Posted on 11/28/2014

Police officers are at increased risk for sudden cardiac death when performing stressful duties like chasing, restraining or fighting with suspects, researchers say.

Sudden cardiac death is up to 70 times more likely during those kinds of stressful activities, compared to when police officers perform routine duties, according a new study of U.S. law enforcement deaths.

The results aren't surprising, said senior author Dr. Stefanos N. Kales of Harvard School of Public Health in Boston.

“In the general population those really stressful things like anger or physical stress, like a lot of snow shoveling for a person who is usually sedentary, can serve as triggers for cardiovascular events,” Kales told Reuters Health. 

“We thought the same thing could happen with law enforcement officers but we were struck by the magnitude of the risks,” Kales said.

He and his coauthors studied 441 cases of law enforcement officers' sudden cardiac death on the job between 1984 and 2010.

Sudden cardiac death occurs when the heart stops beating abruptly because of abnormal rhythms. It can strike young athletes with undiagnosed heart problems. But most often, cardiac arrest happens when people with cardiovascular disease are under severe physical or psychological stress.

Kales’ team reported in the journal BMJ that while routine duties take up about 75 percent of an officer’s time, 77 percent of cardiac deaths occurred during more stressful activities. For example, 25 percent occurred during a restraint or physical altercation, 20 percent during physical training, 12 percent during pursuits, and 8% during rescue operations. The remaining deaths did not fit into any of the pre-determined duty categories.

The researchers calculated that police officers spend 1 to 2 percent of their work time using restraints or engaged in altercations, but because those activities accounted for 25 percent of deaths, they raise the risk by 30-fold to 70-fold compared to when an officer is performing routine duties.

Similarly, pursuits made up less than 2 percent of officers’ on-duty time, but raised the risk of cardiac death 30- to 50-fold.

Overall, however, sudden cardiac deaths accounted for just 10 percent of all on-duty deaths for police officers. The majority involved traumas like gunshot wounds or car accidents.

“The absolute risk for most individuals and all police is quite low and primarily limited to people who have underlying disease, who may not know that they have underlying disease,” Kales said.

The authors recommend that physical fitness be a job requirement for police officers, and should be maintained after graduation from the academy.

Police departments should also ban smoking, since it is so harmful to heart health, Kales said. “Given that we compensate police or firefighters for retirement and disability, it really is incumbent on the jurisdiction to ban smoking,” Kales added.

Denise L. Smith, director of the First Responder Health and Safety Lab at Skidmore College in Saratoga Springs, New York, told Reuters Health, “In the general population there is no public safety risk, only risk to the individual, for sudden cardiac death. But here public safety may be put at risk.”

“First responders come from the general population so they’re just like the rest of us as far as lack of fitness, obesity, blood glucose, cholesterol,” added Smith, who was not involved in the study. “They need to be fitter and healthier than the rest of us.”

Dr. Franklin H. Zimmerman, Senior Attending Cardiologist and Director of Critical Care at Phelps Memorial Hospital in Sleepy Hollow, New York, who also was not affiliated with the study, pointed out that police officers often develop bad habits after graduating from the academy and don’t maintain their fitness.

“Law enforcement is basically a sedentary activity, and you need to go zero to 90 within a few seconds,” Zimmerman said. “Even professional athletes, you would never ask them to start sprinting out of a chair.”

The experts agreed that officers should have annual or near-annual physical examinations to monitor their weight and other risk factors, and that stress testing may be useful for certain officers with more cardiovascular risk to identify those who might be at higher risk for sudden cardiac death.

SOURCE: Reuters Health

ORIGINAL SOURCE: BMJ, online November 18, 2014.