第一响应者早期发现的经济意义

By Todd LeDuc

Sadly, we continue to lose first responders from occupational health threats such as sudden cardiovascular death and occupational cancer. On-duty deaths continue to be dominated bysudden cardiac events and death。实际上，斯基德莫尔学院（Skidmore College）的丹妮丝·史密斯（Denise Smith）博士估计，每一次突然的心脏死亡，发生了17-27次其他非致命心脏事件，使消防员禁用了消防员并改变了他们的生活质量。史密斯博士还发表了来自国家职业安全与健康（NIOSH）消防员死亡报告的数据，发现大约80％的心脏死亡患有冠状动脉或心脏病。她的工作通常也会发生结构性变化，例如心脏增大，尤其是左心室增大，她的工作还详细介绍了这种“沉默杀手”的普遍性，例如未诊断或管理不良的高血压，血糖和不良LDL胆固醇水平。

国家消防员癌症登记处肯定会使我们对全国消防员占领癌症死亡和残疾的幅度有更清晰的了解。从全国最大的消防员癌症研究中发布的数据中，我们知道，NIOSH在费城，芝加哥和旧金山的30,000多名美国消防员中，消防员总体上比一般人群的收缩率更高，总人群高9％高死亡率14％。

有关的

消防室预防癌症

Fire Service Occupational Cancer: The Elephant in the Room

消防队员健康:沉默是Not Bliss

In 2017, NIOSH asked the RAND Corporation to look at the economic impact of early cancer detection and treatment in firefighters. The results were substantial, identifying a four-fold increase in total health costs for a later stage and treatment of cancer than in an early stage (Figure 1) or when found when still contained within the primary site of origin. In almost every later stage finding where the disease had already spread, the condition was often detected only at initial onset of symptoms or very subtle symptoms that did not draw notice as to the pathophysiology. The economic impact is essential in considering the overall health system costs, premiums increases, loss of work, and the role of cancer presumption. Of course, the human toll cannot be downplayed as the primary concern; early-stage cancer detection affords greater treatment options, greater survivability, and less human suffering.

While NIOSH and RAND Corporation focused on the early-detection impacts of cancer, the same can be said for most any disease process or modifiable health risk factors. When it comes to crime prevention strategies, the “broken windows theory” argues that the little things—broken windows, litter, graffiti—contribute to an environment that is conducive to disorder and crime. As part of a “Broken Windows Theory of Health Prevention,” if we focus on the “little things” before they become “big things,” our overall outcomes tend to be better. Dr. Denise Smith has validated this with the significantly elevated risk when it comes to unmanaged hypertension and sudden death in firefighters. We know that the cost to modify lifestyle risk factors and undertake antihypertensive therapy is far less than a sudden cardiac event , bypass, or revascularization procedure. This does not factor in the human toll and effect on activities of daily living being restricted.

Many if not most states in the country provide some form of presumption coverage for first responders for “heart and lung” coverage as well as cancer. We must work proactively to assure that not only baseline annual NFPA medical exams are in place but that enhanced occupational early detection screening be looked at as an investment in the health, wellness, and survival of first responders. Whereas the U.S. Preventative Health Task Force screening recommendations focus on primary care and general population, they do not address the unique occupational health risks that firefighters face. As such, in additional to baseline occupational first responder health exams, enhanced and earlier screenings and enhanced early detection opportunities and better outcomes but also make employer and health system economic sense.