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Logo of bumcprocBaylor University Medical Center ProceedingsAbout the JournalBaylor Health Care SystemSubmit a Manuscript
 
Proc (Bayl Univ Med Cent). 2010 July; 23(3): 235–238.
PMCID: PMC2900974

Implementation of the first wellness-fitness evaluation for the Dallas Fire-Rescue Department

Abstract

More than 100 firefighters lose their lives in the line of duty each year; many of these deaths are caused by cardiovascular events and underlying coronary heart disease. In addition, firefighters are at higher-than-normal risk of developing certain types of cancer. To improve health and fitness among its firefighters, the Dallas Fire-Rescue Department developed and implemented an annual wellness-fitness program in 2008. The program detected and addressed medical issues including coronary disease, hypertension, high triglyceride levels, high cholesterol, high blood glucose levels, and hematuria. Prostate, thyroid, breast, kidney, and bladder cancers were also detected. By identifying these issues, engaging the firefighters' personal physicians, and recommending individualized treatment plans, this program may have extended lives and improved the quality of life for the firefighters.

Each year, more than 100 firefighters lose their lives in the line of duty (1), and approximately 80,000 firefighters are injured (2). Up to 45% of deaths among firefighters on duty are caused by cardiovascular events that are largely due to underlying coronary heart disease (CHD) (3, 4). A variety of reasons for the risk of death from CHD have been proposed (3, 5, 6). Fighting fires and providing out-of-hospital emergency medical care entail tremendous physical exertion and place unique demands on the circulatory and respiratory systems (5). In the event of a fire, firefighters must suddenly stop their routine activities and perform a variety of demanding tasks while wearing 75 to 100 pounds of gear and being subjected to temperatures that may exceed 350°F. Specific work duties that involve physical exertion—including not only fire suppression but also alarm response, alarm return, and physical training—are associated with a risk of death from CHD (3). While inhaling smoke, firefighters are also exposed to potentially harmful chemicals such as carbon monoxide, hydrogen cyanide, and hydrogen chloride (6, 7).

In addition to the risk of CHD, firefighting poses carcinogenic hazards. Several studies have suggested that firefighters have an increased risk of developing certain cancers, including leukemia and cancers of the colon, brain, thyroid, and bladder (811).

In an effort to improve the health and wellness of firefighters, and help prevent death and injuries, the two major fire service organizations, the International Association of Fire Fighters and the International Association of Fire Chiefs, worked jointly to develop a comprehensive wellness-fitness program designed specifically to address the hazards faced by firefighters (12, 13). The mission of the Joint Labor Management Wellness-Fitness Initiative stated that an overall wellness/fitness system should be the objective of every fire department. It also emphasized that any program of physical fitness must be positive and not punitive in design; require mandatory participation by all uniformed personnel; allow for age, gender, and position in the department; allow for on-duty-time participation utilizing facilities provided by the department; provide for rehabilitation and remedial support for those in need; and contain training and education components.

Based on this Joint Labor Management Wellness-Fitness Initiative, the National Fire Protection Association (NFPA) has developed standards regulating wellness-fitness programs for firefighters. NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, provides guidance to medical personnel regarding medical conditions that may prevent someone from performing the essential job functions of a firefighter (14). NFPA 1583, Standard of Health-Related Fitness Programs for Fire Department Members, outlines the procedure for evaluating the fitness level of firefighters (15).

Using these standards as a model, the Dallas Fire-Rescue Department (DFRD) developed and implemented an annual wellness-fitness program to evaluate and improve health, fitness, and wellness among its firefighters.

METHODS

The wellness-fitness assessment was implemented within the DFRD on March 3, 2008. A medical evaluation and fitness assessment were provided by a Baylor Health Care System (BHCS) physician to 1437 DFRD firefighters employed at 55 fire stations located throughout the city of Dallas. The assessments were planned to be conducted annually. The assessments had two major components:

  • Medical/physical examination
    • – Medical history
    • – Complete physical examination including blood pressure
    • – Fasting metabolic panel, including total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, and glucose values
    • – Urinalysis
    • – Vision test
    • – Audiogram
    • – Spirometry (lung capacity test)
    • – Chest x-ray
    • – Stress electrocardiogram
    • – Cancer screening: prostate-specific antigen test for men who were over age 50, over age 40 with a positive family history, African American, or had other clinical indications; and mammogram for women over age 40
  • Fitness assessment (14)
    • – Aerobic capacity, calculated using the stress electrocardiogram results
    • – Body composition, using a skin caliper test
    • – Muscular strength, using a hand grip strength test
    • – Muscular endurance, using number of push-ups and crunches
    • – Flexibility, using a sit-and-reach test

Results of the blood pressure and metabolic tests were graded as shown in Table Table11. Results of the fitness assessment were graded using a classification system developed by BHCS, the DFRD, and the Baylor Tom Landry Fitness Center using the American College of Sports Medicine charts (16) and the Cooper Institute Fitnessgram®(17). On each test, the firefighter was assigned a point value and rating of superior, excellent, good, fair, poor, or very poor. Scores were added together to obtain a total fitness score and rating for each firefighter. A small cash incentive was provided to firefighters who scored in one of the top three categories (good, excellent, or superior) on their fitness assessments.

