Everyone looks healthy in Breckenridge, Colo. This resort town located at 9,700 feet in the Rocky Mountains is a center for outdoor sports: hiking, mountain biking, running, river rafting, mountain climbing and, of course, world-class skiing. Walk down the street during any season and you'll encounter families, young adults and retired people who all look like they just finished a 10k run.
Members of the Red, White and Blue Fire Department are no exception. This career department of around 40 members includes many who first came to Colorado for the skiing or the scenery and found their calling as firefighters. The department is young, with an average age of 32, and members pride themselves on their skills, readiness, and physical fitness and health.
One role model in all these areas was Barry Niebergall, a veteran firefighter with more than 25 years of service in Summit County. At 56, Niebergall was one of the oldest firefighters on the job, but he prided himself on setting an example for the younger members. He also was deeply committed to staying strong and fit for his job, even to the point of wearing an airpack when working out on the Stairmaster at the local recreation center.
On March 17, 2004, Niebergall was working a 24-hour shift and, as was normal for him, went to work out in the evening. He was preparing for his wildland firefighter Red Card test later that spring. When other firefighters in the station hadn't seen him in a while, they went to check on him. They found Niebergall lying next to the treadmill, dead of a heart attack.
No longer ‘bulletproof’
Shock immediately swept through the department; it was the first on-duty death. The first reaction was disbelief. “Our people almost had this air of being bulletproof, typical of what you see in a young firefighter,” says Chief Gary Green. An autopsy later showed that Niebergall had significant coronary arterial blockage and had died instantly.
Prior to his death, Red, White and Blue had in place a department fitness program. Firefighters were strongly encouraged to work out on duty for an hour each shift, either at the local recreation center or on equipment in the stations. Although the program was informal, most department members were motivated to participate. In addition, entry-level physical testing took place, and there was a requirement that all firefighters pass their annual Red Card test.
Following Niebergall's death, according to Green, “the whole department took that sense of invincibility that they had and started to look within themselves. There was a sense of, if it can happen to Barry, it can happen to any one of us.” There was strong motivation to take health and physical fitness more seriously. The death caused everyone to get on board with finding a new and more effective approach to firefighter fitness and health.
Create a baseline
Green was at a Colorado State Fire Chiefs' Association meeting later that year and talked to Div. Chief Mike Gress from Poudre Fire Authority. Gress told Green that Poudre Fire had formed a partnership with medical professionals at Colorado State University in Fort Collins to provide enhanced fitness evaluation for the fire department. “I just said, wow. That's pretty innovative,” remembers Green, who returned to his department and discussed the possibility of using the CSU program with his operations and training chiefs. They enthusiastically supported pursuing the program for Red, White and Blue.
Green contacted Tiffany Lipsey, assistant director of human performance at the CSU Clinical Research Laboratory. He obtained a proposal from her regarding logistics and costs of the program, and after consulting with his staff, approved funding for the 2005 budget year to cover the additional costs of the new program. One priority of the new program, according to then — Asst. Chief Nick Drelles, was to find a way of identifying undiagnosed heart disease. “There were two camps,” he says. “One camp said that the stress test worked great. The other camp said that the stress test won't pick it up; that you have to have the full body scan.”
But funding for full body scans for every department member, at over $1,000 each, was not feasible. “The more we looked into the stress tests and complete physicals, we found that although it isn't perfect, there would be signs that would be enough to identify people that needed further testing,” says Drelles.
The program that was ultimately designed for Breckenridge firefighters goes well beyond just stress tests. “There's body-fat analysis, blood work and strength testing,” according to Green. “Then the doctors involved with the Human Performance Clinical Research Laboratory look at all the data and make recommendations based on that.” The recommendations result in a personalized fitness program for every firefighter, including guidance on nutrition, exercise and general lifestyle changes that could lead to a healthier life.
The goal for 2005 was to create a baseline of information about every firefighter from the physical evaluations. Follow-up on the data and further testing will take place in 2006 and beyond, with more stringent evaluation for firefighters with higher risk factors. In addition, the department is creating a new position that will coordinate health and safety issues in the department. “We're moving from an informal approach to a formal approach when it comes to health and fitness,” says Green.
