Risk of Sudden Cardiac Events and the Role of Fitness in Prevention

CarolinaFireJournal - Karen Leatherman
Karen Leatherman
10/19/2016 -

Firefighters are required to perform a complex series of physically demanding tasks in hot, dangerous environments with heavy protective gear while being exposed to smoke and toxic chemicals. As a result, 85 to 100 firefighters die each year with approximately 35 to 45 due to sudden cardiac events. 


This is 45 to 50 percent of all firefighter duty related fatalities. The figures in the chart compare, deaths from sudden cardiac events, burns and asphyxiation since 1990.

There are multiple factors acting together to influence the cardiovascular strain of firefighting. Three of these are:

  • Sympathetic nervous system activation, which begins with the alarm and continues throughout the call because the fire scene is a dynamic environment.
  • Strenuous physical work that is both aerobic and static such as climbing and carrying heavy equipment. During peak times firefighters are often near their max heart rate and results in O2 uptake of greater than 40ml/kg min.
  • Exposure to heat and pollutants contained in smoke exacerbating cardiovascular strain associated with heavy work.

The group with the greatest risk are those with previous history of heart disease. In addition, low fitness levels also contribute to increased risk because fit firefighters experience less cardiovascular strain with the same level of work. Unfortunately many often lack high fitness levels and a large percentage are overweight or obese.

There is some good news. If you look at the figure above, you will note the downward trend during the past 10 years. This encouraging trend may be caused by efforts of the International Association of Firefighters, International Association of Fire Chiefs and National Volunteer Fire Council, which have encouraged medical evaluations and promoted firefighter wellness and fitness.

Bottom line, as exercise professionals, we have a unique opportunity to discuss why it is important for firefighters to increase physical fitness not only to help with their job duties but also to potentially save their lives. This is a remarkable occupation that is so important to our public safety.

Karen Leatherman is president/owner of Fitness Forum Occupational Testing Services. She has over 30 years performing exercise stress testing and has been testing firefighters for over 20 years. She was on the American College of Sports Medicine (ACSM) Health and Fitness Certification Committee where she travelled with a team from the U.S. to India and Hong Kong to teach and administer ACSM exams.
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