FIRST RESPONDER PHYSIOLOGY: HEART

I’m sure you’ve heard some of the scary statistics surrounding the increased risks of cardiovascular disease (CVD) in emergency service personnel, but if you’ve somehow managed to avoid them, let me warn you – they don’t make for pleasant reading. 

"Australian police officers are 25% more likely to die from CVD than violent offenders"

Research in 2015 echoed findings from 16 years earlier which discovered that around 90% of paramedics had at least one lifestyle factor increasing their risk of cardiovascular disease, with overweight or obesity accounting for 78% [1]. In the US, sudden cardiac death is the leading killer of firefighters, with CVD accounting for “45% of all firefighter-duty-related fatalities” [2], and closer to home, Australian police officers are 25% more likely to die from CVD than violent offenders [3].   

Before we dig into prevention methods, it’s important to understand why first responders face increased risk. Your heart doesn’t know what kind of uniform you put on before you head off to work, so why are these statistics so prevalent among all of our emergency services alike? To put it simply, it’s a combination of occupational stress, physical activity, nutrition, lifestyle factors, and sleep, and they all form an interconnected network which influence one another.

Occupational Stress

"Police officers frequently respond to routine jobs such as domestic violence and concern for welfare checks that cause their heart rates to elevate above 100% of their predicted HR max."

I’d go out on a limb to suggest the stress experienced by a first responder during an average workday would eclipse the highest levels felt in most other occupations. Whether it’s the danger of the environment you operate in, the violent offenders you’re faced with, or the life-saving decisions you have to make, stress comes part and parcel with the job. A 2022 study from the Bond Tactical Research Unit on the Gold Coast found that police officers frequently respond to routine jobs such as domestic violence and concern for welfare checks that cause their heart rates to elevate above 100% of their predicted HR max. [4]. For context, this would be the exercise equivalent of collapsing to the floor after an effort on the echo bike with your heart beating out of your ears.    

The physiological result of these stress-inducing jobs is the release of cortisol, elevated heart rate, and sky-high blood pressure, all of which increases the overall burden placed on your cardiovascular system. Over time, stress itself can directly increase your risk of heart disease, but it also increases your likelihood of sedentariness, poor nutrition habits, and lifestyle factors such as smoking and excessive alcohol intake.   

Physical Activity

We’ve all heard that sitting is the new smoking. This is because general sedentariness is one of the leading health-related risk factors facing Australians across the board right now and as technology continues to infiltrate our daily lives, it’s only becoming more common. Even seemingly hands-on, physical occupations like firefighting, policing and paramedicine are suffering from too much sitting, and not enough movement.

"Operational firefighters spend on average 12.2 hours of their day sitting, and paramedics are reportedly 14% less physically active than the Australian general public."

Over sustained periods of sitting or lying down, the heart doesn’t need to work very hard to supply blood to the working muscles, and it weakens. It’s essentially the opposite of the higher demands that are required to strengthen the heart and cardiovascular system through aerobic training. So, when I tell you that operational firefighters spend on average 12.2 hours of their day sitting [5], and paramedics are reportedly 14% less physically active than the Australian general public, alarm bells should be ringing.

Even with daily intentional exercise, sedentariness can contribute to the risk of CVD, particularly when increased sedentariness correlates with poor nutrition.   

Nutrition

First responders spend a lot of their time on the road or away from their station, meaning food storage, access, and timing are all barriers to nutrition. As a result, convenience often outweighs health, and instead of pre-packing a balanced, nutritious meal and snacks, it’s a quick detour to the closest Maccas when time allows.

Add the fact that being on the road after 2200 severely limits the available options, and that quick insulin spike from some lollies or chocolate temporarily keeps the sleepiness at bay, and I absolutely understand why this is a tough hurdle to overcome. Instead of fuelling with low GI carbs for a sustained release of energy, fibre and protein for satiety, and fruit and vegetables for micronutrients, it’s foods high in saturated fat, LDL cholesterol, simple, processed carbohydrates, and sodium. These foods directly lead to plaque buildup, high blood pressure, fluctuations in blood sugar, and weight gain, all of which significantly adds to the cardiovascular burden.

