Fit for Duty, Fit for Life

Smoke inhalation, burns, hazardous material exposure, falls. These well-known perils routinely take center stage in media reports of firefighter injuries and deaths. In reality, however, more than half of firefighter line-of-duty deaths (LODDs) can be attributed to problems related to the health, fitness and wellness of the firefighters themselves.

“The health and fitness of uniformed personnel has a direct impact on their ability to withstand the stresses and dangers of the job,” says Dr. Lori Moore-Merrell, assistant to the general president/technical assistance and information resources, International Association of Firefighters (IAFF). Heart disease, diabetes and weight issues are on the rise in the emergency responder community, and budget cuts that require firefighters to respond to emergencies with fewer personnel only add fuel to the proverbial fire, with additional physical and emotional stress.

In a 2006 study, LODD data compiled between 2000 and 2005 was used to analyze factors that contributed to 644 (the number with sufficient data for inclusion in the analysis) cases of LODD with respect to frequency and clusters (contributing factors that frequently occurred together). Analysis revealed that 97.5 percent of all firefighter LODDs that occurred during the years studied were attributable to an identifiable cluster of contributing factors.

The first three clusters included factors such as incident command, training communications, standard operating procedures, pre-incident planning (Cluster 1); vehicles, personal equipment, equipment failure, human error (Cluster 2); and privately owned vehicles – accidental and civilian error (Cluster 3). It was, however, the fourth cluster that was of special interest to Moore-Merrell, the study’s lead investigator. In addition to company staffing and operating guidelines, Cluster 4 included health, fitness and wellness of uniformed personnel. In fact, frequency analysis revealed dominant contributing factors to LODD as health/fitness/wellness (53.885), versus personal protective equipment (19.41 percent) and human error (19.1 percent). Independent of the other three clusters, Cluster 4 accounted for more than 44.72 percent of all LODDs during the study period. And, when analyzed in conjunction with the other clusters, it accounted for an additional 16 percent of all LODDs.

“These findings represent both a sobering and a reassuring reality,” says Moore-Merrell. “They underscore the challenge we face, but also make it clear that firefighter deaths are eminently preventable.”

One of several recommendations that arose from the study calls for mandatory wellness/fitness programs to reduce risk factors for cardiovascular disease and improve cardiovascular health. In fact, the blueprint for a comprehensive wellness/fitness program has existed since 1996, but many fire departments seem reluctant to pick up the gauntlet.

“While time and resources are routinely devoted to the maintenance of apparatus, very little, if any, such attention is being devoted to the maintenance of the most important “apparatus” of all – the firefighters themselves,” cautions IAFF Health and Safety Director Patrick Morrison. “Firefighter health and wellness is no longer an initiative; it’s a necessity whose time has come.”

A Call to Action

In what is being called a historic partnership between IAFF and the International Association of Fire Chiefs (IAFC), a bold endeavor is underway to commit both labor and management to the wellness of uniformed firefighter personnel. “The Fire Service Joint Labor Management Wellness-Fitness Initiative is a call to action,” says Morrison, who stresses that all fire departments and labor unions must make the health and fitness of uniformed personnel the No. 1 priority.

Ten U.S. and Canadian public professional fire departments participated in the development of the initiative, and each has required mandatory participation of all their uniformed personnel. The program focuses on medical, physical and emotional fitness and, when indicated, access to rehabilitation.

The mission statement put forth by the creators of the initiative calls for every fire department, in cooperation with its local IAFF affiliate, to “ … develop an overall wellness/fitness system to maintain uniformed personnel physical and mental capabilities.” While the statement calls for “mandatory participation by all uniformed personnel in the department once implemented,” it goes on to note that, “… agreement to initiate it must be mutual between the administration and its members represented by the local union.”

Special emphasis is placed on the need for programs that are designed to be positive and not punitive, with provisions made for on-duty-time participation, access to facilities and equipment provided or arranged by the department and rehabilitation and remedial support for those who require such services.

Nuts and Bolts

The Wellness-Fitness Initiative is a multifaceted program that requires implementation of all five of its main components:

• Comprehensive, mandatory medical exams – These annual exams are intended to identify health problems, determine ability to perform essential duties, monitor effects of exposure to hazardous agents and provide cost-effective investment via early detection and prevention of disease. The exams include physical evaluation, body composition, lab and vision tests, hearing evaluation, spirometry, EKG, cancer screening, immunizations and infectious disease screening, referrals and data collection.
  
