We in EMS deal in disease. We spend all day every day trying to bring the sick and injured back to health. We strain our backs lifting overweight and obese patients. We give medications to combat chest pain and heart failure. We rouse individuals suffering diabetic emergencies. Yet we ourselves aren’t immune. How many among us know an EMT who has diabetes? Hypertension? Who’s overweight? These problems are on the rise among EMS practitioners, just as they are everywhere else in the country.1
A recent study in Boston found that among new recruits for fire and EMS services, only 22% were at a healthy weight, while 44% were overweight and 33% were obese. That means that three out of every four recruits were above their recommended healthy weight.2 And these statistics aren’t limited to the young. Three-quarters of active emergency responders nationwide are overweight or obese.1 Additionally, 75% have been classified as hypertensive or prehypertensive.1
Many risks are associated with being overweight. Carrying excess weight is associated with higher rates of type 2 diabetes, hypertension, heart disease, stroke and some cancers, as well as with many other health conditions.3 The practical implication? An astonishing 11% of on-duty deaths for EMS personnel are the result of cardiovascular disease (CVD), making CVD the No. three on-the-job killer.1,4
Being overweight or having hypertension and diabetes is frequently an unfortunate consequence of the EMS lifestyle. Shift work, excessive work hours, poor nutrition and limited exercise lead to decreased health. Emergency personnel work all hours of the day and night, regularly leading to sleep disruption and deprivation. Short sleep duration is related to an increase in obesity, and inadequate sleep can more than double the risk of developing type 2 diabetes.5
Excessive work hours, such as those undertaken by EMS personnel going straight from one job to another or working 40 hours straight, have similar risks: There’s a threefold increase in the risk of developing diabetes when working more than 50 hours of overtime per month compared with a standard 40-hour work week, and overtime has been shown to have a linear correlation with increased body weight and waist circumference (i.e., more hours means a larger waistline and a higher weight).5 Unfortunately, the average EMS employee has little control over these factors. Shifts last as long as they need to, and due to lower-than-ideal salaries, many responders must work two or more jobs.
Nutrition & Exercise
Nutrition and exercise, however, are areas in which an individual can make a change. Poor nutrition is often a challenge due to limited healthy food options while on duty, and regular exercise is hard to come by with little time for sleep. But small changes in these areas could have a major affect on your health.
In the simplest of terms, body weight is a result of the balance between the energy you take in and the energy you burn. If you take in the same amount of energy you burn, your weight stays the same. If you take in fewer calories than you burn, you lose weight. And if you take in more calories than you burn, you gain weight.
Such simple things as packing one healthy meal a day, stocking the station with low-calorie snacks and learning to identify the most nutritious options from fast food restaurants can all add up to significant long-term results. Adding in short periods of low-impact physical activity, such as walking or riding a bicycle on most days of the week, can also lead to substantial cardiovascular health improvement.
Even better news: You don’t have carve out huge chunks of your day for exercise. Breaking it down into a few 10-minute sessions has been shown to have the same cardiovascular benefits as a longer workout.6 So try exercising in between calls, before work in the morning or after dinner on your days off. Whenever you have a few minutes to spare, you can do a little to improve your heart heath.
The benefits of healthy responders aren’t just personal. A physically fit caregiver is able to carry patients and equipment more easily, traverse such obstacles as stairs and hillsides more quickly and is less likely to suffer a personal health event that interferes with patient care. Taking a little time each day to focus on your own health could help you in the long run to provide your patients with the highest possible level of care.
Body Mass Index
Body mass index (BMI) is used to categorize an individual’s weight. To see where you fit in, calculate your BMI using the following formula and consult the chart below.7
BMI = Weight in kilograms à· (Height in meters)2
“¢ Underweight: <18.5
“¢ Normal weight: 18.5—24.99
“¢ Overweight: 25.0—29.99
“¢ Obesity Grade I: 30.0—34.9
“¢ Obesity Grade II: 35.0—39.99
“¢ Extreme obesity (Grade III): â‰¥40.0
1. Kales SN, Tsismenakis AJ, Zhang C, et al. Blood pressure in firefighters, police officers, and other emergency responders. Am J Hypertens. 2009;22(1):11—20.
2. Tsismenakis AJ, Christophi CA, Burress JW, et al. The obesity epidemic and future emergency responders. Obesity. 2009;17(8):1648—1650.
3. National Heart Lung and Blood Institute. (Nov. 11, 2010). What Are Overweight and Obesity? In National Heart Lung and Blood Institute. Retrieved Feb. 11, 2009, from www.nhlbi.nih.gov/health/health-topics/topics/obe/.
4. Maguire BJ, Hunting KL, Smith GS, et al. Occupational fatalities in emergency medical services: A hidden crisis. Ann Emerg Med. 2002;40(6):625—632.
5. Elliot DL, Kuehl KS. Effects of sleep deprivation on fire fighters and EMS responders: Final report. International Association of Fire Chiefs. 2007.
6. United States Department of Agriculture. (2010.). Dietary Guidelines for Americans 2010. In U.S. Department of Health and Human Services. Retrieved Feb. 25, 2012, from : www.health.gov/dietaryguidelines/.
7. World Health Organization. (2012). BMI classification. In World Health Organization. Retrieved Feb. 25, 2012, from http://apps.who.int/bmi/index.jsp?introPage=intro_3.html/.