Surviving the fire service – what we know

The fire service has evolved into an “all-hazards” provider of service to protect the public which it serves. Modern hazards include terrorism, biological, chemical, nuclear and explosive traditions in addition to more traditional “bread and butter” core services of fire prevention, extinguishment and emergency medical assistance.

Fire service occupational risk has been documented through a number of different mediums including the United States Fire Administration (USFA), National Institute Occupational Safety & Health (NIOSH) and industry associations such as the International Association of Firefighters (IAFF) and the National Fallen Firefighters Foundation (NFFF), although opportunities exist for national tracking registries as have been recently created with the establishment of a “national cancer registry”. While opportunities exists for more robust data collection systems on fire service occupational health, we have gained an understanding that three of the leading threats to surviving your fire service career resolve around elevated risks of certain types of cancers when compared to general population controls as determined by a NIOSH study of over 30,000 firefighters in three large United States metropolitan cities (Philadelphia, Chicago, San Francisco). Annually, the USFA reports on fire service line of duty deaths (LODD) and historically over fifty percent are cardiovascular related with the majority of those occurring on the fire ground despite that activity accounting for a fraction of daily activities. With inconsistent reporting mechanisms, the fire service has also come to realize elevated risk and prevalence of behavioral health disorders with the most severe manifestation being attempted or completed suicide. NFPA estimates firefighters also suffer more than 71,000 injuries annually – some of which are career ending. Most of these occupational threats are able to be managed and mitigated with specific strategies aimed at addressing environmental, health and wellness behaviors, interventions and risk reduction strategies.

Research has demonstrated chronic exposures to heat, smoke and toxic flame retardants through inhalation, ingestion, and skin absorption place firefighters at elevated risk of certain cancer types when compared to non-firefighters. In particular, the largest NIOSH study of fire service occupational cancers demonstrated higher rates of certain types of digestive, oral, respiratory and urinary cancers in firefighters versus general populations. These realities are still being better defined by ongoing continuous research in the areas of personal protective equipment and barrier protection standards, early decontamination practices and proactive facility and apparatus design to limit carcinogenic contaminant exposures and early detection practices enhancing survivability from identified cancers. European fire services have reported on the “skelleftea” model that focuses on healthy approach and decontamination of firefighters and resources immediately post exposure. Within the United States, various levels of post exposure decontamination have been implemented uniformly such as “gross decontamination” of gear and skin, utilization of cleansing wipes in limited studies demonstrating a fifty (50%) decrease in absorption and finer decontamination procedures. With elevated core body temperatures enhancing rates of skin absorption, the earlier these practices are implemented the greater the ability to prevent carcinogenic particulate matter from being absorbed into the blood stream and organs.

Early preventative screenings and firefighter specific medical exams are critical to early detection, early treatment and successful outcomes for cancer. The National Fire Protection Association has developed standard 1582 on the examination of firefighters and provides a reference to address occupational health threats. In addition the International Association of Fire Chief’s Safety, Health & Survival Section (IAFC) published “A Healthcare Provider’s Guide to Firefighter Physical’s” which recommends appropriate colon screening beginning at age forty, annual PSA with digital rectal exam between ages 40-45, annual pap smear, annual mammograms at age forty, annual testicular, head to toe skin examinations as well as annual urinalysis for microscopic hematuria (blood in the urine). Additionally, additional non-invasive imaging studies have been utilized as early detection methods. The IAFC has focused on a “get seen, be screened” and “Get Checked” awareness campaigns to elevate the importance of receiving firefighter specific annual medical physicals.

Significant cardiovascular demands of firefighting lead to acute coronary events leading to nearly 50% of all on-duty firefighter deaths annually compared to 15% of all deaths among more conventional occupations. Stressors of the occupation may also be responsible for higher prevalence of weight gain and obesity, elevated blood pressures, diabetes, and other metabolic factors that may further elevate cardiovascular risk coupled with the inherent heat stress, dehydration and strenuous aerobic and metabolic demands of the essential tasks of firefighting. The IAFC Providers Guide recommends through screenings for cardiovascular risk factors and aggressive treatment of those identified to manage or reduce preventable risk. In particular the Provider’s Guide from the IAFC recommends additional, non-invasive imaging diagnostic imaging tests are recommended for early detection of coronary artery disease and cardiac structural abnormalities.

Published evidence based research has demonstrated higher levels of behavioral health disorders. The mental and physical stressors of firefighting and repeated exposure to trauma may lead to depression, anxiety, acute stress reactions, and post-traumatic stress disorder and suicide ideation. Self-medication with alcohol and drugs is common as coping mechanisms. Published has cited rates of Post-Traumatic Stress Disorder upwards of 37% in firefighter populations. Further published work has demonstrated a 46.8% of firefighters studied have considered suicide with 15.5% reporting to have attempted suicide over the course of their service. These levels are troubling and elevated compared to general population. Further work has demonstrated a prevalence of sleep apnea, insomnia, shift-work disorder and restless leg syndromes. These sleep disorders are linked to increased risk for cardiovascular disease, diabetes, depression and anxiety. The IAFC Healthcare Providers Guide highlights recommended specific behavioral health and sleep disorder screening tools. It is imperative to have multiple safety networks in place to address behavioral health support and “healthy sleep”. Examples of approaches have included peer support programs, post traumatic growth programs, awareness training and health resources that are not punitive and demonstrated the importance of early identification, recognition and support.

Finally, with in excess of 70,000 annual injuries recorded, we know the high intensity and dynamic work environment of firefighting leads to such a high incidence of musculoskeletal injuries. Low back injuries represent approximately 50% of all job related musculoskeletal injuries among firefighters. Sprains, strains, disc injuries are common. We also have demonstrated with the published fire service research that obesity and deconditioning are strong predictors of musculoskeletal injury. Addressing weight loss and maintenance programs have been demonstrated to reduce injuries as well as establishing human performance and tactical athlete programs focusing on range of motion, lower back strengthening and flexibility along with core muscle enhancement exercises. An excellent is the joint IAFF/IAFC Wellness Fitness Initiative to design programs addressing occupation injury and disability.

While firefighting no doubt will remain and inherently dangerous profession, we continue to evolve our understanding of the occupational risks which we are exposed to and threated with. This empiric data population will continue to assist with the development of risk mitigation strategies that will manage preventable risk and enhance the safety, health and survival of members of the global fire service. There is no doubt that ongoing research and data analysis will touch nearly every corner of the fire service as we understand it and guide our decision making and practices for greater efficiency and effectiveness – while at the same time assuring we “ Survive the Fire Service”.

For more information, go to www.iafcsafety.org