Why firefighter research sends mixed signals

One morning the newspaper headlines read that research discovered that eggs are the perfect food for perfect health. The next day they read that scientists have found that eating eggs for breakfast is like holding a loaded gun to your head.

It is so confusing that it makes you just want to eat a donut, doesn't it?

This scientific double talk isn't confined to breakfast foods. You may remember the debate about cancer and firefighting in 2009.

After a review of the scientific literature, the National League of Cities issued a press release stating, "A study released today titled 'Assessing State Firefighter Cancer Presumption Laws And Current Firefighter Cancer Research,' found there is inadequate scientific research to determine a link between working as a firefighter and an elevated risk of contracting cancer." 

After a review of the same literature, other groups of scientists with the International Association of Fire Chiefs and the International Association of Fire Fighters came to different conclusions.

The prevailing consensus among scientists is that firefighting significantly increases the risk of several types of cancers; however, even that statement comes with some qualifiers.

The qualifiers
Not all types of cancers are found to be increased among all firefighters. There may be certain exposures that are more likely to lead to cancer than others. There may be firefighters who are more likely to develop cancer than others.

Exactly how to prevent these cancers also is unclear, although there are several educated guesses at prevention.

Even among the published cancer research, not every study of a specific type of cancer finds the same results — but that is likely due to the different sample of firefighters used, the exposures of the firefighters included and how rare the cancers may be.

The challenge with science is that the answer you get is entirely dependent on the questions you ask, who you ask them of, and how you ask them. What that means is that any specific study has limitations and only answers a very specific question that usually leads to more questions.

This is not to say that science is a waste of time or money. Rather, it explains why almost every peer-reviewed publication suggests that more research needs to be done in its discussion section.

The recommendation does not mean that the findings of the study aren't valuable. It means that the authors realize there are limitations to any study and that their research is only part of the bigger picture.  

Decade of data
After 9/11, there was an increased awareness nationally about the health challenges firefighters face. Around the same time, several national initiative began including the Every Goes Home efforts, the development of the IAFC's Safety, Health and Survival Section, and the efforts by IAFF and others to secure funding for health research specific to the risks of firefighting.

Ultimately, FEMA began funding Research and Development grants through their Assistance to Firefighters Grant Program around 10 years ago.

More than half of the firefighter health research from the past 100 years was conducted in just the past decade. We know more about the health concerns of firefighters, the health risks they face and the health behaviors they practice than ever before.

In an academic setting, the outcome of research and the measure of success is the number of publications that result from a study. Obviously, peer-reviewed research is not widely read through the fire service community. But the impact of the research findings has been significant and is shaping priorities nationally, regionally and locally for departments.

At a recent meeting, a well-respected and educated chief was talking to me about the research going on in the fire service. He pointed to a nearby firefighter and asked, "How is your work going to effect that guy?"

While the noted firefighter likely won't ever read any particular article we write, the impact of these lines of research have significant implications even at the "boots on the ground" level.

Data's impact
Research findings have been the basis for revisions to national health and safety guidelines, cardiac health manuals, and white papers from organizations like the USFA, IAFF, NFFF, NVFC, and IAFC. Findings also have led to more data-driven decisions about national standards and have informed NIOSH fatality investigation findings.

As the risks firefighters face become clearer, the information is shaping how physicians and other groups intervene on fire and EMS personnel. Further, prevention and intervention efforts for the most significant concerns also continue to be shaped by research results.

On a local and regional level, data are being used to advocate for programs and priorities to improve firefighter health and help offset some of the negative impact of being on the job. Data also is helping provide evidence for presumptive laws that adequately compensate firefighters who die because of job-related tasks.

National efforts to create useable takeaways from firefighter health research include the development and deployment of the Firefighter Safety Through Advanced Research program. The group created a toolkit and centralized repository for firefighter health research that is available at www.fstaresearch.org.

In addition to cataloguing research, the program provides regular updates on research as it is published, creates useable takeaways, and provides summaries of studies complete with real-world applications of data.

While there are limitations to any specific study, the body of research being produced is shaping the current practices and future directions of the fire service. Despite the individual differences in findings, all the research points in one direction — that firefighting and EMS work take a physical and psychological toll on fire and EMS personnel.

Emergency responders should not only tolerate, but expect their organizations to do everything possible to maintain the health of their members given the risks. And that breakfast donut, the research is pretty clear on it.