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Firefighter Health and Fitness

Firefighter Health and Fitness
Paper details:
This is five separate literature reviews, each literature review must be at least 1 page but no more than 2 pages long. You must use the articles and references I have uploaded and provided. Please do not use any other articles or references.
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The Key to Reducing Firefighter Deaths
Basri, R. (2005, 08). The key to reducing firefighter deaths. Firehouse, 30, 82­86,88. Retrieved from http://search.proquest.com/docview/229543087?accountid=10674
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Abstract (summary)
A team of health professionals brings the medical exams onsite to the firehouse between 6 and 9 P.M. and/or selected Saturday mornings. We set up various required stations
within the social hall or truck bays to perform the separate parts of the exam.
Full text
Headnote
Firefighter Health & Safety
Headnote
One statistic says it all: Every year, nearly half of the line­of­duty deaths of U.S. firefighters are caused by heart attacks.
As a physician and as a firefighter, I am keenly aware of the risks common to all who serve in the fire service. One statistic says
it all: Every year, nearly half of the line­of­duty deaths of U.S. firefighters are caused by heart attacks. In 2004, there were 49
heart­related fatalities of 104 U.S. firefighter line­of­duty deaths. Over the last decade, this grim statistic remains unchanged
despite the mandate to do fire physicals. The purpose of this article is to provide you with a better understanding of fire
physicals and to describe some specific steps you can take to help reduce firefighter deaths due to heart attacks.
Several important questions must preface this discussion:
1. What are we doing about this?
2. Does the leadership of the fire service have a plan to address this issue?
3. Is it possible to significantly reduce our loss of life to heart attacks while still maintaining the volunteer spirit of the fire
service?
4. Are there enough resources, time, money and determination to accomplish a significant reduction in firefighter deaths?
My training as a physician allows me to reduce the risk of heart attacks for my civilian patients every day. If we apply the same lifesaving principles to the fire service, we can
directly reduce the number­one cause of firefighter deaths: heart attacks. The fire physical plays a significant role in this process, but currently is inadequate to reduce the number
of deaths.
GOOD NEWS!
Fortunately, most of the groundwork to reduce deadly heart attacks in the fire service is already in place. So is most of the funding. We already mandate and budget for medical
exams for active firefighters. That is part of the solution.
The second phase of the solution is to include specific cardiac risk screening for firefighters. Current physicals do not routinely include screening for cardiac risk factors in a
structured format. Screening for cardiac risk factors identifies people who have a high risk of heart attack. This allows them to change some aspects of their risk profile such as
smoking, diet and exercise to reduce their risk of having a heart attack.
STANDARD PHYSICAL
Firefighters and fire officers must understand that just because a firefighter had a physical does not reduce his or her chance of having a heart attack. Current physicals may
catalog pre­existing illnesses and find important new conditions such as high blood pressure. We need to set a standard for the physical exams that puts in place a program for
tallying the cardiac risk factors found during this screening.
So far, we have not demanded that the medical team address this issue as it performs the physical exams on our firefighters. The fire service pays for medical exams, but has no
requirement that during the physical, appropriate diagnostic screening tools be used that would detect firefighters at risk for heart attacks. However, firefighters continue to die
from heart attacks at the same rate as 10 years ago. In fact, in 2003, “There was a sharp increase, however, in heart attack deaths from 37 in 2002 to 47 in 2003.” (Full report,
Firefighter Fatalities in the U.S. 2003, NFPA, Paul R. Leblanc, June 2004, http://www.dps.state.mn.us/fmarshal/Response/FFFatalities2003.pdf.)
CARDIAC SCREENING
The following questions provide the framework to understanding how cardiac screening could work to save firefighter lives:
1. Is it possible to screen firefighters as part of their medical exams?
2. Is there a significant additional expense?
3. Would firefighters want to be screened or would they see this as another unnecessary burden?
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4. Would the healthcare providers currently performing these exams be able to do the screening in the firehouse?
HEART ATTACKS DON’T JUST HAPPEN
Heart attacks are one form of cardiovascular disease. Let’s take a look at the problem, what it is and how often it strikes Americans.
Cardiovascular disease comprises diseases of the heart, hypertension, congestive heart disease, heart attacks or myocardial infarctions, and strokes, which are like heart attacks in
the brain. Cardiovascular disease is a lethal epidemic in the United States. It is the number­one cause of death in the U.S. and it kills more than the next five causes of death
combined. Each year, at least 600,000 Americans die of heart attacks and for half the first symptom is death.
These are horrible statistics and the situation is getting worse each year. One in five American men have coronary heart disease before the age of 60. It is reasonable to roughly
assume and estimate that one in five firefighters has the same disease! Coronary heart disease can be asymptomatic, without any symptoms, even in its most severe form. One­
third of all heart attacks are silent. You or your firefighters may already have had a “silent” heart attack and you may not know il!
RISK FACTORS
Risk factors for coronary heart disease and heart attacks are high blood pressure (hypertension), high cholesterol (hyperlipidemia), elevated blood sugar (diabetes), smoking,
being a male, older age, obesity, and family history of a parent or sibling having heart attack, stroke or bypass surgery before the age of 60. Some of these risk factors can be put
into an equation to calculate the 10­year cardiac risk for an individual. We can estimate with a fair degree of certainty using risk factors those firefighters most likely to sustain
heart attacks in the future. We don’t need to wait until our people drop dead on the fireground! For many firefighters, this is their first and last symptom.
Some risk factors of them can be modified, treated or controlled, and some can’t. The more risk factors you have, the greater your chance of developing coronary heart disease at
a younger age. Also, the greater the level of each risk factor, the greater the risk. For example, a person with a total cholesterol of 300 mg/dL has a greater risk than someone
with a total cholesterol of 245 mg/dL, even though everyone with a total cholesterol greater than 240 is considered high­risk.
OSHA QUESTIONNAIRE
Fire physicals were not a homegrown idea for firefighters by firefighters to help our own. First, the federal government issued a requirement to protect firefighters using respiratory
protection called the Occupational Safety and Health Administration (OSHA) 1910.134 respiratory standard. It states that before an employee may use any type of respiratory
protection, he or she must have a medical evaluation using a medical questionnaire or an initial medical examination that obtains the same information as the questionnaire.
