Letters to the Editor  |   March 2009
Self-Reported Cardiac Risks and Interest in Risk Modification Among Volunteer Firefighters
Author Affiliations
  • James L. Fleming, DO, MPH
    Phoenix (Ariz) Fire Department Health Center
    Medical Director
Article Information
Cardiovascular Disorders / Professional Issues
Letters to the Editor   |   March 2009
Self-Reported Cardiac Risks and Interest in Risk Modification Among Volunteer Firefighters
The Journal of the American Osteopathic Association, March 2009, Vol. 109, 123. doi:
The Journal of the American Osteopathic Association, March 2009, Vol. 109, 123. doi:
To the Editor:  
I read with great interest the December 2008 special communication article regarding the evaluation of volunteer firefighters for cardiac risk by Patrick Scanlon, PA-C, DO, and Elizabeth Ablah, PhD, MPH.1 
As an osteopathic physician who provides care full time for firefighters, I am well aware of the health hazards that these individuals face on a daily basis. The survey results reported by Drs Scanlon and Ablah1 provide good insight into a population that represents more than 70% of the firefighting community—the volunteers.2 
I must point out, however, that the National Fire Protection Association (NFPA) 1582 standard3 that was referenced by Drs Scanlon and Ablah1 is quite dated. There have been three updates to this NFPA standard since the 1998 publication of that document. The most current standard, from 2007,4 provides clear healthcare guidance to fire departments, as well as to physicians involved in providing care for firefighters. 
According to the current NFPA standard,4 medical examinations are required annually for all fire department members—not on a graduated basis depending on age, as indicated in the article by Drs Scanlon and Ablah.1 In addition, these annual examinations are required to be at the expense of the employer. 
In addition, I would recommend that body mass index (BMI) be used with caution when evaluating the health and fitness of the firefighter population. We have found that BMI does not fairly measure our fire department members, mainly as a result of the consistently high muscle weight that these individuals often maintain in order to effectively perform the functions of their profession. We find that performing actual body fat measurement is more predictive of health risk in firefighters than is BMI. 
A strong support mechanism exists for fire department members to obtain information and assistance in health maintenance. The International Association of Fire Fighters and the International Association of Fire Chiefs have collaborated to develop a comprehensive Wellness-Fitness Initiative,5 which is available to all fire departments and department members. In addition, fire departments may also be able to obtain financial assistance from the Federal Emergency Management Agency in developing and managing their own wellness-fitness programs. 
Scanlon P, Ablah E. Self-reported cardiac risks and interest in risk modification among volunteer firefighters: a survey-based study. J Am Osteopath Assoc. 2008;108:694-698. Available at: Accessed March 3, 2009.
Fact sheet. National Volunteer Fire Council Web site. Available at: Accessed March 3, 2009.
Section 1582: Standard on comprehensive occupational medical program for fire departments. In: National Fire Protection Association. Fire Department Occupational and Health Safety Standards Handbook. Quincy, Mass: National Fire Protection Association;1998 .
National Fire Protection Association. NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments, 2007 Edition. Quincy, Mass: National Fire Protection Association;2006 .
International Association of Fire Fighters. The Fire Service Joint Labor Management Wellness-Fitness Initiative. 3rd ed. Washington, DC: International Association of Fire Fighters; 2008. Available at: Accessed January 13, 2009.