Is Heart Disease in the Fire Service a Concern

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Is Heart Disease in the Fire Service a Concern?

• Thomas Hales, MD, MPH
• CDC NIOSH
• DHS - Program/Office of Grants
• and Training Meeting
• January 8, 2007
• WDC

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(No Transcript)
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Outline

• Heart disease and fire fighting
• Key findings
• Key Recommendations
• Research Needs

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Exposures

• CO
• Shiftwork Overtime
• Heat Noise
• Diesel exhaust ETS
• Rapid HR ? BP
• emergency calls
• heavy physical exertion

Source Steenland Fine. Occup Med State of
the Art Reviews 2000157-24
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• Heavy physical exertion
• Trigger
• Heart attacks

Sources Willich et. al. NEJM 19933291684 Tofler
et. al. J Am Coll Cardiol 1992201049 Mittleman
et. al. NEJM 19933291677
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Exposures

• Heavy physical exertion
• Trigger ??
• Heart attacks

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CVD Fatalitiesby Location
N134
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Risk Factors for On-duty CVD Fatalities

• Risk Factor OR (95 CI)
• Fire Suppression 64 (7.4-556)
• Training 7.6 (1.8-31.3)
• Alarm Response 5.6 (1.1-28.8)

Source Kales et. al. Environ Hlth a global
access science source. 2003214
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Findings - CVD Fatalities by Time of the Event
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Circadian Distribution of CHD
Kales et. al. Environ Hlth a global access
science source. 2003214
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Do FF have increased RATES of heart disease?

• 25 SMR studies mixed results
• Limitation - Healthy Worker Effect
• In 2000, Choi concludes, there is strong
  evidence of an increased risk of death overall
  from heart disease among fire fighters.

Source Choi. J Occup Environ Med
2000421021-34.
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Do FF have increased RATES of heart disease?

• In 1995, Guidotti concluded,
• sudden death, myocardial infarction, or fatal
  arrhythmia occurring on or soon after
  near-maximal stress on the job are likely to be
  work related.

Source Guidotti. J Occup Environ Med
1995371348-56
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Acute Exposures

• Heavy physical exertion
• Trigger
• Heart attacks

??
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Outline

• Heart disease and fire fighting
• Key findings
• Key Recommendations
• Research Needs

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Findings - Autopsy

• Only 69 of CVD fatalities had autopsies
  performed
• Why?
• Cause of Death
• PSOB application

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Findings CAD Risk Factors

• 90 1 CAD risk factors
• Modifiable
• Diabetes, Hypertension, Smoking, Cholesterol,
  Obesity/Lack Exercise
• Non-Modifiable
• Age, Gender, Family Hx

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Findings CAD Risk Factors

• 90 1 CAD risk factors
• High cholesterol (58)
• Smoking (57)
• HTN (49)
• Lack of exercise/obesity (42)
• Diabetes (16)

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Pre-placement Medical Evaluations
Illness Investigations
Pre-placement Medical Evaluations
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Periodic Medical Evaluations
Illness Investigations
Periodic Med Evaluations
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Periodic Medical Evaluations
Illness Investigations
Exercise Stress Tests
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Wellness/Fitness Programs,1998-2004
Illness Investigations
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CVD Fatalities Resuscitation

• Automated External Defibrillators (AEDs)
• Misuse in 4 cases

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Findings - Surprising

• CO poisoning
• possible factor in only few CVD fatalities
• Cardiomyopathy cases
• Particularly among young FF
• No fatalities due to hypoglycemia due to diabetes
• Lack of FF with diabetes?

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Outline

• Heart disease and fire fighting
• Key findings
• Key Recommendations
• Research Needs

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Recommendations

• Autopsies
• Medical Screening Programs
• EST
• Fitness/Wellness Programs
• Phased-in, non-punitive
• Negotiated with local union
• Resuscitation training
• AEDs intubation procedures

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Outline

• Heart disease and fire fighting
• Key findings
• Key Recommendations
• Research Needs

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Research Needs Workplace factors

• Health effect of chronic CO exposure
• Exposure to cyanide (HCN)
• Environmental
• Biological monitoring

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Research Needs Personal Risk Factors

• Barriers to implementing wellness/fitness
  programs
• Effectiveness studies
• Cost-effectiveness studies

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The findings and conclusions in this presentation
have not been formally disseminated by the
National Institute for Occupational Safety and
Health and should not be construed to represent
any agency determination or policy.