b'A P P E N D I X CProviders Guide to FIREFIGHTER MEDICAL EVALUATIONSFirefighting is a uniquely stressful and dangerous job that requires working in unpredictable and often toxic environments. Due to the demands, firefighters are at increased risk for job-related CANCER, MENTAL HEALTH CONCERNS, and CARDIOVASCULAR EVENTS.While the USPSTF recommendations should be used as a baseline, they are designed for the general population and not an occupational group with increased risk. Providers should be aware of the unique exposures and consider this in conjunction with personal and family risk factors when weighing timing and frequency of screenings.CARDIOVASCULAR DISEASE (CVD) FIREFIGHTERS AS TACTICAL ATHLETESSudden cardiac events account for ~50% of acute duty-related death among firefighters primarily by myocardial infarction or cardiac arrest. 1 Cardiovascular Extreme physical work, Consider thoroughly screening and aggressively70 lb of gear, strain ontreating CVD risk factors. An ASCVD risk score cancardiovascular systemhelp identify firefighters who may need to initiateHematologicaltreatment for hypertension or dyslipidemia. Dehydration (decreased plasma volume), Expert Panel Recommendation: Based on risk factors,hemoconcentrationevaluate firefighters for coronary heart disease (CHD)Thermoregulatoryand structural heart changes, specifically consider: 2 Elevated core temperature, Coronary Artery Calcium (CAC) Scan at age 40 yrs.,dehydration, heat stressor earlier based on clinical judgment and risk profileRespiratoryIncreased breathing rate Screening for structural heart disease including leftand oxygen consumptionventricular hypertrophy, cardiac chamberMetabolicenlargement, valvular abnormalities, orOxygen cost (extreme diastolic/systolic dysfunction using screeningphysical work), increased echocardiography in the presence of hypertension,lactate, fatigueobesity, Metabolic Syndrome or sleep apnea Immune/EndocrineIncreased leukocytes and hormonesA large-scale autopsy review found approximatelyNervous80% of firefighters who suffered a sudden cardiacSympathetic surge, event had evidence of both coronary heartincreased adrenalinedisease (50% occlusion) and a structurallyMuscularenlarged heart. Only about 20% of autopsies hadIncreased oxygen use and evidence of an intracoronary thrombus,heat production suggesting ischemic heart disease and resultantPsychologicalcomplications may be responsible for a largeRepeated exposures to trauma, percentage of cardiac line of duty deaths. 3 sleep disruption, increased mental and behavioral health concernsClick here bit.ly/3yX8lfA or Scan the QR code for Screening Tools, Resources & More62'