Firefighters' Cardiovascular Risk Behaviors

Abstract

Cardiac events are strongly associated with line-of-duty deaths among firefighters. The frequency with which firefighters succumb to cardiovascular events while on duty is well documented. Many firefighters have undiagnosed or undertreated hypertension, hyperlipidemia, and obesity, as well as poor dietary habits and marginal physical fitness. Extremely high heart rates while engaged in fire suppression increase the risk for cardiovascular line-of-duty death. Exposure to smoke and unsafe levels of carbon monoxide is an occupational hazard that intensifies cardiovascular risk within the fire service. Cultural factors such as shift work and crew cohesion create multiple levels of influence on firefighters' decisions about engaging in positive health behaviors. This review highlights the significance of primordial and primary prevention of cardiovascular disease that is culturally congruent with the fire service.

References

Barnard

R. J.

Duncan

H. W.

(1975). Heart rate and ECG responses of fire fighters. Journal of Occupational Medicine: Official Publication of the Industrial Medical Association, 17(4), 247–250.

Barnard

R. J.

Weber

J. S.

(1979). Carbon monoxide: A hazard to fire fighters. Archives of Environmental Health, 34(4), 255–257.

Bledsoe

(2007). The heart dangers of CO: Understanding cardiovascular risks to responders from CO exposure. JEMS: Journal of Emergency Medical Services, 32(12), 54–59.

Bolstad-Johnson

D. M.

Burgess

J. L.

Crutchfield

C. D.

Storment

Gerkin

Wilson

J. R.

(2000). Characterization of firefighter exposures during fire overhaul. American Industrial Hygiene Association Journal, 61(5), 636–641.

Burgess

W. A.

Sidor

Lynch

J. J.

Buchanan

Clougherty

(1977). Minimum protection factors for respiratory protective devices for firefighters. American Industrial Hygiene Association Journal, 38(1), 18–23. doi:10.1080/0002889778507906

Carey

M. G.

Al-Zaiti

S. S.

Liao

L. M.

Martin

H. N.

Butler

R. A.

(2011). A low-glycemic nutritional fitness program to reverse metabolic syndrome in professional firefighters. Results of a pilot study. Journal of Cardiovascular Nursing, 26(4), 298–304.

Centers for Disease Control and Prevention-NIOSH Publications and Products. (2007). Preventing fire fighter fatalities due to heart attacks and other sudden cardiovascular events (2007–133). Retrieved June 18, 2011, from http://www.cdc.gov/niosh/docs/2007-133

Cone

D. C.

MacMillan

D. S.

Brown

D. J.

Weir

S. D.

Bogucki

(2005). Noninvasive fireground assessment of carboxyhemoglobin levels in firefighters. Prehospital Emergency Care, 9(1), 8–13.

Driessen

(2002, February). Crew cohesion, wildland fire transition, and fatalities. Washington, DC: United States Department of Agriculture Forest Service Technology and Development Program TE02P16.

10.

Elliot

D. L.

Goldberg

Duncan

T. E.

Kuehl

K. S.

Moe

E. L.

Breger

R. K.

Stevens

(2004). The PHLAME firefighters' study: Feasibility and findings. American Journal of Health Behavior, 28(1), 13–23.

11.

Elliot

D. L.

Goldberg

Kuehl

K. S.

Moe

E. L.

Breger

R. K.

Pickering

M. A.

(2007). The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) Firefighter Study: Outcomes of two models of behavior change. Journal of Occupational & Environmental Medicine, 49(2), 204–213.

12.

Elsner

K. L.

Kolkhorst

F. W.

(2008). Metabolic demands of simulated firefighting tasks. Ergonomics, 51(9), 1418–1425. doi:10.1080/00140130802120259

13.

Ernst

Zibrak

J. D.

(1998). Carbon monoxide poisoning. The New England Journal of Medicine, 339(22), 1603–1608. doi:10.1056/NEJM199811263392206

14.

Fahy

R. F.

(2005). U.S. firefighter fatalities due to sudden cardiac death, 1995–2004. Quincy, MA: National Fire Protection Association; Fire Analysis and Research Division.

15.

Geibe

J. R.

Holder

Peeples

Kinney

A. M.

Burress

J. W.

Kales

S. N.

(2008). Predictors of on-duty coronary events in male firefighters in the United States. The American Journal of Cardiology, 101(5), 585–589. doi:10.1016/j.amjcard.2007.10.017

16.

Hall

Adams

(Eds). (1998). Essentials of firefighting (4th ed). Stillwater, OK: Fire Protection Publications.

17.

Horn

G. P.

Gutzmer

Fahs

C. A.

Petruzzello

S. J.

Goldstein

Fahey

Smith

D. L.

(2011). Physiological recovery from firefighting activities in rehabilitation and beyond. Prehospital Emergency Care, 15(2), 214–225. doi:10.3109/10903127.2010.545474

18.

Janke

H. D.

(2011). BJA Fact Sheet: Public safety officers' benefits program. Washington, DC: U.S. Department of Justice, Bureau of Justice Assistance. FS.000359. Revised April 2011. Retreived on June 19, 2011, from www.psob.com

19.

Jankovic

Jones

Burkhart

Noonan

(1991). Environmental study of firefighters. The Annals of Occupational Hygiene, 35(6), 581–602.

