Download Fire Fighting and Health

After the Smoke Clears,
Keeping Fire Fighters Healthy
Dr. Sara Rodgers, NMD
Lewiston, ID 2007
What this Presentation is about
• Specific Health Risks for Fire Fighters
– Heart Disease
– Cancer
– Chronic diseases
• Treatment Suggestions
– Nutrition
– Exercise
– Detoxification
• Suggestions for Idaho
Fire fighters have one of the
highest rates of mortality for any
profession in the US.
Hazardous Working Conditions
Environmental Exposures
Stress
Disease Predisposing Factors
The Hidden Risks
• Between 1977-2002, coronary heart disease
(CHD) accounted for 45% of on-duty fatalities
• Stress may play a large factor in these deaths,
but when compared to comparable stressful
professions, firefighters have a larger risk of
heart-related deaths.
– Firefighters: 45%
– Policeman: 22%
– Other EMS professionals: 11%
– Occupational fatalities overall: 15%
Cardiovascular Disease
CVD: cardiovascular disease
CHD: coronary heart disease
Heart Disease
• 48% of deaths of active fire fighters are attributed
to cardiovascular disease
• Fire suppression accounted for 36% of coronary
heart disease deaths, but fire suppression may
only represent 2% or less of a firefighter's yearly
duties.
• Firefighters with 30 years on duty have increased
rates of cardiovascular disease aortic
aneurysms.
Potential reasons for on-duty
cardiac disease related deaths
• Pulse rate goes up with alarms and sirens
• Physical burden of wearing 50+ pounds of
protective equipment while working near
maximal heart rates
• Heat stress and fluid loss can cause
decreased cardiac output even with
increased pulse
• Personal protection devises reduce
environmental toxic exposure, but does not
eliminate all toxins.
Volunteer risks
• Volunteers may not be required to stay in
physical shape or get yearly physicals
• Both professional and volunteer health
risks
– Long sedentary periods followed by heavy
exertion
– Shift work
Study of 52 Coronary Heart
Disease Deaths
• Most emergency calls occurred between
noon and midnight.
• This was also the time when most
firefighter trauma deaths and coronary
heart disease deaths occurred.
• This pattern occurred with both 24-hour
shift work for professional firefighters and
volunteer fire fighters.
Circadian Rhythm Risk
CVD deaths
increase over
trauma deaths
after 6 pm.
Cardiovascular Disease Deaths Compared to the General Public
General Population: Monday
morning heart attack
• General population has higher risk of
Coronary Incidents in the morning
because:
– Increased arterial blood pressures
– Increased platelet aggregation (increased
clotting)
– Increased serum cortisol (stress response
hormone)
– Increased catecholamines (stress response
hormones)
Emergency Response
The Evening Heart Attack
•
60 times the risk of
CHD death over non
emergency-duty
Similar factors as the general public MI
• Increased blood pressure at onset of alarm
• Loud sirens can cause increased blood pressure
• Increased demands on the cardiovascular system
Physical Fitness
• Strenuous training drills were a source of CHD
deaths for firefighters lacking physical fitness
• Most fire departments do not require regular
exercise.
• In one study 33% of fire fighters were measured
as obese with this figure increasing to 40% four
years later
Cardiovascular Disease Death
Risk Factors
Individual predictors
• > 45 years old
• Hypertension
• Smoking
• Previous diagnosis of CHD
Other risk factors
• Diabetes
• Hypercholesterol (cholesterol > 200)
Study Conclusion
• Most on duty coronary heart disease deaths are
work precipitated
• These deaths occur to fire fighters with
underlying CHD risk factors
• The death incidences occur with increase in
emergency calls
• Strenuous activities associated with fire fighting
work is associated with CHD deaths
• Fire fighters without CHD risk factors are unlikely
to suffer from CHD death
Falling through the cracks
• Most of the CHD death
firefighters did not have a fire
department medical exam 2
years prior to death incident
• Many rural fire departments are volunteer
based. Many of these individuals have
other jobs that may not require physical
activity
Cancer
• Fires expose fire fighters
to a variety of chemicals
and substances
• There is associated
incidences of cancers with
these exposures
Cancer Risk
• Firefighters are twice, sometimes three times as
likely, to develop testicular or skin cancer and
leukemia.
