How to Improve the Health of ­Volunteer Firefighters

One of the many challenges volunteer fire departments face is the health and fitness levels of their members. Although this is a pressing issue, the vast majority of volunteer fire departments are doing little to address it, and the logistical and regulatory burdens surrounding this task further hinder the development of these programs.

Background

Volunteer fire departments make up the majority of the fire service. According to the National Volunteer Fire Council (NVFC), of the 1,140,750 firefighters nationwide, 69 percent are volunteers. Additionally, of the 30,052 fire departments in the United States, 85 percent are staffed mostly or entirely by volunteers.1 Volunteer fire departments are also important to their communities. Most departments provide high-quality medical care in addition to performing their normal duties of fire suppression and responding to vehicle accidents.2 Furthermore, volunteer departments provide significant cost savings to local governments and taxpayers.3

However, despite the dependency on volunteer fire departments, their members are suffering from serious health problems. For example, 70 percent of American firefighters are overweight or obese.4 This weight problem is associated with an increased risk of job-related disabilities and accidents, high blood pressure, and cardiovascular disease. (4) Moreover, because firefighting is a physically demanding vocation, obesity makes it more difficult to perform this duty effectively. (4) Finally, obesity and a sedentary lifestyle are common causes of heart attacks.5

To that point, the leading cause of on-duty deaths for volunteer firefighters is cardiac complications. In 2015, for example, 51 percent of on-duty deaths were the result of cardiac complications; only three percent of deaths were from burns, 13 percent from asphyxiation, and 24 percent from trauma. Moreover, with few exceptions, cardiac complications have been the leading cause of on-duty firefighter deaths since 1983.6 Thus, it is apparent that the poor health of volunteer firefighters is often more dangerous than the physical dangers they face on the job.

Table 1. Percentage of Fire Departments with Health and Fitness Programs as of 20167

Lack of Health and Fitness Programs for Volunteer Departments

Notwithstanding the risks associated with obesity, a sedentary lifestyle, and cardiac arrest, volunteer fire departments are not providing adequate means for volunteer firefighters to remain healthy. Nationwide, only 27 percent of fire departments provide a program to maintain basic fitness. Further, 62 percent of all firefighters belong to departments that do not have health and fitness programs.7 However, as Table 1 illustrates, these numbers include departments from major metropolitan areas that usually have fitness programs. Thus, the situation is much worse for smaller volunteer fire departments than is depicted in the overall statistics.

From the table, we see the following: Fire departments that protect large populations usually have health and fitness programs; fire departments protecting 500,000 people or more (almost exclusively staffed by career firefighters) have a health and wellness program 89 percent of the time; departments that protect medium-sized populations usually have health and wellness programs but not as frequently as in larger departments (for instance, departments that protect 25,000 to 49,000 people have a health and fitness program 66 percent of the time). Moreover, although these medium-sized departments are usually staffed by career firefighters, they often rely on volunteer firefighters as well.8

At the other end of the spectrum, fire departments that protect smaller populations almost never have health and fitness programs. Further, these departments are staffed almost exclusively by volunteer firefighters. For example, only 22 percent of fire departments with a local population of 2,500 to 4,999 residents have a health and fitness program.. For departments of this size, they are staffed mostly or entirely by volunteers 96.6 percent of the time. Additionally, in departments with a local population of fewer than 2,500 residents, only 15 percent offer a health and fitness program. Such departments are staffed mostly or entirely by volunteers 98.6 percent of the time. Therefore, smaller volunteer fire departments are the least likely to offer health and fitness programs. (8)

Benefits of a Health and Wellness Program

Health and wellness programs have many benefits.9 They provide a cost-effective way to reduce heart attacks and other health issues and can prevent strains, back problems, and other work-related injuries. Remaining in good physical shape enhances a firefighter’s ability to fight fires, which is of utmost importance,10-11 and group exercise can foster a sense of camaraderie. However, notwithstanding the benefits of these programs, serious logistical and regulatory burdens hinder the creation of health and wellness programs, especially among smaller, volunteer departments.

