Inadequate sleep can help explain high rates of suicide and cardiac events among firefighters

Studies indicate sleep deprivation increases susceptibility to cancer, cardiac disease, and post-traumatic stress disorder.

Firefighters sleep wildfire
USFS photo.

An article by Eric Saylors at emphasizes how important sleep is to firefighters.

He reports that one study found men kept awake between 10 p.m. and 3 a.m. showed a 70 percent reduction of cancer-fighting immune cells known as “natural killers” after one night. These cells detect and control early signs of cancer. The data in the study indicates that even a modest disturbance of sleep produces a reduction of natural immune responses.

Below are excerpts from Mr. Saylor’s article, which also draws information from several other researchers:

“Lack of quality sleep could explain why cardiac events are common in firefighters, regardless of fitness programs. ”

“Rosaline Cartwright, professor of psychology in neuroscience, explains the mind needs sleep to processes stressful events. Without sleep the brain cannot decouple the memory of tragic events and the physiological response. Essentially, if you can’t sleep on it, you can’t get over it. This explains a new epidemic in the fire service; firefighter suicide.”

“Cartwright’s research suggests the mind needs dreams followed by REM sleep and to process upsetting experiences. In other words, you have to recreate tough experiences in your dreams so your mind can break them down. Without the combination of REM sleep and dreams, memories of traumatic events remain fresh in the person’s mind. As a result, a firefighter who is sleep deprived accumulates traumatic events like a trash can that is never emptied.”

“Contributing to cancer, cardiac events, and PTSD, lack of sleep may be the greatest cause of firefighter deaths.”

Eric Saylors is an instructor, author, pilot, consultant, and 3rd gen firefighter with a Masters degree in security studies from the Naval Post Graduate School.

Study shows firefighters’ exposure to smoke increases disease risk

Depending on the type of work performed and the number of years of exposure, the increased risk can be 22 to 39 percent.

Above: Smoky conditions on the Legion Lake Fire in Custer State Park in South Dakota, December 12, 2017. Photo by Bill Gabbert.

Originally published at 6:02 p.m. MT, February 6, 2018.

After collecting data from wildland firefighters in the field, a group of researchers concluded that firefighters’ exposure to smoke can increase the risk of mortality from lung cancer, ischemic heart disease, and cardiovascular disease. In this first section we cover what is in vegetation fire smoke, and after that we have details about the additional mortality risk faced by firefighters who can’t help but breathe the toxic substances.

What is in the air that firefighters breathe?

There have been many studies about smoke dating back to the 1988 NIOSH project at the fires in Yellowstone National Park. Most of them confirmed that yes, wildland firefighters ARE exposed to smoke and in most cases they quantified the amount.

In 2004 Timothy E. Reinhardt and Roger D. Ottmar  found a witches’ brew of methyl ethyl bad stuff that firefighters are breathing. All of these are hazardous to your health:

  • Aldehydes (volatile organic compounds); can cause immediate irritation of the eyes, nose, and throat, and inhalation can cause inflammation of the lungs. Short-term effects include cough, shortness of breath, and chest pain. The most abundant aldehyde in smoke is formaldehyde. When formaldehyde enters the body, it is converted to formic acid, which also is toxic.
  • Sulfur dioxide (SO²); causes severe irritation of the eyes, skin, upper respiratory tract, and mucous membranes, and also can cause bronchoconstriction. It forms sulfuric acid in the presence of water vapor and has been shown to damage the airways of humans.
  • Carbon monoxide (CO); As CO is inhaled it displaces O2 as it attaches to red blood cells and forms COHb. COHb reduces the ability of the blood to carry oxygen and causes hypoxia (a condition in which the body does not receive sufficient oxygen). Due to their strenuous work, wildland firefighters often have increased respiratory rates, which will increase the amount of CO being inhaled when smoke is present. COHb has a half-life (the time it takes half of the COHb to dissipate from the body) of about 5 hours. Symptoms of CO exposure include headaches, dizziness, nausea, loss of mental acuity, and fatigue. Prolonged, high exposure can cause confusion and loss of consciousness
  • Particulate matter; Respirable particulates are a major concern as they can be inhaled into the deeper recesses of the lungs, the alveolar region. These particles carry absorbed and condensed toxicants into the lungs
  • Acrolein; may increase the possibility of respiratory infections. It can cause irritation of the nose, throat, and lungs. Long-term effects can include chronic respiratory irritation and permanent loss of lung function if exposure occurs over many years.
  • Benzene; can cause headaches, dizziness, nausea, confusion, and respiratory tract irritation. Although the human body can often recover and repair damage caused by irritants, prolonged exposure from extended work shifts and poorly ventilated fire camps can overwhelm the ability to repair damage to genes and deoxyribonucleic acid (DNA).
  • Crystalline silica; can cause silicosis, a noncancerous lung disease that affects lung function. But OSHA classifies it as a carcinogen.
  • Intermediate chemicals; have been shown to cause a variety of health problems including bronchopulmonary carcinogenesis, fibrogenesis, pulmonary injury, respiratory distress, chronic obstructive pulmonary disease (COPD), and inflammation.

