Matters of the Heart

By Marc D. Greenwood and Roger K. Turner

“Lieutenant Jones, are you in for lunch and dinner?” asked the fire station cook. Pausing for a second, Jones replied, “No, I can’t eat that stuff you guys eat.” Jones recently learned he has high cholesterol and has transformed his eating habits, rejecting gustatory delights like grease pie and artery glue. Grease pie features ground beef, topped by fried potato nuggets, then fried in a skillet. Ba Fon Gu, or artery glue, contains heaps of ground beef laced with enough cheese to spasm the arteries.

Meanwhile, across town, Lieutenant Smith wavered: Would he or wouldn’t he eat in the mess? Smith also has high cholesterol. Smith said, “Yeah, I guess I’ll just have to double my dose of cholesterol-lowering medicine.” Smith decided by his glands, rejecting reason, his health, and longevity.

These vignettes illustrate the cultural, social, and nutritional blockades that impede firefighters seeking to create a heart-healthy lifestyle. Without substantial changes, the 44-percent line-of-duty deaths from heart attacks could escalate.

NO-TOBACCO POLICY PART OF HEALTH PROGRAM

Chief Alvin Payne of Myrtle Beach, South Carolina, had seen enough. Following his installation as chief, he introduced a no-tobacco policy for on-duty firefighters. Payne believed it inconceivable to outfit firefighters in sophisticated breathing apparatus and disregard the devastation caused by using tobacco products. According to the American Cancer Society, smoking causes one in five deaths each year; the Environmental Protective Agency (EPA) ranks secondhand smoke in the same category as asbestos, radon, and benzene (secondhand smoke comes from a smoker’s burning cigarette, and everyone must inhale what is exhaled into the air, nonsmokers included). Smokeless tobacco is no safer than smoking. In fact, smokeless tobacco contains more nicotine than cigarettes and causes several cancers.

How did Payne implement his program? “I introduced a 90-day cessation plan at no cost to the employee, and employees requesting nicotine patches were sent to a physician,” he said. Leadership demands that leaders make courageous decisions to protect firefighters.

Payne’s leadership modeling has revolutionized his department’s health, culture, and philosophy and illuminates the bleary landscape plaguing too many departments. Payne recounted this story: A visiting retiree was disgusted when he heard the firefighters planning a meal of boneless, skinless, grilled chicken breasts; tons of salad; and copious amounts of water. The retiree couldn’t believe it and yearned for the good old days.

Successful leaders create a winning environment. Payne didn’t just rant about his firefighters’ dietary habits; he enlisted a nutritionist to come to the fire stations and help firefighters prepare healthful and wholesome meals. “You don’t put diesel in a truck that runs on unleaded, do you?” asked Payne. “Likewise, you should be careful about what you eat,” he said.

“Three individual firefighters have lost at least 100 pounds, and several others have lost between 30 and 40 pounds,” said Payne. Leading by example, Payne has lost 20 pounds by exercising and modifying his eating habits.

AVOID SEDENTARY LIFESTYLE

“In America, even the Grim Reaper is flabby,” said Frank W. Booth, Ph.D., a biomedical and physiology professor at the University of Missouri-Columbia. Because firefighting consists of lulls, punctuated by frenetic activity at working fires, mega-meals, and downtime, it seduces firefighters to embrace a sedentary lifestyle.

Booth said, “Sixty percent of Americans are sedentary by my definition, compared to 25 percent by the Surgeon General.” He classified sedentary in this way: “It should be based upon the occurrence of disease or the frequency of disease at a certain activity level.” How much should firefighters exercise? Booth said, “Several research studies have established 30 minutes of activity a day as the breakpoint for health.” The body requires this much activity to avoid coronary artery disease, diabetes type II, stroke, obesity, ischemia, hypertension, and osteoarthritis.

Earlier in the article, we stated skilled leaders created an environment conducive to success. Booth agreed: “Willpower is important, but it’s an environmental thing.” Related to the fire service, this means providing firefighters with equipment, facilities, time, and opportunity to exercise. These items aren’t optional or luxuries. They’re imperatives.

