From Firefighter to Fire Chief: Hard Truths Everyone Needs to Know

Updated November 17, 2016

I hope what you’re about to read upsets you.

• Annually, on average, there are between 80-100 line-of-duty-deaths (LODD).
• Annually, on average, approximately 50% of LODDs are due to sudden cardiac events (SCE).
• Annually, there are also between 800 and 900 non-fatal yet high-impact SCEs reported. This figure is believed to be drastically underreported (Smith, 2015).  
• According to a study published in the New England Journal of Medicine (study period: 1994-2004), an average of 1% of a firefighter’s time is spent in fire suppression activities, yet it accounts for over 32% of cardiac related LODDs (Kales, 2007).

You see, there’s a serious problem in the fire service when it comes to health and wellness.  No one can deny the fact that for decades upon decades, our number one killer has been our own poor health.  The problem is, it’s an intellectual agreement for many.  In other words, while many support firefighter health and wellness in fundamental terms, far fewer are doing anything about it.  And, as improbable as it may seem, there are even some out there that still try to deny or minimize the issue.

Let me give you some more information that should raise your eyebrows.  It is what we know – either as a result of reliable statistics, formal clinical studies, or both:

• The median age of first heart attack in the general population is 66.
• The median age of first heart attack for firefighters is 49.
• From 2005-2014, the average age of firefighter cardiac-related LODDs was 52.8.
• 79.5% of the career fire service is considered overweight or obese; 33.5% of the career fire service is considered obese.  78% of the volunteer fire service is considered overweight or obese; 43.2% of the volunteer fire service is considered obese (Jahnke, 2015).

Finally, indulge me as I provide some scientific facts that you may not know or understand.  I’ll put them in firefighter-speak later:

• Blood flow and vessel stiffness (arterial stiffening) both increase during firefighting activities.
• In an 18 minute interior firefighting scenario-based study conducted by Dr. Denise Smith (2015), blood plasma volume was shown to decrease by 15%
• In the same study, blood platelet count was shown to increase by 30%.
• Laboratory studies show that heat stress due to PPE ensembles and environmental factors significantly impair firefighter performance – this impairment is in addition to the impairment caused by the weight of the gear. The weight and heat stress associated with PPE lead to increased cardiac strain.  Dehydration further adds to this impaired state.

What Does it all Mean?

In a nutshell, a decrease in plasma volume and increase in platelet count increase your vulnerability to SCE.  It means that at the time you need the most performance from your heart and circulatory system – when your heart needs an increased oxygen level to operate efficiently (firefighting activities), your blood vessels are stiffening and your blood is becoming more viscous (thicker).  It means that arterial plaque is at a greater risk of rupture, which causes clot formation, which leads to sudden heart attack. 

The science does not lie.

So, while we can all agree that even more research is needed to understand how the firefighting environment affects our bodies, there is more than enough proof right now to start doing something about it.

I ask all of you, from the firefighter to the fire chief, where do you stand?

1. What is your current attitude about firefighter health and fitness?
2. What level of personal accountability do you have?  Do you truly own this issue, or do you spout rhetoric?
3. Most importantly, what actions will you take to move from the intellectual understanding of the problem to actually doing something about it for yourself and your fire service brothers and sisters?

Benefits of Firefighter Fitness

Now that you’ve digested some well-known statistics as well as some very eye-opening scientific data, consider that participation in a regular fitness program will:

• Increase thermal tolerance
• Increase plasma volume (studies show regular exercise increases plasma volume by 20%, which decreases the effects of dehydration).
• Increase cardiac efficiency                                   
• Increase work capacity
• Increase (improve) your clotting profile 

                                                                                                                         (Smith, 2015)

What else can you do?

Beyond exercise, there are many other interventions that will help you to reduce your cardiac risk profile:

• Get an annual NFPA 1582 medical evaluation.  Medical evaluations can identify underlying conditions that can in many cases, be corrected. The newly released Health Care Provider's Guide to Firefighter Physicals is now available for FREE download. Take it to your doctor if your department doesn't provide annual medical evaluations.  

• Check your blood pressure (BP). Check your BP at the start of every shift.  Approximately 30% of firefighters are hypertensive, and this risk factor is magnified due to the strenuous work you do.  If you are hypertensive or pre-hypertensive, seek definitive treatment now.
• Take control of your diet.  Proper nutrition is essential.  Make small changes to cut out or reduce intake of food and drinks that are unhealthy. 
• Hydrate.  Drink plenty of water, from the time you wake up until the time you go to sleep.  Proper hydration reduces cardiac strain.
• Sleep.  As much as possible, try to get regular, uninterrupted sleep (at least 7-8 hours).

Firefighter Line of Duty Deaths: 2014

(USFA, 2015)

Conclusion

During November and December of 2015, I was honored to be invited to participate in two very important events sponsored by the National Fallen Firefighter Foundation (NFFF):  The 2015 Fire Service Research Agenda Symposium, and Heart to Heart: Strategizing an Evidence-based Approach to Reduce Cardiac Disease and Death in the Fire Service.  I recently returned to assist in development of a messaging campaign designed to reach as many fireighters as possible.  Sadly, as of this update, the 2016 Needs Assessment conducted by teh NFPA indicates that only 27% of fire departments in America have even a basic health and wellness program in place.

I can say without fear of contradiction that the researchers, scientists, and fire service advocates from organizations across the country at these events continue to work tirelessly on your behalf, in the name of reducing cardiac-related LODDs. While there is still research to conduct and data to analyze, while we still need to develop and deliver the appropriate messages and create impactful interventions, there is already enough overwhelming scientific and statistical evidence to prove that action is needed now.  We simply must do everything we can to address the modifiable risk factors that increase our chances of suffering a cardiac event. 

As the chart above demonstrates, the hard truth is, SCEs are what kill us the most.  From individual firefighters to fire chiefs, from grass-roots and regional efforts to national initiatives, we must move beyond agreement on an intellectual level that our health problems are our own worst enemy: We must take definitive action.    

Starting today, what are you going to do about it?

Dan Kerrigan, MS, EFO, CFO is co-author of Firefighter Functional Fitness and Assistant Fire Marshal, East Whiteland (PA) Fire Department. A 30-year fire service veteran, he is a passionate advocate for firefighter health and fitness and regularly researches, presents and is published on firefighter fitness, health & wellness.

The Director of The First Twenty’s Firefighter Functional Training Advisory Panel, he also works closely with the IAFC, NFFF, and NVFC on strategies to improve fitness and reduce health-related LODDs in the fire service.  He is a frequent contributor to Fire Engineering Magazine and Firefighter Toolbox.

He was the 2014 recipient of the IAFC-VCOS Emerging Leader Scholarship sponsored by Dr. Richard Gasaway.

Connect with Dan on Twitter (@dankerrigan911 & @FirefighterFFit), on LinkedIn, Facebook (@FirefighterFFit), and at FirefighterFunctionalFitness.com.

References

Jahnke, S. A. (2015). State of the science: How health behaviors contribute to LODDs [PowerPoint slides].

Kales, S. N., Soteriades, E. S., Christophi, C. A., & Christiani, D. C. (2007, March 22). Emergency duties and deaths from heart disease among firefighters in the United States. The New England Journal of Medicine, 356(12), 1207-1215.

Smith, D. L. (2015). Cardiac strain and sudden cardiac events [PowerPoint slides].