September 21, 2007–ATLANTA–Firefighters are dying on the job from preventable cardiovascular conditions. Death from sudden cardiac arrest (SCA) represents the most common cause of a firefighter fatality.
According to a new National Institute for Occupational Safety and Health (NIOSH) alert, measures by fire departments and fire service agencies can prevent such incidents. Sudden cardiac death represents the most common cause of on-duty firefighter fatalities, killing about 45 each year.
The report, "Preventing Fire Fighter Fatalities Due to Heart Attacks and Other Sudden Cardiovascular Events," incorporates findings from NIOSH investigations into sudden cardiac-related deaths, an extensive review of the literature, and opinions from 12 outside experts in the fire service and occupational health communities.
NIOSH concludes that for firefighters, coronary artery disease and sudden cardiac death involve a combination of personal and work-related factors. These include age, gender, family history, diabetes, hypertension, smoking, high cholesterol, obesity, and lack of exercise.
The occupational issues can include exposure to fire smoke, heavy physical exertion, heat stress, exposure to carbon monoxide, and other physical stressors. The alert offers detailed recommendations for fire departments, firefighters, firefighter candidates, and fire service agencies to reduce the risks.
These include:
- Medical evaluation programs
- Comprehensive wellness and fitness programs
- Proper use of personal protective equipment
- Proper management of the fire scene to reduce hazardous exposures and heat stress.
According to the alert, Fire Departments should take the following steps to reduce on-duty heart attacks and other sudden cardiovascular events:
- Provide medical evaluations to ensure that candidates and members are capable of performing job tasks with minimal risk of sudden incapacitation
- Ensure that physicians conducting the medical evaluations are knowledgeable about the physical demands of firefighting, the essential tasks of firefighting, and the consensus guidelines developed by the fire service
- Implement a comprehensive wellness/fitness program for firefighters to reduce risk factors for CVD and improve cardiovascular capacity
- Control exposure to carbon monoxide and other fire contaminants through proper management of the fire scene and proper use of respiratory protection
- Ensure adequate staffing levels for operations to prevent over-exertion
- Provide on-scene rehabilitation to monitor vital signs for indication of excessive cardiovascular strain, and to cool and hydrate the firefighter.
To help fire departments implement these steps, fire service agencies should conduct research on the following:
- Effectiveness of health promotion programs to reduce the incidence of heart disease among firefighters.
- Barriers to implementing health promotion programs (both wellness and fitness).
- Effectiveness of on-scene rehabilitation to reduce cardiovascular strain.
- Risk posed to firefighter’s cardiovascular system due to occupational exposures.
NIOSH recommendations include the following:
- Place and maintain AEDs on all fire department apparatus that are not equipped and staffed for manual defibrillation
- Train firefighters on the proper use of AEDs
- Remind emergency department personnel and medical examiners to perform carboxyhemoglobin testing on all fire fighters who experience a cardiac arrest
- Control exposure to carbon monoxide and other fire contaminants through proper management of the fire scene and proper use of respiratory protection.
The alert is available online at http://www.cdc.gov/niosh/docs/2007-133.