Article

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

ABSTRACT

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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    • "Typically, an auditory alarm will sound, at any time of the day or night, alerting personnel to the type and location of the incident to which they are responding (Barnes, 2000). The majority of existing research in the area of alarm response focuses on physiological risks to the individual, particularly to cardiovascular (CV) health (Kales et al., 2003, 2007). The primary risk associated with alarm response is hypothesized to be the sudden increase in heart rate in response to the alarm itself, followed by a period of strenuous physical activity (Barnard and Duncan, 1975; Karlsson et al., 2011; Kuorinka and Korhonen, 1981). "
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    • "Therefore, acute immune–endocrine relationships observed in the current study could be an early indicator of chronic, firefighterrelevant health outcomes associated with dysregulation to these systems. For instance, high levels of depression have been reported among firefighters (Carey et al. 2011; Cook and Mitchell 2013; An et al. 2015), while fire suppression activities were associated with an increased risk of death from coronary heart disease (Kales et al. 2007). Short-term elevations in HPA axis and immune activity have also been related to acute changes in mood (Kemeny 2007; Vgontzas et al. 2008). "
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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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