Health and medical issues have become increasingly important to the North American fire service.

Firefighters and fire service managers know all too well how the medical and physiological demands of firefighting have changed as personal protective equipment has improved, as firefighters encounter “super bugs” in the community and as the physical and mental requirements for being a member of the firefighting community have increased.

There are two programs that will have more impact on the general health and physical well-being of the fire service than anything else in the foreseeable future: the IAFC/IAFF Wellness-Fitness Initiative and NFPA 1582, Comprehensive Occupational Medical Program for Fire Departments.

The Wellness-Fitness Initiative is a cutting-edge program initially developed and implemented by 10 fire departments in North America. Aside from the tremendous collaboration between the fire chiefs and the firefighters, the initiative created an integrated, multidisciplinary approach to management of firefighter health and fitness for duty. This comprehensive program had focused relevance to the fire service.

The Wellness-Fitness Initiative is a comprehensive program. A detailed approach to medical requirements, tangible physical fitness goals, and the concept of job-specific rehabilitation after illness and injury are provided to firefighters and fire service leadership. A complete behavioral health component also is included in the initiative. This program provides excellent service to firefighters and early detection of treatable disease while helping us develop a better picture of what contributes to the health of the North American firefighter community.

NFPA 1582, Comprehensive Occupational Medical Program for Fire Departments, is a natural extension of the Wellness Fitness Initiative. NFPA 1582 provides a comprehensive approach to health and medical services for the firefighter.

The standard offers an extensive overview of the medical evaluations of firefighters, occupational medical evaluation of firefighters, the occupational fitness evaluation of members and the need for job-specific rehabilitation. The medical detail in the document gives a department's fire chief and medical staff elaborate, complete recommendations for the medical evaluation of the firefighter.

NFPA 1582 also helps chiefs integrate medical professionals into the fire department. The standard has specific recommendations about what the physician needs to know to best apply the science and art of medicine to the fire service's medical and health needs.

Extensive guides

These two documents provide extensive guides for the fire service community. The medical details and direction needed to manage most of the health and medical concerns of the North American fire service are provided by these two programs.

According to the NFPA standard, “The most vital resource of any fire department is its members. This standard is to be implemented in a process aimed at improving member health and wellness. Due to the hazardous nature of the occupation, methods to reduce the risk of occupational injury, illness, and exposures to communicable diseases are warranted.

“Annual reports repeatedly indicate over 100 line-of-duty deaths and 100,000 occupational injuries and illnesses among career and volunteer fire fighters. Another concern is the fire fighters who experience disabling injuries or develop occupational diseases and conditions, which often have debilitating or fatal results, forcing them to leave their fire service activities. There is an increased risk of respiratory and heart disease in fire fighters and emerging evidence of a link to some cancers and other conditions related to occupational exposures to carcinogens, toxic products of combustion, and hazardous materials.

“Safety and health are two of the many components of the risk management process. The intent of this standard is to reduce the risk and burden of fire service occupational morbidity and mortality while improving the welfare of fire fighters. By implementing the medical requirements of this standard, a fire department commits to a process that evaluates and enhances the health and fitness for duty of members.”

These two programs help us get this done. Both documents provide an extensive overview of medical and fitness evaluations and the need for job-specific rehabilitation of the firefighter. Additionally, NFPA 1582 and the Wellness-Fitness Initiative emphasize the need for health data on firefighters as a group. As a profession, how are our cholesterol levels? How is our blood pressure? Is our body mass index consistent with good health?

The last several years of the Wellness-Fitness Initiative have focused on the individual and personal health. We must now begin the analysis of our workgroup. This can be done in a manner that preserves confidentiality for the individual, but provides the health care professionals with the information we need to improve the community health of firefighters. The knowledge acquired from the group will help provide better medical and health services for the individual.

Metabolic syndrome

This roadmap for improved firefighter health has been created as the medical community developed a better understanding of the significant interrelationship between hypertension; high cholesterol; central obesity; glucose intolerance, which leads to diabetes; and premature heart disease, which leads to death.

This collection of separate diseases has been lumped together into the metabolic syndrome. The metabolic syndrome ties together at a physiological level those medical diagnoses that previously were noted to occur in the same patient but without a physiological link. A firefighter can have each medical problem without the others, but when he or she has several of these medical problems, the diagnosis changes. This is important, because it can help to define prevention and treatment of previously disconnected medical problems.

The metabolic syndrome is being identified as one of the major causes of premature disability and death in our country, and certainly the fire service will not be immune to the effects of this syndrome. Despite this complex interaction of medical issues, much of the prevention and non-drug treatment involves changes in diet, physical fitness and termination of cigarette smoking. Where these preventative measures have been started, there has been an improvement or reduction in the number of people who have or will develop metabolic syndrome.

The changes in diet stress increased consumption of whole grains, fresh fruit and vegetables. The reduced consumption of saturated fats found in red meat and dairy products is also part of the diet. Of course, not taking the second helping and staying away from processed foods are emphasized. These lifestyle changes are the backbone of prevention of the metabolic syndrome.

My personal compromise to prevent the metabolic syndrome is to substitute soy-based products for meat and dairy products. Tofu that has been cut into very small chunks and then browned in a frying pan can take the place of meat in any chili recipe. The flavor and texture are virtually identical to a meat-based chili.

The Wellness-Fitness Initiative and the Comprehensive Medical Program for Fire Departments provide the fire service with powerful tools for enhancing the health and fitness for duty of all firefighters. Our mutual obligation is to use these tools and the information obtained from them.

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Dr. Franklin D. Pratt, FACEP, has been the medical director of the Los Angeles County Fire Department since 1989, overseeing policy and practice relating to any medical services used by or rendered by the department. He responds to local emergency incidents as the medical director and nationally as a member of FEMA US&R Task Force CA-TF2. Pratt serves on the NFPA 1710, Career Deployment and Staffing, and NFPA 450, Emergency Medical Services, Technical Committees. After graduation from the University of Chicago Medical School in 1981, Pratt completed residency training in emergency medicine and internal medicine at Harbor — UCLA Medical Center in Torrance, Calif. He subsequently was board-certified in both specialties, and from 1985 until 1989 he was a member of the full-time faculty in the medical center's Department of Emergency Medicine. Pratt was appointed a medical director of the Torrance Memorial Medical Center Emergency Department in 1994. He can be reached at drpratt@lacofd.org.