Workplace Medical Mystery Solved: Fire Training Officer Lands in Hospital with a Distressing Lung X-Ray

Bob, an experienced firefighter and trainer started to experience chest pain, shortness of breath, and a cough with blood following a firefighter training that he set up and led. At the emergency room, the doctor ruled out a blood clot in his lungs. However, an x-ray did show Bob had small nodules in his lungs.

Bob’s doctor asked him to walk him through his activities the day his symptoms started. Bob explained some of the tasks involved with setting up and running the training. Concerned about the amount of smoke simulant Bob may have inhaled, his doctor asked, “do you know what that smoke is made of?” “It’s an oil-based smoke,” Bob said, “I’m pretty sure it isn’t hazardous.” The doctor had his answer.

Bob was exposed to mineral oil mist from the smoke simulant. Even short-term inhalation exposures to mineral oil mist, such as when Bob adjusted the supply nozzle or when he briefly opened the door to check on the progress of the smoke and fire, can cause an uncommon condition called lipoid pneumonia. Other health effects from acute exposure to mineral oil mists may include eye, skin, and upper respiratory tract infection, central nervous effects, and respiratory distress.

While rare, lipoid pneumonia is also known as “fire-eaters lung” because it has been documented in a small occupational group of performers (fire-eaters) who use liquid hydrocarbons for flame blowing.

Other occupations such as actors may also encounter oil- or glycol-based theatrical smoke, however, in a theater, the smoke is typically used sparingly to create effects without obscuring the scene, whereas in firefighter training, it is used liberally, creating high concentrations of particulate to create low to no visibility conditions. Thus, the health risk from simulated smoke used in firefighter training is expected to be greater than theatrical uses.  NIOSH conducted an HHE in 1990 to examine concerns among actors working in a theater who were exposed to theatrical smoke.  For more information view the HHE report.

Bob was treated for work-related pneumonitis/lipoid pneumonia and remained in the hospital for a week. Over the next few months his symptoms improved.

The fire department can protect its training staff by taking the following actions:

• Rotate training officer duties throughout a full day of training exercises.
• Ensure that trainers do not re-enter the training tower without wearing appropriate respirators until the tower is visibly clear of smoke simulant.
• Require trainers to wear self-contained breathing apparatus inside the training tower even if they are outside the training room during training exercises that involve heat or fire.
• Require trainers to wear self-contained breathing apparatus or full-face piece air purifying respirators with cartridges or canisters that are effective against oil-based aerosol and formaldehyde during training exercises that involve only smoke simulants. Trainers should wear these respirators inside the training tower even if they are outside the training room. Respirators should also be worn during maintenance and adjustment activities if smoke simulant release is expected.
• Maintain all respirators and make sure they fit and function properly.
• Create a schedule for changing out respirator cartridges and canisters.
• Fit test the trainers for each of the respirators that they are to wear.
• Encourage trainers to report any health concerns or symptoms associated with work tasks to a supervisor.

Bob and his fellow fire department trainers can do the following to protect themselves from the smoke simulants:

• Report health concerns or symptoms that could be work-related to a supervisor.
• Follow all procedures including work rotations, personal protective clothing, and respirator use.
• Make sure you are fit-tested for each respirator you wear.

Stephanie Stevens, MA, is a Health Communication Specialist in the NIOSH Office of the Director.

This is the most recent installment in the NIOSH Workplace Medical Mystery Series. This “mystery” is loosely based on Health Hazard Evaluation (HHE) reports conducted by NIOSH and other sources, and any recommendations made herein were 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.  HHEs are publicly available at www.cdc.gov/niosh/hhe/reports/, but the names of individuals and facilities mentioned in the HHE reports and in this series have been changed to protect their identities. For more information on the NIOSH HHE program, visit www.cdc.gov/niosh/hhe/.

Sources:

Fent, K.W., Musolin, K., Methner, M. (2013). Health Hazard Evaluation (HHE) Report 2012-0028-3190 Evaluation of Chemical Exposures during Fire Fighter Training Exercises Involving Smoke Simulant. Retrieved from http://www.cdc.gov/niosh/hhe/reports/pdfs/2012-0028-3190.pdf

Betancourt, S., Martinez-Jimenez, S., Rossi, S.E., Truong, M.T., Carrillo, J., Erasmus, J.J. (2010). Lipoid Pneumonia: Spectrum of Clinical and Radiologic Manifestations. American Journal of Roentgenology 194(1). Retrieved from http://www.ajronline.org/doi/full/10.2214/AJR.09.3040

Harris, K., Chalhoub, M., Maroun, R., Abi-Fadel, F., Zhao, F. (2011). Lipoid pneumonia: A challenging diagnosis. Heart & Lung: The Journal of Acute and Critical Care 40(6): 580−584. Retrieved from http://www.sciencedirect.com/science/article/pii/S014795631000470X