Editing Firefighter (section)

==Occupational health and safety==
===Direct risks===
====Fires====
[[File:Firemen's Monument, Boston by John A Wilson- far.jpg|thumb|[[Firemen's Memorial (Boston)]] by [[John A. Wilson (sculptor)|John Wilson]]]]
[[Image:Airport-firefighters-drill.jpg|thumb|right|Firefighters wearing [[Personal protective equipment|PPE]] tackle an aircraft fire during a drill at [[Dyess Air Force Base]] in [[Abilene, Texas]]]]
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 super heated gases. A special device called a [[PASS device|Personal Alert Safety System]] (PASS) is commonly worn independently or as a part of the SCBA to alert others when a firefighter stops moving for a specified period of time or manually operates the device. The PASS device sounds an alarm that can assist another firefighter ([[firefighter assist and search team]] (FAST), or [[rapid intervention team]] (RIT), in locating the firefighter in distress.

Firefighters often carry personal self-rescue [[rope]]s. The ropes are generally {{convert|30|ft}} long and can provide a firefighter (that has enough time to deploy the rope) a partially controlled exit out of an elevated window. Lack of a personal rescue rope is cited in the deaths of two New York City firefighters, Lt. John Bellew and Lt. Curtis Meyran, who died after they jumped from the fourth floor of a burning apartment building in the Bronx. Of the four firefighters who jumped and survived, only one of them had a self-rescue rope. Since the incident, the Fire Department of New York City has issued self-rescue ropes to their firefighters.<ref name=NYT>{{cite news |author=James Barron |url=https://www.nytimes.com/2005/01/24/nyregion/3-firefighters-die-in-blazes-in-brooklyn-and-bronx.html |title=3 Firefighters Die in Blazes in Brooklyn and Bronx |newspaper=[[The New York Times]] |date=January 24, 2005 }}</ref>

[[Hyperthermia|Heat injury]] is a major issue for firefighters as they wear insulated clothing and cannot shed the heat generated from physical exertion. Early detection of heat issues is critical to stop dehydration and heat stress becoming fatal. Early onset of heat stress affects cognitive function which combined with operating in dangerous environment makes heat stress and dehydration a critical issue to monitor. Firefighter physiological status monitoring is showing promise in alerting EMS and commanders to the status of their people on the fire ground. Devices such as [[PASS device]] alert 10–20 seconds after a firefighter has stopped moving in a structure. Physiological status monitors measure a firefighter's vital sign status, fatigue and exertion levels and transmit this information over their voice radio. This technology allows a degree of early warning to physiological stress. These devices<ref>Zephyr Technologies [http://www.zephyr-technology.com/bioharness-bt.html BioHarness BT] {{webarchive|url=https://web.archive.org/web/20100407031009/http://www.zephyr-technology.com/bioharness-bt.html |date=2010-04-07 }}</ref> are similar to technology developed for [[Future Force Warrior]] and give a measure of exertion and fatigue. They also tell the people outside a building when they have stopped moving or fallen. This allows a supervisor to call in additional engines before the crew get exhausted and also gives an early warning to firefighters before they run out of air, as they may not be able to make voice calls over their radio. Current [[Occupational Safety and Health Administration|OSHA]] tables exist for heat injury and the allowable amount of work in a given environment based on temperature, humidity and solar loading.<ref>{{cite web|url=https://www.osha.gov/dts/osta/otm/otm_iii/otm_iii_4.html |title=OSHA Technical Manual (OTM) - Section III: Chapter IV: Heat Stress |publisher=Osha.gov |access-date=2012-12-10}}</ref>

Firefighters are also at risk for developing [[rhabdomyolysis]]. Rhabdomyolysis is the breakdown of muscle tissue and has many causes including heat exposure, high core body temperature, and prolonged, intense exertion. Routine firefighter tasks, such as carrying extra weight of equipment and working in hot environments, can increase firefighters' risk for rhabdomyolysis.<ref>{{Cite web|publisher=NIOSH|date=2018-05-01|title=What structural fire fighters need to know about rhabdomyolysis.|url=https://www.cdc.gov/niosh/docs/2018-133/pdfs/2018-133.pdf?id=10.26616/NIOSHPUB2018133|doi=10.26616/nioshpub2018133|doi-access=free}}</ref><ref>{{Cite web|date=2018-05-01|title=What wildland fire fighters need to know about rhabdomyolysis.|url=https://www.cdc.gov/niosh/docs/2018-131/pdfs/2018-131.pdf?id=10.26616/NIOSHPUB2018131|doi=10.26616/nioshpub2018131|doi-access=free}}</ref>

====Structural collapses====
Another leading cause of death during firefighting is [[structural collapse]] of a burning building (e.g. a wall, floor, ceiling, roof, or [[truss|truss system]]). Structural collapse, which often occurs without warning, may crush or trap firefighters inside the structure. To avoid loss of life, all on-duty firefighters should maintain two-way communication with the [[incident commander]] and be equipped with a [[PASS device|personal alert safety system device]] (PASS) on all fire scenes and maintain radio communication on all incidents.<ref>[[National Institute for Occupational Safety and Health]] Alert: [https://www.cdc.gov/niosh/99-146.html Preventing Injuries and Deaths of Fire Fighters due to Structural Collapse]. August 1999.</ref><ref>[[National Institute for Occupational Safety and Health]] Alert: [https://www.cdc.gov/niosh/99-146.html Preventing Injuries and Deaths of Fire Fighters Due to Truss System Failures]. May 2005.</ref> [[Francis Brannigan]] was the founder and greatest contributor to this element of firefighter safety.

====Traffic collisions====
In the United States, 25% of fatalities of firefighters are caused by [[traffic collision]]s while responding to or returning from an incident. Other firefighters have been injured or killed by vehicles at the scene of a fire or emergency (Paulison 2005). A common measure fire departments have taken to prevent this is to require firefighters to wear a bright yellow reflective vest over their turnout coats if they have to work on a public road, to make them more visible to passing drivers.<ref>Federal Highway Administration DOT 23CFR634 Worker Visibility.</ref>

====Violence====
Firefighters have occasionally been assaulted by members of the public while responding to calls. These kinds of attacks can cause firefighters to fear for their safety when responding to specific areas and may cause them to not have full focus on the situation which could result in injury to their selves or the patient.<ref>{{Cite web|title=Rapid Response: Firefighters describe alarming moments during riots|url=https://www.firerescue1.com/firefighter-safety/articles/rapid-response-firefighters-describe-alarming-moments-during-riots-iftvQ2TdlzaaGo1W/|access-date=2020-12-05|website=FireRescue1|language=en}}</ref> Workplace violence<ref name="Murray-2019">{{Cite journal |last1=Murray |first1=Regan M. |last2=Davis |first2=Andrea L. |last3=Shepler |first3=Lauren J. |last4=Moore-Merrell |first4=Lori |last5=Troup |first5=William J. |last6=Allen |first6=Joseph A. |last7=Taylor |first7=Jennifer A. |date=2019-12-16 |title=A Systematic Review of Workplace Violence Against Emergency Medical Services Responders |journal=NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy |language=en |volume=29 |issue=4 |pages=487–503 |doi=10.1177/1048291119893388 |issn=1048-2911 |pmc=8594050 |pmid=31841060|bibcode=2020NewSo..29..487M }}</ref> consists of the mental and physical abuse sustained during on-duty activities. First Responders are the most likely to experience this type of violence and EMS even has a percentage range of 53-90% of calls that had an instance of Workplace violence. This type of violence is a major reason for burnout and depression in First Responders, while EMS deal more with people on a daily basis, ~18% Firefighters experience PTSD due to WPV<ref name="Murray-2019" /> and 60% had at least one call where they had feared for their life or questioned their safety.<ref>{{Cite journal |last=Setlack |first=Jennifer |date=2019-04-02 |title=Workplace violence and mental health of paramedics and firefighters |url=http://hdl.handle.net/1993/34347 |journal=University of Manitoba |hdl=1993/34347 |language=en}}</ref><ref>{{Cite journal |last1=Murray |first1=Regan M. |last2=Davis |first2=Andrea L. |last3=Shepler |first3=Lauren J. |last4=Moore-Merrell |first4=Lori |last5=Troup |first5=William J. |last6=Allen |first6=Joseph A. |last7=Taylor |first7=Jennifer A. |date=February 2020 |title=A Systematic Review of Workplace Violence Against Emergency Medical Services Responders |journal=NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy |language=en |volume=29 |issue=4 |pages=487–503 |doi=10.1177/1048291119893388 |issn=1048-2911 |pmc=8594050 |pmid=31841060|bibcode=2020NewSo..29..487M }}</ref>