The OSHA respiratory questionnaire is used by many departments as a yearly means for firefighters to self report any symptoms, conditions or new medical history. This is an
excellent tool to conveniently monitor the health of our members between the medical exams. It does depend on firefighters honestly answering the questionnaire if they truly feel
symptoms.
FIRE PHYSICALS
The fire service mandated physical exams for firefighters as part of the National Fire Protection Association (NFPA) 1582 standard in 1992. It calls for the fire service to fund and
implement medical exams consisting of a health history; physical exam by a doctor, physician assistant or licensed nurse practitioner; electrocardiogram; and lung function test. It
set the frequency of exam based on the firefighters’ age and recommended vaccination for hepatitis B.
Since that time, there has been almost universal acceptance of fire physicals for at least some personnel in all departments. However, there has been no scientific study done to
evaluate the benefit to the individual firefighter or the fire service. We should consider how to collect data on the reliability of fire physicals and to specifically consider if heart
disease is being found before it kills firefighters.
SHOULD ALL FIREFIGHTERS HAVE MEDICAL EXAMS?
Some departments offer fire physicals only to interior qualified firefighters based on their use of respiratory protection or active firefighters such as drivers. Should we offer it to
fire police, veteran firefighters with many years of service, and should it include the electrocardiogram and lung function testing?
My opinion is yes. I believe that every firefighter who responds to an alarm needs and deserves to receive a medical exam. One may view the medical exam as a valuable benefit
being offered the firefighters in return for their service to the community or an opportunity to access a checkup for those unable to afford medical care.
I believe that it can and should be viewed as the gift of life for members. It must be presented as a “how can we keep you fit to fight fires with us” type of physical. Too often, it is
presented to members as a negative threat to weed out firefighters if they have a medical problem. We could and should use firefighter physicals as a recruiting and retention tool,
not a hammer to drive members away. We need to start a “fit to fight” mentality to replace the “sacrifice ourselves” mentality.
The fire service should want every firefighter, regardless of his or her function on the fireground, to be screened, especially for heart disease because there is inherent risk to
personnel every time we respond to an alarm. The adrenaline of responding can trigger a heart attack. So can directing traffic or doing a fire investigation. Look at the case
histories ­ fatalities are not only occurring to interior firefighters! The fire district and local government share an opportunity to reduce their potential liability if all firefighters are
given medical exams and especially if the exam screens for heart disease.
It is also common for interior qualified firefighters to migrate over the years to less strenuous (less physically demanding) assignments such as drivers, fire police or chief officers.
While the first expectation is that this may reduce the likelihood of a jobrelated heart attack, the converse is actually true. The probability of cardiovascular disease increases with
age, making any fire­related activity more dangerous with time. These assignments come with additional emotional stresses that are every bit as significant as physical stress.
Heart attacks account for a higher proportion of deaths among older firefighters, as may be expected. Two­thirds of the firefighters over age 50 who died on duty in 2003 died of
heart attacks. The youngest heart attack victim was 35 years old.
SOME FIREFIGHTERS DON’T WANT FIRE PHYSICALS
Do firefighters want the medical exams? Some do, while others, especially the younger members, regard it as another administrative burden. At least for those under 30, it is
required every third year. The frequency of the exam is every other year for firefighters ages 30 to 40 and every year for personnel over age 40.
Some firefighters, especially career firefighters, view the medical exam as a potentially career­ending exam if they are found to have a disqualifying condition. I have faced this
many times with commercial airline pilots as a senior medical examiner for the FAA. Medical issues with commercial pilots could suddenly end a lucrative career and many years of
experience.
There is never a time that either a pilot or a firefighter would not want to know if something is wrong. The truth is that everyone wants to be healthy and find a potentially serious
condition before it leads to an early death. This is what medical screening exams want to accomplish. My work with pilots has never been hindered by their concern that I would
ground them, since anything I find will be the first step to get help and return safely to flying. Then I offer my support to requalify them as fit for duty.
The same is true for the fire service and our members. No one wants to disqualify anyone from serving unless it is a question of safety. All people want to be assured that if
something is wrong, it will be addressed and helped back to their previous activities. It is the responsibility of the fire department’s medical program to follow up with these
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firefighters until they are back to duty.
THIS IS A SIMPLE ISSUE OF SAFETY
Fire districts and our officers have a responsibility to be sure members do not present a threat to other members in the department, the public we serve and even mutual aid
companies. For example, when a firefighter is struck down suddenly by a disabling heart attack, other members will have to remove or rescue him or her from the interior fire
attack or search operation. This scenario will stop the fire attack, which may be protecting search teams, and place a huge burden on firefighters engaged in the suppression
operation. An alternate scenario is the rapid intervention team is tasked with rescue and removal of the downed firefighter.
Anyone who has been on the scene of a firefighter down call knows how hectic it can be. The entire operation may focus on the firefighter and not the civilians or property we were
trying to save. If the firefighter is a driver, sudden illness or death could result in a motor vehicle accident with a fire apparatus with injury to members and the public.
NO FIRE PHYSICAL CAN FIND EVERY PROBLEM
No single medical exam can address every possible medical issue or condition for which a firefighter may be suffering. When a firefighter has a history of an eye condition that is
out of my experience, I must ask them to return with a note from their eye doctor clearing them for duty. I can’t do this without the help of the eye doctor.
It is the responsibility of the firefighters, if they want to serve, to produce the documentation. For volunteer firefighters, the cost of the eye exam is their responsibility, not the
department’s. The fire service cannot and should not be asked to pay for the specialist’s care for anyone wanting to volunteer. This is not part of the basic medical exam offered by
the fire service, but rather a clearance from a specialist that the firefighter needs to bring to the department in order to complete its review.
POSITIVE STEPS
Risk factors for cardiovascular disease should be part of every health screen done for every firefighter during every medical exam. The medical officer must review the OSHA
respiratory questionnaire for symptoms of existing heart disease and also offer a separate questionnaire that would identify cardiac risk factors. If a firefighter does not know his or
her cholesterol, either the department’s exam should provide this test or the department’s policy should direct the member to return to their own doctor for the test.
The OSHA questionnaire asks the firefighter to report symptoms such as chest discomfort or shortness of breath. If the firefighter is not sure if what he or she is experiencing is
chest discomfort, the questionnaire is an opportunity to ask about it. Usually, the medical examiner will request those answering yes to those symptoms to come in for an exam.
