Hey….
Below is a report of interest that you may not have yet seen. We are trying our new Secret List format to see how well it "sends" in the body of this e-mail as we do not send attachments. See below on how to view the report if this doesn’t show up well for you.
During a 3-month period, volunteer firefighters serving Nassau and Suffolk counties in Long Island, NY, were asked to complete a non validated, 19-item questionnaire regarding their health habits, medical history, and demographics. 730 surveys were returned among a potential study population of 20,590 volunteer firefighters. More than three-quarters of respondents met the criteria for being overweight or obese, and nearly 40% reported having high blood pressure, high cholesterol, or both. Most respondents expressed at least some interest in attending a fire service sponsored health lecture and participating in a fitness program. Interesting stuff of interest to any Firefighter-volunteer and career.
Take a look below for all the details. NOTE: If this report doesn’t come thru well for you, we have also posted a PDF version of it on our home page, news and updates area.
BillyG
The Secret List 1-6-08 / 0844 hours
Self-Reported Cardiac Risks and Interest in Risk Modification Among Volunteer Firefighters: A Survey-Based Study
Patrick Scanlon, PA-C, DO; Elizabeth Ablah, PhD, MPH
From the Department of Preventive Medicine and Public Health at the University of Kansas School of Medicine-Wichita (Dr Ablah) and the New York College of Osteopathic Medicine of New York Institute of Technology in Old Westbury (Dr Scanlon), where Dr Scanlon was a student at the time of the study.
Address correspondence to Elizabeth Ablah, PhD, MPH, Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, 1010 N Kansas St, Wichita, KS 67214-3124. E-mail: [email protected]
Context: Coronary heart disease causes approximately 45% of firefighterdeaths annually. Although firefighters have clinically significant cardiacrisks, a paucity of research and data exists.
Objective: To evaluate firefighters’ cardiac risk factors aswell as their motivation to resolve these risk factors.
Methods: During a 3-month period, volunteer firefighters representingthe 79 fire departments serving Nassau and Suffolk countiesin Long Island, NY, were asked to complete a nonvalidated, 19-itemquestionnaire regarding their health habits, medical history,and demographics.
Results: A total of 730 surveys were returned among a potential studypopulation of 20,590 volunteer firefighters. More than three-quartersof respondents met the criteria for being overweight or obese,and nearly 40% reported having high blood pressure, high cholesterol,or both. Most respondents expressed at least some interest inattending a fire department–sponsored health lecture andparticipating in a fitness program.
Conclusion: Firefighters expressed desire to learn more aboutrisk factor modifications and have fire departments take a moreactive role in helping firefighters improve their health. Theeffectiveness of resources and intervention programs shouldbe assessed.
There are more than 1 million firefighters in the United Statestoday, 72% of whom are volunteers.1 Firefighting—by careerand volunteer firefighters alike—is physically demandingand necessitates good physical and cardiovascular fitness.2–4 Althoughall firefighters tend to be selected based on applicants’ physical fitness,cardiovascular health does not necessarily play a dominant rolein defining fitness, especially over time. Approximately 100firefighter deaths occur every year—excluding those thatoccurred on September 11, 2001—and about 45% of thesedeaths are caused by coronary heart disease.2
At a moment’s notice, firefighters are called to respond tovarious alarms that require considerable demands on their bodies,some of which require working at near maximal heart rates foran extended time.5 These physiologic changes, the increasedphysical load from their protective equipment, and psychologicalstressors can cause severe strain on a firefighter who is notphysically fit to perform his or her duties.6 One study7 indicated thatspecific duties (eg, fire suppression, alarm response) wereassociated with statistically significant risks of coronaryheart disease.
Even among firefighters who are apparently fit, the extremephysical demands of firefighting are still evident, especiallyin hot and smoky conditions.8 Firefighters’ cardiovascular fitnessis important not only to their own health and safety, but alsothe lives of other firefighters and victims in need of assistanceor rescue.
