Contributed by Nicholas E. Blonien, D.O.

What if you were told there is a drug that prevents cancer, cardiovascular disease, and mental illness? Not only is the drug free, but it also has zero negative side effects, is nearly impossible to overdose on and offers seemingly endless additional health benefits. Would you take it?

That “drug” exists, though not in pill form. Exercise is medicine, and the potent tool we have for fighting off chronic disease and improving overall wellness. Some is better than none, and more is generally better.

Consistent exercise decreases inflammation, improves immune function, inhibits abnormal cell growth, enhances clearance of dysfunctional cells and improves metabolic health. This has a favorable impact on warding off cancer and cardiovascular disease. Exercise can also be effective in helping prevent, manage and treat behavioral health conditions like anxiety and depression.

For firefighters, this is especially important. Firefighters are at increased risk for cardiovascular disease, some cancers and mental illness, given their routine exposure to hazardous environments, circadian rhythm disruption, sleep insufficiency and psychosocial trauma.

Low-intensity exercise

Even low-intensity exercise can be beneficial to the goal of improved wellness. Lower-intensity aerobic exercise improves mitochondrial function. Mitochondria are the power plants of cells, using fuel (carbohydrates, fat, etc.) and oxygen to generate energy. The healthier and more numerous your mitochondria, the more efficiently you can burn fuel (fat stores, dietary intake) and avoid the metabolic dysfunction that leads to diabetes, fatty liver and other chronic diseases.

This low-intensity exercise is commonly referred to as Zone 2 exercise. If you’re exercising at Zone 2 intensity, you can likely carry on a conversation without too much difficulty but will need to take a breath every sentence or so. Another method for guiding Zone 2 intensity is subtracting your age in years from 180. Your heart rate during Zone 2 exercise should hover slightly below this number. Experts recommend at least three hours of Zone 2 exercise weekly for optimal health, and at least 45 minutes per session, but any amount is better than none. Examples include a slow-pace jog, a leisurely bike ride or a brisk walk either uphill or while carrying some extra weight (rucking).

High-intensity exercise

Higher-intensity aerobic exercise offers similar benefits to lower-intensity exercise, but also induces cardiovascular adaptations that make your circulatory system more resistant to diseases like high blood pressure. It increases your exertional capacity and improves your ability to utilize oxygen for physical activity, something proven to have strong correlation with living healthier for longer (“health-span”). Recent research has suggested that high-intensity interval training (HIIT) might offer similar benefits to lower-intensity exercise, but require less time with less monotony.

Put them together

Endurance athletes often follow “polarized” training programs, where they spend about 80% of their exercise time performing lower intensity (Zone 2) exercise, and the other 20% focused on higher intensity exercise that approaches maximal aerobic output. Firefighters don’t need to train like world-class endurance athletes. The take-home point here is when it comes to aerobic exercise, firefighters should:

• Get a lot of it.
• Aim for getting a few hours of lower intensity exercise in per week.
• Toss in higher-intensity cardio 1-2 times per week.

Resistance training

But it’s not all about cardio. Resistance exercise builds strength and helps prevent injury – both of which are incredibly important for all firefighters, whether full-time, part-time or volunteer. Up-tempo full-body weight training several times per week may be a useful strategy for building both muscle and aerobic capacity simultaneously. Peripheral Heart Action (PHA) training is a style of exercise that has shown some promise here. The military has recommended PHA training for special operators and combat fighter pilots, but it could be useful for anyone looking to improve fitness. When it comes to resistance exercise:

• Aim to train muscle groups 2-3 times per week.
• Remember that in general, muscles need at least 48 hours to recover from resistance exercise.
• Up-tempo whole-body resistance exercise (like PHA training) may be an efficient way to get both strength and cardio benefits.

Mental health benefits

Consistent exercise, whether it’s low-intensity, high-intensity or resistance training, can also promote mental wellness. Some research has demonstrated exercise can be just as effective as medication in the management of anxiety and depression.

Exercise is medicine, and one of the six pillars of a healthy lifestyle according to the American College of Lifestyle Medicine. Move daily and often at low-moderate intensity, and with vigor a few times per week. In the fire service, this is perhaps the most powerful tool for preventing the chronic health conditions that burden this community.

