HETA 97–0034–2683

International Association of Fire Fighters

Indianapolis, Indiana

Calvin K. Cook, M.S.

Doug Trout, M.D., M.H.S.

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports

This Health Hazard Evaluation (HHE) report and any recommendations made herein are for the specific facility evaluated and may not be universally

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

applicable. Any recommendations made are not to be considered as final statements of NIOSH policy or of any agency or individual involved.

Additional HHE reports are available at http://www.cdc.gov/niosh/hhe/reports
ii

PREFACE

The Hazard Evaluations and Technical Assistance Branch of NIOSH conducts field investigations of possible

health hazards in the workplace. These investigations are conducted under the authority of Section 20(a)(6)

of the Occupational Safety and Health Act of 1970, 29 U.S.C. 669(a)(6) which authorizes the Secretary of

Health and Human Services, following a written request from any employer or authorized representative of

employees, to determine whether any substance normally found in the place of employment has potentially

toxic effects in such concentrations as used or found.

The Hazard Evaluations and Technical Assistance Branch also provides, upon request, technical and

consultative assistance to Federal, State, and local agencies; labor; industry; and other groups or individuals

to control occupational health hazards and to prevent related trauma and disease. Mention of company names

or products does not constitute endorsement by the National Institute for Occupational Safety and Health.

ACKNOWLEDGMENTS AND AVAILABILITY OF REPORT

This report was prepared by Calvin K. Cook and Doug Trout of the Hazard Evaluations and Technical

Assistance Branch, Division of Surveillance, Hazard Evaluations and Field Studies (DSHEFS). Desktop

publishing was performed by Ellen E. Blythe. Review and preparation for printing was performed by Penny

Arthur.

Copies of this report have been sent to employee and management representatives at the International

Association of Fire Fighters, Indianapolis Fire Department, and the OSHA Regional Office. This report is

not copyrighted and may be freely reproduced. Single copies of this report will be available for a period of

three years from the date of this report. To expedite your request, include a self–addressed mailing label

along with your written request to:

NIOSH Publications Office

4676 Columbia Parkway

Cincinnati, Ohio 45226

800–356–4674

After this time, copies may be purchased from the National Technical Information Service (NTIS) at

5825 Port Royal Road, Springfield, Virginia 22161. Information regarding the NTIS stock number may be

obtained from the NIOSH Publications Office at the Cincinnati address.

For the purpose of informing affected employees, copies of this report shall be

posted by the employer in a prominent place accessible to the employees for a

period of 30 calendar days.
iii

Health Hazard Evaluation Report 97–0034–2683

International Association of Fire Fighters

Indianapolis, Indiana

April 1998

Calvin K. Cook, M.S.

Doug Trout, M.D., M.H.S.

SUMMARY

On November 12, 1996, the National Institute for Occupational Safety and Health (NIOSH) received a request from

the International Association of Fire Fighters (IAFF) Local 416 on behalf of 78 fire fighters involved in a chemical

warehouse fire that took place in Indianapolis, Indiana, on October 12, 1996. Fire fighters dispatched to the fire

scene experienced chemical exposures and injuries. NIOSH was asked to provide technical assistance in reviewing

the circumstances surrounding fire supression and overhaul activities, evaluate the overall incident command

structure, and investigate chemical exposures and injuries experienced by fire fighters. Records were reviewed

for 19 fire fighters who experienced acute health effects during and after fire suppression; these health effects

included frequent headaches, chemical burns, irritation on face and hands, nose bleeds, cough, and a metallic taste

in the mouth. Injuries experienced by two other fire fighters included a fractured pelvis and a concussion. This

medical information was summarized in a letter dated May 23, 1997.

Numerous reports and notes from the Indianapolis Fire Department’s (IFD) Health and Safety Office, the

Indianapolis Fire Investigation Unit, the local health department, and a local hospital were collected and later

reviewed. Some fire fighters were interviewed (confidentially) in person and others interviewed by telephone to

gather additional details of the incident. Deficiencies that contributed to injuries and illnesses were identified.

Response activities, including medical care and monitoring, were reviewed to reconstruct events both during and

after the fire incident.

On the basis of the information obtained and reviewed, NIOSH investigators concluded that a variety of

acute symptoms experienced by fire fighters were associated with occupational exposures in the course

of fire suppression. Skin irritation temporally associated with the use of equipment previously used at the

UCR fire could be due to residual chemical contamination of the equipment. Recommendations are

offered in this report to address safety and health deficiencies of the overall incident command system and

activities, and to improve the medical evaluation system for fire fighters.