====Chemical exposure====
While firefighters are generally responsible for managing hazardous materials in the environment, there is a great deal of risks that they face by doing so.<ref>{{Cite journal |last1=Young |first1=Anna S. |last2=Hauser |first2=Russ |last3=James-Todd |first3=Tamarra M. |last4=Coull |first4=Brent A. |last5=Zhu |first5=Hongkai |last6=Kannan |first6=Kurunthachalam |last7=Specht |first7=Aaron J. |last8=Bliss |first8=Maya S. |last9=Allen |first9=Joseph G. |date=May 2021 |title=Impact of "healthier" materials interventions on dust concentrations of per- and polyfluoroalkyl substances, polybrominated diphenyl ethers, and organophosphate esters |url=|journal=Environment International |volume=150 |pages=106151 |doi=10.1016/j.envint.2020.106151 |pmid=33092866 |pmc=7940547 |bibcode=2021EnInt.15006151Y |issn=0160-4120}}</ref> [[Flame retardant]]s are chemical products that are utilized to slow down or stop the spread of a fire by reducing its intensity. While there are numerous benefits to flame retardant products in terms of the reduction of major fires, the components that make up these substances are extremely harmful.<ref name="ReferenceA">{{Cite journal |last1=Sim |first1=Wonjin |last2=Choi |first2=Sol |last3=Choo |first3=Gyojin |last4=Yang |first4=Mihee |last5=Park |first5=Ju-Hyun |last6=Oh |first6=Jeong-Eun |date=2021-03-05 |title=Organophosphate Flame Retardants and Perfluoroalkyl Substances in Drinking Water Treatment Plants from Korea: Occurrence and Human Exposure |journal=International Journal of Environmental Research and Public Health |language=en |volume=18 |issue=5 |pages=2645 |doi=10.3390/ijerph18052645 |pmid=33807996 |pmc=7967649 |issn=1660-4601 |doi-access=free }}</ref>

The most concerning materials that make up these products are [[Per- and polyfluoroalkyl substances|PFAS]] chemicals. Studies linked PFAS exposure with health effects including major neurological defects and cancer.<ref name="ReferenceA"/> Long term exposure to these chemicals is a notable concern.

While many hazardous chemicals used in fire-fighting materials, such as penta-bromdiphenyl ether have already been banned by the government, they are almost immediately replaced by a new substance with similar harmful effects. After banning penta-bromodiphenyl ether, chlorinated tris, chloroalkyl phospahtes, halogenated aryl esters, and tetrabromophthalate dio diester were used instead.<ref name="ReferenceB">{{Cite journal |last1=Clarity |first1=Cassidy |last2=Trowbridge |first2=Jessica |last3=Gerona |first3=Roy |last4=Ona |first4=Katherine |last5=McMaster |first5=Michael |last6=Bessonneau |first6=Vincent |last7=Rudel |first7=Ruthann |last8=Buren |first8=Heather |last9=Morello-Frosch |first9=Rachel |date=December 2021 |title=Associations between polyfluoroalkyl substance and organophosphate flame retardant exposures and telomere length in a cohort of women firefighters and office workers in San Francisco |journal=Environmental Health |language=en |volume=20 |issue=1 |page=97 |doi=10.1186/s12940-021-00778-z |pmid=34454526 |pmc=8403436 |bibcode=2021EnvHe..20...97C |issn=1476-069X |doi-access=free }}</ref> While these chemicals are constantly changing with attempts to make it safer for the public, firefighters have constant, up-close exposure that can put them at increased risk.<ref name="ReferenceB"/>

=== During debris cleanup ===
{{Main|Occupational hazards of fire debris cleanup}}
[[File:Three New York City fire fighters in front of burning building following September 11th terrorist attack (29318406842).jpg|thumb|Firefighters at [[World Trade Center site|Ground Zero]] during the [[September 11 attacks]]]]
Once extinguished, fire debris cleanup poses several safety and health risks for workers.<ref name="Beaucham-2019">{{Cite web|url=https://www.cdc.gov/niosh/hhe/reports/pdfs/2018-0094-3355.pdf|title=Evaluation of fire debris cleanup employees' exposure to silica, asbestos, metals, and polyaromatic hydrocarbons|last1=Beaucham|first1=Catherine|last2=Eisenberg|first2=Judith|date=August 2019|website=U.S. [[National Institute for Occupational Safety and Health]]}}</ref><ref name="California Division of Occupational Safety and Health-2019">{{Cite web|url=https://www.dir.ca.gov/dosh/wildfire/worker-health-and-safety-during-fire-cleanup.html|title=Worker Safety and Health During Fire Cleanup|date=April 2019|website=[[California Division of Occupational Safety and Health]]|access-date=27 March 2020}}</ref>

Many hazardous substances are commonly found in fire debris. [[Silicon dioxide|Silica]] can be found in concrete, roofing tiles, or it may be a naturally occurring element. Occupational exposures to silica dust can cause [[silicosis]], lung cancer, pulmonary tuberculosis, airway diseases, and some additional non-respiratory diseases.<ref>{{Cite journal|publisher=NIOSH|date=2017-05-13|title=Health effects of occupational exposure to respirable crystalline silica.|url=https://www.cdc.gov/niosh/docs/2002-129/default.html|language=en-us|doi=10.26616/NIOSHPUB2002129|website=U.S. National Institute for Occupational Safety and Health|doi-access=free}}</ref> Inhalation of [[asbestos]] can result in various diseases including [[asbestosis]], lung cancer, and [[mesothelioma]].<ref>{{CodeFedReg|29|1910|1001|}}</ref> Sources of metals exposure include burnt or melted electronics, cars, refrigerators, stoves, etc. Fire debris cleanup workers may be exposed to these metals or their combustion products in the air or on their skin. These metals may include [[beryllium]], [[cadmium]], [[chromium]], [[cobalt]], [[lead]], [[manganese]], [[nickel]], and many more.<ref name="Beaucham-2019" /> [[Polycyclic aromatic hydrocarbon|Polyaromatic hydrocarbons]] (PAHs), some of which are carcinogenic, come from the incomplete combustion of organic materials and are often found as a result of structural and wildland fires.<ref>IARC 2002.</ref>

Safety hazards of fire cleanup include the risk of reignition of smoldering debris, [[electrocution]] from downed or exposed electrical lines or in instances where water has come into contact with electrical equipment. Structures that have been burned may be unstable and at risk of sudden collapse.<ref name="California Division of Occupational Safety and Health-2019" /><ref name="U.S. Centers for Disease Control and Prevention-2012">{{cite web|url=https://www.cdc.gov/disasters/wildfires/cleanupworkers.html|title=Worker Safety During Fire Cleanup|date=27 December 2012|website=U.S. [[Centers for Disease Control and Prevention]]|access-date=25 March 2020}}</ref>

Standard [[personal protective equipment]] for fire cleanup include [[hard hat]]s, [[goggles]] or safety glasses, heavy [[work glove]]s, [[earplug]]s or other [[Hearing protection device|hearing protection]], [[steel-toe boot]]s, and [[fall protection]] devices.<ref name="U.S. Centers for Disease Control and Prevention-2012" /><ref>{{Cite web|url=https://www.dir.ca.gov/dosh/wildfire/Protective-Equipment-During-Fire-Cleanup.html|title=Personal Protective Equipment During Fire Cleanup Operations|website=California Division of Occupational Safety and Health|access-date=2020-03-28}}</ref> Hazard controls for [[electrical injury]] include assuming all power lines are energized until confirmation they are de-energized, and grounding power lines to guard against electrical feedback, and using appropriate personal protective equipment.<ref name="U.S. Centers for Disease Control and Prevention-2012" /> Proper respiratory protection can protect against hazardous substances. Proper ventilation of an area is an [[Engineering controls|engineering control]] that can be used to avoid or minimize exposure to hazardous substances. When ventilation is insufficient or dust cannot be avoided, personal protective equipment such as [[N95 respirator]]s can be used.<ref name="U.S. Centers for Disease Control and Prevention-2012" /><ref>{{Cite web|url=https://www.dir.ca.gov/dosh/fire_resp_protection.html|title=Respiratory Protection During Fire Cleanup|website=California Division of Occupational Safety and Health|access-date=2020-03-28}}</ref>

