According to the U.S. Fire Administration, as of 2024, approximately 50 percent of firefighter line-of-duty deaths resulted from on-duty cardiovascular events. So, I ask, why is it that the NFPA found that a minority of U.S. fire departments have implemented a comprehensive physical and wellness program?

In addition to cardiovascular events, several types of cancer, mental health disorders, respiratory disease and infectious disease are of great concern. Firefighters have a 9 percent higher risk of being diagnosed with cancer and a 14 percent higher risk of dying from cancer than the general population, according to Firefighter Cancer Support Network. Additionally, firefighters are twice as likely than the average American to be diagnosed with testicular cancer. In terms of mesothelioma, multiple myeloma, skin cancer, brain cancer, prostate cancer and colon cancer, the greater risk amounts are 2.0 times, 1.53, 1.39, 1.31, 1.28 and 1.2, respectively. Fortunately, there is better research and firefighter/fire department support to attempt to reduce these risks.

Fire service leaders must be aware of these trends and the need for comprehensive physical and mental health exams on a regular basis.

Comprehensive program

My passion for urging fire chiefs and administrators to implement a comprehensive physical program for their department is personal. My father, Lt. Donald J. Felker (Collingdale Fire Company #1), died in the line of duty while on an EMS call on April 16, 1978. We later found that my father had a thoracic aortic aneurysm, which he wasn’t aware of and that, unfortunately, ruptured after carrying a patient to the ambulance. He died before his fellow EMTs could start CPR.

I joined the volunteer fire service as a teenager and went on to become a volunteer and career firefighter/EMT and a chief officer. I also am a certified physician assistant and have worked in emergency medicine for the past 30 years. While I served as the fire chief for West Grove Fire Company (Chester County, PA) in 2013, our department made a commitment to pay for comprehensive physical exams for every active volunteer and career member.

The program required significant financial investment and administrative adjustments to allocate funds for this resource.

What is a comprehensive physical and wellness program? NFPA 1582: Standard on Comprehensive Occupational Medical program for Fire Departments defines comprehensive physical to include a medical history and physical exam; cardiopulmonary assessment (including a treadmill stress test); diagnostics (EKG, chest X-ray, pulmonary function tests); laboratory tests; and hearing and vision testing. Except for a chest X-ray (every five years), NFPA suggests that these should be completed on an annual basis. Mental health screenings also should be implemented for each firefighter.

Barriers to implementing a program

Common barriers to implementing a comprehensive physical and wellness program are cost, liability and resistance to changing department culture.

Cost can range from $500–$800 per member per year depending on the program and the company that provides the service. That said, grant opportunities can help departments. The Assistance to Firefighters Grant (AFG) provides funding for such programs. In Pennsylvania, the Volunteer Firefighters Relief Associations allow funds to be used for health and wellness for volunteer firefighters, and the Office of the State Fire Commissioner has grant opportunities to fund new or current programs. Fire service leaders must investigate grant opportunities in their state or region.

Further, leaders must address the addition of a comprehensive physical program with members. It’s imperative that leaders have buy-in from members. Leaders must instill confidence that the primary goal for implementing such a program is to promote members’ health and wellness. This likely will require changes to the collective bargaining agreement.

Implementing a program

Starting a program requires department leadership to institute a new or revised standard operating procedure. This is the easiest step.

There are many options for departments to consider when they develop a physical exam and wellness program. Some departments partner with local physicians or health systems to create a program. In this case, departments can access resources from the NFPA to help to guide their local healthcare providers in initiating a new program.

The First Responder Center for Excellence provides a comprehensive list of resources that can be accessed to assist fire department leaders.

Many corporate and occupational health organizations offer comprehensive physical exams.

My department has used several of these national organizations since it implemented its program 13 years ago. The department added ultrasonography to its annual program to include ultrasound imaging of the neck (carotid and thyroid), chest (echocardiogram and aortic root), abdomen, pelvis (for females) and testes (for males).

Initially, implementing and coordinating the program on an annual basis is time consuming, but after a couple of cycles, the administration of the regular annual program is more straightforward.

Regardless of which healthcare provider or organization a department selects, a member who’s within the department must organize and administer the program. In our department, our health and safety officer works collaboratively with the department office manager to manage the coordination and scheduling.

Benefits of a program

Fire departments and municipalities spend countless hours and resources on capital expenditure plans. Department leaders have planned new ambulances, new pumpers, new ladder trucks and new fire stations. However, the fire service’s most valuable asset (whether volunteer or career) is the people who staff stations and apparatus. Investing in members’ health should be a department priority.

Our small department of 120 members has seen the dividends of this investment. Our program discovered coronary artery disease in a 58-year-old member that required bypass surgery; heart arrythmia in a 24-year-old member that required a cardiac ablation; a cancerous liver mass in a 65-year-old member; hypothyroid and thyroid masses in a 17-year-old member; and countless instances of high blood pressure, diabetes, high cholesterol and skin lesions, all of which required further investigation. It’s likely that these diagnoses and the life-saving treatments that resulted never would have been discovered without a program being in place.

Act now

If your department doesn’t have a comprehensive physical exam and wellness program in place, I urge every department and municipal leader to make this a priority for your upcoming budget cycle. The health and well-being of members must be your priority.