Keywords: SIC 9224 (Fire Protection), fire fighters, firefighters, industrial fire, chemical fire, chemical warehouse,

incident command system, ICS, health effects, self–contained breathing apparatus, SCBA, PPE, contamination,

overhaul.
TABLE OF CONTENTS

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Acknowledgments and Availability of Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii

Introduction ......................................................................... 2

Background ......................................................................... 2

Evaluation Methods ................................................................... 3

Evaluation Criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Findings and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Incident Command Activities ........................................................ 4

Administrative Communications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Personal Protective Equipment (PPE) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Medical Evaluations of IFD Fire Fighters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Medical Evaluations of Perry Township Fire Fighters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Medical Program for Fire Fighters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

OSHA Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

NFPA Standard 1582 ........................................................... 7

NIOSH Publication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Literature Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Conclusions and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Incident Command Activities ........................................................ 8

Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Page 2 Health Hazard Evaluation Report No. HETA 97–0034–2683

INTRODUCTION

In November 1996, the National Institute for

Occupational Safety and Health (NIOSH) received a

health hazard evaluation (HHE) request from the

International Association of Fire Fighters (IAFF)

Local 146 on behalf of the Indianapolis Fire

Department (IFD) and Perry Township Fire

Department (PTFD) personnel who were exposed to

chemicals or injured during and after fire suppression

activities at UCR, Incorporated, a chemical

warehouse located in Indianapolis, Indiana. NIOSH

was asked to review the circumstances surrounding

the fire, evaluate the overall incident command

system, and investigate chemical exposures and

injuries experienced by fire fighters. NIOSH

investigators met with IFD management and union

representatives on January 28, 1997. An interim

letter describing the medical record review was sent

to management and union representatives on May

23, 1997.

BACKGROUND

The fire incident took place on October 12, 1996, at

UCR, Incorporated, which occupied a one–story

warehouse made of block and frame construction

located in an urban, residential setting. With 10 to

15 employees, UCR is a metal finishing company

that uses large quantities of organic and inorganic

chemicals. (See the Appendix of this report for the

inventory of chemicals present at the time of the

fire.) The fire (later ruled accidental) was caused by

the ignition of insulation by a welder’s torch while

he was constructing a handrail on a stairway leading

to chemical mixing tanks. When IFD arrived at the

fire scene there was no placarding on the exterior of

the building, as required by the National Fire

Protection Association (NFPA) Standard 704.(1) The

NFPA placarding requirement is intended to alert or

notify outsiders, such as fire fighter personnel, about

the presence of hazardous materials stored at the

facility.

At 1549 hours, three engine and two ladder

companies from IFD were dispatched to the fire

scene. At 1552 hours, the first unit to arrive on scene

was engine company #26 and they established a

command post. At 1601 hours, the first of two

explosions occurred inside the warehouse, creating

a large, multicolored cloud which immediately came

down as fallout on fire fighter personnel at the

established incident command post. This explosion

thrusted a fire fighter against a fire engine truck and

caused him to lose consciousness (this fire fighter

was later felt to have suffered a concussion). Several

fire fighters were inside the facility performing

search and rescue functions at the time of the

explosion but escaped safely. Consequently, a

defensive mode of attack on the fireground was

declared, and the command post was re–established

at a safer distance away from the fire. Prior to this

explosion, the Hazardous Materials (HAZMAT)

Program Coordinator at the fire scene had

forewarned that the initial command post was

established too close to the burning facility. 

A tactical support unit arrived on scene at 1602 hours

to provide support activities of replacing depleted

supply–air cylinders and performing equipment

repairs. The first of four fire rescue units arrived on

the scene at 1605 hours (later accompanied by

medics from a local hospital) and established a triage

area for rehabilitation and medical monitoring of fire

fighters who suffered chemical–related illnesses,

injuries, or heat–related disorders (i.e., thermal burns,

heat exhaustion).

Minutes after the first explosion, a second explosion

occurred, spraying a green cloud of an unidentified

chemical material on some fire fighters that were

near the burning facility. The appearance and nature

of the fire indicated the involvement of large

quantities of hazardous chemicals. Three HAZMAT

teams were then dispatched, and the first team

arrived at 1610 hours. A decontamination area was

immediately established to decontaminate

chemically exposed fire fighters.

The building’s Site Safety Plan and Material Safety

Data Sheets (MSDS) (acquired from an employee
Health Hazard Evaluation Report No. 97–0034–2683 Page 3

contact) were reviewed by the Incident Commander

and the HAZMAT Coordinator to identify and locate

chemical materials stored in the burning facility. The

most hazardous chemicals present in the burning

building were copper cyanide, sodium cyanide,

methanol, propanol, and corrosive materials. To

impede the fire from spreading in the middle area of

the building where the cyanide chemicals were

stored, a mobile foam truck was dispatched. It

arrived at 1637 hours and fire fighters applied an

aqueous (alcohol–based) to suppress the fire.

On the afternoon of the fire, the local weather

conditions included temperatures as high as 68°F

with an average wind speed of 11 miles per hour

(light breeze) from the south and southwest

directions. The fire created a plume of smoke which,

as a precautionary measure to the public, warranted

the evacuation of some neighboring residents from

the neighborhood by the local police department. 

