By Todd LeDuc
At every presentation of “Surviving the Fire Service” this year, I asked attendees to raise their hand if they knew a colleague who was lost to suicide, cancer, or cardiac events. Note that in the photo above, nearly every hand is raised.
There are only about two and a half weeks left in the year 2019 (and the decade). Thus far, the United States Fire Administration (USFA) is reporting 55 firefighters this year have lost their lives while on duty. That’s compared to the 82 firefighters who died on duty in 2018, an approximate 33-percent decline, according to the USFA. Perhaps this is because of the continued result of our industry’s heightened focus on safety, health, and survival, or a recognition that fires have decreased in the United States by 6.2 percent (USFA). Many of these reported on-duty deaths continue to be cardiac in nature and do not tell the full story. According to published work by Smith and Kales, for every cardiac line-of-duty death there are reported to be approximately 17 additional non-fatal cardiac events that significantly impact the quality of life of firefighters.
Dr. Denise Smith and Stefanos Kales have demonstrated that significant physiological changes occur during the stress of firefighting. These include maximal or near maximal heart rates, a 35-percent decrease in stroke volume, a nearly 15-percent decrease in plasma volume and platelet changes occurring–all suggesting the development of a pro-clotting state.
Obesity continues to be an alarming concern and precursor to cardiac risk in firefighters, with 32-40 percent of firefighters reported to be “obese” and 77-90 percent reported to be either overweight or obese. Furthermore, reports have demonstrated 20-30 percent of firefighters have high blood pressure; in many, it is poorly controlled. Twenty percent of firefighters have elevated cholesterol levels placing them at higher proportional risk for cardiac events. Dr. Smith has also documented the prevalence of left ventricular hypertrophy in firefighters suffering both fatal and non-fatal cardiac events, and often driven by poorly controlled hypertension.
These numbers do not tell the story of occupational cancer in our ranks as we work to set up the national firefighter cancer registry. Unfortunately, we currently do not have robust tracking mechanisms in place to determine the magnitude of fire service cancer in 2019. Our largest study, conducted by NIOSH, determined firefighters had a nine-percent higher rate of developing cancer overall and 14-percent more likely to have a fatal diagnosis. The national cancer registry will hopefully enhance our understanding of the prevalence and inroads we are making on addressing firefighter occupational cancer.
Firefighter suicide prevalence also continues to be a defining challenge because of the lack of robust reporting systems. Reports that have been circulated suggest that confirmed responder suicides are higher than reported USFA on-duty deaths. We know that we must continue to focus of better defining the behavioral health impacts and develop appropriate safe guards to support members wellness.
Todd J. LeDuc, MS, CFO, FIFirE, retired after nearly 30 years as assistant fire chief of Broward County, Florida, an internationally accredited career metro department. He served as chief strategy officer for Life Scan Wellness Centers, a national provider of comprehensive physicals and early detection exams. He has served as a member of the International Association of Fire Chief’s Safety, Health & Survival Section for over a decade and is currently secretary of the section. He is a peer reviewer for both professional credentialing and agency accreditation. He is editor of Surviving the Fire Service (Fire Engineering Books) and serves on numerous advisory boards and publications.