Way too many times in my career—and I bet in yours—I’ve heard the sorrowful wails at fire/EMS service funerals. It seems there’s often more than one person stressing something along the lines of, “If only I was there, Johnny would still be here today.” But you and I both know that, more than likely, being there at the instance that Johnny went down would have little or no impact on the outcome.
Let’s face it: We are not superhuman; we are fallible human beings, just like the rest of the people whom we serve. We can, however, be there BEFORE Johnny goes down. After all, preparation is a key strategic planning tool.
The “65 percent problem”
What sets us apart from those we serve is that we’re there at the other people’s darkest and most stressful moments, often expected to perform these “superhuman” feats of heroism and utilize breathtaking marvels of modern field paramedicine to “fix it.” The rest of the population does not have that weight on their shoulders; we do.
So it should go without saying that we need to be in “superhuman shape”—and this includes our mental, moral and physical strength—to be able to perform those acts. When we look among our own ranks, though, it doesn’t take long to see one of those not-so-secret dirty little secrets—that our mental, moral and physical strength can be far from superhuman. And as I have stated before, this article has NOTHING to do with being a volunteer or paid firefighter. Those in need don’t make that distinction, and neither will I.
The issues of post-traumatic-stress, substance abuse and suicide have become so pervasive in our midst; however, for the purpose of this article, please allow me to focus on the “65 percent problem.” More specifically, according to the National Fallen Firefighters Foundation (NFFF), 60 to 70 percent of the firefighters who die in the line of duty die from a physical well-being issue, most often one related to cardiovascular health—NOT from the crashes, collapses, burns and scene dramas.
Consider these headlines:
- “Fire chief crashes and dies after experiencing medical emergency en route to call”
- “Lieutenant collapses and dies after training exercise”
- “Firefighter found dead in chair at station when alarm sounds”
- “86-year-old firefighter dies while directing traffic at emergency scene”
- “Veteran firefighter dies after shift”
This is merely a sampling; so many more cross our paths every day.
Medical matters
There are a million issues and excuses of how and why we got here—“here” being a place where our physical well-being, well, sucks—and there is no way to address ALL of those issues directly in one column. So let’s focus mainly on preparing to fix the 65 percent problem as well as preventive steps you can take now to keep from becoming part of that problem.
I’ve written before about diet and exercise as part of the “Our Dirty Little Secrets” article (firehouse.com/12233678). What we have not talked much about is the medical side of our preventative care.
Does your fire/EMS department require an entry physical before allowing an individual to participate in any strenuous activity? High school sports do. Let that sink in for a minute. Physicals should be a no-brainer. Remember, we need to be ready to perform “superhuman” tasks at any given moment.
I’m still waiting for a single legitimate excuse to be presented that makes it “OK” to NOT require pre-entry physicals for law enforcement officers, firefighters, EMTs, paramedics AND dispatchers. Yes, dispatchers too. The dispatch job is mentally stressful (I started my career as a dispatcher), and we need to ensure that the individuals answering these calls and working these radios are “fit enough” (morally, mentally, physically) to handle that pressure. If your argument is money, then you shouldn’t be in this business. The health of your people should not be held hostage by the lack of funding for the most basic of needs.
This is not rocket science, however, the attainment of medical physical standards seems to elude many of our departments. Fortunately, the National Fire Protection Association (NFPA), the International Association of Fire Chiefs (IAFC) and our other sister agencies have done a tremendous amount of work to guide us toward a medical physical protocol.
NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments (nfpa.org/1582) outlines an occupational medical program that has PROVEN to reduce risk and save lives. NFPA 1582 should be applicable across the board for our folks—paid and volunteer. Like those calling us in need, the standard does not differentiate. I fully recognize that this is not necessarily an easy task, especially for the majority of smaller departments. It is, however, a moral imperative that we must honor. The IAFC has published a great resource called the “Fire Department’s Guide to Implementing NFPA 1582” (http://tinyurl.com/IAFC-NFPA1582), which offers assistance in this arena.
Please, let’s not fight the “standard” versus “law” here either. I consider NFPA 1582 an industry best practice, regardless of whether YOUR department has adopted the standard or not. Sooner or later, it is likely that you or your department will be standing in front of a judge having to defend a wayward decision to NOT implement this standard. NFPA 1582 is NOT “simply an entry physical standard”—a statement I have heard many times and one that many political folks could easily absorb without a little education.
In the Prince George’s County Fire/EMS Department (PGFD), originally driven by union negotiation for paid firefighters, we implemented annual physical requirements many years ago. I don’t believe anyone is delusional about the success of ensuring that EVERYONE completed their annual requirement; however, as chief, I can personally attest to the success of the annual physical requirements. I have laid witness to the personal testimony of multiple PGFD firefighters who are alive today because of issues discovered during our mandated annual physicals.
Our 1582 physicals identified 283 individual abnormalities in personnel—folks who merely showed up for their annual physical. Nearly 120 were cardiac cases, some requiring bypass surgery and ultimately retirement. Pulmonary and hearing issues were also identified, some requiring retirement. Additionally, 154 lab abnormalities were identified, some requiring surgery, medication and/or retirement. These are successes in that they otherwise may have resulted in one of the deadly headlines mentioned above.
PGFD has for years required NFPA 1582 entry physicals for volunteers, similar to the career force. This year, funding has been proposed to provide annual physicals for PGFD’s volunteer firefighters as well. With more than 1,500 fit-test certified members, this will be no easy (nor inexpensive) task. While popular with some, the mandate is viewed with weary eyes by others—weary of “the decline of volunteers,” weary of knowing “what we don’t know,” and, yes, weary of individual personal decline (whether mental, moral or physical) that some have suspected but never validated.
Will some folks not make it through the physical process? Yes. Just like on the paid side of the house, some won’t make it. Should there be opportunities for remediation to allow volunteers more opportunities to pass the physical? I believe yes. Implementation of NFPA 1582 should NOT be a tool of discipline, rather it should be a tool of well-being and risk reduction. It is important to understand that some people will NOT pass the physical requirements. This is a demanding profession, so it’s certainly reasonable that not everyone will be up to the physical task.
Flip the narrative
Chiefs, companies/departments, 501(c)(3)s, unions, governments all place themselves in a position of personal and professional legal liability if they allow firefighters to practice in strenuous environments after an individual has failed a physical, and therein lies the rub a lot of folks don’t want to admit. They are indeed afraid of losing people to “a stupid physical” when they’re struggling to get fire trucks and ambulances out the door.
We MUST flip that narrative to ensure that we are able to serve our community when they need us and so we are rightfully afraid of losing one of their own members, instead of playing the game of chances many continue to play today. We must be prepared to make the rescues, and to be able to rescue our own.
This is unpopular, but should that 400-pound firefighter go down, there is little many of us will be able to do to affect their rescue. Further, should 82-year-old members be actively providing service in a strenuous environment? Yes, each of us is different, and some can perform better than others; however, we must take a realistic look at whether we should allow individuals to continue in active operational service, including driving and operating heavy apparatus, especially with the well-documented lapses in sensory perception and/or response times. As I’ve said before, be the chief your people NEED, which is likely not the same as the one they WANT.
It is important to recognize that NFPA 1582 physicals should not be a “one-and-done” opportunity. Entry physicals and annual physicals thereafter should be a starting point to not only identify what hidden issues may be lurking, but also to provide a personal roadmap to better health. They will also provide a professional roadmap to reduced organizational risk/cost as well as better service to the communities we serve. After all, if WE don’t make it to them, who’s going to help them—and who’s going to rescue us?
