Cardiovascular Disease in US Firefighters: A Systematic Review

According to a study titled “Cardiovascular disease in US firefighters: a systematic review” by Soteriades et al. (2011), coronary heart disease (CHD) accounted for approximately 45 percent of on-duty mortality in the US. The figures have not changed because the National Fire Protection Association (NFPA) reported that in 2015 alone, 68 firefighters perished while on duty out of which 31 of the deaths resulted from cardiac arrest (Fahy, LeBlanc, & Molis, 2015). Regarding percentages, the figure represents 45.5% which is slightly higher than the rates reported by Kales et al. back in 2011. Moreover, several studies (Smith, Barr & Kales, 2013; Dumas et al., 2012; Yang et al., 2013) have shown that exposure to smoke, psychological stressors, and physical exertion among firefighters have increased chances of cardiovascular-related diseases. With the existing literature, this term paper will entail discussion of heart disease problem among firefighters, causes of cardiac arrest and effects of the issue, how the problem is dealt with and strategies in place for overcoming the negative consequences of cardiovascular-related diseases.

Cardiovascular Disease (CVD)

To understand the problem (heart disease among firefighters) a summary of the functioning of the cardiovascular system follows. The system consists of heart and blood vessels (capillaries, veins, and arteries) that transport both oxygenated and deoxygenated blood through the body. However, CVD or cardiac arrest (heart attack) is a medical condition or disease that alters the normal functioning of the cardiovascular system.  Also, firefighters are a symbol of protection and hope in any community. These specialists (both volunteers and career experts) come to the rescue of other citizens in an emergency situation whenever one occurs. The emergency situations are random and lack proper simulation as they come with varying magnitude and variations. For this reason, firefighters respond to conditions that are unique and daring. Thus increasing their chances of a cardiac attack. A firefighter who has reached the age of 40 years and above are prone to cardiac arrest as reported by Fahy, LeBlanc, & Molis (2015).

Causes of Cardiac Arrest

In general cardiac attack occurs when one or more arteries of the heart (coronary arteries) of a person become blocked. The blocking results from rupture of the artery due to blot clot caused by deposition of cholesterol at the point of rapture (Dumas et al., 2012). Also, the blockage result from continuous narrowing of the lumen of the heart arteries as a result of buildup fat in the lumen. The other cause of heart attack is the spasm of the heart arteries which end up restricting the flow of blood to some parts of the heart muscles. Thus when the muscles lack oxygen supplied in the blood the heart suddenly stops (a condition referred to as cardiac arrest).

The relationship between firefighting activities and CVD is that in all situations firefighters respond to emergency after an extended period of inactivity or in the middle of a strenuous physical training activity. For the case of a long time of inactivity, obesity or buildup of fats take place thus increasing the chances of the cardiac attack. While in the case of a strenuous physical training chances of coronary artery bursting are increased (Fahy, LeBlanc, & Molis, 2015). As several studies have shown, chances of firefighters perishing on duty as a result of CVD are higher compared to the rest of the population. Therefore, the primary cause of heart attack amongst firefighters is exposure to smoke, pressure exertion, rapid response to alarms and strenuous actual or training activities.

Effects of CVD on Societies and Employers

In Europe, CVD is the leading killer accounting for 42% of males and 52 of females’ mortalities annually (Byrne et al., 2015). In economic terms, CVD cost the European Union more than £ 196 billion per annum (Nichols, Scarborough & Rayner, 2013). Also, in the US, 30% of medical expenditure goes to cardiovascular diseases management (American Heart & Stroke Association, 2011). As with any other organization, firefighting agencies face a tremendous loss of workforce when they have to give long sick leaves to their employees whenever they are diagnosed of CVD. The result of more days off results into low productivity and reduced human resources. From the activities carried out by firefighter numbers count and if even one team member is out on leave, the remaining partners have to experience more pressure. Besides, the agency will have to spend more resources on training additional workers in the situation which they lost their employees through the sudden cardiac attack.