Due to water runoff possibly containing hazardous

chemicals, containment areas outside the burning

facility were identified and cordoned off by fire

fighters and other emergency personnel. A field

sheet from the local health department indicated that

air testing (using a chemical vapor analyzer and

detector tubes) done on the fireground during the fire

did not measure chemical levels higher than

background levels. The local health department’s

information sheet concerning the incident indicated

that sampling of the water runoff from the fire

revealed the presence of cyanide and chromium and

a pH that ranged from 9.5 to 11.5 (moderately

caustic). Analysis of soil samples believed to be

exposed to the water runoff did not have elevated

levels of those compounds. 

The fire was declared under control at about

1905 hours. During overhaul, fire fighters

experienced chemical splashes when hot spots were

being hosed down, and at times fire fighters walked

through runoff water that was a greenish color with

an ammonia odor.

During and after fire suppression and overhaul

activities, seven fire fighters were transported to a

local hospital to receive medical treatment for

injuries. Most injuries were minor chemical burns,

but one fire fighter was admitted overnight. Another

fire fighter suffered a fractured pelvic bone as a

result of being pinned against a door of a moving fire

engine truck. In the weeks following the fire incident

some fire fighters continued to report health

problems. Some fire fighters reported skin irritation

while using personal protective equipment (PPE) that

had not been properly inspected and decontaminated

following the UCR fire.

EVALUATION METHODS

On January 28, 1997, NIOSH investigators met with

IFD management, IAFF’s Joint Safety Committee,

with representatives from Perry Township and

Warren Township fire departments also present.

This meeting was arranged to discuss the nature of

the request, the chronology of events, fire

suppression activities, and medical issues.

Numerous reports and notes from IFD’s Health and

Safety Office and the Indianapolis Fire Investigation

Unit were collected and later reviewed. These

included: (1) the Incident History Detail log; (2)

field notes and incident reports by the Safety Officer

and the HAZMAT Coordinator; (3) field sheets from

the Department of Water Quality and Hazardous

Material Management; (4) field sheets from the local

health department; (5) an inventory of the

106 chemicals present at UCR; (6) medical records

of the 11 IFD and 8 Perry Township fire fighters who

received medical treatment, and (7) and other

pertinent letters and documents.

Some fire fighters were interviewed (confidentially)

in person, and others by telephone, to gather

additional details of the incident. This information

was used to reconstruct events and review

procedures followed during the incident, to identify

deficiencies that may have contributed to injuries and

illnesses, and to review the medical care and

monitoring provided to injured and ill fire fighters.
Page 4 Health Hazard Evaluation Report No. HETA 97–0034–2683

EVALUATION CRITERIA

Fire fighters work in varied and complex

environments that increase their risk of on–the–job

death and injury.(2) In 1993, according to the Bureau

of Labor Statistics, the fatal on–the–job injury rate

was three times the national average and was highest

among the protective service occupations.(3) In 1996,

the National Fire Protection Association (NFPA)

reported 92 death occurring in the line–of–duty. In

addition, there were 101,500 fire fighters injured

in the line of duty in 1993.(2) According to

1992 National Safety Council statistics, the

occupational injury and illness incidence rate for

fire fighters was 8.2 cases per 100 full–time

employees, with 3.5 cases per 100 employees

involving days away from work and deaths.(4) In

over 200 residential fires in Boston, air monitoring

(which focused on a small fraction of the possible

combustion products) found varying air

concentrations of carbon monoxide, carbon dioxide,

hydrogen cyanide, benzene, nitrogen dioxide,

hydrogen chloride, and acrolein.(5,6) Other toxic

components of smoke can include ammonia,

acrylonitrile, halogen acids, sulfur dioxide,

aldehydes, isocyanates, methylene chloride,

particulates, and hydrocarbons.(7–9) In addition to

thermal and chemical burns, fire fighters may also

experience heat exhaustion and cold stress. Other

health and safety problems may include injuries

caused by falling objects or debris, muscle strains

from heavy lifting, exposure to high noise levels,

electrical shock, puncture wounds, bruises, and

communicable diseases from rendering medical

services.

Exposures to respiratory irritants such as acrolein,

hydrogen chloride, and nitrogen dioxide may lead to

acute and chronic respiratory problems. There is an

increasing concern about a fire fighter's exposures to

carcinogens released from the combustion of

synthetic materials used in building construction.(11)

FINDINGS AND

DISCUSSION

Incident Command Activities

According to the HAZMAT Coordinator’s field

notes, the command post established at the UCR fire

incident was established too close to the burning

warehouse. Only after the first explosion, which

resulted in chemical exposure to fire fighters, was the

command post re–established to a safer location.