This is how we would identify firefighters needing further evaluation. Perhaps the next step would be to refer the members back to their own doctors or suggest that active
firefighting be postponed pending the followup with their doctors.
The mandatory use of a separate questionnaire for cardiac risk factors comes from decades of analyzing who gets heart attacks. There are printed questionnaires, simple
calculators and online websites that calculate risk scores based on 10­year risk. Any individual with risk above 10% over the next 10 years should be made aware of the risk
factors that could be improved to lower risk such as smoking or high blood pressure. All high­risk individuals should be asked to see their own doctors. The fire service should not
exclude these members from serving, but ask that their own doctors ensure their safety and review their situation. The department’s medical examiner should not accept any
clearance for a member with chest discomfort and a high­risk score that does not include a stress test. Their doctor may find the individual fit to participate in firefighting and
reduce the potential liability of the department and municipality.
Occasionally, firefighters ask that their own physician do the physical exam or that their employment medical exam be substituted for the fire department’s exam. I do not
recommend this since there may be a tendency for one’s own doctor to underestimate the rigors for firefighting or to base an opinion on less data than used for the standard OSHA
exam. I also have seen many instances of doctors finding critical health issues when a patient gets examined one additional time. Ultimately, it is the fire service and its medical
team that takes responsibility for the health and safety of its firefighters.
FIRE PHYSICALS ARE A GREAT TIME TO DISCUSS GOOD HEALTH
The assessment of an individual’s cardiovascular risk factors is an excellent opportunity to counsel the firefighter on the spot. There is no better time to advocate for positive
change than when the firefighter has the knowledge in front of them. Simple lifestyle changes can mean lower risk for years to come.
Smoking cessation should be offered individually to every firefighter at the time of their medical exam. The doctor, physician assistant or licensed nurse practitioner must take the
opportunity to review the smoking history with each firefighter and use the face­to­face contact to ask them to quit on the spot and to write prescriptions, if necessary.
The fire service should also offer smoking­cessation classes yearly to all members and their families. These classes could be sponsored by the fire service on a countywide level.
This is another value­added benefit of membership, which directly helps the firefighter and the department.
I have served as the medical officer for fire departments for 15 years. I believe that a quality medical program for the members should be fully integrated into the department’s
workflow and training programs. The chief should have a medical officer with some medical training such as an EMT who would be a liaison to the medical team performing the
physical exams. This will ease the administrative burden on the chief and ensure the timely scheduling of exams and their completion.
DO THE FIRE PHYSICAL ON SITE
Instead of sending the firefighter to the fire physical, why not send the fire physical to the firefighter? Here is one good solution. I would like to describe our medical program for
local departments in the Hudson Valley of New York provided by Health and Safety Specialists at www.firephysical. com. The OSHA respiratory questionnaire is available online and
may be completed before the medical team arrives on site.
A team of health professionals brings the medical exams onsite to the firehouse between 6 and 9 P.M. and/or selected Saturday mornings. We set up various required stations
within the social hall or truck bays to perform the separate parts of the exam. We ask firefighters to complete the OSHA questionnaire if they have not already done so, and then
route the personnel to one of five stations for vision and hearing testing, electrocardiogram, lung function testing, fit testing, and finally to see the doctor or physician assistant.
The doctor reviews the OSHA questionnaire with the firefighter individually and a cardiac risk calculation is done. Firefighters are also vaccinated for hepatitis B. While firefighters
are waiting, we offer handouts on cardiac health and smoking cessation.
Some departments offer more than the basic services listed above. Some offer to pay for their members to have blood analysis for cholesterol and chemistry, flu and pneumonia
vaccinations, and limited stress testing. This last item, stress testing, is a crucial tool in evaluating high­risk individuals. Fire departments spend lots of money on less­than­critical
items (chrome wheels for rigs, for example). Why not invest your funds wisely on your most valuable resource, your members?
The medical team goes to the firehouse for the convenience of the members and to help create the environment within department that will continue all year long. We set up follow
dates throughout the year to allow departments to stay compliant to the NFPA and OSHA guidelines. If several departments are geographically close, we will offer to see members
from adjacent departments while working at another firehouse. This reduces the time delay in starting new members or returning members to duty after illness or injury.
ADDITIONAL STEPS FOR BETTER OUTCOMES
If we are to reduce the numbers of firefighters being killed by heart attacks each year, we must consider executing the following aggressive steps:
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* First, the physical exams we provide to our members should be standardized.
* second, we should expect that every firefighter over 35 have a cardiac risk assessment done with every medical exam.
* Third, we should review an OSHA respiratory medical evaluation questionnaire every year, regardless of age.
* Fourth, we should ask for funding to screen every firefighter over 35 for cholesterol if they have not had it done within the last two years.
* Fifth, we should offer a smoking­cessation program and medication when appropriate for all who want to quit.
* Sixth, we should gather the data to validate that the physical exams and cardiac risk assessments are effective for the health and safety of our firefighters.
The bottom line is this: firefighters must view themselves as athletes who work at maximum emotional and physical stress levels without the advantage of a warmup in a game
that is not win or lose, but life and death. As the statistics so painfully show, the deaths are often preventable. We must improve the maintenance on our human machines to
insure their reliability and safety.
AuthorAffiliation
By DR. RAYMOND BASRI, MD, FACP
Dr. Raymond Basri, MD, FACP, is in the private practice of internal medicine and diagnostic cardiology in Middletown, NY. He is a I Diplomate of the American Board or Internal
Medicine president of the Mid­Hudson section of the American College of Physicians and a Fellow of the American College of Physicians. In addition, Dr. Basri is an attending
physician in the Department of Internal Medicine at Orange Regional Medical Center in Orange County, NY, and on the consulting staff in cardiology at The Valley Hospital in
Ridgewood, NJ. He also is an 18­year member of the Excelsior Hook and Ladder Company in Middletown and has been a deputy fire coordinator for Orange County for 10 years. Dr.
Basri is the senior physician of the Disaster Medical Assistance Team (DMAT NY­4) part of the Federal Emergency Management Agency (FEMA) ana the Department of Homeland
security. He also a senior medical examiner for the Federal Aviation Administration and the chief physician for Health & Safety Specialists, which does onsite medical examinations
for the fire service, as well as a consultant to FirePhysical.com. Dr. Basri wishes to acknowledge the assistance of Gordon Wren Jr. (see Forum), Jerry Knapp and Mark Davis in the
preparation of this article.
