Standard operating procedure

Photos courtesy Calgary Fire Department All Calgary firefighters undergo regular fitness testing as part of the department’s wellness program.

In 2008, 50 of the 114 U.S. firefighters who died on duty perished due to overexertion.  At 43.8 per cent of all fatalities, overexertion, or heart attacks, were the biggest killer of firefighters compared to other causes of death. The next largest killer – vehicle collisions – came in at 25.4 per cent.

The Canadian government doesn’t keep detailed figures about firefighter fatalities and their causes. However, according to Ian Crosby, a wellness and fitness officer with the Calgary Fire Department, overexertion is just as big a threat to firefighters in Canada. “It’s well known that heart attacks account for the largest share of on-duty deaths,” Crosby says. “The problem is fitness: As firefighters get older, their bodies have a tougher time coping with the demands of the job.”

A firefighter’s job is brutal for the human heart, says Crosby. “When the alarm hits, the heart rate responds by increasing by as much as 50 beats per minute due to the fight-or-flight mechanism. Heart rates often stay elevated for the duration of the emergency due to both workload and hormonal responses,”

The Fire Service Joint Labor Management Wellness-Fitness Initiative is saving lives because physically fit personnel perform better and live longer.
Firefighters take their medicals during regular shifts in an effort to make sure they keep their appointments.
The Wellness-Fitness Initiative or WFI is a comprehensive program aimed at helping firefighters improve their lifestyles without invading their privacy.

Crosby says full turnout gear and SCBA diminish work efficiency by about 30 per cent and the harsh, superheated environment adds additional load to an already stressed cardiovascular system.
“It is quite common to see firefighters’ heart rates exceed their predicted maximum during strenuous, stressful work,” he says. “This is why there is an increased risk of heart attacks among firefighters. It’s not just that they are getting older, but also that many of these firefighters have endured years of such punishment. It adds up; this is tough work.”

Fighting back with WFI
Firefighters and their departments know that physically fit personnel perform better and live longer. This is why the International Association of Fire Fighters, in co-operation with fire departments in nine U.S. cities and in Calgary, has launched a Fire Service Joint Labor Management Wellness-Fitness Initiative or WFI.

The goal of the program is to help firefighters get fit and stay fit by providing medical support and fitness training where they work. But WFI is more than just a gym in every fire hall: It is a comprehensive program aimed at helping firefighters improve their lifestyles without invading their privacy.

Statistics compiled over the last few years by departments participating in the fitness initiative indicate that 65 per cent of firefighters have three or more cardiac risk factors and 40 per cent have four or more. Inactive firefighters have a 90 per cent greater risk of a heart attack than those who are aerobically fit.
In Calgary the process starts with the department’s Wellness Centre at the University of Calgary. This facility has the doctors, physiotherapists and exercise/monitoring technology to put firefighters through detailed physical exams so that effective exercise and diet routines can be formulated.

That said, the mandate of the Wellness Centre is not to wag a finger and tell firefighters they’re out of shape. Instead, “our goal is to get a complete picture of the individual’s overall health, which includes mental, physical and behavioural condition, so that we can understand what changes in their lifestyles might improve their wellness,” says Crosby. “We also provide full physician services to immediate families. We become their family doctors, as it were, except we are far better equipped than most GPs. As well, we have much more sophisticated equipment and, if required, can expedite treatment to other facilities, so there’s a real plus to being part of our program here in Canada.”

Each Calgary fire hall is equipped with treadmills, elliptical trainers exercise bicycles, resistance machines and other equipment for strength training.

“Our approach is to build it, and they will come,” says Crosby. “As a result, we have put in this equipment at each hall, plus made sure that personal trainers are available to help our firefighters develop personalized workout routines. Our goal is to make regular exercise a part of everyday station life and something that firefighters do together. We even provide time for it in their daily schedules and we make sure that the equipment is modern and up to date.”

Calgary’s success has caught the attention of firefighters in Ottawa. Peter Kennedy, president of the Ottawa Professional Fire Fighters Association, IAFF Local 162, said the union is talking to the City of Ottawa, Ottawa Fire Services and the Workplace Safety and Insurance Board of Ontario about implementing such a program to help prevent illnesses and injuries before they occur, “Over the last nine years Ottawa has lost three active firefighters to cancer and a number of retirees to similar work-related illnesses,” says Kennedy.

