Public Safety

Participating core and specialty programs: Emergency Preparedness and Response, National Center for Productive Aging and Work, and Personal Protective Technology.

Management groups, labor organizations, and consensus standard bodies use NIOSH information to prevent exposures to known or suspected carcinogens among public safety workers.

NOTE: Goals in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker population Research Type
A Cancers Exposures during structural operations and overhaul operations Fire service subsector Basic/etiologic

 

B Cancers Respiratory protection during over-haul operations Fire service subsector Intervention

 

C Cancers Respiratory protection during overhaul operations Fire service subsector Translation
D Cancers Exposures from wearing contaminated gear Fire service subsector Intervention
E Cancers Exposure assessment, esp. direct reading Fire Service subsector Basic/etiologic
F Cancers Understanding linkages between shift work and cancers Corrections and

Law enforcement subsectors

Basic/etiologic Surveillance research

Activity Goal 1.9.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand relationship between exposures and cancers among fire service, corrections and law enforcement workers.

Activity Goal 1.9.2 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to reduce exposures to carcinogens among fire service workers.

Activity Goal 1.9.3 (Translation Research): Conduct translation research to understand barriers and aids to implementing effective interventions, particularly related to PPE, to prevent exposures to carcinogens among fire service workers.

Activity Goal 1.9.4 (Surveillance Research): Conduct surveillance research to develop new tools and methods to identify cancer risks and understand the magnitude of those risks among corrections and law enforcement workers.

Burden

Cancer is a leading cause of death in the U.S. and the world. Cancers that occur as a result of exposures in the workplace are preventable, if exposures to known or suspected carcinogens can be reduced [NIOSH 2015]. Based on well-documented associations between occupational exposures and cancer, researchers have estimated that between 3-6 % of all cancers worldwide are caused by exposures to carcinogens in the workplace [Driscoll et al. 2005; Rushton et al. 2012]. NIOSH burden data show the following cancers are an important source of morbidity among workers in the public safety sector: lung and bronchus cancer (attributable fraction [AF] = 15-35 %); leukemia (AF = ~18%); melanoma (skin cancer) (AF = 5-15%); and sinonasal and nasopharynx cancer (AF = 0-2%) [Groenewold et al. 2017]. Among the limited research conducted with the public safety sector workforces, the occupational risks have been evaluated to the greatest extent among firefighters. A recent NIOSH cohort study of 30,000 career firefighters employed from 1950–2009 found an excess risk of developing digestive, oral, pharyngeal, and laryngeal cancers, as well as mesothelioma when compared with the general U.S. population [Daniels et al. 2014, 2015; Pinkerton 2015]. Law enforcement and corrections officers may have several work factors, including shift work and work organization factors, which may be potential causative risk factors for cancer.

Need

The full range of occupational exposures to potential carcinogens among public safety workers is not well understood. For example, for firefighters it is not known how important factors related to occupational cancers among firefighters such as the different sizes of fires and attack methods (including personal protective equipment [PPE] use) have on firefighters’ airborne, dermal, or systemic exposures to potential carcinogens. To date, there has been little to no research studying cancer incidence among the other public safety sub-sectors including law enforcement, emergency medical services, wildland firefighters, and corrections officers; however, there are several work factors, including workplace exposures, shift work, and work organization factors, which may be potential causative risk factors for cancer. To improve the ability to implement effective preventive measures, occupational cancer risks must be identified and the magnitude of those risks better understood. In addition, there is stakeholder interest and a demonstrated need to determine the applicability and performance of air-purifying respirators and powered air-purifying respirators as potential alternatives to self-contained breathing apparatus for fire fighter over-haul operations. Furthermore, current work is underway to evaluate turnout clothing contamination levels and cleaning agents, additional work is needed to develop sampling and testing procedures to assess contaminant levels in turnout clothing materials, characterize persistent contaminants in firefighter protective clothing, and develop validated cleaning procedures to determine efficacy of specific PPE cleaning equipment, cleaning agents, and procedures.

Consensus standard bodies, labor organizations, and management groups use NIOSH information to reduce risk factors to cardiovascular disease among public safety workers.

