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Guides & Toolkits

Provider's
Guides.

Firefighting carries unique health risks. These guides help firefighters and their health care providers, including OB/GYNs, make informed decisions about screening, care and clearance for duty.

Two companion guides to help firefighters take charge of their own health care and make sure their providers understand the physical and mental demands of the job.

Provider's Guide to Firefighter Medical Evaluations

Additional Resources:

ASCVD Risk Calculator

IAFC/IAFF Wellness Fitness Initiative

Dr. Kannler’s Story

OB/GYN Health Resource Guide

Firefighters are required to work in extreme conditions that may impact their health. Here are some of the considerations for OB/Gyns when making decisions about clearance for duty.

Dr. Edwards from Tennessee Tech University speaks on mental health within the fire service and the unique circumstances that drive it.

Dr. Kannler speaks about Melanoma risk within the fire service

Dr. Burgess from the University of Arizona speaks about Cancer risks within the fire service.

Dr. Koval provides an overview of the Provider Guide

Dr. Denise Smith, covers cardiovascular health among firefighters

Screening Tools

Behavioral Health Screening Tools:

PHQ-9

AUDIT & CAGE for Alcohol Screening

Screening tools for sleep disorders:

Epworth Sleepiness Scale

STOP-Bang questionnaire

Berlin Sleep questionnaire

Diagnosis of obstructive sleep apnea (OSA) algorithm

Additional Resources:

ASCVD Risk Calculator

IAFC/IAFF Wellness Fitness Initiative

Dr. Kannler’s Story

Supporting Documents:

NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments

A Fire Department’s Guide to Implementing NFPA 1582

US Preventative Services Task Force

Contributors

Firefighter Health & OB/GYN Resources

Every firefighter needs to take control of their own health care and ensure their providers are aware of the physical and mental health stress common for firefighters.

Dr. Edwards from Tennessee Tech University speaks on mental health within the fire service and the unique circumstances that drive it.

Dr. Kannler speaks about Melanoma risk within the fire service

Dr. Burgess from the University of Arizona speaks about Cancer risks within the fire service.

Dr. Koval provides an overview of the Provider Guide

Dr. Denise Smith, covers cardiovascular health among firefighters

Screening Tools

Behavioral Health Screening Tools:

PHQ-9

AUDIT & CAGE for Alcohol Screening

Screening tools for sleep disorders:

Epworth Sleepiness Scale

STOP-Bang questionnaire

Berlin Sleep questionnaire

Diagnosis of obstructive sleep apnea (OSA) algorithm

Additional Resources:

ASCVD Risk Calculator

IAFC/IAFF Wellness Fitness Initiative

Dr. Kannler’s Story

Supporting Documents:

NFPA 1582: Standard on Comprehensive Occupational Medical Program for Fire Departments

A Fire Department’s Guide to Implementing NFPA 1582

US Preventative Services Task Force

References & contributors

Provider's Guide references

1.Smith, D. L., DeBlois, J. P., Kales, S. N., & Horn, G. P. (2016). Cardiovascular strain of firefighting and the risk of sudden cardiac events. Exercise and sport sciences reviews, 44(3), 90-97.

2. Smith, D. L., Hollerbach, B. H., Bode, E., Haigh, C. A. (2022). BETTER HEART Final Report: Building Evaluations That Translate Evidence & Research to Heart Evaluations and Related Training. First Responder Health and Safety Laboratory, Skidmore College. Not yet available online

3. Smith, D. L., Haller, J. M., Korre, M., Fehling, P. C., Sampani, K., Grossi Porto, L. G., ... & Kales, S. N. (2018). Pathoanatomic findings associated with Duty‐Related cardiac death in US firefighters: a Case–Control study. Journal of the American Heart Association, 7(18), e009446.

4. LeMasters, G. K., Genaidy, A. M., Succop, P., Deddens, J., Sobeih, T., Barriera-Viruet, H., ... & Lockey, J. (2006). Cancer risk among firefighters: a review and meta-analysis of 32 studies. Journal of occupational and environmental medicine, 1189-1202.

5.Daniels, R. D., Kubale, T. L., Yiin, J. H., Dahm, M. M., Hales, T. R., Baris, D., ... & Pinkerton, L. E. (2014). Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009). Occupational and environmental medicine, 71(6), 388-397.

6. Lee, D. J., Koru‐Sengul, T., Hernandez, M. N., Caban‐Martinez, A. J., McClure, L. A., Mackinnon, J. A., & Kobetz, E. N. (2020). Cancer risk among career male and female Florida firefighters: Evidence from the Florida Firefighter Cancer Registry (1981‐2014). American journal of industrial medicine, 63(4), 285-299.

