Strategies for Improving Firefighter Health On-Shift: A Review

Abstract

The fire service suffers from high rates of cardiovascular disease and poor overall health, and firefighters often suffer fatal and non-fatal injuries while on the job. Most fatal injuries result from sudden cardiac death, while non-fatal injuries are to the musculoskeletal system. Previous works suggest a mechanistic link between several health and performance variables and injury risk. In addition, studies have suggested physical activity and nutrition can improve overall health and occupational performance. This review offers practical applications for exercise via feasible training modalities as well as nutritional recommendations that can positively impact performance on the job. Time-efficient training modalities like high-intensity interval training and feasible modalities such as resistance training offer numerous benefits for firefighters. Also, modifying and supplementing the diet and can be advantageous for health and body composition in the fire service. Firefighters have various schedules, making it difficult for planned exercise and eating while on shift. The practical training and nutritional aspects discussed in this review can be implemented on-shift to improve the overall health and performance in firefighters.

Keywords: fatal injuries; fire service; first responder; non-fatal injuries; nutrition; occupational performance; tactical athlete; training.

Figure 1

Mechanisms leading to decreased firefighter health and performance are low levels of physical activity, poor nutrition, obesity, high rates of cardiovascular disease, and injuries on the job. Improving physical activity and nutrition can decrease obesity and lower cardiovascular disease risk, in turn improving performance. Poor body composition is a risk factor for musculoskeletal injury. By improving body composition, occupational performance and health may improve.

Figure 2

High-intensity interval training and resistance training offer many benefits to firefighters’ health and performance such as increased aerobic capacity, neuromuscular function, body composition, and metabolic adaptations.

Figure 3

The literature shows several mechanistic links between health and performance variables and both non-fatal and fatal injuries in the fire service. Poor body composition and neuromuscular performance can impact functional movement on the job, leading to higher rates of musculoskeletal injuries. In addition, cardiometabolic disease and poor body composition are associated with higher levels of physiological stress and cardiac events in the fire service.

Figure 4

An example of implementing on-shift nutritional strategies and training for a 75 kg firefighter. Following the 1.4–2.0 g/kg protein recommendation, the range of protein intake should be 105–150 g/day. The assumption is the firefighter eating at normal mealtimes. It is suggested that caffeine is consumed in the morning to promote alertness, while consuming a snack mid-morning or post-call. Caffeine may help with grogginess as many firefighters note poor sleep quality. In the afternoon, the firefighter is partaking in 30 min of high-intensity interval training followed by protein consumption to help with satiety and recovery. To help meet training and body composition goals, creatine monohydrate should be added daily. Adequate protein consumption should help meet recovery needs based on training and call-volume as well as promote satiety throughout the shift.

Figure 5

Adopting on-shift nutritional strategies such as increased protein intake, supplementation, addition of ergogenic aids, and caloric restriction can offer many benefits to overall firefighter health. Also, incorporating feasible exercise modalities such as high-intensity interval training and resistance training offer numerous advantages to firefighters. Taken together, improving nutrition and the adaptations from exercise can improve occupational performance in the fire service.