REALITY CHECK
By Scott Cook

In January, Hood County, Texas, narrowly avoided our first line of duty death (LODD). Operating at the scene of a structure fire, a firefighter complained of some chest pain. When he was evaluated, he was found to be having a heart attack. Rushed to the hospital—and defibrillated out of v-fib twice during his course of treatment in the cath lab—he is alive today to tell his tale.

According to the USFA’s 2009 Annual Report – Overview of Findings, “heart attacks were the most frequent cause of death with 39 firefighter deaths.” That’s 39 out of the 90 firefighter LODDs in 2009—more than 43%.

If that surprises you, you haven’t been paying attention.

And yet, even though heart attacks kill more firefighters annually than any other single cause, a majority of fire departments do not require any type of physical or medical fitness evaluation prior to joining the department. Some volunteer services do require a physical.

In Texas, if your department participates in the firefighter’s pension administered by the state, you’re supposed to have a pre-assignment physical—which often amounts to nothing more than your doctor noting on a piece of paper that you are fit enough to volunteer.

Career departments generally comply with NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments and do their physicals as required. But I know of some that don’t.

Industrial departments or fire brigades may or may not require a rigorous physical.

None of us is immune to the risk of heart attack. And to be totally honest, I could have stood to lose 5, 10, 50 or 60 lbs when I was in the department. The same holds true today. So I know how difficult it can be to stay fit, and I know that physicals can be intimidating.

The responsibility here is two-fold.
1. As an individual, you are responsible for ensuring you are in the best shape possible to perform your assigned duties. You have a responsibility to yourself, your family and your community to get in shape. Believing it’s OK to die on the job from a preventable medical condition because your family will be taken care of is unacceptable.

2. Departments: It’s time to stop putting the lives of your personnel at risk from preventable health problems. Picture a firefighter dying in their bunk following a run. Now consider the impact that fatality would have if it occurred on the fireground when your crew is depending on each and every crewmember to perform their assigned task. Where is operational safety now? Is the rest of the crew in jeopardy because there’s no water being applied? What if the member is at the wheel of the apparatus? Four of 2009’s fatal heart attacks occurred at the wheel of a vehicle responding to or returning from a call.

I know for a fact that a physical, even one as relatively thorough as a 1582 physical, won’t catch everything. My buddy Keith had one, passed with flying colors, and had a massive heart attack two weeks later. It was almost the big one. (He’s fortunate we can still kid him about being defibrillated without sedation.)

I also know several people who are alive today because the physical revealed a medical issue. As a result, they had the opportunity to make the necessary adjustments in their lives to manage their conditions.

If you’re the chief reading this, I think we agree that it is your job to do everything reasonably possible to ensure the safety of your firefighters. Physical health is included in that. You know if you’ve got crewmembers that are ready to drop on the scene. Your budgeting should include physicals for your firefighters. It may be a big expense, and you may have to cut back in some other area to make it work, but I promise you’d rather pay for the physical than the funeral.

Career departments should also require fitness training as a part of their daily routine. Not all of you do.

Volunteer departments should strongly encourage the same, and make a treadmill, bike and/or weightlifting equipment available.

As for me, I get a 1582 physical with the stress test every year, whether I want it or not, and the doc says the same thing: “You’re in pretty good shape…for a fat guy…” He then goes on to tell me a bunch of doctor’s lingo that loosely translates into, “You’re an idiot for not being in better shape.”

And I know he’s right. And I’m working on it for real this time. Honest.

Scott Cook is the former chief of the Granbury (Texas) Volunteer Fire Department and a fire service instructor. He’s also a member of FireRescue’s editorial board.

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