Copyright Cygnus Business Media Aug 2005
Indexing (details)
Subject
Firefighters;
Heart attacks;
Physical examinations;
Risk factors;
Guidelines;
Safety management;
Questionnaires
Location
United States­­US
Classification
9190: United States
8300: Other services
9150: Guidelines
5340: Safety management
Title
The Key to Reducing Firefighter Deaths
Author
Basri, Raymond
Publication title
Firehouse
Volume
30
Issue
8
Pages
82,84­86,88
Number of pages
5
Publication year
2005
Publication date
Aug 2005
Section
Medical Examinations for the Fire Service
Publisher
Cygnus Business Media, Inc
Place of publication
Fort Atkinson
Country of publication
United States
Publication subject
Fire Prevention
ISSN
01454064
Source type
Magazines
Language of publication
English
Document type
Feature
Document feature
Photographs
ProQuest document ID
229543087
Document URL
http://search.proquest.com/docview/229543087?
accountid=10674
Copyright
Copyright Cygnus Business Media Aug 2005
Last updated
2012­09­27
Database
ABI/INFORM Complete
Bibliography
Citation style: APA6
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1/ 17/20 15 search .proquest .com.dbo7 .linccweb .org/abicomplete/printviewfile?accountid= 10674 Back to previous page PI‘OQJGSE document 1 of 1 ENHANCING FIREFIGHTER SAFETY THROUGH CONTINUOUS PHYSIOLOGIC SURVEILLANCE Derchak, P. A., & Mendenhall, D. (2005, 05). ENHANCING FIREFIGHTER SAFETY THROUGH CONTINUOUS PHYSIOLOGIC SURVEILLANCE. Fire Engineering, 158, 126-129. Retrieved from http://search.proquest.com/docview/229049676?accountid=10674 Find a copy Text? Click for expanded options. http://resolver.flvc.org/FLCCo700?url_ver=Z39.88- 2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&genre=unknown&sid=ProQ:ProQ%3Aabitrade&atitle=ENHANCING+FIREFIGHTER+SAFETY+THROUGH+CONTINUOUS+PHYSIOLOGIC 05-01&volume=158&issue=5&spage=126&au=Derchak%2C+P+Alexander%3BMendenhall%2C+Darrell&isbn=&jtitle=Fire+Engineering&btitle=&rft_id=info:eric/&rft_id=info:doi/ Abstract (summary) None available. Full text FIREFIGHTERS ROUTINELY FACE severe hazards on-duty and during training exercises. But the single biggest health risk for firefighters isn’t trauma, asphyxiation, or burns. It’s heart attack, often as a result of extreme levels of physical exertion, heat stress, and exposure to toxic substances. In fact, cardiovascular problems alone account for nearly half of all firefighter deaths and injuries, according to a 10-year study published by the United States Fire Administration (USFA).’ Those percentages held even in 2004, when nearly half of all firefighter deaths were attributed to nontraumatic injuries such as heart attacks and strokes.2 The USFA also issued a Special Report that documented an increase in trainingrelated injuries by nearly 21 percent to almost 7,000 injuries between 1987 and 2001.3 Many of these deaths and injuries were attributed to poor physical fitness, with heart attacks being the leading cause of death in training-related incidents. The risk of heart attack-known medically as myocardial infarction-increases as the firefighter population ages. In 2004, for example, 52 was the average age of firefighters who died from heart attack or stroke. (2) In addition, the job itself generates its own particular risks because it involves long periods of inactivity, followed by abrupt, unpredictable demands for intense exertion and focus. Other factors that exacerbate the risk of heart attack include being overweight, high cholesterol levels, cigarette smoking, lack of regular physical exercise, a family history of heart disease, hypertension, and diabetes. So, what can be done to address the risk and potentially reduce the number of injuries and deaths? ADDRESSING FIRE SERVICE HEALTH AND SAFETY The fire service is actively addressing firefighter health and safety needs on many fronts through multiple associations, agencies, foundations, and councils. In 1997, the International Association of Firefighters (IAFF), the International Association of Fire Chiefs (IAFC), and 10 large metropolitan departments across the United States and Canada assembled to form the Fire Service Joint Labor Management Wellness-Fitness Task Force. The mission of the task force is to improve the health and safety of the fire service across North America. To this end, the task force has developed and introduced three major programs: (1) The Fire Service Joint Labor Management Wellness/Fitness Initiative, (2) The Candidate Physical Abilities Test, and (3) The Fire Service Peer Fitness Trainer Certification program. In 2004, the National Volunteer Fire Council (NVFC) launched its Heart Healthy Firefighter program. This program is designed to educate firefighters and the communities they serve about the risk of heart attacks and other heart-related dangers inherent in firefighting. Their goal is to reduce heart-related on-duty deaths 25 percent by the year 2008. Additionally, in 2004. the NVFC teamed up with FEMA to develop the new “Health and Wellness Guide for the Volunteer Fire Service.” In 2005. the NVFC also introduced the “Fired Up for Fitness Challenge.” This online interactive program allows firefighters to log on and record their physical activity to earn points and compete for prizes. In March 2004, the National Fallen Firefighters Foundation, in cooperation with the United States Fire Administration (USFA), hosted a two-day National Firefighter Life Safety Summit. The Summit’s purpose was to produce an agenda of initiatives that would help to achieve the Summit’s objectives of reducing line-of-duty deaths by 25 percent in five years and 50 percent within 10 years. Sixteen initiatives were developed and presented as a means to accomplish these objectives The National Fire Protection Agency (NFPA) has published many standards directly addressing firefighter health and safety, particularly NFPA 1500, Standard on Fire Department Occupational Safety and Health Program; NFPA 1582, Standard on Medical Requirements for Firefighters and Information for Fire Department Physicians; and NFPA 1583, Standard on Health-Related Fitness Programs for Firefighters. All of these efforts are valuable and no doubt contribute to the improved health and fitness of firefighters. But the fact remains that heart attack is still the Number 1 risk to firefighters while on-duty and during training exercises. However, new technology is now making it possible to better understand the unique physical demands of firefighting, the training that it requires, and the need to continuously monitor various physiologic parameters of firefighters to help ensure A- 7- their safety. I ( r ( r LIFESHIRT® SYSTEM Recent advances in technology, computing, and wireless communications have come together to provide a tool that will greatly increase the understanding of the physiologie demands of fighting fires. A leader in the field of ambulatory (i.e., highly portable) monitoring is VivoMetrics Government Services, Inc., a Californiabased company that markets the LifeShirt® System. The LifeShirt is a miniaturized, ambulatory version of an exercise physiology laboratory that uses a respiratory measurement technology currently used in more than 1,000 hospitals worldwide. The LifeShirt System is able to bring this