Wildland firefighters’ invisible injuries can be life-threatening

A real-life example after the line of duty death of a fellow firefighter

David Ruhl memorial service
Attendees at the memorial service for David Ruhl in Rapid City, South Dakota, August 9, 2015. Photo by Bill Gabbert.

During his 14 years working for the Bureau of Land Management as a wildland firefighter, a fire that Danny Brown responded to on July 30, 2015 changed his life in ways that most of us cannot fathom. Mr. Brown was one of the first to find the burned body of his friend David Ruhl who was entrapped and killed during the initial attack of the Frog Fire in northern California.

An excellent article by Mark Betancourt in High Country News describes the upheaval that occurred in Mr. Brown’s life, how he tried to deal with it, and how the government’s system for treating on the job injuries failed.

Here is a brief excerpt:

The trauma Brown sustained that day could happen to any wildland firefighter. It drove him out of the career he loved and the community that came with it, and to his agony it limited his ability to support his wife and their three children. He was eventually diagnosed with chronic PTSD — post-traumatic stress disorder — and in his most desperate moments, he thought about taking his life. Adding to his suffering was the feeling that he had been abandoned by the government that put him in harm’s way.

A number of people bent over backwards trying to help Mr. Brown receive the professional help he badly needed, including a friend, a supervisor, the Wildland Firefighter Foundation, and Nelda St. Clair, a consultant who coordinates fire-specific crisis intervention and mental fitness for federal and state agencies.

Federal agencies that employe wildland firefighters (but call them technicians) hire them to perform a hazardous job. A percentage of them in the course of their career will be involved directly or indirectly with a very traumatic event. Many of them will power through it with no serious effects, at least outwardly. But others will suffer unseen injuries after having performed their duties.

These federal agencies do not have an effective system or procedure for helping their employees heal from chronic PTSD — post-traumatic stress disorder —  incurred while on the job. Untreated, chronic PTSD can lead to suicide.

Ms. St Clair tries to keep track of how many wildland firefighters take their own lives each year. Her unofficial tally suggests as many die by suicide as in the line of duty.

I can’t help but think that if the job title of these “technicians” was instead, “firefighter”, it might be easier for the hierarchy to understand, and get them the professional support some of them so desperately need. Range Technicians have different job stresses than wildland firefighters. In some cases chronic PTSD is an issue of life and death, not something we can keep ignoring.

If you are a firefighter of part of his or her family, you need to read the article in High Country News. If family members recognize the symptoms it could be helpful.

If you are in an influential position in the federal land management agencies you need to read the article. Look at the firefighters in the photo above who were attending the memorial service for Mr. Ruhl. Do what you can to ensure that no other employees are forced to suffer like Mr. Brown and no doubt others, have.

If you are a federal Senator or Representative, you need to read the article. Then introduce and pass legislation so that other “technicians” do not have to suffer like Mr. Brown.

Read the article.


Help is available for those feeling really depressed or suicidal.

Wildfire smoke worsens coronavirus risk, putting firefighters in extra danger

Researchers found that wildfire smoke exposure can lead to an increase of other pathogens in lungs.

Norbeck prescribed fire Wind Cave National Park
A firefighter at the end of the day, igniting the Norbeck prescribed fire in Wind Cave National Park in the Black Hills of South Dakota, Oct. 20, 2014. Photo by Bill Gabbert.

By Luke Montrose, Assistant Professor of Community and Environmental Health, Boise State University

(This article first appeared at The Conversation)

As summer approaches, two forces of nature are on a collision course, and wildland firefighters will be caught in the middle.

New research suggests that the smoke firefighters breathe on the front lines of wildfires is putting them at greater risk from the new coronavirus, with potentially lethal effects.

At the same time, firefighting conditions make precautions such as social distancing and hand-washing difficult, increasing the chance that, once the virus enters a fire camp, it could quickly spread.

As an environmental toxicologist, I have spent the last decade expanding our understanding of how wood smoke exposure impacts human health. Much of my current research is focused on protecting the long-term health of wildland firefighters and the communities they serve.

‘Camp crud’ and the dangers of air pollution

People have long understood that the air they breathe can impact their health, dating back more than 2,000 years to Hippocrates in his treatise on Air, Water, and Places. Today, there is a growing consensus among researchers that air pollution, specifically the very fine particles called PM2.5, influences risk of respiratory illness. These particles are a tiny fraction of the width of a hair and can travel deep into the lungs.

