Dr. Michael Hamrock is a primary care physician for Boston firefighters, and an internal medicine and addiction specialist at St. Elizabeth's Medical Center in the Brighton section of Boston. Prior to his career in medicine, Hamrock was a firefighter and medical examiner for the Boston Fire Department (BFD).
Earlier this week, Hamrock shared his unique perspective during a session entitled, “Promoting a Culture of Safety and Fitness: Preventing Cancer, Heart Disease, and Injuries in Boston Firefighters” at the NFPA Conference & Expo. He spoke about cancer, heart disease, physical and mental health injuries; and efforts underway by BFD’s Safety, Health, and Wellness Division to establish a culture of safety and fitness.
“The status quo of a high number of injuries, cancer, and heart disease is no longer acceptable in the fire service. More than ever before, fire officers must be more accountable for the health and safety of those under their command,” Hamrock said.
In Boston each year, there are 1100 injuries occurring in a 1450 member force. On average 8% of the BFD workforce are on injured leave with approximately 150 shoulder injuries per year. Each medical incident typically costs $35,000. Additionally, Boston firefighters experience about 18 cardiac events. They learn about 20 cancer diagnoses per year, at an average cost of $250,000. Acute coronary incidents occur 2.5 times more within BFD than with local residents, and cancer rates among the city’s firefighters are two times higher than those of the general population. Since 1990, there have been more than 190 BFD cancer deaths.
To ensure optimal health and safety in your department, Dr. Hamrock recommends the following ten tips:
- Require confidential and comprehensive annual firefighter physicals for early detection of heart issues and high risk cancers associated with the job. Beginning at age 40, have personnel get an exercise stress echo exam every three years.
- Train at least one firefighter on each group in every firehouse on the 02X Human Performance Train the Trainer Program. O2X is a new concept, based on proven results from Navy Special Warfare. It covers firefighter health risks, nutrition, mental performance, injury causation, prevention and involves a physical workout strategy.
- Make hydration a priority. Encourage consumption of 64 ounces of water per day and be sure to establish a dedicated crew on scene to hydrate all members. Allow time for firefighters to cool down before returning to the fire.
- Emphasize lifestyle changes and an expectation that all members of the department be healthy and fit throughout their careers. Officers and O2X peer trainers should function like coaches and encourage self-care habits.
- Educate for safety. Officers should drill groups like professional athletes; enforce SCBA compliance to prevent inhalation of toxic chemicals; foster communication; address denial behavior; and stress the importance of smoking cessation.
- Train like professional athletes. Schedule 45 minutes of cross training activity in the firehouse per shift, and encourage 45 minutes of fitness training four times per week to reduce issues related to blood pressure, cholesterol, weight gain and diabetes.
- Champion nutrition, focusing on the importance of proteins, good fats, vitamins and minerals. Promote healthy cooking and avoid junk foods. Hamrock says, “a typical firehouse meal is like Thanksgiving with 3500 calories. Most firefighters gain 20 pounds in their first year – equivalent to a half hour air bottle.”
- Proactively tackle substance abuse and mental health issues. A firefighter with untreated mental health or substance problems is a real hazard. Don’t be afraid to ask about anxiety, depression, PTSD or drug usage; and take note of any self-medication to cope with trauma. Avoid enabling behavior, and remember that excessive alcohol use has direct toxic effects on the heart.
- Conduct an After Action Review (AAR) where fire officers sit down with their group at the kitchen table to discuss each call, lessons learned, and any injuries that may have occurred.
- Promote a culture of safety and fitness with strong and consistent management and labor leadership, emphasizing that firefighters are “tactical athletes”. Foster accountability at all levels.
Dr. Hamrock is on the Board of Advisors of the Last Call Foundation and works closely with the Firefighter Cancer Support Network to establish guidelines for primary care providers for comprehensive firefighter physical exams.