• Brain cancer in firefighters with 20 years of
experience is so common in Ontario, Canada
that it is recognized as a workplace injury and
victims are automatically compensated.
• At least 15 studies show a statistical link
between brain cancer and firefighting
Cancer continued
• Elevated mortality risks for brain tumor, cancers
of lymphopoietic, bladder and kidney, and soft
tissue sarcoma have been observed
• The overall risk of cancer among firefighters was
significantly higher when compared to the
general Florida population. Significant excess
mortality observed for respiratory cancer and
skin cancer.
• Cancers may not appear until later in life
Cancer
• Brain cancer
– Of the 14 major studies of firefighters' mortality, which
gave findings for brain cancer, 11 found some excess
risk. Formaldehyde, benzene, vinyl chloride,
acrylonitrile
• Leukemia
– Statistically significant elevation leukemia in firefighter
with >30 years of service
– Potential causative agents include benzene, soot and
polycyclic aromatic hydrocarbons (PAH’s), vinyl
chloride, acrylonitrile, formaldehyde
Cancer
• Colon Cancer
– Statistically significant increases in colon
cancer were identified in three studies.
– Asbestos, PAH’s, acrylonitrile and
formaldehyde
• Bladder cancer
– Increased incidences of bladder cancer
among fire fighters.
– Some evidence of dose response
Types of cancer and exposure
• A 2001 study of 9 municipal fires under
conditions where firefighters would probably
remove self contained breathing apparatus
–
–
–
–
Benzene, toluene, napthalene dominated
Propene, 1,3-butadiene found in all fires
Styrene, alkyl-substituted benzenes frequently found
76 % of all VOC’s measured: Propene, benzene,
xylenes, 1-butene/2-methylpropene, toluene, propane,
1,2-butadiene, 2-methylbutane, ethylbenzene,
naphthalene, styrene, cyclopentene, 1methylcyclopentene, isopropylbenzene
Exposures give carcinogenic risk
• VOC’s found in highest concentrations
have high toxicity and carcinogenicity
– particularly benzene, 1,3-butadiene, and
styrene
Self Contained Breathing
Apparatus (SCBA)
• One study found that fire
fighters only used their
protective breathing
devices for 50% of time at
structural fires and only
6% of time for all fires.
• Urine tests confirmed
exposure to VOCs at site
Heavy Metals
• “Heavy Metals should be measured
as regularly as cholesterol” (Dr Rita
Ellithorpe, MD)
• Blood test only tell current exposure
• Provoked urine test will indicate
some level of body burden
Antimony
Arsenic
Bismuth
Beryllium
Cadmium
Lead
Mercury
Platinum
Nickel
Thallium
Thorium
Tin
Tungsten
Uranium
Why measure heavy metals
• Most likely, we all have heavy metals
– Cigarettes, leaded gasoline (1973), pesticides, foods,
air, water, hobbies (lead bullets, stained glass)
• Heavy metals affect the body in significant ways
– Endocrine (hormones), immune, cardiovascular,
gastrointestinal, neurological systems
– High blood pressure, neuropathies, brain function
• Heavy metals aggravate other disease
conditions
Positive Changes
Not everything is about death, chemicals, and heart attacks!
What can be done
• Prevention
– Proper monitoring
– Nutrition
– Physical Fitness programs
• Detoxification
– Chemicals
– Heavy metals
Prevention
• Preventing disease costs a lot less than treating
chronic disease
• 2002. American Diabetes Association
approximates $132 billion was spent on direct
medical and indirect expenditures.
• 2006. American Heart Association and National
Heart, Lung, and Blood Institute estimate the cost
of cardiovascular disease and stroke to be
$403.1 billion.
Ability to heal
• Unless a disease has created permanent organ
damage, most people can reverse the disease
process
• Cardiovascular disease is preventable and
reversible!
• Diabetes type II is preventable
• If one already has diabetes and is not reliant on
insulin, they can stay that way with proper exercise
and nutrition!
