Overexertion and heat stress in the fire service: a new conceptual framework

From the year 2000, the United States Fire Administration (USFA) has been recording all line-of-duty deaths in the fire service. Stress or overexertion caused 1096 out of 2598 total line-of-duty deaths in the United States from 2000 to 2021. Those deaths due to stress or overexertion were further classified as myocardial infarction (90%), cerebrovascular accident (6.8%), other (2.6%), and heat exhaustion (0.6%). Environmental heat exposure is a concern in firefighting, as firefighters work in extreme conditions, such as high ambient temperatures, while wearing protective clothing. Heat stress is not only hazardous to the cardiovascular system, but may accentuate muscle fatigue and overexertion. In addition, overexertion itself is related to increased incidence of musculoskeletal injuries, usually to the lower extremities. Further, there is a strong physiological mechanistic link to suggest that the increased occupational heat exposure and thermoregulatory strain firefighters experience may be a stressor that increases the risk of injuries. This commentary hopes to show the need for further research on the effects of occupational exposures and physiological strain in the fire service.