Cardiovascular disease (CVD) is a leading cause of Line of Duty Deaths (LODDs) and off-duty deaths among fire fighters.

Fire departments can take steps to reduce the risk of heart attacks and other cardiac events among fire department members. The National Institute for Occupational Safety and Health recommends the following:

• Ensure fire fighters understand the importance of wearing respiratory protection during all phases of fire fighting— from initial attack through overhaul.
• Provide mandatory annual medical evaluations to ensure members are capable of performing job tasks with minimal risk of sudden incapacitation.
• Ensure that physicians conducting the annual medical examinations are knowledgeable about the physical demands of fire fighting, the essential job tasks of fire fighting, and the consensus guidelines developed by the fire service [NFPA 2007].
• Ensure medical clearance for full-duty fire suppression and SCBA use is conducted by either (1) the fire department physician or (2) the primary care physician as previously noted. The medical clearance letter should state what essential job tasks the fire fighter can, and cannot, perform [NFPA 2007].
• Develop a comprehensive wellness/fitness program for fire fighters to reduce risk factors for CVD and improve cardiovascular capacity. The NFPA and the IAFF/IAFC documents can provide guidance.
• Encourage fire fighter participation in the fire department’s wellness and fitness program.
• Ensure a smoking cessation program is included in any wellness program.
• Ensure that all fire stations and other fire department facilities are non-smoking facilities.
• Place and maintain AEDs on all fire department apparatus that are not equipped and staffed for manual defibrillation.
• Train fire fighters on the proper use of AEDs.
• Remind emergency department personnel and medical examiners to perform carboxyhemoglobin testing on all fire fighters who experience a cardiac arrest.
• Implement a comprehensive hearing conservation program which contains the following components: hazard identification and reduction, use of personal hearing protection devises, periodic audiograms, and fire fighter training on hearing conservation [Tubbs 1995].

During Fire Suppression and Training Operations:

• Control exposure to carbon monoxide and other fire contaminants through proper management of the fire scene and proper use of respiratory protection.
• Ensure adequate staffing levels for operations to prevent over-exertion and/or heat stress.
• Provide light weight equipment and personal protective gear to prevent over- exertion and/or heat stress of the fire fighter.
• Provide on-scene rehabilitation to monitor vital signs for indication of excessive cardiovascular strain, and to cool and hydrate the fire fighter.
• Ensure standby emergency medical care is available with transport capability.

For additional information, check out the NIOSH report Preventing Fire Fighter Fatalities Due to Heart Attacks and Other Sudden Cardiovascular Events.