Cardiovascular health effects following exposure of human volunteers during fire extinction exercises

Maria Helena Guerra Andersen, Anne Thoustrup Saber, Peter Bøgh Pedersen, Steffen Loft, Åse Marie Hansen, Ismo Kalevi Koponen, Julie Elbæk Pedersen, Niels Ebbehøj, Eva-Carina Nørskov, Per Axel Clausen, Anne Helene Garde, Ulla Vogel, Peter Møller, Maria Helena Guerra Andersen, Anne Thoustrup Saber, Peter Bøgh Pedersen, Steffen Loft, Åse Marie Hansen, Ismo Kalevi Koponen, Julie Elbæk Pedersen, Niels Ebbehøj, Eva-Carina Nørskov, Per Axel Clausen, Anne Helene Garde, Ulla Vogel, Peter Møller

Abstract

Background: Firefighters have increased risk of cardiovascular disease and of sudden death from coronary heart disease on duty while suppressing fires. This study investigated the effect of firefighting activities, using appropriate personal protective equipment (PPE), on biomarkers of cardiovascular effects in young conscripts training to become firefighters.

Methods: Healthy conscripts (n = 43) who participated in a rescue educational course for firefighting were enrolled in the study. The exposure period consisted of a three-day training course where the conscripts participated in various firefighting exercises in a constructed firehouse and flashover container. The subjects were instructed to extinguish fires of either wood or wood with electrical cords and mattresses. The exposure to particulate matter (PM) was assessed at various locations and personal exposure was assessed by portable PM samplers and urinary excretion of 1-hydroxypyrene. Cardiovascular measurements included microvascular function and heart rate variability (HRV).

Results: The subjects were primarily exposed to PM in bystander positions, whereas self-contained breathing apparatus effectively abolished pulmonary exposure. Firefighting training was associated with elevated urinary excretion of 1-hydroxypyrene (105%, 95% CI: 52; 157%), increased body temperature, decreased microvascular function (-18%, 95% CI: -26; -9%) and altered HRV. There was no difference in cardiovascular measurements for the two types of fires.

Conclusion: Observations from this fire extinction training show that PM exposure mainly occurs in situations where firefighters removed the self-contained breathing apparatus. Altered cardiovascular disease endpoints after the firefighting exercise period were most likely due to complex effects from PM exposure, physical exhaustion and increased core body temperature.

Keywords: Cardiovascular disease; Firefighter; Ultrafine particles.

Conflict of interest statement

Authors’ information

Correspondence regarding this study should be addressed to UV (ubv@nrcwe.dk) or PM (pemo@sund.ku.dk).

Ethics approval and consent to participate

The Danish Committee on Health Research Ethics of the Capital Region (H-15003862) approved the study and study subjects participated in information meeting and provided written informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Creatinine-adjusted urinary concentration of 1-hydroxypyrene in three exposure scenarios (before and after as control measurements, and exposure measurement). Grey symbols and dashed lines are individual results in each subject. Black line is a graphical output of the mixed effect model
Fig. 2
Fig. 2
Cardiovascular endpoints in the three exposure scenarios (before and after as control measurements, and exposure measurement). Natural base log of reactive hyperemia index (one subject was eliminated due to missing data in both control measurements) (a), time domain heart rate variability in pNN50 (b) and RMSSD (c), frequency domain heart rate variability (d), augmentation index corrected for 75 bpm (e) and baseline heart rate (f). Grey symbols and dashed lines are individual results in each subject. Black line is a graphical output of the mixed effect model. pNN50, proportion of successive NN intervals differing by more than 50 milliseconds divided by total number of NN intervals; RMSSD, square root of the mean squared differences of successive NN intervals; bpm, beat per minute; ms, millisecond

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