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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Even though the NFPA recommends annual physical exams, as many as 70% of fire departments across the nation do not require or have programs for periodic physical exams. This is mostly based on state occupational safety and health mandates that enforce compliance within their jurisdiction. Additionally, although NFPA 1582 only requires screening for established disease, it makes no requirement regarding cardiac risk factor screening or management. Multiple studies have demonstrated that cardiac risk factors increase over time in firefighters while cardiovascular fitness decreases. Since cardiac risk factors increase over time, having more frequent exams targeted at identifying cardiac risk factors will increase the opportunities to help firefighters reduce their overall risk of cardiovascular disease by controlling identified risk factors.
Reviewing the Risks
To review the important points of this column:
- Controlling modifiable cardiac risk factors can reduce the overall risk cardiovascular disease and sudden cardiac death
- NFPA 1582 is a standard that recommends screening exams periodically based on age
- NFPA 1582 does not make any recommendations on management of cardiac risk factors
- A prior diagnosis of cardiovascular disease is exclusionary criteria to firefighting duties per NFPA 1582
- Cardiac risk factors increase in firefighters over time
- Having more frequent medical exams targeted at identifying cardiac risk factors can increase the opportunities to effectively reduce firefighters' risk of cardiovascular disease
While NFPA 1582 is good reference to being developing a medical screening program to identify firefighters at most risk of cardiovascular disease, cardiac risk factors also must be controlled to reduce line-of-duty cardiac deaths. Our next column will discuss suggestions for developing a program that incorporates medical exams to identify cardiac risk factors and strategies to control those risk factors.
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.