Italian scientists reported in 2014 that air pollutants can increase the viral load in the lungs and reduce the ability of specialized cells called macrophages to clear out viral invaders.

Researchers in Montana later connected that effect to wood smoke. They found that animals exposed to wood smoke 24 hours before being exposed to a pathogen ended up with more pathogen in their lungs. The researchers showed that wood smoke exposure decreased the macrophages’ ability to combat respiratory infection.

Now, new evidence suggests that long-term exposure to PM2.5 air pollution, which is produced by sources such as wildfirespower plants and vehicles, may make coronavirus particularly deadly.

Researchers from the Harvard T.H. Chan School of Public Health conducted a nationwide study of county-level data and found that even a small increase in the amount of PM2.5 from one U.S. county to the next was associated with a large increase in the death rate from COVID-19. While small increases in PM2.5 also raise the risk of death from other causes for older adults, the magnitude of the increase for COVID-19 was about 20 times greater. The results were released last week, before the usual peer review process was conducted, to help warn people of the risks.

Taken together, these findings suggest that air pollution, including wood smoke, could increase the risk that wildland firefighters will develop severe COVID-19 symptoms.

That probably doesn’t surprise seasoned firefighters.

They’re already familiar with “camp crud,” a combined upper and lower respiratory illness accompanied by cough and fatigue that has become common in firefighting camps.

The National Wildfire Coordinating Group, in its guidance on infectious disease, has pointed out that “the close, overlapping living conditions of an incident command post lends itself to rapid spreading of contagious microorganisms, as witnessed by the common outbreaks of ‘camp crud.’ Outbreaks also have a history of spreading from incident to incident as people are reassigned.”

How to protect wildland firefighters

So, what can be done to avoid the spread of COVID-19 among wildland firefighters and prevent them from being vectors in the communities they serve?

In some areas, officials have been delaying firefighter training sessions and brush-clearing operations that would normally be underway now. But while that might protect firefighters from exposure right now, it can be put off for only so long. Wildfires have already broken out in several states, and delaying controlled burns leaves more fuel when fires get out of control.

The National Wildfire Coordinating Group’s guidance on infectious disease encourages planning ahead so personal protective equipment is available and maintaining records of symptoms so illnesses can be tracked and stopped from spreading.

The guidance also calls for better camp hygiene, providing access to medical care, making isolation possible and coordinating cross-agency communication about the public health risks.

Firefighter camps are not typically well outfitted to promote good personal hygiene. Improving those conditions could help prevent a virus’s spread, such as by adding hand-washing stations and possibly mobile shower units. Single-person tents would allow for more effective social distancing.

Camp personnel should also have access to thermometers and coronavirus test kits. Protocols for quarantining and removing infected firefighters from the field should not only be implemented but practiced.

Also missing from the National Wildfire Coordinating Group’s guidance are policies on traveling to and from training sites, working within communities and traveling from camp. Social distancing may not always be possible, so protective gear, such as face masks, should be made available and their use encouraged.

firefighters crew Whitetail Fire 3-8-2017 Photo by Bill Gabbert
Firefighters on the Whitetail Fire in the Black Hills of South Dakota, March 8, 2017. Photo by Bill Gabbert.

A recent paper from Belgium suggests that even some of the ways firefighters operate in the field should be reconsidered to protect against the virus’s spread. It shows how droplets released when a person exhales can travel farther than six feet during heavy activity. For firefighters, that could mean walking farther apart and in a V-shaped delta formation, rather than a traditional line, to reach the fire.

It is also important to consider that frontline firefighters are often younger and could be asymptomatic but still able to spread the virus, so their contact with with rural community members, such as volunteer firefighters and ranchers, should be considered.

Finally, a system for cross-state communication should be engaged to facilitate sharing of best practices and lessons learned. It also could help track the movement of firefighters across the region.

The safety of rural western communities depends on the wildland firefighters and their ability to respond to emergencies. Protecting their health helps protect public health, too.

Federal employee suicide rate in 2018 was five times higher than private industry

Suicide Helping hands
St.Jude Progress

Wildland firefighters are not alone in their high rate of suicide.

From Fedsmith.com January 8, 2019:

Suicides accounted for 28% of the 124 Federal employee job-related deaths in 2018.

In contrast, suicides accounted for only 5% of the 4,779 private industry employees who died on the job in 2018.

It is OK to ask someone if they are thinking about suicide. Some people think this will spur suicide attempts but this is not accurate. Encouraging them to talk could be the first step leading them to safety.


Help is available for those feeling really depressed or suicidal.

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

Who has your back?