• Individual fitness programs – By providing workout scheduling, resource support and/or access to such resources on duty, physical fitness is incorporated into the overall fire service philosophy. The programs include dedicated time for exercise, access to needed equipment and qualified peer fitness trainers. After medical clearance (required before embarking on any exercise regimen), all uniformed personnel participate in annual, non-punitive (and confidential) fitness assessment after medical clearance, focusing on aerobic capacity, muscular strength and endurance and flexibility. The fitness regimens are then tailored to the firefighter’s specific needs.
  
• Rehabilitation – Individualized rehabilitation (injury, fitness, medical) is provided to ensure full rehabilitation for safe return to duty for affected personnel.
  
• Behavioral health – This critically important, but historically ignored, component of any wellness program is critical to the success of the initiative. Access to comprehensive behavioral health services focuses on nutrition, smoking cessation, substance abuse interventions, stress management, critical incident stress management, comprehensive counseling and chaplain services to address spiritual needs.
  
• Data Collection and reporting – Case information data are collected from participating fire departments for compilation for an international database for the purpose of analysis. All uniformed personnel data collected for the database is confidential; fire departments do not submit identities of individual firefighters to the database.
  

Reaping the Rewards

The human toll of firefighter LODDs extends far beyond the individual – to family, friends, colleagues and the community served. The monetary cost – in terms of lost work time, workers’ compensation claims and health care and disability expenditures – continues to rise.

The ultimate goal of the Wellness-Fitness Initiative is to improve the quality of life of all uniformed personnel – a goal that Morrison views as a win-win proposition. Already, he says, lives are being saved and costs reduced in departments that have implemented the program and are in full compliance. While data are being compiled to evaluate these endpoints, Morrison notes dramatic anecdotal evidence of the above: a potentially fatal heart blockage found in one medical screening, and hepatitis C detected in another. Furthermore, fully compliant departments are already starting to see reductions in health care expenditures.

A follow-up study is underway to evaluate the cost-effectiveness of the program, and an additional study is planned to evaluate line-of-duty injuries.

Keys to Success

To be successful, wellness/fitness programs must address confidentiality, commitment by both labor and management to design programs that are educational and rehabilitative (not punitive), performance testing to promote wellness improvement over time, a wellness approach that is holistic in nature (including medical evaluation, fitness, rehabilitation and behavioral health) and commitment to a long-term program (made available to retirees when feasible).

But before success can be realized, several obstacles need to be overcome.

Funding is, according to Morrison, as large or as small an obstacle as individual departments make it. He explains that when it comes to apparatus, the majority of costs are related to maintenance, and the minority to repair. But when it comes to firefighter health, most costs are incurred after the fact (workers’ compensation, health care costs, etc.). “The goal is to incorporate the program into the budget as a line item. Funding will depend upon the individual departments’ ability to demonstrate cost-effectiveness – specifically as it relates to prevention.” Morrison concedes that some creativity may need to come into play, but he insists that “where there’s a will, there’s a way.”

Changing attitudes, and especially behaviors, is perhaps the most daunting challenge, and the key, says Morrison, is accountability. Furthermore, fears that findings from evaluations and screenings will be “used against” personnel need to be allayed. If screening reveals a medical problem that prevents a firefighter from safely carrying out assigned duties, a clinical pathway is put into effect to deal with that problem, and rehabilitation is provided on an as-needed basis. While the process may require reassignment (temporary or permanent) to tasks that can be carried out safely, “screenings and evaluations are in no way intended to target personnel for dismissal.”

Also critical is the need to reassure personnel that all information obtained from evaluations and screenings is confidential. For example, fire chiefs need only know that an individual firefighter is or is not able to work.

Both Morrison and Moore-Merrell stress the need for leaders to take the initiative in implementing the Wellness-Fitness Initiative, stressing that department chiefs and labor leaders need to make firefighter health and fitness their top priority. “Changes in behavior occur from the top down,” says Moore-Merrell, “and ‘leaders’ don’t have to be officers or managers; they can, and should, be individuals who are simply willing to step up and lead by initiative and example.”

For more information on the Fire Service Joint Labor Management Wellness-Fitness Initiative, visit http://www.iaff.org/safe/wellness2.html. You can find the Fit to Survive microsite (focusing on nutrition) at http://www.iaff.org/safe/content/wellness/index.htm.

Laura Bruck is a Cleveland-based freelance editor and writer with 20 years of experience in the health care field.