Respiratory Diseases and the Fire Service - IAFF

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ii EDITORS: Respiratory Diseases and the Fire Service The IAFF would also like to thank the following editors and authors for their contributions in addressing fire fighter respiratory diseases and the editors for their tireless efforts in developing and editing this manual so it is consistent, readable and understandable to this Nation’s fire service. Richard Duffy, MSc Assistant to the General President Occupational Health, Safety and Medicine International Association of Fire Fighters Washington, DC Andrew Berman, MD Program Director, Combined Training Program in Pulmonary and Critical Care Medicine Associate Professor of Clinical Medicine Albert Einstein College of Medicine Pulmonary Division Montefiore Medical Center Bronx, NY David Prezant, MD Professor of Medicine Albert Einstein College of Medicine Pulmonary Division Montefiore Medical Center Bronx, NY and Chief Medical Officer, Office of Medical Affairs Co-Director of WTC Medical Programs Fire Department City of New York Brooklyn, NY CONTRIBUTING AUTHORS: Amgad Abdu, MD Pulmonary Fellow Albert Einstein College of Medicine Montefiore Medical Center Bronx, NY Thomas K. Aldrich, MD Professor of Medicine Albert Einstein College of Medicine Pulmonary Division Montefiore Medical Center Bronx, NY David W. Appel, MD Associate Professor of Medicine Albert Einstein College of Medicine Director of the Pulmonary Sleep Laboratory Pulmonary Division Montefiore Medical Center Bronx, NY Matthew P. Bars, MS, CTTS Director- FDNY Tobacco Cessation Program Director, IQuit Smoking Centers of Excellence Program Director-Palisades Medical Center Montvale, NJ Andrew Berman, MD Program Director, Combined Training Program in Pulmonary and Critical Care Medicine Associate Professor of Clinical Medicine Albert Einstein College of Medicine Pulmonary Division Montefiore Medical Center Bronx, NY Alpana Chandra, MD Albert Einstein College of Medicine Pulmonary Division Jacobi Medical Center Bronx, NY Naricha Chirakalwasan, MD Pulmonary Fellow Albert Einstein College of Medicine Montefiore Medical Center Bronx, NY Asha Devereaux, MD, MPH President-California Thoracic Society Pulmonary and Critical Care Medicine Coronado, CA
Peter V. Dicpinigaitis, MD Professor of Clinical Medicine Albert Einstein College of Medicine and Director Cough Center Pulmonary Division Montefiore Medical Center Bronx, NY Carrie D. Dorsey, MD, MPH Assistant Professor University of Maryland School of Medicine Occupational Health Program Baltimore, MD Richard Duffy, MSc Assistant to the General President Occupational Health, Safety and Medicine International Association of Fire Fighters Washington, DC Felicia F. Dworkin, MD Deputy Director Medical Affairs Bureau of Tuberculosis Control New York City Department of Health and Mental Hygiene New York, NY Adrienne Flowers, MD University of Maryland School of Medicine Occupational Health Program Baltimore, MD James Geiling, MD Associate Professor of Medicine Dartmouth Medical School Hanover, NH and Chief, Medical Service VA Medical Center White River Junction, VT Subha Ghosh, MD Assistant Professor of Radiology Ohio State University Medical Center Department of Radiology Columbus, OH Linda B. Haramati, MD, MS Professor of Clinical Radiology Albert Einstein College of Medicine Director of Cardiothoracic Imaging Department of Radiology Montefiore Medical Center Bronx, NY Chrispin Kambili, MD Assistant Commissioner and Director, Bureau of Tuberculosis Control New York City Department of Health and Mental Hygiene New York, NY Robert Kaner, MD Associate Professor of Clinical Medicine Associate Professor of Genetic Medicine Weill Cornell Medical College Pulmonary Division New York Hospital New York, NY Kerry J. Kelly, MD Chief Medical Officer, Bureau of Health Services and Co-Director of World Trade Center Medical Programs Fire Department City of New York Brooklyn, NY Angeline A. Lazarus, MD Professor of Medicine Uniformed Services University Bethesda, MD Stephen M. Levin, MD Associate Professor of Medicine Department of Community and Preventive Medicine Mount Sinai School of Medicine New York, NY Michelle Macaraig, MPH Assistant Director for Policy and Planning Coordination Bureau of Tuberculosis Control New York City Department of Health and Mental Hygiene New York, NY Melissa A. McDiarmid, MD, MPH Professor of Medicine and Director, University of Maryland Occupational Health Program Baltimore, MD Lawrence C. Mohr, MD Professor of Medicine, Biometry and Epidemiology Director, Environmental Biosciences Program Medical University of South Carolina Charleston, South Carolina Diana Nilsen, MD, RN Director, Medical Affairs Bureau of Tuberculosis Control New York City Department of Health and Mental Hygiene New York, NY David Ost, MD, MPH Associate Professor of Medicine New York University School of Medicine New York, NY Respiratory Diseases and the Fire Service iii
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Page 22 and 23: 2 Introduction phase (fire is extin
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Page 28 and 29: 8 Introduction rescue workers respo
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36 Chapter 2-2 • Respiratory Infe
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38 mucus plugging can lead to progr
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46 inhalation of an infected aeroso
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48 ill or “toxic". The chest radi
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54 Chapter 2-3 • Tuberculosis: A
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72 Drug and Duration Isoniazid (INH
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80 Chapter 2-4 • Asthma to such a
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82 Chapter 2-4 • Asthma CLINICAL
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84 Chapter 2-4 • Asthma who has p
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86 Chapter 2-4 • Asthma Long-Term
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88 Chapter 2-4 • Asthma Table 2-4