Included in this effort will be attention to firefighter nutrition on duty. The department intends to provide education on healthy menu planning and the benefits of better nutrition. The department also is in the process of upgrading in-station cardiovascular fitness equipment with help from a recent FIRE Grant.
Put in action
Fitness programs such as the one undertaken by Red, White and Blue have been controversial in many departments because of the question of what happens to firefighters who can't meet the fitness standards that are set. According to Green, “If CSU told us that you could not safely function in your position, we would put you on light duty until we found out more.” Little did he know that within months, such questions would go far beyond the hypothetical.
In one of the first groups to go through the CSU evaluation was a 43-year-old firefighter who was active and fit and appeared to be in very good health. During the stress test, the evaluators expressed concerns about what they observed and advised the firefighter to go for further evaluation. Subsequent testing clearly indicated serious coronary artery blockage. Within weeks, the firefighter had a six-way bypass to correct the blockages, including two arteries that were 95% blocked. The blockage that was discovered was significantly worse than what had killed Niebergall just a year earlier.
“The bottom line is that this testing pushes you to your maximum heart rate,” says Green. “They push you pretty hard. Even working out here in the stations, I don't think anyone ever pushes themselves to that level during a workout. So the only time you may experience it is when you are on the fireground.” And by then, it may very well be too late.
After initial recovery from open-heart surgery, the firefighter returned to light duty for several months. Four months after surgery, the firefighter was released to return to full duty and has since resumed his regular position as a company officer.
It's a remarkable success story and not one that will be repeated in every case, acknowledges Green. Other departments that have instituted similar mandatory physical testing have lost firefighters to forced retirements. This has been a chronic sticking point for getting buy-in for such programs — what happens if someone can't ever come back to full duty? Nobody wants to see people lose their jobs. But on the other hand, isn't it better to be alive and doing something rather than dead on the floor of the fire station? Wouldn't it worse to go down at an emergency scene, where other people would be endangered as well?
“Barry's death was an eye-opener for us,” says Green. “The other firefighter's situation, at 13 years younger, really drove home the point of how important this was.” Although he acknowledges that there may be battles to fight regarding the fitness program in the future, at the moment “the people here have completely bought into this, and they see the value in it.”
Worth the costs
The cost of this program is significant, especially for a small department. Program costs include medical testing and follow-up, overtime (about 10 hours per firefighter to travel to Fort Collins for the evaluation, a 140 mile drive in each direction), and equipment. “But after you have a firefighter that dies of a heart attack, and you initiate the program and have a success story like we had, the cost of it does not become an issue,” Green says. “What we're paying, over and above what we paid for the testing we did in the past, is pretty nominal.”
A formalized commitment to firefighter health and fitness has now become part of the culture of the department. The leading cause of firefighter on-duty death continues to be cardiac arrest, and as this fire department has experienced, no one is immune from this risk, even young or apparently fit firefighters. Participation in this program has extended beyond just the line firefighters to administrative staff and even fire board members, all of who go through the fitness evaluation program.
Green emphasizes that the success of the program depends on its holistic and individual approach. “CSU doesn't just look at how you did on the treadmill. They look at other things, too, like how you said you eat, and hereditary factors. There's no reason to lie about it. It's not a competition with other people.”
It will take both commitment and compromise for fitness programs such as this one to be universally accepted. Green admits that his job has been made easier by the environment of Breckenridge, a place where everyone wants to be fit and active for their entire lives. Having a firefighter die of a heart attack in such a community was a wake-up call for a department that on some level felt it could never happen there. Rather than treat Niebergall's death as an anomaly, a bolt of lightning that could never strike twice, the Red, White and Blue Fire Department accepted the reality of their loss and took action — action that resulted in saving the life of another firefighter. “We found the next bolt of lightning before it actually hit the ground,” says Green.
Linda Willing is the principal consultant with RealWorld Training and Consulting and is an instructor with the National Fire Academy Executive Fire Officer Program. She is a retired fire officer with the Boulder (Colo.) Fire Department and was a backcountry ranger with the National Park Service. Wiilling has a bachelor's degree from the University of Pennsylvania a master's degree in management from Regis University in Denver and.