NOTE: Goals in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker population Research Type
A Cardiovascular disease Hazardous exposures (e.g., particulate matter, heat) Fire service and wildland fire subsectors Basic/etiologic
B Cardiovascular disease Workplace stress, work organization factors, and non-occupational risk factors (e.g., hypertension, obesity, smoking) Corrections, law enforcement, emergency medical service (EMS), and Fire service subsectors Basic/etiologic

Surveillance research

C Cardiovascular disease Reduce known non-occupational risk factors Corrections, law enforcement, EMS, and fire service subsectors InterventionTranslation
D Cardiovascular disease Respiratory and thermal protection, other interventions on fire ground Fire service subsector InterventionTranslation

Activity Goal 1.10.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand relationship between exposures and cardiovascular disease among public safety workers.

Activity Goal 1.10.2 (Intervention Research): Conduct intervention studies to develop and assess the effectiveness of interventions to mitigate risk factors for cardiovascular disease among fire service and wildland firefighters.

Activity Goal 1.10.3 (Translation Research): Conduct translation research to understand barriers and aids to implementing effective cardiovascular health interventions among fire service and wildland firefighters.

Activity Goal 1.10.4 (Surveillance Research): Conduct surveillance research to develop new tools and methods to track occupational and non-occupational risk factors for cardiovascular disease among public safety workers.

Burden

Cardiovascular disease (CVD) is the leading cause of death in the U.S. and an occupational health concern among all public safety workers. While some behavior risk factors for CVD have been researched, occupational factors related to CVD among workers is an emerging area of research. Overall, NIOSH burden data show that the attributable fraction for coronary heart disease among workers in the public safety sector is 13-31% [Groenewold et al. 2017]. For structural firefighters, sudden cardiac events account for more than half of all on-duty deaths each year [USFA 2017]. In addition, it is also estimated that that for every one on-duty sudden cardiac death, 17 non-fatal cardiac events occur while on-duty [Karter and Molis 2011].

Data have also indicated that 7-22% of on-duty deaths among police officers, 17% among wildland firefighters, and 11% of emergency medical service workers are due to sudden cardiac events [Butler et al. 2017; Zimmerman 2012; Maguire et al. 2002; TriData Corporation 2002]. Workplace exposures, such as exposure to combustion by-products, physical, and psychological factors likely contribute to increased risk of cardiovascular disease among public safety workers. Rapidly accumulating evidence also suggests that stress at work plays an important role in high blood pressure, cholesterol levels, and other cardiovascular intermediate and end outcomes, and many types of occupational stressors are prevalent among workers in this sector [Fujishiro et al. 2015; Kaur 2014]. For example, among correction officers and law enforcement many stressors fall far outside the range of the ordinary work experience, e.g., habitual exposure to interpersonal violence, anticipation of inmate contact, actual negative or confrontational interactions, and a general sense of job danger. Other workplace factors of concern related to CVD include physical exertion and physical inactivity, excessive heat or cold, noise, and organizational factors such as shift work and long work hours [Stewart et al. 2017; Charles et al. 2016; Giada et al. 2008; Kales et al. 2007; Tomei et al. 2000].

Need

NIOSH investigators have the capability to assess occupational exposures potentially related to CVD among public safety workers, including such exposures such as combustion by-products (among firefighters) and occupational stress and work organization factors. Additional research is needed to better understand the mechanisms by which occupational factors increase risk; the proportion of CVD due to occupational factors; the interaction of workplace factors and known non-occupational CVD risk factors, and the effectiveness of various interventions to reduce CVD among workers. Translational research is needed across the sector to educate public safety workers on NIOSH and stakeholder research findings related to reducing CVD.

Butler C, Marsh S, Domitrovich JW, and Helmkamp J [2017]. Wildland firefighter deaths in the United States: A comparison of existing surveillance systems. JOEH 14(4): 258-270.

Charles LE, Zhao S, Fekedulegn D, Violanti JM, Andrew ME, Burchfiel CM [2016]. Shiftwork and decline in endothelial function among police officers. Am J Ind Med 59(11):1001-1008. doi:10.1002/ajim.22611

Daniels RD, Bertke S, Dahm MM, Yiin JH, Kubale TL, Hales TR, Baris D, Zahm SH, Beaumont JJ, Waters KM, Pinkerton LE [2015]. Exposure-response relationships for select cancer and non-cancer health outcomes in a cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med 72(10):699-706.

