This is the last column in a series devoted to addressing the number-one killer in firefighters: heart disease. Previously, we discussed why firefighters are at a higher risk of cardiac death, why firefighters with underlining cardiovascular disease are at the most risk of suffering a cardiac...
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Exercise recommendations are 30 minutes of aerobic exercise a minimum of four days a week. Physical inactivity is considered a risk factor for cardiovascular disease. Aerobic exercise is also important for firefighters, since multiple studies have demonstrated that firefighting requires high aerobic conditioning. Overall conditioning and strength training can reduce fireground injuries as well. Departments could install exercise equipment in the firehouse if funds are available. Refurbished equipment may reduce the initial expenses. Some departments approach local fitness centers and ask for special group rates. Donations could also be sought from local fitness centers or exercise equipment retailers. Local media outlets could be contacted about the donations and media coverage could be motivation for business owners to participate.
Lifestyle changes also include quitting tobacco. Tobacco use is a well-known risk factor for cardiovascular disease. Studies have shown that firefighters who smoke are at a higher risk of cardiac LODD. Departments should adopt a zero-tolerance smoking policy while in the firehouse, adjacent property, and firematic events. However, quitting smoking is not easy. It takes the average person seven attempts before succeeding. Very few people are able to stop on the first attempt without medication. Fire departments may assist their members by providing smoking-cessation programs.
The National Fire Protection Association (NFPA) 1582 standard lists a previous diagnosis of cardiovascular disease as a category A condition. Category A conditions are considered conditions that could acutely affect a firefighter during an emergency and jeopardize the safety of the firefighter, other firefighters and the public and are an exclusion criteria for firefighting duties. It is recommended that all fire departments adhere to this component of this guideline. A medical study examining line-of-duty cardiac deaths showed that half of the firefighters examined had a previous diagnosis of cardiovascular disease and, according to NFPA 1582, should not have been in active firefighter roles. While some firefighters may object to this, as it may be career ending, it must be conveyed to them that it is their career or their life.
Additionally medical research suggests that the fire service adopt morbid obesity (defined as body mass index over 40) as a category A condition and prohibit the severely obese from performing active firefighting operations. Often, these individuals are more than 100 pounds over their target body weight. Obesity often occurs with high cholesterol and blood pressure, major cardiac risk factors. Obesity itself is now regarded as a cardiac risk factor. Obesity significantly impairs an individual's ability to perform aerobic work. Aerobic functioning is important for firefighters since many functions normally performed at structure fires require high levels of aerobic activity. All of these factors can severely limit an obese firefighter's ability to perform firefighting functions safely.
Firefighters may resist the efforts of leaders to implement a comprehensive medical program and view such a program as a threat to their careers. Volunteers may see such a program as another burden to the growing mandatory requirements on their time. However, a wellness program can be marketed as a "reward of health" for an individual's service.
Start by explaining that you are trying to keep everyone "fit to fight" for the community. Career firefighters may view such programs as a possible threat to their careers if they are found to have an exclusionary medical condition. However, we must assume that most people would want to know that they have a potentially life-threatening condition. In those situations, continuing to work as a firefighter may unnecessarily place their life at risk. For volunteers, such a program could be marketed as a reward for their service to the community. Another benefit is access to care as many people in this country have no insurance. A medical program would let individuals access screening exams that they may not be able to afford on their own.
A comprehensive medical program can help reduce firefighter line-of-duty deaths and improve the overall health of the members of the fire department. It is up to fire service leaders to be advocates for their members and, ultimately, the public we serve and their members' families to implement medical and wellness programs.
We hope that you use the information we've provided in this series to show your members, commissioners and city managers how extensive the problem of cardiac LODDs is. This same information can be used to justify the fund necessary to implement a health and wellness program for your members.