sophisticated, monitoring technology directly into the field, right to the people who put their lives on the line. Before entering a high-risk fire or training situation, and even before suiting up with protective or other turnout gear, a firefighter puts on a simple vest that fits underneath other clothing like an undershirt, close to the skin. Connected to the vest are three easy-to-apply heart rate electrodes that are pressed onto the skin of the chest area. The front of the vest is zipped up so that it fits snugly. A push of a button activates the small recording and transmission device also attached to the vest. That’s it-the firelighter is ready to go. Other clothing and necessary gear are then layered on top as needed (photos 1, 2). From the firefighter’s standpoint, using the LifeShirt System is easy-it’s lightweight and unobtrusive. Most users forget they are wearing it. The complexity of the system is actually engineered into the product in terms of its sensor arrays, wireless transmission hardware, and processing software. Here’s how the technology works: The LifeShirt collects data through sensors built into the LifeShirt. They gather continuous, key physiological data, such as heart rate, respiration, http://search.proquest.com.dbo7.1inccweb.org/abicomplete/printviewfile?accountid=10674 1/3
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ENHANCING FIREFIGHTER SAFETY THROUGH CONTINUOUS PHYSIOLOGIC SURVEILLANCE
Derchak, P. A., & Mendenhall, D. (2005, 05). ENHANCING FIREFIGHTER SAFETY THROUGH CONTINUOUS PHYSIOLOGIC SURVEILLANCE. Fire Engineering, 158, 126­129. Retrieved
from http://search.proquest.com/docview/229049676?accountid=10674
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05­01&volume=158&issue=5&spage=126&au=Derchak%2C+P+Alexander%3BMendenhall%2C+Darrell&isbn=&jtitle=Fire+Engineering&btitle=&rft_id=info:eric/&rft_id=info:doi/
Abstract (summary)
None available.
Full text
FIREFIGHTERS ROUTINELY FACE severe hazards on­duty and during training exercises. But the single biggest health risk for firefighters isn’t trauma, asphyxiation, or burns. It’s
heart attack, often as a result of extreme levels of physical exertion, heat stress, and exposure to toxic substances. In fact, cardiovascular problems alone account for nearly half of
all firefighter deaths and injuries, according to a 10­year study published by the United States Fire Administration (USFA).’ Those percentages held even in 2004, when nearly half
of all firefighter deaths were attributed to nontraumatic injuries such as heart attacks and strokes.2
The USFA also issued a Special Report that documented an increase in trainingrelated injuries by nearly 21 percent to almost 7,000 injuries between 1987 and 2001.3 Many of
these deaths and injuries were attributed to poor physical fitness, with heart attacks being the leading cause of death in training­related incidents.
The risk of heart attack­known medically as myocardial infarction­increases as the firefighter population ages. In 2004, for example, 52 was the average age of firefighters who
died from heart attack or stroke. (2) In addition, the job itself generates its own particular risks because it involves long periods of inactivity, followed by abrupt, unpredictable
demands for intense exertion and focus. Other factors that exacerbate the risk of heart attack include being overweight, high cholesterol levels, cigarette smoking, lack of regular
physical exercise, a family history of heart disease, hypertension, and diabetes. So, what can be done to address the risk and potentially reduce the number of injuries and deaths?
ADDRESSING FIRE SERVICE HEALTH AND SAFETY
The fire service is actively addressing firefighter health and safety needs on many fronts through multiple associations, agencies, foundations, and councils. In 1997, the
International Association of Firefighters (IAFF), the International Association of Fire Chiefs (IAFC), and 10 large metropolitan departments across the United States and Canada
assembled to form the Fire Service Joint Labor Management Wellness­Fitness Task Force. The mission of the task force is to improve the health and safety of the fire service across
North America. To this end, the task force has developed and introduced three major programs: (1) The Fire Service Joint Labor Management Wellness/Fitness Initiative, (2) The
Candidate Physical Abilities Test, and (3) The Fire Service Peer Fitness Trainer Certification program.
In 2004, the National Volunteer Fire Council (NVFC) launched its Heart Healthy Firefighter program. This program is designed to educate firefighters and the communities they
serve about the risk of heart attacks and other heart­related dangers inherent in firefighting. Their goal is to reduce heart­related on­duty deaths 25 percent by the year 2008.
Additionally, in 2004. the NVFC teamed up with FEMA to develop the new “Health and Wellness Guide for the Volunteer Fire Service.” In 2005. the NVFC also introduced the “Fired
Up for Fitness Challenge.” This online interactive program allows firefighters to log on and record their physical activity to earn points and compete for prizes.
In March 2004, the National Fallen Firefighters Foundation, in cooperation with the United States Fire Administration (USFA), hosted a two­day National Firefighter Life Safety
Summit. The Summit’s purpose was to produce an agenda of initiatives that would help to achieve the Summit’s objectives of reducing line­of­duty deaths by 25 percent in five
years and 50 percent within 10 years. Sixteen initiatives were developed and presented as a means to accomplish these objectives
The National Fire Protection Agency (NFPA) has published many standards directly addressing firefighter health and safety, particularly NFPA 1500, Standard on Fire Department
Occupational Safety and Health Program; NFPA 1582, Standard on Medical Requirements for Firefighters and Information for Fire Department Physicians; and NFPA 1583, Standard
on Health­Related Fitness Programs for Firefighters.
All of these efforts are valuable and no doubt contribute to the improved health and fitness of firefighters. But the fact remains that heart attack is still the
Number 1 risk to firefighters while on­duty and during training exercises. However, new technology is now making it possible to better understand the unique
physical demands of firefighting, the training that it requires, and the need to continuously monitor various physiologic parameters of firefighters to help ensure
their safety.
LIFESHIRT® SYSTEM
Recent advances in technology, computing, and wireless communications have come together to provide a tool that will greatly increase the understanding of
the physiologie demands of fighting fires. A leader in the field of ambulatory (i.e., highly portable) monitoring is VivoMetrics Government Services, Inc., a
Californiabased company that markets the LifeShirt® System. The LifeShirt is a miniaturized, ambulatory version of an exercise physiology laboratory that
uses a respiratory measurement technology currently used in more than 1,000 hospitals worldwide. The LifeShirt System is able to bring this sophisticated,
monitoring technology directly into the field, right to the people who put their lives on the line.
