If you asked anyone what the main cause of death for firefighters is, chances are they’d say fire, smoke, or building collapse. But in reality, heart attacks are by far the most common cause of death on active duty. As a result, heart health is critically important for firefighters.
What the numbers say
Each year, dozens of US firefighters die on active service. In 2024, 72 firefighters lost their lives. Of these, half died from cardiovascular events including heart attacks. In the 34 years of data that has been collected by the FEMA Fire Administration, 3,905 firefighters have died, 40% of them from heart attacks. Notably, while the overall number of deaths is dropping (as a result of improved equipment and safety), the proportion of deaths from cardiovascular events is increasing.
Why so many heart attacks?
Firefighters are generally extremely fit. They have to be fit in order to cope with the rigors of the job like hauling hoses, climbing ladders, or rescuing fire victims. So, how come so many of them die from heart attacks and other cardiovascular events? And how many more are left seriously ill after surviving? Well, a firefighter tackling a blaze faces a perfect storm of potential triggers for heart attacks.
- Physical exertion and stress. As mentioned, the job is incredibly physically demanding and places a lot of stress on the heart. Imagine combining the strain of running a marathon with the effort required to be a weight lifter.
- Use of respirators. In most any structural fire, you’ll see firefighters wearing self-contained breathing apparatus (SCBA). These respirators help them survive in air that’s too noxious to breathe. But they place an additional burden on the cardiovascular system.
- Heat stroke. Fires are hot, like really, really hot! And firefighters go into blazes wearing heavy protective turnout gear. This gear keeps them from burning alive, but the temperature inside their clothing still reaches similar levels to a domestic oven! This means they are at extreme risk of heat stroke, where the brain can no longer cool itself. In turn, this greatly increases the risk of cardiovascular events.
There are other risks, such as the risk of panic attacks. But the above are the three biggest problems.
What is being done about this?
Fire departments, unions, and the NFPA have all recognized that this is a major issue. This is one of the big drivers behind the push for annual fitness and health checks.
Annual fitness checks
NFPA 1582 transformed the recruitment and retention requirements for firefighters. The focus shifted from choosing people for their strength and bravery. Rather, it now focuses on overall physical fitness and takes into account risks for things like coronary artery disease.
Improved gear
Over the years, firefighter turnout gear has improved massively. The latest NFPA standards are based on trying to keep firefighters safe from all the risks they face. That includes requirements for wicking and sweat management, as well as water and heat protection.
Better procedures
Nowadays, fire incidents are managed in a way that is designed to reduce risks. Firefighters are only allowed to work for a few minutes in the hottest areas. They are monitored for signs of heat exhaustion. They are made to stay hydrated, and are much more aware of their potential health risks than their forebears 50 or 100 years ago.
What other risk factors exist?
There are many other factors that explain why despite everything, large numbers of firefighters still lose their lives to cardiovascular events.
Diet
It’s well known that diet can directly affect your heart health. As a rule, on duty firefighters eat healthy home-cooked food in the firehouse. However, these meals are often interrupted which isn’t great. Also, a diet with regular take out food can contribute to poor cardiovascular health..
Lifestyle
Lifestyle factors like smoking and drinking can greatly increase the risks. The annual fitness check takes these into account, and firefighters at increased risk receive additional testing. However, this cannot in itself remove the risk. Rather, it requires an actual change in lifestyle and habits.
Toxins
Firefighters are exposed to a range of disease-triggering and potentially deadly toxins. Some of these are known to increase the risk of cardiovascular disease. For instance, PFAS (widely used in protective gear) is linked with dyslipidemia, inflammation and cardiovascular disease. All of which increase the risk of heart attacks. Sadly, PFAS-free turnout gear is still incredibly expensive and rare, with only a handful of cities across the country adopting it to date.
Conclusions
No one doubts the bravery and dedication of firefighters. So, we should all be shocked by how many are dying unnecessarily due to avoidable heart attacks. Politicians in city halls across the country should be pressured into implementing real changes. This would include replacing turnout gear with PFAS free alternatives, targeted screening of high risk firefighters for PFAS exposure, and more active support for programs such as smoking cessation.
