A Deeper Look into Protecting Wildland Firefighter Safety and Health

Wildland firefighters perform a hazardous job in dangerous conditions. Their daily tasks pose risk of burns and other heat-related injuries or illnesses; slips, trips, falls, strains, and sprains; and becoming trapped or injured by equipment or debris.¹ In addition, exposures related to fighting fires—especially when it comes to smoke inhalation—have been classified as “carcinogenic,” or capable of causing cancer in humans.² Wildland firefighters generally do not wear respirators or any other type of self-contained breathing apparatus because they are too hot and bulky for the conditions of the wildland fire environment.³

On February 14, 2024, the authors of this blog were invited to participate in a webinar to further explore the unique challenges of wildland firefighting and its physically hazardous work environment. An archived recording of our presentation is available on YouTube: Protecting Wildland Firefighter Safety and Health.

We received many thoughtful questions from the audience that we were unable to address on the day of the live event. We have provided our responses in this blog.

Wildland Firefighting Exposures

1. How do vegetative (wildland) fires and structural (building) fires differ in terms of carcinogenic exposures?
   Carcinogen exposures will vary based on what is burning. Firefighters’ exposures will depend on the tasks they perform, how long they are exposed, and the personal protective equipment (PPE) they use during a fire response.² Although exposures measured for structural fires often are higher compared to wildland fires, wildland firefighters can work a wildfire response for many days and weeks, multiple times throughout the fire season, with no respiratory protection worn.⁴
2. What components of wildfire smoke are important to sample when conducting exposure monitoring?
   Particulate matter and carbon monoxide are commonly measured air contaminants from smoke. In addition, volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs) have been measured on wildfires and prescribed fires (also known as controlled burns). The smoke component that is measured will depend on the exposure, health risk, or research question of interest.⁵
3. Are workers or landowners who oversee controlled burns included in your research? If not, would the findings of wildland firefighting research apply to these other groups?
   Our previous research has focused primarily on wildland firefighters who conduct prescribed fires. Past exposure assessments indicate high exposures to smoke for these workers.⁵ While it seems logical to think that landowners or non-firefighter workers who oversee controlled burns would have similar exposures to wildland firefighters who conduct prescribed fires, more research is needed to test that hypothesis.⁵
4. Night shift work was mentioned as a probable risk factor for cancer in wildland firefighters. Can you say a little more about that?
   The International Agency for Research on Cancer (IARC) Monographs Working Group classified night shift work as “probably carcinogenic to humans” (Group 2A).⁶ As wildland firefighters may work night shifts, this could be an additional hazard for carcinogenic risk. For more information, please consult this 2021 NIOSH Science blog on the relationship between night shift work and cancer.⁷
5. Is there a specific standard from the National Fire Protection Association (NFPA) that addresses wildfire exposures and applies a hierarchy of controls specific to wildland firefighting activities?
   There are no NFPA standards that recommend any specific administrative controls for wildland fire exposures. NFPA 1984: Standard on Respirators for Wildland Fire-Fighting Operations and Wildland Urban Interface Operations does provide a standard for respiratory protection. The NFPA 1977: Standard on Protective Clothing and Equipment for Wildland Firefighting specifies the minimum design, performance, testing, and certification requirements for protective clothing, helmets, gloves, and footwear. In addition, wildland firefighters are taught to manage hazards in the wildland fire environment using processes outlined in National Wildfire Coordinating Group Incident Response Pocket Guide and NFPA 1500: Standard on Fire Department Occupational Safety, Health, and Wellness Program. Other recommendations to reduce smoke exposure by changing wildland firefighting work practices can be found in the following resources:

• WFSTAR: Smoke – Knowing the Risks
• USFS Wildland Firefighter Smoke Exposure Report
• 2020 Literature Review of Smoke Exposure
• 6MFS Smoke

