Researchers Collaborate with Fire in Texas for Fire Academy Research

Researchers Collaborate with Fire in Texas for Fire Academy Research

The health and wellness status of first responders continues to be an ongoing discussion within the tactical professional network. As such, the availability and utilization of medical and fitness resources need to be constantly assessed. As a team, Jabai Performance and the Health and Human Performance Department of Texas A&M University – Commerce continue to collaborate on various research projects that evaluate the health of first responders and tactical professionals. As the development of tactical research has progressed at Texas A&M University – Commerce, the team decided that there needed to be a working relationship with local academies. Researchers Hussien Jabai and Dr. Michael Oldham traveled to Sulphur Springs, TX to meet with Rodney Caudle of Fire in Texas. Fire In Texas is a Fire and EMS Academy, specializing in Fire Academy and EMS training. With a round table discussion, the group shared ideas on potential research opportunities that would provide baseline data for the cadets and the academy program structure. The group established a mutual benefit in conducting the research with the local fire academy, leading researchers Oldham and Jabai to construct and propose a research study to the governing IRB (Institutional Research Board).

The research project involves evaluating the mobility of fire academy cadets prior to and after the academy. The study will utilize the DARI System as a means of evaluating mobility through movement analysis. After pre-testing is complete, the cadets continue through the academy, while following current program protocols. The project in itself, is a means of evaluating the effectiveness of the current fitness program being provided by the academy staff. The project does not involve any means of education or training interventions provided by the researchers. The cadets will go through follow-up rounds of testing at  6-weeks, 12-weeks, and both 3-months and 6-months in fire service at local departments.

After IRB approval, the team mapped out pre-academy and post-academy testing dates and times. In August 2021, the research team made a trip to Sulphur Springs, TX to work with Class 68 of Fire In Texas’ Fire Academy. So far, the research team has completed the first initial round of testing in August of 2021, with the second round of testing in September of 2021. The research team and cadets are waiting for the next round of testing to be performed.

Researchers begin 6-month Whoop – HRV, Sleep, and Recovery Study with Melissa Fire Department

Firefighters are not only responsible for daily-tasks around the department, but must also be prepared to respond to any incoming emergency (medical or fire) call throughout their shift (day or night). From this perspective, call load, call timing, tasks performed while on-shift, sleeping patterns, nutrition, and off-shift activity can all play factors into total recovery of firefighting personnel. With an increasing wave of wellness initiatives for the first responder community comes personnel willing to dedicate time and resources toward wellness program development. As an expansion of current research collaborations, the Health and Human Performance Department of Texas A&M University Commerce reached out to Melissa Fire Department to partake in a 6-month WHOOP – HRV, sleep, and recovery study. The purpose behind the HRV research collaboration between Jabai Performance, Texas A&M University – Commerce, and Melissa Fire Department is to:
1.) Provide a platform to assist participating firefighters in providing data to help regulate their off-shift physical activity
2.) Provide a means for participating firefighters to understand the impact that sleep, nutrition, job-
tasks/workload, and physical activity has on the body
3.) Provide a line of communication for personnel to engage in conversation with collaborating
parties regarding fitness and nutrition
4.) Provide insight on the impact that the current 24 hour on – 48 hours off shift schedule has on
participating firefighters

The Research

All participants must be full-time firefighting personnel. The participants will wear the WHOOP strap/device, funded by the Ronald McNair TRIO Scholar Award received by researcher Paula Flores, for the entire 6-month duration. Participants are to not remove the device throughout the 6 months, even while off duty. The WHOOP device will gather highly valuable information, such as quality of sleep, level of strain (external/internal stress), caloric expenditure, and heart-rate variability from participating personnel. This data will be collected, organized, and published as formal research in approved research journals. Research data will further encourage current and future researchers, practitioners, and tactical operators to evaluate the pros and cons of different shift types. The information will also encourage the on-going discussion regarding off-duty/on-duty activity and training regulation.

