It seems that the prevailing health theory among firefighters is, “If I don't know anything is wrong, then I'm healthy — I am immortal.” Is ignorance bliss?

Firefighters and paramedics are not immortal. In fact, firefighters increase their potential mortality by the inherent physical nature and risks of the job.

But those aren't the only dangers. To perform the job safely, firefighters must possess the necessary level of fitness. If they're not fit, they risk failing to perform at the incident. If they have heart disease, they could die at an incident, endangering their fellow firefighters and those they're trying to help.

Firefighters and paramedics spend their entire careers working to save the lives of others. Have they forgotten that they also need to work on saving their own? What do we have to do to ensure the health of our firefighters?

In the Los Angeles Fire Department, we believe it starts with mandatory medical evaluations and mandatory on-duty exercise, but that's easier said than done! With the fire chief, union and the wellness program working toward a common goal, the lafd has made significant progress toward improving the health of its members.

In January, the lafd initiated department-wide, task-specific exercise training and is now in final negotiations regarding a mandatory comprehensive medical evaluation. The importance of the medical is to determine overall health in relation to the job and serve as clearance for participation in vigorous exercise.

However, not all departments have the luxury of mandatory medicals. In this column, I hope to help other departments form a strategy for creating healthy firefighters by providing some insight as to how the lafd accomplished its initial steps.

As a consultant, my first step at lafd was rather naïve. After designing a vigorous exercise program to increase and maintain firefighter/paramedic fitness, I thought I could ask the department to follow the American College of Sports Medicine and the American Heart Association recommendation for participants to obtain a medical examination if at moderate or high risk.

Moderate risk is defined as men over 45 and women over 55 years of age, or as people who have two or more coronary artery disease risk factors, including family history, smoking, hypertension, high cholesterol, impaired fasting glucose, obesity and even a sedentary lifestyle.

This is a slam dunk — sounds like just the type of people in the department we're trying to help. They'll get tested, and we'll roll out the program. That's when I learned that “there are no mandatory physicals.” In fact, some lafd members hadn't been to a doctor in years, and many of those over 50 had never had an ekg-monitored exercise test. That's a ticking time bomb, especially with the prevalence of heart disease known to exist in this population and the fact that 43% of the nation's firefighter deaths in 1998 were attributed to heart attack.

We took one big step back and told the chief that mandatory, comprehensive medicals must be a priority. The chief agreed, as did the union, eventually. Although the political and budgetary process grinds slowly, we wouldn't be where we are today without taking those positive steps.

Despite this agreement, we still needed to obtain a medical clearance to exercise vigorously from each firefighter. I thought that since we had mandated exercise, we could also mandate exercise clearance. In addition to encouraging people to see their doctor, we decided to provide physician-monitored exercise testing at the fire department for the approximately 1,200 firefighters at moderate risk.

Whoops! Because this test hadn't been negotiated by the union, it had to be voluntary. Believing people would want to be cleared was the wrong assumption, because some members were afraid that their ability to work would be impaired if they learned something was wrong. Unfortunately, dying does the same thing! We tested just over 300 members, with the health status of the others remaining unknown. We found ourselves asking once again, “What can we do?”

At that point, the lafd faced the same dilemma as those departments that don't have a mandatory medical: Members need to exercise at a high intensity, but first their safety has to be ensured through a physician's evaluation. Our solution was to restrict the rate of exercise for those who hadn't been cleared to less than 70% of their age-predicted maximum heart rate.

This decision had the desired effect. To become physically fit, you need to exercise vigorously, that is, at more than 70% of your maximum heart rate. People complained about not being allowed to exercise or participate in sports at a rate conducive to fitness, but they also asked what they could do to change that. Our answer: “Go to your physician and get cleared. In the meantime, exercise at a moderate intensity and be aware of what you're eating to increase your health and wellness.”

Of course, that second piece of advice is easier said than done. The culture must change to allow for honest discussion about cardiovascular disease, cancer and other ailments that encourages individuals to take charge of their health. We must open up the lines of communication and talk about health and nutrition in the fire station.

Knowledge is power. Armed with the knowledge of their health status, firefighters can take steps to improve their health and, consequently, their fitness. It's the responsibility of every member, from the chief to the rookie, to work together to ensure each other's health and safety.

You need to be able to count on your fellow firefighters' ability to perform. Our customers need to be able to count on their firefighters to perform.

To that end, encourage members to see their physicians. Campaign for mandatory comprehensive medicals. Create your own wellness program. At the lafd, the wellness program was created solely for the members' benefit. The only agenda is wellness, fitness and safety.

Not including those referred for follow-up treatment after their exercise ekg tests, 51 lafd members were treated for cardiovascular-related symptoms last year. One member died of cardiac arrest. You are firefighter, but you are not immortal. Save your own life so you can continue to save others.

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