Perceived Health Risks Among Firefighters; The New Jersey Firefighter Health Survey

Examination of Firefighting as an Occupational Exposure Criteria for Lung Cancer Screening

PURPOSE

Firefighting is known to be carcinogenic to humans. However, current lung cancer screening guidelines do not account for occupational exposure. We hypothesize that firefighting is an independent risk factor associated with the development of high-risk lung nodules on low-dose CT (LDCT).

METHODS

Members of a firefighter's union underwent LDCT at a single institution between April 2022 and June 2023 within a lung cancer screening program. Results were interpreted by designated chest radiologists and reported using the Lung-RADS scoring system. Demographic and radiographic data were recorded, and summary statistics are reported.

RESULTS

1347 individuals underwent lung cancer screening, with a median age of 51 years (IQR 42-58), including 56 (4.2%) females. Overall, 899 (66.7%) were never smokers, 345 (25.6%) were former smokers, and 103 (7.7%) were current smokers. There were 41 firefighters (3.0%) who had high-risk (Lung-RADS 3 or 4) nodules requiring intervention or surveillance, of which 21 (1.5%) were Lung-RADS 3 and 20 (1.5%) that were Lung-RADS 4. Of the firefighters with high-risk nodules, only 6 (14.6%) were eligible for LDCT based on current screening guidelines. There were 7 high-risk nodules (0.5%) that required procedural intervention, 6 (85.7%) of which were from the non-screening eligible cohort. There were also 20 never-smoking firefighters (57.1%) with high-risk nodules that were non-screening eligible.

CONCLUSION

Firefighting, even in the absence of smoking history, may be associated with the development of high-risk lung nodules on LDCT. Carefully selected occupational exposures should be considered in the development of future lung cancer screening guidelines.

Problems of operation of positive pressure ventilators on the basis of surveys of Polish officers of the State Fire Service

Positive pressure ventilators (PPV) used by 97.7% of officers of the National Fire Service in Poland, are characterized by work that is not in line with the expectations of the firefighters. In order to improve the technical and operational features of these devices, a survey was conducted among 25,000 eligible firefighters, identifying the application of these devices, problems in use and expected development directions. A total of 682 officers voluntarily completed the survey. Based on their findings, it was determined that ventilators are most often used to smoke out buildings after or during a fire. Mentioned problems when using these devices were mainly noise (78.2%), exhaust emissions (68.5%), and impediments to mobility through the device's relatively heavy weight (40.2%). Other inconveniences were mentioned by less than 20% of firefighters. Polish firefighters expect the development of these devices mainly in terms of the above-mentioned features (noise reduction (81.7%) and reduction of the weight and size of the ventilators (about 50%)). Other expectations relate to the improvement of smoke removal in buildings: increasing the efficiency of smoke removal (46.4%) and efficiency regarding the rate of smoke removal in a building by increasing the size of the incoming airflow from the building's surroundings (33.2%). About 15% of firefighters expect changes in the operation of the ventilator itself, that is, an increase in the effective operating time (electric ventilators) and an increase in the device's uptime. The aim of the article is to identify the issues encountered during the operation and to indicate the expected direction of development for PPV by users. This information can be used by engineers to initiate new development work on these devices.

Prevalence and predictors of colon and prostate cancer screening among volunteer firefighters: The United States Firefighter Cancer Assessment and Prevention Study

BACKGROUND

Although firefighters have increased risk for colon and prostate cancer, limited information exists on screening practices for these cancers in volunteer firefighters who compose two-thirds of the US fire service. We estimated the prevalence of colon and prostate cancer screening among volunteer firefighters using eligibility criteria from 4 evidence-based screening recommendations and evaluated factors influencing screening.

METHODS

We evaluated colon (n = 569) and prostate (n = 498) cancer screening prevalence in a sample of US volunteer firefighters using eligibility criteria from the US Preventive Services Taskforce (USPSTF), National Fire Protection Association, American Cancer Society, and National Comprehensive Cancer Network. We assessed associations with fire service experience, demographics, and cancer risk perception based on USPSTF guidelines.

RESULTS

For those eligible based on USPSTF guidelines, colon and prostate cancer screening prevalence was 51.7% (95% CI: 45.7, 57.8) and 48.8% (95% CI: 40.0, 57.6), respectively. Higher odds of colon and prostate cancer screening were observed with older age and with some college education compared to those with less education. Fire service experience and cancer risk perception were not associated with screening practices.