Customary hot, warm, and cold zones for HAZMAT

incidents also were not adequately established on the

fireground. Individual working areas such as the

command post, decontamination, and rehabilitation

were reportedly established too close to each other,

which may have contributed to disorganization and

confusion during the incident.

Administrative

Communications

There was an inadequate system for PTFD fire

fighters to report health–related issues to PTFD

management officials. PTFD’s fire fighters involved

in the UCR incident had not formally reported health

problems to their management until weeks later

when a local newspaper covered a story about health

problems experienced by IFD’s fire fighters during

the same incident. Therefore, some fire fighters did

not receive medical attention until that time.

Personal Protective

Equipment (PPE)

Because much of the fire suppression activities

occurred outdoors, with fire fighters attacking the

fire from a defensive mode, a fire fighter at the scene

reported that some fire fighters felt comfortable with

not wearing their self–contained breathing apparatus

(SCBA) in established hot and warm zones. While

a properly operating SCBA worn by a well–trained

individual offers adequate protection against smoke
Health Hazard Evaluation Report No. 97–0034–2683 Page 5

and chemical inhalation, even brief exposure without

respiratory protection presents a health hazard. A

contributing factor to fire fighters’ exposures may

have been the lack of enforcement of PPE

requirements by a delegated safety officer who must

routinely observe operations at the scene of an

incident to ensure safe work practices.

A fire fighter’s complete turnout gear typically worn

during the incident consists of a helmet, hood,

turnout coat, turnout pants, boots, gloves, and SCBA

with a personnel accountability system (PAS) device.

SCBAs provide the highest level of protection

against inhalation exposures, even in atmospheres

considered immediately dangerous to life and health.

Turnout gear is made of fire–resistant material that

will provide protection against flashover

temperatures up to 1500°F for brief periods.

Although turnout gear has the ability to withstand

some types of chemical contact, during a chemical

fire it may not provide protection against chemical

exposure. Skin exposure is very likely because

turnout gear material is not impermeable to many

chemicals. PPE made of a material that is both fire–

and chemical–resistant currently does not exist.

Following the UCR fire, IFD’s quartermaster

replaced 110 items that could not be decontaminated,

and 32 bunker pants and coats were cleaned.

Because the PTFD had an Allowance system in

place, instead of a Quartermaster system, PTFD fire

fighters involved in the UCR fire experienced

problems with replacing turnout gear that was either

permanently damaged or chemically contaminated.

There were reports that some chemically

contaminated turnout gear was still in use weeks

following the incident. The use of this gear may

have resulted in skin irritation when worn by fire

fighters at other fire scenes. Elements of a

Quartermaster system should include the

replacement, repair, laundering, and

decontamination of turnout gear. If feasible, an

adequate supply of replacement turnout gear should

be made available to fire fighters while necessary

replacement, repairs, or laundering is rendered.

The UCR warehouse did not have the exterior

placarding as required by the NFPA Standard 704.(1)

(Appropriate placarding on the building would have

notified or alerted the Incident Commander about the

potential for a chemical fire.) Only after fire fighters

were exposed to chemicals as a result of an explosion

(and after an employee provided MSDSs for

chemical inside the burning) did the Incident

Commander become aware of chemical storage.

Although chemical exposure to fire fighters could

not have been totally avoided during the incident,

placarding would have forewarned the first fire

fighters who arrived on the scene to take appropriate

precautions. In addition, support units (i.e., mobile

foam unit) would have been dispatched sooner.

According to the HAZMAT Coordinator’s incident

report, industrial fires involving chemicals should be

extinguished with a foam material, not water. Under

certain circumstances application of water to a

chemical fire may prove effective in fire control, but

not in extinguishing the fire. Dry chemicals, foams,

carbon dioxide, or halogenated agents are generally

used for chemical fires. Water usage alone greatly

contributes to runoff that may result in chemical

exposure of emergency response personnel and may

cause environmental damage to nearby surrounding

areas.

Following fire suppression activities, overhaul

activities are sometimes undertaken without

adequately protecting the safety and health of fire

fighters. Personnel performing overhaul and

investigations (for cause of fire) are potentially

exposed to combustion products that may cause

acute and long–term health effects or encounter

safety hazards. Physical hazards may include

slips/trips, poor visibility, extreme temperatures, and

building collapse. Fires may produce carbon soot

and pyrenes. Gases and vapors (e.g., hydrogen

cyanide, oxides of nitrogen, aldehydes) are known to

adsorb onto the surface of particles and may pose a

health hazard when inhaled. Disturbance of burned

building materials may lead to exposures to lead

paint and asbestos.
Page 6 Health Hazard Evaluation Report No. HETA 97–0034–2683

MEDICAL

The information from the IFD Health and Safety

Office indicated that seven IFD fire fighters were

transported to a local hospital after the incident (one

was admitted, six were treated and released). The

information from the IFD also indicated that soon

after the incident the IFD had identified all personnel

present at the fire and educational activities and

record–keeping regarding exposures and symptoms

related to the UCR incident had begun. The letter

from the Indiana Poison Center indicated that the

chemicals present at the UCR fire were likely to

primarily cause acute irritant effects (such as

nosebleeds) and recommended that all symptomatic

fire fighters receive a medical evaluation. There was

no information available which documented

exposure of fire fighters (or others potentially

exposed) to any specific substance during the fire.