Barriers to Establishing a Health and Wellness Program

Logistical burdens. There are many potential reasons volunteer fire departments do not offer health and wellness programs. Volunteer firefighters are already busy with their full-time job, family commitments, and current responsibilities at their volunteer fire department.12 Volunteers may not have extra time for these health and fitness programs; conversely, career firefighters may have more time to devote to fitness programs while they are on duty and not running calls. Also, volunteer fire departments often have fewer resources than medium and large fire departments.13 Thus, even if such departments wanted to start a health and wellness program, they may not have the funds to do so. In addition, some volunteer departments may not know how to start a health and fitness program or may not be aware that such programs exist.

Regulatory burden: National Fire Protection Association (NFPA) 1583, Standard on Health-Related Fitness Programs for Fire Department Members. Despite the logistical burdens of establishing a health and wellness program, the principal burden in establishing such a program is complying with the suggested regulatory requirements.14 The NFPA develops and publishes more than 300 model codes and standards to minimize risks associated with firefighting and fires.15 Normally, such standards are voluntary unless a government agency adopts or incorporates such standards into law. However, courts will often look to NFPA standards during civil lawsuits to determine if a fire department acted reasonably under the circumstances.

NFPA 1583 Stipulations16

NFPA 1583 is the model code for developing a health and wellness program. This standard has not been made mandatory by a civilian federal agency or a state government yet, but investigators for the National Institute for Occupational Safety and Health have recommended that it be adopted.17 Further, because courts often look to NFPA guidelines to establish whether a fire department acted in a reasonable manner, failing to comply with NFPA 1583 could be a factor resulting in civil liability.

NFPA 1583 requires the following: appointment of a qualified health and fitness coordinator, periodic fitness assessment for all members, exercise training programs available for all members, health education and counseling for all members, and a system for collecting and maintaining health-related data.

  • Appointment of a qualified health and fitness coordinator (HFC). The HFC, although ultimately appointed by and responsible to the fire chief, oversees the daily operation of the health and wellness program. The HFC can be a member of the fire department or a qualified professional from outside the department. The HFC must have and maintain formal certification from a professional organization, relevant educational experience, and appropriate academic degrees and must have completed course work relevant to the program or attended workshops related to health and fitness. The HFC can also appoint other qualified fitness trainers to assist in the program. Generally, this requirement could be met by having a firefighter become a certified personal trainer.
  • Periodic fitness assessment for all members. The periodic fitness assessment would prove to be a burden for volunteer fire departments seeking to comply with NFPA 1583. First, all members must be medically cleared to participate by a fire department physician. Since a volunteer fire department will not have a fire department physician, an alternative may be for the HFC to require that all firefighters be medically cleared from their doctors before participating in the program or have them sign a medical waiver acknowledging the risks associated with exercise. Following this, the HFC must send out a medical questionnaire to the firefighters seeking to identify issues that would make participation in the program dangerous. If the program is adopted, all members cleared to participate must undergo a fitness assessment at least once a year. The fitness assessment must test for aerobic capacity, body composition, muscular strength, muscular endurance, and flexibility. To accurately test aerobic capacity requires specialized training and equipment.18 However, aerobic capacity can be roughly estimated by the YMCA 3 Minute Step Test.19 This is not the ideal way to measure aerobic capacity, but this test can be administered without specialized equipment or training. It represents a pragmatic way for volunteer fire departments to obtain a baseline level of aerobic capacity inexpensively and efficiently. As a simpler method, fire departments could use a timed mile run to establish a rough estimate of aerobic capacity. Body composition can be roughly estimated by using a BMI calculator. Although this calculator is not ideal for athletes or those with a muscular frame, it will still provide an estimate of a firefighter’s body composition. Muscle strength can be measured in a variety of ways. Perhaps the easiest way would be to have a firefighter perform a one rep max on a bench press. Alternatively, a department could purchase an inexpensive handgrip dynamometer to determine general grip strength. Muscle endurance can be measured by examining how many sit-ups a firefighter can do in one minute and how many pushups a firefighter can do in one minute. Flexibility can be quickly tested by determining if an individual can touch his toes.20 Once again, these are not clinical ways to determine physical fitness, but they will establish baseline results cheaply and efficiently.
  • Exercise training programs available for all members. The exercise training program, administered by the HFC, must have educational programs about the benefits of exercise, exercise regimes for individual firefighters based on the results of their fitness assessment, warm-up and cool-down exercise guidelines, aerobic exercise programs, muscle resistance programs, flexibility exercise programs, and a safety and injury prevention program. (16) There is no per se requirement on how many exercise trainings need to be offered. Firefighters must be medically cleared to participate and can be excused for injury or health issues. Generally, the best way to satisfy this requirement would be to have monthly exercise training. Instructors should require stretching before starting exercising and should speak to the firefighters about exercise safety. This training could alternate among running, weightlifting, cardio exercises, and other workout regimes.
  • Promoting health education and counseling for all members. In a nutshell, firefighters should have ongoing access to information on how to become healthier and remain healthy, how to exercise properly, and how to reduce workplace accidents. This can be done by monthly updates to a bulletin board devoted to health education. The HFC should also send out periodic e-mails with health and wellness tips and should incorporate such education into normal fitness trainings.
  • Collecting and maintaining health-related data. The NFPA requires the collection of demographic information, the preassessment questionnaire, the fitness assessment, and program participation data for each firefighter. These data must be kept confidentially. The data can confidentially be used for statistical or administrative purposes. The HFC should keep a confidential file on all firefighters, preferably under lock and key or under a password-protected computer file. The file should include each year’s initial fitness assessment, medical clearance paperwork or waivers, the individual’s participation rate in the fitness program, and relevant health information. The HFC should aggregate the health and wellness numbers into a single document so that the general health of the entire fire department can be estimated and tracked over time. (16)