Healing is Not Drugs
• Health program must be multi factorial
– Nutrition: Healthy Food Choices
– Supplementation
– Detoxification
• Using pharmaceutical drugs to treat high
cholesterol or high blood pressure does not
treat the cause of disease
Regular Check ups
• Monitoring of baseline
physical fitness
• Cardiovascular fitness
• Pulmonary fitness
• Body Mass Index
• Cancer Screenings
Heart Healthy Suggestions
• Physical Fitness requirements for recruits and current
fire fighters
• Annual monitoring of physiological parameters (ie,
cardiac risk assessment)
– Cholesterol and other cardiac parameters
– Cardiac stress tests
• A recent study indicated that abnormal stress tests were highly
predictive for cardiac deaths in asymptomatic patients
• Nutritional counseling
• Reduction in risk behaviors: i.e., smoking, junk food
• Stress reduction techniques
NVFC Heart Healthy Firefighter
Program
• A national program recognizing the
cardiac risk of volunteer firefighters
• http://www.nvfc.org
• http://www.healthy-firefighter.org/
• This is a good start, but a comprehensive
program supervised by a MD, DO, or NMD
would be preferred.
Decreasing Hypertension with Food
(courtesy of Melissa Spooner)
•
Associated with balance of
minerals
•
Implementation of the
“DASH” Diet (Dietary
Approaches to Stop
Hypertension)
•
http://www.nhlbi.nih.gov/hea
lth/public/heart/hbp/dash/ne
w_dash.pdf
•
The need of “color” in our
food and real foods: color of
the rainbow every day.
Nutrition
• Nutrition is the cornerstone to any healthy
regime.
• Whole foods, not processed
• Organic if possible
• Essential Fatty Acids (ie, wild Alaskan Salmon)
• Eating Breakfast, Eating protein with Breakfast
• Reducing sugar, caffeine, partially hydrogenated
oils
Food vs Medication
1 month supply of
quality omega 3 fatty
acids $30.00/bottle
1 month of Lipitor
For 10mg daily dose
$65.00+
Adaptation
• How do we make the
foods that we love
healthier?
• Do I have to eat fruits
and vegetables?
– YES
• Recipe adaptation –
simple changes
Recipe Adaptation
Courtesy of Melanie Spooner, BSc Nutrition
Making healthy changes to some old stand-bys
Southern Breakfast Casserole
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•
•
Original
18 whole eggs
9 slices
wonderbread
2 lbs pork and beef
sausage links
9 slices American
cheese
Adapted
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4.5 cups egg beaters
9 slices sourdough bread
2lbs turkey sausage
9 slices low fat/low sodium
cheese
1 cup red pepper
1 cup cherry tomatoes
1 cup mushrooms
3 cloves garlic
Example of Adapted recipe:
Southern Breakfast Casserole
Suggested Basic Supplementation
• Multivitamin
– Not one a day, usually 4-8 needed of a good vitamin
– Choose one with no colors, sugar, least amount of “other
ingredients”
• Fish Oil: very healthy for the heart
– Make sure 3rd party tested for contaminants
• Other healthy choices
– Vitamin E: 500 IU d alpha tocopherol (not dl alpha), with mixed
tococopherols
– Magnesium: citrate form better than oxide form
• Magnesium stearate not a dietary magnesium
– Vitamin C: 1-3 grams daily
Physical Exercise
• Daily is good idea
• At least 3-4 times a week
of combined cardio fitness
and weight training.
• Speak to medical
professional before starting
program if not already
exercising.
Detoxification
• First three ways to reduce toxins
– Avoidance
– Avoidance
– Avoidance
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Nutritional supplementation
Sauna
Colon Hydrotherapy
Gentle exercise
NYC Firefighters
• NYC September 11, 2001 exposed Fire fighters,
other emergency workers, and residents to
unprecedented levels of toxins.
