By Jamie Webb
The first call came out just as the morning coffee was brewing and the day hasn’t let up yet. You and your crew have responded to a motor vehicle collision (MVC) with entrapment, given a breathing treatment to an asthmatic patient, performed CPR for the third time this month, and everyone just returned from the structure fire that you thought would never end. It’s been one of those shifts. Although days like this are handled successfully by thousands of firefighters every day, for many it’s days like this that are their last. One of the most alarming statistics in the American fire service is that more firefighters die each year from heart attacks than from any other reason, and this statistic has stood for decades.
Many reasons exist for why firefighters to have such an increased risk of heart attack. Firefighting is an incredibly stressful job, and the physical toll a career in the fire service takes on the body can be dramatic. Poor diet is often associated with poor cardiac health, and lack of regular exercise ill prepares the body for physical activity (Kales et al. 2017). Although some of these triggers or causative factors can be addressed to positively affect the cardiac health of firefighters, others, such as family medical history and the stress of the job, simply cannot be minimized. Therefore it is critically important that we concentrate our efforts on those that we can do something about; primarily, diet and exercise.
Diet and exercise are two areas that have powerful effects when they are incorporated as lifestyle changes and have the potential to make serious strides in combatting firefighter cardiac health. Moreover, the previously listed causative factors that we have no control over can be positively affected by incorporating a healthy diet and regular exercise. For instance, there is no doubt that serving as a firefighter is a stressful job. In fact, CBS News published a list in early 2018 of the most stressful jobs in America, and the job of a firefighter came in at number two on the list, second only to being an enlisted member in the military (Picchi, 2018). So where does all that stress come from, what affect does it have on our bodies, and how can diet and exercise work to minimize its effects? Unfortunately for us, stress is an inherent aspect of being a firefighter.
In 2007, the New England Journal of Medicine published a study that detailed how firefighters are more at risk of suffering a fatal cardiac event than other members of emergency services, such as ambulance personnel and police officers (Kales et al. 2007). The study showed that although being a firefighter is inherently more stressful, participation in fire suppression activities in particular can increase the risk of a heart attack in unhealthy firefighters anywhere from 10-100 times more so than when non-emergency tasks are being performed (Kales et al. 2007). Furthermore, the study revealed that although actively fighting fire only consists of approximately one to five percent of a firefighters’ total time while on the job, 32 percent of fatal cardiac events occur either during or after participation in this type of activity (Kales et al. 2007). Horn et al. 2010, listed the results of a study performed to determine exactly what is going on in the body of a firefighter when participating in fire suppression activities, and found that the resting heart rate nearly doubles, core body temperature rises at least 2ºF, systolic blood pressure rises, firefighters experience increased tension and anxiety, and, most tellingly, blood platelet and coagulation properties increase dramatically and remain elevated for hours after the fire. The latter possibly indicates what causes so many fatal heart attacks during and after this type of activity. This information tells us that our job is undoubtedly stressful, and that our primary function–to provide fire protection and suppression–is one of the most physically demanding tasks imaginable. So now we get back to how diet and exercise changes can positively affect this type of stress on the body.
For starters, it is critically important to understand that proper nutrition is key to improving overall health. Several studies over the past decade have proven links between proper nutrition and disease prevention, disease reversal, and further proven how many of the health factors that unfortunately plague many Americans can be positively affected by improving nutrition (“How is Heart”, 2014). Firefighters must concern themselves with what types of foods we can consume that will decrease our risks of heart disease while also improving overall health. Eating healthy foods such as leafy greens, nuts, fruits, and legumes will reduce the amount of unhealthy fats, plaque, and sugars that are introduced into the body, thus improving overall health. Firefighters unfortunately often partake in unhealthy eating habits and regularly consume a poor diet, which leads to their increased levels of obesity and poor cardiac health (Kales et al., 2017). If healthy eating habits were introduced and instilled in firefighters early on in their careers, there is a good chance that cardiac-related deaths would be reduced and the average obesity rate in the fire service would be lowered from its current rate of more than 40 percent (Poston et al., 2013). Participation in a diet such as the Mediterranean Diet would be extremely beneficial to firefighters as it has been proven to decrease cardiovascular disease and the risk of cancer (Kales et al., 2017). When exercise is combined with a healthy diet to create the foundation of a health and wellness plan, overall firefighter health is greatly improved. So, in simple terms, we need less meals consisting of biscuits and gravy with sausage or bacon, and more meals consisting of chicken and salmon with salads and fruit, followed by daily exercise.