“Having the WFI program started in Ottawa is an effective way to respond to such losses. We feel that if many illnesses can be detected early on then firefighters have a greater opportunity to live a long and healthy life after appropriate treatment.

“Further, the fitness, nutritional and rehabilitative components of the WFI provide for a much more holistic approach to both mental and physical fitness in the workplace that is bound to have positive effects on the home front as well.

“Lastly, the data collection component of the program will enable researchers to detect medical trends that exist and provide an opportunity to change behaviours, protective clothing and tactical approaches to firefighting dangerous emergencies.”

Selling the concept
It isn’t easy getting firefighters, particularly male firefighters, to take preventative steps to protect their health; they tend to wait until something is clearly wrong.

But with heart disease such a serious threat to firefighter health, departments can’t stand by while their personnel procrastinate. This is why getting a full medical has become a requirement for working in Calgary.

“We are very careful how we manage this requirement, because the last thing we want to do is make wellness punitive,” says Crosby. “This program doesn’t have standards, however, it is mandatory; it’s about empowering our personnel through education and health promotion.”.

Ultimately, he says, firefighters are responsible for their own health and well-being – WFI simply gives them direction. Firefighters take their medicals during their regular shifts. If a firefighter misses the appointment twice, the district chief will stop by the station and the firefighter to the Wellness Centre – that has yet to happen in Calgary.

A particularly tricky issue is patient privacy. Firefighters dealing with health concerns that they want to keep private – medical conditions, psychological issues or substance abuse, for example – are unlikely to want to see a department doctor. To help firefighters develop trust Calgary started its program by defining concepts such as wellness versus fit for duty and mandatory non-punitive. Their doctors emphasize health promotion through education.

“We empower our firefighters to make the right decisions based on the physician’s recommendations,” Crosby says. “In this way, our patients are not fearful about being tested. They know that their jobs are not on the line. This is likely why we have a more than 98 per cent participation and compliance with the physician’s advice.”

Results
The WFI initiative is not cheap. In Calgary its works out to about $500 a year for each employee. That covers the Wellness Centre and its staff, exercise equipment and any other related costs. For a 200-person department, a WFI program would cost $100,000 annually after set-up expenses. Is it worth it, especially when budgets are tight?

“We’ve definitely seen results,” says Deputy Chief Ken Uzeloc, head of Calgary Fire Department administration. “Thanks to the WFI’s medical testing, we’ve had a number of firefighters who have had early intervention into problems such as heart disease and other life-threatening illnesses. Without the testing, many of these problems would have gone undetected until they became far more serious.” In addition, says Crosby,

Workmen’s Compensation claims have decreased. “This doesn’t happen at first: During the first wave of testing, we often find untreated injuries that need attention. But once the program is established, the claims drop because people’s bodies are better able to cope with their jobs.”

On a larger scale, fitness levels among Calgary officers have improved annually. Better fitness reduces the risk of heart attack and serious muscular and skeletal injuries.

“We don’t have hard information yet about the WFI’s impact in reducing heart attacks,” Uzeloc says. “However, we are seeing a real difference in terms of firefighter attitudes at work. They are making and eating healthier meals and making time for fitness and wellness activities at work. They are starting to truly look after themselves and this has a positive impact on their morale.”

Uzeloc says the over the long term he expects the program will help firefighters stay healthier and become less prone to injuries.

The WFI has reported a 3:1 return on investment in U.S. departments. Calgary fairs differently because the Canadian health-care system doesn’t burden the department with medical insurance costs, therefore Calgary’s return on investment is a little less than 1:1. To further assist with Calgary’s Wellness operating budget, the clinic is registered with the province and is entitled to bill Alberta Health Care for certain third-party medical procedures.

“All told, a comprehensive WFI program pays off for any fire department,” Crosby says. “This is why we are so excited about it at the CFD, and why we want to help other Canadian departments adopt the same approach. After all, our people are our greatest resource: Keeping them healthy and fit is in everybody’s best interest.”

For more information, visit the IAFF website at www.iaff.org/HS/Well/wellness.html.