Most firefighters, emergency medical personnel, and rescue providers pride themselves on being ready for the next call. They participate in many hours of training, build up on-the-job experience in all kinds of emergencies, and work to prepare their department and community for disasters. But what many forget to take into consideration is whether their bodies are truly ready for the rigors of emergency response. How many responders regularly take stock of their own health to make sure they are physically prepared for the challenges that lie ahead?
Why heart health is a concern for firefighters
Firefighters routinely face extreme environments that may include intense heat and exposure to toxins. Add to that the high stress levels of response, significant exertion, and heavy gear, and you have conditions that are tough even for the healthiest individuals. Because of the nature of being an emergency responder, there are also factors such as interrupted sleep patterns, going from long periods of down time to sudden periods of high adrenaline and stress, and, especially for volunteers, lack of spare time that can lead to unhealthy habits such as eating poorly or not exercising.
Year after year, the number one cause of line-of-duty deaths for firefighters in the United States is heart attack. According to the U.S. Fire Administration, there were 993 on-duty firefighter fatalities in the U.S. between 2006 and 2015. Of these, 530 deaths were classified as being the result of stress/overexertion, with 479 of the deaths in this category specifically attributed to heart attack. That means 48 percent of on-duty firefighter deaths in this 10 year period were due to heart attack – more than any other cause of death.
Because of this trend, much research has been conducted in the U.S. to study the issue of heart disease among firefighters. Here are some of the findings:
A 2007 study published in the New England Journal of Medicine found that emergency firefighting duties were associated with a risk of death from coronary heart disease that was markedly higher than the risk associated with nonemergency duties. Fire suppression was associated with the highest risk.
In 2013, a study in the Obesity Journal found that weight was a significant predictor of incident musculoskeletal injury, with obese firefighters 5.2 times more likely to experience this type of injury than firefighters who fell into a normal weight range. The study concluded that focusing on firefighters’ body composition, nutrition, and fitness can decrease risk for injury.
A 2014 study by the Centers for Disease Control and Prevention reported that 70 percent of firefighters are overweight or obese. Similarly, a 2011 study by the National Volunteer Fire Council (NVFC) reported that the rates of overweight and obese individuals in the fire service are higher than those found in the general public. Obesity threatens firefighter health and safety and can lead to job-related disability, high blood pressure, and heart disease.
What You Can Do
The key to making sure a firefighter doesn’t suffer death or disability due to a heart attack or other heart related illnesses is prevention. Identifying and managing risk factors, early detection of existing problems, and making lifestyle changes to lessen risks are all ways to protect a firefighter from tragic outcomes.
Some responsibility should be taken at the department level. Leadership should embrace healthy behaviors among personnel, such as having healthy foods available at the station, implementing a smoking ban on department property, and establishing a health and fitness program. Identify a member of the department who is health-minded to lead these efforts, with full support from leadership. This person will serve as the health and wellness advocate and will have the task of motivating the rest of the personnel as well as serve as the point of contact for implementing health and wellness initiatives.
In addition, functional fitness can be incorporated into department trainings. Functional fitness is more than just exercise – it is exercise targeting the muscles that are used during emergency response activities and using actions that simulate these activities. While exercise overall is important, firefighters can also be considered a type of athlete that needs to train their bodies to be prepared specifically for the types of actions they need to take while responding to an emergency, such as pulling hose, climbing ladders, and carrying or dragging victims to safety. Develop fitness circuits during training activities that physically prepare firefighters for the rigors of emergency response.
Firefighters should also fit in exercise when they can. Do not assume you are getting enough exercise simply because you are a firefighter or emergency responder. Fitness needs to be ongoing – you need to make the effort to ensure your body is ready for the call. Many exercises can be done during free time while on duty and using items found at the station. Also consider making fitness a group effort and challenge the entire team to focus on getting healthy; this creates a more supportive atmosphere, and monthly fitness challenges can be a great motivator. Fitness activities can also carry over to home time – take walks or hikes with family members, organize sports games with friends, and find other ways to stay active even when away from the station.
When developing a department health and wellness program, consider using National Fire Protection Association (NFPA) 1500, Standard on Fire Department and Occupational Safety and Health Programs, for guidance. The NVFC also has resources for developing health and wellness programs, as well as gaining sponsors for the program if any costs are involved, such as obtaining fitness equipment. These resources, along with example functional fitness exercises and training circuits, can be found on the NVFC Heart-Healthy Firefighter Program web site at www.healthy-firefighter.org.
Nutrition is also a big factor in staying heart healthy. Make healthier food choices to prevent negative impacts from what you ingest. If eating on the go, choose a healthier restaurant or menu option. Opt for snacks such as fruit, nuts, and popcorn instead of those high in sugar, fat, or sodium. Select lean meats and bake, broil, or grill instead of frying. Limit your intake of added sugars and eliminate sugar-sweetened beverages such as soda and sports drinks.
Early Detection is Key
Early detection of potential health problems is a big factor in protecting firefighters and emergency responders. Heart disease risk factors such as high cholesterol, high blood pressure, diabetes, and others can be discovered during routine health evaluations and subsequently managed. Tell your healthcare provider that you are an emergency responder so they can better advise you based on your specific situation.
I can personally attest to why an annual medical evaluation is critical for early detection. I strive to be healthy by eating right and exercising, yet I was completely unaware that I had an underlying heart condition. I had no symptoms and no reason to believe I had heart disease. In July, I traveled to a fire department in North Carolina to learn about their annual physicals program and how other departments may be able to adopt a similar program. While there, I received a medical evaluation, and the results led to more tests that uncovered my heart condition.
Thanks to this early detection, I was able to get the heart bypass surgery I needed to prevent a heart attack. Without this surgery, I could have easily suffered a heart attack or other impairment, perhaps while on the scene or performing my duties as a firefighter. This would have endangered not only me, but also those I serve with and potentially those I was trying to save. Thankfully, we’ll never know what would have happened, but I truly believe I owe my life to the early detection I received as part of the firefighter physical.
The NVFC supports medical assessments for all firefighters, although the organization realizes that financial and other barriers may affect what kind of program a department implements. NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, outlines a complete assessment program for members of the fire and emergency services. The U.S. Department of Transportation provides medical assessment guidelines designed to confirm someone is healthy enough to perform the job of commercial motor vehicle driver. Many departments implement their own physicals program based on the specific job duties and expectations of the agency. Individuals may also utilize annual physicals from their personal physicians to detect illness or risk factors, although this type of evaluation does not specifically assess the ability of a person to perform the job duties of a firefighter.
In addition to identifying heart disease and related risk factors, annual physicals can also provide early identification of other illnesses firefighters are at risk for, such as cancer and diabetes. Early detection of illnesses can mean the difference between positive and negative outcomes.
A stronger you means a stronger crew
Reducing line-of-duty injuries and deaths should be a top priority for all emergency response organizations. However, much of the responsibility lies with the individual. I strongly encourage you to make the lifestyle changes that will help strengthen your heart and better prepare you for the job functions you perform as a firefighter. Your family, your crew, and your community depend on you being healthy and ready to respond. Make sure you are there for them when they need you. Being heart strong will make you a better firefighter, and a better you means a better crew.
For more information, go to www.healthy-firefighter.org