Cardiovascular Disease in Firefi ghters: Defining the Problem

This new column is intended to give readers the most current information regarding medical studies and standards in a coherent and relevant manner as it applies to the fire service. The hope is that this information can be used to help keep firefighters...


This new column is intended to give readers the most current information regarding medical studies and standards in a coherent and relevant manner as it applies to the fire service. The hope is that this information can be used to help keep firefighters safe and healthy and to return us all home...


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This new column is intended to give readers the most current information regarding medical studies and standards in a coherent and relevant manner as it applies to the fire service. The hope is that this information can be used to help keep firefighters safe and healthy and to return us all home. The first topic is a series of columns discussing in depth the number-one cause of deaths in firefighters: heart disease.

We are reminded of the statistics every time we open a fire service journal: an average of more than 100 firefighters die each year in the line of duty. With the exception of 9/11, over the past 20 years, approximately half of these deaths are due to cardiovascular disease. This makes cardiovascular disease the leading cause of death in firefighters consistently over the past two decades. Although cardiovascular disease is the leading cause of death in the United States, recent medical studies have demonstrated that firefighters are at a higher risk of dying from a heart attack than the public.

Anyone who has done it knows that firefighting is a dangerous job. Firefighters have one of the highest occupational mortality rates in the country with cardiovascular disease representing the number-one cause of death. Line-of-duty deaths (LODDs) for firefighters are approximately 50%, which is higher than the cardiac mortality rate for similar professions such as police officers (22%) and EMS professionals (11%). In addition, LODDs in firefighters due to heart attacks are much higher than the occupational cardiac mortality rate for the entire nation (15%) (see Table 1). Clearly stated, firefighters are at a higher risk of dying from a heart attack on the job than the rest of the public. These alarming statistics led researchers to investigate cardiac deaths more closely. The results of these studies are so important that they are discussed below to better characterize and understand the problem.

In a study published in 2003, researchers examined the medical records of 50 randomly chosen firefighters who died of cardiovascular disease over a 10-year period. They concluded that all of these deaths were attributed to work-related activities. The most strenuous activities, such as interior firefighting, had the highest risk of cardiac death, whereas non-emergency activities had a relatively low risk of cardiac death. It is important to note there were no statistical differences in the incidence of cardiac deaths between career and volunteer firefighters.

Another study analyzed on-duty cardiac deaths to determine if there were certain activities that placed firefighters at higher risk of suffering a heart attack. Although most cardiac deaths occurred during fire suppression (32%), firefighters spent the least amount of time fighting fires (see Table 2).

Firefighters who spent the most time performing non-emergency and station duties (48% of a shift) had the lowest risk of cardiac deaths of all activities. In fact, the mortality rate for non-emergency duties is the same as the national average (15%). What was interesting is that in the busiest metropolitan department they studied, firefighters spent only 2% of their time conducting fire suppression activities, while smaller departments spent less than 1% of their time fighting fires.

We need to understand the basics of firefighter LODDs. Fire suppression carried a 67% risk of death over non-emergency duties. Non-emergency duties did not have a higher risk of cardiac death. In addition, responding to and returning from alarms and physical training all had higher risks of death over non-emergency duties. Also important to note is that non-fire emergency responses, including EMS calls, did not have a higher risk of cardiac death than non-emergency duties. This is important since in departments that perform EMS, these represent the majority of emergency responses. Again, it should be noted that no differences were found in the risk of cardiac death between career and volunteer firefighters.

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