Emergency Duties and Deaths from Heart Disease among Firefighters in the United States

Cambridge Health Alliance, Harvard Medical School, Cambridge, MA 02139, USA.
New England Journal of Medicine (Impact Factor: 55.87). 04/2007; 356(12):1207-15. DOI: 10.1056/NEJMoa060357
Source: PubMed


Heart disease causes 45% of the deaths that occur among U.S. firefighters while they are on duty. We examined duty-specific risks of death from coronary heart disease among on-duty U.S. firefighters from 1994 to 2004.
We reviewed summaries provided by the Federal Emergency Management Agency of the deaths of all on-duty firefighters between 1994 and 2004, except for deaths associated with the September 11, 2001, terrorist attacks. Estimates of the proportions of time spent by firefighters each year performing various duties were obtained from a municipal fire department, from 17 large metropolitan fire departments, and from a national database. Odds ratios and 95% confidence intervals for death from coronary heart disease during specific duties were calculated from the ratios of the observed odds to the expected odds, with nonemergency duties as the reference category.
Deaths from coronary heart disease were associated with suppressing a fire (32.1% of all such deaths), responding to an alarm (13.4%), returning from an alarm (17.4%), engaging in physical training (12.5%), responding to nonfire emergencies (9.4%), and performing nonemergency duties (15.4%). As compared with the odds of death from coronary heart disease during nonemergency duties, the odds were 12.1 to 136 times as high during fire suppression, 2.8 to 14.1 times as high during alarm response, 2.2 to 10.5 times as high during alarm return, and 2.9 to 6.6 times as high during physical training. These odds were based on three estimates of the time that firefighters spend on their duties.
Certain emergency firefighting duties were associated with a risk of death from coronary heart disease that was markedly higher than the risk associated with nonemergency duties. Fire suppression was associated with the highest risk, which was approximately 10 to 100 times as high as that for nonemergency duties.

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    • "Male firefighters are among the top three occupational groups with the highest obesity prevalence in the US (Carban et al. 2005; Choi et al. 2010; Haddock et al. 2011). As a result, overweight and obesity is an important occupational health issue to be urgently addressed for the 1.1 million US firefighters (Haddock et al. 2011) who are at high risk of on-duty cardiovascular disease (CVD) mortality (Geibe et al. 2008; Kales et al. 2007) and musculoskeletal injuries (Jahnke et al. 2013; Poplin et al. 2012). "
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    ABSTRACT: Purpose: This study aims to examine whether body mass index (BMI) overestimates the prevalence of overweight or obese firefighters when compared to waist circumference (WC) and skinfold-based percent body fat (PBF) and to investigate differential relationships of the three adiposity measures with other biological cardiovascular disease (CVD) risk factors. Methods: The adiposity of 355 (347 males and 8 females) California firefighters was assessed using three different measures. Other CVD risk factors (high blood pressure, high lipid profiles, high glucose, and low VO2 max) of the firefighters were also clinically assessed. Results: The prevalence of total overweight and obesity was significantly (p < 0.01) higher by BMI (80.4%) than by WC (48.7 %) and by PBF (55.6 %) in male firefighters. In particular, the prevalence of overweight firefighters was much higher (p < 0.01) by BMI (57.3%) than by WC (24.5%) and PBF (38.3%). 60%-64% of male firefighters who were assessed as normal-weight by WC and PBF were misclassified as overweight by BMI. When overweight by BMI was defined as 27.5 - 29.9 kg/m2 (vs. the standard definition of 25.0-29.9 kg/m2), the agreement of the adiposity classification increased between BMI and other two adiposity measures. Obese firefighters had the highest CVD risk profiles across all three adiposity measures. Only when overweight by BMI was defined narrowly, overweight firefighters had substantially higher CVD risk profiles. Obesity and overweight were less prevalent in female and Asian male firefighters. Conclusions: BMI overestimated the prevalence of total overweight and obesity among male firefighters, compared to WC and skinfold-based PBF. Overweight by BMI needs to be more narrowly defined or the prevalence of BMI-based overweight (27.5 to 29.9 kg/m2) should be reported additionally for prevention of CVD among male firefighters.
    International Archives of Occupational and Environmental Health 07/2015; DOI:10.1007/s00420-015-1082-6 · 2.20 Impact Factor
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    • "A high incidence of obesity in paramedics was also reported in an American study by Tsismenakis et al (2009), in which one-third of 370 paramedics ≤30 years of age were obese and, compared with a reference population not actively engaged in sports, had only average physical fitness. Other American studies involving populations of professional and volunteer firefighters (Kales et al, 2007; Maguire et al, 2002; Soteriades et al, 2005) arrived at similar results. Higher incidences of excess body weight and obesity, as well as low levels of physical fitness, are not found only in members of the rescue corps. "
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    ABSTRACT: Purpose: The purpose of the present study was to compare the physical fitness levels of a group of paramedics with the fitness levels of similarly aged student paramedics and individuals in the general population of the Czech Republic. Methods: The present research was performed using a group of 42 professional paramedics, and 32 undergraduate students specializing in paramedics. All subjects underwent spiroergometry tests. Results: Professional paramedics had significantly greater body weight and significantly higher percentage of body fat than men in the corresponding age groups of the Czech population. Physical fitness levels of paramedics were comparable with the general population. The mean oxygen consumption (VO2max) was 36 in the group <30 years of age; 39.8 in the group 31 to 35 years of age; and 31.1 in the group >36 years of age. The student paramedics demonstrated higher mean levels of physical fitness (VO2max 47 compared with the group of professional paramedics. Conclusion: Professional paramedics exhibited significantly greater body weight and body fat percentages than the control group. Their physical fitness level ranged from average to below average. To preserve work effectiveness and a good state of health, lifestyle interventions and establishing physical fitness criteria for paramedics are needed.
    Wulfenia 03/2015; 22(3):205-2012. · 1.31 Impact Factor
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    • "Hence, the heat stress is resulted by the external radiant heat in addition to the body metabolic heat. The heat stress faced by the firefighters has been reported by several researchers (Faff and Tutak 1989; Cheung et al. 2000; McLellan and Selkirk 2004; Kales et al. 2007; Cheung et al. 2010). Various approaches can be adopted for reducing the heat stress, which includes passive recovery (Selkirk et al. 2004; Carter et al. 2007; Barr et al. 2009), the use of extractor fans (Carter 1999), misting fans (Selkirk et al. 2004), immersion of hand and forearm in water (McTiffin and Pethybridge 1994; House 1996) and combined cooling (Barr et al. 2008; Barr et al. 2009). "
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    ABSTRACT: Fire-fighters’ personal protective clothing is the only source of protection for fire-fighters during fire-fighting. The protective clothing should provide adequate protection as well as should be comfortable to wear. The protection and comfort requirements are always the contradicting fact in several protective clothing including fire-fighters’. Appropriate material selection, clothing design and final evaluation of the results play a critical role in predicting the clothing performance and comfort. Several researches have been done on the performance and comfort improvement of fire-fighter’s protective clothing. However, detailed review related to these parameters is not being reported in recent years. In this perspective review, we report the recent trends in the performance and comfort properties of the fire-fighters protective clothing. The clothing design and different materials used to achieve a balance between performance and comfort is illustrated. Various test standards related to the performance and comfort is also being discussed. In addition, the future scopes and challenges while designing tomorrows advanced protective clothing are cited. This would provide a guideline in terms of comfort and performance while developing and designing the fire-fighter protective clothing for different climatic conditions. Keywords: Fire-fighters’ protective clothing; Test standards; Heat stress; Performance; Comfort
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