Introducing the Researchers

Paula Flores
Paula Flores is an upcoming senior majoring in Kinesiology and Sport Studies with a minor in Interdisciplinary Studies. She is a Presidential and Ronald McNair Scholar and currently works as a Resident Assistant for Texas A&M University in Commerce. Paula is a mentor for the Office of Student Disabilities and a mentor for the
student organization Mujeres de Accion, which focuses on empowering first-generation Latina women in college. Paula also volunteers at St. Joseph Catholic Church as a Sunday school teacher and was involved in many service opportunities such as the Special Olympics and Operation Blue and Gold and was nominated for the change maker award. She participates in intramural sports such as tennis and softball. Paula Flores is an undergraduate research assistant, who assists with recruitment, device distribution, device storage, management of study data, and data entry for statistical analysis for the Longitudinal Study of Stress Recovery Indices and Heart Rate Variability in Full-Time Firefighters. Her goal is to make a difference every day, no matter how small the act may be. She hopes to become an Occupational Therapist and help people recover from injuries and at the same time boost their confidence in their abilities.

Paula Flores working in the HHP ROAR Exercise Physiology Lab.

Dr. Michael Oldham
A world-wide human performance practitioner and researcher, Dr. Michael Oldham holds a PhD in Exercise Physiology & Nutrition, exploring the role of supplements in human performance, stress, and recovery. Dr. Oldham’s 30 years of experience as a coach is spread across a variety of youth, collegiate, and professional sports, including a consulting coaching role with the US Women’s National Soccer Team prior to the 1996 Olympics. His current research objectives at Texas A&M University – Commerce center around stress and recovery and increasing mobility in first responders. Stress and recovery research is conducted using heart rate variability (HRV) and continual heart rate monitoring through heart rate monitors worn around the wrist, i.e., the WHOOP Heart Rate System. The WHOOP system allows both participants and researchers continual, 24-hour per day, data streaming that reports on strain, sleep, recovery, calories burned, and resting heart rate. The data is important to tactical athletes to provide stress management strategies, recovery day strategies, and nutritional intake needs on a day by day basis. As researchers gather longitudinal data, while educating first responders on proper data analysis, the data can also be used by municipalities to better structure shift rotations and shift timings. Helping the greater community use data to drive decision making at the highest level of the priority for the Texas A&M University – Commerce Health and Human Performance Department.

Dr. Michael Oldham explaining a Dari System movement analysis report to a Paris FD firefighter.


Hussien Jabai
Hussien Jabai, MS, CSCS, TSAC-F, CPT, is a tactical strength and conditioning professional with a focus in first responder fitness program development, first responder research, and TSAC practitioner professional development. As both an undergrad and grad student at Texas A&M University – Commerce, Mr. Jabai studied kinesiology through the Health and Human Performance Department,
worked as both a personal trainer and personal training manager at the campus recreation center, and devoted hours toward understanding the application of exercise science to tactical personnel. After finishing his master’s degree, Mr. Jabai now dedicates his time toward presenting on the concepts of strength and conditioning for the tactical community, forming research collaborations driven to improve the lives of first responders, consulting with departments on wellness program initiatives, and developing continued education programs designed to educate both exercise science professionals and the tactical personnel that they service. As an expansion to developing education opportunities for TSAC practitioners, Mr Jabai is currently collaborating with the Health and Human Performance department of Texas A&M University – Commerce to offer TSAC practitioner courses for both a certificate program and as credit for student degree plans. Mr. Jabai is currently serving TAMUC as adjunct faculty for the Health and Human Performance Department, driving the initiative for TSAC curriculum within the academic setting.

Hussien Jabai working with Paris Fire Department during a research project training intervention.

What is Heart Rate Variability?


Heart rate variability, known as HRV, is the measured interval between heartbeats utilized as a marker of the capacity to regulate internal and external demands (Young, & Benton, 2018). A higher HRV is associated with better health (Young, & Benton, 2018), while a lower HRV has been associated with many negative health effects (shown below). The measured interval between beats is not always constant (Young, & Benton, 2018), therefore monitoring protocol should allow for a duration of time to develop a baseline for participants. Utilizing devices that monitor HRV is a noninvasive way of evaluating autonomic cardiac function (Harris, et al., 2014).

