Public Safety

Participating core and specialty programs: Authoritative Recommendations, Emergency Preparedness and Response, Personal Protective Equipment, and Surveillance.

Consensus standard organizations, professional associations, policy-makers, researchers, employers and workers use NIOSH information to prevent fixed airways diseases among public safety workers.

Health Outcome Research Focus Worker Population Research Type
A Chronic obstructive pulmonary disease (COPD) Dust inhalation, smoke inhalation during overhaul operations Fire service subsector Basic/etiologic
B COPD Dust inhalation, smoke inhalation Wildland fire subsector Basic/etiologic
C COPD Respiratory exposures during response and recovery work Response workers Basic/etiologic

Activity Goal 5.11.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand relationship between respiratory exposures and fixed airways diseases among structural firefighters, wildland firefighters, and response workers.

Activity Goal 5.11.2 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to prevent fixed airways diseases among structural firefighters, wildland firefighters, and response workers.


There were about 1.16 million local firefighters in the U.S. in 2015. Of these, about 815,000 were volunteer firefighters and 346,000 were career firefighters [NFPA 2017]. Firefighters are routinely exposed to a range of hazardous particulate and gaseous toxins, which vary depending on the materials burning in different fires [Duffy et al. 2010]. For example, structural fires often involve the combustion of by-products of organic and synthetic material, solvents, pesticides, and industrial chemicals. Wildland firefighters are exposed to a complex mixture of organic material pyrolysis and decomposition products [Youakim 2013]. The respiratory effect of these toxic mixes has often been missed when firefighters, who are selected and retained for better-than-average healthiness, are compared to the general population. When mortality studies have addressed this “healthy worker effect” by comparing firefighters to police officers, firefighters had an increased mortality from non-cancer respiratory disease [Feuer and Rosenman 1986; Rosenstock et al. 1990]. Thus, the respiratory hazard posed by firefighting is well-recognized, with 32 states having presumptive disability laws recognizing lung disease in firefighters as occupational [Duffy et al. 2010]. Investigations of first responders at the World Trade Center site have demonstrated that non-routine events can have a devastating impact on the respiratory health of firefighters and other first responders. For example, NIOSH has officially recognized the exposures encountered by World Trade Center responders as a cause of COPD [CDC 2016]. Bronchiolar disorders have also been associated with World Trade Center exposures [Cummings and Kreiss 2015].


Basic/etiologic research is still needed to improve our understanding of the association of fixed airways disease with the dust, smoke, and other airborne exposures experienced by structural firefighters, wildland firefighters, and response workers. Additional research is needed to clarify how repeated exposure to smoke, which commonly occurs in both the structural and wildland fire environment, may be linked with chronic pulmonary disease.

Given the ever-present threat of excessive exposure of structural and wildland firefighters and response workers to respiratory irritants and toxicants, it is essential that they have access to practical, effective interventions. Demonstration of the effectiveness of comprehensive prevention programs addressing primary and secondary preventive interventions is needed. Within the hierarchy of controls, there is stakeholder interest and a demonstrated need to determine the applicability and performance of air-purifying and powered air-purifying (APR/PAPR) respirators as an alternative to self-contained breathing apparatus (SCBA) for over-haul operations and to determine if a respirator is a practical option to prevent exposures in the wildland fire setting. There is also a need to address gaps in personal protective equipment (PPE) availability and training [Haynes and Stein 2016].

Cummings KJ, Kreiss K [2015]. Occupational and environmental bronchiolar disorders. Semin Respir Crit Care Med 36(3):366-78. doi: 10.1055/s-0035-1549452.

Duffy R, Berman A, Prezand D., eds. [2010]. Respiratory diseases and the fire service. International Association of Fire Fighters. Washington DC: International Federation of Fire Fighters.

Feuer E, Rosenman K [1986]. Mortality in police and firefighters in New Jersey. Am J Ind Med 9(6):517-27.

NFPA (National Fire Protection Association) [2016]. Fourth needs assessment of the United States. Quincy, MA: National Fire Protection Association, NFPA No. USS106.,

Haynes HJG, Stein GP [2017]. US fire department profile. Quincy, MA: National Fire Protection Association,

Rosénstock L, Demers P, Heyer NJ, Barnhart S [1990]. Respiratory mortality among firefighters. Br J Ind Med 47(7):462-5.

Youakim S [2013]. Exposure hazards for wildland firefighters. BC Med J 55(10), 466-479.

Page last reviewed: April 24, 2018