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Sudden Cardiac Deaths Amongst Firefighters

Doctor Denise Smith, a Professor of Health and Exercise Sciences at Skidmore College, details findings involving sudden cardiac deaths among firefighters to underscore the work-related factors that contribute to cardiovascular disease in the community. Doctor Smith asserts that those in the medical field who assess the fitness of firefighters may not understand the physiological and psychological strains unique to the profession, and may be green-lighting firefighters for service to their own detriment. We encourage you to read her thorough and informative take on this important issue, and in turn, raise awareness among your own peers, co-workers, or employees. This article was originally featured on the TargetSolutions website and authored by Greg Baldwin.


The dangers of the firefighting profession are never in short supply. Smoke inhalation, burn injuries, car accidents, collapses – just a few of the perils that routinely handcuff themselves to the day-to-day operations of the job.

But there’s another hazard that’s quietly lurking below the radar causing more damage but receiving substantially less attention: sudden cardiac events. With a staggering 51 percent of all firefighting line of duty deaths caused by sudden cardiac events, the epidemic presents itself as the No. 1 firefighting fatality, more than any other fire-related danger combined.

Denise Smith, professor for health and exercise science at Skidmore College in Saratoga Springs, N.Y., is leading the crusade against fire service-related cardiovascular diseases. Citing studies that suggest the cardiovascular disease risk factors in firefighting are similar to those of the general population, Smith poses the question: If a firefighter’s basic cardiovascular disease risk isn’t greater than the rest of the population, why are they so much more likely to die at work?

The answer may lie in the magnitude of the cardiovascular strain they experience during their jobs.

For example, a person not involved with the fire service may harness a similar cardiovascular risk but is unlikely to do work that is as strenuous as a firefighter. More importantly, Smith asks, “are we doing enough to prevent sudden cardiac events in firefighters?”

Smith believes there is an abundance of cases where firefighters are being cleared for duty following a medical evaluation that includes findings of cardiovascular risk. This is due in large part because of the physician’s lack of understanding of the physiological and psychological strain of the job.

Therein lies the problem: Firefighters are being cleared for duty despite the detection of early signs of cardiovascular diseases.

“The firefighter hears ‘I’m cleared for duty, therefore everything is OK,’ but very often those medical evaluations are doing exactly what they should be by detecting early signs of cardiovascular disease or risk factors but the firefighter is failing to follow up because he’s cleared,” said Smith.

Further complicating the issue of medical evaluations are departments that operate in a very black and white manner when it comes to firefighters being cleared for duty. Because of this, physicians are reluctant to take a firefighter off the job because of something like high blood pressure. This results in leaving treatment in the hands of the firefighter and puts them at greater risk if something is not done.

Simply put: Firefighters should receive appropriate medical evaluations and aggressively address risk factors – and departments should provide a comprehensive wellness and fitness program to help them do so, Smith believes.

In some cases, firefighters should be placed on light duty until health issues can be properly addressed. But what constitutes justifiable risk to remove a firefighter from active duty?

Smith suggests that a proper annual medical evaluation is a great place to start, but emphasizes that findings of hypertension, obesity, or diabetes/prediabetes must be taken seriously with accompanied steps to reduce the risk of further progression. Sudden cardiac events account for half of duty-related deaths and close to 1,000 non-fatal events every year.

Ignoring the risk makes no sense, she said.

“I think the possibility of a guy coming off active duty in order to rehabilitate to get those risk factors down to do the job more effectively and safely is a very reasonable approach,” said Smith.

As for what initial health risk factors should take priority, Smith suggests that elevated or borderline cardiovascular levels, especially prehypertension and prediabetes, should be taken more seriously. Too often are these issues seen as minor when, in fact, they’re constituting an exuberant medical risk.

While some may be intimidated by mandated health programs that place greater emphasis on managing a wide array of cardiovascular issues, Smith says the goal should be to turn these programs into a positive message as a way to avoid devastating health incidents.

“Prevention is the most powerful thing that’s largely within a firefighter’s own control,” Smith said. “A firefighter who has good overall health and is exercising, maintaining a normal body weight and eating healthy is the one who’s most protected from cardiovascular disease and cancer.”

“These are largely solvable issues and can be addressed and mitigated by the actions of firefighters to keep themselves healthier.”

  • This article was written by Greg Baldwin of TargetSolutions after an in-depth interview with featured contributor Denise L. Smith.

For the National Fire Protection Association’s report on firefighter fatalities, you can visit here.

