Exploring Physical Health in a Sample of Firefighters

Abstract

Firefighter job responsibilities involve strenuous physical activity and exposure to extremely stressful situations. The purpose of this research study was to describe the physical activity, stress, and culture promoting or inhibiting a healthy occupational environment. A descriptive qualitative study design was used with a convenience sample of firefighters from an urban Midwestern public fire service. Respondents participated in focus groups. Focus group data were audio recorded, transcribed verbatim, and analyzed using Colaizzi’s phenomenological method. Themes derived from the data were: Stressors affecting Physical Health, Barriers to Physical Health, Facilitators of Physical Health, and Motivators to Physical Health. Future research is needed to test interventions developed based on the study findings.

Introduction

Firefighters are among the first emergency responders to arrive to scenes of emergencies and natural or manmade disasters. Firefighters need to be physically fit and healthy so that they can perform their duties in the interest of the public good (Calavalle et al., 2013; Frattaroli, Pollack, Bailey, Schafer, Cheskin, & Holtgrave, 2013; Perroni, Cignitti, Cortis, & Capranica, 2014). Unfortunately, not all firefighters are in optimal physical health leaving them at risk for cardiac disease and injury (Jahnke, Poston, Jitnarin, & Haddock, 2012; Perroni et al., 2014). In order to apply a systems approach for the promotion of firefighters’ physical health, there is a need to understand the contributing factors. Therefore, the purpose of this study was to identify those factors deemed influential by firefighters to promote or hinder their physical health.

Physical health, physical activity, and physical fitness influence firefighters’ ability to perform their job tasks. Firefighters’ job tasks can be strenuous and include handling heavy equipment, moving on or within the fire truck, performing maintenance inspections, and extinguishing fires. The World Health Organization (2013) defines physical activity as “any bodily movement produced by skeletal muscles that require energy expenditure.” Being physically fit involves the combination of cardiovascular fitness, muscular strength, muscular endurance, flexibility, and body composition. When firefighters exceed their physical abilities, their bodies can experience short or long term physical stress. Short term physical stress responses include headaches, diarrhea, indigestion, upset stomach, and fatigue (Norwood & Rascati, 2012). Long term stress responses can lead to a lack of interest, sleep problems, clumsiness, change in performance, and isolation (Norwood & Rascati, 2012). Both short and long term physical stress are undesirable and need to be minimized or eliminated to help protect firefighters from illness and disease while maximizing their productivity.

Significance

Poor physical health in firefighters is a problem with the potential for significant negative outcomes for both firefighters and the public. While much is known about the incidence of disease and injuries in firefighters, minimal information is available to optimize the public health of firefighters during a period of economic downturn. Therefore, this study will contribute to the knowledge on this problem while providing implications for occupational and environmental health nurses.

Methodology

A descriptive qualitative design was used with a convenience sample of firefighters from an urban Midwestern fire department. Following Institutional Review Board approval, respondents were recruited on a volunteer basis from two firehouses. All respondents were adult, full time, active duty firefighter employees. Focus groups, two at each site, were conducted on different rotations to allow all firefighters the opportunity to participate. Each focus group was facilitated by the same researcher for consistency. Questions were asked using a focus group guide and probing questions. The focus group sessions were audio recorded and transcribed verbatim. The transcriptions were analyzed using Colaizzi’s procedural steps in phenomenological data analysis including line-by-line coding, clustering significant statements into themes, and returning to study participants for verification of the study findings (Beck, 2009). NVivo 9 (Burlington, MA) qualitative management software was used for data analysis.

Multiple steps were taken to increase the trustworthiness of the study findings based on recommendations by Lincoln and Guba (1985). For example, the data were independently analyzed by several investigators who then came to agreement on the coding schema. Following the individual analysis of each transcript, the investigators met and discussed the line-by-line coding based on the coding schema. A summary of the results were returned to the respondents for confirmation that the data were correctly interpreted. Respondents supported the findings and no changes were requested.

