Protecting Our Protectors

 

Edward Moncrief 6:59 a.m. PDT July 23, 2016

Snippet_Firefighters_HeartScan_July_2016

According to the US Department of Labor, firefighters have 200 to 300 percent greater risk of dying of a heart attack than any other professional group; moreover, they most often die on the way to a fire, during a fire, or leaving a fire.

Recently, a group of 70 City of Monterey Firefighters visited the Ryan Ranch Center for Advanced Diagnostic Imaging, a part of Salinas Valley Memorial Healthcare System. They had come for a heart scan, a relatively simple procedure — processed by a very complex coronary CT scanner — that could have life-saving consequences.

Doctors Christopher Oh and H. Robert Superko, both Fellows of the American College of Cardiology, know the value of these advanced imaging tools.

“This machine can help in both prevention and diagnosis,” Dr. Oh, a cardiologist with Salinas Valley Medical Clinic’s Central Coast Cardiology explained. “On the prevention side, the CT scan gives us a calcium score which is a measure of each patient’s level of risk of heart disease. This means we can see potential problems before a person ever has any symptoms of heart disease or heart failure. That is a powerful advantage.”

Dr. Superko is a fan of Salinas Valley Memorial’s CT scanner and is using the equipment to help in his latest study of heart risk among firefighters. Dr. Superko, a metabolic cardiologist and former medical director of the Lipid Research Clinic at Stanford University among other distinguished positions, founded the Cholesterol, Genetics and Heart Disease Institute (CGHDI) in 2000 to educate both the lay and medical communities on heart disease and its prevention.

After a career in cardiovascular genetics research, the doctor and his wife Brenda Garrett, a cardiovascular nurse and research associate, moved to Monterey County. During their “retirement,” they maintain a small practice at Prima Heart in Monterey; but most of the time they work as volunteers for the CGHDI, more commonly known as the Family Heart Foundation.

Dr. Superko described how his professional career and his post-retirement activities as a volunteer have combined to bring a firefighter heart disease prevention program to the Monterey Fire Department.

As the doctor spoke, we watched one of the Monterey firefighters, Raul Pantoja, a towering figure in uniform, position himself on the scanner’s cushioned bed. The technician scurried about, preparing for a coronary CT scan to determine a coronary calcium score. The whole process took under five minutes.

This local project is an outgrowth of an effort that started in another part of the country.

“This effort began in Gwinnett, Georgia,” Dr. Superko said. “Steve Rolader, the fire chief there contacted us. He was looking for help. He was aware that firefighters were at greater risk of dying from a heart attack. He wanted to learn what might be done to understand the risks and reduce the incidents and effects of heart disease within his department. Brenda and I were eager to respond. We had a special place in our hearts for firefighters. We remembered 9/11: how everyone was running from the towers except the firefighters. They were running into them.”

“We applied for and received from FEMA a federal grant to conduct the research,” he said. “We put together an outstanding team to study 296 active-duty firefighters from the Gwinnett County Fire Department; all of them 40 years and older. We used non-invasive imaging to discover if the population of firefighters being tested would show higher incidents of traditional risk factors for heart disease compared to the general population —such factors as high HDL cholesterol, high blood pressure, genetic propensity, diet, lifestyle, etc.”

Firefighter Pantoja stepped out of the room.

“Nothing to it,” he said, while Dr. Superko continued his narrative.

“The initial results indicated that the firefighters we tested were not significantly different from the general population concerning these traditional risk factors, Dr. Superko said. “So why, according to numerous studies and the Center for Disease Control, are firefighters dying of heart disease at higher rates?”

“With the more sophisticated imaging techniques you see here today, we conducted arterial wall imaging. We computed coronary artery calcium scores according to the age and sex of the patient. We measured plaque thickness, using an ultrasound machine equipped with specialized software, scanning the interior walls of the three arteries of the heart. We found a slightly higher incidence of blood-clotting issues among firefighters, but the difference, in and of itself, was not that significant,” he said.

“These tests and others led us to the conclusion that one-third of the firefighters who have both clotting issues and an underlying propensity for heart disease (from traditional factors) are at higher risk for suffering from a heart attack,” he continued. “Eventually, we concluded that the impact of clotting issues in combination with the other traditional risk factors is magnified because of firefighters’ exposure to physical and psychological stress, work-related dehydration (excessive sweating), smoke inhalation, and in some individuals, a growing problem with weight control.”

A heart disease prevention program aimed at firefighters, he concluded, could help reduce the high incidence of heart attacks among this population. “This is why we’re here today with the Monterey fire chief and about 70 of his men and women on the line,” he said. “We’ve had great cooperation putting this together.”

Normally, the combination of the blood test and the computerized tomography (scan) would cost each patient about $1,500. In this case, the services were provided free to the firefighters. The costs are covered through a partnership that includes the Family Heart Foundation, Salinas Valley Memorial Healthcare System, Boston Heart Diagnostics, and the City of Monterey Firefighters’ Union.

All of the partners have agreed to pay for a total of 300 blood tests and related costs to support this program here in Monterey County, so the group will be working with other local fire departments to conduct additional scans.

Dr. Superko had one last point.

“You know, any heart attack is a tragedy, but when a firefighter goes down on the job, it can have additional devastating consequences by increasing the risk of injury or even death for others,” he said. “When you think about incidents like 9/11, it’s not hard to imagine a scenario that could compromise our national security. Obviously, we have to do a better job making our firefighters aware that they are at higher risk and taking the right steps to mitigate those risks.”

Gaudenz Panholzer, fire chief of the Monterey Fire Department and Spencer Reade, the department’s wellness program officer joined the discussion.

“Preventive medicine makes so much sense,” Panholzer said. “We know, if we spend a little money now, we’ll save thousands on the back end. It’s also good for each firefighter to learn whether or not he or she is at risk; and, if so, make the necessary changes.”

Another great benefit, Boston Health Diagnostics is offering to each firefighter two phone sessions with a dietician.

During every fire, these guys are breathing noxious, irritating smoke and numerous carcinogens are contained in the smoke. Firefighters are sweating abnormally from carrying heaving equipment and wearing protective gear.

“Their health is going to get compromised if they’re not doing all they can to stay in shape and eat right,” Dr. Oh from Central Coast Cardiology said, “We’re really pleased to take part in this program and the focus it brings to the heart health of our firefighters. This is the kind of test that can benefit just about anyone, though. Having your calcium score is comfortable and convenient, and it gives you great insight into a common area of concern – your heart.”

Firefighter Reade also joined the conversation.

“This scan program gives each of us some peace of mind, just knowing where we are with regard to the risks of heart disease; but it’s also an opportunity to stay healthy in order to serve the community better,” he said.