National Firefighter Registry opens for profession-wide cancer monitoring

The National Firefighter Registry (NFR) officially opens its enrollment portal today after a few months in pre-launch testing and years of preparation by the National Institute for Occupational Safety and Health (NIOSH). Wildland and structural firefighters who register and share their exposure histories at NFR.cdc.gov will help support the NFR’s goal of understanding and reducing cancer in firefighters.

The registry seeks comprehensive participation and notes four objectives that firefighters will support by enrolling:

      • “Help protect your brothers and sisters in the fire service from developing cancer
      • “Help lessen the impact of cancer on firefighters’ families and friends
      • “Pave the way for new health and safety measures to keep the next generation of firefighters safe
      • “Improve understanding of cancer risk among minority, female, and volunteer firefighters, as well as groups like wildland firefighters”

To develop comprehensive and ongoing  analyses of risks and illnesses, the NFR  encourages participation by all firefighters, structural and wildland, and all statuses — volunteer, on-call, seasonal, full-time, retired, disabled, with or without a cancer diagnosis.

While the images on the registry often focus on structural firefighters, the associated links include background health and cancer information for wildland firefighters and a web page focused on outdoor workers and smoke.

National Firefighter Registry

Bill Gabbert wrote many articles in Wildfire Today covering the genesis and progress toward the National Firefighter Registry (also referred to as the “cancer registry”). One article shared Kathleen Navarro’s “A Brief Look” at cancer and health risks for wildland firefighters, which notes an estimated 8-43% increased chance of lung cancer and a 16-30% increased risk of heart disease mortality among wildland firefighters. Gabbert died of cancer in January.

For agencies and organizations seeking to support enrollment, a communications portal offers a range of print and social media messages.

One suggestion when registering: gather up your experience records first. I completed the first three registration stages (the “profile” stage) in around 10 minutes and then took a break to collect some notes on seasons of service and types and amount of exposure. A registrant can step aside from the profile stage of the portal and continue later, but once you enter details of your fire experience in the “experience” stage of registration, you aren’t able to edit it.

Recording an accurate representation of work and fire experience is a core component of the registry, which seeks to create a database of fire experience, firefighter’s risk exposure and long-term health effects. This has proven a challenge for researchers examining the higher prevalence of cancer occurrence among firefighters.

This can be particularly challenging with wildland firefighters serving on seasonal assignments (and with seasonal exposure to many varieties and quantities of smoke and other potential fireline-related carcinogens). The registry includes questions that may assist in determining wildland smoke exposure, including a firefighter’s role in fire — such as hand crew, engine crew, aviation, etc.; firefighter or fire manager; and the duration and type of fires (wildfire vs. prescribed) that a firefighter responded to on average, by the specific positions held. The experience questionnaire includes most varieties of fire experience, including wildland-urban interface as compared to wildfires. The experience and personal demographic sections may take from 20-30 minutes to complete, longer if you’d had a variety of positions and fire experience in your career.

National Firefighter Registry - Stage 3 profile completed.
National Firefighter Registry – the Profile stages completed. Take a break and gather your exposure history before tackling the Experience Questionnaire.

The document below shares a step-by-step process. Note that the consent is in-depth, in part to ensure participants that their shared information will be kept confidential. Survey questions include general health and demographic questions, including a history of tobacco or alcohol use and workplace but non-fire exposure to potential carcinogens.

Once a firefighter is registered, an anonymized tracking system in state cancer registries will link a cancer diagnosis (if one occurs) to the last four digits of a social security number, which will then correlate the diagnosis with the NFR data that includes the firefighter’s experience and exposure. In some cases, NIOSH may connect with a registered firefighter to seek voluntary participation in additional research.

[pdf-embedder url=”https://wildfiretoday.com/wp-content/uploads/2023/04/How-to-signup-for-Firefighter-Registry.pdf” title=”How to signup for Firefighter Registry”]

Firefighter health and workplace initiatives featured Jan. 26

Finding time and priority for our health is key for firefighters and fire managers. This week, we offer four activities for you to pick and choose or preferably quadruple-up, starting with two online meetings on Jan. 26 that will highlight initiatives to improve firefighter working conditions.

(1) On Thursday Jan. 26, 1 pm EST, Fire Engineering and Vector Solutions will host a webinar with Chief Todd LeDuc (Ret.), Chief Strategy Officer for Life Scan Wellness Centers, and Frank Leeb, Deputy Assistant Chief with FDNY, on “The Impact of Occupational Cancer: How to Reduce Exposure & the Role of Early Detection.”

The announcement notes that “The International Agency for Research on Cancer (IARC) recently updated its classification of the firefighting occupation to Group 1, ‘carcinogenic to humans,’ after conducting a new international study that found sufficient evidence linking cancer risk to the occupation. The danger is real, but there are strategies and resources that can reduce risk, enhance survival, and support firefighters.”