In a clinical setting, low HRV is associated with mortality in patients with:

  • coronary artery disease
  • chronic heart failure
  • history of myocardial infarction


Low HRV associated with:

  • hypertension
  • end-stage renal disease
  • diabetes


(de Geus, et al., 2019)


Reduction of HRV also associated with the following:

  • diabetes
  • cardiovascular disease
  • inflammation
  • obesity
  • psychiatric disorders


(Young, & Benton, 2018)

References

de Geus, E., Gianaros, P. J., Brindle, R. C., Jennings, J. R., & Berntson, G. G. (2019). Should heart rate variability be “corrected” for heart rate? Biological, quantitative, and interpretive considerations. Psychophysiology, 56(2), e13287. https://doi.org/10.1111/psyp.13287

Harris, P. R., Stein, P. K., Fung, G. L., & Drew, B. J. (2014). Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality. Vascular health and risk management, 10, 451–464. https://doi.org/10.2147/VHRM.S57524 

Young, H. A., & Benton, D. (2018). Heart-rate variability: a biomarker to study the influence of nutrition on physiological and psychological health?. Behavioural pharmacology, 29(2 and 3-Spec Issue), 140–151. https://doi.org/10.1097/FBP.0000000000000383 

Jabai Performance and Texas A&M University Commerce Collaborate with Paris Fire Department on Research Study

In the public sector, it is becoming more common for exercise science professionals to join forces with the tactical community to incorporate injury management programs.

Read Firefighting On-Duty Injuries and Decreasing Potential Risk Factors

These programs are individualized and unique to a specific department or agency’s budget, resources, and or personnel experience/qualifications. The Texas Tactical Strength and Conditioning Academy (TXTSCA), run by Jabai Performance, continues to drive education and program development throughout the tactical population through research collaborations with local departments. Earlier in the year, Jabai Performance partnered with the Health and Human Performance Department at Texas A&M University – Commerce (TAMUC) to conduct research and provide resources for a local fire department. Dr. Michael Oldham, of TAMUC, is the driving influence from the university staff to support and coordinate the use of exercise physiology resources for first responder research. The research being conducted by Mr. Jabai and Dr. Oldham investigates the impact that a 6-week strength and conditioning program has on the lumbar spine of full-time firefighters. TAMUC is responsible for technology use, procedure of assessment, and data collection; while Jabai Performance performs the strength and conditioning programming portion, conducts training interventions, and evaluates pre/post data comparisons. Although each entity has their own “role” within the study, the partnership involves assisting each other and providing an extra hand when something needs to be accomplished, a clear example of teamwork.

The research conducted with the Melissa Fire Department can be VIEWED HERE.

In order to continue data collection and increase participant count, the researchers expanded the study to include other departments.

Prior Research with Melissa Fire Department: City of Melissa Press Release

https://www.cityofmelissa.com/DocumentCenter/View/760/NR—Melissa-firefighters-involved-in-fitness-research-study

With the expansion of the research study, Hussien Jabai of TXTSCA reached out to Chad Graves, Deputy Chief for A-Shift, of the Paris Fire Department to begin a collaborative partnership. The fire department showed immediate interest and went through the process of administration approval to begin the first steps in recruitment. From there, the recruitment process began with video calls for Mr. Jabai and Dr. Oldham to introduce themselves to the firefighters, explain the concepts of the study, answer any questions or concerns regarding the study, and explain the process of signing up to participate. Deputy Chief Graves assisted Mr. Jabai and Dr. Oldham further through coordinating the personnel participation, organizing for each station personnel to join meetings and attend assessment/training interventions, and relay information throughout the process.

After nearly a week post video call based recruitment, Mr. Jabai, Dr. Oldham, and TAMUC graduate research assistants traveled out to Paris Fire Department with the DARI System, a markerless movement capture software being utilized for the pre and post program assessments.

Learn more about DARI Motion HERE

The Paris Fire Department consists of 3 stations, with approximately 50 personnel. Within each station, firefighters are divided into 3 different shifts on a 24 hr on/ 48 hr off shift schedule (A Shift, B Shift, C Shift). Due to assistance from staff and cooperation from participants, Dr. Oldham and the graduate research assistants were able to set up the movement capture system in the bay of Station 1 and have personnel from each station meet at one location for assessments. The entire assessment lasted approximately 10-15 minutes per personnel.

After all assessments utilizing DARI were complete, firefighters than began a training intervention with TSAC-F Instructor Hussien Jabai. Mr. Jabai explained the reasoning behind exercise selection, demonstrated each movement prescribed in the study, and corrected exercise technique for those needing assistance. Each participant went through the entire warm-up, movement prep, and workout while asking questions and addressing concerns. The training intervention is a vital factor in any training study, as that is where you “set the stage” or “tone” for the remainder of the prescription. For this study, participants will now complete the 6-weeks of strength and conditioning, then perform a post-assessment to evaluate the efficiency of the program.

