The advantages of a workforce populated with both men and women are well-documented and range from increased collaboration to greater productivity.[1] While other industries benefit from a balanced workforce (53% male), the fire service lags behind with the workforce remaining 91% male.[2][3] Many fire departments in the United States have faced challenges trying to attract women to their workforce.[4] In fact, even when compared to other workforces that were historically male dominated, the growth and inclusion of women in the fire service continues to lag despite more women entering the service.[5][6]

For the fire service to experience the same benefits as other industries, it is essential to explore the barriers to entry and retention of women firefighters. The National Occupational Research Agenda (NORA) Public Safety Sector Council convened a meeting with experts across the sector in September 2024 to discuss these barriers with particular focus on health and safety challenges faced by women firefighters. A recap of key messages follows.

What challenges do women in the fire service face?

In the fire service, policies, facility design and layout, and personal protective equipment (PPE) are often created solely with the input and perspectives of existing workers and may fail to identify and address key issues for other types of workers. As a result, in the fire service, some key issues for female workers remain unaddressed, impacting their recruitment and retention and also their health and safety.

Recruitment and Retention

One barrier to entry for women has been uncertainty regarding the physical and other expectations for the position. To help address this barrier, many departments in the United States are now adopting the International Association of Firefighter’s Candidate Physical Ability Test (CPAT) Program. Through this program, mentors work with potential candidates to make sure that they know what to expect throughout the training process and are properly prepared for testing. The CPAT provides standardization of expectations and universal access to those expectations, ensuring that potential candidates are properly prepared for evaluation and uniformly considered.

Departments can help to improve recruitment and retention by making programs, resources, and mentorship accessible to all firefighters including new women candidates as well as to women firefighters throughout their career. Long-term recruitment efforts such as introducing the fire service to high school students who are determining their career paths and connecting students with mentors that can help guide them may also attract more women. Once women join the service, having a transparent process about how to develop as a leader and providing support along the way can provide women with greater opportunities to obtain leadership positions.

PPE Comfort and Fit

Firefighters rely on PPE for protection against many different hazards, but for women firefighters, the design of currently available PPE could lead to discomfort, ill-fitting PPE, and potential injury. Recent information collected indicated that women were two to three times more likely to report that their gear did not fit well compared to men.[7]

Ill-fitting gear is not only uncomfortable, it can hinder mobility and lead to an increased risk of injury from events such as trips and falls. Research suggests that 65% of women firefighters reported encountering problems with ill-fitting gear. The number of firefighter injuries related to the use of turnout gear with poor or very poor fit was more than double that of firefighters wearing very well-fitting turnout gear.[8] Additionally, ill-fitting gear can increase firefighters’ risk of exposure to harmful contaminants including carcinogens which can impact many health issues including reproductive health.

Presenters discussed how departments, researchers, and manufacturers need to look beyond just offering smaller gear sizes for women as body types vary across individuals. Optimally, to ensure the safety of all in the fire service, PPE should be tailored to the individual user, regardless of the individual’s sex.

Station Facilities and Policies

As more women enter the fire service, presenters touched on changes that may need to be made to facilities or policies to reduce retention barriers. Many departments have older facilities that may not have separate dressing space, sleeping quarters, bathrooms, or appropriate lactation space dedicated for their women members. Regardless of whether a department’s facilities are older or if a department is undergoing a new construction, it’s important that departments consider and provide the appropriate privacy for all firefighters.

Family friendly policies, including pregnancy and adoption, are also important considerations. Certain aspects of firefighting such as shift work, circadian rhythm interruptions, exposure to high temperatures and caustic chemicals, and physical strain can be hazardous for all firefighters but may be even more hazardous for pregnant firefighters.[9] By providing family-oriented policies that cover life events such as pregnancy, post-pregnancy, adoption, and child care, departments can better support and protect firefighters and ensure an inclusive and diverse workforce.

For all the barriers discussed, presenters stressed the importance of taking a proactive approach and developing or modifying policies or strategies before they are needed as well as involving women in these conversations. Addressing these challenges can have a positive impact on ensuring that women have long and successful careers in the fire service.

