Saving Our Own: Sudden Death with No Overtime

Today, firefighters dying in the line-of-duty almost always receive a comprehensive autopsy and for many, it is the closest thing they have had to a medical exam in years.Scalpel, please.

Finally, at the time of the Kales study they found that 33 percent of firefighters were obese and that number had increased to 40 percent four years later. (Even firefighter recruits were overweight and had low-normal aerobic capacities.)

The good news is that many of the risk factors that can lead to a fatal cardiac event can be reduced or modified-if we are aware of them.

The Myth: It's the Fire Police
Many professionals are much taken with the myth that cardiac fatality statistics are artificially skewed upward by geriatric fire policemen in the Northeast and other places who are still responding when in their 70's or older. In fact, cardiac heart disease fatalities were more likely to be professionals. There were no significant differences in risk factors between professional and volunteer, and the majority of both groups had not undergone a fire department medical examination in the two years preceding their death.

Failing Grade
Most fire fighters killed in the line of duty die from a cardiac event caused by coronary heart disease (often previously diagnosed) despite the fact that professional standards and commonsense dictate that personnel should receive on-going and comprehensive medical screening and management.

Incredibly, 75 percent of the fatalities in the Kales study had not received a fire department medical examination within two years of the fatal incident. Kales also concluded that "on-duty CHD deaths are unlikely to occur in firefighters without traditional cardiovascular risk factors." A review of the last three years of NIOSH reports attributing cardiovascular disease as the cause of death also reveals that in a majority of cases, either no medical exam was conducted or the testing did not meet the requirements of the relevant NFPA standard.

Fire service leaders of every stripe are failing to take basic actions that would cut our death rate in half. Some national fire service leaders are suggesting that this is an issue for fire chiefs, alone, to confront and solve. Such an approach is doomed to failure. This situation is a complex occupational disaster which requires an equally complex solution that guarantees line firefighters will not lose by aggressively participating in programs designed to prevent or reduce CHD fatalities. In most departments, the current environment rewards ignorance, apathy and worse.

Leaders in both management and labor, pension trustees and elected officials all share responsibility for these needless deaths that occur like clockwork, on average, every eight days, year after year. The reasons for our inactivity are as likely to be social as they are scientific. Fear of job loss or being pushed out of a cherished avocation, though hardly rational when your life is at stake, can be more than reason enough to be (and stay) personally ignorant about our health. Fire department regulations, pension rules, rigid bureaucracies and a fundamental lack of creativity all help to craft an environment where firefighters gamble (and lose) where cardiac risk is concerned.

Into the Future
A majority of states and many municipalities now consider cardiovascular disease to be job-related. Firefighters typically qualify for some combination of medical, worker's compensation and pension coverage as a result of their condition. In those areas where such coverage is not afforded, we should build a similar safety net consisting of private medical insurance and job re-training to ensure that any member who suffers from coronary heart disease does not lose their employment as the result of a work-related medical condition.

Perhaps, at the end of the day, we need to change our concept of a career in the fire service. Given what we now know about the prevalence of heart disease and the role fire suppression activities play in fatal cardiac events, a fire service career might begin in the fire house and conclude in a productive support role where continued employment and a pension are ensured even for those who suffer from a serious cardiac condition.

The Kales study shows that we have the ability to eliminate 30 to 40 percent of on-duty fatalities if we so choose. Simple steps such as annual medical screening, working to reduce risk factors and alternate duty opportunities can dramatically reduce these fatalities.