Results

Eighteen firefighters (16 males, 2 females) participated in the focus groups. No data were collected about age or race. Four themes emerged from the data: Stressors affecting Physical Health, Barriers to Physical Health, Facilitators of Physical Health, and Motivators to Physical Health. Each theme will be discussed in the following sections.

Stressors affecting Physical Health

Physical stressors are the physiological response from the body that leads to a positive or negative adaptation response. Several sources of stress ultimately impacting physical health were identified by study respondents: physical strain, physical exhaustion, and altered circadian cycle. Physical strain was caused by carrying and lifting equipment for long periods of time and regular strenuous training exercises. Physical exhaustion was caused by going “… from zero to 100 in a matter of seconds…” followed by extinguishing fires. An altered circadian cycle was reportedly the result of their 24 hours on and 48 hours off work schedule and the inability to get adequate rest and sleep between medical and fire runs. Several respondents made comments similar to the following comment: “I don't feel rested when I go home from the firehouse. I never get a good night's sleep at the firehouse.” (See Figure 1 for a typical firehouse sleeping station.) The inability to sleep during the night or nap during the day has been worsened by the rotating closure of firehouses known as “brownouts.” The brownouts were believed to be due to a worsening economy and subsequent decrease in the firefighter department budget. The brownouts left firefighters from each firehouse responding to a greater number of calls compared to previous years. In addition, several firefighters reporting leaving the firehouse and working for a second employer. For example, one male respondent said, “We – we're on 24 hours and off 48, so on our – like today – today I'm going to go – at 2:30 I'm driving a school bus for a field trip for a high school” after getting off work at 8:00 a.m.

Figure 1.

Shared space for firefighter sleeping quarters.

Barriers to Physical Health

A barrier to physical health included anything blocking or impeding the ability of firefighters to engage in physical health promoting activities. The predominant barrier identified by the respondents was not wanting to be in the middle of a workout or just finishing a workout and then being too tired to perform to their fullest potential on the call. One firefighter said:

“I don’t feel that we work out here for our health. I do it to – I do it today before I have to come in for my shift, because I don’t want to be here and I’m making myself more tired by working out and then doing the runs, so I’d rather do it on my off time before I come in, and then that way when I come in, I’ll take care of the tasks I have to take care of at work… . Because I don’t know what kind of runs we’re gonna have. You know, I might – if I was to go down on the treadmill and then we get a fire, and you know, I’m kind of fatigued because we’re running around doing this activity, this on the fire scene, it’s like, I get fatigued so I don’t want to do that while I’m here at work. I’d rather workout on my off day than to come in here.”

Another barrier was the inability to schedule workouts due to multiple job-related interruptions. Firefighters also identified poor communication systems in the workout room causing them to not hear a call, and the location of the workout room being too far away from the truck. One respondent responsible for driving the fire engine said, “… our stuff is in the basement. And I hate responding – I don't want to be the last [person] to the truck. That's my – it's my goal is never to be the last to the truck. And especially now that I'm driving…”

Facilitators of Physical Health

Facilitators of physical health are the resources enabling firefighters to engage in activities promoting their physical health. While previously addressed as a physical stressor, the respondents said that hands-on training was a major facilitator, because it helped them build endurance. Resources available such as a workout room (see Figure 2), dietician consultation for weight management, and physical fitness programs also were identified as facilitators. Several respondents made comments similar to these: “… over the years, guys have brought in, you know, an old bench or old weights. They upgraded their own home stuff, or, uh, an old treadmill. And we have it down in our – a room downstairs…” and “Most of the weight rooms in the firehouses are not bought by the City. They’re made and bought by the guys.” Aspects of the health programs including dietician consultants and physical fitness programs were originally part of a Peer Fitness program where a few firefighters were educated to “put a regimen together for you. But that grant funding dried up so that went away.”

Figure 2.

Exercise room in the basement of the firehouse.

