Firefighters face many hazards, including chemical exposure, thermal injury, and trauma. From 1995 to 2007, there were 1,345 on-duty firefighter fatalities (1-3). What is surprising, however, is that over 44% of these deaths were classified as sudden cardiac death (1-3). Volunteer firefighters (VFF) fall victim to sudden cardiac death at a disproportionate rate when compared to professional firefighters (PFF). Of the 440 sudden cardiac death victims from 1995 to 2004, nearly 70% were VFF (1). Of the victims over 60 years of age, 93% were VFF (1).
It was proposed that this might reflect the tendency of VFF to remain active beyond retirement age. From 2001 to 2005, over 80% of the victims were over the age of 40 and over half were over the age of 50 (4). In a review of all on-duty firefighter deaths between 1994 and 2004, 32% were associated with fire suppression duties, 31% involved firefighters responding to or returning from alarms, 13% occurred during training activities, and the remaining 24% occurred during other firefighting duties, such emergency medical services and administrative tasks (5). The author suggests the risk of sudden cardiac death during fire suppression may be increased due to inadequate physical fitness, the presence of cardiovascular risk factors, and existing medical conditions (5). Possible explanations for the increased risk of sudden cardiac death in firefighters include psychological stressors, heat stress, smoke and chemical exposure, and high physical demands (6-7).
It is unclear which and to what degree occupational and personal risk factors increase the risk of sudden cardiac death. The prevalence of cardiovascular disease risk factors in firefighters has been investigated (8- 14). Obesity is known to be a significant risk factor for cardiovascular disease and is associated with adverse health conditions. In a study by Soteriades et al. (8), baseline and 5-year follow-up measurements of body mass index (BMI) and blood pressure were evaluated in municipal firefighters. Of those studied 53% were found to be overweight and 34.9% were obese upon entering the study. After 5 years, obesity prevalence increased significantly to 39.7%. Obese individuals were also more likely to have hypertension at both baseline and follow-up. A separate study conducted by Clark et al. (9) observed similar results. This study also reported significant increases in diastolic blood pressure, total cholesterol and triglyceride levels with increasing BMI (9).
Elevated cholesterol levels are another known cardiovascular risk factor. Hypercholesterolemia has been observed in 69.4% of firefighters as reported by Soteriades et al. (10). In this study, firefighters with higher cholesterol levels were more likely to be older, obese, and have higher triglyceride levels. Likewise, Licciardone et al. (11) reported an age-related increase in body weight, total cholesterol, and blood pressure. Byczek et al. (12) found the prevalence of obesity, hypertension, and high total cholesterol in male firefighters to be higher than those in U.S. adult men. There is limited research investigating the presence of cardiovascular disease risk factors in VFF (13). Swank and colleagues reported similar prevalence of all modifiable cardiovascular disease risk factors between VFF and the general population.
In general, an individual's risk for cardiovascular disease increases with the presence of multiple risk factors, advancing age, or elevations in risk factor severity (14). The presence of cardiovascular risk factors, especially obesity, is known to limit the performance of firefighters (15). Extra fat adversely affects job performance (16) and hinders heat Firefighter Physiology 21 dissipation, which creates strain upon the heart. Overall, the upper body fat distribution typically found in men is associated with higher blood pressure, higher serum glucose and cholesterol levels, and coronary heart disease (17). The high prevalence of cardiovascular risk factors found in firefighters may contribute to a higher risk of sudden cardiac death and adversely affect firefighting performance.
Little research has examined the physiological requirements of firefighting in order to characterize the physical demands and identify fitness characteristics needed for successful job performance (116, 18-29). Firefighting is known to induce significant demands on cardiovascular functioning as well as require substantial physical strength for prolonged periods (18-20). Firefighters endure long periods of inactivity followed by high degrees of physical stress (6). During the immediate response to an alarm, firefighters experience significant increases in heart rate (21). Upon arrival at the fire scene, firefighters work at levels above 80% of their maximal heart rate (HRmax) for a substantial period of time completing fire suppression duties (18). However, quantifying workload from heart rate alone is difficult due to the influence of heat stress, decreased oxygen, and increased carbon dioxide levels.
Source: Indiana University - Firefighter Health and Safety Research
Did you know...
Heart attacks are the number one cause of on-duty firefighter deaths. Heart disease affects 80 million Americans, and the emergency services are not immune. In fact, the stress put on the heart and body by emergency response activities creates an increased risk of heart attack. Protecting your heart through regular health screenings, proper nutrition, fitness, and lifestyle choices is key to lowering your risk of becoming a statistic.
Source: by the NVFC
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