INDIANAPOLIS — Firefighters have one of the nation’s most dangerous jobs. But the leading cause of death among firefighters has nothing to do with flame. Instead, it has everything to do with their hearts.
Cardiovascular disease is the No. 1 cause of death among on-duty firefighters, and it strikes sooner for firefighters than for others. The United States Fire Administration reports that nearly half of firefighter fatalities are due to heart attacks (48.1 percent) — nearly eight times more than the number of firefighter deaths caused by smoke inhalation (6.2 percent).
Further, most cardiac deaths in the line of duty are premature. The average age of firefighters dying from on-duty heart attacks is only 50 years old (Geibe JR, et al. Am J Cardiol 2008;101:585–589). Whereas, for the general public, the average age of first heart attack for males is 64.7, and about 85% of people who die from heart disease are over the age of 65 (American Heart Association 2013 Fact Sheet).
In an effort to further investigate and reverse these alarming statistics, Harvard School of Public Health is conducting a two-part study led by Dr. Stefanos N. Kales, and funded by the Assistance to Firefighters Grants (AFG), a program of the Federal Emergency Management Agency (FEMA). Dr. Kales is an associate professor of medicine at Harvard Medical School and an associate professor and director of the Occupational and Environmental Medicine Residency at the Harvard School of Public Health In a series of prior investigations, Kales’ team consistently found that firefighters succumbing to sudden cardiac death on the job usually had blockages or atherosclerosis of the coronary arteries as expected. Surprisingly, they found that the vast majority of these victims, even younger cases, also suffered from various types of cardiac enlargement. The present research is designed to better understand the underlying cardiac structure and function of firefighters and to develop a risk model to identify those at highest risk for future heart problems.
“Because of the stressful demands of their jobs, firefighters are 10 to over 100 times more likely to suffer a heart attack while putting out a fire than while performing routine duties at the fire station. On the job deaths due to heart disease affect the fire service more than any other profession. That is why for 20 years my primary research focus has been investigating the causal relationship of heart disease among firefighters to their job activities and underlying health and fitness,” said Dr. Kales, who is also the division chief of occupational and environmental medicine at Cambridge Health Alliance.
“The study we are conducting with Indianapolis firefighters, Public Safety Medical and IU Health is the first of its kind,” said Dr. Kales. “It involves taking 3-D images of each participant’s heart so that we can examine the size of the heart and the thickness of the heart’s wall. These measures can reveal early signs of cardiovascular risk associated with conditions better known as cardiomegaly (enlarged heart) or Left Ventricular Hypertrophy (LVH). Our goal is to use this data to develop and validate cost effective methods for early detection and treatment so that we can ultimately decrease firefighters’ morbidity and mortality.”
The City of Indianapolis is a national leader in providing proactive cardiovascular care for its firefighters. Since 1996, Indianapolis has required annual exams for firefighters through a partnership with Public Safety Medical, led by Dr. Steven M. Moffatt. Additionally, labor and management have worked together in a trusted partnership toward this common cause of keeping firefighters healthy.
“We are proud to be a part of this study with Harvard School of Public Health that could lead to better health outcomes for firefighters across the world,” said Indianapolis Fire Department (IFD) Chief, Brian Sanford. “Our men and women with the IFD have seen firsthand the benefits of early detection. Our health partners at Public Safety Medical have caught several heart attacks waiting to happen, and because of their care and intervention, lives have been saved. That makes our participation in this study especially personal.”
The study involves a massive medical surveillance initiative to screen 400 Indianapolis Fire Department personnel in 2014. Indianapolis-based Public Safety Medical and IU Health Cardiovascular Center are teaming up to provide the clinical risk assessments, screening and follow-up care in conjunction with Dr. Kales.
“This research project is extremely important in not only setting the foundation for best practices in the care and treatment of fire fighters, but also helps create awareness of the increased cardiovascular risks that firefighters face,” said Dr. Steven M. Moffatt, Founder and Chief Medical Officer of Public Safety Medical and Co-Investigator in the Harvard Study. “Simply put, this study is about saving the lives of firefighters. Our goal as a study collaborator and as a health care provider is to keep firefighters healthy and doing the jobs they love for as long as they desire.”
