It’s no secret that firefighters face many health and safety risks in their line of work, which is why it’s of the utmost importance for both the fire services industry and individual departments to do everything in their power to keep their firefighters safe.

One of the biggest long-term risks for firefighters is cancer. A multi-year study conducted by the National Institute for Occupational Safety and Health (NIOSH) found that firefighters had a 9% increase in diagnoses and a 14% increase in cancer-related deaths over the entire U.S. population. While the statistics are alarming, there are ways to mitigate these risks.

What can departments do?

Firstly, prevention is key. Educate and train your firefighters on proper decontamination procedures and enforce the use of PPE throughout the duration of each incident. Afterwards, ensure the complete removal of contaminants through effective cleaning methods, such as wet-soap decontamination and commercial wipes. You should also proactively provide annual physicals and cancer screenings for your entire department.

According to a recent study from ESO, decontamination procedures were only documented in 82% of all working fires incidents, and out of those exposures, only 4%  documented all on-scene decontamination procedures. This leaves significant room for improvement. Documenting any and all decontamination is incredibly important, because it allows departments to keep tabs on firefighters that have experienced the most exposures and provide additional healthcare monitoring and increased screening for early cancer detection.

What can the industry do?

By tracking and documenting exposures of firefighters on a national level, we can analyze data to better understand the risks that firefighters are taking. Sharing your own department’s health and exposure data with organizations such as the National Firefighter Registry can help researchers study exposures and their correlating illnesses. This research can help to create better informed best practices, legislation, and guidelines, while also helping to innovate and advance firefighting equipment, suppression tools, and construction materials.

The focus on firefighter health extends beyond January– it’s a year-round priority. Implementing tools like ESO Insights allows fire departments to monitor and document decontamination exposure, helping them take proactive measures to protect their crew’s health.

For more insights that help keep your firefighters safe, download the ESO Fire Index today, or request a copy of the full ESO firefighter decontamination study here.

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Closing the gap 

Through data, ESO is working to identify areas in which we can improve outcomes for all patients. One of these areas is assessing patients with ED-diagnosed strokes. While stroke assessment is documented 38% of the time for patients overall, it is only documented 32% of the time for Hispanic/Latino patients. There are steps to take to work towards closing this gap, such as not prioritizing a set list of symptoms as “normal EKG” and recognizing atypical presentations across different patient populations.  

EMS services can proactively work to improve how they communicate within their communities. Does your department have interpreter policies, interpretation tools, charting standards, and quality assurance reporting to properly assist patients with limited English proficiency? When you’re creating educational resources, are you considering the different languages within your community? The “AHORA” stroke screening tool is a great example of this. The Spanish translation of the “BE-FAST” tool, AHORA, has been effective in helping to improve stroke symptom awareness in Spanish-speaking communities.  

Working towards better detection 

Another area ESO has identified as an opportunity to improve is how EMS services detect a possible STEMI or NSTEMI with a 12-lead EKG. Pre-hospital detection can ensure that the catheterization laboratory is ready by the time the patient arrives, saving precious minutes that can lead to a better outcome. Currently, conventional EMS education tends to center symptoms of a STEMI or NSTEMI for males as “typical” and females as “atypical.” This may unintentionally prioritize 12-lead EKGs in males and create a higher likelihood of failing to recognize symptoms in females.  

To combat this, it’s important to review agency protocols around its use for patients with suspected STEMI or NSTEMI. Research has shown that occurrence of false positive prehospital EKGs is low, while also showing that early identification improves patients outcomes. So be ready to perform and transmit 12-lead EKGs for basic life support units as well as those with advanced life support capabilities.  

Documenting 12-lead EKG in discrete data fields, such as under procedure or vital sign, rather than only in the free-text narrative can also help to ensure better monitoring and improvement initiatives. Then, tracking the outcomes for all patients diagnosed with STEMI or NSTEM, rather than just providing feedback for suspected cases can identify any delays in diagnosis that are hindering care. 