View DARI Assessment and Training Intervention Highlight Reel Below

Currently, firefighters have begun Week 1 of the 6-week study. We will continue to update news reports and articles on the research as the program developments.

Media Coverage on research collaboration with Paris Fire Department:

https://theparisnews.com/news/article_f4314a64-b3fd-11eb-940e-477c79e88a6d.html

Hussien Jabai, MS, CSCS, Collaborates with Human Performance Department of Texas A&M University Commerce to Conduct Firefighter Research

The wellness initiative within the tactical community has inspired exercise science professionals to collaborate with police departments, fire departments, military bases, academies, and universities to provide new innovations in wellness services. As data builds within the published literature discussing injury rates, cause of injury, and details of injury scenarios within the firefighting community, it is time for academics to catch up on publishing literature in regard to injury prevention/management programs.

Read Firefighting On-Duty Injuries and Decreasing Potential Risk Factors

To assist in combating the statistics of firefighter injuries, Hussien Jabai, MS, CSCS, has been working alongside the Melissa Fire Department as a tactical strength and conditioning instructor. In 2018, Mr. Jabai volunteered to provide a 12-week pilot study to display the benefits of an organized and research-driven injury prevention program. Although the pilot study was not published, Mr. Jabai constructed pre and post testing to illustrate the impact that the strength and conditioning program has on performance and movement patterns. The program incorporated dynamic warm up sequences, corrective exercise, strength training methods, circuit training, and variations of interval training. The positive results of the post-test were presented to the administration of the department and the city for program funding requests. Since 2019, Hussien Jabai has been providing strength and conditioning programming for the department and consulting with administration on program development.

(If you would like to consult with Mr. Jabai on program design/development, feel free to contact us here.)

As a former graduate student of Texas A&M University in Commerce, Mr. Jabai reached out to his former professor and colleague Dr. Michael Oldham, in the Human Performance Department, to collaborate on firefighter research. Dr. Oldham and Mr. Jabai worked together to complete the review of past literature and construct a research proposal to acquire IRB approval. The primary objective of the research was to evaluate the impact of a 6-week strength and conditioning program on lumbar spine mobility in full-time firefighters. The phrase “full-time” is key in the research protocol, as a standard schedule for full-time personnel requires being at the station every 3 days for a 24-hour shift. Physical activity can be mandated for firefighters during shift but cannot be mandated off-shift. Additionally, the research project aims to identify the pros and cons of restricted training schedules, e.g., every 3 days.

The highlight of the research revolves around the unique testing method of utilizing the DARI Motion Capture System. DARI, a cutting edge markerless motion capture system, allows the research to be done remotely, without the use of reflective markers for motion capture.

Click Here to visit the Dari system Website

Pre-testing with the DARI System consisted of 3 consecutive days, covering all 3 shifts (Shift A, B, and C). Dr. Oldham, accompanied by graduate research assistants of the Human Performance Department of TAMUC, brought the system to the Melissa Fire Department. The DARI system was set up by Dr. Oldham and the graduate research assistants within the bay of the station an hour prior to the scheduled testing time. Dr. Oldham and his assistants were responsible for set up and utilization of the DARI system. Prior to participating in testing, firefighters read and signed informed consent / liability forms. Post movement analysis via DARI and report explanation, Mr. Jabai coordinated the fitness instruction portion of the study. Mr. Jabai had firefighters walk through the exercise prescription portion of the study to evaluate form and provide modifications when needed. Jabai also discussed protocol for progression of repetitions, training load, and rest durations. Firefighters were also notified to complete a Google form post training to document session completion and provide feedback. As the availability within the fire community is unpredictable due to spontaneous emergency calls, the group of exercise science professionals freed up their entire morning schedules to allow for gaps between testing participants. The pre-testing has been complete, firefighters are currently at the early stages of their 6-week exercise prescription, and post-testing will be scheduled in the next few weeks to evaluate program effectiveness.

TTSCA would like to encourage exercise science professionals to contribute in the mission toward a higher quality of wellness within the tactical community. We would love to collaborate with departments and tactical professionals around the nation, and worldwide. If you need a strength and conditioning program, would love to collaborate on research, are interested in annual fitness testing, or would like to meet with a TSAC Consultant, please complete our CONTACT FORM and note your purpose of communication.

