WILLIAM GOLDFEDER
a Firehouse® contributing editor, is deputy chief of the Loveland-Symmes Fire Department in Ohio. He chairs the IAFC Safety, Health & Survival Section. In addition, he is a member of the National Firefighter Near-Miss Reporting Task Force and a technical reviewer for the National Institute for Occupational Safety and Health (NIOSH) Fire Fighter Fatality Investigation and Prevention Program.
GARY MORRIS
retired as an assistant chief from the Phoenix Fire Department after a 30-year career. He also served as fire chief for the Seattle, WA, Fire Department and the Rural/Metro Fire Department in Arizona. He is an at-large director of the IAFC Safety, Health and Survival Section.
KEITH PADGETT
is a battalion chief in the Fulton County, GA, Fire Department, assigned to the Special Operations Battalion, which includes the Georgia Search and Rescue (GSAR) Task Force and Hazardous Materials Response Team. He is an at-large director of the IAFC Safety, Health & Survival Section.
JOHN TIPPETT
is safety battalion chief for the Montgomery County, MD, Fire and Rescue Service and fire service project manager for the National Fire Fighter Near-Miss Reporting System.
Firehouse® Magazine recently asked a cross-section of fire service leaders to participate in a roundtable discussion of firefighter health and wellness. We selected representatives of organizations or programs that focus on keeping firefighters fit and healthy, on and off duty, with the goal of reducing health-related fatalities.
Q: In your opinion, what is the most significant health issue facing firefighters today and what can they do to protect themselves?
DANIELS: The most significant health issue facing firefighters today is cardiovascular disease. With approximately 50% of the line-of-duty fatalities attributable to heart-related maladies, it's by far the issue that has the most significant impact on the health of firefighters. What firefighters can do to protect themselves is to individually focus more attention on their heart health. To protect themselves, firefighters should focus more attention on their overall health, especially on their diet, exercise and stress-management techniques.
GOLDFEDER: Cancer. Without question, it is cancer, which also may be neck-and-neck with heart disease. But let's just stick to cancer, since we have been talking about heart disease for years, but we have not been talking about firefighter cancer very much. After all, how many of us "know" personally (as in knew them before they were killed) a firefighter that was a line-of-duty death (LODD)? Few have known any firefighter LODDs, but then ask them how many of you know or knew a firefighter with cancer? Firefighting cancer is a huge issue. Recent studies have shown that cancers, including testicular, prostate, skin, brain, rectum, stomach and colon cancer, non-Hodgkin's lymphoma, multiple myeloma and malignant melanoma, are directly related to firefighting in varying levels of increased risk.
MORRIS: Cardiac-related health issues remain the number one cause of firefighter line-of duty-deaths, amounting to nearly half the annual fatalities. There has been much discussion on this issue and, in many cases, fire departments have implemented programs to prevent and reduce deaths. These range from entry level medical exams to the well-known "Wellness Initiative" jointly developed by the International Association of Fire Fighters and the International Association of Fire Chiefs. All fire departments should implement a wellness program.
A 10-year study by the National Fire Protection Association (NFPA) found that about half of the firefighters who died of sudden cardiac arrest, or suffered heart attacks, had a known heart condition. These members should never have been assigned operational duties. Further, 75% had heart conditions that a simple medical test could have detected. Medical exams save lives.
In addition to cardiac-related medical issues, the new hidden killer on the horizon is the rising number of cancer cases. It is rarely listed as a LODD killer, but studies have shown that firefighters have a much higher rate of cancer than the general population. Due to extremely toxic environments that firefighters are exposed to on a routine basis, it is every bit a LODD killer.
The general cause of firefighter cancer is toxic gases in smoke along with particles contained in it. Even the pump operator exposed to drifting smoke is at risk. The preventive measure is to always wear an SCBA. But studies are now revealing that toxins carried in smoke can also be absorbed through the skin.