Before entering a high­risk fire or training situation, and even before suiting up with protective or other turnout gear, a firefighter puts on a simple vest that
fits underneath other clothing like an undershirt, close to the skin. Connected to the vest are three easy­to­apply heart rate electrodes that are pressed onto
the skin of the chest area. The front of the vest is zipped up so that it fits snugly. A push of a button activates the small recording and transmission device also
attached to the vest. That’s it­the firelighter is ready to go. Other clothing and necessary gear are then layered on top as needed (photos 1, 2).
From the firefighter’s standpoint, using the LifeShirt System is easy­it’s lightweight and unobtrusive. Most users forget they are wearing it. The complexity of the system is actually
engineered into the product in terms of its sensor arrays, wireless transmission hardware, and processing software.
Here’s how the technology works: The LifeShirt collects data through sensors built into the LifeShirt. They gather continuous, key physiological data, such as heart rate, respiration,
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activity, and posture. In addition, arterial oxygen saturation, skin temperature, and core body temperature can also be monitored. These data are recorded to a flash card for
subsequent analysis and can be transmitted over a wireless system to a remote monitoring station or command center (investigational use only, wireless transmission system is
pending Food and Drug Administration clearance). The wireless monitoring station displays a second­by­second picture of each firefighter’s physiologic response to the work of
fighting fires, live and in real time.
UNDERLYING SENSOR TECHNOLOGY
The respiratory sensors in the LifeShirt System are wires woven into elastic bands that stretch across the firefighter’s chest and abdomen when the vest is zipped up. As the
firefighter breathes in and out, the bands expand and contract to give continuous respiratory measures essential to monitoring overall health and physiologic status. This
technology is called “respiratory inductive plethysmography (RIP).”
Accelerometers embedded in the shirt detect level of activity and determine whether the firefighter’s body is upright, at a prone or tilted angle, or lying flat. Heart rate electrodes
provide basic ECG measures, which, with the respiratory measures and accelerometers also embedded in the shirt, provide a complete data set on the cardiopulmonary response
to the work of firefighting.
MONITORING FIRST RESPONDERS AND MILITARY PERSONNEL DURING TRAINING
The LifeShirt System has been used by Elk River, Minnesota, and Fairfield, Connecticut, firefighters and haz­mat workers to monitor life signs during training exercises. In each
case, the LifeShirt was worn under fire retardant clothing and Level A haz­mat gear to wirelessly transmit key vital signs to incident command centers (photo 3).
During the Fairfield haz­mat simulation exercise, an 18­wheel tanker truck was lying on its side to simulate a toxic chemical spill. Haz­mat team members wearing LifeShirts
cordoned off the area, set up a decontamination center, and dispatched a crew suited in Level A gear to spray foam on the truck to contain toxic vapors. The team then dragged
200­pound mannequins to the “decon” station, where team members in Level B suits cleaned them and performed life­saving techniques. In Elk River, a donated house was set
afire, and trainees wearing LifeShirts made multiple entries to knock down the fire. As part of both exercises, commanders monitored their team’s life signs from a remote
command truck and noted critical changes.
The LifeShirt’s respiratory sensors have been integrated into the United States Army Research Institute of Environmental Medicine’s (USARIEM) Warfighter Physiological Status
Monitor­Initial Capability (WPSM­IC) Program. The WPSM­IC, with its respiratory sensors, will be worn by soldiers in testing and training scenarios, and there are plans to harden
the system and deploy it in combat operations. This will enable army medics to remotely assess soldier’s health status and begin triage for medical attention as needed.
The LifeShirt System has also been used by the Walter Reed Army Institute of Research, the U.S. Air Force Institute of Technology, and the Fire
Department of New York to address various needs of first responders.
NEW RESEARCH PROJECT IN DEVELOPMENT
The availability of a wearable physiological monitor like the LifeShirt makes it possible to collect a detailed data set describing the responses of
firefighters to training and real firefighting. Up to now, what happens inside the turnout gear in training and real fire situations has not been
studied, but an important research study is about to get underway.
The Indianapolis (IN) Fire Department (IFD) has long been a leader in the area of firefighter health and safety. It has had a wellness program in
place for its firefighters since 1986 that includes a comprehensive annual medical examination and fitness evaluation in which approximately 90
percent of the firefighters participate. The local union has been a strong advocate of this program throughout.
Public Safety Medical Services (www. publicsafetymed.com) is a private occupational medicine clinic located in Indianapolis and Cincinnati that
provides services exclusively to fire, police, and sheriff’s departments. Public Safety Medical Services is the medical provider for the IFD as well
as more than 180 other departments throughout Indiana and Ohio.
The IFD and other surrounding township departments and Public Safety Medical Services have formed a coalition with researchers from the University of Indianapolis, Indiana
University/Purdue University at Indianapolis, and VivoMetrics Government Services to launch a Firefighter Physiologic Surveillance Research Project. “Being able to gain a better
understanding of the unique physical demands that firefighters must endure on a daily basis could have a significant impact on our ability to better prepare our firefighters for, and
protect them from, the hazards of our occupation,” says IFD Chief James Greeson.
The purpose of this study is to obtain a better understanding of real­time firefighter physiology that will result in improved intervention and training programs and contribute to a
reduced incidence of cardiac­related deaths in the fire service. This research project will consist of three distinct phases:
Phase 1: Gather continuous, detailed cardiopulmonary physiologic data during live fireground operations and simulated training operations to describe the normal range of
physiologic responses and potentially identify response characteristics that may warn of an impending negative health event such as heat injury or myocardial infarction. Identify
criteria for proactive intervention, rehabilitation, and reentry to fireground operations.
Phase 2: Analyze data to determine minimal physical fitness characteristics and an ideal physical conditioning program for optimal performance on the fireground.
Phase 3: Develop, implement, and test physical conditioning programs for firelighters.
“Being able to capture and evaluate physiologic data while firefighters perform live fireground or other emergency operations will help us to better understand the true unique
physical demands of our occupation and, subsequently, better prepare our brothers and sisters to meet those demands and protect them from the risks of adverse physical
outcomes,” according to Mike Reeves, IAFF Local 416 president.