Author: Hussien Jabai, MS, CSCS

Obesity Concerns In The Profession of Firefighting

Obesity Concerns In The Profession of Firefighting

By Hussien Jabai, MS, CSCS, CPT

When you dial 911, telecommunicators gather intel and first responders are dispatched to the location of the emergency. As we have all probably witnessed through first-hand experience or media observation, this typically involves some sort of law enforcement, fire department, or medical response depending on the nature of the call. As citizens and members of our society, we expect those dispatched to our aid to be able to accomplish the workload or task presented before them. I am a firm believer that any one call does not have an age restriction, weight standard, or established prerequisite. No matter who shows up to that call, young or old, lean or obese, everyone should be able to provide you with the aid you need. Lack of physical fitness should not be an excuse in living up to the standard of a department. Weight or lifestyle should not be an excuse when unable to perform at an optimal level. Not only is obesity among the firefighting population associated with decreased physical fitness and job-task performance, but it is linked to poor cardio-metabolic profiles, injuries in the field, and possibly cardiovascular issues (Brown et al., 2016).

As if firefighting is not already dangerous enough with breaching burning houses and fighting through debris, sudden cardiac arrest is the leading cause of on-duty deaths (Smith, Barr, & Kales, 2013). Obesity can be seen as a worldwide pandemic, as Researchers Damacena, Batista, Ayres, Zandonade, and Sampaio (2020) found that 48.65% of their sample group of 1018 active military Brazilian firefighters were overweight and 10.99% of that sample group were classified as obese. When looking at national statistics in first responder populations, Brown et al. (2016) found that 70% of firefighters in the U.S. were categorized as overweight or obese. Evaluating risk factors for total mortality, coronary heart disease, and stroke, you can not help but notice hypertension on the list for firefighters (Choi, Schnall, and Dobson, 2016). If we can observe rates of hypertension among firefighters, researchers are then able to evaluate possible obesity trends in the profession. Researchers Choi et al. (2016) found that 11% of a collection of 330 southern California firefighters they studied had hypertension, with 15% of those having uncontrolled high blood pressure. This collection of data indicates 1 out of 10 firefighters in this sample walks around with the major risk factor of hypertension. Although there is not a direct study linking sedentary work on the job as an occupational risk factor for hypertension among firefighters in a clinical setting, Choi et al. (2016) suggests it’s possible involvement. Not only could sedentary work be a factor, but the trend of a decrease in physical activity as one becomes older (Marcos-Pardo, Martinez-Rodriguez, & Gil-Arias, 2018) could also contribute to lack of physical activity and decrease in metabolic expenditure within the profession for career firefighters. Lifetime career firefighters that have been in the profession for awhile would see significant benefits in body composition, by decreasing fat mass and increasing muscle mass, and increasing caloric expenditure when implementing a strength and conditioning or resistance training program (Marcos-Pardo, Martinez-Rodriguez, & Gil-Arias, 2018).

Fire departments should have fitness and wellness programs in place to not only improve their injury management system in place for personnel, but to also reduce the cost of payout toward workers’ compensation claims. Phelps et al. (2018) concluded that claims in this profession could range from $5,168 to $34,000 per claim filed. This would mean that any single injury can greatly impact the finances of the city. With that being said, doesn’t it make sense to incorporate strength and conditioning programs, annual fitness testing, and baseline job-readiness standards. Improving the level of “health and well-being of firefighters is key to preserving public safety” (Yoon, Kim, Y., Kim, S., & Ahn, 2016). Not only would the workers’ compensation claims take a toll on the finances of the city, but you would also have to pay personnel to replace that individual for their shift. So, the department ends up paying out double for covering one shift. Wellness programs that improve the body composition and performance of the firefighters could also change the mentality and morale of the entire department. Departments could hire strength and conditioning coordinators specifically for their designated stations, or contract a vendor to provide physical fitness testing and exercise prescription. However departments decide to combat this growing concern, obesity in the profession of firefighting needs to be controlled and decreased.

