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Surviving the Fire Service

I had the honor of being the keynote presenter at the recent Aircraft Rescue & Firefighting Working Group & Airport Executives annual leadership conference. We discussed the fire service three-legged stool of preventable line-of-duty deaths and disabilities.

Sadly, we continue to lose members of the service to occupational health threats that are preventable with early recognition and intervention. These disease processes, forming the three legs of the stool, are cardiovascular health risks, occupational cancer exposures and threats, and behavioral health diseases, including suicide on the extreme end of the spectrum.

Cardiovascular Health Risks

We have learned through fire-service occupational health research that firefighters have a high prevalence of excess weight and obesity, often due to stress and poor nutritional habits as well as excessive alcohol usage. Research has also demonstrated high rates of hypertension and high cholesterol levels. In fact, untreated hypertension places firefighters at a 12-times greater risk of cardiovascular events.

We also know from autopsies that as high as 85% of firefighters who died in the line of duty from a cardiovascular event have an enlarged heart, a structural change often driven by obesity and untreated hypertension. We also know that for every line-of-duty death from cardiovascular event, about 17-25 firefighters suffer a nonfatal but disabling event.

This underscores the potential need for imaging to detect these changes and begin aggressive treatment.

Occupational Cancer Exposures and Threats

Occupational cancer has been the focus of the fire service to address changes in personal protective gear efficient at blocking particulate matter absorption.

Aggressive and early decontamination of skin, gear and tools reduces skin absorption, and skin wipes are one immediate point-of-contact way of removing particulate matter. This is important as body temperature increases and skin pores dilate allowing high rates of absorption of carcinogenic products into the body.

There are also controllable risk factors, such as weight and nutrition, sleep, moderation of alcohol use, to name just a few. The importance of annual early screening with NFPA 1582 fire service physicals was discussed and the importance of early detection.

In fact, many cancers identified in stage one at the original point of origin have very high survival rates compared to those in later stages that are found after spreading beyond their primary site.

Our department uses Life Scan Wellness Centers for NFPA 1582 physicals as well as ultrasound for early detection of cardiovascular changes and early cancer detection. The aggregate data results found significant early detection and survival.

Behavioral Health Diseases

Behavioral health is the third leg of the three-legged stool. Evidence has demonstrated that firefighters have poor sleep quality and rates of posttraumatic stress disorder as high as 37% of the service members. Research has demonstrated elevated rates of alcohol dependency and binge drinking as well within the fire service.

These create a constellation of risk factors for suicide, and the data suggests that is an occupational risk: as many as 49% of firefighters have considered suicide while 16% have attempted suicide at some point.

These realities underscore the need for behavioral-health support programs, such as peer support teams. Behavioral health screenings for early detection of members struggling are important and providing them assistance is essential.


The Safety Stand Down 2019 will focus on occupational cancer prevention. Agencies are encouraged to suspend all non-emergency activities during the week of June 16‑22 to focus on training and education related to this year’s theme: Reduce Your Exposure – It’s Everyone’s Responsibility.


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