===Long-term risks===
====Cardiovascular disease====
Firefighting has long been associated with poor [[cardiovascular]] outcomes. In the United States, the most common cause of on-duty fatalities for firefighters is sudden cardiac death, accounting for approximately 45% of on duty US firefighter deaths.<ref>{{cite journal|title=The New England Journal of Medicine", March 22, 2007, Accessed:July 17, 2011 |journal=New England Journal of Medicine |volume=356 |issue=12 |pages=1207–1215 |doi=10.1056/NEJMoa060357 |pmid=17377158 |year = 2007|last1 = Kales|first1 = Stefanos N.|last2=Soteriades |first2=Elpidoforos S. |last3=Christophi |first3=Costas A. |last4=Christiani |first4=David C. |citeseerx=10.1.1.495.4530 }}</ref> In addition to personal factors that may predispose an individual to [[coronary artery disease]] or other [[cardiovascular disease]]s, occupational exposures can significantly increase a firefighter's risk. 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 has indicated the toxic gasses put fire service personnel at significantly higher risk for cardiovascular related conditions and death. For instance, [[carbon monoxide]], present in nearly all fire environments, and [[hydrogen cyanide]], formed during the combustion of paper, cotton, plastics, and other substances containing [[carbon]] and [[nitrogen]]. The substances inside of materials change during combustion, and their by-products can interfere with the transport of oxygen in the body. [[hypoxia (medical)|Hypoxia]] can then lead to heart injury. In addition, chronic exposure to [[Atmospheric particulate matter|particulate matter]] in smoke is associated with [[atherosclerosis]]. Noise exposures may contribute to [[hypertension]] and possibly ischemic heart disease. Other factors associated with firefighting, such as [[Stress (medicine)|stress]], [[heat stress]], and heavy physical exertion, also increase the risk of cardiovascular events.<ref>[[National Institute for Occupational Safety and Health]] Alert: [https://www.cdc.gov/niosh/docs/2007-133 Preventing Fire Fighter Fatalities Due to Heart Attacks and Other Sudden Cardiovascular Events.] July 2007.</ref>

During fire suppression activities a firefighter can reach peak or near peak heart rates which can act as a trigger for a cardiac event. For example, [[tachycardia]] can cause plaque buildup to break loose and lodge itself is a small part of the heart causing [[myocardial infarction]], also known as a heart attack. This along with unhealthy habits and lack of exercise can be very hazardous to firefighter health.<ref>[University of Illinois] https://www.fsi.illinois.edu/documents{{dead link|date=October 2017 |bot=InternetArchiveBot |fix-attempted=yes }} /research/CardioChemRisksModernFF_InterimReport2016.pdf</ref>

