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To the Rescue

Dr. Krueger answers alarm to reduce firefighters' risk for heart attacks

When he learned that firefighters have a 300 percent greater risk of heart attack than the average person, Steven Krueger, MD, put his heart and soul into preventing this statistic in Lincoln. 

"It isn't that there is something unique about my love of firefighters. I am passionate about their health because if they have a heart attack while fighting a fire or responding to a call, it may not be just the firefighter who goes down, but also your loved ones. So, my goal is to protect the firefighters who in turn will protect those who live in our community."

Dr. Krueger with firefighters
Dr. Steven Krueger works with Lincoln firefighters to reduce their risk of the number one killer of those in this occupation--heart attack.

Being a firefighter is a dangerous occupation, but few of us would think that heart attack is the No. 1 cause of death for firefighters. Not falling through a burned-out floor, not smoke inhalation, but heart attack. In fact, according to research by Rita Fahy, PhD, Paul LeBlanc and Joseph Molis for the National Fire Protection Association, firefighters have a six-times greater chance of having a heart attack than dying in a fire.

Dr. Krueger explains, "They have a very difficult job. They sit there, relaxed, and the buzzer goes off, and their adrenaline level shoots through the sky, and they are going 100 miles an hour and putting on 60 pounds of personal protective equipment and running into a fire and into smoke. After getting to know these guys, I consider them heroes. And our job is to not ever have one of our heroes go down on our watch."

"It's our motto," echoes Becky Gocke, RN, one of the three staff members dedicated to the program. "None of our heroes go down on our watch." The trio of Bryan Heart Institute cardiologist Krueger and RNs Gocke and Lori Heiss is extremely diligent in accomplishing this goal.

Dr. Krueger chimes in, "We are not going to sit here five years from now and say, 'If we would have just done this back then, we wouldn't be here now.' We are doing everything there is to do now to protect our firefighters."

The program

Three years ago, Dr. Krueger learned of research conducted by cardiologist Robert Superko, MD, on the risk of heart disease in firefighters. Dr. Superko, one of Dr. Krueger's professors during his internship and residency at Stanford University Medical Center in Palo Alto, Calif., was principal investigator in the landmark Federal Emergency Management Agency (FEMA)-sponsored study of firefighters and heart disease.

Though he was intrigued by how he could help the community through a program similar to Dr. Superko's - the only program focusing on genes associated with coronary artery disease - Dr. Krueger chose to implement a program which focused on risk factors.

The first step is for firefighters to fill out the HeartAware survey. (This free screening tool also is available online at to use to determine your risk of heart disease.)

After completing this initial step, the firefighters are taken through a one-on-one interview by a member of the program's dedicated staff. All information is evaluated using a point scale developed by Dr. Krueger to arrive at a reasonable idea of risk.

Once aware of risk factors, the team is very aggressive in encouraging firefighters to modify those factors and communicating with their primary care physicians. "Our goal is to do every single thing we can do now to prevent trouble two, five or 10 years down the line. We work with the firefighters' existing fitness programs to try to accomplish this goal together," Dr. Krueger says.

Firefighters Staying Healthy

Heart attack is the No. 1 cause of death for firefighters. Firefighters have a six-times greater chance of having a heart attack than dying in a fire.


Results so far

While too early to have statistical evidence of success, Dr. Krueger is positive the program has decreased the risk of most of the firefighters enrolled, and for some firefighters, the risk has been decreased a great deal. Out of the nearly 100 Lincoln firefighters who have taken advantage of this voluntary program, all but two individuals have shown at least some risk for heart attack.

"We have identified some participants at risk and found some significant coronary disease in others. A couple of those with significant disease did not have a clue that they were, to a certain extent, time bombs and we took the fuses out."

Dr. Krueger and his team receive many pats on the back from firefighters who have participated in the program. "He saved my life," says firefighter Dan Bare. "Dr. Krueger found I had two coronary arteries that were blocked." Though his family had a history of heart disease, at age 47, Bare had not experienced any symptoms. "My wife and I are so thankful for this program."

It is expected that at least one-half of the 270+ Lincoln firefighters eventually will participate in the program. "We are extremely grateful to Dr. Krueger and his team for taking on this community project for the firefighters of Lincoln," says Battalion Chief Jeanne Pashalek, president of the International Association of Women in Fire and Emergency Services.

"Dr. Krueger also is helping us to establish a bench mark on how our profession affects the health of women specifically," Pashalek adds.

Expanding to Greater Nebraska

"We are getting close to being ready to take this outside of Lincoln. The master plan was to start in Lincoln, tweak the program, take it to surrounding communities and then throughout the state," Dr. Krueger continues.

As a native of Lexington, Neb., and having offered heart clinics to patients throughout Nebraska and surrounding states since coming to Lincoln in 1988, he's seen firsthand the need for intervention in smaller communities.

"A volunteer firefighter in a small town might be the local banker who doesn't get regular exercise, so when that buzzer goes off their adrenaline spikes - and they could be at even a higher risk. There is a lot of interest in Greater Nebraska both from firefighters, themselves, as well as from family doctors," says Dr. Krueger.

"Our first step may be helping primary care physicians realize that voluntary firefighters are at such high risk."

To find out more about this project, contact the Bryan Heart Institute by calling (402) 483-3333. For information on how you can support cardiac care at Bryan Health, please call the Bryan Foundation at (402) 481-8605.

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