An inquiry about Coronary Artery Disease in Firefighters prompted me to dig up this lecture from 1999 and update it with some recent information, only to find not much has changed! Other comments have since resulted in another Blog.
With exception of Firefighters who died on 9/11 at the World Trade Center in New York City, about 100 die in the US each year in the line of duty. Nearly half of those deaths are related to cardiovascular events.
“… Firefighting is a high-hazard job, and at times extremely physically demanding. It involves heavy lifting and maneuvering while wearing heavy clothing and protective gear in a hot environment. In addition, exposure to carbon monoxide and particulate matter in the air is routine, and there is a highly variable risk of exposure to a broad array of other toxic chemicals generated from the smoke of burning materials. It is not surprising that firefighters face an increased risk of illness and death due to cardiovascular disease during periods of intense physical and even psychological stress at work…”
Most of these conclusions were described in the New England Journal of Medicine in 2007, almost eight years after my lecture series to the Portland, Maine Fire Department in 1999. Clearly, little has changed during the intervening years:
And in In 2007 newer data, showing that Coronary Artery Disease continues as the primary cause of death across all age groups:
(From NEJM,2007: Duty-Specific Annual Risk of Death from Coronary Heart Disease among Firefighters, According to Age (Ref #3)
In comparison with other high risk professions Firefighters ranked number 1 in an old study:
Firefighters have to undergo vigorous health testing before acceptance into the force. As a population therefore, they exhibit the Healthy worker effect: a lower overall death rate than those of the general population, because the severely ill and disabled are excluded from employment. Once accepted however, they are exposed to much higher cardiovascular risks than the general public. These include ::
Carbon Monoxide exposure is a specific risk by itself for the development of atherosclerotic coronary artery disease:
Another study showed the effect of an alarm on Firefighters’ heart rate (up to 180/minute for up to 3 hours):
This data is significant in that a tachycardia of 180 bpm, persisting for such a long period of time, is usually reserved for top athletes and then only for much shorter intervals. The cardiovascular strain in lesser mortals is sure to have long term consequences that may also help explain the high incidence of cardiac disease in previously very healthy individuals.
In addition, protective gear, masks etc. are often worn for a limited period only, increasing the exposure to noxious fumes even after the actual fire has become controlled. While Firefighters may enter the workforce particularly healthy, they do not necessarily maintain their health status over time due to poor diet, smoking and inadequate regular exercise.
From personal interviews at the time, I learned the following:
- Firefighting alternates periods of inactivity with acute danger, physical and emotional stress and exposure to extreme heat.
- The protective gear worn at a fire includes breathing masks against noxious fumes that are omnipresent, but with an oxygen supply that is limited (in 1999 about a half hour) and thus of limited practical use.
- As a result, its use is minimized and reserved for “extreme” situations, while exposure is tolerated for as long as possible, in fact may be seen as “manly” and a sign of professionalism rather than dangerous overexposure.
In the face of this, smoking seems a minor risk in comparison to going into a burning building and performing genuine heroic acts.
The recommendations of the National Institute for Occupational Safety and Health arising from the Fire Fighter Fatality Investigation and Prevention Programs are similar to the ones I recommended in 1999 to the Portland Fire Department, showing not much has changed in the past twelve years:
- Fire departments should provide mandatory preplacement and annual medical examinations for all firefighters. These evaluations should include medical clearance for firefighters to wear self-contained breathing apparatuses.
- Wellness and fitness programs should be implemented to reduce risk factors for cardiovascular disease,
- All firefighters should have annual physical performance evaluations.
To these I would add:
- Regular Physical training, appropriate for the required levels of exertion
- Improved Oxygen masks (“Air Packs”), capable of extended periods of O2 supply
- Enforce protective measures until objective tests have shown the environment is safe again.
Now that so many Firefighters have have become EMTs and thus capable of providing even more emergency care to their charges, it is time they extend the same care to themselves. It is disappointing to learn that twelve years later, the same problems persist as in 1999, when I presented my original lectures!
1) Facts About Heart Disease in Firefighters, Presentation to the Portland Fire Department. March, 1999, Joan F. Tryzelaar, M.D., F.A.C.S., F.A.C.C.P., Judith A. Curran, L.P.N., C.S.T., C.F.A.
2) Firefighting and Death from Cardiovascular Causes.Linda Rosenstock, M.D., M.P.H., and Jorn Olsen, M.D., Ph.D, Editorial N Engl J Med 2007; 356;12,
3) Emergency duties and deaths from heart disease among firefighters in the United States. Kales SN, Soteriades ES, Christophi CA, Christiani DC. N Engl J Med 2007;356:1207-15.