Brothers and sisters, 2010 is not off to a good start for the fire service. Yesterday I read about our sixth LODD that occurred in Arkansas, and which happened to be cardiac related. Did you know this was the fifth LODD this year that was cardiac related? That's 5 out of 6 people!

 

Looking back at 2009, we had 93 LODD notifications from the U.S. Fire Administration. Out of those 93 deaths, 45 were cardiac related. I know it's early, but if our trend for 2010 continues, we may pass last year's number.

 

I ask these questions to the Chiefs on here. What are you doing to prevent cardiac related deaths in your department?

·        Do you require NFPA 1582 physicals for new employees and/or volunteers? If so, do you also require annual NFPA 1582 physicals? If not, you better review OSHA 1910.156(b)(2).

·        Do you require firefighters to maintain the same physical entrance standards for the duration of employment/membership?

·        Do you have a Physical Fitness SOP/SOG requirement for on duty personnel?

For the line officers and supervisors, paid and volunteer. Do you,

·        promote physical fitness to your firefighters?

·        lead by example and join in during PT?

·        promote healthy eating while on shift?

·        speak with crews about the risks of obesity, heart disease, and smoking, and unhealthy eating?

·        have a reading of the latest LODD notifications during shift briefing, or post them in the station for all to see highlighting the cause of death?

For the firefighters. Do you, or have you

·        made yourself aware that heart disease is a leading killer of firefighters, both paid and volunteer. Even more so than tanker and POV collisions?

·        made an effort to make and keep yourself physically fit for duty by eating healthy meals and working out both on and off duty?

·        talked with fellow firefighters, and supervisors on the importance of living a healthy lifestyle, and been leading by example?

I don't expect everyone to be a marathon runner, UFC fighter, or Olympic Weightlifter. There are no excuses though for not losing weight, eating right, and working out!

 

What I'm about to say is harsh, but the truth. If you are a firefighter, or emergency service worker with cardiac problems, obese, and/or not able to physically perform duties, then you are a ticking time bomb, and liability.

 

I don't care if you give the excuse of, "well I'm a driver only, or fire police, EMS only or just don't go inside". You are dead wrong, and still a liability. There have been plenty of drivers, fire police, etc who have collapsed on scene and became a cardiac related LODD. Just go back and look at LODD listings for previous years.

 

Let's all do something to prevent this stuff from happening again.

 

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I have to respectfully disagree. Many cardiac events in the fire service are very preventable. There is no comparison. Using US stats, 50% of firefighter deaths each year are heart attacks. 50% of all deaths in the US are not from heart attacks. The percentage of cardiac deaths in the FS are staggering. Weight, food and alcohol intake, exercise are huge ways to prevent it.

There was a study done a while ago that showed a firefighter operates above his threshold heart rate for the majority of a call, from the time the tones go (where he usually goes to max) until they are on their way back from the call. The heart rate climbs if the call is upgraded or confirmed on route to be a confirmed fire or occupants trapped, etc. It stays there until the event is over for many (monitored by heart rate monitors). This coupled with poor nutrition and exercise habits is a recipe for disaster.

I have known athletes to pass as well. One was caused by the enhancement drugs he was taking, the other was because his heart had not grown to accomodate his body and could not handle being pushed the way it was. It almost always has something to do with the limits being put on the heart, marathon runners included.

What we can do is take care of ourselves, be cognizant of the amount of smoke/CO we are taking in (shouldn't be any), be cognizant of offgassing and keep cholesterol and blood pressure low.

Stay safe out there.
I believe that the LODD count is up to 10; 9 in 2010 and 1 from 2009 being added to the 2010 total thus far.
Jeff, you're applying your personal about a single variable to a multi-variable problem with many contributing factors.

You might want to do more research on the actual relative physical conditioning of a lot of those LODD heart attacks. Many are younger than 40, in good physical condition.

There is a lot of evidence that two factors cause a high percentage of firefighter heart attacks - factors that have nothing-nada-zip-zero-zilch-bupkis to do with physical conditioning.

Those two factors are dehydration and cyanide. Dehydration thickens the blood, makes it more prone to clotting, and causes heart attacks and strokes that have nothing to do with weight, atherosclerosis, or other "normal" cardiac risk factors. Heat stress causes that dehydration, and heat stress affects all firefighters, not just the overweight ones.

Cyanide causes two problems - reduced oxygen-carrying capacity by the red blood cells and coronary vasospasms that cause non S-T elevation heart attacks. Cyanide poisoning is worse when it is inhaled - for example, during unmasked overhaul - but it can also absorb through the skin, even when wearing turnout gear.

One potential reason that the heart attack LODD stats have remained fairly constant for 30 years - fitness has improved, health management has improved...but fires are still hot and produce toxins like CN, we still get dehydrated, and we are still exposed to those toxiins.

Your soapbox speech is well-intentioned, and being in good shape is something we should all try to do. It won't prevent heart attack LODDs, though.

