Why do Firefighters Die?

by Charles E. Truthan, D.O., FACOFP
Copyright 1998 by FD Doc®

aka: Doc T DocTruthan@FD-Doc.com

I had been lurking on a thread entitled "Why do Firefighters Die" on the Emergency Grapevine (www.emergencygrapevine.com) and wondering if it would not be more useful to rename it "How do Firefighters die, and how can we prevent it!". I am taking off the gloves, here, and pulling NO punches. If what I have to say disturbs you, GOOD. We MUST do something other than sit around and complain. We need positive action to save our brother and sister firefighters lives!

The observation that nearly 50% of Line of Duty Deaths (LODD) are cardiovascular in nature, is right on numbers. A visit to the NIOSH Firefighters Mortality Reduction Study (http://www.cdc.gov/niosh/firehome.html) reveals that this ratio has been holding steady for some time. A little deeper look into the numbers shows that "older" firefighters tend to suffer the heart attacks and "younger" firefighters tend to die from trauma. Both of which make sense. Look at your own FD's makeup. The older firefighters are on the pump or wearing white coats with bugles. The younger firefighters are in the SCBA's and on the attack lines and hanging off the ladders etc. So, it is not surprising to see this distribution.

"OK, so what can do we do about it?"

Let's first look at the "youngsters" fatalities from trauma. A lot of these deaths occur from reasons well beyond our control. A wall collapses, somebody runs them over or into them with a vehicle. We should establish collapse zones around buildings and use our vehicles to protect us on scene. Other than that, there may not be much we can do about it. Some of this may also come from what I call the "Macho Firefighter Syndrome". This is the firefighter who will not take a break after two bottles of air, or 20 minutes on the ladder. This is the "super hero" who died 2 years ago from a 100% preventable cause, De-@#*-hydration! "I don't need to take a break, or take any liquid." I might be seen as a "sissy" or a "slacker". "Only probies and wimps need rehabilitation (rehab) on scene." I think my point is made, and you can all pick out one or two names on your home FD with just a millisecond of thought.

"OK, Doc, the point is made. Now tell us what to do about it!"

One word: TRAINING. If we train better, train on the MANDATORY need for continuing training and retraining on procedures, incorporate rehab into our training and procedures, we can save lives, reduce stress, and these "youngsters" may survive to become "one of those old farts" and die from a heart attack instead of trauma. Strengthen your Safety Officer's role and responsibility. Train on Rehab and safe operations. Use rehab during drills. Use your vehicles on scene to protect the scene and YOURSELF. Use the spot lights on the trucks to better illuminate the scene as you pull up to it (When was the last time you used those post lights? Truck check? Or at a scene?). Learn and practice safe driving techniques. Enact some "retraining" system for those who are observed to perform unsafe ops at scenes. Resurrect your Run Post Mortem, and be sure it is a FACT-finding and NOT a FAULT finding exercise. We all make mistakes, we usually realize it shortly after we did it, and we are usually our own worst critics. Let us instead pool our knowledge and experience and figure out what did work and what did not work on this call. What could we have done differently? What SOP might we need to change? Make this a positive learning experience. No one can be injured, maimed or killed during the Post Mortem conference. In fact, a well run Post Mortem can save lives. Your life, your fellow firefighters and the citizens we are sworn to protect and render aid to.

Now for the "oldsters". These are the firefighters who may need a "4x4 up alongside the head just to get their attention" (and you can name one or two in your Department with another millisecond of thought). There are 7 basic risk factors for heart disease. 3 you can not control, and 4 that only you have complete control over. The 3 uncontrollable risk factors are:

Sex - Heredity - Age

Sex: men are at a higher risk than women are, (and a sex change operation will not change it either.)

Heredity: you can not change who your genetic parents are. If they have heart disease or died from heart disease, you have an increased risk to also suffer or die from heart disease. That's just the cards you were dealt.

Age: The older you get, the greater your risk is that you will die from heart disease (and all other causes as well). There is only one way to stop getting older, that I am aware of, and that is the one we are trying to avoid in the first place.

The other 4 risk factors, which the individual has complete and sole control over, are:

Smoking - Diet - Weight - Exercise

Smoking: This is the number one preventable risk factor for NOT just heart attack, but stroke, hypertension, and MANY CANCERS. I'll get back to that in detail in a moment.

The next three are so intermingled that they really should be a single word "Diet-Weight-Exercise".

"You are what you eat" is an old, but very true, expression. High fat content meals are becoming the American way of death. Improper diets with high fat and cholesterol contents, low nutrient content, lacking in minerals and essential vitamins lead not to just increased heart disease, but all types of cancers and other nasty illnesses and diseases. Too many of us are overweight (guilty as charged, but I am actively working on it). How did we get there? The wrong diet and lack of exercise. It is these three items that affect your Total cholesterol, your HDL (good cholesterol), and LDL (bad cholesterol) levels. Bad diet, overweight, lack of exercise all lead to elevated total cholesterol and low HDL and high LDL levels. By modifying your of lifestyle, with a proper diet and starting a regular exercise program your excess weight will come off, your cholesterol levels will change for the better and you will once again control your life and reduce your risk factors! Hey, I did not say this would be easy. You must take back control of yourself and not be influenced by "Madison Avenue marketing" and commercials. Ever wonder how those good-looking models stay so thin with all the high fat foods they are promoting?