In another article, we will present and discuss data collected at the FDIC held in Indianapolis April 11­16, 2005. Firefighters there volunteered to wear the LifeShirt System while
participating in the flashover simulations and firefighter safety and survival drills during the Hands­On Training (H.O.T.) classes. We also will discuss in more depth the Firefighter
Physiologic Surveillance Research Project.
The combination of research and firefighting expertise provided by PSMS and the data collection capabilities now available present an opportunity to advance the understanding of
the physiologic stresses faced by firefighters. This advance will make it possible to train and manage firefighters to better ensure their safety and improve their ability to get the
job done.
Footnote
Endnotes
1. “Firefighter Fatality Retrospective Study,” United States Fire Administration, April 2002.
2. “Firefighter Fatality Figures Show 107 On­Duty Deaths in 2004,” press release, United States Fire Administration, January 5, 2005.
3. “Trends and Hazards in Firefighter Training,” United States Fire Administration, May 2003.
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AuthorAffiliation
* P. ALEXANDER DERCHAK, PH.D., is a principal scientist for VivoMetrics and has a bachelor’s degree in science from the University of Notre Dame, a master’s degree in science in
exercise physiology from Indiana University, and a Ph.D. in human performance/exercise physiology from the School of Graduate Studies at Indiana University. He did a post­
doctoral research fellowship at the University of Wisconsin at Madison. Previously, he worked with Eli Lilly and Company.
* DARRELL MENDENHALL, M.S., is director of fitness and health promotion at Public Safety Medical Services, an occupational medicine clinic that provides medical, fitness, and
health promotion services to fire and law enforcement departments in Indiana and Ohio. He has a master’s degree in exercise science from Indiana University. Mendenhall is a
member of the IAFF/IAFC Wellness/Fitness Task Force technical committee and a certified ACE/IAFF peer fitness trainer instructor and a member of the Peer Fitness Trainer
technical committee.
Copyright PennWell Publishing Company May 2005
Indexing (details)
Title
ENHANCING FIREFIGHTER SAFETY THROUGH CONTINUOUS
PHYSIOLOGIC SURVEILLANCE
Author
Derchak, P Alexander; Mendenhall, Darrell
Publication title
Fire Engineering
Volume
158
Issue
5
Pages
126­129
Number of pages
4
Publication year
2005
Publication date
May 2005
Section
Technology Today
Publisher
PennWell Corporation
Place of publication
Tulsa
Country of publication
United States
Publication subject
Public Health And Safety, Fire Prevention
ISSN
00152587
Source type
Magazines
Language of publication
English
Document type
General Information
ProQuest document ID
229049676
Document URL
http://search.proquest.com/docview/229049676?
accountid=10674
Copyright
Copyright PennWell Publishing Company May 2005
Last updated
2010­06­10
Database
ABI/INFORM Complete
Bibliography
Citation style: APA6
Derchak, P. A., & Mendenhall, D. (2005, 05). ENHANCING FIREFIGHTER SAFETY THROUGH CONTINUOUS PHYSIOLOGIC SURVEILLANCE. Fire Engineering, 158, 126­129. Retrieved
from http://search.proquest.com/docview/229049676?accountid=10674
Copyright © 2015 ProQuest LLC. All rights reserved. Terms and Conditions
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UCLA to Help Establish Guidelines for Firefighter Health and Safety
UCLA to help establish guidelines for firefighter health and safety. (2010, 11). Firehouse, 35, 51. Retrieved from http://search.proquest.com/docview/763168110?accountid=10674
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Text? Click for expanded options.
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11-01&volume=35&issue=11&spage=51&au=Anonymous&isbn=&jtitle=Firehouse&btitle=&rft_id=info:eric/&rft_id=info:doi/
Abstract (summary)
Firefighters experience heightened levels of physiological stress, such as strain on the cardiovascular and respiratory systems,” said Dr. Christopher Cooper, principal investigator
for the program and a professor of medicine and physiology at the Geffen School of Medicine. “The PHASER program will help us identify health risks and better understand
challenges facing firefighters in the field.”
Full Text
The David Geffen School of Medicine at UCLA and the UCLA Henry Samueli School of Engineering and Applied Science have been selected by the U.S. Department of Homeland
Security’s Science and Technology Directorate to help establish guidelines for the health and safety of firefighters.
The UCLA team will work with a consortium of academic, industry and government partners on the agency’s PHASER (Physiological Health Assessment System for Emergency
Responders) program, which also draws on the expertise of Skidmore College , Zephyr Technology, a company that develops physiological-status monitoring products, and the
NASA Ames Research Center, which has extensive experience with astronautmonitoring systems.
The UCLA team will use wireless health technologies to remotely monitor firefighters in action and develop metrics to validate and interpret their findings. The results will help
researchers analyze firefighters’ health risks before, during and after response operations, develop national guidelines to optimize exercise and training programs, and manage
health and safety in the field to mitigate fatalities due to cardiovascular events.
Firefighters experience heightened levels of physiological stress, such as strain on the cardiovascular and respiratory systems,” said Dr. Christopher Cooper, principal investigator
for the program and a professor of medicine and physiology at the Geffen School of Medicine. “The PHASER program will help us identify health risks and better understand
challenges facing firefighters in the field.”
Co-investigator William J. Kaiser, a professor of electrical engineering at UCLA Engineering, said, “We will be working closely with our partners in using the latest wireless
technologies to measure and track the fitness and health status of firefighters and to help develop key interventions to improve health.”
The team will initially obtain baseline measurements in the UCLA Exercise Physiology Research Laboratory and develop protocols for firefighter assessment and exercise training,
including tests to assess respiration and aerobic ability. They will also collaborate with regional and national fire services on the project to develop risk profiles and prioritization in
the work environment.
This research will help firefighters and incident commanders recognize health and safety issues in the field early to initiate preventive interventions, such as exercise training,
prehydration and active cooling methods. In addition, the data may lead to the development of new equipment worn by firefighters.
