial Medicine, Early View, Article first published online: January 4, 2016
(subscription required)

From the abstract:
Background: Struck by injuries experienced by females were observed to be higher compared to males in an urban fire department. The disparity was investigated while gaining a grounded understanding of EMS responder experiences from patient-initiated violence.

Methods: A convergent parallel mixed methods design was employed. Using a linked injury dataset, patient-initiated violence estimates were calculated comparing genders. Semi-structured interviews and a focus group were conducted with injured EMS responders.

Results: Paramedics had significantly higher odds for patient-initiated violence injuries than firefighters. Females reported increased odds of patient-initiated violence injuries compared to males, but this relationship was entirely mediated through occupation. Qualitative data illuminated the impact of patient-initiated violence and highlighted important organizational opportunities for intervention.

Conclusions: Mixed methods greatly enhanced the assessment of EMS responder patient-initiated violence prevention.

The Effects of Collective Bargaining Rights on Public Employee Compensation: Evidence from Teachers, Firefighters, and Police

Source: Brigham R. Frandsen, ILR Review, Vol. 69 no. 1, January 2016
(subscription required)

From the abstract:
Widespread public-sector unionism emerged only in the 1960s, as individual states opened the door to collective bargaining for state and municipal workers. In this study, the author exploits differences in timing of legislative reforms across states to construct estimates of the causal effects of public-sector collective bargaining rights on pay, benefits, and employment for teachers, firefighters, and police. Perhaps surprisingly, estimates that allow for state fixed effects and state-specific trends show little effect on teachers’ pay, benefits, or employment, despite significantly increasing union presence among teachers. For firefighters, the results show a substantial positive effect on wages. For police, the wage effect was more modest but the workweek was significantly shortened.

The relationship between burnout, PTSD symptoms and injuries in firefighters

Source: F. Katsavouni, E. Bebetsos, P. Malliou and A. Beneka, Occupational Medicine, Advance Access, First published online: September 25, 2015
(subscription required)

From the abstract:
Background: Firefighters participate in activities with intense physical and psychological stress.
Aims To examine the correlation between work-related injuries (WRIs), burnout and post-traumatic stress disorder (PTSD) symptoms in firefighters.
Methods: The method used for the recording of the elements was the collection of self-report anonymous questionnaires, the completion of which was optional. The questionnaires used were: (i) a WRIs questionnaire, (ii) the Maslach Burnout Inventory (MBI) and (iii) the Impact of Event Scale-Revised-Greek version. Descriptive statistics along with univariate and multivariate logistic regression analyses were applied.
Results: The study population consisted of 3289 firefighters. There was a significant association between WRIs, burnout syndrome, PTSD symptoms and age, work experience and physical condition. Relationships were found between PTSD symptoms, the MBI–emotional exhaustion dimension and WRIs and between MBI–depersonalization dimension and PTSD symptoms. The most traumatic event was the ‘dealing with death or rescue of a child’ and the top stress factor was ‘depression about the responsibility for quality of victims’ life’.
Conclusions: The occupational obligations may be responsible for the psychological and musculoskeletal problems experienced by firefighters. Early recognition and response to psychosomatic issues in firefighters is of high importance.

Pinch Hitting

Source: Michelle Ancell, State Legislatures, Vol. 41, No. 8, September 2015

Doctor shortages in rural America have paramedics stepping up to the plate when needed. … Community paramedicine systems are popping up in Colorado, Maine, Minnesota, Missouri and Nevada to provide health care where few services exist. Often, they save money for patients, hospitals and insurance companies, mostly in avoided costs. A leg amputation, for example, costs around $76,000. That’s about what it would cost to fund community paramedic home visits to Robert for 11 years. Minnesota reported that because of the paramedicine program there, Medicaid providers serving 100,000 residents spent $10.5 million less in 2014 than analysts projected they would. ….