Three Simple Ideas to a Healthier Fire Service

The U.S. Fire Administration (USFA) recently published its yearly analysis, Firefighter Fatalities in the United States in 2009 (http://www.usfa.dhs.gov/downloads/pdf/publications/ff_fat09.pdf). There is a section on firefighter line-of-duty deaths due to stress and overexertion. The year 2009 was particularly bad in terms of lost firefighters, with 56% of all fatalities coming under the category of stress and overexertion.

Here is what the report said: "Firefighting is extremely strenuous physical work and is likely one of the most physically demanding activities that the human body performs. Stress or overexertion is a general category that includes all firefighter deaths that are cardiac or cerebrovascular in nature such as heart attacks, strokes and other events such as extreme climatic thermal exposure. Classification of a firefighter fatality in this cause of fatal injury category does not necessarily indicate that a firefighter was in poor physical condition."

Fifty firefighters died in 2009 as a result of stress/overexertion:

• Thirty-nine firefighters died due to a heart attack
• Eight firefighters died due to strokes
• One firefighter died of heat exhaustion
• One firefighter died from a pulmonary embolism
• One firefighter died from damage to a heart valve, an acute event caused by the extreme physical exertion (see page 110).

We believe that there are three essential principles that must be embraced in order to raise the bar for firefighter health and wellness. We use the word principles because we recognize that it is the responsibility of our leadership to move all of us forward. They are entrusted to better the health and wellness of all firefighters. There is no more important task than saving the life of a firefighter who may be injured or fall victim to a preventable illness:

Principle 1. Firefighters with a history of coronary artery bypass grafting or percutaneous coronary artery angioplasty, or cardiac stents, should not be classified as interior-qualified Class A firefighters.

Principle 2. Firefighters with morbid obesity should not be classified as interior-qualified Class A firefighters if their body mass index is more than 40.

Principle 3. Firefighters should wear their self-contained breathing apparatus (SCBA) during overhaul because of an extreme risk of inhaling ultra-fine particles that can cause cancer, respiratory illness and heart disease.

This month's column focuses on the first principle (the second and third principles will be addressed in upcoming columns). We have learned a lot when we look at the rate of heart attacks in the fire service over the past 20 years. When we look at individual cases and review National Institute for Occupational Safety and Health (NIOSH) firefighter fatality reports, we clearly see a pattern.

Research has shown that approximately half of the cardiovascular deaths are heart attacks in firefighters who have had coronary artery bypass graft surgery or percutaneous coronary artery angioplasty, or cardiac stents. Bypass surgery is a complicated procedure that involves opening the chest and re-establishing blood flow across blocked arteries of the heart using arteries and veins from other parts of the body. Angioplasty is a procedure in which a catheter or wire is placed in an artery of the heart in order to open a critical blockage and re-establish blood flow. Cardiac stents are small sleeves inserted into the artery as part of the angioplasty procedure to keep open the blood vessel.

On Dec. 15, 2003, President George W. Bush signed into law the Hometown Heroes Survivors Benefit Act of 2003. The law presumes that a heart attack or stroke is in the line of duty if the firefighter was engaged in non-routine stressful or strenuous physical activity while on duty and the firefighter becomes ill on duty or within 24 hours after engaging in such activity.

We should consider eliminating the interior-qualified duty status of any firefighter with a history of coronary artery bypass graft surgery or percutaneous coronary artery angioplasty. There is a significant opportunity going forward to reduce these line-of-duty deaths if we all adopt this policy. We should not be so shortsighted as to overlook the medical history of firefighters who are at the highest risk of dying from heart attacks.

This is based upon the statistical fact that these individuals are the predominant victims of cardiovascular line-of-duty deaths. Interestingly, it is not the firefighters with a history of myocardial infarction or heart attack who are at the highest risk. It may be that they are already excluded from being interior-qualified firefighters either because they themselves realize that their history of heart attack warrants changing their duty status or that the medical screening process has determined they should be excluded.

This principle would not dramatically change the process of medically qualifying firefighters for duty. It would be a uniform policy that undergoing cardiac procedures precludes one from returning to interior-qualified duty status. We should not leave this to individual discretion where one's personal physician advocates for a return to interior firefighting. Most physicians do not understand the incredible physical burden imposed upon a firefighter.

In our columns, we say emphatically that every firefighter performing interior firefighting duties should receive a comprehensive medical examination by a qualified physician every year. This examination should include lab work; if the firefighter is a male over the age of 40, it should also include a PSA. Just adding blood work to the screening process every year is a tremendous value-added benefit.

Although National Fire Protection (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, mandates medical examination for the fire service, there is a wide disparity of implementation throughout the country. Furthermore, when we review the 2009 fatalities, we see a spike in the number of heart attacks and strokes involving firefighters ages 41 to 45. This should make us aware of the need to do focused medical examinations that quantify the number of cardiac risk factors of firefighters who are still in their 30s.

DR. RAYMOND BASRI, MD, FACP, is in the private practices of internal medicine and diagnostic cardiology in Middletown, NY. Dr. Basri is a Diplomate of the American Board of Internal Medicine and president of the Mid-Hudson Section. He received the 2008 Laureate Award of the American College of Physicians, of which he is a Fellow. Dr. Basri also is clinical assistant professor of medicine at New York Medical College, attending physician in the Department of Internal Medicine at Orange Regional Medical Center and on the consulting staff in cardiology at The Valley Hospital in Ridgewood, NJ. He is a member of the Excelsior Hook and Ladder Company in Middletown and a deputy fire coordinator for Orange County. Dr. Basri is the senior physician of the Disaster Medical Assistance Team (DMAT NY-4). He is a senior aviation medical examiner for the Federal Aviation Administration (FAA) and chief physician for Health & Safety Specialists in Medicine, which does onsite medical examinations for the fire service and consultant to FirePhysicals.com.

ERIC BERGMAN, PA-C, is a physician assistant practicing internal medicine at Hartford Hospital in Hartford, CT. He earned a bachelor of science degree in allied health from the University of Connecticut and a master's degree from Albany Medical College. He is a member of the Killingworth, CT, Volunteer Fire Company; a past company officer and life member of the Avon, CT, Volunteer Fire Department; and a past member of the Shaker Road-Loudonville Fire Department in Colonie, NY.