====Cancer====
[[File:Sailors participate in a fire drill exercise aboard USS Bainbridge (DDG 96). (40730256683).jpg|thumb|Smoke can expose firefighters to a variety of carcinogens]]
Cancer risk in the U.S. fire service is a topic of growing concern. Recent studies suggest that due to their exposure on the fireground, firefighters may be at an increased risk for certain types of cancer and other chronic diseases.<ref name="Daniels-2014">{{Cite journal |last1=Daniels |first1=Robert D. |last2=Kubale |first2=Travis L. |last3=Yiin |first3=James H. |last4=Dahm |first4=Matthew M. |last5=Hales |first5=Thomas R. |last6=Baris |first6=Dalsu |last7=Zahm |first7=Shelia H. |last8=Beaumont |first8=James J. |last9=Waters |first9=Kathleen M. |last10=Pinkerton |first10=Lynne E. |date=June 2014 |title=Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009) |journal=Occupational and Environmental Medicine |language=en |volume=71 |issue=6 |pages=388–397 |doi=10.1136/oemed-2013-101662 |issn=1351-0711 |pmc=4499779 |pmid=24142974}}</ref><ref>{{Cite journal |last1=LeMasters |first1=Grace K. |last2=Genaidy |first2=Ash M. |last3=Succop |first3=Paul |last4=Deddens |first4=James 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Health |language=en |volume=18 |issue=5 |pages=2519 |doi=10.3390/ijerph18052519 |issn=1660-4601 |pmc=7967542 |pmid=33802629 |doi-access=free}}</ref><ref>{{Cite journal |last1=Hwang |first1=Jooyeon |last2=Xu |first2=Chao |last3=Agnew |first3=Robert J. |last4=Clifton |first4=Shari |last5=Malone |first5=Tara R. |date=January 2021 |title=Health Risks of Structural Firefighters from Exposure to Polycyclic Aromatic Hydrocarbons: A Systematic Review and Meta-Analysis |journal=International Journal of Environmental Research and Public Health |language=en |volume=18 |issue=8 |pages=4209 |doi=10.3390/ijerph18084209 |pmc=8071552 |pmid=33921138 |doi-access=free}}</ref><ref>{{Cite journal |last1=Jalilian |first1=Hamed |last2=Ziaei |first2=Mansour |last3=Weiderpass |first3=Elisabete |last4=Rueegg |first4=Corina Silvia |last5=Khosravi |first5=Yahya |last6=Kjaerheim |first6=Kristina |date=November 15, 2019 |title=Cancer incidence and mortality among firefighters |journal=International Journal of Cancer |language=en |volume=145 |issue=10 |pages=2639–2646 |doi=10.1002/ijc.32199 |issn=0020-7136 |pmid=30737784 |s2cid=73451966|doi-access=free |hdl=10037/17313 |hdl-access=free }}</ref><ref>{{Cite journal |last1=Soteriades |first1=Elpidoforos S. |last2=Kim |first2=Jaeyoung |last3=Christophi |first3=Costas A. |last4=Kales |first4=Stefanos N. |date=November 1, 2019 |title=Cancer Incidence and Mortality in Firefighters: A State-of-the-Art Review and Meta-َAnalysis |url=http://journal.waocp.org/article_88817.html |journal=Asian Pacific Journal of Cancer Prevention |language=en |volume=20 |issue=11 |pages=3221–3231 |doi=10.31557/APJCP.2019.20.11.3221 |issn=2476-762X |pmc=7063017 |pmid=31759344}}</ref><ref>{{Cite journal |last1=Casjens |first1=Swaantje |last2=Brüning |first2=Thomas |last3=Taeger |first3=Dirk |date=October 2020 |title=Cancer risks of firefighters: a systematic review and meta-analysis of secular trends and region-specific differences |journal=International Archives of Occupational and Environmental Health |language=en |volume=93 |issue=7 |pages=839–852 |doi=10.1007/s00420-020-01539-0 |issn=0340-0131 |pmc=7452930 |pmid=32306177|bibcode=2020IAOEH..93..839C }}</ref><ref>{{Cite journal |last1=Lee |first1=David J. |last2=Koru-Sengul |first2=Tulay |last3=Hernandez |first3=Monique N. |last4=Caban-Martinez |first4=Alberto J. |last5=McClure |first5=Laura A. |last6=Mackinnon |first6=Jill A. |last7=Kobetz |first7=Erin N. |date=April 2020 |title=Cancer risk among career male and female Florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981-2014) |url=|journal=American Journal of Industrial Medicine |language=en |volume=63 |issue=4 |pages=285–299 |doi=10.1002/ajim.23086 |issn=0271-3586 |pmid=31930542 |s2cid=210191181}}</ref><ref>{{Cite journal |last1=Pinkerton |first1=Lynne |last2=Bertke |first2=Stephen J. |last3=Yiin |first3=James |last4=Dahm |first4=Matthew |last5=Kubale |first5=Travis |last6=Hales |first6=Thomas |last7=Purdue |first7=Mark |last8=Beaumont |first8=James J. |last9=Daniels |first9=Robert |date=February 2020 |title=Mortality in a cohort of US firefighters from San Francisco, Chicago and Philadelphia: an update |journal=Occupational and Environmental Medicine |language=en |volume=77 |issue=2 |pages=84–93 |doi=10.1136/oemed-2019-105962 |issn=1351-0711 |pmid=31896615 |pmc=10165610 |s2cid=209677270|doi-access=free }}</ref> Additionally, large international studies generally support the finding from U.S. studies that firefighters have elevated rates of cancer, with some variation by cancer site.<ref>{{Cite journal |last1=Ahn |first1=Yeon-Soon |last2=Jeong |first2=Kyoung-Sook |last3=Kim |first3=Kyoo-Sang |date=September 2012 |title=Cancer morbidity of professional emergency responders in Korea |url=http://oem.bmj.com/cgi/content/short/68/Suppl_1/A37-a|journal=American Journal of Industrial Medicine |language=en |volume=55 |issue=9 |pages=768–778 |doi=10.1002/ajim.22068 |pmid=22628010 |s2cid=41791288}}</ref><ref>{{Cite journal |last1=Amadeo |first1=Brice |last2=Marchand |first2=Jean-Luc |last3=Moisan |first3=Frédéric |last4=Donnadieu |first4=Stéphane |last5=Coureau |first5=Gaëlle |last6=Mathoulin-Pélissier |first6=Simone |last7=Lembeye |first7=Christian |last8=Imbernon |first8=Ellen |last9=Brochard |first9=Patrick |date=2015 |title=French firefighter mortality: Analysis over a 30-year period |url=|journal=American Journal of Industrial Medicine |language=en |volume=58 |issue=4 |pages=437–443 |doi=10.1002/ajim.22434 |issn=1097-0274 |pmid=25708859}}</ref><ref>{{Cite journal |last1=Glass |first1=D. C. |last2=Pircher |first2=S. |last3=Monaco |first3=A. Del |last4=Hoorn |first4=S. Vander |last5=Sim |first5=M. R. |date=November 1, 2016 |title=Mortality and cancer incidence in a cohort of male paid Australian firefighters |url=https://oem.bmj.com/content/73/11/761 |journal=Occupational and Environmental Medicine |language=en |volume=73 |issue=11 |pages=761–771 |doi=10.1136/oemed-2015-103467 |issn=1351-0711 |pmid=27456156 |s2cid=43114491}}</ref><ref>{{Cite journal |last1=Glass |first1=Deborah C. |last2=Del Monaco |first2=Anthony |last3=Pircher |first3=Sabine |last4=Vander Hoorn |first4=Stephen |last5=Sim |first5=Malcolm R. |date=September 2017 |title=Mortality and cancer incidence among male volunteer Australian firefighters |url=https://oem.bmj.com/lookup/doi/10.1136/oemed-2016-104088 |journal=Occupational and Environmental Medicine |language=en |volume=74 |issue=9 |pages=628–638 |doi=10.1136/oemed-2016-104088 |issn=1351-0711 |pmid=28391245 |s2cid=32602571}}</ref><ref>{{Cite journal |last1=Glass |first1=Deborah Catherine |last2=Del Monaco |first2=Anthony |last3=Pircher |first3=Sabine |last4=Vander Hoorn |first4=Stephen |last5=Sim |first5=Malcolm Ross |date=April 2019 |title=Mortality and cancer incidence among female Australian firefighters |url=https://pubmed.ncbi.nlm.nih.gov/30674605 |journal=Occupational and Environmental Medicine |volume=76 |issue=4 |pages=215–221 |doi=10.1136/oemed-2018-105336 |issn=1470-7926 |pmid=30674605 |s2cid=59226066}}</ref><ref>{{Cite journal |last1=Harris |first1=M. Anne |last2=Kirkham |first2=Tracy L. |last3=MacLeod |first3=Jill S. |last4=Tjepkema |first4=Michael |last5=Peters |first5=Paul A. |last6=Demers |first6=Paul A. |date=October 2018 |title=Surveillance of cancer risks for firefighters, police, and armed forces among men in a Canadian census cohort |url=|journal=American Journal of Industrial Medicine |language=en |volume=61 |issue=10 |pages=815–823 |doi=10.1002/ajim.22891 |pmid=30073696 |s2cid=51905238}}</ref><ref>{{Cite journal |last1=Kirstine Ugelvig Petersen |first1=Kajsa |last2=Pedersen |first2=Julie Elbaek |last3=Bonde |first3=Jens Peter |last4=Ebbehoej |first4=Niels Erik |last5=Hansen |first5=Johnni |date=April 2018 |title=Long-term follow-up for cancer incidence in a cohort of Danish firefighters |url=https://oem.bmj.com/lookup/doi/10.1136/oemed-2017-104660 |journal=Occupational and Environmental Medicine |language=en |volume=75 |issue=4 |pages=263–269 |doi=10.1136/oemed-2017-104660 |issn=1351-0711 |pmid=29055884 |s2cid=4395029}}</ref><ref>{{Cite journal |last1=Petersen |first1=Kajsa Ugelvig |last2=Pedersen |first2=Julie Elbæk |last3=Bonde |first3=Jens Peter |last4=Ebbehøj |first4=Niels Erik |last5=Hansen |first5=Johnni |date=August 2018 |title=Mortality in a cohort of Danish firefighters; 1970–2014 |url=http://oem.bmj.com/cgi/content/short/74/Suppl_1/A110-b|journal=International Archives of Occupational and Environmental Health |language=en |volume=91 |issue=6 |pages=759–766 |doi=10.1007/s00420-018-1323-6 |issn=0340-0131 |pmid=29808435 |bibcode=2018IAOEH..91..759P |s2cid=44168738}}</ref><ref name="Pukkala-2014">{{Cite journal |last1=Pukkala |first1=Eero |last2=Martinsen |first2=Jan Ivar |last3=Weiderpass |first3=Elisabete |last4=Kjaerheim |first4=Kristina |last5=Lynge |first5=Elsebeth |last6=Tryggvadottir |first6=Laufey |last7=Sparén |first7=Pär |last8=Demers |first8=Paul A |date=June 2014 |title=Cancer incidence among firefighters: 45 years of follow-up in five Nordic countries |url=https://oem.bmj.com/lookup/doi/10.1136/oemed-2013-101803 |journal=Occupational and Environmental Medicine |language=en |volume=71 |issue=6 |pages=398–404 |doi=10.1136/oemed-2013-101803 |issn=1351-0711 |pmid=24510539 |s2cid=24392558}}</ref>

A 2015 retrospective [[longitudinal study]] showed that firefighters are at higher risk for certain types of [[cancer]]. Firefighters had [[mesothelioma]], which is caused by [[asbestos]] exposure, at twice the rate of the non-firefighting working population. Younger firefighters (under age 65) also developed [[bladder cancer]] and [[prostate cancer]] at higher rates than the general population. The risk of [[bladder cancer]] may be present in [[women in firefighting|female firefighters]], but research is inconclusive as of 2014.<ref>{{cite web |last=Daniels |first=Robert D. |date=17 December 2014 |title=Is There a Link Between Firefighting and Cancer? – Epidemiology in Action |url=http://blogs.cdc.gov/niosh-science-blog/2014/12/17/cancer-ff/ |access-date=6 January 2015 |publisher=National Institute for Occupational Safety and Health}}</ref><ref>{{cite web |date=25 July 2014 |title=Study of Cancer among U.S. Fire Fighters |url=https://www.cdc.gov/niosh/firefighters/ffCancerStudy.html |access-date=6 January 2015 |publisher=National Institute for Occupational Safety and Health}}</ref> Preliminary research from 2015 on a large cohort of US firefighters showed a direct relationship between the number of hours spent fighting fires and [[lung cancer]] and [[leukemia]] mortality in firefighters. This link is a topic of continuing research in the medical community, as is cancer mortality in general among firefighters.<ref>{{cite journal |vauthors=Daniels RD, Bertke S, Dahm MM, Yiin JH, Kubale TL, Hales TR, Baris D, Zahm SH, Beaumont JJ, Waters KM, Pinkerton LE |year=2015 |title=Exposure-response relationships for select cancer and non-cancer health outcomes in a cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009) |journal=Occupational and Environmental Medicine |volume=72 |issue=10 |pages=699–706 |doi=10.1136/oemed-2014-102671 |pmc=4558385 |pmid=25673342}}</ref>