Fitness also won't prevent cardiac arrythmia heart attacks that result from genetics or idiopathic cardiac electrical disturbances...classed as "heart attacks" by the USFA, but actually cardiac arrests.

So...your soapbox speech is well-intentioned, and those who listen to you might be in overall better shape, but even if everyone follows your advice, the heart attack LODD rate isn't likely to change much.
Ben
If you really read my posts, you would undertand that it is not so much of an attempt to blame cardiac illness and sudden cardiac events on the lack of phyiscal fitness as it is an attempt to reinfoce the NEED for better levels of fitness in our occupation.

If we found no link what-so-ever between cardiac-related LODD's and physical fitness, would that justify the total disregard for firefighter fitness and conditioning? Falling off the turnip truck some years ago, I found that the actual physical work involved in fire suppression actually did require some degree of strength and endurance. And although I had always been personally motivated to maintain a reasonable degree of fitness and conditioning, I have found that those who do not are far more likely to be incapacitated much earlier during aggressive firefighting activity.

And there are most certainly a good amount of those who are in denial of this, which almost always seem to be those who we find taking the "blow" on the backstep while the others are still working, and having to pick up the extra slack. For those who are in even deeper denial, well those are the one's who are have scoped out and established their hide-outs earlier in the job, or even during the pre-plan.

They'll almost always talk a good game though. And be the first ones to proclaim they don't need any sissy exercise program. Following that will almost always be a reference of some gym rat or marathon runner who collpased at an early age to cardiac disease. "See....what's the point?"

OK MAYBE there may not even be any relation at all to Cardiac LODD's and out of shape, overweight, sedentary, couch dwelling firefighters who never even laid eyes on a a gym sign.

But hose aint that much lighter, water still weighs the same, ladders still require strength and technique to raise, our PPE is still a bitch on those August days, and we have to breath through some restrictive mask and wear all that crap and haul all that equipment to get to where we need to go to begin to do our job.

If THAT aint a good enough reason and incentive to take action and make the effort to get into the best possible condition, well then I would say it is, or the individual is, a lost cause.

Denial.

Now, NOW I will step off my soapbox.
We cannot fall into the trap of a single focus on the issue of heart related LODDs. Everything has to be on the table. Nothing should be discounted until valid, verifiable scientific data is released.
With the relationship between physical and mental stress and its effects on our health becoming more clear, then we should certainly stop dancing around it and fix it.
However; when we are continually bombarded with pictures of morbidly obese people in firefighter T-shirts, what do you suppose the public is going to conclude? We know better, but again; a picture is worth a thousand words and you don't see many pictures of a perfectly chiseled physical speciman lying on the ground from feeling the effects of hydrogen cyanide or CO or heat stress.
No; when we want to talk about heart attacks in the fire service, we have to see the pictures of the 50 inch waists.
Sad but true.
Jeff, you're throwing around a lot of generalizations and personal bias - the exact opposite of the scientific methodology involved in, among other things, the NIOSH LODD investigations.

For example this one... 28 year old, good physical shape, passed a firefighter physical, died due to a heart defect that no physical conditioning would have prevented.

I think I know how much water weighs - 8.35 pounds per gallon or so, the same as it ever was.

If you're going to advertise getting in shape in the interests of being able to do the physical side of the job better, that's great. But...when you tout it as prevention for cardiac-related LODDs, you can't show the scientific link that makes it anything other than "just your opinion". The NIOSH report above is just one of many examples.
This one is pretty simple in my opinion. There are too many firefighter/first responders that are overweight and out of shape. I remember attending FDIC last year and being amazed at how many overweight and obese people there were. While standing in line for a t-shirt, the gentlemen in front of me asked if they carried his size... a 4XL!!!!

ALL dept's MUST have some form of physical fitness standard!!!!!
No Ben, I am not. Again, I must point out to you that I am advocating increased physical fitness standards and awareness becouse if your an obese, or seriously overweight, sedate, physical wreck, your simply not going to be a very effective firefighter. Understand I have probabaly spent as much time learning and training on the reasons why a higher degree of physical fitness will ensure a more productive, and healthier firefighter as those who seem to work so hard to prove their statistics show it's all a big waste of time...it won't prevent a single inicdent.

And just as predictable, the proof will show in the death's of those who made the efforts to attain thier goals of fitness only to succomb to some genetic, or premature cardiac deficency, after which the opinions of certain people will be that it was all a waste of their time.

You have made a fine point by giving that one example Ben. However I take comfort in the knowledge that my opinions are the result of several years...decades even, of instruction on the very opposite of your opinions. Instructions, teachings, opinions even, of those directly involved in the mdeical evaluation of cardiac disease and stroke prevention specifically in firefighters.

As I said before, and will continue remind you, I do NOT believe that physical fitness is the going to prevent all cardiac-related deaths in the fire service, or any other occupation for that matter. Understand that. I am NOT saying that. But I do so believe their is ample scientific proof that elimination of behavioral risks and habits, along with planned, and if needed, supervised fitness programs do in fact reduce the risks to an occupation which has been linked to increased cardiac-related on the job deaths.