(2) Later on Thursday (and on Pacific Time), the Grassroots Wildland Firefighters offer their quarterly update starting at 5:30 pm PST. Register here or find out more at their home page at www.grwff.com. This quarter’s updates will likely discuss recent legislation concerning preemptive cancer coverage in the Federal Firefighters Fairness Act and other Grassroots WFF initiatives, as well as the announcement by outgoing president Kelly Martin of the incoming board, which features Luke Mayfield – President, Riva Duncan – Vice President, Bobbie Scopa – Secretary, and Jami Egland – Treasurer. Kudos to Martin’s work with GRWFF and wishing for continued success to the new board.

(3) In related health news, this past week the U.S. Fire Administration announced the pending opening of the National Firefighter Registry. https://www.usfa.fema.gov/blog/ci-011723.html.

As the USFA notes, “By adding your information to the National Firefighter Registry (NFR), you can help researchers better understand how your work affects the risk of getting cancer and how to lower this risk. According to National Institute for Occupational Safety and Health (NIOSH) research, cancer is a leading cause of death among firefighters, and research suggests firefighters are at higher risk for certain types of cancers when compared to the general population.”

A direct link to the NIOSH NFR website is at https://www.cdc.gov/niosh/firefighters/registry.html. Initially the Registry was anticipated to open this past fall; it’s now scheduled to open this winter for confidential sharing of cancer diagnoses and work histories. As the NFR notes, “The more firefighters who sign up for the registry through its secure web portal, the more information researchers will have to learn about cancer in the fire service and how to protect firefighters from developing cancer in the line of duty.”

(4) Finally, a reminder –- there’s an opportunity to learn more of cancer and PTSD risks while adding a cancer/health donation. See our article Share a few hours for cancer awareness (and help fund our profession’s response) for more – and if you need an extra incentive, remember that the Vector-Solutions sponsored donation deadline is Jan. 31.

Congress may try again to create a firefighter cancer registry

4:35 a.m. MDT Oct. 20, 2021

Pine Gulch Fire Colorado
Firefighters on Pine Gulch Fire during night shift, August 17, 2020. InciWeb.

A bill soon to be introduced in the House of Representatives, the Tim Hart Wildland Firefighter Classification and Pay Parity Act, would accomplish several things to improve the pay and other working conditions of federal wildland firefighters. We covered that in another article.

One of the provisions in that legislation, the creation of a “Federal Wildland Firefighter Cancer and Cardiovascular Disease Database”, is interesting. About three years ago the Firefighter Cancer Registry Act of 2018 which passed July 7, 2018, required that the National Institute for Occupational Safety and Health (NIOSH), an agency within the Centers for Disease Control and Prevention (CDC), establish a Firefighter Cancer Registry. The goal was to better understand the link between workplace exposures and cancer among firefighters. NIOSH has been piddling around with this for four years, led by Kenny Fent, accomplishing very little.

Kudos to the legislators who will attempt to get it done another way, after apparently giving up on the NIOSH Firefighter Cancer Registry.

Articles on Wildfire Today tagged “cancer registry.”

National Firefighter Registry releases time line toward implementation

UPDATED at 10:45 a.m. MDT Nov. 21, 2019

On November 21 the National Firefighter Registry that is being created by the National Institute for Occupational Safety and Health (NIOSH), a division of the Centers for Disease Control and Prevention, released information about their accomplishments. We are updating this article originally published November 17, 2019 to include the new data.

Milestones from this Quarter
Much of the work this quarter focused on creating the NFR protocol, filling staffing needs, and meeting with firefighters and stakeholders about the NFR. Some of our key milestones for this quarter include:

  • Reviewed Federal Register comments made on the NFR’s Request for Information (RFI). Thank you to those that were able to provide feedback. These comments are very helpful in guiding the development of the NFR.
  • Began development of the protocol, informed consent document, and enrollment questionnaire.
  • Started gathering details on record keeping systems at fire departments to better understand what data are available and potential mechanisms for importing the data.
  • Made progress on developing requirements for the registration web portal.
  • Held discussions with representatives from select state cancer registries and related organizations to better understand cancer surveillance on a national level.
  • Hired a new health scientist, Andrea Wilkinson, formerly of the First Responder Health & Safety Laboratory at Skidmore College.
    Created the NFR webpage https://www.cdc.gov/niosh/firefighters/registry.html
  • Began formation of the NFR Advisory Committee. This committee will include at least 10 members with various backgrounds, expertise, and experience related to firefighter health and research.

Next Steps

  • Finalize protocol and consent form
  • Begin Office of Management and Budget (OMB) clearance process for enrollment questionnaire
  • Hire Health Communications Specialist
  • Continue conversations with stakeholders and obtain their support
  • Continue conversations with select fire departments throughout the country.

(Originally published at 9:54 a.m. MDT Nov. 17, 2019)

The National Firefighter Registry, originally called the Firefighter Cancer Registry in the authorizing legislation, has released very broad time-based goals for implementing a system which hopefully can identify any relationships between cancer and occupational exposure to toxicants.

Earlier this year the National Institute for Occupational Safety and Health (NIOSH), a division of the Centers for Disease Control and Prevention, asked firefighters for input on how to maximize participation in the Registry (perhaps working on the first goal in the timeline chart). That comment period ended May 28, 2019.

