The good news is that based on the most recent NFPA report on firefighter fatalities, 2019 was the year with the lowest firefighter fatalities, 48. However, for us at MedicineWithout, 48 is 48 too many1.
What may come as a surprise to many is that Sudden Cardiac Death has been the most common cause of on-duty firefighter death since 1977, with 22/48 deaths this past year due to sudden cardiac events.
NFPA 2019 Report
I know what some of you firefighters out there are thinking. This is where we start nagging you about physical fitness requirements, diet, exercise, and the like. Our goal here isn’t to nag, but rather to educate you and help you make informed decisions. Hear us out. What you read below, will give you a better understanding of why firefighters die sudden cardiac deaths and just might save your life.
Why does it happen?
Pathophysiologically, the American Heart Association published a study based on autopsy data from 1999-2014 in male firefighters aged 18-65 who died while on duty. In this study, an “on-duty fatality” was defined as, “any injury or illness sustained while on duty that proved fatal, which included illness resulting from a sudden cardiac event or stroke within 24 hours of a training activity or emergency response, regardless of whether or not the firefighter complained of illness while on duty”. The study authors then compared the hearts of those who died from cardiac causes (276 cases) and those who died from non cardiac trauma related causes (351). They found two main things: 1) coronary heart disease and 2) Left ventricular hypertrophy (LVH)/cardiomegaly.
Where do coronary heart disease and LVH/cardiomegaly come from?
First: A lot of it comes from the nature of firefighting itself. Check out the figure below: 
Figure:Smith DL, Barr DA, Kales SN. Extreme sacrifice: Sudden cardiac death in the U.S. Extreme Physiol Med. 2013;2(1):6.
Second, it comes from your individual fitness. Are you Mission Ready?
Odds are, you are not. 77-90% of firefighters are either overweight or obese! 20-30% have high blood pressure! More than 20% of firefighters have dyslipidemia!3
Does it happen to any other first responders?
Sadly, yes. In a study of over 4500 deaths of US police officers between 1984 and 2010,, sudden cardiac death accounted for 10% of all on-duty deaths.
So far, I have not been able to find any data on sudden cardiac death in EMS personnel. If any of you are aware of any studies on this topic please send them along to us!
What can we do to prevent sudden cardiac death?
The best thing we can do is minimize cardiovascular risk factors. What does that mean?
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Get fit!
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Get fit!
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Get fit!
The best way to prevent sudden cardiac death is to always be mission ready. Make sure that you are familiar with the medical requirements of being a firefighter as defined under NFPA 1582 and that your organization has a health and fitness program that meets the standards of NFPA 1583.
Don’t know where to start on a fitness program?
Try these two resources:
The International Association of Fire Chiefs/IAFF Fire Service Joint LaborManagement Wellness-Fitness Initiative
National Volunteer Fire Council’s Heart-Healthy Firefighter Program
https://www.nvfc.org/programs/heart-healthy-firefighter-program/
What else can we do?
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Make healthy meals in the firehouse
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Provide annual medical examinations
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Monitor firefighters for 24 hours after incidents.
Stay safe out there!
References
1. National Fire Protection Association. Firefighter fatalities in the United States. https://www.nfpa.org/News-and-Research/Data-research-and-tools/Emergency-Responders/Firefighter-fatalities-in-the-United-States.
2.Smith DL, Haller JM, Korre M, Fehling PC, Sampani K, Grossi Porto LG, Christophi CA, Kales SN. Pathoanatomic Findings Associated With Duty-Related Cardiac Death in US Firefighters: A Case-Control Study. J Am Heart Assoc. 2018 Sep 18;7(18):e009446. doi: 10.1161/JAHA.118.009446. PMID: 30371185; PMCID: PMC6222959.
3. Smith DL, Barr DA, Kales SN. Extreme sacrifice: Sudden cardiac death in the U.S. Extreme Physiol Med. 2013;2(1):6.
4. Varvarigou V, Farioli A, Korre M, Sato S, Dahabreh IJ, Kales SN. Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study. BMJ. 2014 Nov 18;349:g6534. doi: 10.1136/bmj.g6534. PMID: 25406189; PMCID: PMC4240529.
5.
https://www.jems.com/training/calling-attention-to-firefighter-incident-rehab/