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The Effect of Mandatory Fitness Requirements on Cardiovascular Events: A State-by-State Analysis Using a National Database



Dillon Dzikowicz, Sankalp Saoji, Wai Cheong Tam, Wendy Brunner, Mary Carey


Background: Cardiovascular events are known to be the leading cause of death among on-duty firefighters. Implementing fitness standards may help reduce the incidence of cardiovascular deaths; however, standards vary between firefighter type and states. We aimed to investigate the rate of cardiovascular events among firefighters across states. Methods: Using publicly available data from the United States Fire Administration, we explored the rates of cardiovascular deaths between firefighter type (e.g., career, volunteer, wildland). We also examined rates of cardiovascular deaths between California and Tennessee which have fitness standards, and New York which does not have fitness standards. We used descriptive statistics and trend analysis to examine the data. Findings: Most cardiovascular events occur among volunteer firefighters (60.6%, n=877). Volunteer firefighters had 7.5 (95% CI 4.848-11.667, p<0.001) greater odds of cardiovascular events compared to wildland firefighters, who had the lowest incidence of cardiovascular events (1.7%, n=24). New York reported the most cardiovascular events (n=161) primarily among volunteer firefighters (73.9%, n=119). After passage of legislation mandating fitness standards in California, a downtrend in the number of volunteer firefighter fatalities is observed. However, a null effect was observed in Tennessee after passage of similar fitness standards as California. Conclusions/Applications to Practice: Volunteer firefighters are significantly more likely to die of a cardiovascular event than career and wildland firefighters, both of which have stricter fitness standards. However, the effect of legislation mandating stricter fitness standards among volunteers did not produce a clear benefit for preventing fatalities. Nurses need to promote cardiovascular health among volunteer firefighters.
Workplace Health and Safety


Firefighters' death, Cardiovascular events, State-by-state analysis


Dzikowicz, D. , Saoji, S. , Tam, W. , Brunner, W. and Carey, M. (2024), The Effect of Mandatory Fitness Requirements on Cardiovascular Events: A State-by-State Analysis Using a National Database, Workplace Health and Safety, [online], (Accessed April 23, 2024)
Created March 1, 2024