Lifestyle Factors  

In 2018, Beyond Blue published the results of a national survey of Australian first responders that revealed almost 50% of the subjects consume alcohol in excess of the national guidelines for short-and long-term health [7]. Although Australian data is limited, surveys from the U.S. show 31% of their first responders vape, 22.2% smoke cigarettes, and 11% use both [8], while global data suggests that police officers smoke at a significantly higher rate than the general population [9].

Alcohol and tobacco consumption is closely linked to mental health, and the high rates among first responders goes hand-in-hand with high rates of PTSD. Front and centre among the multitude of health conditions caused by alcohol and tobacco is CVD, as they can both damage blood vessels, heart tissues, and raise blood pressure. Not only that, but alcohol consumption can affect sleep quality, which is already an uphill battle for most first responders. 

Sleep

"Most people know that the average adult requires 7-9 hours of sleep per night, but a sleep routine and consistent sleep time are just as important."

Sleep is an often-overlooked aspect of health, and for first responders it’s usually the first thing sacrificed in order to fit in some physical activity, social connection or leisure time. Unfortunately, it is just as important, if not more so. Both sleep duration and sleep length are heavily linked to blood pressure, heart rate and overall inflammation which are major factors influencing CVD. Most people know that the average adult requires 7-9 hours of sleep per night, but a sleep routine and consistent sleep time are just as important which is bad news for those on a 24-hour roster.

While there are inherent challenges with sleep and emergency service occupations, the typical first responder is still leaving a lot on the table. Sleep may well be the nucleus of our five CVD risk factor categories, because by making relatively minor changes to one, your sleep can benefit significantly.

Interventions

Whether it be a poor lifestyle habit, occupation-related, or an unlucky roll of the genetics dice, the average first responder carries increased CVD risk, but here are four simple strategies which positively influence your heart health that you can implement today.

1.    Use physical activity as a stress management strategy:

In his book ‘Emotional Survival for Law Enforcement’, Dr. Kevin Gilmartin talks about the impact of the sympathetic/parasympathetic pendulum, or the ‘Hypervigilance Rollercoaster’ as he calls it. One of his key tips is to complete 20-minutes of cardiovascular activity post-shift to reset your autonomic nervous system and allow your body to decompress.

Not only is physical activity after a shift a great way to reset, but high intensity interval training can be an excellent stress inoculation tool. Short bouts of high intensity cardio pushing you close to your predicted HR max. allows your body to operate in that high stress zone in a controlled, low-consequence environment, meaning the next time the job takes you there, you’ll have experience dealing the physiological symptoms.

Finally, every minute you dedicate to your occupational stress management is one step closer to the weekly goal of >150-min of moderate-to-high intensity exercise recommended by the WHO to decrease the risk of early mortality.

You can read more about the benefits of physical activity for first responders here

2.    Main meal check list: protein, carbs and colour:

Perfecting the balance of macronutrients, micronutrients and calorie intake for each meal can be tricky, so make it simple with a main meal check list of protein, carbs and colour. Your goal for every meal should be to include a serving of protein, a serving of carbohydrates, and a serving of colour.

Protein fuels muscle growth and repair which is valuable from a physical performance aspect, but it also takes time to break down and leaves you feeling full for longer. Combined with starchy, low-GI carbohydrates for prolonged energy release and a serving of colour (fruit or vegetable) for fibre and micronutrients, and you have a meal to sustain you for hours, meaning you won’t be so reliant on caffeine and sugar to keep you alert late in the shift.

Keep in mind – different colours contain different micronutrients, so do your best to eat the rainbow throughout the day.

3.    Establish a sleep sanctuary and bedtime routine:

The low-hanging fruit for most first responders when it comes to increasing the health benefits of sleep is improving its quality. This begins 6-hours before bedtime when caffeine intake should stop.

Then, 1-hour before bed, light sources are turned off or at least minimised (dimmed or lamp light only) and high-stimulation activity is avoided as much as possible. Turn off screens, video games, loud music, social media, and TV in favour of reading, taking a shower, or some light physical activity. Any meals close to bedtime should be small and easily digested.