References

Brown, A. L., Poston, W., Jahnke, S. A., Keith Haddock, C., Luo, S., Delclos, G. L., & Sue Day, R. (2016). Weight loss advice and prospective weight change among overweight firefighters. International journal of occupational and environmental health22(3), 233–239. https://doi.org/10.1080/10773525.2016.1207045

Choi, B., Schnall, P., & Dobson, M. (2016). Twenty-four-hour work shifts, increased job demands, and elevated blood pressure in professional firefighters. International archives of occupational and environmental health89(7), 1111–1125. https://doi.org/10.1007/s00420-016-1151-5

Damacena, F. C., Batista, T. J., Ayres, L. R., Zandonade, E., & Sampaio, K. N. (2020). Obesity prevalence in Brazilian firefighters and the association of central obesity with personal, occupational and cardiovascular risk factors: a cross-sectional study. BMJ open10(3), e032933. https://doi.org/10.1136/bmjopen-2019-032933

Marcos-Pardo, P. J., Martínez-Rodríguez, A., & Gil-Arias, A. (2018). Impact of a motivational resistance-training programme on adherence and body composition in the elderly. Scientific reports8(1), 1370. https://doi.org/10.1038/s41598-018-19764-6

Phelps, S. M., Drew-Nord, D. C., Neitzel, R. L., Wallhagen, M. I., Bates, M. N., & Hong, O. S. (2018). Characteristics and Predictors of Occupational Injury Among Career Firefighters. Workplace health & safety66(6), 291–301. https://doi.org/10.1177/2165079917740595

Smith, D. L., Barr, D. A., & Kales, S. N. (2013). Extreme sacrifice: sudden cardiac death in the US Fire Service. Extreme physiology & medicine2(1), 6. https://doi.org/10.1186/2046-7648-2-6

Yoon, J. H., Kim, Y. K., Kim, K. S., & Ahn, Y. S. (2016). Characteristics of Workplace Injuries among Nineteen Thousand Korean Firefighters. Journal of Korean medical science31(10), 1546–1552. https://doi.org/10.3346/jkms.2016.31.10.1546

Firefighting On-Duty Injuries and Decreasing Potential Risk Factors

Firefighting On-Duty Injuries and Decreasing Potential Risk Factors

By Hussien Jabai, MS, CSCS, CPT

Introduction

At times as citizens within a community, we call upon first responders to aid us in daily emergencies that take place. We might place a 911 call and be met with an law enforcement officer, ambulance, or fire department engine. The type of call will dictate who rushes to your aid, as fire departments respond to fires, search and rescue, and protection of community property and health (Nazari, MacDermid, Sinden, & Overend, 2018). In the instance that we do receive assistance or emergency aid by personnel of a fire department, we hope that the firefighters can withstand external factors in the field. We also hope that personnel are in good health to not only perform the necessary tasks at the time of incident, but also overall job-related tasks. From a city stand point, departments should want their staff to perform at optimal levels, while reducing the likelihood of injury to occur on-duty. In order to evaluate preventative measures, we must review previous literature on statistics of firefighter death and injury, cause of injury and death, and concepts behind coordinating effective wellness programs.

Literature

With a range in cause of injury, whether it be due to their medical calls or hazardous material exposures, there is a firefighter injury presented every 8 minutes (Phelps et al., 2018). This should display a concern for fire departments that wish to maintain healthy and functional staff to performance job-related tasks. In 2015, the National Fire Protection Association reported approximately 1.16 million firefighters, with a reported 68,085 experiencing injuries in the line of duty (Phelps et al., 2018). According to that data, nearly 17% of firefighters encounter some form of injury each year. With 43% of injuries taking place at the fire grounds, falls, slips, and jumps, along with overexertion and strain had the highest presence, both at 27.2% (Phelps et al., 2018). Taking into account the high injury rate among firefighters, we must also glance at the fatality rate within the profession. With a reported 68 firefighter deaths in 2015, nearly 51% of death were associated to sudden cardiac death (Phelps et al., 2018). How does this impact firefighter agendas and wellness programs? How does this impact program budget and staff wellness initiatives? You have workers compensation claims ranging from $5,168 to $34,000 per claim (Phelps et al., 2018), but do fire departments have structured programs to prevent and manage injuries during job related calls and day to day tasks? The literature analyzed by Phelps et al. (2018) found conflicting research when observing risk factors based on demographics and personal factors, although the researchers found situational awareness to be the leading cause of on-duty injury as 37.4% of all injuries, while physical fitness claimed 28.6%, and human error took up 10.6% (Phelps et al., 2018). These statistics show that situational awareness, alongside an elevated and optimal level of physical fitness, could possibly prevent a high percentage of on-duty injuries. From a general perspective of injury, we see situational awareness as the leading cause of on-duty injuries, but strains, sprains, and/or muscular pain claims the leading type of injury with 55.3% of injuries reported in 2015. Looking at fireground injuries, falls/slips/jumps leads with 28.7% of all reported injuries, while overexertion/strain consists of 25.9% of all reported fireground injuries (Phelps et al., 2018).