In order to improve patient outcomes overall, ESO is studying disparities across the board, including those happening outside of the EMS and hospital settings. One area we found in need of improvement is bystander CPR. Of the 86,000 patients that suffered cardiac arrest before EMS arrival last year, 25% received bystander CPR. For Black or African American patients, that number was even lower at 18%.  

Improving the numbers

So how can EMS services work together to improve these numbers? Working with organizations like the American Heart Association to offer education, AED training, and CPR training at local high schools and in the general community is a good first step, especially in communities with low rates of bystander CPR. EMS services can also partner with places of gathering within their communities such as grocery stores, places of worship, and athletic facilities to increase access to AEDs. 

Addressing disparities within healthcare will not be a quick solution, but a series of changes big and small over time. It is EMS services’ responsibility to their patients to put in this work and create a better system for us all. Prioritizing the hiring, retaining, and promoting front-line employees, senior staff, and executive board members who reflect the demographics of their communities is a step in the right direction. As well as creating a paid advisory board filled with community members from a variety of different racial and ethnic backgrounds to help advise their agencies on how to overcome the challenges and barriers their EMS clinicians face within their services

For more insights on improving patient care based on industry data, download the ESO EMS Index today. 

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Here are 9 of the most common incidents that turn into potentials PTEs: 

• Serious injury or line of duty death 
• Suicide of a co-worker 
• Death or serious injury to a child 
• Prolonged failed rescue 
• Multi-casualty incident disaster 
• Victim is known to the responder 
• Any incident where personal safety of the responder is jeopardized 
• Incidents with excessive media interest 
• Any incident with an unusually strong emotional component.  

Putting mental health front and center 

Work to proactively provide training for EMS clinicians based on the latest evidence for PTEs. You should also educate on the importance of mental health and train on the signs of PTSD, stress disorders, and addiction to empower your clinicians to recognize and reach out to those in distress around them. Ensure to create clear policies regarding no tolerance for bullying and harassment to create an atmosphere that promotes respect and fairness.  

Recognize the importance of peer-to-peer relationships and build a supportive atmosphere that includes trained supervisors, managers, and administration, as well as the availability of trained mental health professionals. Share importance resources such as the National Suicide Prevention Lifeline (1-800-273-TALK [8255]) and www.pocketpeer.org. For EMS services, consult the 2022 Public Safety Officer Support Act, which provides line of duty benefits for EMS clinicians who experience PTSD as a result of exposure to critical incidents. 

Documentation is key  

Since you can’t predict what will turn into PTEs, and each person reacts differently to the same critical events, it is important to document each and every one. Then follow up with those who made reports. Considering 75% of fire records didn’t include any documentation of critical incidents whatsoever, there’s a major opportunity here for improvement. 

For more insights and best practices for keeping your firefighters and clinicians safe, download the ESO Fire and EMS Indexes today.

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While it might seem common sense that a firefighter’s duties are particularly hard on the body, it is a bit more surprising that many firefighters are unknowingly suffering from underlying cardiovascular disease.

In fact, new research in Journal of the American Heart Association shows that a large percentage of firefighters who died from cardiac arrest also showed signs of atherosclerotic and hypertensive heart disease at autopsy, undoubtedly contributing to their chances of a fatal cardiac event.

Lifestyle Challenges

So what are the factors in a firefighter’s life that make heart disease such a common risk?

While the job of a firefighter – especially when it comes to fire suppression – is extremely physical, the shift work and busy lifestyle can also hamper the opportunities for regular, proactive exercise. Surprisingly, studies show that the obesity rate for firefighters is in the range between 73-88 percent, actually higher than the general population. And even more concerning are recent studies reflecting that the number of “severely obese” firefighters is rising, with one in 10 firefighters falling into this category.

Studies point to lifestyle factors like shift work and sleep disruption as directly contributors to obesity. Additionally, poor eating habits around the firehouse – like snacking on high carbohydrate snacks or higher fat meals – add to the challenges. In response, organizations like Food on the Stove have formed to specifically support healthier eating habits in firehouses. Operated by firefighters, the organization utilizes certified nutrition therapists to provide tools and resources for supporting healthier lifestyles, heart healthy eating practices, and fitness activities.