Motivators to Physical Health

Motivators to physical health are anything serving as an intrinsic or extrinsic factor for maintaining or contributing to activities promoting physical health. The firefighters identified competition, workouts being a group activity, and wanting to perform better on the job as the leading motivators for their physical health. One of the respondents said:

“Again, it’s the competition thing. You know, we’re on engines so we always paint the truck. You know, stuff like that, to keep the… even the camaraderie going and keeping the guys going. Like I said, you don’t want to have everybody out back having fun doing something… one guy’s, you know, sitting inside. You don’t want to be the guy sitting inside lying on the couch doing nothing.”

Although not currently in practice, respondents believed that department-required health screening and financial incentives would be motivators for their physical health. One respondent emphasized his motivation through financial incentives:

“If the city said, you know, ‘Here's your – you have to have a physical every year, um, and you get – you get a bonus check. Or you get, you know, whatever. We'll pay for your – your food for a week if you – you know, whatever.’ You know, incentives like that, maybe guys would be more apt to – [Another participant: He’s coin operated.] – yeah, I'm coin operated.”

Discussion

The physical health of firefighters is as an essential component of firefighter function and as a problem needing improvement (Dobson et al., 2013; Jahnke et al., 2012). The firefighters in the current study openly expressed their concerns with their physical health. A leading factor causing the firefighters’ physical stress was being on duty for 24 hours and off duty for 48 hours and not being able to get adequate rest and sleep while at work. A similar finding was reported by Dobson et al. (2013) and Jahnke et al. (2012). As society evolves into a 24 hour society, it is not surprising that the number of firehouse calls overnight would increase. This change in societal norms coupled with the firehouse brownouts both likely contributed greatly to the lack of adequate rest in this sample of firefighters.

Rest also was influenced by the work load of firefighters during their 48 hours off duty period (Haddock, Poston, Jitnarin, & Jahnke, 2013). Firefighters holding a second job during their off duty period negate the rest that could have been had. In an effort to address the lack of rest taken by firefighters during their 48 hour off duty period, the fire chief in a different community implemented a 24 hour on and 72 hour off duty rotation (Turner, 2010). Measures of health outcomes were not assessed due to the community’s public forums about the need to close or privatize the fire department in this neighboring community as a result of their decreasing tax base and financial resources.

The adverse health effects associated with firefighters 24 hour/48 hour scheduling will likely continue due to the perceived benefits created by the long, rotating shifts. The benefits gained include cost efficiency for the firehouse, personal time off during the week, a work week that consists of 48 hours which is 8 hours above the normal 40 hour work week, and ability to maintain secondary employment during the off rotation period (Haddock et al., 2013). These benefits are appealing and allow firefighters flexibility with having different days off each week.

Dobson et al. (2013) identified that the intermittent, non-predictability of service calls was a considerable factor that prevented healthy behaviors in their sample of firefighters. The same interruptions prevented an exercise routine in the current study’s sample. The unpredictability in their work shift was the primary rationale offered by those choosing to not start an exercise regimen. Another explanation for not initiating exercise was the distance from the workout basement to the stairwell, and then across the station to the fire engine. While the distance traversed was not extensive (see Figure 3 for image of the distance from the stairwell to the fire engine), the increased time to hear the notification and ultimately be dressed and in the fire engine could prolong the departure by up to 60 seconds.

Figure 3.

Image of firehouse and fire engine taken from the corner stairwell.

Respondents depicted the facilitators of physical health as having access to exercise rooms, dietary consultants, and physical fitness programs. One particular program, the Peer Fitness program, was especially enjoyed by the firefighters. Unfortunately, the program ended when the funding supporting the program ran out. Programs that incorporate peers into their delivery may be especially advantageous. Mabry, Elliot, MacKinnon, Thoemmes, and Kuehl (2013) reported that their firefighter health program diffused from the study participants to their fellow firefighters in different firehouses over time.

