Clotting and fibrinolytic changes after firefighting activities

Approximately 45%-50% of all duty-related deaths among firefighters are due to sudden cardiovascular events, and a disproportionate number of these fatalities occur after strenuous fire suppression activities.

The objective of this study is to evaluate the effect of strenuous firefighting activities on platelets, coagulation, and fibrinolytic activity and to document the extent to which these variables recovered 2 h after completion of the firefighting activity.

Firefighters performed 18 min of simulated firefighting activities in a training structure that contained live fires. After firefighting activities, firefighters were provided with fluid and allowed to cool down and then recovered for 2 h in an adjacent room. Blood samples were obtained prefirefighting, postfirefighting, and 2 h postfirefighting.

Platelet number, platelet activity, and coagulatory potential increased immediately postfirefighting and many variables (platelet function, partial thromboplastin time, and factor VIII) reflected a procoagulatory state even after 2 h of recovery. Fibrinolysis, as reflected by tissue plasminogen activator, also was enhanced immediately postfirefighting but returned to baseline values by 2 h postfirefighting. In contrast, inhibition of fibrinolysis, as evidenced by a reduction in plasminogen activator inhibitor-1, was depressed at 2 h postfirefighting.

Firefighting resulted in elevated coagulatory and fibrinolytic activity. However, 2 h postfirefighting, tissue plasminogen activator returned to baseline and coagulatory potential remained elevated. The procoagulatory state that exists after firefighting may provide a mechanistic link to the reports of sudden cardiac events after strenuous fire suppression activities.