FEMA Heart Study: A lesson in situational awareness

By now, we’ve all read or heard about the preliminary results from the FEMA-sponsored study that found one third of firefighters had heart disease that was unrelated to traditional risk factors, such as high cholesterol, and they have a 300% increased risk of dying from heart disease than other segments of the general population. While these results are astonishing, they also provide vital information to the first responder community that could potentially change fire service culture nationwide.

I recently had the opportunity to speak with Gwinnett Fire & Emergency Services (GFES) Assistant Chief of Operations Bill Myers about how his department became the focus of the study and what, if anything, has changed since the results were released. (By now, we also know it was GFES personnel over the age of 40 who agreed to participate in the study because of the high number of life-altering heart-related problems suffered by its employees.) “It wasn’t just one person in our department,” says Chief Myers. “We had several firefighters who retired and died of heart attacks. We had one firefighter fatality that was the result of a heart attack. A couple of guys had response-ending heart disease or heart attacks—they were 40 years old. We also had a few people who were diagnosed with heart disease and had to be removed from the field.”

It’s widely known that heart disease is the No. 1 killer of firefighters. In an effort to fight this statistic and put a stop to the heart-related problems and tragedies within their department, GFES Chief Steve Rolader increased his focus on the department’s wellness program, and started talking about it to local news stations, which caught the attention of H. Robert Superko, MD, who became the principal investigator in the landmark FEMA-sponsored study.

The results of the study have had a major impact on GFES. “I relate the results of the study to situational awareness,” says Chief Myers. “Firefighters understand the concepts of preplanning, command and control and situational awareness. The results of this study allow firefighters to be in command and control of their own health. It allows them to preplan their own health. The third greatest killer of firefighters is a lack of situational awareness on the fireground. A lack of personal situational awareness will also lead to fatality.”

Chief Myers ensured me that this newfound situational awareness is being taken very seriously; the department has made some dramatic lifestyle changes. “We’ve seen better cooking, better eating, a lot more exercise, and we’ve changed our physical fitness program to include the CrossFit Program , which incorporates more job-related exercises,” Chief Myers explains. “We’ve also changed our radio in-coding system from a loud type of bang to a sound that starts off soft and gets louder gradually, so you’re not startled awake. People love it, and it hasn’t affected our response times at all.”

Chief Myers has a personal stake in the overall health and wellness of his department, as he has a family history of heart disease, like many of us do, and he was found, through the study’s genetic testing, to carry the “heart attack” gene. Fortunately, Chief Myers has always been a watchdog for his own health. “I’ve always exercised, and going through the study tests confirmed for me that I was doing the right things. One of the tests they gave us was a CT scan to locate calcium in the arteries. Fortunately, I had none, but unfortunately, people younger than me did.”

Going forward, Dr. Superko and other researchers at St. Joseph’s Hospital are going to focus on firefighter diet and nutrition as one way to decrease chances of heart attack and/or heart disease among firefighters. “Part of the original study was a diet study in which GFES employees were asked to write down everything they ate for 3 days,” Chief Myers says. “I looked at my calorie intake, and what I was getting my calories from isn’t what I should have been getting my calories from.”

I don’t think it’s going to be a quick and painless process to make sweeping changes to a profession that prides itself on upholding tradition, but GFES has definitely started out on the right foot. “This is the only way we’re going to reduce firefighter fatalities across the country as it relates to heart disease,” says Chief Myers.

Cindy Devone-Pacheco is senior editor of FireRescue magazine.

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Comment by Paul Grachan on April 2, 2009 at 3:14pm
Extremely interesting article and comments. Oddly enough, I am working with a company that creates FR base layer clothing (t's, underwear, etc) for first responders. After some study's, one of the main benefits seems to be the garments' ability to wick moisture away from the body and create a cooler chest skin temp. difference of ~8 degrees. It seems like even the average FF's current equipment works against the heart by upping heart exhaustion and making the organ work harder than it has to, so in addition to the eating (which is obviously the largest factor), some simple equipment changes might also help to extend life.

The FF lifestyle is a total package of risk and it always seems to be those small things that get people in the end.
Comment by Bob Allard on April 2, 2009 at 12:27pm
All the article are enough to change your life style in anyone.
Comment by Cindy Devone-Pacheco, FireRescue on April 2, 2009 at 11:51am
Oldman: You make a great point: Yes, we could do all the right things and there would still be heart disease and heart attacks. But if you're doing ALL the right things, your chances of suffering from these things decreases dramatically. Don't forget that one of the "right things" to be doing is decreasing stress levels whenever possible.