In addition to [[Epidemiology|epidemiological]] studies, mechanistic studies have used [[biomarker]]s to investigate exposures' effects on biological changes that could be related to cancer development. Several of these studies have found evidence of [[DNA damage]], [[oxidative stress]], and [[Epigenetics|epigenetic]] changes related to firefighters' exposures.<ref>{{Cite journal |last1=Abreu |first1=Ana |last2=Costa |first2=Carla |last3=Pinho e Silva |first3=Susana |last4=Morais |first4=Simone |last5=do Carmo Pereira |first5=Maria |last6=Fernandes |first6=Adília |last7=Moraes de Andrade |first7=Vanessa |last8=Teixeira |first8=João Paulo |last9=Costa |first9=Solange |date=August 3, 2017 |title=Wood smoke exposure of Portuguese wildland firefighters: DNA and oxidative damage evaluation |url=|journal=Journal of Toxicology and Environmental Health, Part A |volume=80 |issue=13–15 |pages=596–604 |doi=10.1080/15287394.2017.1286896 |issn=1528-7394 |pmid=28524757 |bibcode=2017JTEHA..80..596A |hdl=10216/111908 |s2cid=205867973|hdl-access=free }}</ref><ref>{{Cite journal |last1=Adetona |first1=Olorunfemi |last2=Simpson |first2=Christopher D. |last3=Li |first3=Zheng |last4=Sjodin |first4=Andreas |last5=Calafat |first5=Antonia M. |last6=Naeher |first6=Luke P. |date=November 11, 2015 |title=Hydroxylated polycyclic aromatic hydrocarbons as biomarkers of exposure to wood smoke in wildland firefighters |url=|journal=Journal of Exposure Science & Environmental Epidemiology |volume=27 |issue=1 |pages=78–83 |doi=10.1038/jes.2015.75 |issn=1559-0631 |pmc=5140750 |pmid=26555473}}</ref><ref>{{Cite journal |last1=Andersen |first1=Maria Helena Guerra |last2=Saber |first2=Anne Thoustrup |last3=Clausen |first3=Per Axel |last4=Pedersen |first4=Julie Elbæk |last5=Løhr |first5=Mille |last6=Kermanizadeh |first6=Ali |last7=Loft |first7=Steffen |last8=Ebbehøj |first8=Niels |last9=Hansen |first9=Åse Marie |last10=Pedersen |first10=Peter Bøgh |last11=Koponen |first11=Ismo Kalevi |date=February 24, 2018 |title=Association between polycyclic aromatic hydrocarbon exposure and peripheral blood mononuclear cell DNA damage in human volunteers during fire extinction exercises |url=https://academic.oup.com/mutage/article/33/1/105/4553087 |journal=Mutagenesis |language=en |volume=33 |issue=1 |pages=105–115 |doi=10.1093/mutage/gex021 |issn=0267-8357 |pmid=29045708|doi-access=free }}</ref><ref>{{Cite journal |last1=Keir |first1=Jennifer L. A. |last2=Akhtar |first2=Umme S. |last3=Matschke |first3=David M. J. |last4=Kirkham |first4=Tracy L. |last5=Chan |first5=Hing Man |last6=Ayotte |first6=Pierre |last7=White |first7=Paul A. |last8=Blais |first8=Jules M. |date=November 7, 2017 |title=Elevated Exposures to Polycyclic Aromatic Hydrocarbons and Other Organic Mutagens in Ottawa Firefighters Participating in Emergency, On-Shift Fire Suppression |url=https://pubs.acs.org/doi/10.1021/acs.est.7b02850 |journal=Environmental Science & Technology |language=en |volume=51 |issue=21 |pages=12745–12755 |bibcode=2017EnST...5112745K |doi=10.1021/acs.est.7b02850 |issn=0013-936X |pmid=29043785}}</ref><ref>{{Cite journal |last1=Hoppe-Jones |first1=C. |last2=Beitel |first2=S. |last3=Burgess |first3=J. L. |last4=Snyder |first4=S. |last5=Flahr |first5=L. |last6=Griffin |first6=S. |last7=Littau |first7=S. |last8=Jeong |first8=K. S. |last9=Zhou |first9=J. |last10=Gulotta |first10=J. |last11=Moore |first11=P. |date=April 1, 2018 |title=515 Use of urinary biomarkers and bioassays to evaluate chemical exposure and activation of cancer pathways in firefighters |url=https://oem.bmj.com/content/75/Suppl_2/A412.2 |journal=Occupational and Environmental Medicine |language=en |volume=75 |issue=Suppl 2 |pages=A412–A413 |doi=10.1136/oemed-2018-ICOHabstracts.1178 |issn=1351-0711 |s2cid=80490930|doi-access=free }}</ref><ref>{{Cite journal |last1=Jeong |first1=Kyoung Sook |last2=Zhou |first2=Jin |last3=Griffin |first3=Stephanie C. |last4=Jacobs |first4=Elizabeth T. |last5=Dearmon-Moore |first5=Devi |last6=Zhai |first6=Jing |last7=Littau |first7=Sally R. |last8=Gulotta |first8=John |last9=Moore |first9=Paul |last10=Peate |first10=Wayne F. |last11=Richt |first11=Crystal M. |date=May 2018 |title=MicroRNA Changes in Firefighters |journal=Journal of Occupational & Environmental Medicine |language=en |volume=60 |issue=5 |pages=469–474 |doi=10.1097/JOM.0000000000001307 |issn=1076-2752 |pmc=5959213 |pmid=29465512}}</ref><ref>{{Citation |last1=Oliveira |first1=M. |title=Levels of urinary biomarkers of exposure and potential genotoxic risks in firefighters |date=March 14, 2018 |url=|work=Occupational Safety and Hygiene VI |pages=267–271 |publisher=CRC Press |doi=10.1201/9781351008884-47 |isbn=978-1-351-00888-4 |last2=Delerue-Matos |first2=C. |last3=Morais |first3=S. |last4=Slezakova |first4=K. |last5=Pereira |first5=M.C. |last6=Fernandes |first6=A. |last7=Costa |first7=S. |last8=Teixeira |first8=J.P.}}</ref>

