human capital 28 th annual virginia ems symposium november 2007 norfolk, virginia

HumanCapital

28th Annual Virginia EMS Symposium

November 2007 w Norfolk, Virginia

Protecting Our Greatest Resource withComprehensive Wellness & Fitness

Programs

28th Annual Virginia EMS Symposium

November 2007 w Norfolk, Virginia

Welcome!

Meet Your Neighbor

Explain to your neighbor your organization’s plan to manage equipment, apparatus, or facility fatigue/obsolescence.

i.e., What’s your apparatus replacement plan?

Are you engaged in a plan to build or replace apparatus or facility?

Meet Your Neighbor

Take four (4) steps to the right.

Now, explain to your new neighbor your organization’s plan to manage personnel fatigue/obsolescence.

Meet Your Neighbor

Take four (4) more steps to the right.

Now, explain to your new neighbor why you are here today and what wellness means to you.

Our Greatest Asset

Greatest Asset

• Our people are our greatest asset and resource

• It is not equipment, apparatus, or facilities

It is through our personnel that the we serve the public, accomplish our missions, and are able to make a difference in our communities!

Greatest Asset

• Firefighters and EMS personnel risk their lives saving people and property

• Value of work has become increasingly apparent following 11 September 2001

• Many Americans – including fire & EMS personnel – don’t realize that our personnel need protecting too

The statistics are clear: our people are at an extremely high risk of becoming injured or dying while helping others.

Greatest Asset

Heart attack is the leading cause of on-duty death among firefighters!

Greatest Asset

• Stress-related cardiac deaths is the leading cause of firefighter fatalities (historically accounting for 50% of firefighter fatalities)1

• Many had pre-existing conditions1 (arteriosclerosis, previous MI, hypertension)

• Most organizations do not have expectations regarding fitness and wellness

• We have lengthy bouts of sedentary activity separated by intense periods of hyper-strenuous activity2

1 United States Fire Administration, Firefighter Fatality Study2 Texas A&M University Study

Greatest Asset

• The risk to our personnel when responding to or operating at a call for service can increase their chance of suffering from a heart attack by 10-100x3

• Other emergency response activities have also been shown to substantially increase the risk of heart attack4

3 Harvard Medical School Study4 Emergency Duties and Deaths from Heart Disease, Kales

Greatest Asset

• Improving the fitness & wellness of our personnel will help ensure safe and effective services for the community

• 7 out of 10 firefighters retire with some sort of disability1

• 1 in 4 firefighters die on the job1

• We lack good data for EMS-only injuries and line-of-duty-deaths

1 United States Fire Administration

Deaths & Injuries of Personnel

2006 Line-of-Duty-Deaths

106 LODDs

• 44 Urban• 46 Rural• 16 Wildland

Firefighter Fatalities in the United States in 2006. U.S. Fire Administration. July 2007.

2006 Line-of-Duty-Deaths

47.2%

22.6%

11.3%

7.5%

4.7%

3.8% 0.9% 1.9%

Nature of Fatal Injury

Heart AttackInternal TraumaAsphyxiationBurnsCrushedCVAElectrocutionOther

Firefighter Fatalities in the United States in 2006. U.S. Fire Administration. July 2007.

2006 Line-of-Duty-Deaths

VolunteerCareer

77 Volunteer29 Career

Firefighter Fatalities in the United States in 2006. U.S. Fire Administration. July 2007.

2006 Line-of-Duty-Deaths

MaleFemale

100 Male6 Female

Firefighter Fatalities in the United States in 2006. U.S. Fire Administration. July 2007.

2006 Line-of-Duty-Deaths

57.5%

42.5%

Emergency

Non-Emergency

Fireground Ops

Other

Responding/Returning

Training

Non-Fire

Post-Incident

0 5 10 15 20 25 30 35 40

36

21

15

9

5

20

Firefighter Fatalities in the United States in 2006. U.S. Fire Administration. July 2007.

2006 Line-of-Duty-Deaths

Stress/Overexer-

tion

Vehicle Collision

Trapped Collapse Struck Lost Contact/Exposure

Other0

10

20

30

40

50

6054

1913

8 63 2 1

Emergency-Related Deaths

Firefighter Fatalities in the United States in 2006. U.S. Fire Administration. July 2007.

2006 Line-of-Duty-Deaths

90.7%

5.6%

1.9% 1.9%

Deaths Caused by Stress/Overexertion

Heart AttackCVAAortic AneurysmEpilepsy-Related

Firefighter Fatalities in the United States in 2006. U.S. Fire Administration. July 2007.