Football players and Vets help each other — maybe the program can be adapted for firefighters

Merging vets and players
Merging Vets & Players photo.

With the suicide rate of wildland firefighters being described as “astronomical” according to information developed by Nelda St. Clair of the Bureau of Land Management in 2017, we need to be situationally aware of any proven or innovative programs that can help mitigate the issues that lead firefighters to think that’s the only option they have.

Today I learned about a program designed to merge former professional football players with veterans of the military. The goal is to give them a new team to tackle the transition together. Called Merging Vets & Players, or MVP, it shows them they are NOT alone.

Fox Sports analyst Jay Glazer and Nate Boyer, retired NFL player and former Green Beret, created MVP in 2015 to address this important challenge.

So far MVP is active in four cities where once a week the former football players and military veterans meet for one hour and 45 minutes in gyms.

Here is how it is described:

The program starts with a 30-minute workout with a warrior to their left and right to get that familiar “burn” going again in them.

The magic of the MVP begins right after with The Huddle, an hour and fifteen minutes of peer-on-peer support, a group of badasses building up fellow badasses. It reminds us of our strength, even when it doesn’t seem clear.

Merging Vets & Players
Merging Vets & Players photo.

The Huddle is where they share their challenges in transition and offer each other support and resources. MVP coaches our vets and athletes to be PROUD OF THEIR SCARS, and to use what they experienced on the battlefield or football field to EMPOWER them through the transition. We don’t run from mental health challenges, we tackle it as a team.

Too many combat vets and former professional athletes think they are alone, MVP is here to show you’re not alone. Whether it’s combat camouflage or a sports jersey, our MVP members help each other find a new identity, — find greatness again — after the uniform comes off.

Wildland firefighters have some things in common with vets and professional football players. Wildland firefighters are tactical athletes, they are members of a team, they depend on each other for success and safety, what they do can be extremely mentally and physically difficult, they are often away from their friends and families, and there are times of the year when they suddenly transition to a much different life style away from their “team”.

Maybe the MVP program could be modified, merging vets with current or transitioned firefighters. Or, it could be just firefighters.

Take a look at the two-minute video that Fox aired on Thanksgiving before the football games.

I’d love to see a group of firefighters doing the “WHO’S GOT MY BACK” call and response.

Learn more about MVP at their website and Instagram.


Help is available for those feeling really depressed or suicidal.

British Columbia initiates wildland firefighter health research

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

Information from the British Columbia Wildfire Service:

VICTORIA – The BC Wildfire Service has provided $305,000 to help fund two research projects looking into the health and wellness of firefighters and associated personnel. The University of Northern British Columbia and the University of Alberta are conducting these studies to learn more about how firefighting activities affect the health of fire crews.

“Our firefighters have worked hard on the front lines to keep British Columbians safe during difficult and record-setting wildfire seasons,” said Doug Donaldson, Minister of Forests, Lands, Natural Resource Operations and Rural Development. “These studies will help us support their long-term health and well-being.”

Research by the University of Northern British Columbia is led by Chelsea Pelletier, PhD, who is an assistant professor with the School of Health Sciences at the University of Northern British Columbia.

A scoping review will:

  • Look holistically at the existing body of research and knowledge about wildland firefighter health and wellness (including its physical, mental and emotional dimensions) by conducting a global scan of the scientific literature;
  • Identify any modifications (based on the scientific literature and work done by wildfire management agencies elsewhere) that could be implemented in the short term to reduce potential health impacts; and
  • Identify any gaps in the work-related health knowledge of wildland firefighters and associated personnel.

The outcomes of this project and other information will help the BC Wildfire Service establish a long-term research strategy for worker health. This research is expected to be completed in the summer of 2020.

Research by the University of Alberta is led by Nicola Cherry, MD, PhD, who is the tripartite chair of occupational health with the Division of Preventive Medicine at the University of Alberta.

It is also supported by the Alberta government and aims to:

  • Examine the nature and concentration of polycyclic aromatic hydrocarbons in the air that firefighters breathe and accumulate on their skin (polycyclic aromatic hydrocarbons are a suite of organic compounds produced when organic material burns, some of which can be hazardous to human health);
  • Explore the practicality and effectiveness of firefighters using respiratory protective equipment; and
  • Investigate whether wildland firefighters have more chronic lung disease than other people of the same age, gender and geographic location.

So far, about 50 BC Wildfire Service firefighters have taken part in this study. Alberta firefighters are also participating. A progress report on the initial phase of this project should be released in March 2020.

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.