• Many exposed people are suffering from multiple
organ system dysfunction
– Persistent lung syndromes, cognitive changes,
gastroesophaegeal reflux disease, respiratory
cancer, other cancers
• PTSD is also commonly diagnosed:
depression, anger, low motivation
Detoxification with Hubbard
Protocol
• Gentle exercise followed by Sauna 140180 0F for 2½ -5 hours daily
• Nutritional supplementation with emphasis
on niacin (nicotinic acid)
– Also Vitamin A, D, C, E, B complex, B1,
minerals
– Diet rich in Omega 6 oils
• Following data reported in Townsend
Letter April 2006, #273
Hubbard Protocol
Free treatment funded by private donations September 2002
• 484 cases: 273 firefighters, 52 sanitation
workers, 19 paramedics, 23 police officers, 117
others
• 7 days a week, average of 33 days (range 23106 days)
• Physician monitoring, individualized care
• Tracked range of symptoms: skin, cardiac,
respiratory, neurological, emotional, cognitive,
gastrointestinal, musculoskeletal,
immunological, endocrine
Hubbard Protocol Success
• All participants reported improvement in
subjective symptoms
• All participants reported in perception of health
• 84% reported decreasing from up to 16 meds to
zero. 7% people had one remaining medication
• Over ½ of participants initially required multiple
pulmonary meds to achieve near normal lung
function.
– At completion, 72% of these people were off drugs
and continued to improve lung function
Hubbard Protocol Success
• Thyroid function tests improved
• Cholesterol measurements improved
• Intelligence quotients and choice reaction
times improved.
• Balance
• Quality of live improved: fear of no longer
able to work abated.
• PTSD symptoms alleviated
Heavy Metals
• Getting rid of Heavy Metals includes
chelation: EDTA, DMSA, DMPS
• Needs to be done with experienced
practitioner
• Nutritional supplementation is necessary
during the process
• Can take 1-2 years and then periodically
Phoenix Fire Department Health
Center
• Medical director, physicians, physician assistant, nurses, x-ray
technician
• IAFF-IAFC Wellness Initiative
• Baseline fitness and annual evaluations
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Aerobic Capacity
Trunk Flexability
Muscular Strength
Muscular Endurance
Pulmonary Function Testing
EKG treadmill stress test
Hearing and vision evaluation
Cholesterol/blood pressure check
Blood and urine analysis
Radiology
Toxic exposure, heat exposure, infectious disease exposure
management
• Contracts to surrounding fire departments to offer physical exams
Naturopathic Care At PFD
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Comprehensive intakes
Blood work as indicated
Hormone panels
Food Allergy/Sensitivity Testing
Heavy metal tests and appropriate chelation
Diet Evaluation Coaching
Professional Grade Nutritional Supplements
Botanical medicines and homeopathy
Acupuncture
Intravenous nutritional procedures (not available in Idaho
at this time by Naturopathic Physician)
Applying a Health Model to Idaho
The Volunteer Factor
• 85% of Idaho fire districts are volunteer
based or volunteer combined with
professional
• This presents an interesting challenge to
maintain health standards
• A mechanism needs to occur to ensure
health of both professional and volunteer
fire fighters
If not already in place
• Professional hiring standard: Candidate Physical
Ability Test (CPAT). Hire from a diversity of
community rather than decrease standards
• Annual stress tests, pulmonary function tests,
cardiac risk blood tests (going beyond
cholesterol), BMI
• Reminders of why SCBA equipment necessary:
reduced exposure = reduced cancer risk
• Specific Dietary suggestions. Healthy menus
emphasized by the state association and
distributed as a resource to departments.
Volunteer suggestions
• Guidelines for volunteers for physical
fitness and laboratory achievement levels
• Education of licensed medical practitioners
in volunteer department areas of how to
monitor volunteer fire fighter health
– This would involve creating community
partnerships with health practitioners
• Create competition and recognition for
healthiest departments.
Fire Fighters Deserve the Best
• You Fire Fighters risk their life and health to
protect the public.
• Fire fighters deserve the best preventative
medical care, education, and support to
reduce job-related cardiovascular deaths.
• Preventing cardiovascular disease, diabetes,
and other chronic diseases can be done.
Thank you for attention
Sara Rodgers, NMD
Boise Natural Health
Boise, ID 83706
www.boisenaturalhealth.com
208-338-0405