Sometimes, the most deadly part of a fire isn't the smoke or flames but the stress placed on a firefighter's body as they move in, out, up and down a burning building.
Wearing heavy "bunker gear" and carrying other equipment and breathing apparatus, firefighters are susceptible to over-exertion and even heart attacks.
Nearly every year, more than half of the firefighters who die in the United States die due to stress directly related to a call.
One Ursinus College professor is working on a study which may help drop that number by raising personal awareness and prompting changes in operations when it comes to fire calls.
Professor Deborah Feairheller runs the HEART (Hypertension and Endothelial function with Aerobic and Resistance Training) Lab at Ursinus, which studies lifestyle effects on heart disease.
Although she keeps busy there running studies and doing research, Feairheller herself is a firefighter who over the past year has run with the East Brandywine Fire Company and now also occasionally with the Collegeville Fire Company.
"My children are now older," she said. "That's why I was able to join."
As such, Feairheller knows firsthand how heavy the gear, which can run between 48 and 52 pounds, feels in the oppressive heat of a building fire.
When East Brandywine Chief John Edwards found out about Feairheller's position at Ursinus, he had an idea for her.
"I've been doing cardio-vascular and blood pressure research for years," Feairheller said. "My chief was like, 'You should do a research study in blood pressure and firefighters.'"
Although East Brandywine has not experienced a cardio-vascular line-of-duty death that Feairheller is aware of, nearby Good Will Fire Company, out of West Chester, lost Capt. Chris Good in 2012 to a heart attack.
Last August, FEMA released a report on firefighter line-of-duty deaths listing "stress and over-exertion" as the leader in line-of-duty deaths. Heart attacks and other stress-related afflictions accounted for 45 of the 81 line-of-duty deaths in 2012 — the most recent year data was available — more than half of those who died that year.
Thirty-nine of those 45 firefighters, which includes Good Will's Good, died of heart attacks, according to FEMA.
"My goal is to ultimately understand this, give (firefighters) some kind of exercise program they can do in their gear and out of their gear," Feairheller said. "I also want to build awareness."
Though studies have been conducted looking into cardio-vascular and stress issues related to firefighting before, Feairheller said they've chiefly involved full-time, professional firefighters.
She said her study focuses on volunteer fire companies which aren't studied as much and have their own special concerns. Among those, she said, is that firefighters in volunteer companies come from a wider age range.
As such, she and the students helping her are focusing on firefighters between 18 and 60, though she said a 65-year-old with the Collegeville Fire Company really wants to get involved.
"I was surprised, I thought I would get mostly 20-, 21-year-olds," Feairheller said. "Turns out my range starts at 40-something and I think the youngest is 19."
Additionally, at certain times of day, some volunteer fire companies may get a call for which they have fewer firefighters on hand. That means some may, by necessity, have to be inside a building longer.
Feairheller called it a "niche" study but it's getting a lot of attention.
"This initial study is basically a pilot study," she said. "I started it as a pilot study but there's been a lot more interest than I originally thought."
Originally shooting for 10 subjects for the study, she's already had 15 firefighters participate and now hopes to test 20.
Feairheller's study basically involves giving firefighters a stress test and monitoring their blood pressure and heart rate "in response to stress."
"We're looking at and calculating VO2, which is a measure of fitness," Feairheller said. "But the more important things are blood pressure and heart rate because you can get those quick on-scene. They're not going to say, 'Your VO2 is...' Most people don't know what that means."
First, the test subjects get on a treadmill in just regular clothes, say a T-shirt and shorts with sneakers, and walk as the treadmill steadily rises into a steeper incline. Through this part of the test, the firefighter's maximum heart rate is discovered.
Next, firefighters put on most of their bunker gear, potentially excluding their helmet, which has some weight to it. They go through the same test, with Feairheller and students like Joy Oakman, Matt Generotti, Avery Perez or JoAnna Iacono helping to monitor and time the test.
Generotti was a student who originally helped Feairheller with the study. He graduated this year but said it gave him a lot of "real-world experience you're not going to get anywhere else."
In the study, firefighters go until they've reached their maximum heart rate and/or decide they can't continue any longer.
All of the testing takes place in an office which is roughly 20 feet by 12 feet. The treadmill is against the back wall, next to high-tech monitoring equipment that is of the same variety used to test the U.S.'s Olympic athletes.
So far, firefighters from Collegeville, Limerick, Trappe and East Brandywine fire companies have participated.
Michael Osinski, 22, a Trappe firefighter, ran the test in full bunker gear, using his breathing apparatus, late Thursday morning.
In his first run of the test in regular, athletic clothes, he went for more than 11 minutes.
Thursday, with 52 pounds of gear weighing on him, Osinski made it approximately 8½ minutes, considered impressive, given the tests.
Given the parameters of the study and what it's trying to simulate, that means that Osinski would have reached the point of exhaustion if he were working inside a house in just those 8½ minutes.
"It's always good to know this when you're inside at a scene," Feairheller told Osinski after he removed his mask and began his cool-down.
Many times, firefighters are inside buildings much longer than that and the temperature is far higher than the slightly uncomfortable 77 or 78 degrees the office was Thursday.
"I had one guy two days ago who said, 'I can't believe it's only been seven minutes and I've already reached my max on my pack, breathing,'" Feairheller said. "'When I'm interior and I'm hosing and pulling down walls,' he says, 'I'm in there for 30 minutes.' I said to him, 'That's exactly why so many firefighters drop dead of a cardiac event.'"
Brian Freas, of the Collegeville Fire Company, took a stress test just before Osinski Thursday.
"Before I joined the fire service, I was naïve to most things other than smoke and fire that were trying to kill today's firefighters; stress and diseases of the heart being at the top of that list," he said. "I feel she is working hard to address a demon that is lurking within every fire department. If we can better understand the heart muscle and our own personal limits and boundaries related to stresses on the fire ground, I believe it will help to bring down the number of heart-related deaths that claim firefighters each year."
Pushing past the determination of trying to stay in a scene as long as possible is a hurdle, but Feairheller feels getting as much personal data as possible on how dangerous that could be is important.
"I think it's important to be aware of that information because when you're actually in a fire, it's definitely really strenuous," Osinski said. "It's good to know how your body responds to it."
Osinski, an Ursinus graduate, said he feels that it's good to have a measure for where his personal blood pressure maximum is for the "rehab" traditionally done after fires.
Expansions to the current study are planned.
Iacono is a graduate student from West Chester University who plans to do a study later this summer involving a swallowable pill which will help monitor the core temperature of football players. Feairheller said they hope to do the same in future iterations of her study on firefighters.
Additionally, since the current study being run is only a pilot, Feairheller wants to apply for FEMA funding and test more.
She hopes that her findings might change the way firefighters attack fires, potentially creating a rotation based on each person's physical abilities to make everything safer.
"I'm approved for a year, and I can always renew it," Feairheller said. "I'm just going to keep it going. The more firefighters I can get, the more information I can get, the more awareness there will be."
Information from: The Mercury, http://www.pottsmerc.com