Redefining the Healthy Firefighter, Part 1

By Jon Hofman

The topic of health and wellness in the fire service has been growing over the years. This can be attributed to a number of factors such as workers compensation, absenteeism, injury reduction, and improved firefighter fitness to decrease adverse health risks/events; all are positives in helping our greatest resource—the firefighter. However, it does also open the door to a lot of problems if this subject is not properly addressed. For example, the two most asked questions I often get it are “What is your policy?” and “What is your fitness standard that establishes them fit for duty?” Both questions are excellent, but often they are not that easy to answer.

You may think that these questions are easy to answer, but over the past nine years, I have come to realize that there are multiple factors to consider when identifying the minimal fitness needs of firefighters. For example, you need to understand the rights of the firefighter, you need to have union approval, and you need to establish what you gain by implementing a health and wellness program; these are just a few of the things that you need to answer; however, and most important, you need to define what a healthy firefighter is, or rather, what it means to be “fit for duty.”

I have come across many different definitions of “fit for duty” or “health and wellness policy,” but none of them actually satisfy me because they do not account for differences in physical demands and personnel composition across departments. There are a number of resources available to help develop these items, but they too are too vague. The idea of “mandatory” and “non-punitive” never made sense to me, either; how do you make people do something without having an action occur? According the recommendations of the International Association of Fire Fighters/International Association of Fire Chiefs’ Wellness Fitness Initiative, a firefighter should have a maximal oxygen consumption (VO2max) score of 42 ml·kg-1·min-1 for aerobic fitness. But what if he has an aerobic capacity of 30 ml·kg-1·min-1? Is he considered unfit for duty? Do we just leave it to him to correct it? Do we force him to correct it? Do we leave it alone? Is it a valid means of stating they are fit for duty? My point is, either way you look at it, the senior administration, the local union, or district and city officials need to make a decision, whether it is good, bad, or indifferent.

What about body mass index (BMI)? We know—based off research—that BMI is a good predictor of injury and a possible screening tool, but that does not mean a firefighter has a good BMI, he is fit for duty. How do I know a firefighter who has a high BMI and is out of shape can’t do the job? I know plenty of firefighters who are overweight and never exercise and do the job very well. Contrary to that, I also know a lot of firefighters who eat well and exercise all the time, but they are not very good firefighters. So, it is not fair to look at BMI, body composition, or any other isolated area/test of fitness to determine physical condition.

So, what about specific tasks aimed at firefighting? Again, this is not really a good indicator of being fit for duty. Why? Some departments have used the star drill to assess their firefighters’ levels of fitness. Yes, it is difficult and firefighter-specific, but has it been validated by science? Will it hold up in court if challenged by a member of the department? What if you found someone who struggled with it? Is it because of a lack of training, a lack of fitness, or not being familiar with the test? If an overweight firefighter who everyone knows is out of shape and struggles with the star drill, the administration deem him unfit for duty and suspend him without pay. This opens a “Pandora’s Box” for lawsuits as well as a number of other issues. In addition, will it protect them from having a heart attack?

No matter how you look at it, the word “standard” or the minimal requirement related to firefighting tasks often worries me. The notion of having a policy that is “mandatory, non-punitive” is an oxymoron and makes no sense. So, what do we do? First, because there is no definition that states “this is considered fit for duty” it has to be negotiated by all parties involved. It is important that both the department and the union negotiate and come to understand what would be deemed fit for duty for their departments. Remember, not every department is the same, so it needs to be open to discussion. Second, it is the union’s responsibility to protect its members, and it is the department’s job to look after the department as a whole. Both usually want to protect the firefighter, but they usually come at it in different directions.

There will be those who read this and think I am crazy. Take the firefighter who has 10-percent body fat, can run 1½ miles in eight minutes, and do every crazy workout known to man; he will typically say “it is my responsibility to be in shape to do the job.” Then, there will be those who are morbidly obese and unhealthy and will say “What does a 1½-mile run have to do with pulling hose?” They are both wrong and right.

It is my job to help the firefighter, which means I need to understand both sides. Over the years, I have come to understand that there is no finite body type or specific body that makes a healthy firefighter. Again, I have seen the young, strong, and healthy firefighter get hurt much easily on the fireground when compared to the older, more robust firefighter. But, I have also seen the older, more experienced, and out-of-shape firefighters have heart problems off the fireground.

As you can see, this is not so simple. Yet, I listen and learn from my firefighters as much as they do from me, and I have to develop my own definition of what it means to be fit for duty; not just physically fit to do physical tasks, but also to cope physiologically with the job-related mental and emotional stress.

How did I develop this concept? I first asked, “What are we really trying to achieve?” Do six-pack abs define a healthy firefighter, or is it longevity (on and after the job)? Then, I started applying science and experience. Second, I listed the questions to the answers I did not know, and I do my best to answer them. Finally, I take into account all the firefighters (from the morbidly obese to excellent shape), the union, and senior administration and develop an idea of balance.

 

What Are You Trying to Achieve?