One of the more recent research efforts, from 2009 to 2012, was led by George Broyles of the U.S. Forest Service, National Technology and Development Program, in Boise, Idaho. They collected data in 11 fuel models in 17 states on initial attack, prescribed burns, and large project fires. The group measured carbon monoxide (CO) with electronic datalogging dosimeters and particulate matter using air pumps and filters.

carbon monoxide exposure firefighters
Data from the 2009-2012 wildland firefighter study led by George Broyles. “TWA” stands for Time Weighted Average. CO is carbon monoxide. OEL is Occupational Exposure Limits.

Monitoring carbon monoxide (CO) can be important, and is also fairly easy to do and not terribly expensive. Researchers have found that it can be a surrogate for the primary irritants of concern in wildland smoke near the combustion source. If CO is present, it’s almost certain that the smorgasbord of nasty stuff is in the air.

wildfire smoke monitoring firefighters
Jon Richert displays the various devices the National Technology Development Center research crews use to measure the amount of smoke firefighters deal with during wildfire suppression. This equipment was used in 2016 in a different but similar study than the one described in this article.
Diffusion tube
Diffusion tube.

Electronic CO monitors are available for $100 to $300. Another option is the little disposable CO monitors called diffusion tubes. With the holder they are about the size of a dry erase marker. Many are made by Drager, and for eight hours can record the cumulative CO. You can’t get an instantaneous reading, but the total hourly exposure can be monitored. They cost about $13 each. If one or two people on the crew carry them it can provide a heads up if the air quality is really bad.

What are the health effects of smoke exposure on a wildland fire?

Employers in most if not all workplaces are required to minimize hazards and provide a safe working environment. But of course it is impossible to totally eliminate all risks to firefighters. A cynic might assume that leadership in the wildland fire community may be hesitant to ask the question if they don’t want to hear the answer.

In spite of numerous studies confirming that yes, there is smoke where wildland firefighters work, there has been little in the literature that quantifies the effects on a person’s health. A new study published in August, 2017 contains a preliminary analysis addressing that question.

It is titled Wildland Fire Smoke Health Effects on Wildland Firefighters and the Public – Final Report to the Joint Fire Science Program. The authors are Joe Domitrovich, George Broyles, Roger D. Ottmar, Timothy E. Reinhardt, Luke P. Naeher, Michael T. Kleinman, Kathleen M. Navarro, Christopher E. Mackay, and Olorunfemi Adetona.

They used the field data collected in the 2009 to 2012 George Broyles study to extrapolate the physical and health effects on humans. The authors actually came up with numbers that indicate firefighters’ relative mortality risk for lung cancer, ischemic heart disease, and cardiovascular disease.
Continue reading “Study shows firefighters’ exposure to smoke increases disease risk”

News roundup, November 15, 2017

Suicide rate among wildland firefighters is “astronomical”

From 2015 to 2016, 52 wildland firefighters took their own lives.

The number of wildland firefighters who have resorted to suicide is shocking — 52 in a two year period, 2015 to 2016. According to Nelda St. Clair of the Bureau of Land Management so far this year there have been another 16.

Wildland firefighting is a niche within the firefighting world. High rates of structural firefighters taking their own lives have been known for years, but these kinds of “astronomical” numbers, as described by Ms. St. Clair, in a much smaller population is stunning. There are only about 13,000 wildland firefighters in the five major federal land management agencies, along with several thousand others working for state and local agencies. It is likely that most of them personally know a firefighting brother or sister who succumbed to what might be called an epidemic.

Assuming for a moment that there are 17,000 wildland firefighters in the United States, approximately 0.3 percent of them took their own lives in 2015 and 2016 — a shocking percentage.

Most firefighters in general, and in particular, wildland firefighters, have a macho, can-do attitude, regardless of their gender. Just give them an objective, and they will figure out how to get it done, with little or no outside help. This can carry over into their personal lives and mental state. When the fire season is over their environment may shift from being part of a close brotherhood working with their buddies for long hours toward a common goal, to something completely different. The reduction in adrenalin and accomplishment of important tasks is more difficult for some to adjust to than others. Suicide rates can rise during the wildland fire off-season.