Learn more about functional fitness for firefighters in MnFIRE’s fitness & nutrition training. Sign up your department for this free class here.

We’re thrilled to announce that former Minnesota State Auditor Rebecca Otto has joined MnFIRE as our first-ever Director of Business Affairs. Rebecca brings nearly four decades of public, private and nonprofit experience, deep financial expertise and strong relationships across the state to the MnFIRE team.

A well-known and well-respected leader, Rebecca served as Minnesota State Auditor from 2007 to 2019, where she led fiscal/legal compliance oversight of $50 billion in local government spending. Most recently, Rebecca served as executive director of the Ernest C. Oberholtzer Foundation, a conservation-minded nonprofit in Northern Minnesota. She also has experience as a state representative, teacher and small business owner.

“From Ada to Zumbrota, firefighters play an incredibly important role in every Minnesota community, and I am honored to be able to help MnFIRE strengthen its mission, build an even stronger and sustainable foundation and support these hometown heroes into the future,” Rebecca said.

“Rebecca has been a supporter of Minnesota’s fire service her entire career, and has built strong relationships with firefighters, legislators and community leaders all across the state,” said MnFIRE Board President George Esbensen. “As the health and wellness resources MnFIRE provides to firefighters and their families become more and more critical, Rebecca’s expertise and passion for the fire service will help our organization become even more effective and further elevate our important mission.”

You can reach her at rotto@mnfireinitiative.com. Please join us in welcoming Rebecca to the team!

Contributed by Nicholas E. Blonien, D.O.

Cancer remains a leading cause of firefighter mortality. Despite marvelous advances in diagnostic technologies and therapeutics, healthy lifestyle choices are still a powerful prevention strategy, especially for those in the higher-risk firefighting field.

Earlier in 2023, leaders in firefighter research published a review of current evidence supporting the effectiveness of lifestyle interventions in preventing cancer in the fire service. Here are the main lifestyle interventions they recommend:

1. Target obesity

Obesity increases risk of many cancers by as much as 30-80%, including some that already impact the fire service disproportionately. By decreasing body fat percentage, we can decrease risk of cancer. This starts with nutrition and exercise.

2. Get moving

With increasing rank within the fire department comes increased risk of sedentary behavior, especially when the job calls for more time at a desk behind a computer. By intentionally replacing inactivity with movement, such as “exercise snacks,” cancer risk can go down.

3. Prioritize sleep

Getting a good night’s sleep during a busy shift is impossible, but the negative health effects of this can be limited by optimizing sleep when it’s available, both at the fire station and at home. Establishing a bedtime routine, eating during times when your body is prepared for it, limiting nightly snacking and managing stress will make a huge difference.

4. Minimize alcohol

While there continues to be debate about the harmful effects of alcohol on the cardiovascular system, evidence for alcohol consumption as a risk factor for cancer development is much clearer. And rates of alcohol consumption and binge drinking are high among firefighters. Less is better, none is ideal.

5. Dial in the diet

Firefighters tend to follow a standard Western diet, consisting of processed foods and comfort food snacking. This type of eating has been clearly associated with increased cancer risk. Alternatively, a nutrition plan resembling the Mediterranean diet has been associated with decreased cancer risk. Sticking to mostly plants, healthy oils, nuts/seeds, fish and minimal meat/dairy is the best fuel plan for tactical athletes like firefighters.

A cultural shift is needed to tackle these issues, and a unified firehouse can be powerful. Talk with family and friends, engage leadership, partner with colleagues and ask healthcare providers questions. Little improvements can make a difference and add up to bigger change.

Protect your department from cancer

Learn more about shifting the culture in MnFIRE’s cancer deep-dive training. In this class, firefighters learn the activities that put them at higher risk for developing cancer, proper PPE strategies for mitigating cancer risks and what types of screenings can be done to catch cancer early. Sign up your department for a FREE training here.

Our trained Peer Support network is made up of firefighters and firefighter family members of all ranks and backgrounds from across the state, and they’re a crucial lifeline to Minnesota’s 20,000 firefighters and their families – from coping with difficult calls to talking through life problems like divorce or a death in the family.

Jen Elleraas, captain and training officer for Garrison Fire & Rescue, is one of those dedicated MnFIRE peer supporters. Here’s our recent interview with Jen where we learned more about the process of getting connected with a peer supporter:

Tell us a little about yourself, your history with the fire service and who you are outside of your role as a firefighter.

