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PTSD and Cancer:
Growing Number of Fire Fighters
and Paramedics at Risk

New Advanced Protocols Needed to
Address the Hidden Health Hazards

 

 

August 2016 


International Assodation of Fire Fighter-5;:  1?

 
 

EMS personnel safe so they can continue to keep
their communities safe.

North America’s fire fighters and paramedics are
dialing 9-1-1 about the dangers of cancer and PostTraumatic Stress Disorder (PTSD) in their ranks –
concerns that are based on a growing body of
research and on-the-job experience.
Fire fighters and paramedics respond to the worst
moments in people’s lives – tragedies ranging in
magnitude from a home fire to the 9/11 attacks on
the World Trade Center and the Pentagon.
Over a career of service to their community, these
stressful incidents compound. As a result, a startling
number of fire fighters and paramedics now
struggle with post-traumatic stress, which can lead
to PTSD and other behavioral health issues.
New information is now known about the emotional
toll these incidents take on our nation’s professional
fire fighters and paramedics as a result of what they
have seen and experienced in the course of
protecting the public.
What’s more, today’s fires burn hotter and faster
than ever, and more consumer products contain
toxic chemicals. The increased use of plastics and
other synthetic materials in residential and
commercial furnishings, products and construction
generate more hazardous vapors and smoke during
a fire. Many of these toxic chemicals are
carcinogenic. Scientific studies show prolonged
exposure to these toxic chemicals is increasing the
rate at which fire fighters are developing and dying
of cancer.

We must work together with elected officials and
communities to develop effective protocols to help
prevent and treat PTSD and to protect our
professional fire fighters and EMS workers from
deadly cancer-causing toxins.

Fire Fighters and Paramedics
Diagnosed with PTSD at High Rates
Most citizens are fortunate enough to only bear
witness through the media to horrendous tragedies
such as the mass shooting at the Orlando nightclub
or the Boston Marathon bombing as the details of
deadly terror events appear on our televisions,
desktop computers and smartphones with
regrettable and numbing regularity.
But these events – as well as everyday emergencies,
such as house fires and car accidents – can severely
traumatize not just the victims but the fire fighters
and paramedics who respond to these emergencies
on every shift at considerable risk to their own
safety. Under extreme stress, they face the
possibility of not saving a life despite their best
efforts, of losing one of their comrades, or not
making it home to their own families.
New research reveals what many in the fire service
have known for decades. Prolonged and regular
exposure to traumatic events trigger PTSD at rates
similar to those found in service members returning
from combat.

Understanding the behavioral and physical effects
of the job is critical to keeping our fire fighters and

PTSD and Cancer: Growing Number of Fire Fighters and Paramedics at Risk 

1 
 

  

PTSD is a serious and chronic condition that can
ruin the careers of fire fighters and paramedics,
destroy families and jeopardize public and fire
fighter safety. According to the Journal of
Occupational Health, approximately 20 percent of
fire fighters and paramedics have PTSD.1
Furthermore, according a 2015 Florida State
University study, nearly half of the fire fighters
surveyed (46.8 percent) have thought about suicide,
19.2 percent had suicide plans and 15.5 percent had
made suicide attempts.2 In fact, those with PTSD
are six times more likely to attempt suicide
compared to demographically matched controls.

Fire fighters and paramedics may believe that PTSD
will go away on its own in time and, therefore, do
not need treatment, or that seeking treatment will
hurt their reputation or not remain confidential.
PTSD can have devastating consequences if
untreated or misdiagnosed and is often associated
with other mental health disorders, such as
depression, substance abuse, family dysfunction,
violence and increased risk of suicide.4

Doctors at the Warriors Research Institute (WRI), a
research arm of Baylor, Scott & White Health in
Austin, Texas, have identified a clear link between
traumatic situations experienced by fire fighters and
paramedics and PTSD, similar to the chronic
disorder experienced by veterans.3

It is important to seek help when experiencing high
levels of stress, but too often, the stigma associated
with needing help prevents many in the fire service
from admitting something is wrong. In fact, Dan
DeGryse, a Chicago fire fighter who has spent
many years with the Chicago Fire Department’s
peer support network, known as the Gatekeepers,
found after a two-year study on suicide in the fire
service5 that 28 percent of fire fighters believe
behavioral health issues might hurt their pride or
reputation, worry that information will not remain
confidential, or say they do not have or are unaware
of services available to address behavioral health
issues.