Medical Evaluations of IFD

Fire Fighters

Review of the 11 medical records and personal

statements regarding IFD fire fighters revealed that

four fire fighters experienced chemical burns on

exposed areas of skin, three experienced nosebleeds,

and three experienced upper respiratory irritation or

congestion. One fire fighter suffered a fractured

pelvis after being pinned against the door of a

moving fire truck. Approximately one month after

the UCR fire, one fire fighter developed increased

shortness of breath and was found to have a

paralyzed right hemidiaphragm. One fire fighter

developed Bell’s palsy (facial paralysis)

approximately two months after the UCR fire. Two

months after that diagnosis, the medical record

indicated improvement (but not complete resolution)

of the facial paralysis in that fire fighter. Another

health effect noted was an elevation of the enzyme

gamma–glutamyltranspeptidase (GGT) in one fire

fighter.

Paralysis of the hemidiaphragm is not likely related

to an environmental exposure; the most common

cause is nerve damage due to cancer.(12) If a person

with paralysis of the hemidiaphragm does not have

a cancer, the cause of the paralysis is often not

discovered. Bell’s palsy is defined as idiopathic

facial paralysis (facial paralysis due to unknown

causes). Some cases of Bell’s palsy have been

shown to be related to a virus,(13) and many

researchers believe that reactivation of viral

infections present in some persons is the main cause

of Bell’s palsy.(13,14) Other factors thought to be

involved include genetic, metabolic, autoimmune,

vascular, and structural factors.(13) Toxic

(environmental or occupational) etiologies of Bell’s

palsy have not been documented in the medical

literature. The enzyme GGT is often included in a

group of blood tests performed to evaluate liver

function. Elevation of the GGT can be caused by

many types of conditions and disorders and is not

specific for exposure to any particular substance.(12)

Medical Evaluations of Perry

Township Fire Fighters

Review of the eight medical records and personal

statements regarding Perry Township fire fighters

revealed that three fire fighters were in the vicinity of

the explosion that occurred at the UCR fire; one of

those fire fighters reported a period of loss of

consciousness and was later diagnosed with a

concussion. A variety of symptoms were reported by

all eight fire fighters, the most common being

headache. In some instances the headaches were

reported to persist one to two months past the date of

the fire. All eight fire fighters were evaluated by a

physician in February 1997, approximately four

months after the UCR fire. At that time, all received

a general examination, pulmonary function test,

urinalysis, several blood tests, and a chest x–ray; all

results were reported as being within normal limits.

There was no information which indicated that these

eight fire fighters had received any medical

evaluation prior to the examinations mentioned

above.
Health Hazard Evaluation Report No. 97–0034–2683 Page 7

Medical Program for Fire

Fighters

The following sections briefly review information

which may be applicable to medical programs for

both hazardous materials (HAZMAT) and

regular–duty fire fighters.

OSHA Standards

The Occupational Safety and Health Administration

(OSHA) standards on hazardous waste operations

and emergency response (29 CFR 1910.120) and

respiratory protection (29 CFR 1910.134) may both

be applicable for these workers. (Although federal

OSHA standards do not legally apply to public

employees, Indiana has an approved State Plan, with

equivalent standards that apply to public employees).

The hazardous waste standard requires medical

examination of workers exposed to hazardous

substances and members of HAZMAT teams: (1)

prior to assignment; (2) at least every 12 months

(every 24 months at the discretion of an attending

physician); (3) at termination of assignment; and (4)

when an employee develops signs or symptoms of

exposure, or is exposed above a specific exposure

limit. The content of the medical examinations is

determined by the examining physician, but must

include a medical and work history and a fitness for

duty evaluation (including ability to wear personal

protective equipment under anticipated work

conditions [including extreme temperatures]). Under

the OSHA respiratory protection standard, a

physician must annually evaluate a worker’s ability

to use a respirator. 

NFPA Standard 1582

The NFPA Standard 1582 on Medical Requirements

for Fire Fighters(15) recommends preplacement,

periodic, and return–to–duty medical evaluations.

The periodic medical evaluations include a history,

physical examination, audiometry, vision testing, and

pulmonary function tests, with lab tests, diagnostic

imaging, and electrocardiography to be performed if

indicated. The standard also lists medical conditions

that are absolute or relative contraindications for

work as a fire fighter. Periodic medical examinations

are recommended every one to three years,

depending on the age of the firefighter.