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90 Chapter 2-4 • Asthma Treatment
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92 Chapter 2-4 • Asthma 21. Natha
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94 Chapter 2-5 • Chronic Obstruct
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100 Chapter 2-5 • Chronic Obstruc
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108 Chapter 2-6 • Sarcoidosis or
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110 Chapter 2-6 • Sarcoidosis Fig
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112 Chapter 2-6 • Sarcoidosis Oth
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114 Chapter 2-6 • Sarcoidosis pri
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116 Chapter 2-6 • Sarcoidosis WTC
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118 Chapter 2-6 • Sarcoidosis 18.
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120 Chapter 2-7 • Pulmonary Fibro
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132 Chapter 2-8 • Pulmonary Vascu
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146 Chapter 2-9 • Fire Fighter Lu
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166 Chapter 2-10 • Asbestos-Relat
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178 Chapter 2-11 • Sleep Apnea Sy
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192 Chapter 2-12 • Cough ACUTE CO
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194 Chapter 2-12 • Cough cough oc
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196 Chapter 2-12 • Cough Gastroes
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198 Chapter 2-12 • Cough WORLD TR
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materials may produce smoke that is
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204 The effects of frequent smoke e
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the most intense exposure to air po
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seizures, coma and death64 . Additi
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highly water-soluble and, thus, wil
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Diagnostic Testing Initial pulmonar
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symptoms in an inhalation lung inju
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17. Musk AW, Peters JM, Wegman DW.
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42. Herbert R, Moline J, Skloot G,
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71. Kales S, Christiani D. Acute ch
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222 Chapter 3-2 • Inhalation Lung
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224 Procedure for Determining Appro
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groups have been identified to be a
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238 fever accompanied by mouth sore
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240 and Aspergillus species which a
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242 renal failure. Encephalitis and
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244 progress to severe, fulminant i
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246 may be present. A systemic dise
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248 one percent are primary pneumon
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250 gentamicin is recommended. In a
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252 9. Kilbourne E. Influenza. 1st
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254 44. Marik PE, Bowles SA. Medica
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256 74. Advisory Committee on Immun
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258 Chapter 3-5 • World Trade Cen
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262 Pulmonary function declines or
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268 (FDNY, NY/NJ consortium coordin
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278 Chapter 4-1 • Pulmonary Funct
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280 Spirometry results can usually
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282 of these conditions on spiromet
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284 Figure 4-1.4: Helium dilution t
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286 calculate a single-breath estim
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288 Chapter 4-1 • Pulmonary Funct
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Class 1, 0%-9%: No Impairment of th
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294 Chapter 4-2 • Imaging Modalit
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314 Chapter 4-3 • The Solitary Pu
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While most people are aware that sm
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332 Modified Fagerström Test for S
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334 nicotine gum, inhalers, or nico
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336 Common Reasons Fire Fighters Ex
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338 and while anyone can temporaril
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340 heart and lungs, increasing the
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342 your doctor, healthcare profess
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344 protection from tobacco craving
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346 cessation. The entire program i
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. drive, the neural control of brea
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350 Figure 4-5.2: The balance betwe
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352 TREATMENT OF RESPIRATORY FAILUR
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354 • Less discomfort Mechanical
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356 WEANING OR REMOVING A PATIENT F
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358 7. Esteban A, Frutos F, Tobin M
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International Association of Fire F
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