It’s no secret that firefighters are subject to health and safety risks.

As a result, they wear and carry protective equipment intended to mitigate such risks.

Nevertheless, when you add up all the hazards firefighters face over the course of their careers, it may not come as a surprise how adversely many firefighters are impacted by the time they get to retirement.

The good news is that improvements in fire safety have made it rare for a firefighter to be killed directly by the flames of a fire. The bad news is that firefighting is still dangerous. The realities of firefighter health and safety include sickness and death caused by a number of factors related to a firefighting career.


One of the primary risks for firefighters is heat injury, which in certain cases can turn fatal if not alleviated. This is further exacerbated by a necessity to wear heavy, insulated clothing, as protection from fire.

Of course, excess heat can affect any person, whether a firefighter or not. But firefighters are exposed to more extreme heat than most non-firefighters.

Heat stress impacts a firefighter’s ability to think clearly. When this occurs while operating in a dangerous environment — such as in a burning building — the risks to oneself and others become magnified.

Related to heat injuries is developing rhabdomyolysis, which is the breakdown of muscle tissue and has many causes including heat exposure, high core body temperature and prolonged, intense exertion. Some symptoms may include muscle pains, weakness, vomiting and confusion. Routine firefighter tasks, such as carrying extra weight of equipment and working in hot environments, can increase firefighters’ risk for rhabdomyolysis.


A leading cause of death during firefighting is the structural collapse of a burning building. This includes a falling wall or the collapse of a floor, a ceiling or roof. Structural collapses often occur without warning and may crush or trap firefighters.

To avoid loss of life, all on-duty firefighters are trained to maintain two-way communication with the incident commander and are equipped with a personal alert safety system (PASS) device on all fire scenes (more below).


Some firefighters have been injured or killed by vehicles at the scene of a fire or emergency.

However, in the United States, 25% of firefighter fatalities are caused by traffic collisions that occur while responding to, or returning from, an incident.

A common measure fire departments have taken to prevent this is to require firefighters to wear a bright yellow reflective vest over their coats if they have to work on a public road, to make them more visible to passing drivers.


Although this is infrequent, sometimes firefighters have been assaulted by members of the public while responding to calls. The threat of such attacks in certain areas can cause firefighters to become distracted from the fire or situation at hand, which could result in injury to themselves or the patient they are aiding, due to insufficient attention.


Cardiovascular diseases represent a number of impairments that involve a person’s heart or blood vessels and is the leading cause of death in most areas of the world.

In the United States, the most common cause of on-duty firefighter fatalities is sudden cardiac death (heart failure).

Historically, the fire service blamed poor firefighter physical condition for being the primary cause of cardiovascular-related deaths. However, over the last 20 years, studies and research have indicated that toxic gasses put fire service personnel at significantly higher risk for cardiovascular-related conditions and death.

Other factors associated with firefighting, such as mental stress, heat stress, and heavy physical exertion, also increase the risk of cardiovascular events.

During fire suppression activities a firefighter can reach peak or near peak heart rates which can act as a trigger for a cardiac event.

Although a certain amount of risk is part of the job, firefighters who maintain unhealthy personal habits and insufficient exercise, are especially prone to cardiovascular diseases.


Smoke can expose firefighters to a variety of cancer-causing substances.

As a result, firefighters are at higher risk for certain types of cancer. For example, firefighters contract mesothelioma, which is a type of cancer caused by asbestos exposure, at twice the rate of the non-firefighting working population.

Firefighters under age 65 have also developed bladder cancer and prostate cancer at higher rates than the general population.

Preliminary research from 2015 on a large group of US firefighters showed a direct relationship between the number of hours spent fighting fires and the potential of dying from lung cancer and leukemia.

This link is a topic of continuing research in the medical community, as is cancer mortality in general among firefighters.

In brief, firefighters are exposed to a variety of cancer-causing substances at fires, including both carcinogenic chemicals and radiation.


As with other emergency workers, firefighters may witness traumatic scenes during their careers. They are thus more vulnerable than most people to certain mental health issues such as post-traumatic stress disorder and suicidal thoughts and behaviors.

Among women in the US, the occupations with the highest suicide rates are police and firefighters, with a rate of 14.1 per 100 000, according to the National Center for Injury Prevention and Control.

Chronic stress over time that affect first responders include such symptoms as anxiousness, irritability and nervousness, as well as memory and concentration problems, which can lead to anxiety and depression.

Mental stress can have long-lasting effects on the brain. A 2014 report from the National Fallen Firefighters Foundation found that a fire department is three times more likely to experience a suicide in a given year than a fatality resulting from line-of-duty work. In other words, it’s more dangerous simply dealing with the stress of being a career firefighter than actually fighting fires.

On-the-job mental stress can also lead to substance abuse and alcohol abuse, as ways of coping with the stress.


Another long-term health risk to firefighters is exposure to high levels of sound, which can cause hearing loss.

Hearing loss in firefighters increases with age and the number of years working as a firefighter.

The most common causes of excessive sound exposure are sirens, fire alarms, and work tools.

Hearing loss prevention programs have been implemented, including attempts to reduce sound exposures for firefighters, by enclosing the cabs of firetrucks to lower the siren volume while driving.

Multiple fire departments have used hearing protection devices that have built-in communication systems, allowing firefighters to speak with each other at safe, but audible sound levels, while lowering hazardous sound levels around them.


To allow protection from the inherent risks of fighting fires, firefighters wear and carry protective and self-rescue equipment at all times.

A self-contained breathing apparatus (SCBA) delivers air to the firefighter through a full face mask and is worn to protect against smoke inhalation, toxic fumes, and superheated gases.

A special device called a Personal Alert Safety System (PASS) is commonly worn independently or as a part of the SCBA to alert others when a firefighter stops moving, which can assist another firefighter or rapid intervention team (RIT), in locating the firefighter in distress.

Firefighters often carry personal self-rescue ropes. The ropes can provide a firefighter a partially controlled exit out of an elevated window.


In brief, firefighting, as a career, imposes health and safety risks on firefighters that are higher than those who work in non-firefighting roles.

The Realities of Firefighter Health and Safety
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