Medical Examinations for the Fire Service: The Key to Reducing Firefighter Deaths

Dr. Raymond Basri provides a better understanding of fire physicals and describes some specific steps to help reduce firefighter deaths due to heart attacks.


As a physician and as a firefighter, I am keenly aware of the risks common to all who serve in the fire service. One statistic says it all: Every year, nearly half of the line-of-duty deaths of U.S. firefighters are caused by heart attacks. In 2004, there were 49 heart-related fatalities of 104 U.S...


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As a physician and as a firefighter, I am keenly aware of the risks common to all who serve in the fire service. One statistic says it all: Every year, nearly half of the line-of-duty deaths of U.S. firefighters are caused by heart attacks. In 2004, there were 49 heart-related fatalities of 104 U.S. firefighter line-of-duty deaths. Over the last decade, this grim statistic remains unchanged despite the mandate to do fire physicals. The purpose of this article is to provide you with a better understanding of fire physicals and to describe some specific steps you can take to help reduce firefighter deaths due to heart attacks.

Several important questions must preface this discussion:

My training as a physician allows me to reduce the risk of heart attacks for my civilian patients every day. If we apply the same life-saving principles to the fire service, we can directly reduce the number-one cause of firefighter deaths: heart attacks. The fire physical plays a significant role in this process, but currently is inadequate to reduce the number of deaths.

GOOD NEWS!

Fortunately, most of the groundwork to reduce deadly heart attacks in the fire service is already in place. So is most of the funding. We already mandate and budget for medical exams for active firefighters. That is part of the solution.

The second phase of the solution is to include specific cardiac risk screening for firefighters. Current physicals do not routinely include screening for cardiac risk factors in a structured format. Screening for cardiac risk factors identifies people who have a high risk of heart attack. This allows them to change some aspects of their risk profile such as smoking, diet and exercise to reduce their risk of having a heart attack.

STANDARD PHYSICAL

Firefighters and fire officers must understand that just because a firefighter had a physical does not reduce his or her chance of having a heart attack. Current physicals may catalog pre-existing illnesses and find important new conditions such as high blood pressure. We need to set a standard for the physical exams that puts in place a program for tallying the cardiac risk factors found during this screening.

So far, we have not demanded that the medical team address this issue as it performs the physical exams on our firefighters. The fire service pays for medical exams, but has no requirement that during the physical, appropriate diagnostic screening tools be used that would detect firefighters at risk for heart attacks. However, firefighters continue to die from heart attacks at the same rate as 10 years ago. In fact, in 2003, "There was a sharp increase, however, in heart attack deaths from 37 in 2002 to 47 in 2003." (Full report, Firefighter Fatalities in the U.S. 2003, NFPA, Paul R. Leblanc, June 2004, http://www.dps.state.mn.us/fmarshal/Response/FFFatalities2003.pdf.)

CARDIAC SCREENING

The following questions provide the framework to understanding how cardiac screening could work to save firefighter lives:

HEART ATTACKS DON'T JUST HAPPEN

Heart attacks are one form of cardiovascular disease. Let's take a look at the problem, what it is and how often it strikes Americans.

Cardiovascular disease comprises diseases of the heart, hypertension, congestive heart disease, heart attacks or myocardial infarctions, and strokes, which are like heart attacks in the brain. Cardiovascular disease is a lethal epidemic in the United States. It is the number-one cause of death in the U.S. and it kills more than the next five causes of death combined. Each year, at least 600,000 Americans die of heart attacks and for half the first symptom is death.

These are horrible statistics and the situation is getting worse each year. One in five American men have coronary heart disease before the age of 60. It is reasonable to roughly assume and estimate that one in five firefighters has the same disease! Coronary heart disease can be asymptomatic, without any symptoms, even in its most severe form. One-third of all heart attacks are silent. You or your firefighters may already have had a "silent" heart attack and you may not know it!

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