Police officers in stressful law enforcement situations are at risk of sudden cardiac death, researchers warn.
“Law enforcement is a dangerous occupation,” said researchers led by Stefanos N. Kales, M.D., of Harvard School of Public Health in Boston.
“The mortality rate among patrol officers in the U.S. is up to five times the national average for private sector employees. Cardiovascular events may account for about seven percent of these fatalities, but this risk “has not been adequately studied,” said the team.
So they examined the link between risk of sudden cardiac death and stressful law enforcement work using details of the deaths of over 4,500 police officers across the U.S. between 1984 and 2010. There were 441 sudden cardiac deaths during this time.
Deaths were linked to restraints or altercations in 25 percent of cases, physical training in 20 percent, pursuit of suspects in 12 percent, medical or rescue operations in eight percent, routine duties in 23 percent, and other activities in 11 percent.
“Compared with routine/non-emergency activities, the risk of sudden cardiac death was 34 to 69 times higher during restraints/altercations, 32 to 51 times higher during pursuits, 20 to 23 times higher during physical training, and six to nine times higher during medical/rescue operations,” report the authors.
Full details appear in the Nov. 19, 2014 British Medical Journal. The team explains that lower stress, routine or non-emergency duties included attending meetings, classroom activities, desk duty and paperwork, escorting (such as funerals, dignitaries), firing range practice, patrol, and roll call.
Conversely, non-routine duties included disturbance (domestic disturbance calls and disturbance of peace calls), medical and rescue operations, physical training, physical restraints or physical altercations (with suspects, prisoners, other detainees, or other uncooperative members of the public), suspect pursuits, testifying in court, and transporting or supervising prisoners.
They report, “We found that stressful and physically demanding law enforcement activities were associated with large increases in the risk of sudden cardiac death, compared with routine/non-emergency policing activities.”
The team believes that stressful activities represent “a sudden increase in cardiovascular demand because of a combination of physical exertion and psychological stress, consistent with ‘fight or flight’ physiology.”
They conclude, “Our findings have public health implications and suggest that primary and secondary cardiovascular prevention efforts could be used to protect police officers from the triggering effects of stressful duties and also reduce rates of long-term cardiovascular disease.”
Dr. Kales stated, “The absolute risk for cardiovascular events in most individuals and all police is quite low and primarily limited to people who have underlying disease, who may not know that they have underlying disease.
“In the general population those really stressful things like anger or physical stress, like a lot of snow shoveling for a person who is usually sedentary, can serve as triggers. We thought the same thing could happen with law enforcement officers but we were struck by the magnitude of the risks.”
He calls on police departments to ban smoking, due to the heart risks. “Given that we compensate police or firefighters for retirement and disability, it really is incumbent on the jurisdiction to ban smoking.”
Kales and the team recommend that physical fitness be a job requirement for police officers, with officers having annual physical examinations to monitor weight and other risk factors. They would also like to see stress testing for specific officers who have more cardiovascular issues and may be at higher risk of sudden cardiac death.
Earlier last year (2014), Kales carried out a separate study to investigate sudden cardiac death among firefighters. They explain that fire scenes are “unpredictable environments characterized by numerous dangers” and that “firefighting is widely recognized as a hazardous profession that can result in burns, trauma, smoke inhalation, and other myriad injuries.”
However, the leading cause of duty-related fatalities is cardiovascular disease, with sudden cardiac death accounting for about 45 percent of all on-duty firefighting deaths in the USA since at least the 1970s.
The team examined the health impact of the physical demands of firefighting, such as stair and ladder climbing, forcible entry, and cutting and chopping to provide ventilation of the building, while wearing heavy protective clothing. As with police work, the ‘fight-or-flight’ response is activated, raising heart rate and blood pressure.
“Firefighters experience alterations in physiological function that can range from moderate to severe,” they report. “In susceptible firefighters including individuals with underlying structural or coronary heart disease, firefighting may result in pathological changes that greatly increase the risk of thrombosis, coronary plaque rupture, and/or arrhythmia.”
Again, they call for a complete ban on smoking and tobacco products in fire services, as well as “encouraging wellness programs that among other measures offer on-duty time for required regular exercise to improve and maintain fitness, mitigate weight gain, and help manage existing heart risk factors.”
Varvarigou, V. et al. Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study. British Medical Journal 19 November 2014 doi: 10.1136/bmj.g6534 British Medical Journal
Kales, S. N. et al. Sudden cardiac death in the fire service. Occupational Medicine, June 2014 doi: 10.1093/occmed/kqu057