Table 1
Medical evaluation parameters and their clinical meaning

BHCS physicians evaluated the results of the medical and fitness assessments to determine each member's duty status. Following recommendations from NFPA 1582 (14) and the position classification specifications of the city of Dallas, the physicians certified whether the firefighter was or was not medically certified to perform the essential job functions, duties, and responsibilities of the position. Based on the evaluations, the firefighters were placed into one of three duty status classifications: full duty, conditional full duty, or limited duty:

  • Full duty: The firefighter was deemed medically qualified for firefighting operations and continued to receive the required annual medical examination and fitness assessments.
  • Conditional full duty: The firefighter was deemed medically qualified for firefighting operations if he or she complied with additional monitoring and treatment requirements to maintain the ability to safely perform the essential functions, job duties, and requirements of the position. Follow-up appointments were conducted by the firefighter's personal physician within 45 days. Any additional follow-up appointments were recorded by the BHCS physician.
  • Limited duty: The firefighter was temporarily assigned to a nonoperations position while further medical evaluation was conducted to determine duty status. The firefighter was allowed to opt for the use of sick leave in lieu of limited duty status, in which case all DFRD regulations for sick leave use applied.

Although participation in the program was mandatory, individual medical records were kept confidential. The DFRD received only aggregate data to assist in monitoring the effectiveness of the program, as well as a form indicating whether each firefighter was medically certified to perform his or her essential job functions. The BHCS physician discussed the results of the assessments with each firefighter, and the firefighter was given an individualized and confidential health improvement plan.

RESULTS

Table Table22 displays the 1437 firefighters' mean values for blood pressure, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, and glucose. Hypertension and high triglyceride levels were the most common conditions noted, occurring in 15% of firefighters (Table (Table33). High cholesterol was also relatively common, with 10% of firefighters having a total cholesterol value of at least 240 mg/dL. High glucose values were relatively uncommon, occurring in only 3% of firefighters. Other notable findings of the medical evaluation included hematuria in 10% of firefighters. Although firefighters were neither required nor encouraged to share the results of their individual assessments with the DFRD, anecdotal evidence suggests that at least 15 cases of cancer were detected, including cancers of the prostate, thyroid, bladder, breast, and kidney. In addition, at least 12 angioplasties were performed as a result of the program. As shown in Table Table44, 69% of firefighters obtained a superior fitness score, and 25% obtained an excellent score.

Table 2
Firefighters' mean values for blood pressure and metabolic tests based on age groups
Table 3
Firefighters at risk of medical conditions
Table 4
Firefighters' fitness levels

DISCUSSION

The objective of this study was to develop and implement an annual wellness-fitness program to evaluate and improve health, fitness, and wellness among DFRD firefighters. Previous studies have found that firefighters are at high risk of death from cardiovascular events (36) and are also at high risk of developing certain types of cancer (711). Improving the health and wellness of firefighters through programs designed specifically to address the job-related hazards they face is therefore a priority for national and international organizations (12, 13).

In this study, both immediately and potentially life-threatening conditions were diagnosed, including cases of cancer and hypertension. By identifying these issues, engaging the firefighters' personal physicians, and recommending individualized treatment plans to address the abnormalities detected, this program may have extended lives and improved the quality of life for DFRD firefighters.

Overall, implementation of the first cycle of this annual program was received favorably by the department and the firefighters themselves. The success of the wellness-fitness program is especially remarkable because it is the first department-wide preventive health program undertaken by the DFRD since its founding in 1884. Initially, some firefighters were skeptical about the objective of the program and whether negative results would be used in a punitive manner. For this reason, providing education about the program prior to implementation was a crucial factor in its success. Before the program began, a presentation was provided at each of the 55 stations to address the purpose of the program, the nonpunitive nature of the program, and the fact that all medical results would be confidential and all procedures would be carried out in accordance with the Health Insurance Portability and Accountability Act (HIPAA) (18). This information was also provided on the DFRD intranet website.

In conclusion, implementation of the first annual DFRD wellness-fitness program to evaluate and improve health and fitness among DFRD firefighters has been successful and has facilitated the detection of medical problems among firefighters, including coronary artery blockages and cancer. Detection of risk factors for atherosclerosis (cigarette smoking, high cholesterol levels, hypertension, and uncontrolled diabetes) and interventions to modify these risk factors have the potential to reduce the incidence of heart attacks and strokes in the future. The first cycle of the program has also helped planners to identify opportunities for improvement in implementation of future cycles. The annual DFRD wellness-fitness program provides a potential model for other organizations to follow to improve the health and wellness of firefighters and help to prevent death and injuries in the line of duty.

References

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Articles from Proceedings (Baylor University. Medical Center) are provided here courtesy of Baylor Health Care System