Firefighters last year were more likely to die on-duty from heart attacks and vehicle crashes than fire-related trauma, according to preliminary findings by theNational Fire Protection Association (NFPA).              The findings, which follow a long-standing trend, were presented today at the NFPA's World Safety Conference and Expo in Las Vegas.

Last year a total of 102 firefighters died on-duty, says Rita F. Fahy, manager of the NFPA's Fire Data Bases & Systems.

Of those deaths, 37 percent were attributed to sudden cardiac arrest. The other leading causes of death for firefighters were internal trauma (28 percent), asphyxiation (23 percent), and burns (4 percent).

Most of the internal trauma deaths, Fahy says, resulted from vehicle crashes as firefighters responded to or returned from calls. In more than two-thirds of fatal crashes, the firefighters who died were not wearing a seat belt. Many of the fatal crashes, 37.6 percent, occurred in the firefighters' personal vehicles, while most of the dead, 68.2 percent, were volunteer firefighters.

Dr. Thomas Hales, an epidemiologist who investigates firefighter fatalities for the National Institute for Occupational Safety and Health (NIOSH), said that firefighters performing fire suppression activities are 64 more times likely to suffer a heart attack than when they're at the fire station.

"There is something about firefighting that taxes the heart," Hales said.

Hales cited a an old study from 1975 that monitored the heart rate of firefighters when responding to alarms. After a fire alarm sounded, firefighters' heart rate shot up from around normal to over 140 beats per minute, dropped back down to around normal when firefighters traveled to the fire, and then skyrocketed up again to about 160 beats per minute when firefighters arrived at the scene.

Firefighters over age 60 were particularly vulnerable to fatal heart attacks while on-duty, but Hales says this statistic alone should not be used to discriminate against older firefighters and take them off the front lines of firefighting.

Smoking, obesity, high blood pressure, high cholesterol, and diabetes are more important—and controllable—risk factors for heart attack. According to NIOSH case studies, over 90 percent of those firefighters who died of a heart attack had one of those five risk factors.

Moreover, fire departments aren't helping matters, Hales said.

Only 57 percent of fire departments require periodic medical evaluations, he says, while only 21 percent require an exercise stress test to screen for heart disease. On the issue of health and fitness, 39 percent of fire departments have a wellness program, while only 9 percent have a mandatory fitness program.

These numbers are paltry considering the NFPA provides  medical program andhealth-related fitness programs guidelines for fire departments, Hales said. While NIOSH issues recommendations regarding these programs to fire departments, it is only a research agency and has no authority to ensure its recommendations are followed.

Last year was also a particularly deadly year for career firefighters. Of the 102  total firefighters who died last year, 42 were career firefighters. The unusually high high total, Fahy says, resulted from a fire in Charleston, South Carolina, last year that killed nine firefighters, the largest multiple-firefighter fatality incident since 9-11.