NIOSH Publication

A document jointly issued by NIOSH, OSHA, the

US Coast Guard, and the Environmental Protection

Agency (EPA) discusses a recommended medical

program for hazardous waste workers which

includes: (1) medical surveillance; (2) medical

treatment; (3) record keeping; and (4) program

review.(16) The general components of each of these

aspects of the medical program are discussed in that

document and can be applied to HAZMAT and

regular duty fire fighters. Recommendations for

medical evaluation of workers exposed to several

specific toxicants are provided in that document.

Other recommendations regarding the prevention of

injuries and deaths of firefighters are published in a

NIOSH Alert.(17)

Literature Review

Occupational medical surveillance involves the

longitudinal, periodic examination of workers who

are potentially exposed to health and safety hazards.

The goals of medical surveillance include: (1)

establishing baseline clinical data against which

future changes can be measured; (2) detection of

medical conditions that predispose to work–related

illness or injury; (3) monitoring of exposure; (4)

evaluation and reinforcement of other health and

safety measures; and (5) detection of early stages of

work–related illness and injury.(18) Various clinical

and diagnostic tests can potentially be used to detect

predisposing conditions, evaluate degree of exposure

to agents, and detect pre–symptomatic changes in

health status. The types of medical tests indicated in

any particular situation may be identified by using

the following approach for selecting a test:(16) (1)

general medical tests based on an individual’s past

medical history and an assessment of likely potential

occupational exposures; (2) medical tests to monitor

exposure to specific toxicants an individual is likely

to be exposed to; and (3) pre–placement blood or
Page 8 Health Hazard Evaluation Report No. HETA 97–0034–2683

urine samples frozen for later testing (limited to

specific situations).

Medical surveillance for both regular–duty and

HAZMAT fire fighters is challenging due to the fact

that fire fighters may be exposed to multiple

hazardous agents, the identity of which may be

unknown, under uncontrolled conditions. These

exposures can rarely be quantified, and they may

vary greatly in time and place. A great deal has been

written discussing the recommended medical

programs for workers potentially exposed to

hazardous materials,(18–22) but little information is

available documenting the utility of performing

specific medical tests in these groups. A recent study

concluded that, among the tests used to evaluate a

group of HAZMAT fire fighters over a two– to

three–year period, baseline and periodic audiometry

and spirometry were useful in medical surveillance;

the authors further recommended that these tests be

included as components of a medical surveillance

program for regular duty fire fighters.(20)

CONCLUSIONS AND

RECOMMENDATIONS

The records which we reviewed regarding the UCR

fire in October 1996, indicated that a number of fire

fighters experienced acute health effects related to

occupational exposures in the course of fire

suppression. We were unable to identify

environmental exposures related to any specific

adverse health effect. Skin irritation temporally

associated with the use of equipment previously used

at the UCR fire could be due to residual chemical

contamination of the equipment. Several other

medical conditions were diagnosed among some of

these fire fighters that were not likely related to

occupational exposures. Information was not

available to evaluate the possibility of ongoing health

problems related to exposures at the fire. The

available records were not sufficient to assess the

adequacy of the formal medical program for the fire

fighters involved.

Incident Command Activities

1. The establishment and location of individual

work areas (i.e., decontamination, rehabilitation) on

the fireground is an important factor which may

impact upon the health and safety of personnel

responding to a fire. During the initial phase of a

fire, the Isolation and Protective Distances

guidelines should be followed to ensure proper

location of the incident command post and individual

support areas during the initial phase of a fire

incident, in accordance with the Emergency

Response Guidelines(23) book. 

2. The establishment of HAZMAT response teams

should not preclude First Responders Awareness

training for fire fighting units to handle chemical fire

incidents. Often these units arrive on–scene at such

incidents before HAZMAT response teams and may

be commanded to perform support activities. The

NFPA 472, Standard for Professional Competence

of Responders to Hazardous Materials Incidents, set

the minimum competencies expected of first

responders to perform certain tasks during a

HAZMAT incident. First Responder Awareness is

for those (such as the first fire fighters who arrived at

the UCR fire scene) who are likely to discover the

release of a hazardous material. Responders should

never attempt to perform tasks beyond their level of

training and competency.

3. Fire fighters may often face chemical exposures

when responding to incidents such as the UCR

chemical fire because they lack appropriate

protective equipment. No PPE currently exist that

will protect against both fire and the chemical

exposures associated with such an incident. To

reduce the likelihood of fire fighters sustaining

undue exposures during these types of incidents, all

fire fighters should properly wear all PPE while in

established hot and warm zones.