I have been a firefighter with Garrison Fire & Rescue since 2019. It’s a rural, paid on-call fire department in Central Minnesota. I also serve as an EMT on the department and casually for an ambulance service. Serving my community as a first responder is one of my greatest honors and has quickly grown into one of my strongest passions. My full-time career has been working in the human services industry for over 20 years. In my free time, I love lake life and spending time with my family and friends.

Why did you become a MnFIRE peer supporter?

Firefighters are servant leaders in their communities answering the call to help others on their worst day. I’m humbled by the honor and privilege to be here to answer the call from a fellow firefighter. Being a peer supporter creates an instant connection because we speak the same language, experience similar things and can relate on the same level. Trauma and grief need a witness and I’m honored to walk beside a fellow firefighter who is bravely traveling on their journey.

What is the most rewarding part of being a peer supporter?

It’s rewarding to support a fellow firefighter and I’ve learned so much from the amazing humans I’ve had the privilege to meet. I am always in awe of the resilience, courage, compassion and commitment of firefighters, who answer the call and put their life on the line before others. It is true bravery when a firefighter answers their own call and reaches out to invest in their emotional well-being.

What is the most surprising part of being a peer supporter?

It’s surprising how much the timeline of connection can vary when supporting my fellow firefighters. Sometimes we connect for a few weeks to talk through a specific incident, and another time I supported a peer for over a year. It is a person-centered approach to benefit the specific needs of that firefighter. There is no timeline or specific commitment. If I am not the right peer match for a firefighter, the firefighter can switch – no questions asked. If a firefighter needs a higher level of care, MnFIRE offers professional counseling sessions at no cost. This program is truly focused on the firefighter to protect and prioritize their emotional health in alignment with MnFIRE’s mission.

What do you see as the most valuable component of the MnFIRE Hometown Heroes Assistance Program?

The program provides vital resources to firefighters in the research-driven areas we need most including cardiac, cancer and emotional health. It provides resources to help fill the gaps for firefighters who experience one of these industry-proven hazards. The Peer Support program is unique, pairing Minnesota firefighters with someone who shares similar experiences, creating an instant connection and trust to be able to open up on the tough stuff we face on and off the fireground.

What two suggestions would you share with every Minnesota firefighter to improve their mental health?

1.) Health is all tied together. Firefighters are often sleep-deprived, trying to grab meals on the go while we balance our family, jobs and relationships. We have to be intentional about our health. Exercise, healthy foods, hydration, laughter and sleep all play a critical role in our emotional well-being. 2.) If you see a fellow firefighter struggling, have the courage to have a conversation. The MnFIRE call line is a quick, easy way to connect someone with resources. The hardest part is making that initial call, so let’s encourage each other to make it. I promise it gets easier from there. We should be spreading the word of MnFIRE like wildfire. It is free, confidential and safe for any firefighter in Minnesota. No one fights fire alone.

See more stories like this in our 2024 Taking the Lead impact report.

Help is just a call away

MnFIRE Peer Support is a safe, confidential space to talk about what you’re going through with someone who gets it. Get connected with a peer supporter by calling our 24-hour helpline at 888-784-6634.

In tandem with our medical experts, dedicated MnFIRE training instructors like Andy Willenbring deliver crucial education about cancer, cardiac, emotional wellness, fitness, nutrition, sleep and more to fire departments across the state – and we couldn’t do it without them.

Andy has been in the fire service for 23 years, a goal of his since he grew up watching his father as a firefighter in White Bear Lake for 30 years. He started as a paid-on-call firefighter and Captain at Maple Grove, and more recently retired as a Lieutenant from the St. Louis Park Fire Department in October 2023. Andy has been a MnFIRE training instructor for four years now and during that time he’s taught nearly sixty trainings to fellow firefighters. We sat down with him to see what inspires him to do this work and how he empowers others to focus more on their well-being and open up about struggles within the fire service.

Why did you want to get involved with MnFIRE and become a training instructor?

I love training and talking to firefighters. It’s one of the best things about being a firefighter. And I got involved with MnFIRE because their Peer Support team got me through some pretty rough, emotionally traumatic times in my life. I thought it would be a great way to give back and tell my story so that no one else has to go through what I went through.