CONCLUSION

This is the first large study to assess colon and prostate cancer screening among US volunteer firefighters based on different screening guidelines. Our findings suggest gaps in cancer prevention efforts in the US volunteer fire service. Promoting cancer screening education and opportunities for volunteer firefighters by their fire departments, healthcare professionals, and public health practitioners, may help to address the gaps.

Perceptions of lung function surveillance in urban firefighters

BACKGROUND AND OBJECTIVE

Workplace health and safety (WHS) is an important responsibility falling on both employers and employees and is most effective when the perspectives of all stakeholders are considered. This study aimed to explore the facilitators and barriers to a voluntary workplace lung function surveillance program from the perspective of urban firefighters and describe their perceptions of its value.

METHODS

Using a qualitative, descriptive methodology, firefighters who had participated in a longitudinal lung function surveillance study were invited to participate in semi-structured interviews. Purposeful, maximum variation sampling was used to achieve diversity in those firefighters invited to participate. We used inductive content analysis to identify themes.

RESULTS

Interviews with 15 firefighters identified 3 main themes: (i) practical experience of surveillance (administration, communication, workplace culture change, convenience, acceptability, and appeal); (ii) value of surveillance (lung health efficacy and control, social support, workplace management support/motivations, contribution to global firefighter health); and (iii) contribution of surveillance to health (occupational risk, relevance in the context of total health, workability, and fitness and future value).

CONCLUSION

Practical and psychosocial facilitators and barriers to providing lung function surveillance in the fire service were identified. In addition to the personal benefits of detecting adverse lung health and allowing for medical intervention, factors known to positively influence firefighter workplace wellbeing, such as providing peace of mind, feedback on good work practices, motivation to utilize control measures, management commitment to health, and providing data to assist with global knowledge were valued aspects of longitudinal lung function surveillance.

Potential impact of metabolic syndrome on cognitive function in US firefighters

Objectives

Among US firefighters, sudden cardiac arrest and psychological stress (i.e., PTSD) are the leading cause of on-duty death. Metabolic syndrome (MetSyn) may influence both cardiometabolic and cognitive health. Here, we examined differences in cardiometabolic disease risk factors, cognitive function, and physical fitness in US firefighters with vs. without MetSyn.

Materials and methods

One hundred fourteen male firefighters, aged 20 to 60 years, participated in the study. US firefighters with MetSyn vs. non-MetSyn were divided by AHA/NHLBI criteria. Of them, we performed a paired-match analysis with respect to the age and BMI of firefighters with (n = 18) vs. without MetSyn (n = 18). The cardiometabolic disease risk factors included blood pressure, fasting glucose, blood lipid profiles [HDL-C, triglyceride (TG)], and surrogate markers of insulin resistance [TG/HDL-C, TG glucose index (TyG)]. The cognitive test included a psychomotor vigilance task as a measure of reaction time and a delayed-match-to-sample task (DMS) as a measure of memory, using the computer-based Psychological Experiment Building Language Version 2.0 program. The differences between MetSyn and non-MetSyn groups in US firefighters were analyzed using an independent t-test adjusted for age and BMI. In addition, Spearman correlation and stepwise multiple regression were conducted.

Results

US firefighters with MetSyn exhibited severe insulin resistance estimated by TG/HDL-C and TyG (Cohen's d > 0.8, all p < 0.01) compared with their age- and BMI-matched counterparts without MetSyn. In addition, US firefighters with MetSyn exhibited higher DMS total time and reaction time compared with non-MetSyn (Cohen's d > 0.8, all p < 0.01). In stepwise linear regression, HDL-C predicted DMS total time (β = - 0.440, R² = 0.194, p < 0.05), and TyG (β = 0.432, R² = 0.186, p < 0.05) predicted DMS reaction time.

Conclusion

US firefighters with vs. without MetSyn were predisposed to metabolic risk factors, surrogate markers of insulin resistance, and cognitive function, even when matched for age and BMI, and there was a negative association between metabolic characteristics and cognitive function in US firefighters. The findings of this study suggest that the prevention of MetSyn may be beneficial to supporting firefighters' safety and occupational performance.