Further, CVD accounts for more deaths worldwide as compared to other related diseases. The consequences are mostly experienced by the family members of the victims. Once an individual test positive of CVD their life expectancy reduces resulting in changes in the structure of the family. In this regard, the individual who in some case was the breadwinner will have to part with most of their resources in containing the medical condition (Fahy, LeBlanc, & Molis, 2015). In summary, once a family is affected due to CVD, the entire society will eventually feel the effect and undergo changes. Also, firefighting agencies are part of a community and whatever affects the society directly or indirectly affect their operations and setup.

Strategies in Combating the Negative Impacts of CVD

In the US, wellness programs have been instituted by the federal and local governments all over the country. Also, community health and wellness centers have been put in place in all states (Cardiovascular Disease in the United States). The programs are aimed at battling a variety of CVD related issues (risk factors) such as lack of exercise (which may result in obesity), poor diet, smoking, and alcoholism. These programs have online platforms where various users interact in reward-based health tasks. The activities include attaining set target for intake of calories, body mass index (BMI) and healthy body weights, regular exercising and attending a medical examination by a certified doctor.

In Europe and the rest of the world, strategies to combat CVD include surveilance by WHO, implementation of smoke-free zones, bans and high tax rates on tobacco-related adverts, psychological interventions (such as motivational interviews and cognitive behavioral therapy), health education programs and population-based dietary salt reduction. These measures set by WHO must focus on preventive activities and strengthening inter-sectoral collaboration (Low, Lee & Samy, 2015).

Conclusion

In as much as the CVD mortality rate for firefighters in Europe and the US are as high as 45% on average, several interventions are put in place to combat CVD. Some of the strategies highlighted include dietary salt reduction, regular exercising, taxation of alcohol and cigarettes. Firefighting undertakings involve heavy strenuous work, adverse environmental conditions and sympathetic arousal which are associated with hyperthermia and dehydration linked with CVD.

References

American Heart & Stroke Association. (2011). Critical coverage for heart health: Medical and cardiovascular disease. Retrieved November 6, 2017, from heart.org: http://www.heart.org/idc/groups/heart-public/@wcm/@adv/documents/downloadable/ucm_428187.pdf

Byrne, R. A., Serruys, P. W., Baumbach, A., Escaned, J., Fajadet, J., James, S., ... & Sianos, G. (2015). Report of a European Society of Cardiology-European Association of Percutaneous Cardiovascular Interventions task force on the evaluation of coronary stents in Europe: executive summary. European heart journal, 36(38), 2608-2620.

Cardiovascular Disease in the United States. (n.d.). Retrieved November 6, 2017, from sites.google.com: https://sites.google.com/a/cornell.edu/cardiovascular-disease-in-the-united-states/solutions-implementation.

Dumas, F., White, L., Stubbs, B. A., Cariou, A., & Rea, T. D. (2012). Long-term prognosis following resuscitation from out of hospital cardiac arrest: role of percutaneous coronary intervention and therapeutic hypothermia. Journal of the American College of Cardiology, 60(1), 21-27.

Fahy, R., LeBlanc, P., & Molis, J. (2015). Heart attacks leading cause of firefighter deaths in 2015. NFPA Journal, 1-3. Retrieved November 6, 2017, from http://www.nfpa.org/news-and-research/publications/nfpa-journal/2015/july-august-2015/features/firefighter-fatalities.

Low, W. Y., Lee, Y. K., & Samy, A. L. (2015). Non-communicable diseases in the Asia-Pacific region: prevalence, risk factors and community-based prevention. International journal of occupational medicine and environmental health, 1-7.

Nichols, M., Townsend, N., Scarborough, P., & Rayner, M. (2013). Cardiovascular disease in Europe: epidemiological update. European heart journal, 34(39), 3028-3034.

Smith, D. L., Barr, D. A., & Kales, S. N. (2013). Extreme sacrifice: sudden cardiac death in the US Fire Service. Extreme Physiology & Medicine, 2(1), 6.

Soteriades, E. S., Smith, D. L., Tsismenakis, A. J., Baur, D. M., & Kales, S. N. (2011). Cardiovascular disease in US firefighters: a systematic review. Cardiology in review, 19(4), 202-215.

Yang, J., Teehan, D., Farioli, A., Baur, D. M., Smith, D., & Kales, S. N. (2013). Sudden cardiac death among firefighters≤ 45 years of age in the United States. The American journal of cardiology, 112(12), 1962-1967.