PTSD can be 100 percent disabling, according to
Dr. Suzi Byrd Gulliver, WRI’s Research Director
who has been studying PTSD for many years.

The fact is, many departments don’t have the
necessary behavioral health services in place to
assist members in crisis.

Dr. Gulliver says communities must confront the
threat of PTSD in the fire service and take steps to
keep it from developing into a disabling or even a
life-threatening condition.

Fire departments need to do a better job of
recognizing the signs and symptoms and providing
the resources to help address PTSD and behavioral
health issues.

Most fire fighters will recall with ease at least three
horrific emergency calls or tragic events that replay
over and over in their minds.

                                                            
1

Cornell, W., Beaton, R., Murphy, S., (1999). Journal of 
Occupational Health Psychology, 4, 131‐141

3

 Waco research facility takes aim at PTSD in first responders. 
September 11 Families Association (www.911families.org) 
July 29, 2015  

2

 Career prevalence and correlates of suicidal thoughts and 

behaviors among firefighters 
Joiner TE2, Stanley IH1, Hom MA2, Hagan CR2, J Affect Disord. 
November 15, 2015

4

 United States Department of Veterans Affairs, National 
Center for PTSD. Co‐occurring conditions. 
(www.ptsd.va.gov/professional/co‐occurring/index.asp) 

5

 Chicago Fire Department’s Suicide Study. Rosecrance. 
(www.rosecrance.org) November, 30, 2015 

 
2 
 

PTSD and Cancer: Growing Number of Fire Fighters and Paramedics at Risk

  
 

Elected officials also must do their part to make
sure fire fighters suffering under the weight of
PTSD have the resources they need to get healthy.
One state – Oregon – and five Canadian provinces
have added PTSD and other mental health disorders
to the list of occupationally related diseases in first
responders for the purpose of workers compensation
benefits, and more states have introduced legislation
that would include PTSD under presumptive
coverage.
More must be done. Presumptive PTSD laws allow
for treatment for fire fighters and EMS workers to
recover and return to work. They also help raise
awareness about the disease and help destigmatize
the condition for those seeking treatment for their
illness. It is clear from the research that fire fighters
are at increased risk for PTSD. By removing
barriers to care and acknowledging the link between
firefighting and PTSD, these laws can help save
lives.

Cancer Strikes Fire Fighters in
Significantly Higher Rates
Fighting fires is even more dangerous than most
people know. In fact, the number-one cause of death
among fire fighters is not from the fire itself, but
from the occupational exposures to the toxins and
carcinogens at the fire scene and exposure to diesel
exhaust. Besides inhalation hazards, chemicals pose
a significant threat to fire fighter health through skin
absorption, even with a full protective ensemble.
Numerous studies have shown that cancer rates run

significantly higher for fire fighters than the general
population.
When fire fighters attack structural fires, they are
exposed to many hazardous chemicals, including
carbon monoxide, hydrogen cyanide, benzene,
styrene, formaldehyde and vinyl chloride, just to
name a few.
All of these chemicals can be found in household
products. A century ago, according to a recent
article in the Atlantic magazine, furnishings were
made from raw materials such as wood, cloth, metal
and glass. Today, more products are made from
synthetic materials – plastics, foams and coatings –
that contain numerous carcinogens and toxins when
they burn making them hundreds of times more
toxic.6
Fire fighters are routinely exposed to these toxic
fumes and chemical substances when they respond
to fires. Additionally, the mixture of hazardous
chemicals is different at every fire with many
substances acting as co-carcinogens. The way all
toxic combustion by-products interact makes fire
fighters’ exposures even more dangerous.
Studies have found an association between
firefighting and a significant increased risk for
specific types of cancer. A study conducted by the
National Institute for Occupational Safety and
Health (NIOSH) in 2013 found that fire fighters
have a 14 percent increased risk of dying from
cancer as compared to the general population.7
In Metro-Dade County, Florida, of 1,792 fire
fighters, 13 percent were diagnosed with cancer in
2011.

