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Fire Fighters: Your Health Exam is Complex

Updated: Dec 28, 2020

The risks a #firefighter faces, due to environmental #pollutions, is significant. They are far more likely to die of sudden cardiac death than most any other profession. This is increased three times if they are obese, four times if they have high cholesterol, eight times if they are a smoker, and ten times if they are #diabetic. If the fire fighter has hypertension, they their risk is twelve times higher, and once they reach the old age of 45, their risk of sudden cardiac death is 18 times higher than the average American. If they have had prior heart disease, that rate is 35 times higher. Cardiovascular events are the leading cause of on duty deaths among firefighters and for every line of duty death, there are an estimated seventeen non-fatal cardiac events on duty among firefighters.

The health evaluation of those who fight our fires is altogether different than that of the typical healthcare consumer. Not only are their risks for sudden cardiac death increased, but so are their risks for #cancer. The chronic exposure to heat, smoke, diesel exhaust, and toxic flame retardants inhaled, ingested, and absorbed into their airways, skin, and gastrointestinal system is deadly. Not only are they at risk in building fires, car fires, dumpster fires, and even kitchen fires, but their own protective equipment and firehouses have accumulated mass amounts of toxins that significantly increase their body's burden.

These carcinogen exposures help account for the very alarming discovery that every three weeks a Boston firefighter is diagnosed with cancer. Boston firefighters have elevated rates of cancers in their brain, lung, colon, prostate, bladder, kidney, and skin. This means the primary care visit for fighter fighters is no joke. Recommendations for screenings differ significantly.

Recommended Firefighter Physical Exam & Screening Tests

Every year, each fire fighter should have their oxygen saturations measured and a thorough skin exam. The skin exam alone is a rarity in most primary care clinics, even when the individual has had a history of skin cancer. If your practitioner isn't having you disrobe, they are doing you a disservice. Eye and hearing screening should be performed in each primary care visit, as well as a thorough oral exam. A mental status exam is also recommended annually for the firefighter.

Laboratory testing for a firefighter includes the routine metabolic and chemistry panels, as well as lipid and hepatitis profiles, a thyroid panel, testing for diabetes, urinalysis, and many recommend an annual EKG. The prostate should be evaluated initially at the age of 40 years, and annual thereafter, as well as pulmonary function tests every three years. CT scans of the chest and coronary arteries should be initiated at the age of 50 years, and repeated every third year. Colonoscopies should be initiated at 40 years, to evaluate for colon cancer, and repeated every fifth year. An exercise stress echocardiogram is also recommended at age 40 years, and then every third year, and mammograms for females should begin at age 35 years. A urinalysis should be obtained annually for microscopic hematuria.

In the line of duty, firefighters are often exposed to carbon monoxide and other inhaled toxins, or irritants that may lead to acute respiratory issues such as hypoxemia or bronchoconstriction. Repeated exposure may cause chronic pulmonary disease and abnormal lung function. Changes in lung function and the development of lung disease may be detected with baseline and periodic assessment, so each exam should include spirometry, to offer both the baseline and the annual pulmonary function levels (including FEV1, FVC, and the absolute FEV1/FVC ratio). A chest x-ray for baseline should be included every fifth year, with the first being at the onset of their service to attain a baseline.

Emotional Toil on Firefighters

Forty-six percent of firefighters, from one study, have considered suicide and fifteen percent have had an attempt during the course of their career. The mental and physical stress of firefighting and repeated exposure to trauma can lead to depression, anxiety, acute stress reactions, post-traumatic stress, and suicidal ideation. Self-medication with alcohol and drugs can result in substance abuse disorders. The primary care provider should utilize depression screening tools with each wellness visit, and the CAGE alcoholic screening tool.

Lack of sleep can add to the emotional and mental burden. Sleep disorders are highly prevalent in firefighters, including apnea, insomnia, shift-work disorder, and restless leg syndrome. It is imperative to screen firefighters for these disorders since they substantially increase the risk of motor vehicle accidents, cardiovascular disease, diabetes, depression, and anxiety in firefighters. Ask about what medications they are using to help them sleep. Screen for sleep apnea and consider a sleep study evaluation. Utilize the Epworth Sleepiness scale, STOP-Bang questionnaire, Berlin questionnaire, or the algorithm for diagnosing obstructive sleep apnea.

On the Job Hazards

Firefighters are often first on the scene of an emergency and may be exposed to HIV, hepatitis (A, B, and C), tuberculosis and other infectious diseases. Discuss vaccinations for Tdap, MMR, HBV, and varicella. Consider baseline screenings for HIV, HBV, HCV and other communicable diseases. Then test periodically with informed consent. Ask about annual influenza vaccines.

Musculoskeletal injuries are common among firefighters. They high intensity and dynamic work environment leads to a high incidence of low back injuries, strains, sprains, and intervertebral disc injuries, which can lead to permanent disabilities. Obesity and deconditioning are strong predictors of musculoskeletal injuries. Full range of emotion should be evaluated, as well as low back strength and flexibility. Posture and core muscle strength should also be evaluated. Refer for therapy and certainly consider #yoga.

The Real Deal

None of this is okay. We need to get serious about protecting our heros. The fact that these environmental toxins continue to plague our environment is simply unacceptable. The amount of evidence is abundant. We need a complete revolution in this regard.

A medical detoxification program, in my opinion, is absolutely vital for firefighters. I would strongly encourage any and all firefighters within my practice to enroll in my #detoxification program, exclusive for primary care clients, and work diligently to reduce your overall body burden. Twice each year this program should be reported, and both phase one and phase two of the detoxification phases should be well supported. It would be my recommendation as well, for all firefighters to have their genetics evaluated so they are mindful of their #genetic polymorphisms and how those might play a role in their health as they assume the responsibility and risks associated with fighting our fires.

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