Daniels RD, Kubale TL, Yiin JH, Dahm MM, Hales TR, Baris D, Zahm SH, Beaumont JJ, Waters KM, Pinkerton LE. [2014] Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med 71(6):388-97.

Driscoll T, Takala J, Steenland K, Corvalan C, Fingerhut M. [2005]. Review of estimates of the global burden of injury and illness due to occupational exposures. Am J Ind Med 48:491-502.

Fujishiro K, Roux AV, Landsbergis P, Kaufman JD, Korcarz CE, Stein JH [2015]. Occupational characteristics and the progression of carotid artery intima-media thickness and plaque over 9 years: the Multi-Ethnic Study of Atherosclerosis (MESA). Occup Environ Med 72(10):690-698 doi:10.1136/oemed-2014-102311.

Giada F, Biffi A, Agostoni P, Anedda A, Belardinelli R, Carlon R, Caru B, D’andrea L, Delise P, De Francesco A, Fattirolli F. [2008]. Exercise prescription for the prevention and treatment of cardiovascular diseases: Part I. J Cardiovasc Med 9(5):529–544

Groenewold M, Brown L, Smith E, Pana-Cryan R, Schnorr T [2017]. An estimate of the total number of incident occupational injuries and illnesses occurring in the United States in 2012. Manuscript in preparation.

Kales S, Soteriades E, Christophi C, and Christiani D [2007]. Emergency duties and deaths from heart disease among firefighters in the United States. N Engl J Med 356:1207–1215.

Karter MJ and Molis JL [2011]. Firefighter Injuries for 2010. Quincy, MA: National Fire Protection Association. http://www.nfpa.org/news-and-research/publications/nfpa-journal/2011/november-december-2011/features/us-firefighter-injuries-in-2010External

Kaur H, Luckhaupt SE, Li J, Alterman T, Calvert GM [2014]. Workplace psychosocial factors associated with hypertension in the U.S. workforce: A cross-sectional study based on the 2010 National Health Interview Survey. Am J Ind Med 57(9):1011–1021.

Maguire BJ, Hunting KL, Smith GS, and Levick NR. [2002]. Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med 40:625-632.

NIOSH [2015]. Occupational Cancer. Cincinnati, OH: National Institute for Occupational Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. https://www.cdc.gov/niosh/topics/cancer/default.html

Pinkerton LE. [2015]. Exposure-response relationships for select cancer and non-cancer health outcomes in a cohort of U.S. firefighters from San Francisco, Chicago and Philadelphia (1950-2009). Occup Environ Med. 72(10):699-706.

Rushton L, Hutchings SJ, Fortunato L, Young C, Evans GS, Brown T, Bevan R, Slack R, Holmes P, Bagga S, Cherrie JW [2012]. Occupational cancer burden in Great Britain. Br J Cancer 107(Suppl 1):S3-7.

Stewart SExternal, Keates AKExternal, Redfern AExternal, McMurray J [2017]. Seasonal variations in cardiovascular disease. Nat Rev CardiolExternal doi:10.1038/nrcardio.2017.76, Advance online publication.

TriData Corporation [2002] Firefighter fatality retrospective study, April 2002. Prepared for Federal Emergency Management Agency, United States Fire Service, National Fire Data Center Arlington, VA.

Tomei FExternal, Fantini SExternal, Tomao EExternal, Baccolo TPExternal, Rosati MVExternal [2000]. Hypertension and chronic exposure to noise. Arch Environ Health.External 55(5):319-25.

USFA [2017]. Firefighter fatality incident data- custom reports. In: Firefighter fatality. Emmitsburg, MD: U.S. Fire Administration, Federal Emergency Management Agency, U.S. Department of Homeland Security https://apps.usfa.fema.gov/firefighter-fatalities/External

Zimmerman FH [2012]. Cardiovascular disease and risk factors in law enforcement personnel: a comprehensive review. Cardiol Rev 20:159-166

Page last reviewed: April 24, 2018