                                                            
6

 How Modern Furniture Endangers Firefighters. The Atlantic 
(www.theatlantic.com) September 11, 2015 
 
 

7

 NIOSH Study of Firefighters Finds Increased Rates of Cancer. 
The National Institute of Occupational Safety and Health 
(NIOSH) (www.cdc.gov/niosh/updates/upd‐10‐17‐13.html) 
October 17, 2013 
  

PTSD and Cancer: Growing Number of Fire Fighters and Paramedics at Risk 

3 
 

  

The IAFF, in conjunction with the Firefighter
Cancer Support Network, has developed an online
cancer awareness and prevention program to
educate fire fighters about the hazards of
firefighting and to help them take steps to reduce
their exposure risk and to stay healthy and safe.

The Firefighter Cancer Registry Act will remedy
these shortcomings by collecting detailed data about
fire fighters with cancer on a national scale.

Meanwhile, members of Congress have taken notice
of the rising reports of cancer in the fire service. In
a rare display of bipartisanship in spring 2016,
members from both sides of the aisle introduced a
bill to create a national registry of fire fighters who
have developed cancer.8
Representatives Richard Hanna (R-NY) and
Bill Pascrell (D-NJ) introduced H.R. 4625,
the Firefighter Cancer Registry Act, to establish
such a registry. Identical legislation, S. 2799, has
been introduced in the Senate by Senators
Robert Menendez (D-NJ) and Lisa Murkowski (RAK). The new legislation would allow novel
research on cancer in fire fighters by providing
scientists with new data.

As we learn more about cancer and the fire service,
many states have enacted presumptive laws that
acknowledge the scientific evidence pointing to the
links between cancer and firefighting. These laws
allow fire fighters who develop cancer to apply for
workers compensation benefits to help treat the
illness and hopefully return to active duty.
Additionally, if unable to return to work, these laws
will cover the disability and provide benefits.
However, several states have yet to enact these
important laws.
North America’s fire fighters are developing jobrelated cancers more than ever before and we are
now learning that an alarming number in our ranks
are struggling under the weight of post-traumatic
stress. The time has come for fire departments,
elected officials and communities to come together
to address these problems.

Cancer is the leading line-of-duty death among fire
fighters today. By strengthening our understanding
of the link between firefighting and cancer, this
important legislation will help develop new tools
and techniques to protect fire fighters, and hopefully
prevent future disease.
Despite the knowledge gained from previous
studies, there are limitations because of relatively
small sample sizes and an under-representation of
certain demographic groups, including women and
minorities. However, that doesn’t take away the
importance that all fire fighters are at a greater risk
than the general population for contracting cancer.

                                                            
8

 Bill Would Create Firefighter Cancer Registry. The Bergen 
Dispatch (www.bergendispatch.com) February 26, 2016  

 
4 
 

PTSD and Cancer: Growing Number of Fire Fighters and Paramedics at Risk

 U.S. State Presumptive Disability Laws for PTSD & Cancer

State

PTSD

Cancer

Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming

Total

Are your
Fire Fighters
Protected?
Canadian Provincial Presumptive Disability Laws for PTSD & Cancer

Province

PTSD

Cancer

5

11

Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and
Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon

Total

The states and provinces listed on those charts have
presumptive disability laws which recognize that fire
fighters are at increased risk for cancer and Post Traumatic
Stress Disorder (PTSD). The laws create a presumption
that these conditions are job related. All state, provincial
and local governments must develop enhanced protocols
to help prevent PTSD from taking hold in fire fighters and
jeopardizing public safety.

1

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THE INTERNATIONAL
ASSOCIATION OF FIRE FIGHTERS

  
 

Resolution No. 44
COMMITTEE ASSIGNMENT: Health & Safety
Re: Continuing IAFF Support for Programs, Initiatives,
and Legislation that Reduces Cancer in the Fire
Service and Assists Members Fighting this Disease
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WHEREAS, research demonstrates that fire
fighters are routinely exposed to cancer-causing
carcinogens in the performance of their duties; and
WHEREAS, there is a proven correlation between
firefighting and occupational cancer through
scientific studies; and
WHEREAS, there is significant scientific
evidence that demonstrates fire fighters have a higher
mortality rate due to cancer, which is why, since
2002, 59% of the names entered on the IAFF Fallen
Fire Fighter Memorial walls were from occupational
cancer; and
WHEREAS, we need to continue to gather the
critical data showing the correlation so we can
continue to ensure that our members have what they
need to protect themselves as much as possible from
the carcinogens; and
WHEREAS, the IAFF has worked with its state
and provincial affiliates to advocate for the inclusion
of several cancers in state and provincial
occupational disease presumptive legislation; and
WHEREAS, the IAFF has assisted affiliate
members who have been diagnosed with cancer, in
their efforts to obtain workers compensation and/or
presumptive benefits; and
WHEREAS, the IAFF works in conjunction with
the Firefighter Cancer Support Network to provide
informational resources and peer to peer support for
those inflicted with cancer, and the IAFF provides
funds, through per capita, to cancer research
programs; and
WHEREAS, the IAFF is continuously raising
cancer awareness to its affiliates and members
through social media, the internet, magazine articles,
national conferences, and the IAFF Cancer
Awareness and Prevention online course; therefore
be it