In considering cardiovascular f
itness, modifiable and nonmodifiablecardiac risk factors exist. Nonmodifiable risk factors includeage, family history, and sex.9 Modifiable risk factors includecigarette smoking, high blood pressure, high cholesterol levels,obesity, physical inactivity, and diabetes mellitus. Individualswith these risk factors are predisposed to increased morbidityand mortality.9 Firefighters can control their modifiable riskfactors through diet, exercise, physician follow-up, and propereducation about heart disease and its associated risk factors.
itness, modifiable and nonmodifiablecardiac risk factors exist. Nonmodifiable risk factors includeage, family history, and sex.9 Modifiable risk factors includecigarette smoking, high blood pressure, high cholesterol levels,obesity, physical inactivity, and diabetes mellitus. Individualswith these risk factors are predisposed to increased morbidityand mortality.9 Firefighters can control their modifiable riskfactors through diet, exercise, physician follow-up, and propereducation about heart disease and its associated risk factors.
The National Fire Protection Agency (NFPA) sets standards regulating appropriatehealth and wellness programs and medical requirements for paidand volunteer fire departments. For example, NFPA 1582 Section2-4.1.3 dictates that fire departments require firefightersto have medical evaluations within a specific time frame: every3 years for persons aged 29 years or younger, every 2 yearsfor persons aged 30 to 39 years, and every year for personsaged 40 years or older.10,11 These medical evaluations are designedto screen for and evaluate conditions that potentially couldcompromise an individual’s ability to function as a firefighter.12
Individual fire departments can impose more stringent requirementsfor their firefighters and require more frequent physical examinationsthan those outlined by the NFPA. In addition, firefighters havethe option of visiting their personal physicians for a physicalexamination under their own insurance. For example, a firefightermay be required by the NFPA and their department to have a physicalexamination once every 3 years, but he or she may choose tohave an annual examination with his or her personal physician.
The NFPA Section 3-7.110 outlines various cardiovascular medicalconditions that could compromise a person’s ability to functioneffectively as a firefighter (Figure). Category A conditionsare deemed clinically significant risks to the safety and healthof the individual firefighter or others. Category B conditions,based on severity, could disqualify a person from firefightingduties. For category B conditions, the evaluating physician—whethera firefighter’s private physician or a fire department physician—determinesthe severity of the condition and whether or not it would hindera firefighter’s performance.
Although it has been suggested that firefighters have clinically significantcardiovascular risks, a dearth of available research and dataon the topic exists. The present study was designed to evaluatefirefighters’ health, knowledge of cardiac risk factors, andmotivation to resolve these risk factors and improve their healthcaremaintenance.
Methods |
Long Island, NY, comprises two counties: Nassau and Suffolk.The volunteer fire service of Nassau and Suffolk consists ofapproximately 20,590 volunteer firefighters from 79 departments.During routine physical examinations at Long Island firehousesbetween September 2006 and December 2006, the primary investigator(P.S.) distributed and collected surveys from firefighters as theywaited to be examined. The Institutional Review Board at Kansas UniversitySchool of Medicine-Wichita approved the use of human subjects.
Although the 19-item volunteer firefighter survey was not validated,it was developed based on methods and findings produced froma literature review.13–16 It included six demographic questions:sex, age, weight (in pounds), height (in feet and inches), yearsin the fire service, and type of firefighter (interior, exterior,emergency medical services, or fire police).
Other items focused on medical history, current medications,physician follow-up, personal health insurance, cigarette use,alcohol consumption, and exercise. The firefighters were askedto express their level of interest (ie, "definitely interested,""somewhat interested," or "definitely not interested") and currentbehaviors regarding fitness programs, proper diet, and reductionof heart attack risk. They were also asked to identify fromfour choices the major cause of death among firefighters nationwide:automobile accidents, burns, heart attacks, or smoke inhalation.
Results |
We received 730 surveys within the 3-month period. Althoughthere were approximately 20,590 volunteer firefighters in LongIsland at that time, the total number of firefighters who hadthe opportunity to complete the survey but chose not to is unknownas a result of th
e "snowball" and convenience sampling techniqueused in the present study.
