Reducing Line-of-Duty Deaths Through Healthful Cooking

By JERRY KNAPP, GORDON WREN, AND DAN NICHOLS

This article will share an innovative solution to help reduce the number of self-inflicted line-of-duty deaths (LODDs) caused by improper maintenance of our bodies through the slow, lingering death from the “firehouse meal.” To understand how valuable this innovative solution is, first you must have a thorough understanding of how devastating the problem is to the American fire service.

The fact remains that we are not dying while making daring rescues to save innocent children from a terrible death by unfriendly fire. We are dying of heart attacks that were years in the making. We are dying alone; in our bunks, stations, and homes; with crushing chest pain—not in our turnout gear or on the fireground. Often, these heart attacks are a direct result of selecting improper foods and cooking them in a suicidal manner.

THE PLAN

If firefighters treated their bodies as they treat and maintain their engines, ladders, and rescue trucks, they could significantly reduce LODDs. Every year, engines get pump tests and ladders get stress tests and, routinely, all of the rigs are inspected for mechanical deficiencies.

(1) Firehouse cooks from Rockland and Dutchess Counties (NY) after completing a one-day healthful eating and cooking class at the Culinary Institute of America. (Photos courtesy of the Culinary Institute of America.)

Like engines, we get a physical each year. Like apparatus, we are stress tested on every call. Just like our rigs, if we have all our moving parts, little rust, and working critical parts, we stay in service. But that is where the similarity of our apparatus to our bodies ends. The bottom line is this: We take better care of our trucks than we do our bodies.

Compare how we treat our rigs with how we treat our bodies. We always put the proper fuel in the trucks, always high-quality, pure diesel fuel—only that which is good for the engine. There is nothing in the fuel that clogs up the fuel lines and stops the flow of fuel, which will kill the engine. However, we consistently ingest high-fat foods that clog our arteries. When we are stressed the most and need the best blood flow, our clogged “fuel lines” will fail us; we will have a heart attack and, consequently, fail.

(2) Firehouse cooks learned to make healthful food choices and prepare the food in a heart smart and healthful manner.

Another maintenance factor we must consider is the quality of the motor oil we put in our rigs. We can equate this with the amount and type of carbohydrates and sugars we eat and how they influence our blood sugar levels. If we add the wrong type of oil, or too much or too little, the motor will suffer and fail. The motor will burn oil, lose power, and wear out critical parts prematurely while operating at a lesser efficiency. Our rigs will die an early death.

How does this relate to us? If we consume too much sugar and carbohydrates, we may develop one of the many forms of diabetes. Statistics prove that two out of three diabetics will experience heart disease. Firefighters who continue to put the wrong oil or sugar in their “motors” will ultimately experience early “engine” failure, resulting in their death, probably during or just after the high physical stress of the fireground.

(3) Chef Mark Ainsworth demonstrates how quick and easy it is to make your own pasta as firehouse chefs in training look on.

Engine and pump tests are conducted with the engine running at full capacity and under load, just like firefighters on the fireground. Ladders are tested with hundreds of pounds suspended from their outstretched rungs. Body pump/ladder (heart) tests and electrocardiograms during physicals are conducted at rest, under no load or strain; only gross abnormalities will be detected during these stress tests. Rig tests are more realistic and effective than the maintenance tests for our bodies. If people are your department’s most valuable asset, why are we not treating them that way?

GROSS VEHICLE WEIGHT

There is a 40-percent obesity rate (30 pounds or more overweight—United States Department of Agriculture) among emergency workers, including firefighters. Even if we are not overweight, we overload ourselves with about 80 pounds of protective equipment and hand tools at every fire as well as a massive amount of additional weight. We are careful not to overload our vehicles with equipment, tools, and applications so they perform well and can accelerate, decelerate, and turn with the quickness and agility we demand during emergency responses. We are less responsible with our bodies. Without a doubt, our rigs are in better shape, weightwise, than we are. How often can you recall your rig not being able to get you to the scene and support you on arrival? How hard and for how long can you work in your turnout gear, where the micro climate is 100°F with 100-percent humidity?

(4) Chief and chef in training. Dan Nichols works with his father, Ray, to prepare the salad.