The fact that a national publication, The Atlantic, has published an in-depth article on the issue is an indicator of the seriousness of this problem. I suggest you read the entire article, but here is an excerpt:

…It’s hard to quantify both completed and attempted suicide rates in populations that aren’t prone to talk about mental health, but both factors are known to be high among “structure” firefighters—those who fight fires in buildings—and members of the military who face similar traumatic, high-stress situations as wildland firefighters. Jeff Dill, a captain at a fire station in Inverness, Illinois, and the founder of the Firefighter Behavioral-Health Alliance, which tracks firefighter suicides, says firefighters are more likely to die by suicide than in the line of duty. In a 2015 study on suicide risk in firefighters, half of those who responded reported that they’d contemplated suicide.

Those concepts align with the wildland reports: St. Clair says they’ve lost five smoke jumpers to suicide in the last seven years, and had two in-the-line-of-duty deaths in the same period. But while structure and wildland firefighters are similar, the groups aren’t perfect analogs, which is why it’s particularly hard to address some of the most insidious risks for wildland firefighters. Urban firefighters, and people who fight structure fires, will usually have year-round work, health insurance, and mandatory trauma training. Their support system is fundamentally different…

The Wildland Fire Lessons Learned Center’s Spring 2017 edition of Two More Chains was dedicated to this issue. An excerpt:

…In researching suicide in the wildland fire service for this issue of Two More Chains, it has been brought to our attention that, in some cases, a stigma regarding employee suicide has been observed not so much among young firefighters—who, it is said, are more open to addressing their emotions—but among some more senior wildland fire and agency managers who are apparently uncomfortable addressing the topic of mental health.

Unfortunately, we have learned that, in at least one instance, a fire manager believed that a firefighter who had died by suicide should not be entitled to an honor guard or a memorial stone in the Wildland Firefighter Foundation monument at NIFC, “because it would dishonor those who died innocently.” Similarly, we have heard about fire managers who have declined offers of free critical stress debriefings for their staff after a coworker suicide—without even asking their staff.

It’s also been brought to our attention that employees have been directed not to send emails that contain information about someone dying by suicide or to mention it in staff meetings—even though the victim’s family has been open about their family member’s cause of death.

We hope and believe that these are isolated incidents. That they are exceptions to the positive efforts that our fire agencies are currently pursuing—reflected throughout the input from our agency SMEs that is shared in this issue’s “SME Insights and Info” document.

By openly addressing the topic of mental health among our employees we can embrace the notion that this issue is no different than any other injury or disease.

We need to help ensure that all of our managers and senior leaders are on board with this enlightened perspective. We should not blame the victim, or treat the person in pain as “weak,” or otherwise refuse to acknowledge their mental health problems.

To be sure, if safety is truly our top priority, then it is our duty to take care of all of our people…

Two More Chains highlights work that is being done on this issue by several people, some of whom are intimately familiar with wildland firefighting. Patty O’Brien worked for 10 years on the Lolo Interagency Hotshot Crew and has a total of 15 years’ experience as a wildland firefighter. She is a fifth year PhD candidate in Clinical Psychology at the University of Montana.

Kim Lightley writes about how she experienced Post-Traumatic Stress Disorder after nine of her fellow crewmembers of the Prineville Hotshots were killed on the 1994 South Canyon Fire along with five other firefighters. After dealing with depression and survivor’s guilt for two years she sought counseling, which helped.

She wrote in Two More Chains:

When I was in the depths of PTSD—because I had all the symptoms—it would have been really awesome if somebody would have come up to me and said: ‘Hey, what you’re experiencing right now is normal, because what you experienced is very abnormal’. If I had heard that, I think I would have felt less crazy.

Today she is the Critical Incident Response Program Management Specialist for the U.S. Forest Service’s Fire and Aviation Management program.

Amanda Marsh’s husband Eric Marsh was one of the 19 firefighters that perished on the Yarnell Hill Fire in 2013. She established the Eric Marsh Foundation which is committed to serving those directly affected by wildland line-of-duty deaths, as well as living wildland firefighters and their families. We asked for her insight:

It saddens me greatly knowing that our wildland firefighters are suffering. In 2015 I came very close to ending my life. I have PTSD and we are not talking about this enough in the fire service, wildland or structure.

PTSD is cumulative. Every traumatic event builds upon the last one, creating a situation where sometimes we feel so hopeless and so helpless that taking our lives seems like the only way out.

At the end of the season the fire family often disburses and the support that was so available during the fire season is no longer present in the way it was. We must begin talking about PTSD in every department, every agency. Our wildland firefighters deserve better, they deserve the ability to discuss openly and without fear of judgement when the stresses of the job begin to compound. I am talking about PTSD, I am talking about suicide openly because it is the right thing to do.

There is help out there. Call the Suicide Prevention Hotline (1-800-273-8255). We also offer help through the Eric Marsh Foundation for Wildland Firefighters by helping wildland firefighters get treatment for PTSD. You are not alone. There are many of us who know how you feel. You are loved and you are seen and you are valid.

