During live-fire firefighting operations and training evolutions, firefighters often consume multiple cylinders of air and continue to wear their personal protective equipment even after fire suppression activities have ceased. However, most studies have only reported core temperature changes during short-term firefighting activities and have shown a very modest increase in core temperature. Therefore, the purpose of this study is to evaluate core temperature and heart rate (HR) during repeated bouts of firefighting activity over ∼3 h. The results of this study show that core temperatures increase by an average of 1.9°C – to a larger magnitude than previously reported – and continue to increase during subsequent work cycles (38.4 vs. 38.7) even after long breaks of more than 30 min. The rate of core temperature increase during work continues to increase later in the training exercise (from 0.036 to 0.048°C/min), increasing the risk for exertional heat stress particularly if long-duration firefighting activity is required at these later times. Practitioner Summary: To date, core temperature and HR changes during firefighting have been reported for short-term studies, which may significantly underestimate the physiological burden of typical firefighting activities. Firefighter core temperatures are shown to increase to a larger magnitude than previously observed and the rate of rise in core temperature increases during subsequent firefighting activities.

Firefighters’ thermal burden is generally attributed to high heat loads from the fire and metabolic heat generation, which may vary between job assignments and suppression tactic employed. Utilising a full-sized residential structure, firefighters were deployed in six job assignments utilising two attack tactics (1. Water applied from the interior, or 2. Exterior water application before transitioning to the interior). Environmental temperatures decreased after water application, but more rapidly with transitional attack. Local ambient temperatures for inside operation firefighters were higher than other positions (average ~10–30 °C). Rapid elevations in skin temperature were found for all job assignments other than outside command. Neck skin temperatures for inside attack firefighters were ~0.5 °C lower when the transitional tactic was employed. Significantly higher core temperatures were measured for the outside ventilation and overhaul positions than the inside positions (~0.6–0.9 °C). Firefighters working at all fireground positions must be monitored and relieved based on intensity and duration. Practitioner Summary: Testing was done to characterise the thermal burden experienced by firefighters in different job assignments who responded to controlled residential fires (with typical furnishings) using two tactics. Ambient, skin and core temperatures varied based on job assignment and tactic employed, with rapid elevations in core temperature in many roles.

Detailed characterization of a firefighter’s typical thermal exposures during live-fire training and responses can provide important insights into the risks faced and the necessary protections, protocols, and standards required. In order to gather data on representative thermal conditions from a firefighter’s continually varying local environment in a live-fire training exercise, a portable heat flux and gas temperature measurement system was created, calibrated, and integrated into firefighter personal protective equipment (PPE). Data were collected from 25 live-fire training exposures during seven different types of scenarios. Based on the collected data, mild training environments generally exposed firefighters to temperatures around 50°C and heat fluxes around 1 kW/m², while severe training conditions generally resulted in temperatures between 150°C and 200°C with heat fluxes between 3 kW/m² and 6 kW/m². For every scenario investigated, the heat flux data portrayed a more severe environment than the temperature data when interpreted using established thermal classes developed by the National Institute for Standards and Technology for electronic equipment used by first responders. Local temperatures from the portable measurement system were compared with temperatures measured by stationary thermocouples installed in the training structure for 14 different exposures. It was determined the stationary temperatures represented only a rough approximate bound of the actual temperature of the immediate training environment due to the typically coarse distribution of these sensors throughout the structure and their relative (fixed) distance from the fire sets. The portable thermal measurement system has provided new insights into the integration of electronic sensors with firefighter PPE and the conditions experienced by firefighters in live-fire training scenarios, which has promise to improve the safety and health of the fire service.

The international fire service community is actively engaged in a wide range of activities focused on development, testing and implementation of effective approaches to reduce exposure to contaminants and the related cancer risk. However, these activities are often viewed independent of each other and in the absence of the larger overall effort of occupational health risk mitigation. This narrative review synthesizes the current research on fire service contamination control in the context of the National Institute for Occupational Safety and Health (NIOSH) Hierarchy of Controls, a framework that supports decision making around implementing feasible and effective control solutions in occupational settings. Using this approach, we identify evidence-based measures that have been investigated and that can be implemented to protect firefighters during an emergency response, in the fire apparatus and at the fire station, and identify several knowledge gaps that remain. While a great deal of research and development has been focused on improving personal protective equipment for the various risks faced by the fire service, these measures are lower in the Hierarchy of Controls, which are considered less effective. Administrative and engineering controls that can be used during and after the firefight have also received increased research interest in recent years. However, less research and development have been focused on higher level control measures such as engineering, substitution and elimination, which may be the most effective, but are challenging to implement. A comprehensive approach that considers each level of control and how it can be implemented, and that is mindful of the need to balance contamination risk reduction against the fire service mission to save lives and protect property, is likely to be the most effective.

The fire service has become more aware of the potential for adverse health outcomes due to occupational exposure to hazardous combustion byproducts. Because of these concerns, personal protective equipment (PPE) manufacturers have developed new protection concepts like particulate-blocking hoods to reduce firefighters’ exposures. Additionally, fire departments have implemented exposure reduction interventions like routine laundering of PPE after fire responses. This study utilized a fireground exposure simulator (FES) with 24 firefighters performing firefighting activities on three consecutive days wearing one of three PPE ensembles (stratified by hood design and treatment of PPE): 1) new knit hood, new turnout jacket and new turnout pants 2) new particulate-blocking hood, new turnout jacket and new turnout pants or 3) laundered particulate-blocking hood, laundered turnout jacket and laundered turnout pants. As firefighters performed the firefighting activities, personal air sampling on the outside and inside the turnout jacket was conducted to quantify exposures to volatile organic compounds (VOCs) and naphthalene. Pre- and immediately post-fire exhaled breath samples were collected to characterize the absorption of VOCs. Benzene, toluene, and naphthalene were found to diffuse through and/or around the turnout jacket, as inside jacket benzene concentrations were often near levels reported outside the turnout jacket (9.7-11.7% median benzene reduction from outside the jacket to inside the jacket). The PPE ensemble did not appear to affect the level of contamination found inside the jacket for the compounds evaluated here. Benzene concentrations in exhaled breath increased significantly from pre to post-fire for all three groups (p-values < 0.05). The difference of pre-to post-fire benzene exhaled breath concentrations were positively associated with inside jacket and outside jacket benzene concentrations, even though self-contained breathing apparatus (SCBA) were worn during each response. This suggests the firefighters can absorb these compounds via the dermal route.

Firefighters’ self-contained breathing apparatus (SCBA) protects the respiratory system during firefighting but increases the physiological burden. Extended duration SCBA (>30 min) have increased air supply, potentially increasing the duration of firefighting work cycles. To examine the effects of SCBA configuration and work cycle (length and rest), 30 firefighters completed seven trials using different SCBA and one or two bouts of simulated firefighting following work cycles common in the United States. Heart rate, core temperature, oxygen consumption, work output and self-reported perceptions were recorded during all activities. Varying SCBA resulted in few differences in these parameters. However, during a second bout, work output significantly declined while heart rates and core temperatures were elevated relative to a single bout. Thirty seven per cent of the subjects were unable to complete the second bout in at least one of the two-bout conditions. These firefighters had lower fitness and higher body mass than those who completed all assigned tasks. Practitioner Summary: The effects of extended duration SCBA and work/rest cycles on physiological parameters and work output have not been examined. Cylinder size had minimal effects, but extended work cycles with no rest resulted in increased physiological strain and decreased work output. This effect was more pronounced in firefighters with lower fitness.