And I think your question is a valid one: Are we dying from cardiac problems more now than ever or has science become more advanced? It's my guess that the answer is "yes" to both. Decades ago, building materials were different, so they emitted different, possibly less harmful chemicals when burned. Our American lifestyle has also changed, sped up. We want things NOW, not later. So maybe that means we eat more fast food than we did before. And, correct me if I'm wrong, but trans fat was introduced into food a few decades ago; it's not something that has always been in the food we buy at the supermarket.

It's been my experience that if you tell yourself you can NEVER eat something again, sooner or later you're going to snap and binge on whatever it is for a week. So I don't tell myself I can't eat something; I just don't eat ALL of it. Eat half a donut instead of a whole one. Eat 3 ribs instead of 6. I drink water with meals, I don't smoke (anymore), I get some exercise and most importantly, I see my doctor.
Comment by ALLAN D HALL on April 2, 2009 at 11:49am
I find this to be very true .. i have had heart surgery..........
Comment by Mike on April 2, 2009 at 11:21am
Prehospital Recognition and Management of Cyanide Poisoning in Smoke Inhalation Victims (Slides With …

In some European Countries the ER's are required to have anti-cyanide Protocols for the treatment of cardiac arrest in firefighters. This protocol is not practiced in the US ER's. In Europe they have determined that cardiac arrest in firefighters is more likely due to the presence of toxins found in the smoke. The theory is that if you treat a firefighter for conventional cardiac arrest protocols without treating as well for the toxins found in the smoke you, by defination, can not bring the firefighter back as long as the toxns are still present. This assumes that these toxins are not just present after fighting a fire but, can accumilate and trigger at a future time.

This is not ment to dismiss the other factors, but, we need to take a look at all factors.

Attached is a presentation reguarding this concept.  Should ambulance districts, fire departments or ER's maintain drugs for the treatment of smoke toxins when Firefighters present with the symptoms of cardiac arrest.
Comment by Jon Herndon on April 2, 2009 at 10:45am
Life is a collection of risk factors it seems. Just doing a firefighter's work exposes us to a significant collection of risks that are not experienced by the general population. PPE is helpful, but doesn't create that magic barrier we would all like. Anything you can do to reduce any risk factor away from the job will hopefully enable you to work longer and collect that pension check for a few more years. I for one don't want to retire any earlier than I want, and I have plans for my pension years. So... if I have to limit myself to one plate at dinner, exercise more often, and follow safety guidelines at work to get a few more years, so be it. Hopefully I won't get run down in the crosswalk by some lunatic after making all these modifications to my lifestyle. That would really piss me off!
Comment by Oldman on April 2, 2009 at 8:52am
Studies, investigations and surveys are important to help us try to change our habits. Unfortunately, we could all have PEG tubes inserted, and live off of Ensure, and there will still be heart disease, and cardiac related deaths.

Are we dying from cardiac related problems more than say 20 years ago, or has science become better at tracing the causes and because of the internet, we are hearing about it sooner?

I'm not trying to down play the issue. But every day there is some new study out that says, "eating red meat has a higher incidence of cancer". "Chicken is injected with cancer causing chemicals", there is Mercury in the worlds fish supply..... on and on and on. I guess that leaves vegetables. Wait a minute, they're loaded with Salmonella.

So now what?
Comment by Gary McGinnis on April 2, 2009 at 8:33am
Proper eating and diet are part of the culture we need to change. I am trying to eat a high fiber diet but I cinfess when I saw a platter of ribs last night I went at them like a hungry wolf. I have a family histroy of heart problems and unfortunately I don't get enough excercise. However I am trying and do well about 5 or 6 days a week. Eating healthy means giving up fun foods such as doughnuts. Then when I have have one I go on a binge.

I know I have to do better but I struggle finding ways and avoiding the bad food binge.

Gary M
Comment by Oldman on April 2, 2009 at 7:57am
Ran across this study. Their results were surprising.

Comment by Wolfy Lang on April 2, 2009 at 6:38am
I did an impromptu survey of the LODD's this year and last, and out of 20 LODD this year, 8 are cardiac related... avg age, 51.25. 33 years old to 73 years old. In 2008 there were 47 Fire Service Line of Duty Deaths nationwide due to cardiac events. Average age, 51 years old. Ages 28 to 82. Several years ago I was eating McD's for breakfast, lunch, and dinner... 5 days a week.. Had a lab tech friend do my cholesterol, and when she pulled my blood, she said it looked like a heavy syrup. Needless to say, I dont eat there any more unless I can't help it (or just want a dbl cheeseburger). Apparently, a fast food meal is a fast casket ticket.

Be Good Be Careful Be Safe!!!

(a 43 year old 32in. waist Marlboro Smoker)

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