Doctor Denise Smith, a Professor of Health and Exercise Sciences at Skidmore College, details findings involving sudden cardiac deaths among firefighters to underscore the work-related factors that contribute to cardiovascular disease in the community. Doctor Smith asserts that those in the medical field who assess the fitness of firefighters may not understand the physiological and […]

Important Trust Reminders

The deadline to submit your district’s proxy form for the CFH Trust membership conference is fast approaching, and we cannot stress how important it is to get your signed and completed forms in before October 10 if you can’t attend this year.

Click here for the official proxy form. Bear in mind that we need at least 30% of our membership and/or proxies in order to establish a quorum and conduct business.


Also, don’t forget to submit your payments for reimbursement! A considerable sum went unclaimed last year due to members forgetting.

Here is a current breakdown of the DOLA reimbursement numbers, as of October 3, 2016:

State Fiscal Year Allocation Total: $939,053

Amount Requested by FFB Employers: $684,839
This amount contains the total of all reimbursement requests that have been received and fully reviewed.

Amount Approved: $657,889
This amount contains the total of all reimbursement requests that have been approved for payment or are pending payment.

Remaining Balance: $281,163 The deadline to submit your district’s proxy form for the CFH Trust membership conference is fast approaching, and we cannot stress how important it is to get your signed and completed forms in before October 10 if you can’t attend this year. Click here for the official proxy form. Bear in mind that we need […]

Trust News and Notes

The Trust renewed all 86 members from last year for fiscal year 2016 and has added a new member. As we’ve already mentioned, DOLA began accepting applications for reimbursement for Fiscal Year 2016 on July 15, 2015. If you haven’t already, please submit your reimbursement request for the 2016 fiscal year.

Below is a breakdown of the current allocation information numbers, as of August 1, 2016:

State Fiscal Year Allocation Total: $939,053

Amount Requested by FFB Employers: $332,025
This amount contains the total of all reimbursement requests that have been received and fully reviewed.

Amount Approved: $332,025
This amount contains the total of all reimbursement requests that have been approved for payment or are pending payment.

Remaining Balance: $607,028

We don’t want to see any fire departments leaving money on the table, so be sure to submit your application at your earliest convenience. In all, there was $103,000 that went unclaimed for the  2015 fiscal year (which ran from July 1 to June 30). Last year, there were four members who never submitted their 2015 payments for reimbursement, and we don’t want you to be one of these departments this year!

The Trust renewed all 86 members from last year for fiscal year 2016 and has added a new member. As we’ve already mentioned, DOLA began accepting applications for reimbursement for Fiscal Year 2016 on July 15, 2015. If you haven’t already, please submit your reimbursement request for the 2016 fiscal year. Below is a breakdown […]

Firefighter Eligibility Outline

Establishing eligibility in the CFH Trust program is an important aspect of determining compliance with Colorado Revised Statute 29-5-302. This outline was written to help answer some questions regarding individual eligibility in the CFH Trust program.

The following scenarios and explanations were drafted bearing in mind instances where a sympathetic jury could conceivably determine that a plaintiff was eligible for coverage. It is our goal to provide equitable treatment to any reasonably qualified firefighter without overstepping the intent of the statute, thus avoiding a substantial future liability. The sample scenarios below speak to some issues which have been presented thus far.

Click here for a downloadable and printer-friendly PDF of the following scenarios

Methodology Abstract

Ultimately, any ruling on benefits must comply with the spirit of the original legislation upon which the CFH Trust is built. The Trust’s mission is to provide benefits to firefighters when they have suffered from a qualifying line of duty cardiac incident. Since eligibility is established within a framework of years of qualifying service, it is that principle upon which the majority of eligibility questions are answered.

As long as a firefighter is on a roster submitted to the Trust by a paid member department, his or her eligibility will be established on a case-by-case basis weighted by a firefighter’s service time. This service must include five (5) or more years as a career, volunteer, or part-time firefighter or other official working in the fire protection service. This includes firefighters, chiefs, trainers, community outreach personnel, administrative staff, and mechanics. The duration of service must exist in the firefighter’s background, but need not immediately precede the qualifying cardiac incident and need not have taken place in the state of Colorado as long as the service was completed in a qualifying role in another state or country.

Eligibility Scenarios

Trust members have posed questions regarding whether benefits may be available in certain scenarios. This document discusses some of these examples along with our response. While this information is intended to assist discussion of eligibility issues, each claim for benefits must be reviewed for eligibility on an individual, case-by-case basis. This guidance is non-binding and is not the basis for any claim of rights, benefits, or liabilities assigned to the Trust or any of its members.

