Now that I have completed my third year with the Los Angeles Fire Department and my second year of writing for Fire Chief, I thought I would take this opportunity to share a wellness plan built for the future. I was going to wait until our wellness plan was fully implemented, but instead I've decided to advance the timeline and share it earlier in the hopes that it will stimulate thoughts of how wellness can work in other departments.

I will be presenting this plan to the LAFD and the city. I think city officials need to understand the complexity of the issue and appreciate the effect they can have on reducing the workers' compensation bill they pay. After three years, I have gained a significant amount of experience and insight into the fire service, and together with my “partner in wellness,” Debbie Brown, have assembled a 10-point wellness plan (four points evaluation and six points implementation) that's built for the present and the future. It will require a department to be brave, intelligent, bold, risk-taking and decisive, just as we expect our members to be when they're out on the fireline. Should we ask anything less of ourselves on this decision that not only affects us, but our families and those we serve?

The wellness plan we propose is intended to make practical sense to management, labor and city officials. It can be stepped up in its complexity and rigor, but these are the minimum guidelines.

Here are the steps for the four-point department evaluation:

1. Identify and total the worker compensation costs of doing business, including injuries and cardiovascular disease. Also, recognize the factors relating to the costs of doing business, such as obesity, lack of appropriate exercise and age.

2. Evaluate your injuries. For example, in the last 10 years, our costs and number of injuries have been significantly higher. Just like many departments, 75% of our injuries are due to back, neck and shoulder injuries, and 75% of our back injuries are to members over 40. How many of your department are over 45 or females over 55?

3. Evaluate your cardiovascular disease risk. The risk of cardiovascular disease increases with age, especially over age 45 for males and 55 for females. High blood pressure, a primary cause of death in firefighters, is two times higher when one is obese. Stop and ask the question: Is the cardiovascular disease related to the job or is it more a factor of lifestyle, such as lack of exercise and obesity? Is the city footing the workers' comp bill for a choice in lifestyle? How many of your members are at higher risk because of age?

4. Evaluate your department's obesity and overweight status. Skip the mathematical equation: Just type body mass index into your computer's Internet search index and select a Web site that will calculate it for you. Remember:

• An excess of 10 to 20 pounds increases the risk of death in adults 30 to 64 years of age.

• Obese people have a 50-100% increased risk of premature death from all causes compared to people of healthy weight, and

• The risk of Type II diabetes is doubled with a gain of 11 to 18 pounds.

How many of your members at higher risk of cardiovascular disease are compounding their risk by being overfat? Here's a more important thought: How many members under the age of 45 are overfat and getting an early start on their cardiovascular disease? Here's the six-point implementation plan:

1. Establish mandatory comprehensive medicals. From this you will know if your members are healthy enough to exercise safely and you may identify medical problems in the early stages.

2. Create a 100-members program foundation. Establish a quarterly fitness test for your department. These can be simple or very elaborate. Articles I wrote in 2001 describe the test which includes timed push-ups, sit-ups, modified pull-ups, step test and flexibility. [Ed.: Visit <www.firechief.com> for 2001 Fitness Issues columns.]

   Randomly select 100 fully active members representing rank, assignment and gender from the age group of 40 to 55 years of age. The age selection is important, as you will see. Take the fitness scores of these 100 members and this will be your 100 members program foundation. Every three years, randomly select a new group of 100 fully active members. If your program is effective, earning full support and accountability by everyone from the rookie to the fire chief, the foundation will continually be more fit and stronger.

3. Wear fitness recognition awards on uniforms. A fitness star is awarded to members who meet the average of the 100 members foundation's fitness scores and a BMI of less than 28. Zero to six stars are possible.

   To earn fitness elite status, a member should achieve one standard deviation above the average of the 100-members foundation on all of the fitness test categories plus a BMI of less than 25 and a value of 15 METS (52ml/kg/min) (predicted aerobic capacity/fitness) on the step test. This is about 50% greater than the NFPA minimum recommended for recruits and incumbents and about 15% higher than the accepted recommendation for being fit for firefighting. Fitness recognition can be determined at yearly division or department evaluations.

   With the foundation being re-established every third year, the standards for fitness recognition will become increasingly higher. Remember, these are members 40 to 55 years old so this is achievable for all members. Do you think someone wants to walk around without any stars? Is this member or his or her crew at risk?

4. Work fitness evaluation. One standard deviation below the average of the 100 members foundation on all fitness tests or less than 10 METS (NFPA minimum) or greater than 30 BMI, indicates obesity. If one or more these conditions are present, a work fitness evaluation is conducted to determine if there is a medical issue.

   If no medical issue is present, the member trains with wellness program support to remove the designation. If the member is unable to improve sufficiently, the member is placed on light duty with 90 minutes of exercise required under the supervision of the wellness program.

   How long can this member be carried on light duty while he or she works on their physical fitness? In the initial two years of your wellness program, it could be for a substantial period of time, but as the program is implemented, eventually this individual will improve or be eliminated.

5. Condition of employment. Like smoking, lack of exercise and obesity have been cited as causal factors related to heart disease. A rookie should be required to meet the average of the 100 members foundation as well as MET value of 12-13 (accepted recommendation for being fit to fight fires) and BMI of 28.

   Ability to retain fitness declines with age. The condition of employment will be based on 100 members foundation values. A 20-year-old rookie can look ahead to 35 years of a fulfilling career with proper care. As the 100 members foundation changes due to increased departmental fitness, new rookies meet the new average value with same MET and BMI values. Previous-year rookies, now incumbents, meet the foundation numbers of their year of employment.

   The condition of employment is up to the department. It may be days off, loss of dessert (that's a joke), loss of promotion, etc. Again, this should not be a problem with fitness recognition and fitness evaluations and accountability. Additionally, the rookie is fully aware of the conditions as they sign up to join the department.

6. All members shall participate in mandatory exercise, on duty. If you do it correctly, your members won't “have to exercise,” they will demand exercise.

Finally, share your evaluation and implementation plans with city officials and allow your department to be held accountable. We can control our own destiny. Good luck.

An exercise physiologist at California State University, Northridge, Steven Loy was hired by the Los Angeles Fire Department to develop an exercise program as their wellness coordinator. His columns will recount his experiences there from the combined perspective of a fitness consultant and a tax-payer.