In the present study, 87.8% of respondents were men, 69.7% wereinterior firefighters, and 56.7% were aged 40 years or older (Table 1).Respondents reported length of service with a fire departmentranging from a few months to 57 years (mean [SD], 15 [13] years;median, 13 years; mode, 1 year). Respondents’ self-reportedweights and heights were used to calculate body mass indexes(BMIs). Although 136 respondents (18.6%) had a BMI that putthem in the "healthy" range, 301 (41.2%) had a BMI that classifiedthem as overweight, and 259 (35.5%) had a BMI that identifiedthem as obese.
In responding to the question, "Have you ever been diagnosedwith or are you currently being treated for any of the followingmedical conditions," 145 respondents (19.9%) indicated havinghigh blood pressure and 135 (18.5%) reported having high cholesterollevels (Table 2). Of these respondents, 62 reported having bothhigh blood pressure and high cholesterol levels. In addition,390 respondents (53.4%) had received an echocardiogram or cardiacstress test at least once.
Although most respondents (69.2%) did not indicate that theywere currently taking any medications, 225 (30.8%) did, of whom218 listed specific medications (Table 3). One respondent reportedtaking eight different medications. As self-reported among respondents,115 took miscellaneous medications (eg, for depression, gout,allergies), 114 took medication for high blood pressure, and80 took medication for high cholesterol levels.
Of the 327 (44.8%) respondents who reported participating inan exercise program, the mean (SD) number of hours each weekof self-reported exercise was 5.92 (4.119). Of the 129 respondents(17.7%) who reported that they currently smoke, the mean (SD)number of packs smoked per day was 1.06 (0.364). Of the 452respondents (61.9%) who reported consuming alcoholic beverages,the mean (SD) number of drinks per week was 4.69 (4.659).
Most respondents (637 [87.3%]) had their own health insurance,and nearly as many (602 [82.5%]) reported receiving "an annualphysical from a physician." Moreover, most firefighters (375[51.4%]) reported "follow[ing] up with a physician" once a year,143 (19.6%) reported doing so every 6 months, and 98 (13.4%)reported following up every 3 months or sooner.
As previously described, NFPA-required physical examinationsare distinct from those conducted by firefighters’ private physicians.In the survey, respondents were asked to report how often they"follow-up with a physician." If the NFPA guidelines for thefrequency of medical evaluations (eg, every 1, 2, or 3 years,according to age group) were applicable to firefighters "follow[ing]up with a physician," 44 respondents (6%) in the 17-to-29–yearage group, 73 (10%) of the 30-to-39–year age group, and88 (12%) of the group aged 40 years or older would not havebeen in compliance with the NFPA guidelines.
To address knowledge of heart disease among firefighters, thequestionnaire directed respondents to select the major causeof line-of-duty deaths among firefighters across the UnitedStates. Three-fourths (554 [75.9%]) of respondents selectedheart attacks; 78 (10.7%), smoke inhalation; 70 (9.6%), autoaccidents; and 18 (2.5%), burns.
The survey prompted respondents to address the roles of firedepartments in firefighters’ health. More than half of the respondents(423 [57.9%]) "strongly agreed" and 255 (34.9%) "somewhat agreed" thatfire departments should take a more active role in informingtheir members about the increased medical risks associated withtheir jobs. In fact, 325 respondents (44.5%) were "definitelyinterested" and 333 (45.6%) were "somewhat interested" in attending"a lecture regarding proper diet and exercise and reducing heartattack risk" if their departments would provide it. Moreover,415 (56.8%) and 292 (40.0%) reported being "definitely interested"and "somewhat interested," respectively, in participating ina fitness program if their departments provided it.
Comment |
The findings of the current study suggest that firefightersknow they are at high risk for cardiovascular disease. Althoughonly 10 firefighters reported having had a heart attack, morethan three-fourths of respondents had a BMI classification—auseful screening measure for the health and fitness of firefighters4—of overweightor obese. In fact, nearly 40% of the respondents reported having highblood pressure, high cholesterol, or both, and nearly one-thirdof the firefighters reported taking medications, most of whichwere to manage cardiovascular disease risks.
