Heart of the Matter

British Columbia has proposed an amendment to the Workers Compensation Act that would restore heart disease to the list of presumptive diseases for firefighters.

The bill, announced on March 10, has passed its third reading and will come into effect after receiving royal assent. The legislation will mean that if a full-time, part-time or volunteer local government firefighter or forest firefighter in British Columbia suffers from heart disease or heart injury, including a heart attack, it will be presumed occupation-related unless proven otherwise.

This will apply to all firefighters who are claimants at the time of or after the date of disablement, but will not be applied retroactively to impairments that occur before the legislation is enacted.

Depending on the situation, compensation may include wage-loss benefits, healthcare services and/or vocational rehabilitation services, notes information from the Ministry of Jobs, Tourism and Skills Training. There are no exclusions for lifestyle factors, such as smoking. There is also no requirement that the worker be employed as a firefighter for a minimum period to qualify for the presumption.

Added Protection

Mike Hurley, president of the British Columbia Professional Fire Fighters Association (BCPFA) in Burnaby, notes that prior to the presumption’s removal, an average of six claims was accepted each year in British Columbia. The number has dropped to about one per year since the presumptive clause was removed.

“If you don’t have a presumption, the onus is on the employee to prove that the heart injury was caused by their job. Now, with the presumption, the onus is on the employer to prove that injury was not caused by the job,” Hurley says.

“Many of those cases were just abandoned, because the members who had heart problems did not want to go through the stress of fighting WCB at a time in their life when they were just worried about actually saving their lives,” Hurley adds in reference to firefighters who had previously made workers’ compensation claims for heart problems.

The ministry says it is committed to protecting firefighters from workplace hazards. “Our government appreciates the vitally important work that firefighters do for the people of our province,” Shirley Bond, Minister of Jobs, Tourism and Skills Training, says in a statement. “Firefighters expose themselves to significant hazards, and we want to provide further protection for these men and women who help to keep our communities safe by recognizing heart disease and heart injury as presumptive diseases.”

When working on the proposed amendment to the Workers Compensation Act, legislators took into consideration consultations with the BCPFA and recent research providing evidence that firefighting increases the risk of heart problems.

According to the Ministry of Jobs, Tourism and Skills Training, WorkSafeBC removed heart disease as a presumptive disease in 2000 to develop a new policy on how heart injury would be recognized for firefighters. Hurley points out that the NDP government’s decision to eliminate the presumption was to give WorkSafeBC time to conduct a study into the matter. “In our minds, the study should have been done before it was removed, which would be the normal way to carry out business,” he says.

Heightened Risks

The University of British Columbia’s (UBC) study on cardiovascular disease among firefighters in the province, funded by WorkSafeBC, was published in 2011. The findings indicate an increased risk of cardiovascular disease among firefighters employed for 20 to 29 years in a fire brigade, but little or no excess risk among firefighters employed for 30 or more years.

The increased risk among firefighters was strongest for acute coronary disease — a category consisting primarily of acute myocardial infarction. “Firefighters are exposed to hazards that could potentially increase their risk of cardiovascular disease, including carbon monoxide, airborne particulates, noise and physical stressors,” the study notes.

Study co-author Dr. Mieke Koehoorn, Ph.D., professor and chair in gender, work and health with the Canadian Institutes of Health Research at UBC in Vancouver, says factors outside of work also contribute to heightened risk. They include tobacco use, physical inactivity, diabetes, hypertension and a family history of heart disease.

“Compared to the general working population, firefighters reported much higher levels of physical activity. Finally, firefighters were more likely to report hypertension, but less likely to report diabetes compared to the general working population,” Dr. Koehoorn says.

In terms of known non-occupational cardiovascular-disease risk factors, firefighters are a healthy cohort of workers compared to the general working population. Dr. Koehoorn says other research done on this issue comparing firefighters to the general population has significant limitations, “as their risk of cardiovascular disease compared to the general working population in previous studies has been lower as a result of their healthy status.”

The study cites noise exposure as an additional stress for firefighters. “In general, noise is considered more of a cumulative physical stressor rather than an acute, startling stressor,” Dr. Koehoorn notes.

She points to a study by Dr. Hugh Davies, who theorizes that the nervous system responds to repeated noise exposure, leading to increased blood pressure and over-secretion of cortisol as a result of this stress. This could then lead to hypertension and insulin resistance.

Prevention First

Dr. Lowell Gerber, medical doctor with Freeport Cardiology in Freeport, Maine, claims that firefighters are no different from the general population. Dr. Gerber led a pilot study to assess the metabolic stress levels of firefighters in Freeport. “What I found is that the firefighters are a representation of the society in general as far as being overweight, having high blood pressure.”

He adds that firefighters had problems with obesity, diabetes, hypertension, pre-hypertension, fats in their blood, hormonal issues, low testosterone and low thyroid. “So all these things together is what we see happening; we have an epidemic of obesity and diabetes in the population in general, and they are no exception to that.”

Dr. Gerber screened firefighters for pre-diabetes, diabetes and hormonal issues, in combination with physical stress-tests, in which participants were hooked up to an electrocardiogram while running on a treadmill. Firefighters were also tested using the Microvalt T-Wave Alternans — a device that uses a periodic beat-to-beat variation in the amplitude or shape of the T-wave in an electrocardiogram — which Dr. Gerber says assesses the risk of sudden cardiac death.

“They did pretty good on the treadmill, but when you looked at their oxygen consumption per body weight, it was low. So although they were strong, their cardiopulmonary fitness was below par,” says Dr. Gerber, adding that he initiated the program after a young firefighter died while exercising at the station. With the metabolic stress data, he suggests that an individualized health program that includes counselling on proper diet and exercise can be created for firefighters.

Recent research shows that firefighters who die of car diovascular problems are most often doing physical activity when they experience the attack. A study from the Zeenat Qureshi Stroke Institute in St. Cloud, Minnesota, presented at the American Academy of Neurology Annual Meeting on April 26, found that 146 out of 199 cardiovascular events (73 per cent) occurred after vigorous activity lasting an average of 33 minutes. Amna Zarar, study author and a researcher at the institute, says fire departments need to be prepared to recognize these events and conduct screenings for those who may be at higher risk.

Dr. Gerber agrees. “If they are a firefighter — we know they are in a very high-risk occupation — we should be providing the services to keep them healthier,” he says. “In the United States, much of our preventive medicine, it is really not preventative at all — it is early detection. And by the time you can detect the disease, you can’t prevent it anymore and it is difficult to reverse it.”

Firefighters elsewhere in Canada are also pleased with the development in British Columbia. “It is a very positive step in the right direction,” says Paul Atkinson, a workers’ advocate with the Toronto Professional Firefighters Association. He says the development is supported by scientific evidence showing that firefighters have a higher propensity for coronary artery disease than the general public. In Ontario, he notes that only one out of nearly 300 workers’ compensation claims for coronary artery disease has been successful.

That said, Atkinson doubts that the changes in British Columbia will have any ripple effect in Ontario, where the workers’ compensation board maintains that scientific evidence on heart disease is inconsistent.

“In the world of science, inconsistent means that there is some science supporting it and there is some science that does not support it.” But Atkinson argues that science is never precise, “and presumptive legislation is really science with common sense added.”

Carmelle Wolfson is assistant editor of OHS CANADA.

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