Copyright Cygnus Business Media Nov 2010
Indexing (details)
Subject Colleges & universities;
Firefighters;
Occupational safety;
Safety programs
Location United States-US
Company / organization Name: University of California-Lo5 Angeles
NAICS: 611310
Classification 9190: United States
9000: Short article
9550: Public sector
5340: Safety management
8306: Schools and educational services
Title UCLA to Help Establish Guidelines for Firefighter Health and
Safety
Author Anonymous
Publication title Firehouse
Volume 35
Issue 11
Pages 51
Number of pages 1
Publication year 2010
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Firefighter Fitness in 2008
Meyer, R. (2008, 04). Firefighter fitness in 2008. Firehouse, 33, 56­56,58. Retrieved from http://search.proquest.com/docview/229605070?accountid=10674
Find a copy
Click for expanded options.
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2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&genre=article&sid=ProQ:ProQ%3Aabitrade&atitle=Firefighter+Fitness+in+2008&title=Firehouse&issn=01454064&date=2008­
04­01&volume=33&issue=4&spage=56&au=Meyer%2C+Rich&isbn=&jtitle=Firehouse&btitle=&rft_id=info:eric/&rft_id=info:doi/
Abstract (summary)
In this series, well break the entire spectrum of firefighter fitness into three levels: awareness, operations and technician. At the awareness level, well refresh some
information that is good to keep in mind regarding heart attacks, injuries, medical issues, obstacles in developing programs and what each stage of fitness should focus on.
At the operations level, well talk about specific equipment, assessment tools, tips on setting up your fitness center and what type of equipment each level should use.
Full Text
Headnote
Part 1 ­ How to Make Sense of the Entire Fitness Spectrum
Another year has begun, and at this time many New Years fitness resolutions may have fallen short. IVe heard time and again, “I want to drop 50 pounds” or “Fm going to
start working out this year.” Unfortunately, statistics from the fitness industry show that many enthusiastic resolution­makers drop out around the six­week mark because
they haven’t seen the results they want. This series of articles will help refresh some basic fitness principles along with helping you understand how to better develop a
comprehensive program to prevent burnout or dropout.
Ultimately, this will help most members of your fire department maintain fitness levels, which will have an impact on reducing heart attacks and strokes and cultivate a
fitness culture. In order for the fire service to reduce line­of­duty deaths from heart attacks and strokes, we must constantly remind each other of the fitness principles,
learn new strategies to stay fresh and motivated, and reduce the stress on our bodies.
Most of the articles in this series will focus on exercise, but its important to remember that committing to a healthy lifestyle will reduce the physical and emotional stress on
our bodies and minds. Fm not saying that everyone in the fire service needs to buy some candles and practice yoga every day, but there are steps we can take to give us the
best chances of surviving and enjoying our retirement without the need to carry an oxygen tank with us.
It doesn’t matter how good your exercise program is or will be ­ if you’re not incorporating healthy nutritional practices into your daily routine, you’re wasting your time.
Here are some other strategies:
* Eat smaller, more frequent meals (four to six per day)
* Eat fruits and vegetables at every meal
* Reduce sugar, alcohol and caffeine
* Drink water throughout the day (until your urine is clear)
* Eat lean sources of protein such as chicken, fish, eggs and lean cuts of meat
* Stay away from fried foods
* Eliminate soda (diet soda is better than regular, but it has no nutritional value)
* Eat fresh foods free of pesticides and hormones (i.e., 100% organic food)
* Control your portions (dont leave the table feeling too full)
* Eat breakfast
* Replace nutrients after a workout or extremely physical job
Obviously, the schedule we follow doesn’t always allow us the privilege of eating healthy. If you miss a mealtime, do your best to eat as soon as you can and make the best
food choice for the situation.
There are many fitness programs being offered around the fire service. Some are good, some are OK and some not appropriate. Your fire department is made up of people
of many different body types and sizes. There are many different levels of conditioning and work capacity along with comfort levels. As we progress through this series, we
will share tips on how to transition from one stage of firefighter fitness to the next. The three stages of firefighter fitness to which we will refer will be line firefighter/fire
officer, shift officer/chief and administrator. The concept is to grasp the idea that we should maintain fitness levels throughout our careers as we transition through the
ranks.
In this series, well break the entire spectrum of firefighter fitness into three levels: awareness, operations and technician. At the awareness level, well refresh some
information that is good to keep in mind regarding heart attacks, injuries, medical issues, obstacles in developing programs and what each stage of fitness should focus on.
At the operations level, well talk about specific equipment, assessment tools, tips on setting up your fitness center and what type of equipment each level should use. Last,
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at the technician level, well talk about programs for each level, give you ideas about circuit training, specific exercises and assessment tests, and show you how to integrate
job performance with a fitness program. At the conclusion of the series, you will have refreshed some good information and learned some new tricks that you’ll be able to
employ in your fire department fitness program immediately.
AuthorAffiliation
RICH MEYER is the author of FAST Responders: The ULTIMATE Guide to Firefighter Conditioning and The Firefighter’s Wellness Handbook. He is a firefighter­EMT and tiazmat
technician with the Auburn, NH, Fire Department and owns FASTBODIES Fitness and Performance. Meyer is a Certified Strength and Conditioning Specialist (CSCS) and a
U.S.A. Weightlifting Sports Performance Coach. He can be reached at richmeyer@fastbodies.com. For a free training journal, visit his website at www.fastbodies.com.
Copyright Cygnus Business Media Apr 2008
Indexing (details)
Subject
Series & special reports;
Firefighters;
Physical fitness;
Occupational safety
Location
United States­­US
Classification
5340: Safety management
9190: United States
9550: Public sector
Title
Firefighter Fitness in 2008
Author
Meyer, Rich
Publication title
Firehouse
Volume
33
Issue
4
Pages
56,58
Number of pages
2
Publication year
2008
Publication date
Apr 2008
Section
FIREHOUSE® FIT ZONE
Publisher
Cygnus Business Media, Inc
Place of publication
Fort Atkinson
Country of publication
United States
Publication subject
Fire Prevention
ISSN
01454064
Source type
Magazines
Language of publication
English
Document type
Feature
ProQuest document ID
229605070
Document URL
http://search.proquest.com/docview/229605070?
accountid=10674
Copyright
Copyright Cygnus Business Media Apr 2008
Last updated
2012­09­27
Database
ABI/INFORM Complete
Bibliography
Citation style: APA6
Meyer, R. (2008, 04). Firefighter fitness in 2008. Firehouse, 33, 56­56,58. Retrieved from http://search.proquest.com/docview/229605070?accountid=10674
Copyright © 2015 ProQuest LLC. All rights reserved. Terms and Conditions
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