The following is the abstract from the 2010 firefighter fatalities report from the NFPA:

“In 2010, a total of 72 on-duty firefighter deaths occurred in the U.S.  This is another sharp drop from the 105 on-duty deaths in 2008 and 82 in 2009, and the lowest annual total since NFPA began conducting this annual study in 1977.  Stress, exertion, and other medical-related issues, which usually result in heart attacks or other sudden cardiac events, continued to account for the largest number of fatalities.  More than half of the deaths resulted from overexertion, stress and related medical issues.  Of the 39 deaths in this category, 34 were classified as sudden cardiac deaths (usually heart attacks) and five were due to strokes or brain aneurysm.” (NFPA, 2010)


The reduction in firefighter deaths last year, is a tremendous step forward for the fire service.  Unfortunately, the majority of firefighter line of duty deaths are still being classified as sudden cardiac deaths.  It is critical that we take a closer look at health and wellness in the fire service.  This is the first of three articles in the “Preventing Sudden Cardiac Death” series from TACFIT Fire Fighter:


Dangers of Firefighting

Firefighting is a dangerous and physically demanding occupation.  The United States Fire Administration reports that approximately 100 firefighters die in the line of duty each year (USFA, 2009). The number of structure fires per year is decreasing, safety standards are higher and technology is better.  Why haven’t we seen a dramatic reduction in firefighter fatalities?

Let’s take a look at  some of the life-threatening situations that firefighters may face:

  • Flashover
  • Backdraft
  • Explosion
  • Entrapment
  • Building Collapse

Statistics show that these events do not cause the majority of firefighter deaths.  The majority of firefighters dying in the line of duty are succumbing to a sudden cardiac event. The USFA reports that in 2009 heart attacks and strokes account for nearly 60% of all firefighter deaths (USFA, 2009).

Smith, Liebig, Steward, and Fehling (2010) found that the acute physiological effects of firefighting such as adrenaline surge, increased core temperature and dehydration coupled with underlying cardiovascular disease may contribute to a sudden cardiac event (Smith, Liebig, Steward, & Fehling, 2010).


Physiological Effects of Firefighting

Picture yourself sound asleep at your fire station on a Tuesday night.  The tones go off for a residential structure fire with victims trapped.  What is your heart rate as you leap out of bed and run to the rig?  Your sympathetic nervous system has just been activated.  Siddle (1995) states, “The activation of this system increases heart rate, which in turn, has a crucial effect on motor performance, visual processing and cognitive reaction time” (Siddle, 1995, p.7).  You pull up on scene and it is time to get to work.  The initial adrenaline surge has already impacted your cognitive and motor function.  Now consider the physical, mental and emotional stress of the fire scene.  You are in full gear doing strenuous work in a super heated environment.  The physiological strain of this incident is enormous.

Smith et al. (2010) detail research findings on the effect firefighting has on the major systems of the body:

Cardiovascular:  Heart rate and blood pressure are increased.  Firefighters may be working near maximum heart rate for the duration of their air bottle depending on the circumstances.

Thermoregulatory: The superheated environment coupled with the layers of protective clothing causes a significant increase in core body temperature.  The physical work and heat conditions can quickly lead to dehydration.

Respiratory and Metabolic: The mental, emotional and physical stress causes increased respiratory rate, oxygen consumption and lactate fatigue.

Nervous: The sympathetic nervous system is activated and large amounts of adrenaline are being released to help manage the perceived threat.

Muscular: The physical nature of the work leads to increased oxygen consumption, heat production and fatigue.

These stressors may help explain how firefighting may serve as a trigger for a sudden cardiac event in individuals with underlying cardiovascular disease. This “trigger effect” may be the root cause of many fire fighter deaths each year (Smith et al., 2010 pp. 3-10).

If we know what the physiological effects of fire fighting are, can’t we prepare our bodies and minds to better handle these stressors?


Survival Stress Management for Fire Fighters

Siddle (1995) states the three important perceptions that influence the level of survival stress:

1.  Level of threat perceived such as nature of the incident, potential victims, etc.

2.  Individual confidence in knowledge, skills and ability to control the threat.

3.  Past experience in dealing with the threat.


This provides the foundation for training goals and objectives:


Skill Confidence: Hands on training for the wide variety of skills required for firefighters such as hose and ladder evolutions, ventilation, etc.

Situational Confidence: Participation in regular scenario based training to prepare for the incidents that may be encountered such as residential structure fires, high rise drills, firefighter survival drills, etc.

Visualization: Use fire scene photos to generate conversation about strategy and tactics.  Discuss fire scenarios for buildings in the response area.

Breath Control:  Practicing slow controlled breathing when stress levels are increased can help control anxiety and re-focus on the task at hand (Siddle, 1995, pp. 91-107).

Physical Training: Firefighters are tactical athletes.  Sonnon (2010) states, “tactical athletes require a comprehensive physical training program which will foster the physical skills, attributes and energy reserves necessary for tactical response (Sonnon, 2010).  This training approach not only improves performance on the fire ground, but it will also help prepare your body for the physiological strain of firefighting.

Understanding the physiological effects of fire fighting and training frequently to minimize these effects is a vital first step to preventing a sudden cardiac event.


Next week we will take a closer look at the risk factors for cardiovascular disease.




Smith, D., Liebig, J., Steward, N., & Fehling, P.  (2010).  Sudden Cardiac Events in the Fire Service: Understanding the Cause and Mitigating the Risk.  Skidmore College.


Siddle, B. K.  (1995). Sharpening the Warrior’s Edge: The Psychology and Science of Training. Millstadt, IL: PPCT Research Publications.


Sonnon, S.  (2010). TACFIT: First In – Last Standing.  Atlanta, GA:  RMAX International.


United States Fire Administration (USFA). (2009).  Firefighter fatalities in the United States in 2009. Emitsburg, MD.


National Fire Protection Association (NFPA) Fire Analysis and Research. (2010). Firefighter fatalities in the United States in 2010. Quincy, MA.