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Cardiovascular Risks of Firefighting

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Health Risks and Fair Compensation in the Fire Service

Part of the book series: Risk, Systems and Decisions ((RSD))

Abstract

Cardiovascular disease (CVD) is the leading cause of on-duty death among firefighters (45 % of on-duty fatalities) and a major cause of morbidity. CVD in the fire service also has adverse public safety implications as well as significant cost impacts on government agencies. Recently, our understanding of CVD in the fire service has significantly improved and provides insight into the risks of firefighting and potential prevention strategies. The CVD risks of firefighting relate primarily to the interaction of physically and psychologically stressful duties with underlying CVD. These strenuous duties provoke a physiology of cardiovascular arousal in association with acute firefighting activities, which usually have no long-term consequences in healthy firefighters, but can trigger pathophysiologic changes and acute CVD events in firefighters with underlying heart disease. Accordingly, unique statistical approaches have documented that on-duty CVD events do not occur at random in the fire service. They are more frequent at certain times of day, certain periods of the year, and are overwhelmingly more frequent during strenuous duties compared to non-emergency situations. Moreover, as expected, on-duty CVD events occur almost exclusively among susceptible firefighters with underlying CVD. The most recent studies of on-duty deaths in the fire service indicate that both coronary heart disease (CHD) due to atherosclerosis of the coronary arteries and cardiac enlargement are key the pathologic hallmarks of underlying CVD and often co-exist. Despite the strenuous nature of emergency duty, the prevalence of low fitness, obesity and other CVD risk factors in the fire service are high. Robust evidence for both highly prevalent risk factors and the interaction of strenuous duties with underlying CVD supports the aggressive application of preventive measures with proven benefits such as lifestyle modifications and medical treatment to mitigate CVD risk factors. Furthermore, all fire departments should have entry level medical evaluations, institute periodic medical and fitness evaluations and require rigorous return to work evaluations following any significant illness. Finally, based on overwhelming evidence supporting markedly higher relative risks of on-duty death and disability among firefighters with established CHD, with few exceptions, firefighters with known CHD, other atherosclerotic endpoints and marked cardiomegaly should be restricted from participating in emergency duties.

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Authors and Affiliations

  1. Laurentian University, SE 205-F Education Building, Sudbury, ON, P3E 2C6, Canada

    Nancy Lightfoot PhD, MSc

  2. Department of Environmental Health, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Elpidoforos S. Soteriades MD, SM, ScD

  3. Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA

    Stefanos N. Kales MD, MPH, FACP, FACOEM

  4. Occupational Medicine Residency, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Stefanos N. Kales MD, MPH, FACP, FACOEM

  5. Division Chief OEM, Cambridge Health Alliance, CHA Cambridge Hospital campus, 1493 Cambridge St, Cambridge, MA, 02139, USA

    Stefanos N. Kales MD, MPH, FACP, FACOEM

Authors
  1. Nancy Lightfoot PhD, MSc
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  2. Elpidoforos S. Soteriades MD, SM, ScD
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  3. Stefanos N. Kales MD, MPH, FACP, FACOEM
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Correspondence to Nancy Lightfoot PhD, MSc .

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Editors and Affiliations

  1. Washington, District of Columbia, USA

    Tee L. Guidotti

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Lightfoot, N., Soteriades, E.S., Kales, S.N. (2016). Cardiovascular Risks of Firefighting. In: Guidotti, T. (eds) Health Risks and Fair Compensation in the Fire Service. Risk, Systems and Decisions. Springer, Cham. https://doi.org/10.1007/978-3-319-23069-6_8

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