The Other Side of Training…Physical Conditioning and Medical Evaluation

     Recently I had a pinnacle event occur in my career. I was participating in the Job Related Physical Abilities Test at work. I found myself after running this test saying what the heck just happened?  A friend of mine was on duty and...


     Recently I had a pinnacle event occur in my career. I was participating in the Job Related Physical Abilities Test at work. I found myself after running this test saying what the heck just happened?  A friend of mine was on duty and assisting with the testing.  He asked me after i completed the exam if I was OK?  The conversation continued with me asking how do I look?  His reply was, "Like you crap."  I replied, "I feel like it as well, I may be a statistic."  there was some humor in this but reality was, I was spent. What used to be easy was now challenging. I guess reality set in about being not so diligent on hitting the weight room or doing cardiovascular training. Reflecting on my increasing age came to mind. Bottom line is the job of firefighting requires certain abilities and physical conditioning levels. This article will explore the etiology behind why we need to make this a priority in our organizations and personal lives.
     In 2009 the fire service saw just under 100 line of duty deaths. Nearly 50 percent of these deaths were related to heart attacks. For more than 20 years, the leading cause of line of duty deaths in the fire service has been attributed to “heart attacks”. The majority of line of duty deaths due to heart attacks occurs suddenly and with few or no warning signs. In 1998 the U.S. Fire Administration’s data shows that 41 firefighters died of heart attacks or strokes, 19 of which had prior histories of cardiac or vascular disease. Training exercises accounted for 12 line of duty deaths, with 8 of these being from heart attacks. 
     There are several standards and rules that address physical conditioning;
Ø 29CFR 1910.120
Ø 29CFR 1910.134
Ø NFPA 1500 Chapter 8, 8-1
Ø NFPA 1500 Chapter 8, 8-3
Ø NFPA 1582 Standard on Medical Requirements for Firefighters
 
So with all of these standards and rules why is the number of deaths due to heart attacks so high? 
Anatomical Factors
Ninety percent of the cases of firefighters who have died suddenly, the anatomic abnormality present is coronary artery atherosclerosis. Some of the hearts had scarring from previous myocardial Infarctions (MI) or heart attacks.
Transient Factors
The second element in sudden cardiac death is some sort of transient event that perturbs normal cardiac physiological. When emergency scene operations are taking place, the transient event is assumed to be some effect of exertion. Five years of studies have shown that there is a 5-times greater risk of a myocardial infarction within the hour after heavy exertion than during times of sedentary life activities. Other studies have shown a documented increase of sudden deaths or MIs following natural disasters and in the early morning hours, both situations are when stress is heightened. To those of us involved in the fire service, it is obvious that fire fighting related sudden deaths is too frequent given the small amount of time that is spent in a tour of duty directly engaged in emergency scene operations. Therefore, some effect of emergency scene operations must factor into these deaths. These factors are exertion and stress levels.
Electrophysiological Factors
The third event associated with most sudden cardiac deaths is an electrophysiological abnormality that triggers an arrhythmia (rhythm disturbance). These occur because of abnormalities in transport of ions across cell membranes, which is the way electrophysiologic impulses are propagated. These abnormalities can occur in normal heart muscle that is damaged by a medication or electrolyte imbalance. Electrolyte imbalance is probable for most firefighters after each working incident due to the amount of body fluid lost due to the heat factor of gear. It is not uncommon for firefighters who are engaged in heavy workloads during fire suppression activities to loose consistently a liter of fluid in approximately 20 minute. This is a significant amount that can cause severe electrolyte imbalances if the firefighter is not properly hydrated prior to the incident (most of which are not).
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