HARRY R. CARTER, Ph.D., MIFireE

Over the past few months, we have been following the case of the Hepatitis C controversy in the Philadelphia Fire department. The manner in which this whole matter has unfolded seems to be quite akin to a walk through a minefield. Just when you think you are safe, there is another explosion.

The true magnitude of this problem is unknown at this time. It reminds me of a problem the shipping industry has always had with icebergs. Thanks to the History Channel, and the affinity of my two daughters for the actor Leonardo DiCaprio, I now know a lot more than I once did about how the Titanic was sunk by an iceberg.

It seems to be common knowledge among seafarers the world over that ships are damaged by the part of the iceberg that you never see. Hence the famous quotation we have all heard, "… that’s only the tip of the iceberg."

In the matter of the current problem we are seeing with Hepatitis C in the emergency service world, I think that the iceberg metaphor is most appropriate. We have no idea how severe the problem really is. Until we can get people to be tested, we will never know where we stand.

An ongoing poll from Firehouse.com gives us an idea of how bad things are. Seventy-five percent of those responding to the survey that asked ‘Does your department routinely test for infectious diseases encountered on the job’ said that there is no testing. Only twenty-one percent indicated that their departments had such a program.

Let us return to the analogy of the Titanic and the Iceberg. Seafarers have known about icebergs for centuries. They long ago learned that the part you saw was but a fraction of the hazard. And they also learned that the hazard of the iceberg was extremely unforgiving. In the days before radios, a collision with an iceberg almost always guaranteed tragic results.

I would suppose that Viking’s encountered such hazards way back in history. I would also imagine that the sad lessons learned by each succeeding generation were forwarded along in some fashion. Although, if they were like our fire service, there were probably several in each generation who kept crashing into icebergs, "… because we have always done it that way."

My research indicates that there were a number of things that a prudent sea captain would do to avoid losing their ship to the iceberg peril. They could:

• Avoid iceberg areas by sailing a more southerly course
• Post extra sailors to watch for icebergs
• Slow down in areas where icebergs were suspected
• Slow down in areas where icebergs had been spotted

As we all now know, the Captain of the Titanic chose to do it his way. Since his ship was deemed by its builders and owners to be unsinkable, he apparently felt that there was nothing to fear from icebergs. The result of this narrow view of the hazards in the North Atlantic had tragic results.

I think that the same case can now be made for the Hepatitis C problem facing America’s fire and emergency medical services. Our propensity for considering ourselves as society’s invulnerable heroes will act to compound the growing tragedy. People who have been exposed over the past two decades have to be taught to understand that this disease can be a ticking time bomb within them. No one is invulnerable to this menace.

My familiarity with this topic goes back a number of years. And it revolves around a program on this topic that was developed by the International Association of Firefighters. The primary thrust at that time involved training people to avoid being exposed to the AID’s virus. However, there was a strong secondary message about the potential for exposure to a disease about which I had never been taught: Hepatitis – C. I guess you could call this one of the first calls from the crow’s nest, "iceberg ahead!"

This video program scared me. In the first instance, the disease seemed quite serious, and extremely persistent. In the second instance, I was worried because of the numerous times over my career where I had been exposed to human bodily fluids. As a veteran of many years with the First Aid Squad in my hometown of Freehold, New Jersey, as well as the U.S. Air Force, Adelphia, Rahway, and Newark Fire Departments, I had been splashed with, spit upon, vomited on, and bled upon more times than I ever want to recall.

What was my potential for future health problems? How could I tell? None of these agencies have ever tested us for these things. What am I to do?

In New Jersey, we operate under a number of health and safety regulations. Each of us is required to attend an initial course on the problems we face with blood-borne pathogens. We then are required to take an annual refresher course to maintain our awareness of the problems. Each of us also has been given the opportunity to receive a series of shots to immunize us against Hepatitis B. However, if you do not take the shots, you must sign a waiver to that effect.

Unfortunately, no such preventive medicine exists for Hepatitis C. This is the reason why a strong preventive program is so critical to our future health and safety. The components of this effort need to be employed across the whole of our great land. They are:

education proper tools and equipment a realization that this issue is terribly important periodic testing to screen for the disease

The disease has no cure at this time. That is why we need to step up our efforts at training and equipping our emergency service workers. Each day that goes by, without the testing and training, increases the potential for more people to become infected.

Like all issues of this magnitude, efforts are needed at the highest levels. We need to become vocal in the battle to make the federal government recognize the magnitude of this problem. My union, the International Association of Firefighters, is working hard to get the National Institute of Occupational Safety and Health (NIOSH) involved in studying the outbreak of Hepatitis C.

If our history in the fire and emergency services world is any guide, I guess a heck of a lot more people will have to die before people in high places finally come to the realization that this is a serious problem. Why do I now seem to feel like one of the sailors up in the crow’s nest shouting at the top of my lungs, "…Iceberg ahead?"

The commentary in this column does not necessarily reflect those of Firehouse.Com, Firehouse Magazine, their employees or parent company Cygnus Business Media. Harry R. Carter, Ph.D., MIFireE, is an internationally known municipal fire protection consultant and contributing editor to Firehouse Magazine. He recently retired as a Battalion Commander with the Newark, New Jersey Fire Department. His commentary appears regularly on Firehouse.Com. For more commentary and information, visit Carter's web site at www.harrycarter.com Harry has published several books available for online ordering, including Firefighting Strategy and Tactics and Management in the Fire Service