When it comes to the sleep sanctuary, the goal is to create an environment that encourages sleep. Shut out light and noise, keep your phone face down and on silent, ensure the room is cool and spend a maximum of 20-minutes trying to fall asleep before getting up, doing some light activity, and trying again.

4.    Combine physical activity, leisure time and social connection:

Frontline first responders will often dedicate days or weeks at a time to the job, completely neglecting their own wellbeing, and then try to maximise their days off by squeezing everything into a short timeframe. As mentioned above, in an attempt to catch up with friends, fit in a workout and have time to themselves to relax, this can result in an early morning and a late night at the sacrifice of good sleep.

Look for opportunities to maximise your time and ensure you can prioritise sleep and recovery. Instead of carving out time for them all individually, find ways to combine your exercise, relaxation and socialisation. For example, take the dog for a run with a friend and finish at the café for a coffee. This is a great way to look after your physical and mental health simultaneously without making sacrifices along the way.

Cardiovascular health is a critical concern for first responders, whose unique occupational demands expose them to elevated risks far beyond those faced by the general population. Stressful environments, irregular sleep patterns, poor nutrition, and prolonged sedentary periods create a perfect storm for cardiovascular disease. While these challenges are inherent to the job, they are not insurmountable.

By prioritising proactive strategies—such as using exercise to manage stress, adopting simple nutrition principles, improving sleep hygiene, and integrating social connection with physical activity—first responders can significantly reduce their risk and enhance overall well-being. Small, consistent changes in daily habits can yield profound long-term benefits, not only for heart health but also for mental resilience and operational performance.

Ultimately, protecting your heart is not just about longevity; it’s about sustaining the strength and readiness required to serve your community effectively. Your health is your most valuable asset—invest in it today to safeguard your future.

References:

1.      Hegg-Deloye, S., Brassard, P., Prairie, J., Larouche, D., Juarvin, N., Poirier, P., Tremblay, A., Corbeil, P. 2015, ‘Prevalence of risk factors for cardiovascular disease in paramedics’, International Archives of Occupational and Environmental Health, pp. 1-8.

2.      Jeung, Da-Yee, Hyun, Dae-Sung, Kim, Inah, Chang, Sei-Jin 2022, ‘Effects of emergency duties on cardiovascular disease in firefighters’, Journal of Occupational Environmental Medicine, vol. 64, no. 6, pp. 510-514.

3.      Police Health, ‘Heart attacks: in the top 5 causes of police officer deaths. The statistics are alarming’.

4.      Decker, Amy, Hinton, Ben, Dawes, Jay, Lockie, Robert & Orr, Rob 2022, ‘Physiological demands of common occupational tasks among Australian police officers: a descriptive analysis’, Bond University Tactical Research Unit.

5.      Vancampfort, Davy, De Soir, Erik, van Winkel, Ruud, Louw, Quinette Abegail, McKeon, Grace, Rosenbaum, Simon, Seedat, Soraya & Ramos-Sanchez, Carlos Pelayo 2023, ‘Physical activity, sedentary behaviour and mental health outcomes in firefighters: a cross-sectional study’, Journal of Workplace Behavioral Health, pp. 1-18.

6.      Sheridan, Samantha 2019, ‘Paramedic health status, fitness and physical tasks: a review of the literature’, Australasian Journal of Paramedicine, vol. 16, pp. 1-7.

7.      Beyond Blue 2018, ‘Answering the Call’.

8.      Gross, Shifra Leah 2021, ‘Vaping, smoking, dual use, and stealth vaping/smoking among first responders: law enforcement, firefighters, and paramedics/emergency medical technicians (EMT)’, Florida Institute of Technology.

9.      Sayampanathan, Andrew, Wei En Ong, Jordan, Ng, Yih Yng, Liu, Jiaming, Arulanandam, Shalini, Ing Hee, Hwan 2025, ‘Prevalence and factors associated with cigarette smoking in police forces: a systematic review and meta-analysis’, Policing: An International Journal, vol. 48, no. 3, pp. 580-609.