2006 Line-of-Duty-Deaths

Post-Incident Other On-Duty On Scene Fire Responding Training On Scene Non-Fire0

2

4

6

8

10

12

14

16

18

2018

98

7

5

3

Heart Attacks by Type of Duty

Firefighter Fatalities in the United States in 2006. U.S. Fire Administration. July 2007.

2006 Line-of-Duty-Deaths

< 21 21-25 26-30 31-35 36-40 41-45 46-50 51-60 > 610

5

10

15

20

25

1 1 1 1

6 6

10

20

10

3

6

4

910

5

3

6

4

LODD by Age & Nature

Heart Attack/CVA Trauma

Firefighter Fatalities in the United States in 2006. U.S. Fire Administration. July 2007.

Health Surveillance of Personnel

Spirometry; 29%

ECG; 24%

Hyper-tension;

36%

Physical Exam; 10%

Abnormal Findings

Spirometry ECG Hypertension Physical Exam

Health Surveillance for Rural Volunteer Firefighters and Emergency Medical Services Personnel. American Association of Occupational Health Nurses, Inc. February 2007.

2001 Non-Fatal Injuries

Thermal Stress; 4%Other; 12% Burns; 7%

Smoke-Gas Inhalation; 4%

Respiratory Dis-tress; 2%

Wound-Cut-Bruise; 20%

Dislocation-Fracture; 3%MI-CVA; 1%

Strain-Sprain-Pain; 47%

2001 Firefighter Injuries. Michael J. Karter, Jr. and Joseph L. Molis.

The Population

• American’s aren’t active! We like to think of ourselves as “not part of the general population”

• After all, we are the ones who come to help those in need

• Emergency services personnel are not an exception

We are a cross-section of the population and representative of the population-as-a-whole.

Physical Activity Level

1997

2002

Total

25-44 years

Female

75 years and over

Male

18-24 years

45-64 years

65-74 years

0 40%20% 80%60%

National Health Interview Survey. Department of Health & Human Services, CDC. 2002.

No Physical Activity for Adults by Gender & Age

Greatest Asset

• The research supports the need to give greater attention and focus to wellness

• The health and well-being of many of our people is in serious jeopardy every day

We should strive to help our greatest resource – our people – better prepare themselves for the selfless duties they perform daily.

The only way to do this is through comprehensive wellness and fitness programs.

Wellness

Wellness

• Wellness is a comprehensive term that includes all of the following:– Medical Fitness & Health– Physical Fitness– Emotional & Behavioral Health– Rehabilitation– Data Collection & Reporting

Wellness programs are intended to strengthen personnel so that their mental, physical, and emotional capabilities are resilient enough to withstand the stresses and strains of life and the workplace.

Wellness

We’ve supersized everything:

• Food• Drinks• Vehicles• Homes• Even emergency

apparatus

Isn’t it time we super-size wellness?

Super-Sized

Bigger is better, right?

Super-Sized

The Benefits of Wellness

What are the benefits of wellness?

Make two (2) lists:1. Organizational benefits2. Individual benefits

Select a leader to present your findings in five (5) minutes.

Benefits to the Organization

• Better Overall Fitness

• Better Total Wellness

• Reduced Injuries• Reduced

Disabilities• Reduced Sick Leave• Lower Long-Term

Healthcare Costs

Benefits to the Individual

• Greater strength and stamina

• Weight reduction/control

• Lower cholesterol and blood pressure levels

• Decreased risk of death, injury, or disability

• Improved job performance & enjoyment from work

• Better posture and joint functioning

• Reduction of anxiety, stress, tension, and depression

Benefits to the individual

• Increased energy, general vitality, & mental sharpness

• Enhanced self-esteem & self-image

• More restful sleep

• Enhanced capacity to recover from strenuous & exhaustive work

• Increased tolerance for environmental stress

• Improved mobility, balance, and coordination

Cost-Benefit

Cost-Benefit

Many corporations tout returns of $1.50-$3.40 for every dollar invested in wellness efforts

Cost-Benefit

• In January 1997, the City of Phoenix, Arizona conducted an audit of their disability retirement program for all city employees

Annual Disability Pension Costs:

The reduced disability pension cost for the Phoenix Fire Department reflects their 12-year commitment to an effective wellness & fitness program.

