Risk Management

The Daily habits of people have a great deal more to do with what makes them sick and when they die than all the influences of medicine.
L.Breshlow, M.D.

The seven habits research has associated with health and longevity, include: regular exercise, adequate sleep, a good breakfast, regular meals, weight control, abstinence from smoking and drugs, and moderate use of alcohol.

In other words individuals are responsible for their health

Human Factors

The Wildland Firefighter Safety Awareness Study identified a number of strategies to address human factors, including: prevention of fatigue, accurate assessment of fatigue and health, recognition of differing capabilities of crews, and fostering physical fitness for the job. A 1999 General Accounting Office report on federal wildfire activities identified issues that could affect the agencies' ability to manage firefighting programs, including the shrinking wildfire workforce. And a Brookings Institute study has identified physical fitness reguirements as one of the most important issues in its study entitled, "Where Have All the Firefighters Gone?" In addition to a loss of expertise due to the retirement of an aging workforce, fire managers are faced with a precipitous decline in the fitness and health of the existing and prospective firefighters.

In recent years the United States has become the fattest nation in the world, with 55 percent of the adult population overweight or obese! Adult onset diabetes is appearing in teenagers. When doctors examined teenage hearts donated after accidental deaths, they found one in six already showed the blockages and plaque deposits of coronary artery disease. These alarming developments cannot be blamed on genetics. Studies of genetically similar Pima Indians living in Arizona and Mexico indicate a greater incidence of obesity and diabetes in Arizona. Obesity expert Claude Bouchard blames the epidemic of obesity on an increase in caloric intake and a decrease in caloric expenditure. In other words, Americans are eating too much and exercising too little. The excess calories are stored as fat.

Toxic Food?—Americans are eating more fast food and prepared foods, with high levels of fat and calories. Brownell has coined the term "Toxic Foods" to describe the effects of a steady diet of high-fat foods. Schools are leasing lunch programs to fast food outlets, or kids go to the mall for a burger, fries, and shake (1,500 calories and 50 grams of fat). With both parents working, more meals are eaten out or ordered in. The result is a steady diet of toxic food, high in fat and calories, and low in nutrients. In addition to the effects of overweight on everyday life, the excess fat inhibits the action of insulin and increases the risk of diabetes. The fat and excess calories raise the blood lipids (cholesterol and triglycerides), leading to an increased likelihood of heart disease. This epidemic of obesity and inactivity will result in staggering health care costs in the future. The immediate effects include a decline in fitness and work capacity.

Fit to Work?—Candidates for firefighting jobs reflect the national trend toward higher weight and lower fitness. Children, teens, and adults spend their hours sitting in school or at work, in front of computers, TV's, and video game displays. No national program is in place to reverse the alarming decline in physical activity. As a consequence, few workers are equipped with skills and experience in arduous work. Fewer still come to a job work hardened, or with effective work habits. Overweight and inactivity combine to reduce fitness and work capacity. Excess weight is a handicap that increases metabolic heat production and heat storage, making the job tougher and the worker more prone to heat disorders.

While lower levels of work capacity may be accommodated in jobs where mechanical assistance is possible, they pose a risk to the health and safety of wildland firefighters. Firefighters work in remote locations where accommodations cannot be used. They must wear protective clothing, and carry gear, water, and tools weighing over 30 pounds. They must negotiate difficult terrain, under extreme environmental conditions. And they are expected to perform useful work. When emergencies arise, firefighters must be able to take care of themselves and to help others if necessary. Those who lack the capacity risk their lives and the lives of those who stay behind to help (see the Ruby, Ledbetter, and Armstrong study on safety zone evacuation).

Participants at the Wildland Firefighter Health and Safety Conference (1999) made a number of recommendations to improve the health, safety, and productivity of the work force. They endorsed the use of the work capacity test (pack test) for firefighters, and recommended mandatory participation in fitness programs for seasonal and full-time employees engaged in wildland fire suppression. The pack test defines the minimal level of work capacity for wildland firefighting. Higher levels of work capacity are needed to sustain work output all day under difficult environmental conditions, to stand up under repeated days of arduous work, and to meet unforeseen emergencies. Fire managers have higher performance expectations for Type I crews. Yet current work capacity requirements do not differentiate between the capabilities of Type I and Type II crews. Participants at the Wildland Firefighter Health and Safety Conference recommended the review and possible improvement of crew standards.

Wildland firefighting is tough work, and it may be getting tougher. Proposed increases in the use of prescribed fire have the potential to extend the fire season to more than 6 months for some workers. To maintain the health and safety of the work force, fire managers need to resist efforts to lower work capacity standards. They should make the standards known to potential recruits and help them meet the standards. Field data and experience indicate that high standards attract fit, motivated workers to fire crews. Low standards damage morale, decrease productivity, and risk the health and safety of the work force.

Fitness and Injury

A study of 861 male and female U.S. Army trainees indicates that the fittest workers (measured by pushups, situps, and 1- and 2-mile runs) have the lowest injury rates. Women recruits experienced twice as many injuries as men, with 57 percent of the females experiencing one or more injuries compared to just 27 percent of men. The risk of serious injuries was almost 2.5 times higher for females than for males. The study's authors, Hemenway and others, indicated that the gender-injury relationship appears to be explained by physical fitness, especially aerobic fitness. The slowest runners experienced more sports injuries and the fastest runners experienced the fewest, regardless of gender. This study agrees with a 1999 study of Australian Army recruits by Pope and others that found a negative association between fitness and injuries. In another Australian study a modified physical training program reduced injury and medical discharge rates for male recruits, but not for females. The authors, Rudzki and Cunningham, recommended fitness standards for recruits entering the service.

Obesity and Asthma

As the prevalence rates of obesity and asthma increase, recent studies have detected a link between the conditions. Using data from the Nurses Health Study, a cohort of 85,911 female registered nurses, from 26 to 46 years old, researchers correlated asthma with obesity as indicated by the body mass index (BMI = weight in kilograms divided by the square of height in meters). The results showed a strong positive association between BMI and the risk of adult-onset asthma. Women who gained weight after age 18 were at significantly increased risk of developing asthma during the 4-year followup period.

Note: Obesity is defined as a BMI above 29. See BMI chart in Sharkey, B., Fitness and Work Capacity, NFES 1596, 1997.