Personal Protective Equipment (PPE) for Wildland Firefighters

6. What types of face coverings and other PPE do wildland firefighters wear, especially to reduce smoke inhalation?
   The National Wildfire Coordinating Group requires that only respirators approved by NIOSH will be used on the fireline.³ There are currently no NIOSH Approved® respirators available that protect against all inhalation hazards identified in the National Fire Protection Association (NFPA) 1984 standard’s recommendations for respiratory protection and meet all the functional requirements for wildland firefighting. However, NIOSH has approved respirators that address most hazards identified in the NFPA 1984 standard (except for acrolein and carbon monoxide), and these can help provide respiratory protection as part of an overall OSHA approved respiratory protection program. It is not recommended that wildland firefighters use non-NIOSH-certified respirators (e.g., KN95 respirators) or face coverings (including bandanas, gaiters, and other devices) in place of a NIOSH approved respirator during wildland fire suppression activities. While the respirators currently approved by NIOSH do not meet NFPA requirements in full, these products can serve a role in providing respiratory protection as part of an overall respiratory protection program even though they may not provide protection against all the gases and vapors encountered on the fireline, such as acrolein and carbon monoxide, which may be present during wildland fire suppression activities.
7. How much does wildland firefighter PPE typically weigh? What effects does it have on firefighter performance and fatigue, especially when navigating steep and unsteady terrain?
   Generally, wildland firefighter PPE consists of a flame-resistant shirt and pants (commonly known as Nomex®), boots that meet certain fireline safety specifications, gloves, eye protection, hearing protection (during chainsaw or heavy equipment use), and a hardhat.³ Together, these may weigh up to 15 lbs. Depending on the crew or resource type, wildland firefighters may also carry “web gear” (often a backpack) that holds a fire shelter and any other gear or supplies required for daily operations. The fire shelter can reflect heat and trap breathable air in the event the firefighter is unable to escape to safety. The web gear and supplies can range in weight from 40-50 lbs. The weight of the PPE, web gear, and supplies needed for daily operations may require additional physical effort and contribute to firefighter fatigue throughout a shift. Weight and type of equipment is always a challenge when navigating different terrains, especially hillsides. Physical training is an important part of a wildland firefighter’s job.
8. What work is being done to improve PPE design and use for wildland firefighters?
   Wildland PPE designed to provide radiant heat protection uses fire-resistant fabrics and is constructed to allow for an air gap. This keeps the hot fabric off the skin. Unfortunately, this same design requirement is causing serious sizing issues for smaller and larger individuals. These issues may contribute to health disparities for specific groups of wildland firefighters, including women. The NFPA wildland firefighter PPE committee is currently working on an updated standard, which includes improving fabric performance and particulate protection qualities. In addition, there is work being done on respiratory protection products.⁸ Finding a respirator is difficult because it must filter out the required contaminants but also allow the firefighters to work effectively in the extreme wildland environment.
9. Has any research explored the short- or long- term health effects of oxygen therapy for wildland firefighters?
   We are not aware of any research exploring the short- or long- term health effects of oxygen therapy for wildland firefighters.
10. What are your thoughts on the small Powered Air Purifying Respirators (PAPR) being developed for wildland firefighter use?
    A small PAPR could be a good option for respiratory protection for wildland firefighters as long as the facepiece can function in windy conditions the firefighter may encounter. It may be able to filter out many contaminants and reduce heat or discomfort on the face. PAPRs are easier to breathe through but require a fully charged battery to work properly. Using a PAPR brings challenges regarding battery use and maintenance in operations.⁹   A respirator must also allow a wildland firefighter to maintain situational awareness and communications. With that in mind, this type of respirator may be best used by firefighters who work on fire engines and engage in structure protection activities at the wildland-urban interface.^8,10

The National Firefighter Registry (NFR) for Cancer

In 2018, Congress passed the Firefighter Cancer Registry Act. Under this Act, NIOSH established the National Firefighter Registry (NFR) for Cancer to collect data from a large and diverse population of firefighters so that we can better understand the link between firefighting and cancer. Participation in this voluntary registry is open to all U.S. firefighters, with or without a cancer diagnosis.

11. What is the current wildland firefighter participation rate in the NFR?
    As of February 2024, there are approximately 1,800 enrollees who identify as a wildland firefighter in the NFR. That is around 10% of the total enrolled population.
12. Is the NFR linked to any other firefighter exposure reporting systems, such as the U.S. Fire Administration’s (USFA) National Fire Incident Reporting System (NFIRS) or state-based exposure registries?
    The NFR is not currently linked to exposure tracking systems. However, NIOSH has obtained support from leadership behind several existing exposure tracking applications and are exploring options for linking exposure data to NFR data. The unique NFR participant number that is assigned after participants provide informed consent can be provided to exposure tracking programs to permit these linkages in the future. Additionally, the USFA is in the process of developing a new system that will replace NFIRS. This new system is known as the National Emergency Response Information System (NERIS). NIOSH is providing input on the development of NERIS. NIOSH has tremendous support from USFA to explore the logistics of linking NERIS response information to the NFR in the future.
13. Is it possible to enroll a career firefighter who passed away from cancer in the NFR if a family member has all the pertinent medical and job history information?
    Unfortunately, due to the necessity of providing consent to participate as mandated by the voluntary nature of the Firefighter Cancer Registry Act of 2018, NIOSH is unable to accept registrations on another’s behalf, deceased or otherwise.
14. Are there any other registries for firefighters that are not focused solely on cancer?
    To our knowledge, there are no other nationwide health registries exclusive to firefighters. The NIOSH World Trade Center (WTC) Health Program is a limited health benefit program that provides medical monitoring and treatment to responders and survivors of 9/11. The WTC Health Program also funds the World Trade Center Health Registry which documents and evaluates the long-term physical and mental health effects of 9/11 and gaps in care. The Registry includes 3,000 firefighters who responded to 9/11 out of 71,000 enrollees.
15. Where should people go for more information on the NFR?
    To learn more about the NFR, please visit our website: cdc.gov/NFR. To register, please visit: https://nfr.cdc.gov/
    
16. Who should researchers contact to explore NFR-related collaboration opportunities?
    Researchers interested in collaborative opportunities should email the team at nfregistry@cdc.gov.

