This is the third column in a series devoted to addressing the number-one cause of death in firefighters: cardiovascular disease. In the previous column, the high physical exertion endured by firefighters during fire suppression was discussed. It is this high physical stress on firefighters...
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This is the third column in a series devoted to addressing the number-one cause of death in firefighters: cardiovascular disease. In the previous column, the high physical exertion endured by firefighters during fire suppression was discussed. It is this high physical stress on firefighters' cardiovascular systems that likely is the cause of the high occupational cardiac mortality rate in firefighters.
Firefighters with underlying cardiovascular disease are at the most risk of dying on the job from cardiovascular disease. Additionally, studies have shown that the presence of major cardiac risk factors in firefighters can be used to predict which firefighters have underlying cardiovascular disease and are at the most risk of sudden cardiac death. In this column, how identifying these firefighters can reduce line-of-duty deaths will be reviewed along with current screening guidelines.
Having a medical screening program aimed at detecting major cardiac risk factors can help detect the firefighters who are at most risk of suffering sudden cardiac death. This is an important concept because it has been shown that controlling the modifiable cardiac risk factors (see our May column) can reduce the overall risk of cardiovascular disease. If firefighters are identified with modifiable cardiac risk factors, effective strategies can be instituted to help reduce their overall risk of sudden cardiac death.
A standard is already in place to help departments develop a medical screening program. In 2000, the National Fire Protection Association (NFPA) Technical Committee on Fire Service Occupational Medical and Health released the NFPA 1582 standard outlining physical screening recommendations to determine fitness for duty for firefighters. Currently, NFPA 1582 is only a recommendation to fire departments and not required since the NFPA is not a government organization, unless your state does adopt NFPA standards as law.
The standard divides medical conditions into two categories. Category A conditions are conditions that could acutely and significantly impair a firefighter during firefighting activities, which would place themselves, their coworkers and/or the public at risk. Category A conditions include visual problems, heart conditions with impaired cardiac function, the presence of a pacemaker, history of seizure activity, and uncontrolled blood pressure or evidence of end-organ damage such as renal disease or retinopathy as a result of uncontrolled blood pressure. Prior history of cardiovascular disease, coronary artery bypass surgery or coronary artery angiography are also Category A conditions. This is important since it has been shown that half of firefighters who died of sudden cardiac death had an established diagnosis of cardiovascular disease.
Category B conditions are those that can possibly lead to acute adverse events impairing one's ability to perform the job safely. Some of the conditions included in this category are asthma, hearing impairment, diabetes mellitus and uncontrolled blood pressure without evidence of end-organ damage. Firefighters being treated for high blood pressure with normalized blood pressure readings do not qualify for either Category A or B criteria.
According to the NFPA, Category A conditions are absolute contraindications to performing firefighting activities. Category B conditions are possible contraindications to performing firefighting activities; however, candidates can be cleared to perform activities after evaluation and medical clearance by a physician. The NFPA 1582 guidelines also recommend that firefighters undergo periodic physical examinations, the frequency of which is determined by age. For firefighters younger than 39 years of age, physical examinations are recommended every two or three years, whereas they are recommended annually for individuals 40 and over.