Firefighters are dying on the job from heart attacks more than any other risk they face, but researchers and firefighting professionals say increased focus on physical fitness with annual medical and fitness testing could increase their resiliency.

Heart disease and other cardiac issues have long been recognized as significant health risks for firefighters.

Cardiac-related events have accounted for 43% of the on-duty duty fatalities over the past 10 years, according to a National Fire Protection Association report. In the general population in the U.S., about one in five people die from heart disease.

Matt McAllister, a research fellow with the Translational Health Research Center at Texas State University, studies the effect of stress on firefighters and its relation to cardiovascular health. He’s an associate professor of exercise and sports science in the Health and Human Performance Department at Texas State and leads the Metabolic and Physiology LAB, which studies physical stressors and how to mitigate them for high-stress occupations like firefighting.

“Exercise and training are the best thing you can do to increase performance and reduce the risk for chronic disease,“ he said in a recent interview.

His research indicates a prevalence of obesity in firefighters — high waist circumference and high body mass index (BMI). McAllister said firefighters need both resistance training, such as weightlifting, and endurance training with activities like running, cycling and swimming.

He stressed the need for annual medical and fitness testing that can reveal untreated or undetected issues like high blood pressure, diabetes and others. Annual testing for fitness and medical issues is among the standards proposed by the National Fire Protection Association, but whether those standards are followed depends on fire chief priorities and government funding.

Finding a solution

State and national organizations have guidelines for annual tests for firefighters, but those are seen as recommendations. In an effort to improve compliance, the Texas State Association of Fire Fighters is launching a survey to determine which fire departments are complying with national standards.

The state association’s health and safety director, James A. Younger, recently wrote about the survey in the Texas Fire Fighter quarterly newsletter, saying, “Physical readiness for the job as a firefighter is the complete package (and) too many of us are guilty of concentrating on just part of the package.”

Younger, a firefighter with the El Paso Fire Department for 30 years, said some departments follow recommendations on a piecemeal basis and some don’t follow any.

“A lot of smaller departments just don’t have the budget to deal with it,” he said in a recent interview.

Volunteer firefighters are more vulnerable

Statistics on firefighter deaths consistently show more volunteer firefighters die on duty from heart attacks than paid firefighters. According to the NFPA’s 2022 report on fatal fire injuries, 96 firefighters died of on-duty injuries. Of those, 51 were volunteers, 38 were career firefighters, six were contractors working for state or federal land management agencies and one was a federal land management employee.

Of about 1.1 million firefighters in the U.S., about 70% are volunteers, according to the New England Journal of Medicine, and 60-100 firefighters die each year in the line of duty. An NFPA comparison of deaths among career and volunteer firefighters since 1977 shows that in all but two years, volunteer firefighters suffered more casualties.

Among the 254 counties in Texas, 106 have only volunteer fire departments.

It’s harder to maintain fitness standards in volunteer departments, said Rhea Cooper, a longtime firefighter who works as an interim chief at small Texas departments and has worked with both career and volunteer firefighters. He said departments that try to enforce fitness standards risk losing volunteers.

Volunteer firefighters are generally older people who came from a generation of volunteers, Cooper said.

“So you have the older, overweight people that are volunteering and those are the ones that are at the highest risk and end up having a heart attack,” Cooper said. “The problem is, we have a hard enough time getting volunteers. That’s the real struggle.”

Getting buy in

Firefighters can be apprehensive about taking the medical and fitness tests, assuming bad results could cost them their job, Cooper said. They are more willing to comply when they realize personal information is kept confidential.

In the best departments, health and fitness is part of the culture. In departments not doing as well, an attitude of “we’ve never done it that way” can make culture hard to change, Cooper said.

The retired Lubbock fire chief just finished a stint as the Boerne Fire Department’s interim chief this spring. He said testing comes with a cost.

“I think it’s an education thing for cities and entities and a commitment to fund them. Funding is definitely a problem,” Cooper said.

One department’s plan

Professor McAllister’s research pointed to the importance of high cardiorespiratory fitness and low waist circumference to reduce cardiometabolic disease. Firefighters are often required to perform tasks that require a significant amount of cardiorespiratory conditioning, as well as muscular strength or endurance, such as carrying heavy objects, moving charged hose lines, climbing, rescuing victims and using forced entry — all while wearing heavy protective gear.

“One of the best things you can do is regular exercise training,” McAllister. “The hard thing is no one size fits all for diet. With exercise, you tend to get more prominent and beneficial effects.”

Bryan Fire Chief Richard Giusti points to the reason fitness is so important.

“We go from zero to 100 very quickly and that puts a lot of strain on the heart,” said Giusti, 55. He’s been a firefighter for 38 years, including 26 at the San Antonio Fire Department before moving to Bryan as chief in 2021.

A new health and wellness initiative for the Bryan Fire Department was approved by the Bryan City Council unanimously in February with a price tag of $630,500 for three years. A grant for $195,000 will cover much of the first year, which has produced new workout equipment for Bryan’s five fire stations, and two new hires — a physical therapist and a medical director.

Terry Bertling teaches journalism at Texas State University and is the lead reporter for Texas Community Health News, a collaboration between the School of Journalism and Mass Communication and the university’s Translational Health Research Center. TCHN stories, reports and data visualizations are provided free to Texas newsrooms.