How are the training lessons benefitting Minnesota firefighters? What impact are they having?

I think a lot of people roll their eyes when they hear about a training presentation, but making it interesting – adding my own stories, experience and knowledge – makes it more fun for people to learn and be there. When I talk about my struggles with emotional trauma, it adds a real face to a real problem that many are struggling with and are afraid to talk about. When someone is standing in front of a class talking about their thoughts, nightmares, struggles and legitimately crying, it adds a realness to the training that hopefully makes a difference in someone’s life.

Why is it important for departments to participate in MnFIRE training?

[Cardiac disease, cancer and emotional trauma] are real problems in the fire service. Real problems that can be addressed with some simple changes in the way we live our lives and the way departments operate. I think it’s important for departments to all learn the same things to improve firefighters’ quality of life. No matter the size, location or function, all firefighters in Minnesota are in this together. No matter how different each department is, we all should have the same goal: the health and wellness of all firefighters.

Has there been anything surprising that you’ve learned during your time as a MnFIRE trainer?

I’ve had several firefighters reach out to me from all across the state after a training session and tell me that they have been having emotional trauma problems, and after listening to my presentation, they decided now is time to get help. It’s very surprising how widespread the need for help across the state is. We are so fortunate in Minnesota to have the Hometown Heroes Assistance Program. It’s a one-of-a-kind program.

Is there anything else you want to tell firefighters about this training?

MnFIRE training is more important than you think it is. It’s important for firefighters to learn about how to better help themselves and help each other. But it’s even more important to share this information with your family and friends. Talk openly and be honest about what it means to be a firefighter, and how others can help you be a better person and live a long happy life.

Remember, it’s OK to not be OK. We all want to go home at the end of a shift or call, and these trainings will help you and your fellow firefighters do that.

Get trained for free

The Hometown Heroes Assistance Program supports annual MnFIRE training for all Minnesota firefighters, at no cost to departments. If your department has already completed our general awareness training about firefighter occupational health risks, there are several new deep-dive trainings now available. Click here to learn more and register for a training.

If you’re interested in becoming a MnFIRE training instructor like Andy, please reach out to Director of Program Delivery DeeDee Jankovich. We’re especially looking for new trainers in greater Minnesota.

Contributed by Paul J. Anderson II, M.D.

As a firefighter, anything can happen on a shift or a call. That’s why firefighters are trained to always be sharp and ready. But the beverages you consume when you aren’t on duty could impair your performance when the call comes in. Caffeine and alcohol can both have harmful effects on firefighters if not used in moderation, so it may be wise to “rethink your drink.”

Use caffeine to your advantage

We often associate caffeine with its ability to reduce sleepiness or daytime drowsiness. In reality, there are several benefits when used wisely, including improved reaction time and physical endurance. But a little can go a long way. An 8-ounce cup of brewed coffee has about 90 milligrams of caffeine and the recommended maximum daily dose is around 400 milligrams. And the effect can take time to wear off. In fact, it takes about 10 hours for caffeine to completely leave your system once consumed.

For people with normal sleep and wake cycles, caffeine use is best limited to 100 to 200 milligrams per day and restricted to the morning hours. Firefighters, who typically have irregular sleep patterns and/or sleep deprivation, may need to think differently about caffeine and reserve caffeinated beverages for when it’s most beneficial. This means consuming relatively little caffeine (or none) most of the time and then increasing caffeine consumption during periods of high need, like a busy night shift, working tired or working overtime. Rethinking caffeine may mean that using less helps you benefit more.

Enjoy alcohol in moderation

It goes without saying that heavily drinking or binge drinking alcohol is not compatible with being ready for firefighting duty. Even moderate alcohol consumption can erode sleep quality, delay reaction times and could progress to alcohol dependence over time. So as a firefighter, you may want to rethink your relationship with alcohol.

Alcohol slows down your nervous system and gives you a temporary sensation of relaxation when consumed in moderate amounts. While alcohol has long been integrated into social interactions and celebrations around the world, it can be problematic when abused. Firefighters know the realities of this, having answered calls for preventable fires where alcohol was involved, auto accidents due to drunk driving, alcohol-related domestic problems and alcohol-induced health issues.