A study from the Robert Wood Johnson Foundation (RWJF) found that the obesity rate is above 20 percent in 49 states; 12 states are above 30 percent (five years ago, Mississippi was the only state with an obesity rate above 30 percent). Obesity is defined as a body mass index, which is calculated based on height and weight measurement, of 30 or more. According to the RWJF’s Jim Marks, “The numbers have skyrocketed over the past couple of decades because of the growth of portion sizes and the ready availability of unhealthful foods. Schools have ditched physical education programs, and school lunches have become less healthy.” Similarly, the American fire service has done little to train its members in proper food selection and preparation and physical fitness. Jeffrey Levi, from the Trust for Public Health, in the 2011 report states, “When you look at it year by year, the changes are incremental. When you look at it by a generation, you see how we got into this problem.”

FIT WORKER SYNDROME

We replace old fire trucks when we think they may be unreliable for service. In comparison, we expect veteran firefighters to perform the same or more demanding tasks just as we do the newest, fittest probie. The veteran’s fuel and oil may not have been the best during his career, and his performance will suffer until a catastrophic failure occurs. LODDs are usually caused by heart attacks. This syndrome arises because employees enter the service very fit and healthy. As their careers progress, we assume they are just as fit and healthy as when they first started when, in reality, their health and fitness may be decreasing annually.

GENERATIONAL DEGRADATION

While attending an anniversary celebration for a local fire department, Gordon Wren, the Rockland County (NY) fire coordinator, observed, “The department put together a montage of pictures and movies from the 1950s and 1960s, with some pictures of the members in dress uniforms. The guys in the 1950s and 1960s were ramrod straight, lean, and fit. Broad shoulders and narrow waists were everywhere.”

(5) The healthful meals prepared are put on the buffet table by Harold Straut from the Nanuet (NY) Fire Department.

Wren continues, “Then, the recent pictures popped on the screen. Broad shoulders gave way to broad waists and narrow shoulders. Let’s just say their bellies were considerably rounded and protruding, and belt buckles strained under the load. I don’t know if it was a carryover from members being in the military or just because we were more physically oriented without 200 TV channels, computers, and electronic thumb games. What I do know is that those members were in better shape and they were not weighted down with 80 pounds of protective equipment and SCBAs that we wear today at every alarm.”

WHOSE FAULT IS IT?

It’s no one’s fault! We were taught how to take care of our trucks, operate pumps and ladder trucks, conduct searches, cut roofs, and push hoselines into burning buildings but never how to select or prepare our meals. How did you learn to cook? Most likely from your mother. Where did she learn? Her mother. You may be preparing meals based on 50-year-old information and techniques such as cutting off the end of a ham before cooking it. You didn’t know why it was done that way, but it was just something you always did. This is the way it is in the firehouse: We are selecting and preparing our meals without a solid training and knowledge base.

TRAINING FIREHOUSE COOKS

Rockland and Dutchess County (NY) firefighters teamed up with the Culinary Institute of America (CIA) to pilot a program to teach firehouse cooks how to select and cook healthful or, at least, more healthful food. The concept was the brainchild of Wren and Roosevelt (NY) Fire District (RFD) Chief Dan Nichols. RFD provides fire protection to the CIA. Wren has been a student of healthy eating and is a highly vocal proponent of improving firefighters’ health through nutrition. Healthy food selection and preparation can decrease LODDs and extend the quality of life of veteran and retired members. The partnership was a natural; Wren and Nichols knew each other professionally from cooperative work on other projects. Wren supplied the motivation and concept while Nichols had the contacts at CIA to suggest a pilot program. The CIA jumped at the chance.

The CIA is the world’s premier culinary college. Founded in 1946 to help returning World War II veterans learn a skill for rejoining America’s workforce, the college now has 2,800 students pursuing bachelor and associate degrees in culinary arts and baking and pastry arts. In addition, more than 3,000 professionals each year enroll in continuing education courses; another 4,500 participate in programs for food enthusiasts. In addition to the main campus in Hyde Park, New York, the CIA has campuses in California’s Napa Valley and San Antonio, Texas, as well as an international campus in Singapore.

