NIOSH Firefighter Fatality Investigation and Prevention, and NIOSH Division of Surveillance,

Hazard Evaluations, and Field Studies. Preventing Fire Fighter Fatalities Due to Heart

Attacks and Other Sudden Cardiovascular Events. Cdc.gov. N.p., June 2007. Web. 4 Apr.

2018. <https://www.cdc.gov/niosh/docs/2007-133/pdfs/2007-133.pdf>.

Fire Departments should take the following steps to
reduce on-duty heart attacks and other sudden
cardiovascular events:
 Provide medical evaluations to ensure that
candidates and members are capable of
performing job tasks with minimal risk of
sudden incapacitation.
 Ensure that physicians conducting the medical
evaluations are knowledgeable about the
physical demands of fire fighting, the
essential tasks of fire fighting, and the
consensus guidelines developed by the fire
service.
 Implement a comprehensive wellness/fitness
program for fire fighters to reduce risk factors
for CVD and improve cardiovascular
capacity.
 Ensure adequate staffing levels for operations
to prevent over-exertion.
In order to prevent/reduce the risk of cardiovascular
events the employer should: provide physicals for all
employees that evaluate their physical health to the
extent of them being able to do their jobs. These
physicals should be performed by doctors who are
trained/have experience with the effects of the job on
a firefighter. The employer should provide resources
necessary for the firefighter to stay physically fit
which reduces the risk for cardiovascular disease.
Make sure that you are not understaffed.
Understaffing issues causes staff to be overworked
and over-exerted.

Coronary artery disease among fire fighters is Cardiovascular disease can be caused by a number of
due to a combination of personal and workplace different factors. Everyone is generally well aware of
factors. The personal factors are well the personal factors such as age or family history.
known: age, gender, family history, diabetes However, most people do not realize to what extent
mellitus, hypertension, smoking, high blood workplace factors play a role in cardiovascular
cholesterol, obesity, and lack of exercise disease among firefighters.
[AHA 2007]. Not as widely known, however,
is that fire fighters have exposures to workplace
factors that are associated with adverse
cardiovascular outcomes. Fire departments
have a responsibility to implement
effective prevention programs for workplace
risk factors for cardiovascular disease.
Carbon monoxide, a by-product of incomplete One gas that is commonly breathed in by firefighters
combustion, is present in virtually all is carbon monoxide. It is pretty much unavoidable
fire environments. A number of studies have since it is in basically every fire that occurs. Many
quantified a fire fighter’s exposure during previous studies have shown that when you inhale
various phases of fire suppression [Gold large amounts of this gas it can result in a lack of
1978; Brandt-Rauf 1988; Jankovic 1991]. oxygen and cause cardiac injury.
High concentrations of carbon monoxide
have been documented not only during
knockdown, but also during overhaul when
fire fighters frequently remove their self contained
breathing apparatus (SCBA) [Bolstad-Johnson
2000]. If inhaled, carbon monoxide
disrupts the blood’s transport of, and
intracellular use of, oxygen [Ernst 1998].
The resulting hypoxia can cause myocardial
injury [Satran 2005].
Hydrogen cyanide is formed during the incomplete Hydrogen cyanide is another gas commonly inhaled
combustion of substances containing by firefighters. This gas is common in every
carbon and nitrogen (e.g., paper, cotton, firefighters favorite structure fire. Previous studies
wool, silk, plastics, etc). Hydrogen cyanide have shown that high levels of this gas cause a lack
frequently has been detected in structure of oxygen that can result in cardiac issues just like
fires and levels have been shown to exceed with carbon monoxide.
established exposure limits [Jankovic 1991;
Brandt-Rauf 1988; Gold 1978]. Like carbon
monoxide, hydrogen cyanide disrupts the
intracellular use of oxygen, resulting in intracellular
hypoxia with cardiac manifestations
[Purser 1984].
Fire fighters have significant exposure to fire Smoke particulate matter is something that
smoke particulate matter during fire suppression firefighters are also exposed to. This is very
[Treitman 1980; Brandt-Rauf 1988]. dangerous, especially for those who already have
Studies in the general population suggest cardiac issues. Studies have shown that short term
particulate matter, as a component of air exposure to this particulate matter has been known to
pollution, has cardiovascular effects [Brook cause heart attacks in those who have existing cardiac
2004]. For example, long-term repeated issues.
exposure to elevated concentrations of particulate
matter has been associated with cardiovascular
mortality and the initiation/progression
of atherosclerosis [Dockery 1993;
Pope 2002, 2004]. In addition, short-term
exposure to fine particulates has been associated
with triggering heart attacks, particularly
among people with pre-existing heart
disease [Peters 2001; Pope 2006]. These
findings have implications for the fire service
given fire fighters’ exposure to fire smoke
particulate matter [Treitman 1980].