Avoiding a sedentary lifestyle can make firefighters healthier and less likely to suffer a fatal cardiac event. Throughout the career of an average firefighter, they tend to become more sedentary as time goes on and gain an average of 1-3 pounds per year of service (Poston et al., 2013). Now I’m not saying that firefighters are lazy by using the term “sedentary,” rather what I’m trying to convey is that firefighters often work long shifts and then part-time jobs on their days off from the station. This may mean that time for routine fitness is often placed on the back burner or simply overlooked because of the jam-packed schedules we create for ourselves.
However, when habitual exercise is present in a person’s life, their risk of suffering a fatal heart attack is considerably lowered. Regular exercise, which should sometimes be vigorous, will reduce cardiac-related line-of-duty deaths among firefighters. The benefits of regular exercise for the body include increased exercise tolerance, reduced bodyweight, reduced blood pressure, lower levels of bad cholesterol (LDL), higher levels of good cholesterol (HDL), and an increase in insulin sensitivity (Meyers, 2003). With nearly 50 percent of annual firefighter line-of-duty deaths being caused by cardiac conditions, improving cardiac health through regular exercise will directly lower the amount of these deaths that occur each year. Furthermore, with 32 percent of cardiac-related deaths among firefighters occurring during or after participation in fire suppression activities (Kales et al., 2007), when the physical demand on the body is highest, participation in a regular exercise regimen would reduce this percentage as routine exercise better prepares the body for bouts of extreme exertion (Meyers, 2003).
We in the fire service have become increasingly proactive in the way we train and prepare ourselves for the endless possibility of calls we may respond to, and it is now time to also become increasingly proactive in the way we fight cardiac related LODDs. We must make the conscious effort to not only maintain mental readiness, but physical readiness as well. Start placing exercise as a priority in your life. Sit down with your brother and sister firefighters and come up with a healthy eating plan. We spend roughly 1/3 of our lives with each other, and because of that we have the inherent responsibility to take care of each other. Eat healthy, exercise often, get a yearly physical, and perhaps give yourself the opportunity to do the job you love better than ever.
Horn, Gavin P; Petruzzello, Steven J; Fahey, George C; Fernhall, Bo; Woods, Jeffrey; Smith, Denise L. (2010). The Effects of Fire-Fighting and On-scene Rehabilitation on Homeostasis.
How is Heart Disease Treated? (2014). National Institutes of Health. U.S. Department of Health and Human Services. Retrieved from: https://www.nhlbi.nih.gov/health/health-topics/topics/hdw/treatment.
Kales, Stefanos; Soteriades, Elpidoforos S; Christophi, Costas A; Christiani, David C. (2007). Emergency Duties and Deaths from Heart Disease among Firefighters in the United States. New England Journal of Medicine 2007; 356; 1207-1215 March 22, 2007. Doi: 10.1056/NEJMoa060357.
Kales, Stefanos; Korre, Maria; Moffatt, Steven; Smith, Denise. (2017). Cardiac Enlargement in U.S. Firefighters. Findings and Recommendations from Non-Invasive Identification of Left Ventricular Hypertrophy/Cardiomegaly in Firefighters. National Fallen Firefighters Foundation.
Meyers, Jonathan. (2003). Exercise and Cardiovascular Health. Circulation, 2003; 107: e2-e5. Originally Published January 7, 2003. American Heart Association Journals.
Picchi, Aimee (2018). 9 Most Stressful American Jobs in 2018. CBS NEWS Moneywatch. Published 2018 Jan 11.
Poston, Walker SC; Haddock, Christopher K; Jahnke, Sara A; Jitnarin, Nattinee; Day, Sue R. (2013). An examination of the benefits of health promotion programs for the national fire service. MBC Public Health. 2013; 13:805. Published online 2013 Sep 5. Doi: 10.1186/1471-2458-12-805.
Jamie Webb is a driver/engineer and EMT-I with Cobb County (GA) Fire and Emergency Services. He has degrees in fire safety and occupational safety and health from Columbia Southern University. He is also a member of the of safety and cancer prevention committee with Clayton County Fire & Emergency Services.