I believe the future will reveal that we must decontaminate our personal protective equipment (PPE), and tools, after each structural fire in a manner similar to today's hazardous materials operation. The PPE we wear can absorb large amounts of highly contaminated particles that, as the coat dries, become airborne. Coats and pants are carried in enclosed cabs of fire apparatus, thus creating continuous exposure. A post-fire washdown of PPE, and routinely decontaminating the cab, will reduce exposure. The PPE should be cleaned by a commercial laundry on a regular basis. Additionally, a post-fire shower at the fire station immediately after the fire, and a change of clothes, will remove contamination.
Remember, four decades ago, our forefathers didn't believe smoke was a health issue. We now know it is a killer and shortens life expectancy. Two decades ago, we didn't recognize the hazards of blood-related exposure either. Now we know and take measures to prevent exposure and decontaminate EMS equipment, and ourselves, after each medical run. A similar procedure should be applied to smoke exposure.
PADGETT: It is always the cardiac-related issues that kill so many good firefighters year after year. In 2007, heart attacks were the most frequent cause of death, with 52 firefighter deaths. However, it is not always the stereotypical overweight, out-of-shape person that suffers from this medical condition. Many firefighters that appear to be a picture of health can be at risk from high cholesterol and high blood pressure.
My own family has high cholesterol. My wife had a heart attack at the age of 31 and survived. A healthy young female suffering a heart attack is virtually unheard of; however, this revealed to us that our son and daughter both also have extremely high cholesterol and are now currently on cholesterol-lowering drugs. That is why it is so important to take care of yourself and get a yearly physical to identify these types of things. Don't always assume that you are healthy just because you feel well. Check with your primary physician and set up an appointment to have a physical soon.
TIPPETT: The most significant health issue facing firefighters today is cancer. The insidious nature of cancer in the world of firefighters truly makes it our silent killer. What makes the disease so devastating is the years it takes to manifest itself. Many firefighters are past retirement when they are struck so they are essentially not considered casualties. We seem to be making inroads as an industry in pockets for more prolonged use of SCBA, but there are still too many firefighters out there who think little about the long-term consequences of the actions they take today. What we know about the toxic nature of today's combustion products should be a clarion call for us to insist on more stringent attention to cleaning our protective clothing, not wearing turnout gear in station living areas, keeping our gear in gear bags to limit the hazards of offgassing and wearing respiratory protection from entry through overhaul.
Again in 2008, we lost more than 100 firefighters in the line of duty, many due to health-related causes. What must be done on an everyday basis to keep firefighters fit and healthy?
DANIELS: Studies suggest that a significant percentage of those who experience duty-related heart problems have pre-existing cardiovascular disease. Paying attention to firefighters' heart health on a daily basis is one way to ensure that underlying issues don't become bigger ones. Daily, firefighters check the fluids and tire pressure on vehicles, but rarely check their blood pressure or heart rates or those of the people they will be working with during the shift.
Firefighters could also take seriously the opportunities provided by their organizations to participate in heart-healthy activities and take every possible opportunity to work "smarter" rather than work "harder." When faced with the option of doing work alone or in teams, choose the team. If there is a viable mechanical option available, take it. If you're going to have to overexert yourself to do the work, get help or perhaps don't do it unless your life depends on it.
GOLDFEDER: One of the easiest and simple things we can do is to make sure all firefighters wash themselves to get rid of the soot and other related residues from fires so we can avoid skin exposure. For years, we would walk around with that stuff all over us, almost enjoying it and feeling good about it. Then we end up finding out that the stuff is being sucked into our bodies by our skin and is a "freeway" for cancer-causing stuff to directly enter our systems. Nearly everything we deal with today is man made and can off-gas cyanide poison - pretty nasty stuff. We should be cleaning ourselves as quickly as possible after a fire and cleaning our gear after every working fire, including hoods. A soot-filled hood spends a lot of its time on our necks, our necks sweat, the pores open and the body can soak up the bad stuff. We do not want the body to soak up the bad stuff. We want the gear washers to soak up the bad stuff, not us.
Additionally, we need to look hard at what is being made for us that can help better minimize the bad stuff from getting in or on us, such as the IAFF (International Association of Fire Fighters) Project Heroes PPE System that actually will provide a positive-pressure system, making it harder for the bad stuff to get in or on us. While today's PPE is good, the near future of PPE will be better as manufacturers continue to understand exactly what we must be protected from. For more information related to firefighting and cancer, go to the website www.FireFighterCancerSupport.org.