In the first phase of the study, which is currently underway, volunteers from the IFD are being selected at random to undergo an hour-long series of safe, highly accurate and noninvasive cardiovascular screenings at IU Health Methodist Hospital. The firefighters are being recruited during their annual evaluations at Public Safety Medical by Dr. Steven M. Moffatt.
Each firefighter who participates in the screenings receives a cardiac magnetic resonance imaging (MRI) and an echocardiogram -- an ultrasound of the heart. Board-certified physicians at IU Health Methodist Hospital supervise the tests, interpret the images and notify the firefighter’s personal physician for further evaluation if any heart abnormalities are detected.
The de-identified images are then sent to Boston for further analysis by an imaging laboratory at Brigham and Women’s Hospital -- a major teaching hospital of Harvard Medical School. Test results will be used to develop a risk model to prospectively identify those firefighters at risk for future heart problems. Medical researchers will pay close attention to a variety of potential risk factors, including the firefighter’s age, weight, activity level, blood pressure, sleep, diet and family history.
The second phase of the study will apply the risk models developed in Indianapolis to a separate group of firefighters in Kansas City, Missouri in order to test and validate the models.
“Firefighters are unique in both the physical requirements of their job and their extremely high risk for developing cardiovascular disease. However, little is known about how their job and training might affect the structure and function of their heart,” said Dr. Richard Kovacs, a cardiologist at the IU Health Cardiovascular Center and professor of clinical medicine for the Indiana University Krannert Institute of Cardiology.
“Ultimately, this study will help to develop better standardized cardiovascular testing for firefighters nationwide,” said Dr. Kovacs. “Given the important role firefighters serve in keeping the public safe, the enormous public investment in their training and the unique physical nature of their occupation, it is important to understand the factors that contribute to their high risk of cardiovascular disease.”
Public Safety Medical and IU Health Cardiovascular Center expect to complete their screenings by end of year 2014. Initial study findings will be released by Harvard School of Public Health later in 2015.
“We selected the Indianapolis Fire Department for the study because of their nationally-recognized commitment to the health of their firefighters.” We don’t consider the firefighters as subjects, but as trusted partners and participants in this vital research,” said Dr. Kales. “The collaboration of all involved from the IFD to Public Safety Medical to IU Health to the firefighters who have volunteered for this study has been outstanding. We look forward to reviewing the data and continuing to advance this important area of research for the well-being of our public safety officers.”
The study is supported by the U.S. Federal Emergency Management Agency (FEMA, Washington D.C., USA) Assistance to Firefighters Grant (AFG) program award EMW-2011-FP-00663 to Harvard University (PI: Dr. SN Kales).
The Indianapolis Fire Department is comprised of an 1153 sworn and 60 civilian member team dedicated to serving the residents of its 278 square mile service district. For over 150 years, its mission has been to provide an appropriate safe and professional response to fire, medical and environmental emergencies.
Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.
Dr. Stefanos Kales is a leading researcher in the area of cardiovascular health of firefighters and other public safety officers. As a result of his research efforts, Dr. Kales has influenced national thinking among occupational physicians regarding firefighter’s fitness for duty, the need for improved wellness programs, and better control of risk factors.
Founded and based in Indianapolis by Steven M. Moffatt, M.D. in 1990, Public Safety Medical is a nationally recognized Center of Excellence that provides specialized medical, fitness, and psychological services for fire, EMS, and law enforcement personnel. Serving hundreds of public safety departments every year, Public Safety Medical is the most experienced provider of public-safety-focused evaluations in the Midwest. They have been awarded the prestigious national Corporate Health Achievement Award from the American College of Occupational and Environmental Medicine for their work with the Indianapolis Fire and Police Departments.
IU Health Cardiovascular ranked in the top 50 national programs for Heart & Heart Surgery in U.S.News & World Report’s 2013-2014 edition of Best Hospitals. The IU Health Cardiovascular Center, in association with the Indiana University School of Medicine—one of the nation’s top-ranked academic teaching hospitals—provides comprehensive services and is also a state and regional referral resource for the most complex, advanced heart, lung and vascular disease problems.
Cambridge Health Alliance is a vital and innovative community health system that provides essential services to Cambridge, Somerville, and Boston’s metro-north communities. It includes three hospital campuses, a network of primary care and specialty practices, and the Cambridge Public Health Dept. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine, and Tufts University School of Medicine.