Quantifying self-contained breathing apparatus on physiology and psychological responses during firefighting: a systematic review and meta-analysis

Objectives. There is no consensus regarding the efficacy of self-contained breathing apparatus (SCBA) on firefighters' physiological and psychological stress responses. This study synthesized and quantified the psycho-physiological demands placed on firefighters wearing SCBA compared to a control group. Methods. Five databases were searched with English-language restrictions from inception to January 2021. As dependent variables, physiological (rectal temperature [T_re], mean skin temperature [T¯sk], heart rate [HR], maximal heart rate [HR_max], maximum oxygen uptake [V_O2max], total sweat rate [TSR]) and psychological (rating of perceived exertion [RPE] and thermal sensation [TS]) responses were continuously collected. This study is registered with PROSPERO (CRD42021228363). Results. Nine eligible studies with 289 participants met the inclusion criteria. The pooled estimates for V_O2max statistically significantly decreased, whereas T¯sk, HR, HR_max, TSR and RPE increased significantly. Additionally, the T_re and TS parameters were elevated but not significant. Subgroup analysis revealed that, except for V_O2max and TSR, the SCBA weight did not differ significantly between groups on any outcome measure. Conclusions. Our meta-analysis indicates that wearing SCBA elicits thermoregulatory, metabolic and psychological stress. However, this is not primarily explained by the weight of SCBA, highlighting the value of ergonomic design and physiological monitoring.

Workers' Compensation Claims for Conditions Presumed to Be Occupational Diseases Among Firefighters in Washington State, 2000-2017

OBJECTIVE

Occupational disease presumption laws for firefighters are common, yet little is known about the workers' compensation claims filed for them.

METHODS

We identified Washington State's workers' compensation claims for conditions covered by presumption among firefighters during 2000 to 2017, and described them by disease type and claim characteristics. Claim rates for specific cancers were compared with statewide incidence rates using the Washington State cancer registry.

RESULTS

Firefighters filed 330 claims for conditions covered by presumption (heart problems, 43%; cancer, 35%; respiratory disease, 15%; and infectious diseases, 8%), with acceptance rates varying by disease and insurer type. Cancer claims were associated with the highest claim costs and time loss.

CONCLUSIONS

This study provides necessary baseline data to understand the impact of presumption laws on workers' compensation systems, and can inform future decisions presumption law expansions for firefighters.

Association of Occupational Stress With Tinnitus Among Career Firefighters in the United States

OBJECTIVE

This study explores the relationship between occupational stress and tinnitus among firefighters, a group often exposed to two tinnitus risk factors: high stress and noise.

METHODS

This cross-sectional study includes 240 firefighters in the United States. Data describing demographic characteristics, occupational stress, noise exposure, and tinnitus were collected by survey. Occupational stress was measured using the short version of the Effort-Reward Imbalance Questionnaire.

RESULTS

Forty-three percent of participants reported experiencing tinnitus within the past month. For occupational stress, higher effort (odds ratio, 1.25; 95% confidence interval, 1.05 to 1.49) and higher effort-reward ratio (odds ratio, 12.28; 95% confidence interval, 3.08 to 48.86) were associated with increased odds of tinnitus, after adjustment for demographic characteristics and noise exposure.

CONCLUSIONS

Occupational stress may increase the likelihood of tinnitus for firefighters, an already at-risk group of workers. Health providers should incorporate stress assessment into tinnitus management programs.

Firefighter Well-Being Defined and Operationalized at the Organizational and Worker Level: A Qualitative Study

OBJECTIVE

The aim of the study is to define and explore organizational- and worker-level factors of firefighter well-being.

METHODS

Qualitative data were collected using interviews and focus group sessions among 17 career firefighters across 4 fire departments. Interviews were recorded and transcribed, and a general inductive approach was used to code similar concepts into themes.

RESULTS

Firefighters defined well-being as being content with oneself and being able to balance ones' emotional, mental, and physical health. Themes contributing to firefighter well-being include the nature of the job, the influence of others, and physical health. Subthemes mapping to themes include dealing with trauma, compartmentalizing work and home life, coworkers and station culture, the role of superiors on attitudes and practices, being a reliable firefighter, and lack of sleep.

CONCLUSIONS

Career firefighters describe well-being as a holistic approach to balancing emotional, mental, and physical health.