4. The recent revision of the OSHA respiratory

protection regulation (CFR 1910.134) includes

measures designed to protect fire fighters while

working inside burning buildings and should be
Health Hazard Evaluation Report No. 97–0034–2683 Page 9

implemented.(24) The rule, referred to as a “double

buddy system” or more commonly the 2 in/2–out

rule, states that whenever fire fighters enter a burning

structure, they must do so in teams of at least two

and remain in direct voice or visual contact with each

other at all times. Also, at least two other fully

equipped and trained fire fighters must remain

outside the structure to monitor those inside and be

prepared to rescue them.

5. Immediately following fire suppression and

overhaul activities involving chemical fires, fire

fighters should have all potentially contaminated

PPE thoroughly inspected, tested, and laundered in a

timely fashion. They should also be instructed to

promptly discontinue the use of any potentially

contaminated PPE and equipment. While the IFD

had a Quartermaster system in place to manage their

supplies and equipment issues, PTFD had adopted an

Allowance system. Whether a Quartermaster system

or an Allowance system is used, an adequate supply

of backup equipment should be available to fire

fighters.

6. Since fire fighting is a highly hazardous

occupation, safe work habits and use of PPE is

strongly emphasized. During a fire incident the

assigned Safety Officer must have full authority to

move around the scene to observe and address safety

and health hazards, including such unsafe practices

of not wearing respiratory protection in hot and

warm zones. At future fire incidents, the Safety

Officer should enforce the use of all necessary PPE

in hot and warm zones and also identify other unsafe

practices on the fireground.

7. Fire fighters and fire investigators involved in

overhaul operations should take precautions to

protect themselves from physical and chemical

hazards. If SCBAs are not used, management should

require the use of full–face respirators equipped with

a combination of organic vapor/acid gas chemical

cartridges and a high–efficiency particulate air

(HEPA) filter. Training and planning may help to

minimize other unique hazards that may be present

during overhaul operations. 

8. Inter–departmental communication should be

improved to address safety issues and concerns (e.g.,

contaminated equipment). Shortly after incidents,

such as the UCR fire, that require cooperation of

more than one fire department, a meeting should be

held among fire chiefs, incident commanders, safety

officers, and possibly other personnel to discuss,

share, and document information about lessons

learned, near misses, safety, and administration

problems that were encountered.

9. Emergency response preplanning documents

were only available at the central HAZMAT office

of IFD. For better preparation and availability to

these documents, each fire station should have copies

for all businesses that store sufficient quantities of

hazardous materials in their area. Furthermore, a

system could be computerized by address, so that

when an alarm occurs for a certain address, a unique

warning signal will notify the central HAZMAT

office and dispatched fire stations about the potential

for chemical fire.

10. The IFD and PTFD should consider issuing a

written “Alert” to small businesses to inform them

about fire protection issues, including emergency

response preplanning and the importance of

reporting any chemical storage and use at their

facility to their local fire department, in accordance

with NFPA standard 704. The UCR fire incident (or

other similar incidents) and its consequences could

be included as an example.

Medical

1. Fire fighters who participated in the UCR fire

and who continue to be symptomatic should receive

medical follow–up as part of a formal medical

program (see #3 below).

2. Fire fighters who were in the vicinity of the

explosion at the UCR fire should have follow–up

audiometric testing.

3. A formal medical program for routine medical

evaluation should be established and made available

to all fire fighters (as well as other emergency and
Page 10 Health Hazard Evaluation Report No. HETA 97–0034–2683

rescue personnel) responding to hazardous material

incidents. Although this applies directly to

HAZMAT fire fighters, a similar, if not identical,

medical program should be available for

regular–duty fire fighters as well. Regular–duty fire

fighters may respond to chemical fires and

HAZMAT incidents, and as initial responders to

these incidents, regular fire fighters may be exposed

to dangerous conditions before the hazards are

appreciated.

a. The basic components of this type of

program have been outlined previously(16) and

include: (i) medical surveillance, including

pre–placement, periodic, and termination

medical examinations; (ii) medical treatment,

including emergency and non–emergency

treatment; (iii) record keeping; and (iv) program

review.

b. The baseline (pre–placement) medical

examination should include a medical and

occupational history and a physical

examination, with focus on the cardiovascular

and pulmonary systems. The extent and type of

laboratory and other medical testing to be

included should be determined with the help of

occupational health professionals experienced in

performing medical surveillance exams and with

consideration of the potential exposures faced

by any specific group of workers. Baseline

testing should in most cases include: (i) vision

testing; (ii) audiometry; and (iii) spirometry. A

recent evaluation of HAZMAT fire fighters(20)

suggested that audiometry and spirometry are

useful tests to repeat periodically in an ongoing

manner to potentially detect auditory (hearing)

and pulmonary (lung) effects due to exposure to

noise and pulmonary irritants.

Chest x–ray, electrocardiogram, and other

medical testing should be performed as part of

this exam if clinically indicated.(16) Some

authors(19,20) recommend these types of tests as

part of the preplacement examination, although

their effectiveness in documenting work related

problems in a medical surveillance program has

not been demonstrated.

c. The utility of performing other medical tests

(baseline and/or periodic) should be determined

by the health professionals involved with the

medical program for any specific group of

workers. These other medical tests could

include specific markers of exposure to (or

health effects from) hazardous materials that

may be encountered by that group of workers.