Firefighters regularly encounter [[Carcinogen|carcinogenic materials]] and hazardous contaminants, which is thought to contribute to their excess cancer risk. Dozens of chemicals classified by the [[International Agency for Research on Cancer]] (IARC) as known or probable carcinogens have been identified on the fireground.<ref name="linkinghub.elsevier.com">{{Cite journal |last1=Marques |first1=M. Matilde |last2=Berrington de Gonzalez |first2=Amy |last3=Beland |first3=Frederick A. |last4=Browne |first4=Patience |last5=Demers |first5=Paul A. |last6=Lachenmeier |first6=Dirk W. |last7=Bahadori |first7=Tina |last8=Barupal |first8=Dinesh K. |last9=Belpoggi |first9=Fiorella |last10=Comba |first10=Pietro |last11=Dai |first11=Min |date=June 2019 |title=Advisory Group recommendations on priorities for the IARC Monographs |url= |journal=The Lancet Oncology |language=en |volume=20 |issue=6 |pages=763–764 |doi=10.1016/S1470-2045(19)30246-3 |pmid=31005580 |s2cid=128350881}}</ref><ref>{{Cite journal |last=IARC Working Group on the Evaluation of Carcinogenic Risks to Humans |date=2010 |title=Painting, firefighting, and shiftwork |journal=IARC Monographs on the Evaluation of Carcinogenic Risks to Humans |volume=98 |pages=9–764 |issn=1017-1606 |pmc=4781497 |pmid=21381544}}</ref> Several studies have documented airborne and/or dermal exposures to carcinogenic compounds during firefighting, as well as contamination on [[Bunker gear|turnout gear]] and other equipment worn by firefighters.<ref>{{Cite journal |first1=J. |last1=Jankovic |first2=W. |last2=Jones |first3=J. |last3=Burkhart |first4=G. |last4=Noonan |year=1991 |title=Environmental study of firefighters |url=|journal=Annals of Occupational Hygiene |volume=35 |issue=6 |pages=581–602 |doi=10.1093/annhyg/35.6.581 |pmid=1768008}}</ref><ref>{{Cite journal |last1=Bolstad-Johnson |first1=Dawn M. |last2=Burgess |first2=Jefferey L. |last3=Crutchfield |first3=Clifton D. |last4=Storment |first4=Steve |last5=Gerkin |first5=Richard |last6=Wilson |first6=Jeffrey R. |date=September 2000 |title=Characterization of Firefighter Exposures During Fire Overhaul |url=|journal=AIHAJ - American Industrial Hygiene Association |language=en |volume=61 |issue=5 |pages=636–641 |doi=10.1080/15298660008984572 |issn=1529-8663 |pmid=11071414}}</ref><ref>{{Cite journal |last1=Austin |first1=C. C. |last2=Wang |first2=D. |last3=Ecobichon |first3=D. J. |last4=Dussault |first4=G. |date=July 15, 2001 |title=Characterization of Volatile Organic Compounds in Smoke at Municipal Structural Fires |url=|journal=Journal of Toxicology and Environmental Health, Part A |language=en |volume=63 |issue=6 |pages=437–458 |doi=10.1080/152873901300343470 |issn=1528-7394 |pmid=11482799 |bibcode=2001JTEHA..63..437A |s2cid=36263955}}</ref><ref name="Fent-2017">{{Cite journal |last1=Fent |first1=Kenneth W. |last2=Alexander |first2=Barbara |last3=Roberts |first3=Jennifer |last4=Robertson |first4=Shirley |last5=Toennis |first5=Christine |last6=Sammons |first6=Deborah |last7=Bertke |first7=Stephen |last8=Kerber |first8=Steve |last9=Smith |first9=Denise |last10=Horn |first10=Gavin |date=October 3, 2017 |title=Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures |journal=Journal of Occupational and Environmental Hygiene |language=en |volume=14 |issue=10 |pages=801–814 |doi=10.1080/15459624.2017.1334904 |issn=1545-9624 |pmid=28636458 |s2cid=44916370|doi-access=free |hdl=2142/101922 |hdl-access=free }}</ref><ref>{{Cite journal |last1=Mayer |first1=Alexander C. |last2=Fent |first2=Kenneth W. |last3=Bertke |first3=Stephen |last4=Horn |first4=Gavin P. |last5=Smith |first5=Denise L. |last6=Kerber |first6=Steve |last7=La Guardia |first7=Mark J. |date=February 1, 2019 |title=Firefighter hood contamination: Efficiency of laundering to remove PAHs and FRs |journal=Journal of Occupational and Environmental Hygiene |language=en |volume=16 |issue=2 |pages=129–140 |doi=10.1080/15459624.2018.1540877 |issn=1545-9624 |pmc=8647047 |pmid=30427284}}</ref> Some of these compounds have been shown to absorb into firefighters' bodies.<ref>{{Cite journal |last1=Beitel |first1=Shawn C. |last2=Flahr |first2=Leanne M. |last3=Hoppe-Jones |first3=Christiane |last4=Burgess |first4=Jefferey L. |last5=Littau |first5=Sally R. |last6=Gulotta |first6=John |last7=Moore |first7=Paul |last8=Wallentine |first8=Darin |last9=Snyder |first9=Shane A. |date=February 1, 2020 |title=Assessment of the toxicity of firefighter exposures using the PAH CALUX bioassay |journal=Environment International |language=en |volume=135 |pages=105207 |doi=10.1016/j.envint.2019.105207 |issn=0160-4120 |pmid=31812113 |s2cid=208870627|doi-access=free |bibcode=2020EnInt.13505207B |hdl=10356/148860 |hdl-access=free }}</ref><ref>{{Cite journal |last1=Fent |first1=Kenneth W. |last2=Toennis |first2=Christine |last3=Sammons |first3=Deborah |last4=Robertson |first4=Shirley |last5=Bertke |first5=Stephen |last6=Calafat |first6=Antonia M. |last7=Pleil |first7=Joachim D. |last8=Wallace |first8=M. Ariel Geer |last9=Kerber |first9=Steve |last10=Smith |first10=Denise |last11=Horn |first11=Gavin P. |date=March 2020 |title=Firefighters' absorption of PAHs and VOCs during controlled residential fires by job assignment and fire attack tactic |journal=Journal of Exposure Science & Environmental Epidemiology |language=en |volume=30 |issue=2 |pages=338–349 |doi=10.1038/s41370-019-0145-2 |issn=1559-0631 |pmc=7323473 |pmid=31175324|bibcode=2020JESEE..30..338F }}</ref>

In addition to chemical exposures, firefighters often work 24-hr shifts or longer, and may respond to emergencies at night. Night [[shift work]] has been classified as a probable human carcinogen by IARC.<ref>{{Cite web |title=IARC Monographs Volume 124: Night Shift Work – IARC |url=https://www.iarc.who.int/news-events/iarc-monographs-volume-124-night-shift-work/ |access-date=September 1, 2022 |website=www.iarc.who.int}}</ref> Some firefighters also work with [[Dangerous goods|hazardous materials]] and trained to control and clean up these dangerous materials, such as [[oil spill]]s and [[chemical accident]]s. As firefighters combat a fire and clean up hazardous materials, there is a risk of harmful chemicals coming in contact with their skin if it penetrates their [[personal protective equipment]] (PPE).<ref name="Pukkala-2014" /> In June 2022, IARC classified occupational exposure as a firefighter as "carcinogenic to humans."<ref>{{Cite journal |last1=Demers |first1=Paul A. |last2=DeMarini |first2=David M. |last3=Fent |first3=Kenneth W. |last4=Glass |first4=Deborah C. |last5=Hansen |first5=Johnni |last6=Adetona |first6=Olorunfemi |last7=Andersen |first7=Maria H. G. |last8=Freeman |first8=Laura E. Beane |last9=Caban-Martinez |first9=Alberto J. |last10=Daniels |first10=Robert D. |last11=Driscoll |first11=Timothy R. |date=July 1, 2022 |title=Carcinogenicity of occupational exposure as a firefighter |url= |journal=The Lancet Oncology |language=en |volume=23 |issue=8 |pages=985–986 |doi=10.1016/S1470-2045(22)00390-4 |issn=1470-2045 |pmid=35780778 |s2cid=250227232}}</ref>

Firefighters are in addition to carcinogenic chemicals, firefighters can be exposed to [[radiation]] ([[alpha radiation]], [[beta radiation]], and [[gamma radiation]]).<ref name="IARC">{{cite journal |title=Painting, firefighting, and shiftwork |journal=IARC Monographs on the Evaluation of Carcinogenic Risks to Humans / World Health Organization, International Agency for Research on Cancer |volume=98 |pages=9–764 |year=2010 |pmid=21381544 |pmc=4781497|author1=IARC Working Group on the Evaluation of Carcinogenic Risks to Humans }}</ref>