MORRIS: The fire service is a labor-intensive workplace. Its demand on the human body is similar to a competitive athlete. If we can't maintain proper health and fitness, we can't deliver an acceptable level of performance. We further expose our body to great risk of a heart attack or stroke. The public we serve recognizes we are not super-human, but they do expect us to perform effectively for a reasonable period of time. Collapsing in exhaustion 15 minutes into a fire is putting the firefighter and the public at risk.
Proper diet certainly reduces cardiac risk. A good diet also allows the body to perform better at emergencies. A regular program of combined strength training and aerobic exercise prepares us to do our jobs better. Ultimately, it also allows us to live well into our retirement years.
Good health and fitness is a personnel commitment. But management also has a responsibility. They too must "walk the talk" and maintain a healthy lifestyle and fitness level. We shouldn't be selecting firefighters that have not demonstrated a commitment to health and fitness. Additionally, fire department leaders must do all they can to implement a wellness program that can detect evolving medical issues early. Early detection leads to survivability. If a high school can mandate that a student must get a basic medical exam before being allowed to play football, surely we can require such an exam for new candidates and incumbent members - both career and volunteer. As noted in the NFPA study, 75% of the heart conditions could have been detected by simple medical exams.
And finally, firefighters need to know when to leave the fire service and do so before the job kills them. Age puts all of us at risk. The risk of a fatal medical event starts rising dramatically after 50 years of age. Medical conditions begin to appear (NFPA study above) telling us we're at risk and it's time to leave. Every one of our firefighters should go home from the run and everyone should enjoy retirement.
PADGETT: Many of us make excuses as to why we do not exercise or eat right. Not enough time in the day is probably the most common excuse. We must prioritize and place this at the top. I try to go to the gym in the mornings and ride the bike as I read the morning paper. I know this may sound as if I am not getting a "real" workout, but my heart rate is up above 120 beats a minute for 45 to 60 minutes and I am starting my morning off right.
Convenience, on the other hand, is what we are the most guilty of when it comes to eating. Quick and easy doesn't always mean fast food. It can be a nice restaurant that is close to work, or something at the house that is not really what we should be eating. However, it's convenient because it's on the way home or we just don't have time to get something else. There is only one of you and you are the one that must take care of yourself.
Fire chiefs must come to realize that the most important thing in their organization is the firefighter. The big red trucks don't operate without a "fit-for-duty" firefighter riding on that truck. Allow firefighters time to workout and keep that important piece of equipment (the firefighter) in shape and ready to perform when called upon.
One of the easiest ways to stay in shape is walking, and it doesn't cost one penny. Set time aside for crews to just walk. They can do this at the firehouse or go to the local high school track. Volunteer departments can conduct their weekly training and follow up with a short walk to discuss how it went and other issues in the department. This can be a time to build relationships and also get that much-needed exercise in an informal environment.
TIPPETT: Firefighters must take ownership of their personal fitness and health. Optimally, departments will adopt the IAFF/IAFC Wellness Fitness Initiative or NFPA 1582. However, in lieu of those two exceptional resources, I think there are several steps firefighters can take on a daily basis to stay fit. Eating properly and getting sufficient rest is paramount. We all recognize that the schedules firefighters keep are horrific. Often, these schedules are self-imposed. The value of a good night's sleep is becoming more evident from scientific research. Whether you are a shift-working career firefighter or a volunteer summoned from home, getting sufficient rest is essential to restore every body system.
The proper diet component cannot be underestimated either. Most of us don't eat the way we should because less-nutritious foods are easier to obtain given our schedules. Most nutritionists suggest a more planned approach to meals as opposed to eating on the run. There are a number of easy-access resources now available on the web to help with nutrition planning. Infusing even a modest exercise program pays huge dividends. You don't need a gym membership to take a walk around the block, use the stairs instead of the elevator for short trips or knock out 10-15 pushups and core exercises.
One other consideration is an annual physical. Make an appointment with your doctor once a year to make sure you are fit enough to do the job..
