Firefighter Stressors

Firefighters face temperature extremes of anywhere from below freezing to in excess of 300°C (>570°F), and in many cases these extremes occur within minutes of each other. They are continuously exposed to various chemical and physical hazards, one of which is the microclimate that is created by the protective gear that they wear. The protective barrier of the gear also prevents the body from properly cooling itself. The heavy physical labor that firefighters must perform can result in heart rates of 88±6% of the predicted maximum. The generation of internal body heat and the inability to dissipate heat are further compounded by the weight of the gear (bunker suit, helmet, and self-contained breathing apparatus), which approaches 24 kg (53 lb.). Add to this that the firefighter must be able to transport various pieces of equipment that can weigh over 35 kg (77 lb.) while still in full gear, in a dark, smoky environment, with limited visibility.

Research shows that most firefighters fall into the sedentary range of physical fitness. This is misleading, though, because firefighters must go from a sedentary lifestyle to a sudden, very physical, high-stress situation that requires them to be able to perform duties as needed. Firefighters must be able to lift and hold for extended periods of time various pieces of equipment that may weigh in excess 35 kg (>77 lb.). They're also required to ascend ladders in full gear, while carrying additional pieces of equipment of various weights. Therefore, strength or muscular endurance would be of utmost importance to the firefighter.

The most frequent illness among workers exposed to heat stress through environmental conditions and/or clothing requirements is heat exhaustion, which is most likely due to dehydration. Some workplaces will also report frequent occurrence of muscle cramps. To reduce the risk of heat disorders, a strong emphasis is placed on heat-stress hygiene practices. These include self-limitation, adequate fluid replacement, eating a good, well-balanced diet, monitoring health status, and allowing for acclimation to the heat. The workers must be aware of what they can do to lower their individual risks for heat disorders, and the employer must do those things that are reasonable to encourage these practices.

Interestingly, almost 50% of firefighter fatalities on duty are not from direct fire related injuries but from heart attack and stroke. Direct injuries that occur to firefighters include heat illness related to dehydration, smoke inhalation, burns, sprains, and other traumas to the musculoskeletal system. Chronically, firefighters experience a high incidence of knee injuries, usually due to prolonged, physical stress on the joints. Most scenarios in which the injuries occur cannot be changed, but the procedure on how to prevent each injury can. Firefighters, in general, should receive training and in-service education on nutrition, which could help prevent the leading causes of death among these workers. Nutrition classes, taught by a Registered Dietitian, have had a direct, positive effect on helping firefighters achieve adequate fluid intake for better hydration, and in reducing the total caloric intake and the grams of fat consumed each day. Regular exercise that includes aerobic and anaerobic training, can be used as another "precaution."

Generally, the chronic physical risks that firefighters face include being overweight or obese, or possibly having cardiovascular disease or osteoarthritis in the knee. They also face a considerable amount of mental stress. Most firefighters are on duty for 24 hours, then they are off for 48 hours. During this time they live at the fire station. Since there is never a "planned emergency," they are always anticipating the alarm. It's similar to being on a roller coaster. Once the alarm sounds there is an automatic adrenaline "rush" and an increase in their heart rate, before they even get to the fire. Combine the emotional stress of this with the health stresses of being overweight and having low cardiovascular fitness, and the physical stress of fighting the fire, and you have a candidate for a heart attack. Practical instruction on fluid intake, food portion control, and food label reading is beneficial. Education has made an impact, and results in positive changes, if the information is modified to meet the specific lifestyle and needs of the specific occupation with which you consult.

One of the most important concepts that I stress is the importance of continuous fluid consumption. Due to the fact that a firefighter never knows when they will be called to a fire and that they should not rely on their thirst mechanism, it is important that they drink appropriate fluids throughout their entire shift.