Findings

Hypertension and Sudden Cardiac Death

When considering possible risk factors for sudden cardiac death, we must take a swift glance toward systemic arterial hypertension, the “modifiable risk factor for all-cause morbidity and mortality worldwide” (Oparil et al., 2018). As hypertension is not only a major risk factor but also an ongoing worldwide problem, researchers Tereshchenko, Soliman, Davis, and Oparil (2017) observed that the “lifetime risk of sudden cardiac death at 30 years of age is higher by 30% in individuals with hypertension.” The sudden cardiac death risk of individuals increases 20% for each 20/10 mmHg that the systolic/diastolic blood pressure increases (Tereshchenko et al., 2017). Not only does more than half of the population with hypertension do not realize that they have it, but many individuals that are aware might not even receive treatment or are treated insufficiently (Oparil et al., 2018). Presenting an issue with hypertension, and the possible concern that fire departments face when analyzing the health status of their staff. In regards to hypertension being a major concern for departments due to the sudden cardiac death rates of 2015, Choi, Schnall, and Dobson (2016) observed 330 California firefighters for an obesity project. 11% out of the 330 participants had hypertension, while 50% of those had uncontrolled high blood pressure (Choi et al., 2016). Based on this small sample group of 330 firefighters, we could analyze and hypothesize that 1 out of every 10 firefighters have hypertension. This could also mean that 1 out of every 10 firefighters walks around with a higher chance of falling victim to sudden cardiac death. An increase in job demands and the number of 24 hr shifts performed by the individuals are suggested factors in hypertension and blood pressure (Choi et al., 2016). Based on this, those who take on more overtime responsibilities and off-duty work might be setting themselves up for a higher chance of hypertension, unless awareness and counter actions are performed. Fire department should make a strong wellness initiative for their personnel when aiming to decrease the presence of hypertension, cardiovascular disease’s most common preventable risk factor (Oparil et al., 2018). Other risk factors of sudden cardiac death explored in research suggests “carrying heavy equipment with protective gear, heat stress, and working at near maximal heart rates for extended periods of times” could potentially contribute (Nazari et al., 2018).

Decreasing Risk of Hypertension

Departments could address lifestyle changes, such as physical activity, monitoring and adjustments of dietary and alcohol intake, and a regulation of sodium and potassium intake (Oparil et al., 2018). Things like physical activity could be issued by standard strength and conditioning programs, with set times set aside for fitness session bouts. Departments have a few options when looking at implementing strength and conditioning programs. The first option includes getting captains or selected personnel per shift to acquire some form of exercise science degree or personal training certification. This option allows for education within the department, but can hinder the overall impact due to presence of bias thoughts in demands of energy for oneself, relationships between individuals, lack of lifelong commitment toward the field of exercise science, and interference of other job related tasks. A second option departments could explore is the option to hire a tactical strength and conditioning facilitator within the department. This person would have specific job tasks with designing and implementing strength programs, performing annual and entry fitness testing, and assign corrective exercise for each individual. The third option would be for the department to bring in a vendor, or independent contractor, hired by the city to perform specific tasks. This individual could perform anything as minimal as fitness testing each year or brought in weekly/monthly for supervised strength and conditioning sessions. The con to bringing in an outside vendor would be the overall impact that the person has on the culture of the department since there would be a hindrance in frequency of communication and day to day supervision. Dietary and alcohol regulations, along with sodium and potassium intake could be more of an educational component within a wellness program. Providing things like information material from recruited health professionals or reliable nutrition sources could be utilized as posters within the department or as weekly/monthly emails.