Pushing Your Body to Its Limits

The connection between on-duty deaths and heart disease stem from the body’s reaction to stress and exertion, specifically when it relates to fire suppression. According to a recent article by Fire Engineering citing numerous scientific studies, the risk of a heart attack in unhealthy firefighters increases anywhere from 10-100 times compared to performing non-emergency tasks. Additionally, even though active fire fighting makes up only approximately one to five percent of a firefighters’ total time on the job, 32 percent of fatal cardiac events occur either during or after participation in active fire suppression.

Studies have shown that during a fire suppression activity, a fire fighter’s resting heart rate nearly doubles, core body temperature rises at least 2ºF, systolic blood pressure rises, and tension and anxiety increase. Additionally, blood platelet and coagulation properties increase dramatically and remain elevated for hours after the fire, suggesting what causes so many fatal heart attacks during and after fire suppression activities.

Additionally, the common experience of sleep interruption and being woken from a deep sleep has been linked to elevated heart rates and symptoms of chronic stress exposure. Other studies suggest a connection between heart disease and shift work, specifically working in a night shift setting. While some people appear to more easily adapt to shift schedules, others experience problems sleeping and a wide range of health problems including heart problems.

Knowing the Enemy is Half the Battle

So while it seems that firefighters have the deck stacked against them when it comes to increased risk factors, the good news is that, according to the American Heart Association (AHA), is that the risk of heart disease can be greatly reduced by simple lifestyle changes.

A key element is the very first step: schedule a physical and have all your key vitals recorded. This is the easiest way to identify any red flags that may be silently damaging your health. Then, you can focus on the AHA’s “Life’s Simple 7.”

1. Manage Your Blood Pressure: Nearly half of American adults have high blood pressure and don’t know it, due to the fact that there are very few symptoms. Reducing your blood pressure helps reduce the strain on your heart, arteries, and kidneys, which keeps you healthier longer. Tips for reducing blood pressure include eating a well-balanced diet that’s low in salt, limiting alcohol, enjoying regular physical activity, managing stress, and maintaining a healthy weight.
2. Control Cholesterol: High cholesterol contributes to plaque, which can clog arteries and lead to blockages, heart disease, and stroke. Again, healthier lifestyle choices, diet, and weigh management can all help improve cholesterol readings.
3. Reduce Blood Sugar: Most of the food we eat is turned into glucose (or blood sugar) that our bodies use for energy. Over time, high levels of blood sugar can damage your heart, kidneys, eyes and nerves. Many studies show that lifestyle changes, such as losing weight, eating healthy and increasing physical activity, can dramatically help manage proper blood sugar levels.
4. Get Active: Living an active life is one of the most rewarding gifts you can give yourself and those you love. Daily physical activity increases your length and quality of life, and can most definitely help you do your job as a firefighter more efficiently.
5. Eat Better: A healthy diet is one of your best weapons for fighting cardiovascular disease. When you eat a heart-healthy diet, you improve your chances for feeling good and staying healthy. It can be challenging to eat healthy at the station, but helping your crew stay healthier can benefit your overall outcomes and help save lives on your own team.
6. Lose Weight: Losing extra pounds reduces the burden on your heart, lungs, blood vessels, and even skeleton. Obesity in the firehouse can mean underperformance, more missed work days, and increase injuries. Losing weight not only helps you look better, but perform your job more effectively and for more years.
7. Stop Smoking: Cigarette smokers have a higher risk of developing cardiovascular disease. In the 1990s, the rate of smoking with firefighters was around 50 percent; today, studies show it’s in a much lower range between 7 to 13 percent. Quitting smoking can be a real challenge, but the benefit to your health is undeniable.

A firefighter’s job is undoubtedly dangerous enough with the obvious and present dangers faced with each entry into a fire suppression activity. However, the silent killer of cardiac disease appears to have a much greater impact than most would imagine. With focused, active efforts and a shift to focusing more on firefighter health, the number one threat to today’s firefighters can be greatly reduced.

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