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Research Study Rates EMS Providers’ Fitness Levels.

I How Fit Are We? I
Poston WS, Haddock CK, Jahnke SA, et al. The prevalence of overweight, obesity and substandard fitness in a population-based firefighter cohort. J Occup Environ Med. 2011; 53(3):266–273.

The title of this paper should immediately raise some eyebrows. We’re used to hearing about the rise of bariatric health issues, but this study reminds us that EMS and fire aren’t immune to the ills of our society. I give kudos to these researchers for tackling a sensitive topic in a scientific and constructive format.

These researchers randomly selected and recruited 11 career and 13 volunteer fire departments from the Missouri Valley region. They succeeded in enrolling 677 firefighters (478 career and 199 volunteer). The investigators used multiple measurements to determine fitness: body fat percent, age, waist circumference, body mass index (BMI), blood pressure, cholesterol and self-reported physical activity in their questionnaire.

All the tools used had been validated in previous studies. The prospective methodology, with researchers actually doing the measurement instead of relying on self-reported data, makes this study even stronger. They also were careful not to use just one method, because BMI studies have come under scrutiny in some circles. A BMI of greater than 25 kg/m2, a waist circumference of greater than 40 inches and a body fat percentage of greater than 25 were considered “obese.”

This study also used the National Fire Protection Association 1582 minimum post-cardiac event exercise tolerance threshold of greater than 12 metabolic equivalents of aerobic capacity (METs) as a lower limit threshold for job readiness.

Their results showed that 75% of subjects couldn’t attain the 12 METs threshold, regardless of weight status or career vs. volunteer status. A larger percentage of firefighters was overweight (~44%) than U.S. population averages. The number of obese firefighters (33%) was similar to the general population. Weight problems were more common in firefighters who were older (mean age 41.5 years) and had more time on their department (16 years vs. 13 years).

The authors make excellent points about the need for more research in this area, which I will echo. EMS-specific research is needed to establish measurable fitness requirements that can be compared with other emergency services professions. If anyone reading this has seen one such study, please share, but keep in mind that our scientific work in EMS needs to be published in a peer-reviewed journal to count.

Bottom Line
What we know: In 2007, Studnek and co-authors published the first baseline assessment of EMS-specific health indicators using the self-reported LEADS study in the American Journal of Industrial Medicine. More than 50,000 EMS providers returned the survey. The mean BMI was greater than 27.7 kg/m2; 26% were obese, and 45% were overweight. The overwhelming majority didn’t meet the Centers for Disease Control and Prevention’s recommendations for physical activity.

What this study adds: This study adds stronger evidence that EMS providers must take fitness seriously if we hope to reduce injuries and line-of-duty deaths from cardiovascular events.

Nausea & Vomiting
Barrett TW, DiPersio DM, Jenkins CA, et al. A randomized, placebo-controlled trial of ondansetron, metoclopramide, and promethazine in adults. Am J Emerg Med. 2011; 29(3):247–255.

The authors concluded there was no difference between medications in this randomized, prospective and double-blind study. During a 16-month period, 163 emergency department (ED) patients complaining of nausea and vomiting were enrolled, and anyone who had already taken anti-emetic medication prior to arrival was screened out. The authors used a visual analog scale to measure each patient’s perception of their nausea, waiting 30 minutes to assess the full effect of the intervention. Even if this was a sample of convenience (anyone entering the ED was eligible), the randomization worked well, because all groups had similar demographics, severity of symptoms and outcomes.

The authors ended the trial early due to slow enrollment and a statistical prediction that continuing the project wouldn’t yield a difference. Interestingly, the group receiving saline did just as well statistically as the groups receiving medications. The authors suggest that “this study provides support for the early initiation of aggressive intravenous hydration and more judicious use of anti-emetics.”

Readers should keep in mind that previous studies have also found anti-emetics helpful and that no single study should change your practice. A potential flaw is that some of the patients received opiates or anti-inflammatory medications, meaning their symptoms may have been adversely affected, so potential for inadvertent co-intervention bias exists. JEMS

Glossary Double-blind: A comparison of techniques or medications in which neither the patient nor the provider knows what intervention or medication is being administered. The study drug is de-identified or masked. This type of study is very difficult and considered a gold standard in research.

This article originally appeared in June 2011 JEMS as “Fit to Save Lives? Study rates health of EMS providers.

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