What Does It Cost to Prevent On-Duty Firefighter Cardiac Events? A Content Valid Method for Calculating Costs

Cardiac arrest is a leading cause of mortality among firefighters. We sought to develop a valid method for determining the costs of a workplace prevention program for firefighters. In 2012, we developed a draft framework using human resource accounting and in-depth interviews with experts in the firefighting and insurance industries. The interviews produced a draft cost model with 6 components and 26 subcomponents. In 2013, we randomly sampled 100 fire chiefs out of >7,400 affiliated with the International Association of Fire Chiefs. We used the Content Validity Index (CVI) to identify the content valid components of the draft cost model. This was accomplished by having fire chiefs rate the relevancy of cost components using a 4-point Likert scale (highly relevant to not relevant). We received complete survey data from 65 fire chiefs (65% response rate). We retained 5 components and 21 subcomponents based on CVI scores ≥0.70. The five main components include, (1) investment costs, (2) orientation and training costs, (3) medical and pharmaceutical costs, (4) education and continuing education costs, and (5) maintenance costs. Data from a diverse sample of fire chiefs has produced a content valid method for calculating the cost of a prevention program among firefighters. 1. Introduction Firefighters in the United States suffer cardiac-related line of duty death (LODD) at exceedingly high rates with events 10–100 times more likely to occur during, or in the hours immediately following, fire suppression [1]. The underlying mechanism for cardiovascular events among firefighters is unknown, but it is believed to be multifactorial including both occupational and lifestyle factors. Occupational factors such as shift work, lifestyle factors, and the exposures associated with fire suppression (e.g., smoke, chemicals) may predispose the firefighter to earlier onset of heart disease [2]. Additionally, rates of hypertension, overweight, and obesity within the fire service exceed those seen in the general population increasing the baseline risk for a cardiovascular event [3, 4]. Fire suppression activities result in significant cardiovascular strain and provide potential triggers for ischemic events (e.g., myocardial infarction, stroke). There is a rapid rise in heart rate following the activation of a fire department which may persist for as long as 20 minutes [5, 6]. Even in cases where heavy work is not being performed, the repetitive upper body exercise associated with tool use raises heart rate disproportionately to oxygen consumption [7]. Finally, the heat