The success of Mabry et al.’s (2013) program was identified as team support and competition; both being motivators identified by the current study respondents. Firefighters in the present study reported their fellow firefighters influencing their need to be physically active and healthy. Mabry et al. (2013) described that one physically healthy firefighter led to the diffusion of his or her colleagues also to become healthier. The same was true in the reverse with the single firefighter adopting the healthier lifestyle of his or her counterparts. However, it was not known how many and to what degree firefighters opted to be physically active versus resting on the couch when their partners were being physically active.

Competition was a characteristic that could be effective to motivate firefighters to be more physically healthy as noted by one of our respondents being “coin operated.” Competition was so successful with the firefighters in Mabry et al.’s (2013) study that their participants would compare their anthropometrics and actively coach an individual firefighter in their rotation and firehouse towards improved measures so that the team as a whole would outperform other firefighters in other firehouses or rotations.

This study was limited by the small, homogenous sample. Although the sample size was small, the findings were not intended to be generalizable. The authors believe that the findings may be transferable to other firefighter settings where the exemplars about physical health are similar.

Implications for Practice

The practice of occupational and environmental health nursing in a firehouse environment will be considerably different from other practice environments such as hospitals and manufacturing plants. Typically, employees will be encouraged to seek out opportunities to increase their physical activity such as using the stairs and taking a walk during their lunch break. As noted by the respondents in this study, exercise was seen as a barrier to performing the role of a firefighter due to the risk of fatigue. One strategy that may facilitate increased physical activity is exercising five minutes at the start of every hour while awake. Although the exercise may not maintain aerobic activity for a desirable time period or reach a moderate or vigorous intensity as recommended by the Physical Activity Guidelines Advisory Committee (2008), the accumulative exercise of 60 minutes or longer will be health promoting while not leading to a state of fatigue that would be harmful at a fire scene.

Competition and gaming may be additional strategies to incorporate into the daily practice of firefighters. For example, an interactive gaming system like Wii can be used to motivate firefighters to be off the couch and physically active while at work. In addition, firefighters can challenge one another to achieve higher scores within the gaming system. The occupational and environmental health nurse can further promote physical health in firefighters by assessing anthropometric measures, and then evaluating measurement changes over time comparing results by individual firefighters, engine companies, and/or firehouses. Small tokens can be distributed as prizes for individuals or teams with the greatest improvements in the measurements.

Finally, occupational and environmental health nurses can solicit health champions within each firehouse rotation. The champions within the firehouses can become drivers of health promoting behaviors (Kuehl, Mabry, Elliot, Kuehl, & Favorite, 2013; Frattaroli et al., 2013). Once in place, the nurse can provide regular education to the champions for each month’s health promotion focus. Examples of education are incorporating intentional physical activity into the daily work practices, how to track caloric burn based on physical activity, and the eight events necessary for firefighters to demonstrate their physical ability to work (see Table 1). The champions then would be charged with assuring the firefighters in their station are practicing health promoting behaviors and performing the eight tasks competently and safely.

Table 1.

Essential tasks to evaluate firefighter physical fitness while wearing a 50 pound weighted vest.

Tasks

Climb a flight of stairs while carrying 25 pounds weight in addition to the weighted vest. Place a ladder on the ground and extend it to a roof or upper story window. Drag an uncharged hose its full length. Remove equipment from fire engine and carry it to a simulated fire scene. Penetrate a lock door or breach a wall to forcibly enter a simulated fire scene. Crawl through a darkened room with non-sharp debris or other large objects to simulate a search for victims. Drag a simulated victim or firefighter from a building presumed to be on fire. Pull down a ceiling to check for a fire.

Adapted from International Association of Firefighters (2014).

Conclusion

Firefighters in good physical health are essential to public health. Multiple barriers exists preventing health promoting activities in this sample of firefighters. However, facilitators for health also exist. Occupational and environmental health nurses need to develop and implement interventions that minimize the identified barriers and strengthen facilitators such that the physical health of firefighters will be improved. Future research is needed to evaluate the efficacy of proposed interventions based on these study findings.