City of Phoenix Department Annual Cost

Fire $100,000

Police (2x as many personnel as Fire) $721,000

General Government (5x as many personnel as Fire) $623,000

Cost-Benefit

• Companies starting to realize the importance of wholly-well staff

• Higher healthcare costs of staff with sedentary lifestyles & poor diets

• Charging higher healthcare premiums to those with poor diet, and/or unhealthy habits

• Companies are allowing – and encouraging – fitness/wellness activities “on-the-clock”

A Commitment,A Partnership

Commitment & Partnership

• A wellness program is not just another program, it is a total commitment to:– the health, safety, and longevity of all personnel– the productivity and performance of personnel– the cost effectiveness and welfare of the

organization

Commitment & Partnership

• When personnel are ill or injured, malnourished or overweight, over stressed or out of balance, it affects their ability to effectively do their job

Wellness is a personal commitment that all personnel must make to survive, ensure career success, and to improve their quality of life.

What is your commitment?

Take a few minutes to complete your pledge card.

Pledge how you plan to make a change in your level of commitment to individual wellness as soon as you leave the room today.

Commitment & Partnership

• Responsibility for wellness & fitness cannot just be given to management

• Without labor input & cooperation in the process, members will not “buy in” to the program

• Labor & management must develop a wellness program that is educational and rehabilitative – not punitive

Commitment & Partnership

• Wellness is important for all personnel• Some individuals may gravitate to job tasks

other than firefighting or EMS delivery because of personal necessity or interest

• All “jobs” are important and involve significant physical and emotional stress

Remember to include uniformed and non-uniformed personnel in your efforts!

ACTION #1

Develop an organizational fitness & wellness team.

Wellness-Fitness Team& Resources

Who should be on your team?

Take a few minutes to jot down who you think would make good Wellness & Fitness Team members.

Resources

International Association of Fire Fighters• Fit to Survive!• www.iaff.org/HSInternational Association of Fire Chiefs• www.iafc.orgAmerican Council on Exercise• www.acefitness.org

IAFF/IAFC/ACE Joint Labor ManagementWellness-Fitness Initiative, Second Edition

Resources

National Volunteer Fire Council• www.nvfc.org• www.healthy-firefighter.org• www.cholesterolalarm.com

Resources

U.S. Department of Agriculture• www.MyPyramid.govFirefighters Workout• www.firefightersworkout.comOccupational Safety & Health Administration (OSHA)• www.osha.govNational Institute for Occupational Safety & Health

(NIOSH)• www.cdc.gov/nioshCenters for Disease Control (CDC)• www.cdc.gov

Resources

American Speech-Language Hearing Association• www.asha.orgAmerican College of Sports Medicine• www.acsm.orgAmerican Heart Association• www.americanheart.orgHealthier US• www.healthierus.gov

Resources

Aerobics & Fitness Association of America• www.afaa.comAmerican Dietetic Association• www.eatright.orgNational Fire Protection Association• www.nfpa.orgUnited States Fire Administration• www.usfa.dhs.govNational Fallen Firefighters Foundation• www.firehero.org

Resources

Albemarle County Department of Fire Rescue• www.ACFireRescue.orgOther Departments• Miami-Dade County , FL Fire & Rescue• Fairfax County, VA Fire & Rescue• Austin, TX Fire• Charlotte, NC Fire• Los Angeles, CA Fire• New York City, NY Fire• Phoenix, AZ Fire• Seattle, WA Fire

Our Culture

What is our current culture?

Put others before ourselves:“Greater love hath no man than this, that a man lay down his life for his friends.” - John 15:13

Contradicting culture: “Do no further harm.”“Check the scene of safety.”“Ensure that it is safe for us to help.”

What is our current culture?

If we – our people – are not physically fit or emotionally well, are we really helping as we should be?

We train, we practice, we drill, we evaluate, we respond.

But, are we potentially creating another hazard by being unprepared physically and emotionally?

Changing Our Culture

• Research has shown the need for high levels of aerobic fitness, muscular endurance, & muscular strength to perform safely and effectively

• Physical fitness & emotional well-being is critical to maintaining the wellness of our personnel

• Fitness & wellness must be incorporated into the overall fire/EMS philosophy & culture

What initiatives are in place now?

Gather with your group again.

List the initiatives that your organization already has in place.

You may find that you already have key components of a program in place.

ACTION #2

Evaluate established practices and current

initiatives.

Identifying the Need

Identifying the Need

• Direct relationship between high levels of aerobic & muscular fitness and work place productivity & safety

• Greater physical capacity increases the ability to deal with adverse conditions such as:– hard, repetitive physical labor– exposure to extreme environments– long work hours– reduced sleep and rest

Identifying the Need

• A low level of fitness jeopardizes the safety of not only the individual but also their colleagues and the public

• Physical fitness & emotional health – combined with training & experience – are the most crucial factors in determining an individual’s ability to perform safely & efficiently

ACTION #3

Identify where changes or additions are needed.

