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Firefighters cannot avoid all risks. We must control health risk factors that are modifiable.

An unfair hand

Most of us enter the fire service knowing that danger and risk are inherent parts of the job. We know that we will be exposed to heat, smoke, and flame, but many do not realize the hidden dangers that we face far away from the fireground.

Becoming a firefighter is a choice. But it is a choice that comes with a requirement to fully commit to the higher standards that come with the profession, regardless of whether you are paid or volunteer. As David J. Soler shares in the book Firefighter Functional Fitness, “The deck of cards is stacked against firefighters and their health. When we took the firefighter oath, we never knew that our life expectancy would automatically be reduced by the hazards that confront us. Take your pick: Heart disease, obesity, diabetes, cancer, inhalation hazards, dehydration, overexertion, heat stress, sleep deprivation and disorders, traumatic and thermal injuries, psychological and emotional stress, PTSD, infectious disease, physical assault…. On and on, the list of hazards and ‘career side effects’ continues with almost no end in sight.”1  

Like it or not, as a firefighter, you have been dealt an unfair hand. This requires you to develop the mental, physical, and emotional skills necessary to perform in arduous situations, but also to recognize and take action to reduce your risk of death or injury due to “stress and overexertion.” It is in this realm that we suffer the most line-of-duty deaths (LODDs), and it is also where we can have the most productive effect on reducing that number.

Year after year, statistics have shown that the number one cause of US line-of-duty deaths fall into the United States Fire Administration’s (USFA) stress and overexertion category. It is within this category that the elephant in the room lies: sudden cardiac death.

We invite you to visit usfa.fema.gov and perform a quick search of line-of-duty death statistics. Unfortunately, what you will find is that the overall percentage of cardiac-related LODDs has remained unchanged for decades upon decades. Regretfully, we can say with confidence that the American fire service will lose 40-50 on-duty firefighters annually because of heart attacks and strokes.

In order to fully prepare yourself for the job of firefighting, you must look beyond firefighting strategies, tactics, and skills. You must commit to a career that includes a lifestyle of fitness and health as your foundation. In short, you must accept the fact that being fit for duty is a requirement of the job, and you must take action to get fit and stay fit.

Strenuous firefighting and your body

L.B. Rowell, in Human Cardiovascular Physiology, lamented: “Probably the greatest stress ever imposed on the human cardiovascular system is the combination of exercise and hyperthermia. Together, these stresses can present life-threatening challenges, especially in highly-motivated athletes who drive themselves to extremes in hot environments.” To be blunt: You are a professional, occupational athlete. And there is no better example of exposing a human body to such a drastic and simultaneous combination of high-intensity exercise (work) and hyperthermia that that of a firefighter.

Any firefighter who has put in work on a tough fireground can relate to how it feels to punish the body. Sore muscles, fatigue, and even sheer exhaustion are commonplace. But did you know that strenuous firefighting affects every body system?

Strenuous firefighting affects every body system.4

Strenuous firefighting affects every body system.

Your risk factors

According to Dr. Stefanos Kales and the International Association of Firefighters (IAFF), firefighters face the following increased risks of sudden cardiac death while participating in firefighting activities:2

Obesity: 3.1 times greater odds

Hypertension: 12 times greater odds

Diabetes: 10.2 times greater odds

High cholesterol: 4.4 times greater odds

Smoking tobacco: 8.6 times greater odds

Over age 45: 18 times greater odds

Prior diagnosis of heart disease: 35 times greater odds

While there are some risk factors no one can control, obesity, hypertension, diabetes, high cholesterol, heart disease, and tobacco use are controllable, preventable, and treatable. It is here where we have traditionally underperformed.

We strongly encourage younger firefighters to start their “fitness journey” early on in their careers. Making health and fitness fundamental priorities will continuously reap dividends for the entire duration of a firefighter’s career. For those firefighters who have been in this job for a while and may have neglected their health, let this be a reminder – it is never too late to start your fitness journey. At any phase in your career, any small, positive step you take will put you on the path to success and greater career longevity. Take action – your life depends on it! Here are some simple steps to get you started:

  1. Start small. Focus on your strengths and work slowly to develop your fitness by adding small challenges to your routine, remembering to celebrate your successes, no matter how small.
  2. Make your fitness goals S.M.A.R.T goals. Specific, measurable, attainable, realistic, and timebound objectives that are written down will help you to stay on track.
  3. Stick to your plan–if you decide that it is realistic to train three times a week, then train at least three times a week, no matter what.
  4. Make a small, positive change to your nutrition and hydration habits every week. For example: One less soda a day, one more glass of water a day; one less serving of potato chips, one more serving of vegetables a day.
The strenuous work of firefighting continues long after the fire is extinguished.

The strenuous work of firefighting continues long after the fire is extinguished.


Being fit for duty means more than just “working out.”

In the fire service, our approach to carcinogen exposure protection on the fireground is largely based on thermal protection and “wearing our air.” And while these measures make sense and are absolutely critical, the very construction of a firefighter’s protective ensemble exposes them to a whole host of carcinogens. This is now proven to dramatically increase a firefighter’s risk of being diagnosed with cancer at some point in their lifetime. In the Boston Fire Department for example, statistics show that 6 of every 10 firefighters will at some point be diagnosed with some form of cancer.3 Beyond the fireground smoke, other carcinogen exposures include diesel exhaust, post-fire activities (cleaning tools and equipment), and wearing contaminated turnout gear and duty uniforms which have been exposed to carcinogens.