CIA staff created a six-hour pilot training program that included 90 minutes of nutrition basics, a 30-minute overview of the menu and preparation methods, and three hours of hands-on kitchen cooking. During the program’s last hour, we got to eat what we cooked! The program was extremely well researched and professionally delivered. Through this short program, we learned to produce life-saving changes for the remainder of our lives. If we follow what we learned in this training, it will start to reduce the biggest cause of LODDs: heart attacks. Additionally, this program will be the start of teaching firehouse cooks how to select and prepare delicious tasting foods that will also provide the proper fuel for future generations of firefighters. The training had the following learning objectives.

OBJECTIVE #1: UNDERSTAND THE EFFECTS OF FOOD ON YOUR BODY

Did you know that we are eating ourselves to death? Marjorie Livingston, a registered dietitian and nutritionist, lectured the group on nutrition and explained the following facts:

  • There are eight leading causes of death in the United States: heart disease, cancer, stroke, diabetes, chronic obstructive pulmonary disease, accidents, pneumonia, and influenza. The first four are strongly influenced by nutrition. By eating the wrong amounts and types of foods, we are, in fact, increasing the speed of the onset, the severity and the odds of disease development, and the associated causes of death. Based on several studies, firefighters have an increased risk of type 2 diabetes. Diabetes leads to heart disease in two out of three cases.
  • From 1997 to 2001, obesity increased from 35 to 40 percent in the United States.
  • Obese firefighters were more likely to have hypertension [high blood pressure (BP)] and bad ratios of good/bad cholesterol. These factors lead to stroke and heart disease.
  • Approximately 75 percent of emergency workers have prehypertension or hypertension (BP of 180/80 or greater).
  • Heart disease is responsible for about 45 to 50 percent of LODDs annually. We also suffer passively from “healthy worker effect.” We come on the job healthy but are not medically followed up aggressively and continue to eat in a less-than-healthy manner. Livingston explained that we don’t have to eat things that taste like cardboard to be healthy; this was also the theme of the hands-on cooking portion of the training.

SIMPLE CHANGES, BIG RESULTS

Following are a few important simple and small changes you can make in your next meal to make it a bit more healthful and taste as good, if not better, than before:

  • Increase consumption of whole grains and vegetables.
  • Limit consumption of processed foods.
  • Reduce consumption of saturated fats.
  • Eat lean meat and fish.
  • Control portion sizes (you can eat almost anything you want; just consider eating less of the “suicidal” foods).
  • Eliminate excess calories from sodas, sweets, pastry, and other simple carbohydrates.
  • Eat more fruit, which is good for you on a number of levels.
  • Eat more of the “super foods” such as beans, broccoli, oats, wild salmon, spinach, walnuts, tomatoes, blueberries, oranges, pumpkin, soy, tea, yogurt, and turkey. Experts say these foods can help ward off heart disease, cancer, high cholesterol, and other common diseases.

So, our first major objective was met: We learned what we should be eating and why. The information was presented based on the latest scientific facts and studies. However, to the modern firefighter, “eating healthy” did not sound appetizing; all 15 students who attended this program were very skeptical. “I hate veggie pizza, and I ain’t eating that ’cause it tastes like cardboard!” were typical responses during the break. The next objective was to learn to cook things that taste good but are “firefighter healthy.”

OBJECTIVE #2: STEALTH COOKING

Next, Certified Executive Chef Mark Ainsworth, a full professor and 18-year CIA faculty member, instructed us on the finer arts of firehouse cooking. Ainsworth was a great fit; he could have taken off his chef gear, put on fire gear, and fit in seamlessly in any firehouse in America. This was a key to breaking our preconceived notions that healthful food does not taste good.

Ainsworth described what we would be cooking; broke us up into four four-person teams; and provided us with a well-researched, easy-to-cook, and very tasty menu. He quickly reviewed the menu, which described healthful substitutions we would stealthily put in our firehouse meals. Then came the moment of truth: We were issued our aprons and chef hats and were off to the kitchen.

With the help of Ainsworth and a few CIA staff members, we entered the massive kitchen. There were four stations set up, each with raw food products we needed for our specific group and menu, access to spices, refrigerated products, cooking utensils, pots, stoves, and ovens. After a short tour of the kitchen, Ainsworth ordered, “OK, start cooking. Be prepared to serve your meal at 12:30 [pm].”

