Are You Heart Smart?

A call comes in for a crash with entrapment. You arrive to find the collective emergency-response teams working feverishly to treat and extricate the victim. The adrenaline is pumping, and you are exerting all forces to get the job done. During the activities, you experience an unusual sensation in your chest, but you write it off as just stress from the job. Returning to the station, you still have that “funny” feeling, but you continue to ignore the symptom. You feel exhausted and want to sit down and rest. Twenty minutes or so pass and you still have that “funny’’ sensation, so you decide to head home. Unfortunately, you only make it to your car, where you are found some time later by a fellow crewmember. Sound far-fetched? Not so. This is an all-too-familiar scene played out in the EMS industry.

Extent of the Problem

The “funny” sensation in the above scenario was actually a collection of multiple symptoms that were not recognized by the provider as a clue to a more serious problem. Since a majority of emergency medical calls involve heart problems, it should be easily recognized as a differential diagnosis when looking at our own signs and symptoms. The signs in the scenario included moving from a sedentary status to sudden physical and mental exertion, perhaps pushing the provider over the edge of previous warning signs. In turn, enough was enough, and the result was a heart attack.

Smoking, alcohol consumption, inferior diet, lack of exercise, poor stress management and family history are major risk factors for heart disease. EMS providers do not have to look far to see why they rank near the top when looking at the challenge of controlling the contributing factors. In an industry riddled with sedentary lifestyles, one could easily conclude that the emergency services are their own worst enemy. Providers must recognize that they are not immune, and, in some ways, are more susceptible to heart disease than the patients they respond to assist.

Heart attacks continue to be the leading cause of line-of-duty deaths in the fire service and, although national EMS statistics are limited, it could be argued that heart attacks are also the leading cause of death in the EMS industry. The United States Fire Administration (USFA) reports that 45% of line-of-duty deaths each year are attributed to heart attacks. The National Fire Protection Association (NFPA) lists stress and overexertion as the leading cause of heart-related fatal injuries among firefighters.

This year, the Public Safety Officer Benefit (PSOB) added death benefit coverage for heart attacks and strokes that occur on the job or are job-related within 24 hours of an incident. A noble benefit, but how long should we excuse the ignorance shown toward addressing the real problem—the contributing factors? All but one of the risk factors previously mentioned is preventable, and even though the hereditary factor may not be preventable, it certainly is identifiable. That identification can permit providers to adapt their lifestyles to potentially ward off heart disease.

The Challenge

EMS providers not only know the signs and symptoms of heart disease, they also know the major factors that contribute to the disease itself. So why don’t providers recognize their own risk factors? This question must be answered by every emergency service organization if a lifestyle change is to occur.

According to the USFA, physical fitness is at the core of wellness. These core dimensions include cardiovascular fitness, muscular fitness, body composition and adequate and healthful nutrition.

The AHA states that cigarette smoking is the single most preventable cause of premature death in the United States, accounting for more than 440,000 deaths annually. The Surgeon General calls cigarette smoking “the most important of the known modifiable risk factors for coronary heart disease in the United States.” Cigarette smoking alone increases the risk of coronary heart disease, according to the AHA.

The NFPA points out that comprehensive safety and health programs could prevent fatalities related to heart disease.

What You Can Do

Organizations should consider a comprehensive health and wellness program that specifically addresses:

• Promotion of prudent lifestyle practices and policies to reflect such practices.
• Implementation of annual physicals, and physical fitness and exercise programs.
• Initiation of smoking-cessation programs.
• Promotion of healthy diets.

Summary

Heart attacks may be a leading killer of emergency-service providers, but many of the contributing risk factors can be addressed through prudent lifestyle practices. Of all businesses and industries, emergency services generally have more knowledge, time and/or flexibility to exercise and actively participate in healthy lifestyles. Perhaps more emphasis should be placed on healthy living than on benefits that deal with the results of unhealthy lifestyles. Stop smoking, drink sensibly, eat a healthy diet and exercise. Until next time…be safe!

Bibliography

• American Heart Association websites, July 14, 2004: www.americanheart.org; www.americanheart.org/presenter.jhtml?identifier=4545.
• EMS Safety: Techniques and Applications, United States Fire Administration, 1994.
• NFPA Online, July 2, 2004: www.nfpa.org/PressRoom/NewsReleases/FFDeaths/ffdeaths.asp.
• Sanders MJ. Mosby’s Paramedic Textbook, 2nd Edition. St. Louis, MO: Mosby Lifeline, 2001.