Current research efforts

Another barrier to retaining women firefighters is their underrepresentation in firefighter health research, despite their growing numbers. During the meeting, presenters shared information on three research studies addressing this challenge.

Since 2016, the University of Arizona and several partners have been establishing a long-term prospective cohort study, the Fire Fighter Cancer Cohort Study (FFCCS). The study aims to better understand the carcinogenic exposures firefighters face and how these exposures affect their risk of cancer. This study includes a sub-study specifically focusing on women firefighters as research has shown they have an increased risk of certain cancers, including cervical and thyroid cancers, and adverse reproductive health effects.[10][11]

The FFCCS women firefighter study aims to evaluate causes of stress, cancer, and adverse reproductive health effects in women firefighters. Part of this study looks at anti-mullerian hormone levels and their association with depression, anxiety, and post-traumatic stress disorder (PTSD). Women’s anti-mullerian hormone levels impact fertility and their ability to conceive. Early results suggest that anxiety and PTSD have negative effects on anti-mullerian hormone levels. Additionally, when looking at factors associated with moderate to high levels of perceived stress, the project team found that women who reported PTSD and poor organizational cohesion have higher levels of stress. The project team has already enrolled more than 900 women firefighters from over 50 departments and aims to expand that number to 2,000 women. Additionally, they are interested in following their women participants overtime to assess changes in reproductive and stress outcomes.

The National Institute for Occupational Safety and Health (NIOSH) is also working to address the adverse health effects firefighters face. One research effort is specifically looking at wildland firefighters as the burning of wood during wildfires and wildland urban interface events creates chemical transformations that result in polyaromatic hydrocarbons (PAHs), gases, and volatile organic compounds (VOCs) being released into the air. These chemicals can lead to issues impacting the brain, heart, and the respiratory, reproductive, and urinary systems. In situations where wildland firefighters are working 2-to-3-week shifts, dirty gear that contains these contaminants may be worn multiple days increasing firefighters’ exposure. These exposures can have adverse reproductive health effects for women firefighters such as pre-term births and low birthweight babies. NIOSH has developed and is in the process of testing a portable decontamination system that can be used to reduce wildland firefighters’ exposures to PAHs, gases, and VOCs. The goal of this project is to provide departments a decontamination system that they can build on their own and bring into the field to help reduce exposures to harmful chemicals.

NIOSH is also working to address some of the PPE challenges women firefighters face through its pilot project, Advancing PPE Protection for Women Working in Hazardous Environments. The project aims to develop a draft framework that informs the selection and sustainability of PPE for women workers across high-risk industries. Once the framework is drafted, NIOSH will determine a method to check if it works for other populations and settings to ensure that it drives changes in selecting and obtaining PPE to ensure women workers are properly protected.

In 2024, NIOSH created the Center for Firefighter Safety, Health, and Well-being. The Center provides a central place for firefighters and other fire service organizations to engage with the broad scope of research and service NIOSH provides to the fire services. In addition, the new Center will promote faster identification and prevention of new and emerging hazards in the fire service. The Center and the NORA Public Safety Sector Council will continue to focus on this important issue and engage firefighters and fire service organizations in the conversation.

Suzanne M. Marsh, MPA, is Research Statistician and Team Lead for the Special Studies Team within the Division of Safety Research and is a Coordinator for the NIOSH Public Safety Program.

Meghan Kiederer, BA, is a Health Communication Specialist within the NIOSH National Personal Protective Technology Laboratory and is the Communications Coordinator for the NORA Public Safety Sector Council and NIOSH Public Safety Sector Program.

Wesley R. Attwood, DrCJ, is an Investigator and Program Advisor in the NIOSH Fire Fighter Fatality Investigation and Prevention Program within the Division of Safety Research and is a Coordinator for the NIOSH Public Safety Program.

Susan Moore, PhD, is the Associate Director for Science in the NIOSH National Personal Protective Technology Laboratory.

References

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