With a staggering 51 percent of all firefighting line of duty deaths caused by sudden cardiac events, the epidemic presents itself as the No. 1 firefighting fatality.

The dangers of the firefighting profession are never in short supply. Smoke inhalation, burn injuries, car accidents, collapses – just a few of the perils that routinely handcuff themselves to the day-to-day operations of the job.

But there’s another hazard that’s quietly lurking below the radar causing more damage but receiving substantially less attention: sudden cardiac events. With a staggering 51 percent of all firefighting line of duty deaths caused by sudden cardiac events, the epidemic presents itself as the No. 1 firefighting fatality, more than any other fire-related danger combined.

Denise Smith, professor for health and exercise science at Skidmore College in Saratoga Springs, N.Y., is leading the crusade against fire service-related cardiovascular diseases. Citing studies that suggest the cardiovascular disease risk factors in firefighting are similar to those of the general population, Smith poses the question: If a firefighter’s basic cardiovascular disease risk isn’t greater than the rest of the population, why are they so much more likely to die at work?

The answer may lie in the magnitude of the cardiovascular strain they experience during their jobs.

For example, a person not involved with the fire service may harness a similar cardiovascular risk but is unlikely to do work that is as strenuous as a firefighter. More importantly, Smith asks, “are we doing enough to prevent sudden cardiac events in firefighters?”

Smith believes there is an abundance of cases where firefighters are being cleared for duty following a medical evaluation that includes findings of cardiovascular risk. This is due in large part because of the physician’s lack of understanding of the physiological and psychological strain of the job.

“In my mind, every firefighter should have a medical evaluation by a physician who understands the stressful nature of the job. Sometimes firefighters go to physicians who say ‘you are kind of in normal shape’ and clears them for duty, but doesn’t understand how stressful the job is.”

Denise Smith, Professor for Health and Exercise at Skidmore College (N.Y.)

Therein lies the problem: Firefighters are being cleared for duty despite the detection of early signs of cardiovascular diseases.

“The firefighter hears ‘I’m cleared for duty, therefore everything is OK,’ but very often those medical evaluations are doing exactly what they should be by detecting early signs of cardiovascular disease or risk factors but the firefighter is failing to follow up because he’s cleared,” said Smith.

Further complicating the issue of medical evaluations are departments that operate in a very black and white manner when it comes to firefighters being cleared for duty. Because of this, physicians are reluctant to take a firefighter off the job because of something like high blood pressure. This results in leaving treatment in the hands of the firefighter and puts them at greater risk if something is not done.

Simply put: Firefighters should receive appropriate medical evaluations and aggressively address risk factors – and departments should provide a comprehensive wellness and fitness program to help them do so, Smith believes.

In some cases, firefighters should be placed on light duty until health issues can be properly addressed. But what constitutes justifiable risk to remove a firefighter from active duty?

Smith suggests that a proper annual medical evaluation is a great place to start, but emphasizes that findings of hypertension, obesity, or diabetes/prediabetes must be taken seriously with accompanied steps to reduce the risk of further progression. Sudden cardiac events account for half of duty-related deaths and close to 1,000 non-fatal events every year.

Ignoring the risk makes no sense, she said.

“I think the possibility of a guy coming off active duty in order to rehabilitate to get those risk factors down to do the job more effectively and safely is a very reasonable approach,” said Smith.

As for what initial health risk factors should take priority, Smith suggests that elevated or borderline cardiovascular levels, especially prehypertension and prediabetes, should be taken more seriously. Too often are these issues seen as minor when, in fact, they’re constituting an exuberant medical risk.

While some may be intimidated by mandated health programs that place greater emphasis on managing a wide array of cardiovascular issues, Smith says the goal should be to turn these programs into a positive message as a way to avoid devastating health incidents.

“Prevention is the most powerful thing that’s largely within a firefighter’s own control,” Smith said. “A firefighter who has good overall health and is exercising, maintaining a normal body weight and eating healthy is the one who’s most protected from cardiovascular disease and cancer.”

“These are largely solvable issues and can be addressed and mitigated by the actions of firefighters to keep themselves healthier.”

  • This article was written by Greg Baldwin of TargetSolutions after an in-depth interview with featured contributor Denise L. Smith.

About the Contributor

Denise L. Smith, Ph.D., is a Professor of Health and Exercise Sciences at Skidmore College where she directs the First Responder Health and Safety Laboratory, and a Research Scientist at the University of Illinois Fire Service Institute. Dr. Smith has co-authored an Exercise Physiology and an Advanced Cardiovascular Exercise Physiology textbook. Dr. Smith has published more than 50 scientific papers and has received funding from FEMA-AFG, DHS S&T, NIOSH and DOD to pursue her research agenda. She is a member of the National Fire Protection Association (NFPA) Fire Service Occupational Safety and Health committee, and she regularly conducts fatality investigations for the National Institute of Occupational Safety and Health (NIOSH).