Firefighter instructors “at greater risk of cardiovascular diseases and infection”

Led by Dr Emily Watkins, lecturer in environmental and exercise physiology at the University of Roehampton, the study measured blood samples, blood pressure and psychological data from 136 UK Fire and Rescue Service personnel (among them breathing apparatus instructors) over six months.

Breathing apparatus instructors exposed to over 20 fires per month showed clear signs of systemic inflammation, which occurs when the immune system is constantly defending the body, in turn making them more susceptible to infections and illness.

Among the symptoms reported by breathing apparatus instructors were fatigue, sleep disturbances, headaches and flu-like illness, with which systemic inflammation may be associated. This is the first study to indicate that these symptoms are consistently shown amongst breathing apparatus instructors over time.

The research also found that breathing apparatus instructors exposed to a greater number of physically demanding tasks, encapsulating personal protective equipment and extreme heat environments, exhibit elevated levels of numerous biomarkers that place them in high-risk categories for cardiac events, such as a heart attack.

Systemic inflammation may increase the risk of future cardiovascular events due to the association of inflammation with atherosclerosis, the formation of plaques in blood vessels that results in luminal narrowing or precipitating thrombi that can then obstruct blood flow.

Fire exposure

Firefighter instructors train firefighters on search and rescue skills, communication and teamwork skills within tense environments and educate on preparation for real-life fire scenarios in purpose-built facilities. Depending on their role and service station, these instructors can be exposed to real fires twice a day, five days per week.

The research demonstrates the importance of Fire and Rescue Services ensuring that fire training workloads are safely and effectively managed and that exposure limits – particularly for firefighter instructors – are applied.

At present, while some Fire and Rescue Services in the UK do limit exposure to fires, this practice is not widespread, with variations in the limits used. Some Fire and Rescue Services allow unlimited exposure to fires despite growing evidence of health risks. The research recommends that ten-to-15 fire exposures per month represents a reasonable maximum workload, with a greater number of exposures per month elevating the likelihood of systemic inflammation.

Chronic and consistent symptoms

Dr Emily Watkins commented: “By evaluating the impacts of fire exposures across a six-month period, this is the first research to identify that firefighters, and particularly so firefighter instructors, are reporting chronic and consistent symptoms of illness and inflammation. Based on this evidence, it’s imperative that Fire and Rescue Services carefully evaluate and limit the number of exposures faced by their members of staff and review working practices in order to ensure instructors’ health is being prioritised.”

The research follows on from last year’s findings unearthed by the World Health Organisation’s International Agency for Research on Cancer, which has now classified occupational exposure to fires as carcinogenic to humans, with sufficient evidence of mesothelioma and bladder cancer in firefighters.

Dr Watkins was part of the research team that contributed to the study. Chronic inflammation forms one of the characteristics of ‘Mechanistic Evidence’ which was considered as part of the evaluation.

The research team also included Dr Alan Richardson (joint lead researcher from the University of Brighton), Dr Nadia Terrazzini (also from the University of Brighton), Catherine Gage (formerly of the University of Brighton), Dr Ben James Lee (Coventry University), Rebecca Bradley (University of Brighton) and Dr Peter Watt (University of Brighton).

*Copies of the research paper entitled ‘Inflammatory and Psychological Consequences of Chronic High Exposure Firefighting’ are available to download. Visit https://www.sciencedirect.com/science/article/pii/S0306456522002133?via%3Dihub