Recommendations

The NFPA should adopt new standards for health and wellness programs as they pertain to volunteer fire departments. The requirements for physician approval, initial screening of all firefighters, and data collection are far too burdensome for a small volunteer fire department. Adopting more realistic standards could result in more volunteer departments starting health and wellness programs while still following NFPA protocol for safety matters. The standard should allow for a voluntary, nonpunitive health and wellness program that is simple enough to be administered without outside experts. Volunteer departments able to do so should set up health and wellness programs in accordance with NFPA 1583. Although it would be burdensome for a volunteer department, it is theoretically possible. (14)

Creating a voluntary program according to NFPA 1583 would also provide maximum legal protection if there is a lawsuit and would also provide useful data for tracking the health of the department over time. At the very minimum, volunteer departments that establish health and wellness programs should follow NFPA safety regulations, ensure that all firefighters are medically cleared to participate, and obtain waivers from all participants acknowledging the inherent risks of exercise.

Departments should also consider incorporating more physical activity into their regular fire training.21 Doing this can be as simple as dedicating more fire training sessions to search and rescue operations, breaching, vehicle extrication, and other training that necessitates high levels of energy. Departments could also purchase fitness equipment so members can exercise at the fire station.22 Departments with discretionary resources could offer a free or a discounted membership at a local gym.

Firefighting is a physically demanding activity, and heart attacks represent a pressing danger to volunteer firefighters. Therefore, volunteer departments should take steps to improve the health and fitness levels of their members, and the NFPA should adopt more realistic standards for health and wellness programs for volunteer fire departments.

Endnotes

1. Volunteer Fire Service Fact Sheet, National Volunteer Fire Council, 2013; http://www.masc.sc/SiteCollectionDocuments/Risk%20Management/Fire_Service_Fact_Sheet_2015.pdf/.

2. “Declining Membership and an Increase in Medical Emergencies: The Challenges Facing the Modern Volunteer Fire Department,” Ryan Harding, FIRERESCUE, Nov. 15, 2016; http://www.firerescuemagazine.com/articles/print/volume-11/issue-11/management-and-leadership/declining-membership-and-increasing-medical-emergencies.html.3. Tax Savings and Economic Value of Volunteer Firefighters in New York, Fireman’s Association of the State of New York, Dec 2015; https://statter2017.wpengine.com/wp-content/uploads/2016/02/VFEconomicImpactStudy.pdf.

4. Wilkinson, Michelle Lynn, et al. “Physician Weight Recommendations for Overweight and Obese Firefighters, United States, 2011-2012,” Center for Disease Control and Prevention, July 10, 2014; https://www.cdc.gov/pcd/issues/2014/14_0091.htm/. “The Firefighter Workout,” Anahd O’Connor, NEW YORK TIMES, Mar. 5, 2015; http://well.blogs.nytimes.com/2015/03/05/the-firefighter-workout/?smid=nytcore-iphone-share&smprod=nytcore-iphone&_r=1. “Addressing the Epidemic of Obesity in the United States Fire Service (2011),” National Volunteer Fire Council; http://www.healthy-firefighter.org/files/documents/Obesity_Study.pdf/.