SCENARIO: Full-time Colorado firefighter (FF) has 10 years of continuous service, leaves the country for 18 months, and then returns to a full-time FF position in Colorado. Ten months later, the FF has a heart attack. He is on the roster as an eligible FF and the department has paid the contribution. Based on the department’s interpretation of the statute, the FF is eligible because the statute does not specify that the five years of continuous service must take place either “immediately preceding the heart incident” or that continuous service had to be in-state.

RESPONSE: The Trust agrees with the department’s interpretation. The five years of service do not need to immediately precede the heart incident. As long as five years have been served and the other eligibility requirements are met, the FF is eligible.

SCENARIO: A volunteer FF with 10 years of service at the same department becomes paid full-time staff. The FF previously qualified as a volunteer, so we presume his qualification continues. The department is currently paying a contribution.

RESPONSE: Service that is split between volunteer and career positions should not be excluded as long as the other eligibility requirements are met.

SCENARIO: A volunteer FF with four years and nine months of service with the same employer becomes a full-time paid FF with the same employer. We presume that the combination of volunteer time plus full-time years of service accumulates to qualify this FF when a total of 5 years is reached.

RESPONSE: Same as previous – service time that is split between volunteer and career positions should not be excluded as long as the other eligibility requirements are met.

SCENARIO: A mechanic who had previously worked as a sworn FF with 10 years of service and is also on call to respond to equipment failures at a fire scene, training grounds, or wherever required. The employee was called out in the middle of the night to an equipment malfunction at the scene of a multiple alarm fire, and has a heart incident while trying to get water to his crew. Is his mechanic position directly related to the provision of fire prevention services as specified by the statute?

RESPONSE: Any sworn FF, regardless of current position, is eligible. This includes mechanics, community outreach personnel, training staff and other administrative workers, provided the incident involves stressful and strenuous activity and other eligibility requirements are met. Activities outside of those under the definition of a work event do not result in eligibility.

SCENARIO: A sworn FF who is now providing community outreach and fire safety awareness to a fire department in a full-time position has a qualifying heart incident. The department the sworn FF works for contracts with a neighboring district to provide “Fire Prevention Services.” We presume services for fire safety awareness education and outreach is part of the direct provisions of fire prevention services to another community.

RESPONSE: Same as previous: any sworn FF, regardless of current position, is eligible. This includes mechanics, community outreach personnel, training staff and other administrative workers, provided the incident involves stressful and strenuous activity and other eligibility requirements are met. Activities outside of those under the definition of a work event do not result in eligibility.

SCENARIO: A fire chief has almost 20 years of service as a career FF in another state plus 2 years in Colorado as a career FF. The fire department administration interprets the legislation as qualifying him under the 5 years or more of career service requirement and has paid the contribution.

RESPONSE: The five years of service requirement can also be served in another state as long as it meets the other eligibility requirements.

 Establishing eligibility in the CFH Trust program is an important aspect of determining compliance with Colorado Revised Statute 29-5-302. This outline was written to help answer some questions regarding individual eligibility in the CFH Trust program. The following scenarios and explanations were drafted bearing in mind instances where a sympathetic jury could conceivably determine that […]

Bringing Cardiovascular Assessments to Colorado Firefighters

Cardiovascular related events continue to be the leading cause of on-duty death for those working in the fire service. The State of Colorado passed a law to provide funds for firefighters who suffer a cardiovascular event while on duty. In order to be eligible for these funds, firefighters must:
  1. Be continuously engaged in fire prevention services for five years
  2. Have a medical examination after the date of hire but before a heart incident that would reasonably find the presence of cardiovascular disease
  3. Be diagnosed with a heart incident within 48 hours of a stressful or strenuous work event
A proper heart assessment is a critical component to facilitate the process for determining participants’ eligibility for these state funds. The Colorado Firefighter Heart and Circulatory Benefits Trust (CFH Trust) has partnered with Colorado State University (CSU) to offer a basic, mobile heart disease screening program that can be provided on location at fire agencies throughout Colorado. (more…)Cardiovascular related events continue to be the leading cause of on-duty death for those working in the fire service. The State of Colorado passed a law to provide funds for firefighters who suffer a cardiovascular event while on duty. In order to be eligible for these funds, firefighters must: Be continuously engaged in fire prevention […]