"Ok Doc, but I get a lot of exercise on the job. What am I supposed to do?"

Well, you may get a lot of exercise, but you are still overweight in spite of it! Obviously, you need to perform separate exercises above and beyond your regular work life. The first exercise to add is the "push-away" exercise. This is performed at the dinner table (push your belly away from the second and third helpings). Cut back on those evening snacks, which are inevitably loaded with fat. Now, I did not say "stop those evening snacks", I said to "cut back". Maybe only once or twice per week, and change it from chips to fruit.


Walking is one of the easiest and most convenient activities one can do. I do mean walk and not jog. Jogging, especially for the overweight, will add too much stress to your ankles, knees and hips. Whether you jog one mile, or walk one mile, you have exerted the same amount of effort. Only the intensity is different. Walking has been shown to offer 80 to 90% of the cardio-protective effect that jogging does. Start off with a 5-minute walk after supper. Walk at a pace where you can carry on a normal conversation. Increase your walking time by 3 to 5 minutes each week. Take small, incremental increases in time. It took you several years to add that weight, expect to take some time to lose it. A good goal to aim for, is one pound per week. More than that is usually just water. Expect to reach weight plateaus. With exercise, your body is building muscle. That muscle adds weight, while losing fat. If you have 50 pounds (as I do) to lose, expect to take 50 weeks to lose it!

Another pointer on weight loss

Measure your weight ONCE PER WEEK. Your body normally fluctuates in weight daily. So, check your weight every Monday, or Wednesday, or Friday. Do it at the same time. First thing in the morning, or last thing at night. Final comment. This is one "game" where the real winners are the losers. You have to lose weight to win. The only way you will fail, is to stop trying.

And now, for the "big one"

As has been pointed out, there are a lot of firefighters who smoke. We all know that it is bad. We all say we "want to quit", but..... Let’s look at the first, and the only important factor here. There is NO ONE BUT YOURSELF LIGHTING UP THAT WHITE STICK AND PUTTING YOUR LIPS ON IT! Let's accept it the way it is now folks, and yes, I am "one of those", a reformed smoker. Oh NO! That being said, let's look at what some of the risks are that you take, every time you light up. Not only does your heart disease risk skyrocket, but so do your risks of lung diseases, including cancer of the lung, as well as cancer of the throat, lips, stomach and colon. And that is the "good news". ALL Firefighters are at an increased risk for developing cancers, of all causes. For Firefighters who smoke, there is an EXPONENTIAL INCREASE IN RISK FOR ALL CANCERS. Think about why we wear SCBA's. Because there are lots of "nasty things" in the incomplete products of combustion, especially from all the synthetic products so common in today’s construction.

Now for some real help

The American Cancer Society has a program called "Fresh Start". This is an EXCELLENT program, and the price is right ($0.00)! What they do, is give you practical ideas and methods of dealing with those "cravings" and how to avoid the "habits" and how to survive smoke free. Make NO mistake about it; smoking is an extremely addictive habit with an enormous psychological addiction as well as the physical component. If you read the package inserts that come with all of the patches, gums, etc, they will ALL say something like "…this product is best when used in conjunction with a 'complete' smoking cessation program…". In other words, their product will only take care of the physical component of the addiction, but will not do squat for the more powerful psychological component. On the brighter side of statistics, for every time you try to quit smoking and fail, your chance of succeeding the next time actually increases! So, there is hope, as long as you keep trying.

One last shot at you smokers

If you enjoy smoking, why do you bother to put an SCBA on at all? Along those same lines, we ALL need to watch out for how soon we take off those SCBA's. Fire is out, and we take off the SCBA's during overhaul ops, right when the products of incomplete combustion are at their thickest and when the ventilation is at the poorest. Positive pressure ventilation techniques are excellent, but it may be turned off too soon. I'll get out my "crystal ball" and predict that within 10 to 15 years, firefighters will change out of their SCBA's during overhaul and into a canister, half mask respirator of some type.

We know why our brother and sister firefighters die. Now it is our duty to figure out just what can we do to prevent it! I offer the following:

  1. Training
  2. Smoking cessation
  3. Diet-Weight-Exercise
  4. Daily aspirin

The benefits of daily aspirin to reduce risk of heart attack, are well documented in the medical journals. Until we have better research on why firefighters as an occupation have a high death rate from heart disease, it would seem only reasonable for firefighters to take a daily aspirin. A single baby aspirin is all that is needed on a daily basis. As long as you do not have a blood clotting disorder (hemophelia, etc), one adult aspirin per day will also work. I would recommend that firefighters 35 years of age and older take one baby aspirin daily.

All this has been easy enough to say, but it is harder to accomplish. The first step in finding a solution to any problem is to admit that a problem exists. We've done that. Now let's get on with the easy part.

So, I'll step off the soapbox, and wait for the comments to fly.

Doc T.

Charles E. Truthan, DO, FACOFP
President & Medical Director, F.D. Doc®
F.D. Doc-
25 Years Fire Service Experience
Member of Advisory Board, The American Firefighter

Editor's note: Our thanks to "Doc T." for his many contributions to this nations fire service. His "pull no punches" articles are very much appreciated…