Prevention and early detection are critical to helping firefighters manage cardiovascular, cancer and mental health issues
Read our industry news on any given day. It is full of reports of untimely passings of members of our service. The causes are a repetitive cycle of preventable and occupationally linked diseases – some acute and some not – forming a fire service occupational deaths trifecta:
- Cardiovascular-related deaths
- Cancer-related deaths
- Deaths by suicide
We are challenged to fully understand the magnitude of these losses, as our reporting systems often do not capture national statistics linking deaths to our occupation, especially in the case of volunteer firefighters, whose full-time occupation may be reported in lieu of their firefighting service. Hopefully, the future national cancer registry will make strides to more accurately capture the magnitude of this scourge on the fire service.
1. FIRE SERVICE CARDIOVASCULAR-RELATED DEATHS
Research has expanded our knowledge on the cardiovascular strain that the rigors of firefighting and heat place on our cardiovascular system. We know that firefighters are not immune from the typical cardiovascular risk factors, such as obesity, high blood pressure, diabetes and high cholesterol. In fact, studies of firefighters who have experienced cardiac events have shown a greater risk from each of these independent factors.
An example of elevated risk is that untreated high blood pressure or hypertension in firefighters has been correlated with a 12 times increased risk of a cardiovascular event. Additionally, we have a better understanding from post-mortem findings of firefighters who suffered fatal heart events in the line of duty that structural heart changes are present in some firefighters, such as enlargement of the left ventricular and septal wall of the heart muscle, caused by unmanaged hypertension and obesity.
The cardiovascular strain of firefighting aerobic/metabolic demand elevates our risk, particularly if we have not controlled our modifiable risk factors, such as weight, cholesterol, blood sugar and blood pressure.
2. FIRE SERVICE OCCUPATIONAL CANCER-RELATED DEATHS
Approximately 20 cancers have been occupationally linked to firefighting through evidence-based research. And according to www.cancer.gov, 38.4% of general population men and women will be diagnosed with cancer at sometime during their lives. The risk to firefighters exceeds that number, largely due to exposure to carcinogenic contaminants that are absorbed or inhaled into the body prior to proper decontamination.
We continue to apply mitigation practices in our profession to reduce our exposure risk by enhancements to our barrier protection within our PPE or bunker gear, continuous respiratory protection, on-scene decontamination, and aggressive cleaning of gear and equipment, as well as apparatus cabs.
3. FIREFIGHTER DEATH BY SUICIDE
The third aspect of the trifecta is perhaps the most difficult for responders and families to deal with, speak about and acknowledge due to what some still perceive to be a stigma associated with behavioral health issues.
Like some of the other occupational diseases we have discussed, our understanding of the magnitude or prevalence is hampered by the lack of a national reporting or tracking system. Additionally, much of our understanding as to the prevalence of behavioral health issues is based on self-reporting and, as such, may be vastly underreported.
According to the NFPA’s “Trouble in Mind,” firefighters have higher rates of alcohol abuse/dependency, stress, sleep disorders, post-traumatic stress injury or disorder (PTSD) and suicide. Researchers have reported PTSD rates as high as 37% for firefighters, and one study reported 49% of firefighters had considered suicide at least once during their service and 16% have made at least one attempt. Further, based on reporting from Jeff Dill of the Firefighter Behavioral Health Alliance, a department is more likely to experience a member suicide than a line-of-duty death. However, based on what we know of occupational exposure and repetitive trauma, many consider death by suicide to be an occupational LODD.
FOCUS ON PREVENTION AND EARLY DETECTION
Each of the common causes of deaths that continue to plague the fire service and needlessly take members from our ranks are largely preventable and successfully treatable with early detection.
NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments establishes guidance for annual exams for firefighters. And the International Association of Fire Chief’s (IAFC) published the Healthcare Provider’s Guide to Firefighter Physicals in an effort to educate clinical providers as to the unique occupational health risks faced by members of the fire service and more aggressive screening at younger ages than more traditional patient populations. The IAFC also conducted research that demonstrated that many members of both the career and volunteer fire service are not receiving annually occupationally appropriate physicals. This entails early detection and screening for impending cardiac events, early-stage cancers and behavioral health issues. In each of these domains, early detection typically ensures beneficial outcomes.
Bottom line: The key to surviving your fire service career is prevention of occupational health risk in combination with annual occupationally comprehensive medical exams.