Are you honestly saying you are unaware of any scientific, or medically controlled tests and research done on firefighters in this area? Just out of curioisty, why is it that there has been such an increased effort towards educating firefighters on the values of increased levels of physical fitness?

I read NIOSH reports Ben. You see I am all about learning from past mistakes in hopes that we don't repeat them over and over. Scientific? Sometimes that's even questionable. However the REAL problem there is that regardless of the lessons learned, rarely, if ever, is any real degree of corrective behavior, or shall we say punishment dealt to the agency that may have been lacking in whatever areas contributed to the demise of the studied firefighter fatality. Actually, even though the fire service continues to make the same mistakes over and over, about all we get are recommendations...mundane, ineffective recommendations that read "fire departments should' or "fire chiefs shall" etc. Usually nothing new, just the same old stories told over and over. Not always though. See I won't ever committ to say always...I learned that too.

We will continue to debate this subject for a long time. The fire service will most likely never, ever come to adopt MANDATORY training standards or MANDATORY physical fitness standards. And that's just for the simple reason that many of the walking, talking health hzards, the ineffective and grossly out of shape so-called "firefighter" would then be demoted to spectataor. The same goes for the untrained, and unskilled who make every excuse against any measures of mandated training.
Becouse they know too well they can't meet those standards.

In closing, I know I would be hard pressed to find any fire department physician, or city insurance retained physician that would argue the point that there is no scientific evidence pointing towards firefighter fitness helping to reduce the chance of cardiac disease. Do some more research, and not just NIOSH reports. I only wish Dr. Paul Davis was a member of this forum. Although he did prepare me for the inevitiable skeptics.

On to greener pastures. Hopefully, no offense either. Maybe just a difference of opinion, or maybe a misunderstood one.
Im wondering what percentage of deaths in the "non-firefighter" population are cardiac related? And what other job do you go from being sound asleep to working as hard as you can in ten minutes at three in the morning... After years it takes a toll on our bodies. We are human as well. Of course departments can implement more strict exercise regiments, but is up to us as firefighters to follow through, and really make our bodies in as great of condition as they should be.
Dustin:
So you were at FDIC last year and didn't come see me at the FirefighterNation/FireRescue booth?
And you go to any Harley store and they will carry up to 6XL on their t-shirts.
I agree on diet and exercise, but also linkage between the nasties that we deal with and the effects of it on our health.
And if you're going to FDIC this year, you'd better damn well make it a point to see me.
Jeff, when you threw this statement out, you indeed were engaging in posting a biased opinion that the data just flatly doesn't back up...

"What I'm about to say is harsh, but the truth. If you are a firefighter, or emergency service worker with cardiac problems, obese, and/or not able to physically perform duties, then you are a ticking time bomb, and liability."

As of 2008 - the last year for which the USFA stats are available, there were 1,148,850 firefighters in the U.S. That year, there were 52 LODDs attributed to all cardiac causes.
That's a 0.004% LODD rate from cardiac causes.

There are an estimated 308,732,000 U.S. citizens with a cardiac-related death rate of 631,636 in 2006, the last year for which the stats are available. That's 0.2%.

In other words, cardiac-related death is much more likely in the general population than for firefighters.

That's not an opinion - it's borne out by the data.
Ben
I don't know if that quote was suppossed to be mine, but I looked back through my posts and just couldn't find it. Whatever...

Regardless, it HAS been established that there are certain lifestyle alterations that have been proven to lower the chances of heart disease. I am also fairly certain our occupation has been proven to be particularly streesful on the heart as well as rather physically demanding. That's not me making blind statements Ben, I do think I remember reading something along those lines before.

Help me out folks.

You seem to be avoiding the real issue here. That being that we can go along ways towards improving our health, and job performance by engaging in a regular, structured exercise and physical fitness program. THAT is, and has been my point.

Now, if you DO have cardiac illness, ARE obese, smoke, eat garbage, and avoid everything that even remotely can be considered regular exercise, then YOU are a liability, and yes, you ARE at increased risk for heart attack. Dispute that. And if you are included in that group, you can pretty much figure you are incapable of performing the duties of a firefighter efficently and safely, and I for one, don't want you working next to me.

Personally, nothing angers me more than people in this business who downplay the importence of physical fitness for firefighters. I guess it's for a reason. I've been doing this job for over 30 years, and I know the actual physical labor involved in stretching hose, throwing ladders, flipping the roof, making the search...etc, is pretty much the same no matter where you go. Of course if your district has nothing above the second floor, climbing multiple flights of stairs won't be an issue.

So if all that stuff is as demanding on me, I gotta figure it's gonna be pretty close to the same for others.

I'm curious Ben. What IS your opinion on firefighter physical fitness? Is it all a big waste of time since you seem to be of the opinion it has little impact on decreasing cardiac disease risks?

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