The Journal of Occupational and Environmental Medicine (2006) provides these examples of elevated cancer risk in firefighters:

Testicular cancer: 102%

Skin cancer: 39%

Stomach cancer: 22%

Multiple myeloma: 53%

Brain cancer: 32%

If your fire department does not have a cancer prevention standard operating procedure or guideline, consider creating one. Here are some best practices to include: 

  • For any smoke exposure, mandate wearing respiratory protection during firefighting operations and during overhaul.
  • Have firefighters remove all contaminated turnout gear and personal protective equipment (PPE) as soon as possible.
  • To remove surface carcinogens, have members use body wipes on the most vascular areas of their skin – face, jaw, neck, armpits, hands, arms, and groin (if possible).
  • While on scene (and before eating any food), wash hands and face with water and a degreasing soap.
  • Wet contaminated PPE with a hose spray. This will remove some surface contaminants and minimize off-gassing from the gear.
  • Transport gear back to the station in a large, sealed trash bag or outside the fire truck’s passenger compartment.
  • Once back at the station, shower as soon as possible with a degreasing soap, wash contaminated PPE and personal clothing, and clean contaminated equipment (SCBA, tools, thermal imaging camera) with soapy water.
  • Rehydrate aggressively over the next 24 hours to give your body the opportunity to flush carcinogens from vital organs.

Get checked

One of the most important things you can do to increase your odds of staying healthy is to participate in annual medical evaluations appropriate for the job of firefighting. Whether provided by your employer or not, medical evaluations are essential to every firefighter, and they must include comprehensive cancer screening as well as the other components required by NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments. If your fire department does not provide medical evaluations, download the International Association of Fire Chiefs’ FREE Healthcare Provider’s Guide to Firefighter Physicals, and take it to your doctor to receive a proper examination.

Mental stress

Everything is connected.

What we physically experience on and off the fireground will affect our mental well-being, and vice versa. The importance of monitoring our own mental health as well as looking out for our brothers and sisters cannot be overstated. In 2016 alone, the Firefighter Behavioral Health Alliance verified 132 firefighter, emergency medical service, and law enforcement suicides in the U.S. and Canada. While many departments have employee assistance programs (EAP), how many have counselors who are trained to understand the cumulative traumatic effects faced by emergency responders?  

You must remember that above all else, you are a human being. Becoming a firefighter does not change the fact that the things you have seen will leave a lasting mark on you. Proactively addressing cumulative traumatic stressors associated with the job is a key element of a comprehensive health and wellness program. Engaging in a regular fitness program is proven to reduce stress and depression. Finally, getting out of the firehouse and allowing yourself the time you need for recovery, rest, and recreation is imperative to help you maintain your “edge.”


To be an emergency responder, you must commit. And commitment goes far beyond mastering fireground skills. We control what we can control on the fireground, knowing that even if we do, something tragic may occur–this is a risk inherent with the job. But we have a lot of work to do in controlling the risk factors that have been proven to increase our risk of a sudden cardiac event, cancer diagnosis, or mental and emotional stress. You made the choice to become a firefighter. You must also make the commitment to live up to the oath you swore, both on and off the fireground.

Take care of yourself, so that you can take care of others.

For more information, go to www.FirefighterFunctionalFitness.com and www.nvfc.org


  1. Kerrigan, D. & Moss, J. (2016). Firefighter Functional Fitness: The Essential Guide to Optimal Firefighter Performance and Longevity. Firefighter Toolbox LLC. Trabuco Canyon, CA.
  2. International Association of Firefighters. (2013). Heart Disease in the Fire Service. Retrieved from: https://www.iaff.org/hs/PDF/HeartDiseaseManual_2013.pdf
  3. MDM Publishing, Ltd (2016). Boston FD and embryo creative: Working together to raise firefighters awareness of cancer risks. Retrieved from: https://gulffire.mdmpublishing.com/boston-fd-and-embryo-creative-working-together-to-raise-firefighters-awareness-of-cancer-risks/
  4. Smith, D.L., Liebig, J.P., Steward, N.M., Fehling, P.C. (2010). Sudden Cardiac Events in the Fire Service: Understanding the Cause and Mitigating the Risk. First Responder Health and Safety Laboratory, Skidmore College.
Written by

Dan Kerrigan and Jim Moss are the co-authors of Firefighter Functional Fitness. It is the essential guide to optimal firefighter performance and longevity. It provides all firefighters with the knowledge, tools, and mindset to maximize their fireground performance, reduce their risk of injury and line-of-duty death, and have long, healthy careers and retirements.

Dan Kerrigan and Jim Moss are the co-authors of Firefighter Functional Fitness. It is the essential guide to optimal firefighter performance and longevity. It provides all firefighters with the knowledge, tools, and mindset to maximize their fireground performance, reduce their risk of injury and line-of-duty death, and have long, healthy careers and retirements.

Dan Kerrigan

Dan Kerrigan and Jim Moss are the co-authors of Firefighter Functional Fitness. It is the essential guide to optimal firefighter performance and longevity. It provides all firefighters with the knowledge, tools, and mindset to maximize their fireground performance, reduce their risk of injury and line-of-duty death, and have long, healthy careers and retirements.

Jim Moss

Photos courtesy of Lauralee Veitch and graphic courtesy of Denise Smith.

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