Our study yielded conclusions similar to those of other studies.17,18 Inthe present study, at least 90% of respondents favored firedepartments’ taking a more active role in informing its membersabout the increased medical risks associated with their jobs,would attend a department-organized lecture regarding properdiet and exercise and reduction of their risks of heart attack,and were interested in participating in a department-sponsoredfitness program.
Many respondents had cardiovascular disease risk factors, anda few even had previous cardiovascular incidents. Moreover,when returning their surveys, many firefighters reported tothe survey collector (P.S.) that they had difficulty decreasingtheir risk factors because of a lack of education about cardiovasculardisease or difficulty in receiving appropriate healthcare.
Although firefighters are required to have a regular physicalexamination, fire departments may not pay for the examination.Even if the fire department covers the cost of the physicalexamination, the
individual firefighter is responsible for payingfor any further tests or follow-up care, making it particularlydifficult for firefighters without health insurance.
individual firefighter is responsible for payingfor any further tests or follow-up care, making it particularlydifficult for firefighters without health insurance.
The present study substantiates the need for further healtheducation as most (657 [90%]) of the respondents reported havingat least some interest in learning more about how to decreasetheir cardiac risk factors. Firefighters’ reported desire tolearn presents an exciting opportunity for healthcare providersand public health advocates to partner with fire departmentsto improve access to resources, identify cardiac risk factors,and assist in modifying these risk factors.
In addition, fire departments must take a more proactive approachto ensure that their firefighters are healthy.14 They couldprovide lectures, seminars, and counseling to begin or enhance firefighters’education about cardiovascular disease. A physical fitness programat a local health club or a firehouse gymnasium could allow firefightersto improve their physical fitness. The NFPA does recommend that firedepartments have a fitness program, which may vary from havinga gym on the firehouse premises or reimbursing for personaltrainers or weight loss programs. Although some fire departmentsincluded in the current study had some form of fitness programin place, specific information was not collected because ofthe amount of variance among programs.
Resources are available, including those provided by PredictiveAdvanced Cardiovascular Evaluation (http://www.pacecardio.com), theAmerican Heart Association (http://www.americanheart.org), andWebMD (http://www.webmd.com), to address cardiovascular diseaseamong a number of populations and can be applied to the fireservice. Moreover, although 635 (87%) of the firefighters inthis study reported having health insurance, fire departmentscould contact local government officials about health insurancesupplementation for those without insurance. Fire departmentofficers could also contact local physicians to establish areferral base for firefighters who do not have a primary carephysician.
Certain limitations to the present study exist. For example,all data collected in the current study were self-reported.No objective data, such as blood pressure readings or levelsof high-density lipoprotein, low-density lipoprotein, totalcholesterol, triglycerides, or glucose, were collected. However,because of the number of respondents in the current study, whichwas considerably higher than those in similar studies,16,17,19 collectingobjective data might be more difficult. Also, although objective datawould be useful, self-reported data have value, especially regarding interestin department-sponsored education or exercise initiatives.
In addition to including objective data, the survey instrumentwould benefit from further clarification, such as a clear definitionof how much alcohol constitutes one drink. Respondents may ormay not have had an accurate understanding of alcohol content,so further explanation would increase the accuracy of the answerto this question. However, even with these limitations, thesurvey provides important data on the lifestyles and risk factorsof firefighters.
Another potential limitation of the present study is that thefindings cannot be generalized beyond the Long Island geographicregion. Even so, our study has identified a relatively largepopulation interested in receiving educational resources, andthis in itself is valuable.
Conclusion |
The findings of this study suggest that coronary heart diseaseand its associated risk factors are prevalent in the fire service.Moreover, volunteer firefighters are generally aware of thepotential risk of cardiovascular disease in their occupationand are interested in learning more about risk factor modification.
Future research should evaluate firefighters’ knowledge, behaviors,and intentions regarding risk factors after a lecture or intervention.It is important for the health and safety of firefighters andthe communities they serve for fire district commissioners orfire chiefs to provide resources and interventions for theiremployees and volunteers. Effectiveness of resources and interventionprograms among this population should also be evaluated for futureuse and potential guidelines.
