The Heart of a Firefighter

“We must begin to think about safety differently.  We must embrace Health as well as Safety: To be safe, you must be healthy,” Feature Speaker Denise Smith, director of the Skidmore College First Responder Health and Safety Laboratory, stressed in her address at Thursday’s General Session. She asked the audience “to think more deeply about what constitutes health and what constitutes safety and the relative effort devoted to each.” 

Smith, who has been working since 1991 with the Illinois Fire Service Institute to more completely understand the effect of personal protective equipment (PPE) on firefighter heat stress, explained, what she labeled “startling,” the results of what she considered “a pretty straightforward research study”: “When firefighters walked on a treadmill for 15 minutes in fully encapsulating PPE, they had maximal heart rates (HRs). This was surprising because they were walking only 2.2 miles per hour. When they were wearing their station uniforms, their HR increased only to 120 beats per minute–a ‘low workload.’” These results, she said, “verified that fully encapsulated gear indeed increases thermal strain and indicated that firefighters need to be more attentive to heat stress than in the past.”

This project, Smith explained, led to many questions–but most especially why cardiac events are the leading cause of line-of-duty deaths (LODDs)? “The science was absolutely compelling,” Smith reported: “no other occupational group experiences such severe cardiovascular strain. “We have documented that essentially every system of the body is disrupted by firefighting,” Smith noted. In addition, she said, “We have shown that even in young, healthy participants, firefighting leads to maximal heart rates, decreases in blood volume and stroke volume, increased arterial stiffness, and increased blood clotting potential. We have also provided models that describe how cardiovascular disease risk factors and individual behaviors increase the risk of sudden cardiac events.”  

Smith listed (and applauded) numerous major safety initiatives that have led to a reduction in LODDs, including the use of incident command and safety officers; the 360°-size up; the two-in/two-out rule; radio communications; improvements in PPE and advances in breathing apparatus; the widespread use of thermal imaging cameras; safer apparatus; SOPs on emergency operations, vehicle operations, Maydays, and so on; the seat belt pledge; rescue ropes; the adoption of 1403; and support for minimum staffing. 

However, she told the audience, “these safety measures cannot protect YOU from the greatest risk you face–heart attacks or other cardiac issues.” She then posed this question: “In light of fatality statistics AND research data documenting the cardiovascular strain of firefighters, are we properly balancing our efforts at health and safety to combat cardiovascular deaths and injuries as well as the other risks firefighters face?” 

Smith reported that several important health initiatives are underway, very good resources are available for departments, and many fire departments have taken a leadership role in ensuring the health of their members. “But, she quickly interjected, “there are still too many cases in which we must overcome hurdles, meet challenges, and save lives.” 

She invited audience members who advocate for safety also to become a champion for health because “to safely perform firefighting activity, YOU must be healthy enough and fit enough.” She urged them to consider health challenges in the same way they consider safety risks when approaching the fire scene: “Do a 360° size-up and become aware of the threats to your health, including cardiovascular disease and cancer. “That means,” she elaborated, “getting an NPFA 1582-compliant medical evaluation by a physician who understands the physical strains of firefighting and getting screened for cardiovascular disease and cancer using the best available guidelines and technology.” It also means following through on the doctor’s recommendations. She told of a firefighter who had died from a cardiovascular event. The doctor had advised this firefighter, based on the results of his recent medical evaluation, to seek medical attention to address elevated potential risk factors for heart disease. Since he was cleared to work, he interpreted the advice as optional and did not follow up or discuss the test findings with his wife. At his funeral, his wife asked Smith, ‘How could this have happened? He just had a physical exam?’  

RELATED: National Study Seeks to Improve Firefighter SafetyIFSI Study Underway on Firefighter HealthResearch report details relationship between heat stress, firefighter fatalities | Skidmore College Professor’s Study “Firefighting and the Heart”, Appears in Scientific Journal Circulation

Smith related that getting to know firefighter hearts “figuratively as well as literally” and recognizing what firefighters give to the job has led her to be more passionate in her pursuit of science to support the fire service. “I now find the firefighters (as people) more compelling than the science, and I’m focused not just on describing physiological responses, but also on finding meaningful ways to mitigate the physiological dangers that firefighters face,” she explained. 

Smith noted the progress the fire service has made in elevating the status of Health as an immediate concern:  disseminating the research results in scientific and medical journals, fire service reports, magazines, National Fire Protection Association committees, and through educational programs sponsored by fire service organizations. The efforts will continue, she said, as she recruited the audience members: “Ultimately, our goal is to make sure that science informs departmental policies and procedures to improve the health and safety of firefighters. And that will require your involvement and leadership.”

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