Firefighter Health and Fitness Assessment: A Call to Action
ABSTRACT Sudden cardiac deaths experienced by firefighters in the line of duty account for the largest proportion of deaths annually. Several fire service standards for fitness and wellness have been recommended but currently only 30% of U.S. fire departments are implementing programs for this purpose. The Department of Homeland Security Science and Technology Directorate has initiated the Physiological Health Assessment System for Emergency Responders (PHASER) program aiming to reduce these line-of-duty deaths through an integration of medical science and sensor technologies. Confirming previous reports, PHASER comprehensive risk assessment has identified lack of physical fitness with propensity for overexertion as a major modifiable risk factor. We sought to determine if current levels of fitness and cardiovascular disease (CVD) risk factors in a contemporary cohort of firefighters were better than those reported over the past 30 years. Fifty-one firefighters from a Southern California department were characterized for physical fitness and CVD risk factors using standard measures. Overall, physical fitness and risk factors were not different from previous reports of firefighter fitness and most subjects did not achieve recommended fitness standards. Considering the lack of widespread implementation of wellness/fitness programs in the U.S. fire service together with our findings that low physical fitness and the presence of CVD risk factors persist, we issue a call to action among health and fitness professionals to assist the fire service in implementing programs for firefighters that improve fitness and reduce CVD risk factors. Fitness professionals should be empowered to work with fire departments lending their expertise to guide programs that achieve these objectives, which may then lead to reduced incidence of sudden cardiac death or stroke.
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ABSTRACT: Currently, there is no enforcement of physical standards within Australian fire services post-recruitment, possibly leading to inappropriate fitness and body composition. This study evaluated the impacts of ageing on physical standards of Australian firefighters. Seventy-three firefighters from three different 10-year age groups [25-34 years (n = 27), 35-44 years (n = 27), 45-54 years (n = 19)] volunteered for physical testing using dual-energy X-ray analysis and existing fitness tests used for recruitment by an Australian fire service. Older (45-54 years) participants demonstrated significantly poorer physical standards compared with younger participants including cardiovascular fitness (p < 0.05), strength (p = 0.001) and simulated operational power testing tasks (p < 0.001). Age-related body composition changes were also observed independent of body mass index. Minimum recruitment standards and fitness programs need to account for age-related declines in physical capabilities to ensure that the minimum standard is maintained regardless of age. Practitioner Summary: Using dual-energy X-ray analysis and established fitness testing protocols, this study aimed to gain an appreciation of the current standards of body composition and fitness of Australian firefighters and the effects of ageing on their physical abilities post-recruitment. The study demonstrated a significant decline in physical standards due to age.Ergonomics 04/2014; 57(4):612-621. DOI:10.1080/00140139.2014.887790 · 1.56 Impact Factor
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ABSTRACT: Introduction: Firefighters perform strenuous muscular work while wearing heavy, encapsulating personal protective equipment in high temperature environments, under chaotic and emotionally stressful conditions. These factors can precipitate sudden cardiac events in firefighters with underlying cardiovascular disease. The purpose of this pilot study was to deploy and explore the feasibility of the resting "advanced" 12-lead electrocardiogram (A-ECG) as a remote firefighter risk assessment tool for improved assessment of cardiac risk. Materials and methods: Conventional 12-lead resting electrocardiograms (ECGs) were collected for 5 min by using high-fidelity PC-based ECG hardware and software while subjects (n=21) rested comfortably. Raw data from the ECG system were securely transported via a secure network to a server where they were archived and processed. Authorized personnel performed both conventional ECG and A-ECG analyses from each digital recording, generating A-ECG "scores" in a blinded fashion. A separate cohort of firefighters (n=6) was trained to administer the A-ECG and rated the system's usability and frequency of technical problems. Results: Of the 21 uniformed personnel who completed testing, only 1 had a positive A-ECG score for coronary artery disease, which was subsequently confirmed by a cardiologist. All other subjects were classified as healthy by A-ECG. Firefighters trained to administer the A-ECG responded favorably in rating the usability of the system. Conclusions: We have demonstrated that a new technology, A-ECG, can be deployed for remote firefighter risk assessment being performed by firefighters themselves and interpreted centrally. This simple, time- and cost-effective approach can help identify individuals potentially at increased risk for line-of-duty death due to underlying cardiovascular disease.Telemedicine and e-Health 05/2014; 20(7). DOI:10.1089/tmj.2013.0321 · 1.67 Impact Factor
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ABSTRACT: The Wellness-Fitness Initiative submaximal treadmill exercise test (WFI-TM) is recommended by the US National Fire Protection Agency to assess aerobic capacity (VO2 max) in firefighters. However, predicting VO2 max from submaximal tests can result in errors leading to erroneous conclusions about fitness. To investigate the level of agreement between VO2 max predicted from the WFI-TM against its direct measurement using exhaled gas analysis. The WFI-TM was performed to volitional fatigue. Differences between estimated VO2 max (derived from the WFI-TM equation) and direct measurement (exhaled gas analysis) were compared by paired t-test and agreement was determined using Pearson Product-Moment correlation and Bland-Altman analysis. Statistical significance was set at P < 0.05. Fifty-nine men performed the WFI-TM. Mean (standard deviation) values for estimated and measured VO2 max were 44.6 (3.4) and 43.6 (7.9) ml/kg/min, respectively (P < 0.01). The mean bias by which WFI-TM overestimated VO2 max was 0.9ml/kg/min with a 95% prediction interval of ±13.1. Prediction errors for 22% of subjects were within ±5%; 36% had errors greater than or equal to ±15% and 7% had greater than ±30% errors. The correlation between predicted and measured VO2 max was r = 0.55 (standard error of the estimate = 2.8ml/kg/min). WFI-TM predicts VO2 max with 11% error. There is a tendency to overestimate aerobic capacity in less fit individuals and to underestimate it in more fit individuals leading to a clustering of values around 42ml/kg/min, a criterion used by some fire departments to assess fitness for duty. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: email@example.com.Occupational Medicine 01/2015; 65(2). DOI:10.1093/occmed/kqu189 · 1.03 Impact Factor