Develop a health and wellness program in a proactive manner where all parties achieve success; that means that the ultimate goal is to retire “healthy.” Understand the fine print needs to be negotiated.

Next, list the questions that you have not answered, some of which follow:

  1. Is exercise on duty allowed? Will equipment be provided?
  2. Will only on-duty exercise be enough for firefighters to maintain their level of aerobic fitness?
  3. If firefighters need to maintain their level of fitness, will they be covered for off-duty exercise? What type of exercises will be covered?
  4. Will firefighters be provided light duty status if they become injured?
  5. Will firefighters be provided a resource to help them succeed if they do not achieve the standard?
  6. What would be the time frame for corrective actions?
  7. What if firefighters achieve the time frame?
  8. Will blood work be required? If so, who pays for it? Will it be done on duty?

Considering all sides of this issue can be challenging, but this is where I began forming my definition of being fit for duty. No matter how you look at these items, they cannot be argued because it is the job, and it is what makes a healthy firefighter.

Following are the six categories specific to needs of the job and a firefighter’s longevity:

  1. Do you exercise? The type of exercise does not matter. Do you do a workout for 20 minutes a day three to four times a week? All exercise programs work, so I do not get into specifics until you actually start making it a priority. Will you be able to meet the agreed on standard?
  2. Do you eat well? Nutrition is similar to exercise; there are only three categories: plant-based, high protein/low carb, and low calorie. Pick any famous diet, and it will fall under one of those categories. It doesn’t matter if you want to eat ice cream at the end of the night (if you are exercising, it’s okay), but do you eat whole grains, vegetables, fruits, and so on? I do not get caught up specific diets, but rather, I look at what you need. If you have high blood sugar, I will educate you on a high protein diet. If you have high cholesterol, I will educate you on a more plant-based diet. If you’re overweight, I will educate you on low calorie diet.
  3. Do you get your blood work annually? At the very least, simple tests such as blood sugar, cholesterol, spirometry, and inflammation should be monitored. It is known that if your numbers are off the chart, you will die; it doesn’t matter if you’re a firefighter or not. If your cholesterol is high, you need to address it. If your blood sugar is high (e.g., type 2 diabetes), there will be a number of health issues. There are a number of studies that show the relationship between high inflammation and chronic disease (cancer, heart disease, stroke, and so on).
  4. Are you mentally sound? Do you suffer from depression, substance abuse, and so on? Mental health issues are very common in the fire service, and if you suffer from this, you will need to address it because it will impact your overall health and wellness. Depression is associated with pre-type 2 diabetes, high levels of inflammation (IL-6), and heart disease. (Note: This specific criterion would probably be the hardest to monitor, but it is just as important as the rest.)
  5. Are you tactically sound? Do you train? How are your firefighting skills? Health and wellness will save your life over a career; training will save your life on the fireground. Just because you’re in shape and can run 1½ miles in eight minutes does not mean you are tactically sound. Fitness compliments the job; it does not replace it. As I tell my recruits, the better in shape you are, the better you can train. Both will save your life.
  6. Do you have physical pain? It’s not a matter of if you get hurt, but rather when you will you get hurt. Firefighting is a physically demanding job, and injuries will occur somewhere during your career no matter what kind of shape you are in. For sure, firefighters will get old, but the job does not change, and that means there is an increased possibility of injury. This is important to understand because it may prevent you from addressing the previous five questions. Throughout my experience, I have helped many of my members rehab their injuries. If a firefighter is suffering from low back pain, he may not be able to perform the annual fitness assessments or, worse, not train properly. On the other end, I have experienced with some of my firefighters the negative side effects of pain management and prescription pills, which has taken a toll on them mentally and physically. So, we must remove the pain (the best we can) so they can function properly and have a safe and healthy life.

Defining “fit for duty” has been discussed over the years, and there have been numerous explanations for it, but in the end, many roadblocks have been created that actually prevent departments from establishing a health and wellness policy to protect their greatest asset—the firefighter. My recommendation would be to start with these six questions, and then develop a policy that will address each area.

My job as a strength and conditioning coach for the Sacramento (CA) Fire Department is simple: I am there to help them. This is how i start with each individual. If you are not addressing one, two, or all six questions, I can start to help you address them…slowly. You could say it is our “health and wellness policy,” yet there is nothing on paper and, everybody buys in.

 

John Hofman, CSCS, MS, is one of leading experts in the field of firefighter health and wellness. As the strength and conditioning coach for the Sacramento (CA) Fire Department (SFD), Hofman oversees the Wellness Centre, coordinates the SFD’s medical and fitness assessments, develops recruit fitness training and preemployment medical and fitness evaluations, and assists the SFD’s 20 certified peer fitness trainers. In addition, Hofman is the co-founder of 911TacticalPerformance.com, a company focusing on injury prevention and performance training specifically for first responders.

To help keep firefighters safe, Hofman authored “Beyond the Turnouts: A Comprehensive Guide to Firefighter Health & Wellness,” where he combined the latest research and his years of experience developing firefighter health and wellness programs within the fire service.

 

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