Firefighting is dangerous work. Each year, approximately 80,000 firefighters are injured and about 100 firefighters lose their lives in the line of duty. Firefighters face multiple dangers in the course of their work; they encounter toxic fumes, dangerous products of combustion, high radiant heat loads, and a chaotic work environment. Despite the myriad dangers, the leading cause of line-of-duty death among firefighters is sudden cardiac event, accounting for approximately 45% of duty deaths. Firefighting requires high levels of aerobic fitness, anaerobic capacity, and muscular strength and endurance; however, data suggest that many firefighters do not possess high aerobic or anaerobic capacity. Furthermore, many firefighters are overweight and have one or more modifiable risk factors for cardiovascular disease. The safety of the public and the health and safety of firefighters would be enhanced if firefighters followed well-designed fitness programs to improve overall health and fitness.

Firefighting is a hazardous profession which has claimed on average the lives of 105 US firefighters per year for the past decade. The leading cause of line-of-duty mortality is sudden cardiac death, which accounts for approximately 45% of all firefighter duty-related fatalities. Strenuous physical activity, emotional stress, and environmental pollutants all strain the cardiovascular system, and each can increase the risk of sudden cardiac events in susceptible individuals. Sudden cardiac death is more likely to occur during or shortly after emergency duties such as fire suppression, despite the fact that these duties comprise a relatively small proportion of firefighters' annual duties. Additionally, cardiac events are more likely to occur in firefighters who possess an excess of traditional risk factors for cardiovascular disease along with underlying atherosclerosis and/or structural heart disease. In this review, we propose a theoretical model for the interaction between underlying cardiovascular disease in firefighters and the multifactorial physiological strain of firefighting.

This study investigated the effects of strenuous live-fire firefighting drills and a 90 min recovery period on selected hormonal, immunological and psychological variables. Apparently healthy, male, professional firefighters (n = 11) performed three trials of standardized firefighting tasks in a live-fire training structure. There was significant leukocytosis immediately post firefighting activity that persisted following recovery, although there was a variable response among the leukocyte subsets. Most notable was the decrease in number and percentage of lymphocytes following 90 min of recovery. Plasma levels of ACTH and cortisol were significantly elevated post firefighting activity and cortisol remained elevated following 90 min of recovery. Elevated cortisol immediately following activity was related to reduced feelings of energy. These data demonstrate the magnitude of the physiological and psychological disruption following strenuous firefighting activity and suggest that immune function may be altered following such activity. This is a finding that may have practical consequences for this group of first responders.

Cardiovascular disease (CVD) continues as the most important cause of mortality. Better risk screening and prediction are needed to reduce the cardiovascular disease burden. The aim of the study was to assess the role of serum biomarkers in the prediction of CVD among asymptomatic middle-aged adults with no prior CVD history. A systematic review and meta-analysis were carried out using literature from PubMed and following PRISMA reporting guidelines. Twenty-five studies met our inclusion criteria and were included in the systematic review. The most commonly studied biomarker was high-sensitivity C reactive protein (hs-CRP) (10 studies), which showed that higher hs-CRP levels are associated with an increased risk of subsequent CVD events and mortality. In addition, several less-studied biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), fibrinogen, gamma-glutamyl transferase (GGT), and others) also showed significant associations with greater future risk of CVD. A meta-analysis was possible to perform for hs-CRP and NT-proBNP, which showed statistically significant results for the ability of hs-CRP (hazard ratio (HR) 1.19, (95% CI: 1.09–1.30), p < 0.05) and NT-proBNP (HR 1.22, (1.13–1.32), p < 0.05) to predict incident CVD among middle-aged adults without a prior CVD history or symptoms. Several serum biomarkers, particularly hs-CRP and NT-proBNP, have the potential to improve primary CVD risk prevention among asymptomatic middle-aged adults.