Firefighters working on EMS units respond to patients ravaged by diabetes. These patients are afflicted with blindness, have poor circulation, and suffer amputation of their limbs. Astonishingly, a gain of just 11 to 18 pounds doubles the risk of developing type II diabetes—an illness that has increased by nearly 50 percent in only the past decade. (U.S. News & World Report- 8-9-02, “A Fat Nation” by Amanda Spake)

One other ominous note: More than 80 percent of people with diabetes are overweight or obese. (Overweight and Obesity Fact Sheet: Health Consequences)

The first observable defect in type II diabetes often occurs in inactive skeleton muscle. Booth explained this phenomenon in simple language: “Within days of becoming inactive, the muscle becomes resistant to insulin.” Insulin is a hormone that causes blood sugar to go into the muscle. Booth continued, “Physical inactivity bolts the door and doesn’t allow insulin to unbolt the door and allow blood sugar to get in—an early sign of what could develop in years or decades into type II diabetes.”

TAKE OWNERSHIP OF HEALTH AND FITNESS

Firefighters must take ownership of their health and fitness, pursuing it with the fervor and aggression they display when making the stairs at a working fire or seeking to extricate an injured child from a crushed vehicle. Chief officers’ obligation to protect firefighters means more than providing gleaming apparatus. They must provide facilities, equipment, and opportunity for firefighters to maintain health and fitness.

Dr. Julie Kerr, an attending physician of the Sports Health and Rehab Center in Akron, Ohio, works with nurse practitioner Cindy Bennett to provide health risk appraisals. They elicit information detailing a client’s lifestyle and family history by interviewing and having clients complete a questionnaire. Health appraisals can uncover undetected medical conditions in the early stages where they can be treated with a high probability of success. Thus it’s imperative that firefighters seek annual health appraisals.

When asked whether more injuries occur in the athletic or industrial population she works with, Kerr answered, “There is not a significant difference in the number of injuries.” She said conditioned athletes and well-trained work crews both sustain injuries. Further-more, she observed, “The focus has been on treatment, and the emphasis is just beginning to shift to injury prevention. It has been a very slow change but a welcome one.”

The downtime from injuries varies between athletes and workers. Many athletes burn to return to the playing field as soon as possible; younger athletes recover more quickly. An injured worker’s financial concerns may influence the return to work.

Juliet Draper, 2003 national Combat Challenge winner, says her military training sharpened her work ethic and her discipline. She has a Web site (firejock.com) and has inspired others to compete in the Combat Challenge.

Draper said to find activities you like: “Some people like to play ball; others like to golf. I like to work out and lift. This is how I’m able to maintain my level of fitness. None of the equipment used in firefighting is light, so I lift to prepare for the heavy equipment I use every day.”

Draper fractured her leg sliding down a pole. “I understand why the National Fire Protection Association doesn’t recommend installing poles in stations any more,” she said. But she gleaned valuable lessons post-injury. She was forced to concentrate on increasing her upper body strength and exercising patience. Her patience blossomed as she let the injury heal. She recognized that no amount of working out could make the bone heal faster. Upper body strength resulted in large part because she could only work her upper body and by using crutches. Now her physique is symmetrical because she was able to focus on one thing instead of doing too many things at one time.

“Once you lose your health, you basically will pay any amount of money to attempt to get your health back, ” she said. She wants firefighters to enjoy life after retirement. She explained, “Fitness is a mysterious area to many people who are not into competitive athletics but want to maintain a degree of fitness.” She said, “A lot of people are interested but do not know where to get information.” Her Web site has received hits from people as far away as New Zealand seeking nutrition and exercise tips.

“As far as nutrition goes, try to eat from all of the major food groups and drink plenty of water, ” Draper explained. “The water keeps the system flushed and can prevent problems with dehydration while working out and fighting fires.” She also stresses eating green leafy salads with meals: “The food you eat is the fuel for the human engine. It is always better to put premium fuel into the machine whether the machine is a Cadillac or a Yugo.”

Eating a healthful diet can vastly improve performance in the field and on the fireground. Draper noticed this the most when she switched from body building to fitness training. A body builder looks very fit but can have low endurance. Her fitness training increased her endurance dramatically.

Her Web site contains an intense 21-day workout routine. “The average person will see far greater gains than someone who already has increased the base level of fitness. However, you should follow a regimen to increase your level of fitness or to maintain your current level if you are near your peak fitness. The 21-day workout is an efficient way to manage your time and not overtrain, which may cause an injury instead of prevent one. Some people can get overly zealous in their training and do too much too fast,” she said.

Draper wants to see everyone increase their ability to perform. “We can decrease the number of heart attacks and improve the quality of life for many members of the firefighting community,” she said. The best way to increase longevity is to maintain a consistent exercise program.

MARC D. GREENWOOD is a lieutenant/paramedic in the Akron (OH) Fire Department.

ROGER K. TURNER is a firefighter in the Akron (OH) Fire Department.

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