According to the Fire Service Joint Labor Management Wellness-Fitness Initiative, alcohol is the most commonly abused substance among firefighters, and it’s unfortunately common among firefighters to help deal with the emotional trauma experienced on the job. The numbing effects of alcohol consumption are only temporary, however. Once a person is sober, any mental health issues or memories of traumatic calls are still there. These problems may even feel worse after being temporarily alleviated, which helps fuel the cycle of substance abuse.

Heavy drinking is defined as more than two standard drinks per day for men, or more than one standard drink per day for women. A standard drink is defined as a shot of liquor (1.5 ounces), a 12-ounce beer (4% ABV), or a 5-ounce glass of wine. Binge drinking (more than six drinks in a short period) is another harmful pattern of drinking to avoid.

The good news is that going alcohol-free for a period or cutting down on alcohol has never been easier. Dry months are common practice, and there has been an explosion of alcohol-free beers, wines and spirits that can make cutting back on alcohol or stopping drinking altogether much easier. Cutting back on alcohol with a group of people as a challenge can be a fun and effective challenge for team building.

While it goes without saying that no firefighter should use illegal substances, it may be beneficial to analyze your use of these more common substances. Any efforts that improve your ability to be safe and live well as a firefighter are worth the time.

Need help? MnFIRE’s got your back

If you or a firefighter loved one need help with alcohol or substance abuse, please call our 24-hour helpline at 888-784-6634. Free counseling visits, peer support and other resources are available through the MnFIRE Assistance Program. This confidential, free service is available for all active volunteer, paid-on-call, part-time and full-time Minnesota firefighters and their families, and for all levels of support.

“We had an incident where a person lost their life in a grain bin. We all knew this farmer who lost his life. Once we left the scene, I knew it had touched all of us,” explained Chief Jeff Leuer of the West Suburban Fire District, a paid on-call department of 50 firefighters covering 50 square miles including stations in Loretto and Hamel.

“When I left the scene and was driving back to the station, I called MnFIRE and I said, ‘We just had this incident. I am concerned that I am going to have some people who are going to have to deal with this. What do I do? How do I direct them?’”

Fortunately, Jeff knew that confidential help was available 24/7 for any firefighter and their family through the MnFIRE Assistance Program, which targets emotional health and stress unique to the fire service through connection to mental health counseling and peer support.

The trained MnFIRE Peer Support specialist who answered Jeff’s call reassured him: We can help. Point them our way. What Jeff didn’t realize was that it wasn’t just his firefighters who stood to benefit from the program.

“That peer supporter from MnFIRE, they said, ‘How are you doing?’ They stopped me in my tracks,” said Jeff.

That simple question helped Jeff realize his bucket of stress and trauma was practically overflowing. After being in the fire service for 25 years, he could barely take it anymore. With the peer supporter’s reassurance and the offer to talk again, they hung up.

Jeff talked about the conversation with his wife and thought maybe that was it. But the next morning, he got a call from that same peer supporter, saying, “Good morning, Jeff. How are you doing today? It’s a new day. The sun is shining.”

From that day forward for about a month straight, the peer supporter would call or text him.

“While I didn’t go get formal, professional help, that person helped bring me from the really tough place I was at,” said Jeff. “‘We’ve got to get some of this stuff out of your bucket,’ they would say. I still get emotional.”

“MnFIRE, and the peer support, it means so much to me.”

And those firefighters Jeff referred to MnFIRE? Two of them told him how glad they were that someone reached out, that they had an excellent experience. Jeff said, “Even if they don’t get formal help, they are guided in the right direction.”

This incident wasn’t the first time Jeff or his team needed some help from MnFIRE, and it won’t be the last. Two of his firefighters recently experienced cardiac events and sought help from the Critical Illness benefit. And others sought out MnFIRE Peer Support when a fellow firefighter died unexpectedly in 2021.

Jeff’s department takes mental health very seriously. And talking about it, he believes, makes it easier for people to reach out when they need it.

“I have had struggles. Still today, if something comes up, I’m not afraid to give a call and talk to someone,” Jeff said. “By firefighters hearing the chiefs say, ‘I had a problem. I needed help. I reached out and it helped.’ It makes it okay for them to give a call. It’s for firefighters, and it’s for chiefs, too.”

