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EMT Corner
Taken straight from the heart
Volume 25 Summer

Cardiac arrest now leads the list as the greatest risk to professional firefighters? Greater than smoke, carbon monoxide or any other danger present at the fire scene. How did that happen? The answer is simple. For years we preached about air packs and scene safety. Today, fire officers are better trained about not placing firefighters at risk. What got past us in the drive to better protect firefighters is something called "exertion stressors" that lead to cardiac arrest from undiagnosed heart disease. Its closest competitor for killing firefighters is getting run down by inattentive drivers.

A report by the Center for Disease Control and Prevention acknowledges that fire fighting is a physically demanding way to make a living.

"Fire fighting activities require firefighters to work at near maximal heart rates for long periods," a CDC report states. "An increase in heart rate typically occurs in response to the initial alarm and persists throughout the course of fire suppression activities."

Continual stressors, often unacknowledged by the individual, continue to be a reality in fire suppression and rescue. This is not an isolated issue but appears to be the norm across the ranks. It’s time for chief officers to pay attention to NFPA 1582.

NFPA manual 1582 lays out the standards for medical evaluations of line personnel. The standards are designed to "reduce the risk of sudden cardiac arrest or other incapacitating medical conditions among fire fighters." It also recommends that asymptomatic individuals more than 45 years old receive annual stress and exertion testing to detect the presence of coronary artery disease (CAD) if they have related identifiable risk factors (i.e. hypertension, diabetes, high cholesterol, smoking, family history, etc.). It is also recommended that all extinguishment personnel have annual medical evaluations and be cleared by a physician knowledgeable about the:

• physical demands of fire fighting,

• personal protective equipment worn by line personnel, and

• requirements of NFPA 1582.

The physician is the final word on the readiness and ‘fitness’ of individuals for the rigors of extinguishment and rescue (this includes the usage of SCBA). NFPA 1582 goes on to add that wellness programs should be developed to "reduce risk factors for cardiovascular disease and improve cardiovascular capacity."

So where does this leave firefighters? In reality this is going to be a total mess in the end. Firefighters diagnosed with coronary artery disease may be unfit for the rigors of firefighting and may not get clearance from attending physicians. The only remedy for these individuals may be reassignment to non-rigorous job categories or out and out retirement on occupational disease disability pensions. This also could be contested by municipalities on the grounds that certain risk factors may not be job related and the resultant CAD may not qualify for an occupational disability if risk factors determine it is not job related.

Well, pensions and reassignment aside, who is going to pay for all of these medical checkups and tests to determine suitability? Who is going to pay for the wellness programs mandated by NFPA 1582 (ref. NFPA 1583, Standard on Health-Related Fitness Programs for Fire Fighters)? This is going to be a major issue for municipalities facing across the board budget cuts (and don’t think emergency services are immune to the budget axe). Municipal managers across the country face huge reductions in funding due to the economic slump with no end in sight. Industrial fire brigade monies may be cut when company profits nosedive and CEO’s face serious operational issues. Really, do you think a 30 percent drop in company valuation is going to help industrial firefighters?

The costs to implement 1582 are going to be staggering. Employee turnaround may also be affected. Losing veterans who fail to pass medical screening can seriously effect operations and staffing. This disqualification may affect even younger employees, meaning less than 45 years of age, the cut-off for age related screening as outlined in 1582. What happens to younger employees who, after receiving medical evaluation, show signs of possible unsuitability. How will this affect smaller, volunteer or fire protection districts running on scant or self-raised funding for all of their operations?

This is another example of a mandate unsupported by funding. Saving firefighters from certain death with a mountain of regulations (ok, maybe NOT a mountain) will result in demands that may cripple some agencies. Now, am I against all of 1582 (and 1583)? No, not at all! But who is going to write the check? I’m all for protecting the Brothers and Sisters from, what is now, the second leading cause of duty related deaths. Just like we would lobby for adequate manpower on apparatus, and proper and well fitting PPE (helmets, turnout coats, boots, etc), we need to make the job as safe as possible. But some of the unfunded provisions of 1582 could break the bank. If you want to set standards, someone has to figure out how to pay for these brilliant ideas behind them. In the end it all comes down to the almighty dollar.

William R. Kerney is a professor of emergency medicine at the College of Southern Nevada in Las Vegas, NV. Contact him at


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