There are many types of firefighters. Most research on firefighters' cancer risk has involved structural or municipal career firefighters. [[Wildfire suppression|Wildland firefighters]] are specially trained firefighters tasked with controlling [[Wildfire|forest fires]]. They frequently create fire lines, which are swathes of cut-down trees and dug-up grass placed in the path of the fire. This is designed to deprive the fire of fuel. Wildland firefighting is a physically demanding job with many acute hazards. Wildland firefighters may hike several miles while carrying heavy equipment during the wildfire season, which has increased in duration over time, especially in the western United States. Unlike structural firefighters, wildland firefighters typically do not wear [[Respirator|respiratory protection]], and may inhale [[Particulates|particulate]] and other compounds emitted by the wildfires. They also use [[Controlled burn|prescribed fires]] to burn potential fire fuel under controlled conditions.<ref>{{Cite web |title=Firefighters: Occupational Outlook Handbook: U.S. Bureau of Labor Statistics |url=https://www.bls.gov/ooh/protective-service/firefighters.htm#tab-2 |access-date=February 1, 2022 |website=www.bls.gov |language=en-us}}</ref> To examine cancer risk for wildland firefighters, a risk assessment was conducted using an exposure-response relationship for risk of lung cancer mortality and measured particulate matter exposure from smoke at wildfires. This study concluded that wildland firefighters could have an increased risk of lung cancer mortality.<ref>{{Cite journal |last1=Navarro |first1=Kathleen M. |last2=Kleinman |first2=Michael T. |last3=Mackay |first3=Chris E. |last4=Reinhardt |first4=Timothy E. |last5=Balmes |first5=John R. |last6=Broyles |first6=George A. |last7=Ottmar |first7=Roger D. |last8=Naher |first8=Luke P. |last9=Domitrovich |first9=Joseph W. |date=June 2019 |title=Wildland firefighter smoke exposure and risk of lung cancer and cardiovascular disease mortality |url= |journal=Environmental Research |language=en |volume=173 |pages=462–468 |bibcode=2019ER....173..462N |doi=10.1016/j.envres.2019.03.060 |pmid=30981117 |s2cid=108987257}}</ref> The research on cancer for other subspecialty groups of firefighters is limited, but a recent study of fire instructors in Australia found an exposure-response relationship between training exposures and cancer incidence.<ref>{{Cite journal |last1=Glass |first1=D. C. |last2=Del Monaco |first2=A. |last3=Pircher |first3=S. |last4=Vander Hoorn |first4=S. |last5=Sim |first5=M. R. |date=October 2016 |title=Mortality and cancer incidence at a fire training college |journal=Occupational Medicine (Oxford, England) |volume=66 |issue=7 |pages=536–542 |doi=10.1093/occmed/kqw079 |issn=1471-8405 |pmid=27371948|doi-access=free }}</ref>

Due to the lack of central and comprehensive sources of data, research on cancer rates amongst firefighters has been challenging.<ref name="Daniels-2014"/><ref>{{Cite journal |last1=Tsai |first1=Rebecca J. |last2=Luckhaupt |first2=Sara E. |last3=Schumacher |first3=Pam |last4=Cress |first4=Rosemary D. |last5=Deapen |first5=Dennis M. |last6=Calvert |first6=Geoffrey M. |date=May 6, 2015 |title=Risk of cancer among firefighters in California, 1988-2007 |url=|journal=American Journal of Industrial Medicine |volume=58 |issue=7 |pages=715–729 |doi=10.1002/ajim.22466 |issn=0271-3586 |pmc=4527530 |pmid=25943908}}</ref><ref>{{Cite journal |last1=Lee |first1=David J. |last2=Koru-Sengul |first2=Tulay |last3=Hernandez |first3=Monique N. |last4=Caban-Martinez |first4=Alberto J. |last5=McClure |first5=Laura A. |last6=Mackinnon |first6=Jill A. |last7=Kobetz |first7=Erin N. |date=April 2020 |title=Cancer risk among career male and female Florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981-2014) |url=https://pubmed.ncbi.nlm.nih.gov/31930542 |journal=American Journal of Industrial Medicine |volume=63 |issue=4 |pages=285–299 |doi=10.1002/ajim.23086 |issn=1097-0274 |pmid=31930542 |s2cid=210191181}}</ref><ref>{{Cite journal |last1=Ma |first1=Fangchao |last2=Fleming |first2=Lora E. |last3=Lee |first3=David J. |last4=Trapido |first4=Edward |last5=Gerace |first5=Terence A. |date=September 2006 |title=Cancer incidence in Florida professional firefighters, 1981 to 1999 |url=https://pubmed.ncbi.nlm.nih.gov/16966954 |journal=Journal of Occupational and Environmental Medicine |volume=48 |issue=9 |pages=883–888 |doi=10.1097/01.jom.0000235862.12518.04 |issn=1076-2752 |pmid=16966954 |s2cid=45179842}}</ref> On July 7, 2018, Congress passed the Firefighter Cancer Registry Act of 2018 requiring the [[Centers for Disease Control and Prevention]] to create the [[National Firefighter Registry]] designed to collect data on cancer rates among U.S. firefighters.<ref>{{Cite web |title=Firefighter Cancer Registry Act of 2018 (2018 - H.R. 931) |url=https://www.govtrack.us/congress/bills/115/hr931 |access-date=May 9, 2022 |website=GovTrack.us |language=en}}</ref><ref>{{Cite web |date=2022-09-19 |title=National Firefighter Registry |url=https://www.cdc.gov/niosh/firefighters/registry/index.html |access-date=2022-11-08 |website=U.S. National Institute for Occupational Safety and Health |language=en-us}}</ref><ref>{{Cite web |title=The National Firefighter Registry: An update on the plan to track firefighter cancer |url=https://www.firerescue1.com/cancer/articles/the-national-firefighter-registry-an-update-on-the-plan-to-track-firefighter-cancer-NQ5oPnbOKPDtfWiO/ |url-status=live |archive-url=https://web.archive.org/web/20220407003328/https://www.firerescue1.com/cancer/articles/the-national-firefighter-registry-an-update-on-the-plan-to-track-firefighter-cancer-NQ5oPnbOKPDtfWiO/ |archive-date=April 7, 2022 |access-date=September 30, 2022 |website=FireRescue1 |date=17 March 2022 |language=en}}</ref>

====Mental stress====
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]]<ref>{{cite news |url= https://www.theguardian.com/public-leaders-network/2017/aug/23/mental-health-fire-service-government-cuts-grenfell-firefighters-charity |title= Fire fighters' battle with PTSD: "Every day is an anxious day" |date= 23 August 2017 |access-date= 22 September 2017 |newspaper= [[The Guardian]]}}</ref><ref>{{Cite journal|last1=Berger|first1=William|last2=Coutinho|first2=Evandro Silva Freire|last3=Figueira|first3=Ivan|last4=Marques-Portella|first4=Carla|last5=Luz|first5=Mariana Pires|last6=Neylan|first6=Thomas C.|last7=Marmar|first7=Charles R.|last8=Mendlowicz|first8=Mauro Vitor|date=2012-06-01|title=Rescuers at risk: a systematic review and meta-regression analysis of the worldwide current prevalence and correlates of PTSD in rescue workers|journal=Social Psychiatry and Psychiatric Epidemiology|language=en|volume=47|issue=6|pages=1001–1011|doi=10.1007/s00127-011-0408-2|pmid=21681455|issn=0933-7954|pmc=3974968}}</ref> and suicidal thoughts and behaviors.<ref>{{Cite journal|last1=Stanley|first1=Ian H.|last2=Hom|first2=Melanie A.|last3=Joiner|first3=Thomas E.|title=A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics|journal=Clinical Psychology Review|volume=44|pages=25–44|doi=10.1016/j.cpr.2015.12.002|pmid=26719976|year=2016|doi-access=free}}</ref><ref>{{Cite journal|last1=Stanley|first1=Ian H.|last2=Hom|first2=Melanie A.|last3=Hagan|first3=Christopher R.|last4=Joiner|first4=Thomas E.|title=Career prevalence and correlates of suicidal thoughts and behaviors among firefighters|journal=Journal of Affective Disorders|volume=187|pages=163–171|doi=10.1016/j.jad.2015.08.007|pmid=26339926|year=2015}}</ref> 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, CDC.<ref>{{Cite journal|last=Lindahl|first=Björn|title= Why are suicide rates higher for farmers and firefighters than for librarians? |url= http://www.nordiclabourjournal.org/nyheter/news-2016/article.2016-10-09.4724251880/|journal=Nordic Labour Journal}}</ref> Chronic stress over time attributes to symptoms that affect first responders, such as anxiousness, irritability, nervousness, memory and concentration problems can occur overtime which can lead to anxiety and depression. Mental stress can have long lasting affects on the brain.<ref>{{Cite news|url=https://www.firehouse.com/safety-health/article/12152154/health-wellness-how-firefighters-can-manage-stress|title=Health & Wellness: How Firefighters Can Manage Stress|work=Firehouse|access-date=2018-09-11|language=en}}</ref> 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 line-of-duty death.<ref>{{Cite news|url=https://www.usatoday.com/story/news/2015/01/15/stress-takes-heavy-toll-on-firefighters-experts-say/21830649/|title=Stress takes heavy toll on firefighters, experts say|work=USA TODAY|access-date=2018-09-11|language=en}}</ref> Mental stress of the job can lead to substance abuse and alcohol abuse as ways of coping with the stress.<ref>{{Cite web|url=https://www.nfpa.org/news-and-research/publications/nfpa-journal/2014/may-june-2014/features/special-report-firefighter-behavioral-health|title=Special report: Firefighter behavioral health - NFPA Journal|website=www.nfpa.org|language=en|access-date=2018-09-11}}</ref> The mental stress of fire fighting has many different causes. There are those they see on duty and also what they miss by being on duty. Firefighters schedules fluctuate by district. There are stations where fire fighters work 48 hours on and 48 hours off, whereas some allow 24 hours on and 72 hours off.<ref>{{Cite web|url=https://www.firerescue1.com/exclusives-1/articles/9-sources-of-firefighter-stress-o2KNDn8vMYZTq2FB/|title=9 sources of firefighter stress|website=FireRescue1|date=9 February 2015 |language=en|access-date=2019-11-26}}</ref> The mental impact of missing a child's first steps or a ballet recital can take a heavy impact on first responders. There is also the stress of being on opposite shifts as a spouse or being away from family.

