This is the fourth column in an in-depth series devoted to the number-one killer of firefighters each year: heart attacks. Previous columns have established that medical exams targeted at assessing cardiac risk factors could identify the firefighters at most risk. By identifying these...
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This is the fourth column in an in-depth series devoted to the number-one killer of firefighters each year: heart attacks. Previous columns have established that medical exams targeted at assessing cardiac risk factors could identify the firefighters at most risk. By identifying these firefighters, their risk of cardiovascular disease can be reduced by treating these risk factors.
National Fire Protection Association (NFPA) 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, can be used as a guideline to develop a medical screening program. In this column, we will discuss how annual physical exams with cardiac risk factor identification and management will help reduce the number of cardiac deaths in firefighters each year.
Currently, NFPA 1582 recommends yearly physical exams for Class A, or interior, firefighters. Multiple studies have shown that cardiac risk factors, including high blood pressure, obesity and cholesterol levels and the incidence of diabetes, increase with age. Annual medical exams for firefighters would increase the opportunities to identify cardiac risk factors and institute appropriate therapies to control them. Physical exams should include blood pressure monitoring and weighing the firefighters to determine their Body Mass Index (BMI). This allows for an accurate assessment of body fat. Some firefighters' medical exams include blood work such as glucose, chemistry and cholesterol. Although the blood tests are not part of the mandated NFPA examination, they add significant information for firefighters who would not otherwise have a complete medical exam with their own doctor. Although the rate of diabetes in firefighters is unknown, it is a widely accepted major cardiac risk factor and annual exams offer an excellent opportunity to screen for this condition.
We can lower the risk of cardiovascular disease by controlling modifiable cardiac risk factors. Annual exams are only the first component to reducing cardiac line-of-duty deaths. The second component is treating risk factors. Annual exams will only identify who is at risk, but cardiac risk factors must be controlled in order to reduce firefighters' risk of cardiovascular disease. This requires instituting lifestyle changes and perhaps medication.
The National Institute for Occupational Health and Safety (NIOSH) recommends that physicians performing physical exams be experienced in the field of occupational medicine and familiar with the physical demands of firefighting to be able to thoroughly assess for risks in firefighters. This is because the physical demands of structural firefighting are unique and so strenuous that the physician's experience with the job makes a crucial difference.
The medical screening program should include a smoking cessation program. Smoking is recognized as a major cardiac risk factor and is detrimental to overall health. Although some career departments have adopted a zero-tolerance policy on tobacco use, this is not universal. Additionally, quitting tobacco use is not easy. One study estimated that it takes an average of seven attempts to quit smoking. Both career and volunteer departments should make smoking cessation policy part of their health and wellness programs. A medical screening program would offer an excellent opportunity to screen for tobacco use and counsel firefighters on the available tobacco cessation methods.
Who Should Be Screened
All firefighters should have yearly medical examinations. Part of every exam should be screening for cardiovascular disease. While interior firefighting operations have the highest risk of cardiac death, responding to and returning from alarms also has a significantly increased risk of cardiac death. For volunteer departments, this includes older members who typically do not perform interior operations such as engineers or fire police members. For career departments, this also applies to chauffeurs and administrative personnel who respond to multiple-alarm fires for support.