Confidential help is available over the phone or online, anytime for any Minnesota firefighter and their family through the MnFIRE Assistance Program. For more details or for help, call 888-784-6634 or click here.

Contributed by MnFIRE Mental Health Director Melinda Coscarelli, PhD, LPCC, LADC

As firefighters, you’re taught to always be prepared. Your department spends hours practicing and preparing for that moment when someone calls for help. But how do you answer the call from one of your own?

Mental health problems can come in all sizes, from a firefighter facing burnout to one who is having suicidal thoughts. With the mental demands and emotional toll of firefighting, fire service leaders must be prepared to offer support to their fellow firefighters when needed. After all, firefighters with more supportive cultures and departmental resources perceive their work environment as less stressful, which can lessen manifestations of mental health problems such as anxiety, substance abuse, insomnia and depression.

Here are a few things you can do to be better prepared.

Get trained

Fire service leaders should receive training on how to talk to their crew about mental health concerns. These situations are delicate and at times need to be handled differently than your typical calls. MnFIRE provides access to suicide prevention classes and emotional wellness deep-dive trainings. Because with proper education, you can identify the warning signs for emotional trauma and feel more comfortable having these conversations with your firefighters.

Build awareness and support

Making small changes now can help build a stronger foundation to stand on later. Put up posters around your department with messages and tips for managing different symptoms such as sleep deprivation or moodiness. Posters can be placed in prominent areas like the kitchen, or more discrete locations such as the restrooms. MnFIRE also offers educational materials on resources to help, which show MnFIRE’s free helpline for getting support 24/7.

While a few posters or brochures won’t change the fire service culture, having them visible and accessible can be helpful to someone suffering in silence and start building awareness for the support that’s always available to them.

Be proactive

Several departments have started doing regular check-ins with their crews. A good time for doing this is at roll call or shift changes. It can be as simple as asking your crew to rate their current mental status on a scale of one to 10, with 10 being mentally maxed out. If one of your firefighters is at a seven or higher, pull them aside and ask them what you can do to support them. A simple check-in adds accountability and shows the crew that you genuinely care.

It’s also helpful to develop a safety plan for your department so you know what process to follow to de-escalate any type of crisis situation.

Stay calm

If a mental health emergency does arise, stay calm. Ask the firefighter what you can do to support them through their difficult situation. Steer clear of offering advice, but rather listen and empathize.

Be attentive

Taking a class like MnFIRE’s emotional wellness training or the suicide prevention skills training we put on for our peer supporters can be very beneficial to learning warning signs for someone in distress. Non-verbal and verbal language both give clues about when a firefighter’s mental health may be starting to decline, or they may even become suicidal. It is best to recognize these signs before they escalate into a dangerous situation.

Call MnFIRE

If you don’t feel prepared, know that we are. The MnFIRE toll free number is staffed by masters-level clinicians all day, every day. From one-on-one calls to department debriefs, during the middle of a crisis or after a tough call, we are here for you. Don’t hesitate to use this free, confidential resource available to all full-time, part-time, on-call and volunteer firefighters in Minnesota. Just call 888-784-6634.

To Our Minnesota Fire Service Sisters and Brothers:

Everyone at MnFIRE joins the entire state as we mourn the loss of Burnsville firefighter/paramedic Adam Finseth and police officers Paul Elmstrand and Matthew Ruge in yesterday’s tragedy. During this difficult time, please remember that the full resources of the MnFIRE Assistance Program are available to all Minnesota firefighters and their families.

Confidential help – including connection to no-cost mental health care and peer support – is available anytime for any Minnesota firefighter and/or their family. Phone lines are answered 24/7 by Master’s-level trained mental health professionals who provide confidential support, guidance and mental health resources.

For immediate, 24/7 support call 888-784-6634.

Any member of a firefighter’s household can use these important Hometown Heroes Assistance Program (HHAP) resources. Each firefighter and/or their family members can access up to five counseling visits a year (additional support is available as needed). Firefighters are also matched with a member of MnFIRE’s team of trained peer supporters who know firsthand the difficulties firefighters face and are well-equipped to walk alongside a firefighter in need as they navigate their situation.

If you’d like to talk, we’re here.

For more information or for help, call 888-784-6634 or visit liveandworkwell.com, access code: MnFIRE.

Contributed by Nicholas E. Blonien, D.O.