Program Components

Program Components

• Medical – Fit-for-Duty Exams/Annual

Physicals• Fitness – Trainers/Specialists– Assessments, Personalized Plan– Equipment/Gym Memberships– Time for Exercise

• Infection/Exposure Control– Immunizations

• Occupational Exposure Plan

Program Components

• Behavioral– Wellness Education– Individual Health-Risk Appraisals– Injury Prevention– Critical Incident Stress

Management– Chaplaincy Program– Nutrition Education

• Rehabilitation• Data Collection and Reporting

ACTION #4

Identify alternative approaches for each

objective/component.

Select the best alternatives.

Developing Your Plan

Your Fitness & Wellness Plan

• Budget constraints should not be a major barrier

• Consider alternative funding sources• Education is always a great option• Think Simple!• Consider partnerships

Understanding the risks and consequences of not participating in a health and wellness program is a critical step.

Alternative Funding Sources

• Fees for Service• Grants (Assistance to Firefighters Grant,

SAFER)• Foundations• Corporate Donations• Cause-Specific Fundraising

Explore Potential Partnerships

• Health Clubs, Gyms, Fitness Facilities• Hospitals, Medical Officers, Physical Therapists• Colleges & Universities, Schools• Fitness Stores• Health Stores• Local Businesses

ACTION #5

Prepare a draft plan.

Drafting Your Plan

• Combine existing programs with new/proposed components into a draft plan:– Plan can be organized in any way

– Include how the organization intends to meet the objectives of the program

– Include a timetable & program implementation schedule

– Some components may have to be phased-in

– Make participation incentives part of the plan

Participation Incentives

More reasons a person has to participate, the more likely they are to do so!

• Programs supported by personal or financial incentives average 50-60%1 participation– Cash or Gift Certificates– Schedule Priority– Choice of Duties– Recognition– Finance Rewards for Reaching Individual Goals– Reimbursement for Gym Membership

1 Healthy Balance Program. Wellness Council of America. 2000.

ACTION #6

Have administrators review the plan.

Administrative Review

• Conduct thorough review with administration– Solicit feedback, comments, suggestions

• Include reviews from:– Legal– Insurance Company– Risk-Management– Human Resources/Personnel– Management & Budget– Others

ACTION #7

Submit the revised plan for adoption.

Adopt the plan.

Revise & Adopt Your Plan

• Revise draft plan based on feedback

• Include an executive summary making “your case”– Highlight goal of achieving specific levels of wellness & fitness– Include anticipated benefits to the organization, the individual, & the

community at-large

• Educating all parties responsible for the adoption of the plan is crucial

• Emphasize the program would help bring the organization into compliance with national standards & regulations

• Adopt the plan (legislative or administrative)

ACTION #8

Organize implementation teams and

identify implementation strategies.

Establish Implementation Teams

• Establish implementation teams (1+)• Empower each team to implement specific

components• Teams should report to a central

authority/responsible party• Use a common-sense approach • Integrate each component in a way that

ensures the best chance of meeting identified objectives

• Strategies must consider the climate of the specific organization

ACTION #9

Implement the plan; monitor progress.

Implement Plan & Monitor Progress

• Use an identified step-by-step process• Complete the process sequentially• Periodically assess progress; require regular

updates from team leaders• Employ standard project management

practices

Reality Check

Top Five Reasons Programs Fail

Top Five Reasons Programs Fail

1. Lack of Information on Risk to Self

2. Lack of Individual Goals

3. Lack of Appropriate Training

4. Lack of Time to Devote to the Program

5. Lack of Motivation

Top Reasons Fitness Programs Do Not Work. Michael Stefano. www.firefightersworkout.com

ACTION #10

Review and update the plan regularly.

Evaluate & Update

• Make sure implementation plan includes when & how program components should be reviewed & updated– Review periodically– Ensure that objectives & assumptions are still valid– Make appropriate changes or modifications

Things to Remember

• Not quick or easy• Important process to ensure high level of service• Will help change our culture and our philosophy• Make it a priority; always advocate in words and

actions

A comprehensive wellness & fitness program provides critical level of maintenance and support to the most important resource within our organization – our people!

Questions?

Thanks for Coming!Stay Well!

