Iowa Firefighters Push for Mandated Cardiac Testing
Ames Tribune, Iowa
June 17—Angie Buser knows she can't dwell on the "what ifs" surrounding her husband's unexpected death last year, but she admits that doesn't necessarily mean those thoughts don't cross her mind occasionally.
She still wonders how Steve Buser, the man considered "the picture of health," could have died from a cardiac issue at age 51, especially when many departments do regular cardiac stress tests for the firefighters once they hit age 40. Well, the answer to the second part of that question is the Ames Fire Department, for at least the last five years, has not mandated cardiac stress tests for firefighters over the age of 40.
All of this has led to even more questions from Angie, as well as several members of the Ames Fire Department, which they all hope sparks a conversation that will eventually lead to department-wide changes in dealing with cardiac health in firefighters.
"I knew right after Steve died, I was like, 'Oh they don't do that cardiac stress testing anymore,'" Angie said. "From the very beginning, I thought that if anything's going to come of Steve's death, I really wish that they would reimplement these tests."
Steve Buser was found unresponsive in the Fire Station No. 2 gym on the morning of Friday, March 17, 2017. And from day one, Angie said in addition to all the other emotions during that grieving period, she was angry, because well before that day last spring, Angie had heard Steve express his concerns on this issue countless times.
"He's voiced concerns all along about the decisions that had been made the past few years, and felt like the firefighters are just a number and not people anymore," Angie said. "There was no open discussion about anything; it was just, 'here's what we're doing,' period."
According to the National Fire Protection Association, sudden cardiac death accounted for 38 percent of firefighter fatalities in 2017, which is tied for the leading cause along with internal trauma. The NFPA said that number is usually around 45 percent compared to only 15 percent in conventional jobs. This is why the NFPA recommends thoroughly screening for, and aggressively treating, all cardiovascular disease risk factors.
The NFPA advises that certain risks such as ischemia—an inadequate blood supply to the heart muscles—are best evaluated by an imaging exercise stress test at age 40 or earlier.
According to the NFPA, an exercise stress test is just one diagnostic test to a persons' fitness for duty that is part of a comprehensive evaluation that includes diagnostic testing, personal medical history and other indicators of health status.
Iowa Professional Fire Fighters President (and former president of Ames Professional Firefighters Local 625) Doug Neys said all firefighters are mandated to undergo a cardiac stress test when they are hired. But given that the NFPA provides standards and not laws, departments can vary on what specific standards they choose to follow.
"Many departments are compliant with what's on the trucks, and our boots and gear, and all those kind of things, but we seem to fall short with NFPA compliance on a number of things including the fire department physicals," Neys said. "I wouldn't expect every city to be 100 percent compliant with every NFPA standard, however the ones that you can be, that are financially attainable, you should be at least at that minimum."
According to Neys—who has been with the Ames Fire Department since 2001—under former Fire Chief Clint Peterson, physicals for firefighters over the age of 40 included a cardiac stress test. Though he said the department was closer to compliance then, even he admits they weren't 100 percent compliant.
Peterson retired in 2012, and in early 2013, under now former Fire Chief Shawn Bayouth, Neys said he had firefighters approach him saying they hadn't yet received their cardiac stress test. Neys said he went into Bayouth's office to make the chief aware of what the firefighters were saying, to which Neys said that Bayouth replied the test was no longer needed.
"Through that test monitoring, we have actually saved firefighters, caught something early, which without potentially could have led to their death or injury to themselves or citizens," Neys said. "I thought it was inappropriate that there was no consultation with the local members of the employee group for these changes."
Neys said at the time he talked with other members of the employee group about filing a grievance, but that initiative ended up stalling. Fast forward to last fall, Neys again approached Bayouth about his same concerns, and once again was not heard.
Bayouth served as fire chief from 2012 until leaving for a position with Arkansas State University in Jonesboro, Ark. this past April.
Attempts to reach Bayouth for comment were unsuccessful.
Neys said he and other firefighters have spent years trying to reinstate these tests, which he said gained a lot more traction and interest following Steve Buser's death. But now Neys, and even Angie Buser, said they see a light at the end of the tunnel.
Shortly after Bayouth left, former Deputy Chief Rich Higgins was appointed the interim chief, and talks about the cardiac screening resumed.
Ames Firefighter Tim Hansen—who said he actually spoke to Steve Buser about this very topic the night before he died—said that from the start, Higgins seemed onboard with moving this process forward and that Higgins' prioritizing of this issue has really impressed him and many others in the employee group.
"We've made more progress in the last month than we've made in the past five years with the administration on this," Hansen said.
When interviewed, Higgins only said it was in the "preliminary stages" and that they were re-evaluating their entire process. Higgins said the safety and wellness of firefighters is his top priority, and the department is working hard to ensure that when implementing NFPA standards, they "get it right."
"It's really early on so I'm not going to be able to paint a good picture for you right now, but there are a lot of really great things happening," Higgins said.
Steve's brother Dan is a lieutenant with the Iowa City Fire Department, which he said is in a similar situation in that cardiac stress tests are not mandated unless a firefighter displays symptoms—even then the test is conducted by the person's own physician. But the difference between Iowa City and Ames, Dan Buser said, is that to the best of his knowledge, the Iowa City Fire Department has never conducted mandatory cardiac stress tests (other than that initial test), regardless of age.
As a firefighter who would qualify for an annual test (Dan is 55), and as the brother of a firefighter who died as a result of cardiac issues, he said he is 100 percent behind conducting these tests regularly, regardless of age.
"This is just one of those jobs where you come from 0 to 100 miles-per-hour at the sound of tones going off," Buser said. "It's a great job; it's the best job in the world, but it's not the most cardiac friendly."
One of the biggest issues related to the screenings is the cost. Though no specific cost was given, Neys said the test usually runs around $200, and with 50-some firefighters in the department, annual screenings can add up.
As Dan Buser spoke more about his brother, he emphasized how as one of nine children the family considered Steve to be the healthiest. Dan said he continues to disbelieve that something like a cardiac problem could go undetected with his brother.
And unlike Angie and Neys, Dan said he is convinced the test would have made a difference with his brother and he hopes for the sake of other firefighters and their families that this becomes a top priority at all departments.
"I hate to say it, but I have pretty strong feelings that if that had still been in place, something would have been caught with my little brother," Dan Buser said. "They would have seen some sort of preliminary blockage of something, and he would have acted on it."
Though Angie Buser cannot say if the test would have saved her husband's life, she said she has no difficulty using his death as an example, and hopes it can serve as a catalyst for change within the department.
"Steve would want this for other people," Angie said. "This is the worst thing that could happen, so let's learn from it and do something good for other people."