Freezing of blood and urine (archived

specimens) may theoretically be useful in

certain instances to provide a baseline

measurement for use after a specific exposure

has occurred, but it may be of little practical

value unless the post–exposure specimen is

obtained soon after the baseline measurement.

d. The frequency of periodic re–evaluations

should be determined by the level of exposure or

other relevant clinical factors; annual or

biannual re–evaluations are generally

considered reasonable approaches.

4. The availability of proper emergency and

episodic medical care should be a component of the

medical program, including prompt evaluation of

personnel who are symptomatic after an incident and

also evaluation of asymptomatic persons believed to

have potentially received a significant toxic

exposure. Fire department management should

ensure incident reports are completed in a timely

manner by all fire fighters who experience injuries or

illnesses on duty, or who have potentially received a

toxic exposure. Fire fighters who are symptomatic

should be re–evaluated in an ongoing manner as

clinically indicated. Medical personnel and others

involved in administering the medical program

should be aware that all health effects may not be

immediate and that delayed health effects can result

from occupational exposures. 

5. Continuity of care is important in providing

occupational health services to groups of workers, so

to the extent possible, the same medical provider

should be used over time.
Health Hazard Evaluation Report No. 97–0034–2683 Page 11

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Health Hazard Evaluation Report No. 97–0034–2683 Page 13

APPENDIX

INVENTORY OF CHEMICALS STORED AT URC, INC.

INDIANAPOLIS, INDIANA

HETA 97–0034–2683

BROMOCRESOL

BUTOXYNE

1,4–BUTYNEDIOL

CADMIUM

CALCIUM NITRATE

CELOSOLVE ACETATE

CELLOSOLVE SOLVENT

CHROMIC ACID

CITRIC ACID

CHLOROHYDRATE

CHLOROBENZALDEHYDE

COLBALT CHLORIDE

DC ANTIFOAM H–10

DENATURED CHLORAL HYDRATE

DEXTROSE

DICALITE

DIMETHYLAIMINOPROPYLAMINES

DISODIUM PHOSPHATE ANHYDRIDE

DODECYL BENZENE SULFONATE

DRISNATE TX

EDTA

ETHANE

ETHOMEEN

ETHYENE DIAMINE

FLORAL BRAND SURFACTANT

FERRIC CHLORIDE ANHYDROUS

FERRIC SULFATE

FIBRE DRUMS

FORMALDEHYDE

FORMIC ACID

GLACIAL ACETIC ACID

GLYCOL ETHER

GOLPANOL BMP

HEXAFLOC AM26

HYDROCHLORIC ACID

HYDROFLUORIC ACID

HYDROFLURSILICIC ACID

IGEPAL 730

IGEPAL 630

IGEPAL 887

IMIDAZOLE POLYMER

ISOPRPYL ALCOHOL

LIQUID CAUSTIC POTASSIUM

MARASPERSE N–22

METHANOL

MONOETHANOLAMINE

MURIATIC ACID

NACONNAL 90

NBC–25

NICKEL CHLORIDE

NIAPROOF SURFACTANT

NITRIC ACID

NS–10

NTA

ORTHO–CHLOROBENZEALDEHYDE

PAILS

PETRO

PHOSPHPORIC ACID

POTASSIUM FERRICYANIDE

POTASSIUM METABISULFTE

POTASSIUM TRIPOLYPHOSPHATE

POTASSIUM CHLORIDE 

POTASSIUM IODIDE

POTASSIUM NITRATE

PROARGYL ALCOHOL

ROCHELLE SALTS

SULFOBETAINE

SACCRINE

SODIUM FLUOROSILICATE

SODIUM METASILICATE

SODA ASH

SODIUM ACETATE

SODIUM ACID PYROPHOSPHATE

SODIUM BENZOATE

SODIUM BICARBONATE

SODIUM BICHROMATE

SODIUM BISULFITE

SODIUM CITRATE

SODIUM FLUORIDE

SODIUM GLUCONATE

SODIUM LIGNOSULFONATE

SODIUM NITRATE

SODIUM NITRITE

SODIUM TOLSULFONATE

SODIUM SULFATE

SODIUM TETRASULFIDE

SODIUM THIOSULFATE

SYN–FAC 8118

TETRAETHYLENEPENTAMINE

TETRASODIUM PYROPHOSPHATE

THIOUREA

TRIBUTYL PHOSPHATE

TRITON CF–10

TRITON DF–16

TRITON X100

TRITON DF–20

TRI–VALENT (BLUE)

WCA (CHROME MIST0

ZINC NITRATE

ZINC OXIDE