Firefighters, police and healthcare workers could benefit from regular checks and monitoring to avoid heart events at work that could injure themselves or others, according to a review article published today in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).
The document summarizes existing knowledge on screening, surveillance and risk management in hazardous jobs – defined as those where cardiovascular disease has the potential to impact the safety of the employee and / or others and the employer has a duty to manage these risks. In addition to emergency workers, hazardous occupations include bus and truck drivers, pilots, flight attendants and astronauts.
But the article points out that “the lack of consensus or contemporary evidence usually results in decisions based on expert opinion. This can lead to inconsistency in clinical decision-making which is increasingly contested,” by both employees and employers “.
The authors said more research is needed to determine the optimal balance between protecting workers and the public while avoiding false-positive career-ending outcomes.
Cardiovascular disease is the most common cause of death in service for firefighters, a trend that has grown over the past two decades. Heart attacks and sudden cardiac death account for 45% of deaths among active duty firefighters and occur primarily during firefighting activities.
If we take the example of firefighters, we know that the act of firefighting is associated with sudden cardiac death from coronary artery disease. Currently, fire departments are examining cardiovascular fitness, but testing varies widely from country to country. “
Dr Iain T. Parsons, review author, Royal Center for Defense Medicine, Birmingham, UK
“In high-risk occupations, it is very common to apply a minimum standard of physical fitness,” he continued. “The fitness and strength standards have two distinct advantages. First, ensure that employees can undertake the key physical tasks required in their role. Second, failure to meet certain fitness thresholds will expose undiagnosed health problems (especially in the cardiopulmonary and musculoskeletal systems) that would be associated with a significantly increased risk to the affected individual, their colleagues, or limbs. public. “
“However, optimal screening or periodic examination should be supported by evidence, which is currently lacking,” said Dr Parsons. “More research is needed to determine when to assess fitness, what additional measures might reduce morbidity or mortality (for example, an EKG or risk assessment), and what are the downsides of implementing these measures,” for example in terms of cost, false positives and loss of labor. “
With regard to pilots, there is a lack of standardization regarding licensing requirements to ensure aviation safety. “Despite recent efforts to unify standards in order to improve consensus in the assessment of cardiovascular risk, various approaches exist to assess a pilot’s risk of. [cardiovascular] events, ”the log reads. “The requirements for reporting health concerns to authorities also vary among regulatory jurisdictions. “
Regarding astronauts, the authors predicted that with the advent of commercial space travel and space tourism, the professional management of astronauts is likely to increase. Dr Parsons said: “It may be that skilled astronauts who are ‘mission managers’ for space tourists need more robust screening, because a cardiac event in a lay responsible case could be even more so. catastrophic. However, this would depend on the vehicle and the intended trip as well as the degree of automation. I predict that future safety models would be based on the priority of aviation with doubly qualified astronauts required per mission. “
The authors called for collaboration between employers, regulators and medical societies to provide transparent criteria for professional screening that balance individual health, patient rights and public safety.
Dr Parsons said: “The most urgent need is to achieve a societal standardization of how to detect and manage worker risks, as well as to provide an opportunity to provide preventive care in order to keep people employed. Additionally, most of the research in this area has been done in men. As women increasingly assume dangerous roles, it is crucial that studies examine how best to assess and monitor their cardiovascular risk and, ultimately, prevent dangerous health problems. “
European Society of Cardiology
Parsons, computer science, et al. (2021) Cardiovascular risk in high-risk occupations: the role of occupational cardiology. European Journal of Preventive Cardiology. doi.org/10.1093/eurjpc/zwab202.