Fire fighters react to these emergency It is common for firefighters to respond to a call and
calls with an increase in their heart rates, jump into action when they may have been sitting
probably due to a surge in sympathetic nervous around doing nothing. Because of this, every time the
system activity (e.g. the flight or fight alarm sounds, there is an increase in their heart rates
response) [Barnard 1975; Kuorinka 1981]. because they are going from a resting state to a
The increase in heart rate frequently persists “running” state. Studies have shown that this pattern
through the course of fire suppression of resting followed by surges of exertion is a
activities; a finding not surprising given the suspected cause of putting firefighters at higher risk
heavy physical demands of structural fire for acute heart attacks.
fighting [Lemon 1977; Hurley 1980; Manning
1983; Guidotti 1992; Smith 1995].
The pattern of sedentary periods interrupted
by catecholamine surges and heavy physical
exertion has been suspected to put fire
fighters at increased risk for acute heart attacks.
Epidemiologic studies in the general
population report that heavy physical exertion
sometimes immediately precedes and
triggers the onset of acute heart attacks and
sudden cardiac death [Willich 1993; Mittleman
1993; Siscovick 1984; Tofler 1992;
Albert 2000].
Heat stress and heat illnesses are well recognized Fire fighters run in and out of extreme temperatures
hazards of fire fighting. Fire suppression every day. Studies have shown that when the body
can increase body temperature fails to regulate its temperature and heat stroke
resulting in sweating and fluid loss, which occurs, the risk for heart arrhythmias and ischemia is
can cause serum electrolyte changes, lower increased.
stroke volume (the volume of blood pushed
during each contraction of the heart), or
lower cardiac output [Rossi 2003; Smith
2001; Costrini 1979]. Heat stroke has been
reported to increase the risk of myocardial
ischemia, arrhythmias, and conduction abnormalities
[Akhtar 1993].
Several studies suggest a modest association Many studies show that it is important for firefighters
between rotating shifts (e.g., a week of to stay on their assigned shift for shiftwork since
days, a week of evenings, a week of nights, there is a certain number of days on/off and in
with weekends off) and heart disease between their 24 hour shift. It has been shown that
[Steenland 2000]. Because most career fire working 24 hour shifts can lead to hypertension,
departments work 24-hour shifts and volunteers stressful conditions and increased heart disease.
fire fighters do not work shifts at all,
these findings may have limited application
to the fire service. A 24-hour shift, however,
is long, stressful, and fatiguing. The literature
also suggests long hours can increase
blood pressure and lead to increased heart
disease, independently of other stressful
conditions at work [Steenland 2000].
Fire fighters with medical conditions presenting a If a firefighter already has medical problems that can
risk for sudden incapacitation pose a hazard to lead to cardiovascular problems they are a risk to not
themselves, their co-workers, and civilians. Medical only themselves but also their co-workers and those
evaluations can diagnose these medical conditions. who they are trying to save. This is why it is
The fire service recommends medical evaluations and recommended that firefighters have medical
participation in comprehensive fitness and wellness evaluations regularly performed to detect these issues
programs to reduce the number of on-duty CVD and prevent further issues from occurring.
fatalities.

USFA survey that report 76% of fire departments The majority of fire departments did not have
lacked programs to maintain basic fire fighter fitness programs available to keep their employees fit and
and health [USFA 2006]. Obvious barriers Fire healthy. Many reasons this happens is because of
Fighter Fatalities to implementing these programs are cost, being able to maintain members, and problems
costs, job security issues, and (for voluntary fire with job security.
departments) maintaining a critical number of
members. Additional research is needed to identify
factors that can lower these barriers, thereby reducing
the number of on-duty fire fighter fatalities due to
CVD.