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Doctors worry about health of existing force

By Kay Lazar
Globe Staff / June 10, 2010

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The requirement that newly hired Boston firefighters undergo a physical and pass a fitness test every year is a good first step, say doctors who study firefighters’ health, but the agreement misses those most at risk for injury or death on the job — the veteran members of the force.

Up to 40 percent of firefighters in Massachusetts and nationwide are overweight, and as a result, they have a much higher risk of suffering a heart attack on the job than the general population, according to data compiled by Harvard researchers. Yet many fire departments do not require annual physicals or fitness tests beyond the ones required when a new recruit is hired.

“This [new contract] is missing a lot of people who are at high risk now, but at least it’s going to correct that in the future with new hires,’’ said Dr. Stefanos Kales, an associate professor at the Harvard School of Public Health.

“It was a huge concession to get this going forward,’’ he said. “They are ahead of most cities and towns in Massachusetts.’’

Kales was senior author of a study published last year that found that roughly 77 percent of recruits for firefighting and emergency medical technician jobs in Massachusetts were overweight or obese. The study, which focused on recruits most likely to be hired, also found that 7 percent of the overweight and 42 percent of the obese recruits failed to meet the minimum level in exercise tests recommended by the National Fire Protection Association, a nonprofit that sets standards for the industry.

Firefighting exerts phenomenal physical pressures on the body, from the 50-pound gear the firefighters shoulder to the intense fluid loss often experienced while battling flames under stressful conditions, Kales said. Excess weight makes firefighters less able to withstand the stress.

“Fitness levels generally decline as one gets older, but it can be accelerated by excess weight,’’ Kales said. “The heavier firefighters tend to have their fitness levels drop off more quickly as they age.’’

Dr. Michael Hamrock, a former Boston firefighter who now oversees medical issues for the Boston Fire Department, said he lobbied for a contract that would have required all firefighters to undergo annual physicals and fitness tests. He also favored requiring that each firefighter work out at least 45 minutes during every shift in a program that includes job simulation-type activities that emphasize core muscles, endurance, and aerobic activity.

“Boston firefighters have two to three times the rate of heart disease and cancer compared to other Boston residents,’’ said Hamrock, who believes a mandatory wellness program could help to lower those rates. That program was not included in the firefighters’ new contract.

The contract will award a 1.5 percent annual increase in the base pay of firefighters hired after June 30 who undergo an annual physical, which includes a stress test to measure the person’s heart function while walking on a treadmill, and who pass an annual fitness test. The fitness test, designed by the state, demands that the firefighters crawl under a 3-foot-high ceiling while dragging a 180-pound mannequin.

Firefighters already on the job will get the pay raise without undergoing these tests — a concession the city isn’t crazy about, but a top official said was necessary to resolve the thorny contract negotiations. The veterans will, however, have to undergo drug and alcohol testing to get their raises.

“We’ve done things, and will continue to do things, to encourage all firefighters to participate in onsite health screenings, and various blood pressure clinics,’’ said John Dunlap, director of labor relations for the city of Boston.

“Only 30 percent of firefighters go to see their primary care physician for an annual physical,’’ Dunlap said. “When we looked at that, compared to the rest of our workforce, it’s disproportionately lower because it’s a disproportionately male workforce, and males are not good at getting physicals.’’

Studies have not yet been done to pinpoint how fit a firefighter needs to be to lower his or her risk of injury or death, and whether annual physicals and fitness tests make a difference.

Kales recently received two federal grants to track thousands of firefighters in hopes of answering those questions. He will be conducting two parallel studies.

One will follow 1,000 firefighters from Kansas, Missouri, and Ohio for at least three years and record detailed information about what they eat and how much they exercise. It will measure their health through a battery of medical tests.

The other study will review the records of 4,500 firefighters in Indiana, Virginia, and Arizona who underwent annual physicals and stress tests as part of their departments’ requirements, and will correlate that with their rates of injury and deaths.

“The hypothesis is, the more fit they are, the lower risk they have of injury, illness, or disability retirement, particularly from heart problems,’’ Kales said. “The basic goal is to establish what would be the recommended fitness level that should be required.’’

Kay Lazar can be reached at klazar@globe.com.

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