After about three hours, we plated our healthful meals and put them on a large buffet table under heat lamps to keep them warm. Ainsworth gave us a quick review of our combined prepared foods, ordered us into the dining room, and told us to remove our aprons and hats and enjoy the meal. We picked up plates and sampled a bit of everything the group had cooked. With four groups of four firehouse cooks creating four menu items each, we had a very nice, healthful buffet meal.

Eating our creations was a lot of fun! It did not take long before we returned to the buffet table to sample something we missed or to get a bit more of one of our favorites. There were no negative comments about the taste of the dishes we prepared, and it was all firefighter healthy! There were not a lot of leftovers, proof positive of the genuine nature of the comments.

STEALTH COOKING AND HEALTHFUL CHOICES

The following is a list of some of the menu items that were prepared, with an explanation of their healthful properties:

1 Black bean quesadillas with pico de gallo. Beans (legumes) and rice each contain an incomplete amino acid. Together, the whole wheat tortilla and the beans make a complete protein, supplying eight essential amino acids, which are essential building blocks and energy sources for all the cells in our bodies. We usually get amino acids from animal products. However, they contain the bad fats (saturated) that are part of our suicidal diet leading to heart attacks. The limited cheese in the recipe adds protein, and the vegetables in the pico de gallo (similar to salsa) add fiber, vitamins, and antioxidants to our diet.

2 Romaine with Caesar-style dressing. Everyone likes a good Caesar salad; this was no exception. The difference here is the fat and cholesterol had been reduced and substituted with firefighter-healthy ingredients such as reduced oil and low-fat sour cream.

3 Roasted vegetable pizza on flaxseed crust. Less oil and cheese and the added benefit of vegetables. The flaxseed was not noticeable in the crust, but it has many health benefits and aids the digestive process.

4 Oven-fried chicken. Tastes like fried chicken, but it did not have the fat and cholesterol.

5 Bacon mashed potatoes. Reduced-fat sour cream and buttermilk replaced the saturated oils usually contained in the mayonnaise. They added a great, unique flavor.

6 Venison burgers. A very lean substitute for fatty beef burgers.

7 Garlic croutons. Another favorite but usually loaded with fat and bad cholesterol. This version added a little garlic butter and a lot of great taste.

8 Italian beef and vegetable kabobs. Lean beef and a generous supply of vegetables (tomatoes, onions, mushrooms, garlic) cooked over a grill, reducing the fat from the meat.

9 Oven-baked sweet potato fries. Obviously not fried, but they just tasted like it—only better!

10 Albuquerque grilled pork tenderloin. Lean grilled tenderloin with a barbecue sauce that would make any pit boss jealous. Less fat than ribs or beef.

CHOOSE YOUR MEALS WISELY

More than anything else, these items were chosen because they tasted good and were common everyday foods—and they just happened to be healthful but not wanting for flavor. These dishes were chosen for their lean meat, whole grains, and vegetables. The fit and lean firefighters of the 1950s and ’60s ate better than we do today. They consumed a lot less processed foods and meat and ate more vegetables. They also ate sandwiches for lunch—not pizza—and the beverage of choice was certainly not soda or sweet tea. A lot can be learned from the simpler diet of our grandparents.

There are three inescapable truths we learned during this pilot training program. First, we were never trained on how to make nonsuicidal food selections or in their preparation. Second, with the proper training of the cook, healthful cooking is delicious. Third, if we are to significantly attack the major cause of LODDs (heart attacks), we have to start with what we eat and how it is prepared.

Authors’ note: We would like to thank Mark Ainsworth, Majorie Livingston, and Jay Blotcher for their help in coordinating, researching, and presenting this program and for their assistance with this article.

JERRY KNAPP is a 35-year veteran firefighter/EMT with the West Haverstraw (NY) Fire Department and assistant chief with the Rockland (NY) Haz Mat Team. He has a degree in fire science and is a nationally registered paramedic. He is also a training officer at the Rockland County (NY) Fire Training Center in Pomona, New York, and an FDIC HOT Engine Company instructor and seminar presenter. He recently retired from the Directorate of Emergency Services at West Point.
GORDON WREN is the director of the office of fire and emergency services for Rockland County, New York.
DAN NICHOLS is chief of the Roosevelt (NY) Fire District.

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