 

  

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RESOLVED, That the IAFF and its affiliates
strongly re-affirm our commitment of reducing the
risk of toxic carcinogenic exposure; and be it further
RESOLVED, That the IAFF shall continue to
educate, train, and heighten the awareness of the
effects of the toxic and carcinogenic products of
combustion to its members and the public; and be it
further
RESOLVED, That the IAFF will continue to push
for more scientific research into the effects of
exposure to carcinogens on the job and will provide
the best practices to affiliates and members to
prevent unnecessary exposure to carcinogens on the
fire scene and within the firehouse; and be it further
RESOLVED, That the IAFF will continue to
support state and provincial legislative efforts to pass
fire fighter cancer presumptive legislation.

Submitted by: IAFF Executive Board
Cost Estimate:
None
COMMITTEE RECOMMENDATION:
CONVENTION ACTION:

 

  
 

Resolution No. 45
COMMITTEE ASSIGNMENT: Health & Safety
Re: Re-affirming the IAFF’s Commitment to Mental
Health Initiatives through Efforts to Expand
Resources, Education and Treatment for Our
Members
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WHEREAS, the nature, frequency, and intensity
of daily duty-related traumatic exposures have a
cumulative impact on the mental health and wellbeing of fire fighters and emergency medical
personnel; and
WHEREAS, it is estimated that, while 3.5% of
the general population meet criteria for posttraumatic stress disorder (PTSD), approximately 20%
of fire fighters and emergency medical personnel in
the U.S. suffer from PTSD; and
WHEREAS, a recent study on career fire fighters
indicated that, at some point of time throughout their
career, 19% of those in the fire service made suicide
plans and 15.5% attempted suicide; and
WHEREAS, the IAFF has become the leader in
the fire service raising awareness of behavioral
health issues through our website, social media,
magazine articles, national conferences, the IAFF
Behavioral Health Awareness on-line course, and
through the new Peer Support Training Program; and
WHEREAS, the IAFF has been diligently
working to establish protocols, procedures and
appropriate treatment programs and facilities to
recognize and treat post-traumatic stress among our
members because of the high incidence rate in the
profession; and
WHEREAS, it is the duty of every government
and its fire department in which our members serve
to reduce the stigma of behavioral health issues and
to provide the necessary support and access to
resources to assist them in their time of need;
therefore be it
RESOLVED, That the IAFF shall continue to
educate, train, and raise awareness among our

 

  

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members, fire department administrations, the public,
the media and lawmakers about the effects of posttraumatic stress on its members and the proper ways
to ensure that our members have what they need, in
their time of need; and be it further
RESOLVED, That the IAFF and its affiliates
strongly re-affirm our commitment to reducing the
stigma of behavioral health issues, to encouraging the
departments where our members work to adopt the
appropriate protocols, procedures, and support
programs to properly identify and treat behavioral
health issues in a non-punitive manner; and be it
further
RESOLVED, That the IAFF will continue to
develop resources to ensure that our members receive
the appropriate level of care needed in response to a
post-traumatic stress designation, and we will
continue to support and encourage state and
provincial government to pass post-traumatic stress
presumptive legislation to ensure that these disorders
receive the recognition they deserve as a job-related
health issue.

Submitted by: IAFF Executive Board
Cost Estimate: None
COMMITTEE RECOMMENDATION:
CONVENTION ACTION:

 

 FIRE FIGHTERS CALLING 9-1-1

PTSD and Cancer: Growing Number of
Fire Fighters and Paramedics at Risk

    



Department of Communications and Media
International Association of Fire Fighters
1750 New York Ave. N.W.
Washington oc 20006
(202) 824-1506