The obesity epidemic and future emergency responders.

Emergency responders should be fit to safely perform strenuous duties. In particular, young recruits are expected to be at or near peak career fitness. We studied the prevalence and health associations of excess weight among 370 consecutive emergency responder candidates for fire and ambulance services in Massachusetts. The mean age and BMI of the recruits were 26.3 (3.8) years and 28.5 (4.9) kg/m(2), respectively. Seventy-seven percent had BMI >or=25 kg/m(2), and 33% were obese (BMI >or=30 kg/m(2)). After multivariate adjustment, both higher BMI categories and unit increases in BMI were significantly associated with higher blood pressures, worse metabolic profiles, and lower exercise tolerance. Excess weight is highly prevalent and associated with elevated cardiovascular risk among future emergency responders. These findings in a population expected to perform demanding duties supporting public safety merit prompt public health intervention.

Predictors of on-duty coronary events in male firefighters in the United States.

Coronary heart disease (CHD) accounts for 39% of "on-duty" deaths in firefighters in the United States. No studies have examined the factors that distinguish fatal from nonfatal work-associated CHD events. Male firefighters experiencing on-duty CHD events were retrospectively investigated to identify cardiovascular risk factors predictive of case fatality; 87 fatalities (death within 24 hours of the event) were compared with 113 survivors who retired with disability pensions for heart disease after on-duty nonfatal events. Cardiovascular risk factors were then examined for associations with case fatality. Predictors of CHD death in multivariate analyses were a previous diagnosis of CHD (or peripheral/cerebrovascular disease) (odds ratio [OR] 4.09, 95% confidence intervals [CI] 1.58 to 10.58), current smoking (OR 3.68, 95% CI 1.61 to 8.45), and hypertension (OR 4.15, 95% CI 1.83 to 9.44). Age < or =45 years, diabetes mellitus, and serum cholesterol level were not significant predictors of case fatality. In conclusion, previous CHD, current smoking, and hypertension are strong predictors of fatality in male firefighters experiencing on-duty CHD events. Accordingly, prevention efforts should include early detection and control of hypertension, smoking cessation/prohibition, and the restriction of most firefighters with significant CHD from strenuous duties.