BACKGROUND: Firefighting is a strenuous job with high stressors, some of which can be potentially traumatic and can play a significant role in the overall well-being of first responders. These jobs require high levels of physical exertion, shift work, and unstructured sleep schedules all of which can put them at risk for cardiovascular disease, musculoskeletal injury, and mental health concerns. Moreover, the data collected for this study was during the COVID-19 pandemic, which had negative impacts on these risk factors. PURPOSE: The aim of this study was to track the changes in health variables among rural firefighters and to determine if the pandemic had an impact on any of the variables. METHODS: A cohort of 70 career firefighters from one southeastern fire department volunteered to participate in this study. The department participated in daily exercises as part of its health and wellness programming during their shift. Health variables were measured following the guidelines set by the National Fire Protection Association (NFPA) over time (2019-2023). A mixed model with repeated measures was employed to estimate the trend of health variables (Body Fat [BF], BMI, Systolic and Diastolic Blood Pressure [SBP, DBP], resting Heart Rate [rHR], Body Density [BD], and Abdominal Circumference [AC] while adjusting for age of the participants. RESULTS: A general observable trend is the deterioration in health variables during and following the occurrence of the COVID-19 pandemic and going back to the 2019 levels in 2023. More specifically, in 2020, the SBP was, on average 4.35 ± 1.73 mmHg higher in 2020 compared to 2019 (p=0.021). The average DBP measured in 2022 was 3.05 ± 1.49 mmHg higher compared to 2022 compared to 2019 (p=0.045, Effect Size [ES]=2.05). There is a statistically significant difference in rHR in for all the measurements compared to the 2019 one (2020 Difference [Δ] =+3.73 ± 1.61, p=0.024, ES=2.32; 2021 Δ=+8.87±1.62, p<0.0001, ES=5.48; 2022 Δ=+9.80±1.52, p<0.0001, ES=6.45; 2023 Δ=+8.14±1.65, p<0.0001, ES=4.93). AC was, on average, 2.22 ± 0.57 cm higher in 2021 compared to 2019 (p=0.0002, ES=3.89). BD decreased on average by 0.01 ± 0.002 g/cm2 (p<0.0001, ES=5) in 2020 and 0.014 ± 0.002 g/cm2 (p<0.0001, ES=7) in 2021 as compared to 2019. There is no statistically significant difference over time in BF and BMI. CONCLUSIONS: When comparing current results to those found around the onset of the pandemic, the health variables of these firefighters have generally declined. Across a 5-year span, there were significant fluctuations in health variables. Changes in the health variables may have been due to numerous factors, including the pandemic, changes in fitness policies, fitness incentive programming, and employee changeover. Tracking departmental health may give insight into the internal and external influences on firefighters' health.

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