THURSDAY, April 27, 2006 (HealthDay News) -- Fires don't kill American firefighters as much as heart attacks do.
A new government study has found that sudden cardiac death is the leading cause of death in the line of duty for both volunteer and career firefighters.
Traumatic injuries from motor vehicle crashes while responding to an emergency were a close second for volunteers, said the report, which appears in the April 28 Morbidity and Mortality Weekly Report, a publication of the U.S. Centers for Disease Control and Prevention.
The real message, though, is that these causes are preventable and that things can be done to reduce the risk.
"The leading cause of death is sudden cardiac death, and we can reduce these risks by having fitness programs and annual physicals," said Marilyn Ridenour, co-author of the report and an epidemic intelligence officer with the CDC's National Institute for Occupational Safety and Health. "Fire departments should consider mandatory annual fitness exams for firefighters, and seat-belt use and safe-driving practices. That should help reduce these risks," she said.
"We do have standards, but we need implementation and adherence to the standards," said Rita Fahy, manager of fire databases and systems at the National Fire Protection Association in Quincy, Mass. "A lot of it comes down to behaviors."
According to Ridenour, the findings are consistent with previous data.
Fahy agreed. "The results are fairly consistent from year to year," she said. "Heart attack or sudden cardiac death is the major cause of firefighter death. Crashes would come in second. Speed and failure to wear seat belts are the most frequently cited contributing factors."
An earlier study had reported that, for the past 25 years, heart attacks have typically caused the most deaths among firefighters. However, as awareness of heart disease and prevention has increased, the number of deaths attributed to heart attacks has dropped by more than one-third, the report found.
There are 800,000 volunteer firefighters in the United States and 300,000 career firefighters. Volunteers tend to serve smaller communities (fewer than 25,000 residents), while career firefighters serve larger communities.
For the new study, Ridenour and her colleagues analyzed data from the U.S. Fire Administration, which keeps a database of all on-duty firefighter deaths based on death certificates and fire department interviews. On-duty firefighter deaths include all those that occur within 24 hours after a response to a call.
From 1994 to 2004, 610 volunteer and 368 career firefighters died while on duty, 97 percent of them male. The median age was 47 years for volunteers and 44 years for career firefighters.
Half of the deaths among volunteer firefighters were from heart attacks and 26 percent from motor vehicle-related trauma. Almost three-quarters (73 percent) of motor vehicle-related deaths were caused by crashes, 30 percent of which involved private vehicles. Eighty percent of the crashes occurred en route to calls, while 5 percent occurred during returns.
Among career firefighters, 39 percent of deaths were caused by heart attacks; 29 percent from other causes, such as burns, cerebral vascular accident or drowning; and 20 percent by asphyxiation (mostly from being caught or trapped).
In both categories of firefighters, most heart attacks occurred among people aged 45 to 54. The majority were attributed to stress and overexertion for both volunteers (98 percent) and professionals (97 percent).
The study also provided details of two particular fatalities, one of a volunteer and one of a career firefighter.
On July 28, 2003, two volunteer firefighters responding to a trailer fire sped down a two-lane road at about 80 miles per hour in a privately owned vehicle with emergency lights on. The speed limit was 55. The driver lost control when the vehicle drifted off the pavement. He was killed, and the passenger sustained serious injuries. The fire department required that firefighters obey local traffic laws.
In the second case, a 51-year-old career captain collapsed while responding to a fire in the attic of a two-story dwelling. An autopsy revealed that the man had cardiovascular disease. He had also suffered a heart attack 13 years prior and had undergone angioplasty of his right coronary artery. According to the article, under these circumstances, the captain should have been issued work restrictions.
And there are initiatives under way. The International Association of Fire Fighters (IAFF) has just started a new program to reduce vehicle crashes.
"A lot of that is education and changing the culture of firefighters," said Patrick Morrison, IAFF's health and safety director.
As for heart attacks, Morrison said, "Some of them are preventable; for some, we don't have the proper early screening and detection." Many cardiac stress tests, for example, only pick up when the person already has a 75 percent blockage, he said.
"We need to know if there are tests that will work earlier," Morrison said.
The National Institute for Occupational Safety and Health has recommendations on protecting firefighters.