5. Obesity Information, American Heart Association, Oct. 18, 2016; http://www.heart.org/HEARTORG/HealthyLiving/WeightManagement/Obesity/Obesity-Information_UCM_307908_Article.jsp#.WG9WsoWcGM8/.

6. Fahy, Rita F, et al. “Firefighter Fatalities in the United States – 2015,” National Fire Protection Association (NFPA), June 2016; http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/the-fire-service/fatalities-and-injuries/firefighter-fatalities-in-the-united-states.

7. “Fourth Needs Assessment of the U.S. Fire Service,” NFPA, Nov. 2016; http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/the-fire-service/administration/needs-assessment/.

8. NFPA Fourth Needs Assessment. Hylton, JG Haynes and Gary P. Stein, “U.S. Fire Department Profile-2014,” NFPA, Jan. 2016; http://www.nfpa.org/news-and-reearch/fire-statistics-and-reports/fire-sttistics/the-fire-service/administration/us-fire-department-profile.

9. “The Importance of Physical Fitness Standards in the Fire Service,” FIRERESCUE, Mar. 31, 2014; http://www.firerescuemagazine.com/articles/print/volume-9/issue-4/firefighter-fitness-and-health/the-importance-of-physical-fitness-standards-in-the-fire-service.html. “Physical Fitness in the Fire Service, Guido Calcagno, Fire Engineering, Dec 1, 2012; http://www.firengineering.com/articles/print/volume-165/issue-12/features/physica-l-fitness-fire-service.html/.

10. “Cost-effectiveness of workplace wellness to prevent cardiovascular events among U.S. Firefighters,” P. Daniel Patterson, et al, BMC Cardiovascular Disorders, 2016; 16:229.

11. “Health and Wellness Guide for the Volunteer Fire and Emergency Services,” U.S. Fire Administration (USFA), 2009; http://www.usfa.fema.gov/downloads/pdf/publications/f_321.pdf/.

12. “Retention and Recruitment for the Volunteer Emergency Services,” USFA, 2007; https://www.usfa.fema.gov/downloads/pdf/publications/fa-310.pdf/.

13. “Lack of money shuts down volunteer fire department,” Melissa Klaric, FIRERESCUE, April 10, 2015; https://www.firerescue1.com/fire-chief/articles/2152610-Lack-of-money-shuts-down-volunteer-fire-department/.

14. “Implementing NFPA 1583: Standard on Health-Related Fitness Programs for Fire Department Members,” Gregg Squeglia, Fire Engineering, Nov 12, 2012; http://www.fireengineering.com/articles/2012/11/implementing-nfpa-1583-standard-for-health-related-fitness-programs-for-fire-department-members.html/.

15. “Understanding and Implementing Standards NFPA 1500, 1720, and 1851,” NVFC, 2007; http://www.nvfc.org/wp-content/uploads/2015/09/Standards_Guide_1500_1720_1851.pdf/.

16. NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members, 2014.

17. A summary of a National Institute for Occupational Safety and Health firefighter fatality investigation, Feb 2014; https://www.cdc.gov/niosh/fire/reports/face201323.html/.

18. “Aerobic Endurance Fitness Tests,” Amy Dixon, Live Strong, Dec 13, 2015; http://www.livestrong.com/article/356776-acrobic-endurance-fitness-tests/.

19. “3 Minute Step Test”, Pete Mazzeo, Today Fitness, 2006; http://www.todayfitness.net/onlinetrainer/TFOT-steptest.htm/., Dec. 13, 2015.

20. “Can’t Touch Your Toes? Find and Fix the Root of the Problem,” Perry Nickelston, Breaking Muscle, 2016; https://breakingmuscle.com/learn/cant/touch/your/toes/find/and/fix/the-root-of-the-problem/

21. “Building a Functional Fitness Program: Firefighter Fitness and Health,” Monte Egherman, FIRE RESCUE, Feb 15, 2013; http://www.firerescuemagazine.com/articles/print/volume-8/issue-4/firefighter-fitness-and-health-building-a-functional-fitness-program.html/.

22. “How to outfit your fire station with fitness equipment,” Robert Avsec, Fire Chief, Feb 14, 2014; http://www.firechief.com/2014/02/14/outfit-fire-station-fitness-equipment/.

Ryan T. Harding is a volunteer firefighter on the Carroll Fire Department in Urbana, Illinois.

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