Cardiac Fatalities in Firefighters: An Analysis of the U.S. Fire Administration Database.
Level 4 - case-series / case-control
Retrospective database analysis of firefighter fatalities without a non-deceased control cohort
PubMed 25501775 · doi:10.1097/BCR.0000000000000225
What was done
The authors analyzed firefighter death records from the U.S. Fire Administration database from January 2002 to December 2012 (n = 1,153 fatalities). They examined associations between age, firefighter classification (volunteer vs. career), duty type, and causes of fatal cardiac events, using multivariable analysis adjusted for rank and classification.
What was found
Cardiac fatalities comprised 47% of all 1,153 deaths over the 10-year period. Firefighters with cardiac fatalities were significantly older than non-cardiac cases (mean age 52.0 ± 11.4 vs. 40.8 ± 14.7 years, P < .05). Volunteer firefighters accounted for 62% of cardiac fatalities compared to 32% in career firefighters (P < .05), and cardiac death was the leading cause of death among volunteers (54%, P < .05). On-scene deaths made up 29% of cardiac fatalities, followed by after-duty deaths at 25% (P < .05). Stress and overexertion were cited in 98% of cardiac fatalities. Independent predictors of cardiac death were age (OR 1.06, 95% CI 1.05–1.08) and stress or overexertion (OR 11.9, 95% CI 1.7–83.4).
Why it matters
Nearly half of on-duty firefighter deaths are cardiac-related, disproportionately affecting older and volunteer firefighters during or after stressful physical duty. These data highlight specific high-risk subgroups requiring targeted cardiovascular screening and prevention protocols.
Limits
The study is restricted to deceased firefighters from a surveillance database, lacking an active, non-deceased firefighter denominator to determine absolute incidence rates. Pre-existing medical conditions, cardiovascular history, and detailed autopsy findings were not captured. The effect estimate for stress and overexertion had an extremely wide confidence interval (95% CI 1.7–83.4).
Cited by
- supports The leading cause of death and disability among firefighters in the United States is cardiovascular disease and stroke, not firefighting fire.