Further reading

The Wildland Fire Lessons Learned Center solicited and received insight from six wildland fire agency subject matter experts about the wildland firefighter suicide issue.


Thanks and a tip of the hat go out to Brian.
Typos or errors, report them HERE.

NBC News: cancer among firefighters

Above: Firefighter working on a smoky wildfire at Buffalo Gap, South Dakota, March 3, 2016.

(Originally published at 10 p.m. MDT October 23, 2017)

This report by NBC News about the rising rates of cancer among firefighters exclusively shows the structural side of the job. Obviously they are exposed to different toxins than their wildland brothers, so it is unknown how much the data crosses over. One of the big differences between the two disciplines is that for structure and vehicle fires a breathing apparatus (BA) is always available. Firefighters on wildland fires NEVER have access to BAs, which only last for minutes, while they can be exposed to smoke for most of their shifts which on large fires are typically up to 16 hours. And wildland firefighters rarely have the opportunity to, as the video recommends, change clothes and shower within an hour after exposure.

In 2010 we began calling for the wildland fire agencies to conduct a study led by medical doctors and epidemiologists to evaluate the short and long term effects of smoke on firefighters. The federal agencies that should take the lead on this are the National Park Service, Bureau of Land Management, Bureau of Indian Affairs, Fish and Wildlife Service, and the Forest Service. State agencies with significant numbers of wildland firefighters need to also be involved.

It is possible that the agencies that employ firefighters do not want to expose the facts about the dangers of smoke. It could cost them money to change their practices, provide a safer workplace, and cover the costs of presumptive illnesses.

Various bills have been introduced in Congress that would establish a cancer registry for firefighters, but to our knowledge none have passed.

Here is an excerpt from an article we wrote March 17, 2017:

“On Wednesday [March 15, 2017] a Montana legislative committee voted down a bill that would have provided benefits for firefighters who developed a lung disease on the job. Republican Mark Noland of Bigfork said firefighters “know what they’re doing”, and:

That is their profession, that is what they chose, and we do not want to, you know, slight them in any way, shape or form, but it is something they’re going into with their eyes wide open.

That is asinine, ridiculous, reprehensible, and irresponsible.

Rep. Mark Noland
Rep. Mark Noland of Bigfork, MT.

He is assuming that when firefighters began their careers they knew there was a good chance they would damage their lungs. If that is common knowledge now, or was 20 years ago when the firefighter signed up, why haven’t the employers already established coverage for presumptive diseases? There is a great deal we do not know about the effects of breathing contaminated air on structure, vehicle, and wildland fires.

Many agencies and government bodies have already established a list of presumptive diseases that will enable health coverage for firefighters. For example the British Columbia government recognizes at least nine “presumptive cancers” among firefighters, including leukemia, testicular cancer, lung cancer, brain cancer, bladder cancer, ureter cancer, colorectal cancer, and non-Hodgkins’s lymphoma.

The Montana legislation would have only covered one of these nine illnesses.

When a person enlists in the military and they come home injured or permanently disabled, should we ignore them, saying they knew what they were getting into? Their “eyes were wide open”? How is treating firefighters injured on the job different? One could argue that they are both defending and protecting our homeland; one of them actually IN our homeland while the other may have been on the other side of the world.” [Update October 23, 2017: for example in an African country, Niger, many Americans have never heard of].

Early diagnosis of firefighter mental and physical health issues

It can extend or improve the quality of life.

The leading cause of fatalities on wildland fires is medical issues, according to data for 1990 through 2014 supplied by the National Interagency Fire Center. The numbers would probably be significantly higher if deaths that occurred away from the fireline but caused by the job were figured in, such as leukemia, testicular cancer, lung cancer, brain cancer, bladder cancer, ureter cancer, colorectal cancer, and non-Hodgkins’s lymphoma. Many jurisdictions list these as “presumptive cancers” and will automatically cover the medical bills of firefighters diagnosed with the conditions.

Another medical issue affecting firefighters, the elephant in the room, is mental health, something that is rarely talked about in a job where physical prowess and endurance is often used as a measuring stick. We are reminded of a firefighter who earlier in his career was highly regarded and respected, but has changed to the point where he is causing serious problems on and off the job. Some of his colleagues think he might benefit from professional psychiatric help.

Early diagnosis and treatment of physical and mental conditions can extend or improve the quality of life. We often hear, “If you see something, say something”. Usually that is used in the context of possibly dangerous conditions or crew resource management, but it can also apply to our co-workers who might need treatment for a dangerous physical or mental issue.

All firefighters and their families need to see the excellent nine-minute video covering the physical and mental health of firefighters  produced by Edmonton Fire Rescue. It was made possible by the family of deceased firefighter Edward James Paul (1954-2015).

Watch the video.

And, be careful out there.