From the time line, it appears that NIOSH hopes to begin enrolling firefighters sometime between 2019 and 2022.

firefighters smoke
Firefighters in a smoky environment on the White Tail Fire, March 8, 2019, Black Hills National Forest.

Previous studies, including one completed by NIOSH in 2014, have highlighted firefighters’ increased risk for certain cancers compared to the general population. However few previous studies have collected data about wildland firefighters, volunteer firefighters, or sufficient numbers of female and minority firefighters in order to draw conclusions regarding their risk of cancer.

In one study that collected 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 by 22 to 39 percent. The project only looked at the wildland fire environment, and was not a long term study of firefighters’ health.

The ultimate goal of the Registry is to better understand the link between workplace exposures and cancer among firefighters. The Registry will include all U.S. firefighters, not just those with a cancer diagnosis. The Registry also has the potential to provide a better understanding of cancer risk among subgroups such as women, minorities, and volunteers, and among sub-specialties of the fire service like instructors, wildland firefighters, and arson investigators.

From the Registry information, CDC/NIOSH will estimate an overall rate of cancer for firefighters. They might find certain groups of firefighters are at a higher risk of cancer than others based on level of exposure, geography, gender, or other factors. They may also find that certain protective measures are associated with a reduced risk for cancer, which could provide additional evidence and support for specific control interventions.

The Registry will be completely voluntary, and no one can force a person to join.

All active and retired as well as volunteer, paid-on-call, and career firefighters will be encouraged to join the Registry, regardless of their current health status.

CDC/NIOSH promises that they will always maintain participants’ privacy and will never share personal information with an outside organization including fire departments, unions, or other researchers without permission of the individual.

NBC News: cancer among firefighters

smoke firefighter health cancer wildfire

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].

Two bills introduced in Congress that could affect wildland firefighters

Washington DC mall capitol
Washington, DC, December 13, 2015.

I have to admit that I have become a bit cynical about firefighter legislation. We dutifully report when a bill is introduced that specifically affects wildland firefighters, but they almost never progress beyond the committee stage. A person has to wonder why these bills are drafted if they stand so little chance of seeing the light of day. Is it because Congress is so dysfunctional that very few bills get passed at all unless they are absolutely critical to keeping the doors of government open? Or, do politicians simply want to get their name out there hoping voters will remember it the next time they are up for reelection? Maybe this year with both houses and the Presidency controlled by one party more can get done (he thought very optimistically).

Having said that, below we have information about two bills that were introduced in the Senate on April 26. They are both cosponsored by Senators Steve Daines (D-MT) and Maria Cantwell (R-WA). A handful of other Senators have said they intend to sign on as cosponsors.

S.949 – Wildland Firefighter Recognition Act

It would require the Director of the Office of Personnel Management to create a classification that more accurately reflects the role of wildland firefighters in the Departments of Interior and Agriculture. Their official title would become “Wildland Firefighter”. Employees currently employed, many of them with the title “Forestry Technician”, would have the choice of retaining their previous job series or moving to the new Wildland Firefighter series.

In a press release, the two Senators wrote:

Providing wildland firefighters with the proper title will improve recruitment efforts and morale and also give due recognition to those brave individuals who risk their lives to protect others’ and their property.

Text of the bill as of April 26, 2017. Track the progress of the bill.

S.950 – Wildland Firefighter Fairness Act

This bill has a number of provisions, some of which have been proposed before in various forms:

  • A pilot program would authorize the department Secretaries to allow seasonal employees to work beyond their 1,040-hour per year limit “in a given year if the covered Secretary determines the expansion to be necessary to stage fire crews earlier or later in a year to accommodate longer fire seasons.”
  • The incident qualification systems of the Departments of Interior and Agriculture would be merged into one, and no agency would be allowed to require additional competencies to become qualified for a position.
  • It would allow a firefighter who was injured and disabled on the job to retain the 20-year firefighter retirement track if they return to work in a non-fire position, rather than converting to the 30-year retirement program of ordinary federal employees. It would also allow the injured firefighter’s history of overtime pay to be considered as income for purposes of calculating worker’s compensation disability benefits.

In our April 20 interview with Dan Buckley, the National Fire Director for the National Park Service, he talked about the need for extending the terms of seasonal firefighters, the first item listed in the description of the above bill. That topic begins at 11:49 in the video.

Text of the bill as of April 26, 2017. Track the progress.

The legislation will be considered by the Senate Homeland Security and Governmental Affairs Committee. A source in D.C. who is not authorized to speak publically on this subject told me that the plan is to “staple” these two bills to others related to firefighting, such as the Firefighter Cancer Registry Act of 2017 introduced in February (which would include wildland firefighters) and the reauthorization of the Assistance to Firefighters (AFG) and Staffing for Adequate Fire and Emergency Response (SAFER) grant programs. The strategy is that if these (hopefully) non-controversial bills are stapled together they could be passed in the Senate with very little debate and a quick unanimous vote — perhaps two to three months from now.

One hurdle to overcome is the fact that little or no action can occur legislatively until the Administration first says yay or nay. And the politically appointed positions that would review these proposed bills are still vacant.

Now what?

If wildland firefighters have an opinion about this introduced legislation, they should contact their Senators and Representative.