20.

Kales

S. N.

Polyhronopoulos

G. N.

Aldrich

J. M.

Leitao

E. O.

Christiani

D. C.

(1999). Correlates of body mass index in hazardous materials firefighters. Journal of Occupational and Environmental Medicine/American College of Occupational and Environmental Medicine, 41(7), 589–595.

21.

Kales

S. N.

Soteriades

E. S.

Christophi

C. A.

Christiani

D. C.

(2007). Emergency duties and deaths from heart disease among firefighters in the United States. The New England Journal of Medicine, 356(12), 1207–1215. doi:10.1056/NEJMoa060357

22.

Kales

S. N.

Soteriades

E. S.

Christoudias

S. G.

Christiani

D. C.

(2003). Firefighters and on-duty deaths from coronary heart disease: A case control study. Environmental Health: A Global Access Science Source, 2(1), 14. doi:10.1186/1476-069X-2-14

23.

Karter

M. J.

Molis

J. L.

(2005). Firefighter injuries. Quincy, MA: National Fire Protection Association.

24.

Karter

M. J.

Stein

G. P.

(2012). U.S. Fire Department profile through 2011. Quincy, MA: National Fire Protection Association: Fire Analysis and Research Division.

25.

Lees

P. S.

(1995). Combustion products and other firefighter exposures. Occupational Medicine (Philadelphia, PA), 10(4), 691–706.

26.

Lloyd-Jones

D. M.

Hong

Labarthe

Mozaffarian

Appel

L. J.

, Van Horn, L., … the American Heart Association Strategic Planning Task Force and Statistics Committee. (2010). Defining and setting national goals for cardiovascular health promotion and disease reduction. Circulation, 121(4), 586–613. doi:10.1161/CIRCULATIONAHA.109.192703

27.

MacKinnon

D. P.

Elliot

D. L.

Thoemmes

Kuehl

K. S.

Moe

E. L.

Goldberg

Ranby

K. W.

(2010). Long-term effects of a worksite health promotion program for firefighters. American Journal of Health Behavior, 34(6), 695–706.

28.

Mittleman

M. A.

Maclure

Tofler

G. H.

Sherwood

J. B.

Goldberg

R. J.

Muller

J. E.

(1993). Triggering of acute myocardial infarction by heavy physical exertion: Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. The New England Journal of Medicine, 329(23), 1677–1683. doi:10.1056/NEJM199312023292301

29.

Putnam

(1995). The collapse of decision making and organizational structure on Storm King Mountain. Washington, DC: USDA Forest Service, Missoula Technology and Development Center.

30.

Ranby

K. W.

MacKinnon

D. P.

Fairchild

A. J.

Elliot

D. L.

Kuehl

K. S.

Goldberg

(2011). The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) Firefighter Study: Testing mediating mechanisms. Journal of Occupational Health Psychology, 16(4), 501–513. doi:10.1037/a0023002

31.

Rhea

M. R.

Alvar

B. A.

Gray

(2004). Physical fitness and job performance of firefighters. Journal of Strength and Conditioning Research / National Strength & Conditioning Association, 18(2), 348–352. doi:10.1519/R-12812.1

32.

Satran

Henry

C. R.

Adkinson

Nicholson

C. I.

Bracha

Henry

T. D.

(2005). Cardiovascular manifestations of moderate to severe carbon monoxide poisoning. Journal of the American College of Cardiology, 45(9), 1513–1516. doi:10.1016/j.jacc.2005.01.044

33.

Smith

D. L.

Petruzzello

S. J.

Chludzinski

M. A.

Reed

J. J.

Woods

J. A.

(2005). Selected hormonal and immunological responses to strenuous live-fire firefighting drills. Ergonomics, 48(1), 55–65. doi:10.1080/00140130412331303911

34.

Soteriades

E. S.

Smith

D. L.

Tsismenakis

A. J.

Baur

D. M.

Kales

S. N.

(2011). Cardiovascular disease in US firefighters: A systematic review. Cardiology in Review, 19(4), 202–215. doi:10.1097/CRD.0b013e318215c105

35.

Staley

J. A.

Weiner

Linnan

(2011). Firefighter fitness, coronary heart disease, and sudden cardiac death risk. American Journal of Health Behavior, 35(5), 603–617.

36.

Theil

(1999, January). Special Report: Improving firefighter communications: USFA-TR-099. Washington, DC: Department of Homeland Security, United States Fire Administration National Fire Data Center.

37.

TriData Corporation. (2002, April). Firefighter fatality retrospective study. Emmitsburg, MD: Federal Emergency Management Agency United States Fire Administration National Fire Data Center.

38.

U.S. Fire Administration. (2009). Health and wellness guide for the volunteer fire and emergency services (FA-321). Washington, DC: Federal Emergency Management Administration. Retrieved from http://www.usfa.fema.gov/downloads/pdf/publications/fa_321.pdf

39.

U.S. Fire Administration. (2012, July). Firefighter fatalities in the United States in 2011. Washington, DC: U.S. Department of Homeland Security, Federal Emergency Management Administration, U.S. Fire Administration.

40.

Withen

(1994). Fire culture. Inner Voice, September/October, 12–13.