Case Study

Case Study

• Fitness assessments were conducted on prior to and immediately following an intense twelve-week “boot camp” style, individualized physical training (PT) program

Case Study

• The assessments consisted of:– Pre-Evaluation

• Fitness-for-Duty Medical Exam• Self-Assessment Tool• Medical/Lifestyle History

– Aerobic Capacity• Gerkin Protocol (Treadmill)

– Muscular Strength• Hand-Grip, Leg, & Arm (Jackson Strength

System & Jamar Hand Dynamometer)

– Muscular Endurance• Push-Up & Sit-Up (WFI Protocol)

– Flexibility• Sit & Reach (Standard)

– Post-Evaluation• Body Composition (Skinfold Caliper)• Nutrition Workshop

Case Study

• Personnel had a minimum of four (4) hours of PT weekly

Case Study: Aerobic Capacity

Fitness can be measured by the volume of Oxygen one can consume while exercising at maximum capacity.

VO2 High VO2 Average VO2 Low

Prior 62.3 50.8 41.3

Post 69 61.2 48.6

5.0

15.0

25.0

35.0

45.0

55.0

65.0

ml/

kg/m

in

Case Study: Muscular Strength

Grip strength, upper body strength, and lower body strength are key to a firefighter’s efficient performance.

Grip Strength High Grip Strength Aver-age

Grip Strength Low

Prior 64 53.3 44

Post 55 48.2 40

5.0

15.0

25.0

35.0

45.0

55.0

65.0

Grip Strengthkg

Case Study: Muscular Strength

Arm Strength High Arm Strength Aver-age

Arm Strength Low

Prior 53 43.9 36

Post 57 44.5 38

5.0

15.0

25.0

35.0

45.0

55.0

Arm Strengthkg

Case Study: Muscular Strength

Leg Strength High Leg Strength Aver-age

Leg Strength Low

Prior 181 138.9 101

Post 191 150.3 114

10.030.050.070.090.0

110.0130.0150.0170.0190.0

Leg Strengthkg

Case Study: Muscular EnduranceCore body strength and stability and general

muscular endurance are imperative to a firefighter’s performance and safety.

Push-Ups High Push-Ups Average Push-Ups Low

Prior 68 36.6 10

Post 80 43 19

5.0

15.0

25.0

35.0

45.0

55.0

65.0

75.0

Push-UpsQ

uanti

ty

Case Study: Muscular Endurance

Curl-Ups High Curl-Ups Average Curl-Ups Low

Prior 56 36.4 12

Post 78 43.4 25

5.0

15.0

25.0

35.0

45.0

55.0

65.0

75.0

Curl-UpsQ

uanti

ty

Case Study: Flexibility

Flexibility is necessary for normal activities and especially necessary during strenuous ones. Maintaining a solid range-of-motion allows the firefighter to complete tasks, maintain good posture, and reduces the possibility of injuries and lower back problems.

Sit & Reach High Sit & Reach Average Sit & Reach Low

Prior 15.5 13.6 11

Post 19 16.6 15

1.03.05.07.09.0

11.013.015.017.019.0

Inch

es

Case Study: General Health

Weight High Weight Average Weight Low

Prior 123 86.7 72.7

Post 105.5 84 70.91

10.0

30.0

50.0

70.0

90.0

110.0

130.0

Weightkg

Case Study: General Health

RHR High RHR Average RHR Low

Prior 82 66.2 60

Post 64 54.2 40

5

15

25

35

45

55

65

75

85

Resting Heart Rate

bpm

Case Study: General Health

Systolic High Systolic Average Systolic Low

Prior 152 124 100

Post 128 114 105

10

30

50

70

90

110

130

150

Resting Systolic Blood Pressurem

mHg

Diastolic High Diastolic Aver-age

Diastolic Low

Prior 90 80.2 64

Post 82 68 60

5

15

25

35

45

55

65

75

85

Resting Diastolic Blood Pressure

mm

Hg

Case Study: Body Composition

Lean Muscle High

Lean Muscle Av-erage

Lean Muscle Low

Prior 79.8 68.7 59

Post 89 71.1 61

5.0

15.0

25.0

35.0

45.0

55.0

65.0

75.0

85.0

Lean Muscle Masskg

Fat High Fat Average Fat Low

Prior 33.7 16.8 8.5

Post 25.5 14.6 7.4

2.5

7.5

12.5

17.5

22.5

27.5

32.5

Fat Weight

kg

Case Study: Body Composition

Body Fat High Body Fat Average Body Fat Low

Prior 0.275 0.1874 0.1063

Post 0.2516 0.1676 0.1063

2.5%

7.5%

12.5%

17.5%

22.5%

27.5%

Body Fat PercentagePe

rcen

tage

Thanks for Coming!Stay Well!