February is American Hearth Month – a time when people are encouraged to focus on their cardiovascular health.

While we can celebrate continued advancements in cardiovascular disease (CVD) care and research, this largely preventable disease remains the leading cause of on-duty deaths in the fire service. A recent national study showed that in 2022, 49 of the 96 on-duty fatalities among U.S. firefighters were due to overexertion. Of these, 73% were confirmed due to heart attack or stroke.

What is CVD?

CVD is a disorder of the body’s circulatory system, which includes the heart and blood vessels. CVD encompasses numerous conditions, many of which are related to atherosclerosis. Atherosclerosis is characterized by abnormally stiff and plaque-burdened blood vessels. Primary factors contributing to the development of atherosclerosis and CVD include smoking, high blood pressure, high cholesterol, metabolic disease and physical inactivity.

These conditions ultimately create an environment of increased stress and inflammation within the blood vessels, leading to vessel wall injury, plaque accumulation and increased risk of blockage or rupture. This blockage and narrowing of blood vessels supplying the heart is called coronary artery disease (CAD). When blockage becomes complete, the heart muscle blood supply is cut off, resulting in a heart attack.

CVD and Firefighters

Firefighters are at increased risk for CVD. Routine sleep interruption, suboptimal nutrition, physical inactivity, hazardous exposures and psychosocial stress all lead to chronic physiologic disruption that sets the stage for the development of CVD. Then, when stressed acutely during calls that require intense physical exertion and trigger sympathetic nervous system activation – the fight-or-flight response – the cardiovascular system is pushed to the limit. If baseline CVD is present, there is an increased risk of a sudden cardiac event.

Contributing Factors

Sleep: Over 50% of firefighters report poor sleep quality, and firefighters screening positive for a sleep disorder may have significantly higher odds of developing CVD.

Nutrition: The standard American diet, which includes foods high in calories, saturated fats, sugar and sodium, is common among U.S. firefighters. The eating pattern has been clearly correlated to higher levels of inflammation and higher cholesterol, both risk factors for CVD. Recent research has indicated that firefighters who instead adhered to the Mediterranean diet – high in fruits, vegetables, whole grains, nuts, seeds and beans – had more favorable cholesterol profiles.

Exercise: A large percentage of firefighters do not meet the American Heart Association’s recommendations for weekly exercise. Lower levels of cardiorespiratory fitness due to insufficient exercise is strongly correlated with increased CVD risk. A 2023 research review confirmed this correlation in firefighters.

Stress: High psychosocial stress has been correlated with CVD, and firefighters experience a lot of it with dangerous situations, pressure to perform and exposure to traumatic experiences.

Other factors: Environmental exposure to hazardous chemicals and particulate matter can increase risk for adverse cardiac events. Recreational exposure to smoking and alcohol also increases CVD risk.

Making Change

We know that 80 to 90% of CVD is preventable. With change at both the organizational and individual level, we can reduce risk of CVD for all firefighters whether they are full-time, part-time or volunteer.

Fire service leaders can promote departmental adherence to NFPA 1582 and 1583, ensuring that minimum fitness standards are maintained and routine assessment of individual CVD risk in firefighters is performed. Increased funding may allow for improved manpower, salary increases (if applicable), heightened health surveillance and more health-protective equipment and facilities.

Each of these changes could have a significant impact on CVD risk in the fire service.

Independent of funding, firehouse leaders can promote a culture that values advancing health and wellness, as cultural shift is a necessary component of achieving lasting health behavior change. Looking for a great place to start? Register your department for a cardiac deep-dive training through MnFIRE this month. Departments with supportive cultures and education/coaching programs have been most successful with reducing CVD risk.

Firefighters may also target key pillars of Lifestyle Medicine to guide their individual approach to CVD risk reduction. This may include partnering with fellow firefighters to adopt more sleep-protective behaviors in the firehouse and at home, adhering to a whole food, plant-predominant diet, engaging in the recommended amount of aerobic exercise weekly, eliminating tobacco use and minimizing alcohol consumption, and openly discussing stressors of the job to support one another and connect.

Firefighters have a unique bond that can be incredibly supportive of health behavioral improvement. With lifestyle modification, cultural change and organizational level support, fire departments can reduce CVD risk and save firefighters from early cardiovascular death.