What's killing firefighters — and what to do about it

A study published earlier this year revealed the biggest on-duty killer of firefighters is coronary heart disease and the subsequent potential for cardiac arrest.

It is a study that every fire department needs to read because it clearly discusses what is killing our people.

The primary investigator on this Harvard study, published in the New England Journal of Medicine (NEJM), was Dr. Stefanos Kales, who has a long relationship with the fire service. He, along with Dr. David Christiani — another researcher of the study — have been working with fire departments and hazardous materials teams for more than 15 years.

Overall, cardiovascular disease accounts for 45 percent of all on-duty deaths. Specifically, the NEJM study shows that of the 1,144 on-duty deaths in firefighters from 1994 to 2004, 39 percent of the deaths were due to coronary heart disease. The research also showed firefighters' professional activities strongly influence the chances of a cardiac event. There were some very surprising facts that were raised in the study:

  • Firefighters are 12 to 136 times more likely to die from heart disease when involved in fire suppression activities.
  • Firefighters are 3 to 14 times more likely to die from heart disease when responding to an alarm.
  • Firefighters are 2 to 10.5 times more likely to die from heart disease when returning from an alarm.
  • Firefighters are 3 to 7 times more likely to die from heart disease when engaged in physical training.

Firefighting is one of the most strenuous jobs in the United States. It requires heavy lifting, crawling, climbing, and wearing heavy equipment while performing their tasks. "This study provides some of the strongest evidence that certain firefighting activities can greatly increase the potential for a life-threatening cardiac event,"  Dr. Kales said.

Research shows that these cardiac events are often work-related since they occur in association with specific duties and are distributed throughout the day as call volume occurs, rather than peaking in the morning as they do among non-firefighters.

"This can be related to several things including increased heart rates and blood pressure with the alarm, added cardiac workload at a fire, and smoke exposure," Dr. Kales said.

Healthy firefighters required
With that knowledge, certain things can and should be instituted to help decrease the risk of a cardiac event from occurring. Regardless of a department's location or size, fires still burn hot and it takes strenuous work to put them out. It also takes healthy firefighters to put them out.

One of the most significant things to decrease the risk of cardiovascular disease is the implementation of health and wellness programs. This means more than the inexpensive sets of free weights and a bench. Rather, it means developing programs in the areas of exercise and diet to keep firefighters healthy and decrease their risk factors for cardiovascular disease. The fire service needs to begin changing its culture to encourage and make physical fitness programs mandatory as a way to decrease the potential for cardiac events.

In addition to health and fitness programs, the fire service must be diligent in maintaining involvement in such programs over the entire career of a firefighter. Recruits are strong and healthy. However, years of firefighting can take a physical toll. Firefighters should have yearly physicals to screen for the potential of cardiovascular risk. 

Dr. Kales advises that there are often underlying cardiac issues that may go untreated. He warns that smoking, untreated hypertension, obesity, and high cholesterol levels are all things that need to be treated with by a physician because of the impact on the coronary vascular system.

Unfortunately, these important issues are often overlooked or not given the importance they deserve considering the harsh working conditions firefighters face every day.

Only 14 percent of fire departments in the United States serve populations larger than 100,000 residents. T|he vast majority of firefighters, about 75 percent, are volunteers. However, we are all facing the same challenges. A previous study in 2005 by the NFPA found that 70 percent of fire departments lacked fitness and health programs.

Another area that needs to be looked at on the fireground scene is rehab. Every fire department needs to have a rehab policy, and to follow that policy. This will ensure that our firefighters are allowed to rest and get hydrated. Along with rest and hydration, this is an ideal area to monitor a firefighter's vital signs and ensure a return to normal blood pressure.

This study is a further reason to adapt a healthy lifestyle for the fire service. If we want to ensure the long-term safety and longevity of our firefighters, everyone needs to accept and adapt a new lifestyle to ensure everyone goes home safely

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