Screening, Assessments, and Evaluations

17. What screening (examination) options are available to understand the potential exposure effects of structural and wildland firefighting?
    Past health assessments of wildland firefighters have included many types of examinations and measures to assess lung, cardiovascular, and cancer risk. This includes assessing lung function, inflammation, and oxidative stress in wildland firefighters across individual fire shifts and fire seasons.⁵
18. What resources are available to help conduct needs assessments for wildland-urban interface fires?
    A 2022 consensus study report from the National Academies of Sciences, Engineering, and Medicine provides many recommendations, including research topics, that could help to inform decision-makers charged with mitigating wildland-urban interface fire impacts.¹¹ NFPA also provides a Fire Service Needs Assessment Survey every 5 years, with a section that covers wildland and wildland urban interface firefighting.
19. It seems the tools available for wildland firefighters have not changed much over time. Have there been any evaluations to determine how design changes might improve wildfire firefighter health or safety?
    See the efforts described in #8 related to work on respiratory protection and clothing options.

This blog and the February 14^th webinar were coordinated by the NIOSH Office of Research Integration as part of the NIOSH Expanding Research Partnerships Webinar Series.

NIOSH has also released a Request for Information (RFI) seeking information from the public to develop a hazard review document that summarizes the scientific literature about the potential health effects from exposure to wildland fire smoke and provides recommendations to protect outdoor workers. Comments will be accepted until May 13, 2024. To view the Federal Register Notice, please visit: Federal Register: National Institute for Occupational Safety and Health; Outdoor Workers Exposed to Wildland Fire Smoke; Request for Information

Please note that comments on this blog will not be included in the RFI. To ensure comments and information are included in the RFI, please follow the procedures noted in the Federal Register notice.

Kathleen Navarro DuBose, PhD, MPH, is the Wildland Firefighter Health and Wellbeing Program Coordinator in the Office of Wildland Fire at the Department of the Interior.

Kenny Fent, PhD, CIH, is the Manager of the Firefighter Health Program in the NIOSH Division of Field Studies and Engineering.

Rick Swan is Director of The Wildfire Conservancy.

Jay L Tarley, CFEI, is a Physical Scientist and Lead for the Post-Market PPE Testing Team in the NIOSH National Personal Protective Technology Laboratory.

References

¹ NIOSH. Fighting Wildfires. https://www.cdc.gov/niosh/topics/firefighting/default.html Accessed 26 March 2024.

² Demers P., DeMarini D., Fent K., Glass D., Hansen J., Adetona O., et al. 2022. Carcinogenicity of Occupational Exposure as a Firefighter. Lancet Oncol 23(8) 985-986.  https://doi.org/10.1016/S1470-2045(22)00390-4.

³ Interagency Standards for Fire and Fire Aviation Operations Group. 2024. Interagency Standards for Fire and Fire Aviation Operations. Available online:  https://www.nifc.gov/standards/guides/red-book. Accessed 25 March 2024.

⁴Cherry, N., Brotnitsky, N., Fedun, M., Zadunayski, T. 2022. Respiratory tract and eye symptoms in wildland firefighters in two Canadian provinces: Impact of discretionary use of an N95 mask during successive rotations. Int J Environ Res Public Health. 19(20), 13658. https://doi.org/10.3390/ijerph192013658.

⁵ Navarro K. 2020. Working in Smoke: Wildfire Impacts on the Health of Firefighters and Outdoor Workers and Mitigation Strategies. Clin Chest Med. 41(4):763-769. https://doi.org/10.1016/j.ccm.2020.08.017.

⁶ International Agency for Research on Cancer. 2022. Night Shift Work. IARC Monographs on the Identification of Carcinogenic Hazards to Humans Volume 124. https://publications.iarc.fr/593. Accessed 26 March 2024.

⁷ Lawson, C.C., Whelan, E.A., Carreón-Valencia, T., Caruso, C.C. 2021. NIOSH Science Blog: Recent News about Night Shift Work and Cancer: What Does it Mean for Workers? Available online: https://blogs.cdc.gov/niosh-science-blog/2021/04/27/nightshift-cancer/. Accessed 28 March 2024.

⁸ Department of Homeland Security. 2022. Wildland Firefighter Respirator.  Available online: https://www.dhs.gov/sites/default/files/2022-12/23_0103_WildlandFirefighterRespirator_December2022.pdf. Accessed 26 March 2024.

⁹NIOSH. 2013. Getting optimal performance from a powered air‐purifying respirator (PAPR) depends on the condition of its battery!. Available online: https://www.cdc.gov/niosh/docs/2013-146/pdfs/2013-146.pdf. Accessed 11 April 2024.

¹⁰National Urban Science & Technology Laboratory (DHS). 2022. TechNote: Respiratory Protection for Wildland Firefighters. Available online: https://www.dhs.gov/sites/default/files/2022-08/22_0817_st_saver_technote_wildland_fire_respirators.pdf. Accessed 26 March 2024.

¹¹National Academies of Sciences, Engineering, and Medicine. 2022. The Chemistry of Fires at the Wildland-Urban Interface. Washington, DC: The National Academies Press. https://doi.org/10.17226/26460.