When not on the scene of an emergency, firefighters remain on call at [[fire station]]s, where they eat, sleep, and perform other duties during their shifts. Hence, [[Shift work sleep disorder|sleep disruption]] is another occupational hazard that they may encounter at their job.<ref name="Fent-2017" />

====Occupational hearing loss====
Another long-term risk factor from firefighting is exposure to high levels of sound, which can cause [[noise-induced hearing loss]] (NIHL) and [[tinnitus]].<ref name="Hong">{{cite journal |last1=Hong |first1=O. |last2=Samo |first2=D.G. |title= Hazardous Decibels: Hearing Health of Firefighters |journal= Workplace Health & Safety|date=1 August 2007 |volume=55 |issue=8 |pages=313–319 |doi= 10.1177/216507990705500803|pmid=17847625 |s2cid=36850759 |doi-access=free }}</ref><ref name="Tubbs">{{cite journal |last1=Tubbs |first1=R.L. |title= Noise and Hearing Loss in Firefighting |journal= Occupational Medicine |date=1995 |volume=10 |issue=4 |pages=843–885 |pmid=8903753 |url= https://www.ncbi.nlm.nih.gov/labs/articles/8903753/}}</ref> NIHL affects sound frequencies between 3,000 and 6,000 Hertz first, then with more frequent exposure, will spread to more frequencies.<ref name="Tubbs"/> Many consonants will be more difficult to hear or inaudible with NIHL because of the higher frequencies effected, which results in poorer communication.<ref name="Tubbs"/> NIHL is caused by exposure to sound levels at or above 85dBA according to [[National Institute for Occupational Safety and Health|NIOSH]] and at or above 90dBA according to [[Occupational Safety and Health Administration|OSHA]].<ref name="Tubbs" /> [[A-weighting|dBA]] represents A-weighted decibels. dBA is used for measuring sound levels relating to occupational sound exposure since it attempts to mimic the sensitivity of the human ear to different frequencies of sound.<ref name="Tubbs" /> OSHA uses a 5-dBA exchange rate, which means that for every 5dBA increase in sound from 90dBA, the acceptable exposure time before a risk of permanent hearing loss occurs decreases by half (starting with 8 hours acceptable exposure time at 90dBA).<ref name="Tubbs" /><ref name="OSHA" /> NIOSH uses a 3-dBA exchange rate starting at 8 hours acceptable exposure time at 85dBA.<ref name="Tubbs" /><ref name="NIOSH" />

The time of exposure required to potentially cause damage depends on the level of sound exposed to.<ref name="NIOSH">{{cite web|title=NIOSH/Criteria for a Recommended Standard--Occupational Noise Exposure, 1998|url=http://www.nonoise.org/hearing/criteria/criteria.htm|website=www.nonoise.org}}</ref> The most common causes of excessive sound exposure are sirens, transportation to and from fires, fire alarms, and work tools.<ref name="Hong" /> Traveling in an emergency vehicle has shown to expose a person to between 103 and 114dBA of sound. According to OSHA, exposure at this level is acceptable for between 17 and 78 minutes<ref name="OSHA">{{cite web|title=Noise exposure computation - 1910.95 App A {{!}} Occupational Safety and Health Administration|url=https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9736|website=www.osha.gov|language=en-us}}</ref> and according to NIOSH is acceptable for between 35 seconds and 7.5 minutes <ref name="NIOSH" /> over a 24-hour day before permanent hearing loss can occur. This time period considers that no other high level sound exposure occurs in that 24-hour time frame.<ref name="NIOSH" /> Sirens often output about 120&nbsp;dBA, which according to OSHA, 7.5 minutes of exposure is needed<ref name="OSHA" /> and according to NIOSH, 9 seconds of exposure is needed<ref name="NIOSH" /> in a 24-hour time period before permanent hearing loss can occur. In addition to high sound levels, another risk factor for hearing disorders is the co-exposure to chemicals that are [[Ototoxicity|ototoxic]].<ref>{{Cite journal|last=Johnson|first=Ann-Christin |last2=Morata |first2=Thais C. |date=2010|title=Occupational exposure to chemicals and hearing impairment. The Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals. 44 (4): 177.|url=https://gupea.ub.gu.se/bitstream/2077/23240/1/gupea_2077_23240_1.pdf|journal=Arbete och Hälsa|volume=44|pages=177}}</ref>

The average day of work for a firefighter can often be under the sound exposure limit for both OSHA and NIOSH.<ref name="Tubbs" /> While the average day of sound exposure as a firefighter is often under the limit, firefighters can be exposed to [[Impulse noise (audio)|impulse noise]], which has a very low acceptable time exposure before permanent hearing damage can occur due to the high intensity and short duration.<ref name="Hong" />

There are also high rates of hearing loss, often NIHL, in firefighters, which increases with age and number of years working as a firefighter.<ref name="Hong" /><ref>{{cite journal|last1=Taxini|first1=Carla|last2=Guida|first2=Heraldo|title=Firefighters' noise exposure: A literature review|journal=International Archives of Otorhinolaryngology|date=6 January 2014|volume=17|issue=1|pages=080–084|doi=10.7162/S1809-97772013000100014|pmid=25991998|pmc=4423242}}</ref> [[Hearing conservation program|Hearing loss prevention programs]] have been implemented in multiple stations and have shown to help lower the rate of firefighters with NIHL.<ref name="Tubbs" /> Other attempts have been made to lower sound exposures for firefighters, such as enclosing the cabs of the firetrucks to lower the siren exposure while driving.<ref name="Tubbs" /> NFPA (National Fire Protection Association) is responsible for occupational health programs and standards in firefighters which discusses what hearing sensitivity is required to work as a firefighter, but also enforces baseline (initial) and annual hearing tests (based on OSHA hearing maintenance regulations).<ref name="Hong" /> While NIHL can be a risk that occurs from working as a firefighter, NIHL can also be a safety concern for communicating while doing the job as communicating with coworkers and victims is essential for safety.<ref name="Hong" /> [[Hearing protection|Hearing protection devices]] have been used by firefighters in the United States.<ref name="Tubbs" /> Earmuffs are the most commonly used hearing protection device (HPD) as they are the most easy to put on correctly in a quick manner.<ref name="Tubbs" /> Multiple fire departments have used HPDs that have communication devices built in, allowing firefighters to speak with each other at safe, but audible sound levels, while lowering the hazardous sound levels around them.<ref name="Tubbs" />