Decreasing Risk of Injury

With falls, slips, and trips, overexertion, and strain being the leading causes and types of injuries for firefighters in the field (Phelps et al., 2018), we must evaluate prevention techniques toward reducing the likelihood of injury. Griffin et al. (2016) explored the data in which specified those with a lower level of physical fitness were more likely to acquire some form of occupational injury by 220%. In association to this, those who partake in an on-duty physical fitness program were half as likely to be injured due to non-exercise related incidents (Griffin et al., 2016). Simultaneously, you have over one-third of firefighters reporting injury as a result of fitness training or some form of job-related training tasks. Not only do one-third of firefighters reporting injury due to training, but those that do perform physical activity in the form of exercise training has a 4 times risk of acquiring on-duty injury during training (Griffin et al., 2016). With this data, we should understand that strength and conditioning programs should be carried out by professionals that understand both the profession of firefighting, their job-tasks, and energy demands, along with the education of exercise science and tactical performance. Departments can’t afford to both hire strength and conditioning professionals specifically designated toward implementing injury prevention programs, while simultaneously paying out in workers compensation due to training injuries.

Conclusions

Throughout our evaluating of literature regarding risk factors of injury and potentially death, we explored sudden cardiac death and hypertension, as well as physical risk factors such as physical fitness levels. With hypertension being a precursor to sudden cardiac death (Tereshchenko et al., 2017), departments and clinics or medical professionals hired by departments should make an agenda to monitor health markers such as blood pressure. If we don’t monitor these health markers, personnel could be walking around with an elevated level of risk for sudden cardiac death and not be aware that they need to impliment strategies toward preventing progression. Departments should make annual health screenings a priority, along with strategies toward decreasing risk factors. In regards to physical fitness, personnel should partake in proper strength and conditioning programs to decrease the likelihood of injury, but must make sure the program is designed by qualified individuals. Not only should programs be designed properly, but qualified staff or vendors should monitor and regulate the program based on daily needs. The lack of regulation in on-duty physical activity could actually increase the chances of injury, and need some form of supervision or upper level of education within the department staff.

Future Research

We have investigated potential risk factors of on-duty injury, in efforts to coordinate future research and assist departments in implementing effective and efficient wellness programs for their staff. As statistics reveal the types and cause of injuries in history, we must utilize this to conduct future studies. Analyzing how strength and conditioning programs impact injury prevention initiatives within departments will continue to be an effective form of evaluating what works and what does not. Just because a department has a program in place, does not mean it is effective, nor does it mean the program is built by qualified individuals utilizing proven research. Programs need to be monitored, both on evaluating who the coordinator is and the action plans being executed. Departments could bring in vendors or contractors that not only take time to construct the program, but is also devoted toward continued education and research studies within the profession of firefighting. Research could include 1. HRV, heart rate variability, to monitor recovery post-incident, 2. heart rate training during bouts of on-duty exercise, 3. mobility and flexibility evaluation quarterly in conjunct with annual testing, 4. movement screening to observe and assess movement patterns, and 5. air consumption of firefighters on an annual basis during their career. All areas of study will assist the department at that local level and department around the world if the research is published or shared in conferences or media outlets. However we choose to pursue continued research on firefighter on-duty injuries, it is imperative that all departments construct a well-developed wellness program and health initiative for their personnel.

References

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Griffin, S. C., Regan, T. L., Harber, P., Lutz, E. A., Hu, C., Peate, W. F., & Burgess, J. L. (2016). Evaluation of a fitness intervention for new firefighters: injury reduction and economic benefits. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention22(3), 181–188. https://doi.org/10.1136/injuryprev-2015-041785

Nazari, G., MacDermid, J. C., Sinden, K. E., & Overend, T. J. (2018). The Relationship between Physical Fitness and Simulated Firefighting Task Performance. Rehabilitation research and practice2018, 3234176. https://doi.org/10.1155/2018/3234176

Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A. F., Grassi, G., Jordan, J., Poulter, N. R., Rodgers, A., & Whelton, P. K. (2018). Hypertension. Nature reviews. Disease primers4, 18014. https://doi.org/10.1038/nrdp.2018.14

Phelps, S. M., Drew-Nord, D. C., Neitzel, R. L., Wallhagen, M. I., Bates, M. N., & Hong, O. S. (2018). Characteristics and Predictors of Occupational Injury Among Career Firefighters. Workplace health & safety66(6), 291–301. https://doi.org/10.1177/2165079917740595

Tereshchenko, L., Soliman, E., Davis, B., & Oparil, S. (2017, August 14). Risk stratification of sudden cardiac death in hypertension. Retrieved August 07, 2020, from https://www.sciencedirect.com/science/article/abs/pii/S0022073617302534