You wouldn’t expect firefighters with known heart conditions to be out responding to fires and other stressful emergencies, yet they often are on the front lines and die in big numbers.

According to a 10-year study of sudden cardiac deaths of American firefighters by the National Fire Protection Association, about half of the firefighters who died of heart attacks had known heart conditions, and another third had heart conditions that simple medical testing could have detected.

Heart attack is the No. 1 cause of firefighter on-duty deaths, but with proper screening and follow-up care, job-duty restrictions and active promotion of heart-healthy behavior, fire departments could prevent many of these deaths.

According to the NFPA, heart attacks continue to drive persistently high firefighter fatalities despite fewer structure fires and fewer fireground LODDs. An average of 97 firefighters died per year in the 1990s, but since 2000, the yearly average has been 102, not including the 340 firefighters killed responding at the World Trade Center on Sept. 11.

According to the study, which looked at firefighter line-of-duty deaths from 1995 to 2004, 440 firefighters -– 43.7% of those who died on the job -– experienced sudden cardiac death (heart attacks and other heart-related sudden death), typically triggered by stress or exertion.

NFPA was able to gather information on medical conditions for 308 of those 440 firefighters. Researchers found that 134 had previously suffered a heart attack, undergone bypass surgery or angioplasty/stent placement. An additional 97 had severe blockage of the heart’s arteries, but it was unclear whether this was known prior to their deaths, the NFPA said.

Rita Fahy, author of the study, said the same percentages have been reflected in NFPA’s annual study of firefighter fatalities for many years. “We consistently find almost 50% had prior heart attacks, bypass surgery or angioplasties -– and those are conditions that people probably knew about, as opposed to the arterioslcerotic heart disease, which makes up about 30% or so; those people might not have known that they had that condition [because] that would have to be tested for, or it might show up in the autopsy.”

Several NFPA standards, if adopted and implemented, would help, specifically NFPA 1500, Fire Department Occupational Safety and Health Program; NFPA 1582, Comprehensive Occupational Medical Program for Fire Departments; and NFPA 1583, Health-Related Fitness Programs for Firefighters.

“What we’d like to see is more screening of firefighters,” said Fahy. “We have a standard that lists medical conditions that recruits should be screened for [1582] that should probably preclude people from active firefighting roles.... But then, we also ask for the same kind of screening annually for firefighters who are on the job, and then when they’re screened appropriate treatment could be undertaken and an appropriate assignment given to them.”

Many important jobs at a fire department don’t involve active fire suppression or emergency response (and hence reduce stress on people with heart conditions), Fahy noted, such as inspections, public education and some training jobs, especially classroom training.

Fahy said the report did not reach any conclusions about whether volunteers or career firefighters were more prone to heart attacks. “It doesn’t get into that, because it’s not a medical study; it only reports the numbers… but it did show that almost all of the older firefighters who died as a result of sudden cardiac death were volunteers. That’s probably a reflection of the tendency of volunteer firefighters to remain active past retirement age,” Fahy said. “That was one very clear difference between the two.”

The NFPA plans to post the report online June 1.

Beyond the 10-year report on cardiac deaths, the NFPA’s study of 2004 firefighter fatalities in the United States concludes:

• For the second consecutive year, less than 30% of line-of-duty deaths occurred on the fire ground, the lowest rate on record. (Of these 29 fire-ground fatalities, 10 were caused by sudden cardiac death.)
• 
  
  
• The 17 firefighters who died in vehicle crashes in 2004 was half the number in 2003, when deaths in crashes reached an all-time high of 33.
• 
  
  
• Deaths during EMS responses, which had been dropping through the 1980s and 1990s, have risen sharply since 2000. In the past five years, there were 21 deaths at medical calls, compared with six deaths in the previous five-year period.
• 
  
  
• No deaths occurred in vacant or idle buildings for the first time since NFPA began gathering this data in 1977. The number of deaths in fires in these types of buildings (including those under construction or renovation) dropped from a high of 37 in the first five years of the study to just eight in the five most recent years. This trend reflects a greater understanding by firefighters to battle fires from the outside when no lives are at stake inside.
  
  

For more details, see the NFPA fatality reports online.