7. Tsai, R. J., Luckhaupt, S. E., Schumacher, P., Cress, R. D., Deapen, D. M., & Calvert, G. M. (2015). Risk of cancer among firefighters in California, 1988–2007. American journal of industrial medicine, 58(7), 715-729.

8. Jalilian, H., Ziaei, M., Weiderpass, E., Rueegg, C. S., Khosravi, Y., & Kjaerheim, K. (2019). Cancer incidence and mortality among firefighters. International journal of cancer, 145(10), 2639-2646.

9.Demers PA, DeMarini DM, Fent KW, et al. Carcinogenicity of occupational exposure as a firefighter. Lancet Oncol. 2022;23(8):985-986. doi:10.1016/S1470-2045(22)00390-4

10. Ma F, Fleming LE, Lee DJ, Trapido E, Gerace TA. Cancer incidence in Florida professional firefighters, 1981 to 1999. J Occup Environ Med. 2006;48(9):883-888. doi:10.1097/01.jom.0000235862.12518.04.

11. Ma F, Fleming LE, Lee DJ, et al. Mortality in Florida professional firefighters, 1972 to 1999. Am J Ind Med. 2005;47(6):509-517. doi:10.1002/ajim.20160.

12.Boffa, J. W., Stanley, I. H., Hom, M. A., Norr, A. M., Joiner, T. E., & Schmidt, N. B. (2017). PTSD symptoms and suicidal thoughts and behaviors among firefighters. Journal of psychiatric research, 84, 277-283.

13. Carey M, Al-Zaiti S, Dean G, et al. Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters. J Occup Environ Med. 2011;53:928–933.

14.Haddock CK, Jahnke SA, Poston WSC, et al. Alcohol use among firefighters in the Central United States. Occup Med Oxf Engl. 2012;62(8):661-664. doi:10.1093/occmed/kqs162.

15. Haddock CK, Day S, Poston W, Jahnke SA, Jitnarin N. Alcohol Use and Caloric Intake From Alcohol in a National Cohort of U.S. Career Firefighters. J Stud Alcohol Drugs. 2015;76(3):360-366.

16. Heinrichs, M., Wagner, D., Schoch, W., Soravia, L. M., Hellhammer, D. H., & Ehlert, U. (2005). Predicting posttraumatic stress symptoms from pretraumatic risk factors: a 2-year prospective follow-up study in firefighters. American Journal of Psychiatry, 162(12), 2276-2286.

17. Heyman M, Dill J, Douglas R. The Ruderman White Paper on Mental Health and Suicide of First Responders. 2018. Accessed January 7, 2021.

18. Jahnke S, Poston W, Haddock C, Murphy B. Firefighting and mental health: Experiences of repeated exposures to trauma. Work. 2016;53:737-744.

19. Lim D, Baek k, Chung I, et al. Factors related to sleep disorders among male firefighters. Ann Occup Environ Med. 2014;26:11.

20.Fent, K. W., Evans, D. E., Babik, K., Striley, C., Bertke, S., Kerber, S., ... & Horn, G. P. (2018). Airborne contaminants during controlled residential fires. Journal of occupational and environmental hygiene, 15(5), 399-412.20.

21. Burgess, J. L., Nanson, C. J., Bolstad-Johnson, D. M., Gerkin, R., Hysong, T. A., Lantz, R. C., ... & Witten, M. L. (2001). Adverse respiratory effects following overhaul in firefighters. Journal of occupational and environmental medicine, 467-473.

22. Mustajbegovic, J., Zuskin, E., Schachter, E. N., Kern, J., Vrcic‐Keglevic, M., Heimer, S., ... & Nada, T. (2001). Respiratory function in active firefighters. American journal of industrial medicine, 40(1), 55-62.

Contributors

Derek JH Hughes, MS, RD/LDN, CSCS, MRSA

Occupational Health and Safety Manager

Broward Sheriff’s Office, Ft Lauderdale, Florida

JoAnne E. Rice, MPA, CFO

Assistant Director

Division of Florida State Fire Marshal

Greg Lind, ARNP

Firefighter Primary Care

Everett, Washington

Heather Maykel, DetecTogether

Director, Partnership and Program Development

Chief Todd J. LeDuc, (Ret) MS, CFO, FIFirE

IAFC Safety, Health & Survival Board Member

First Responder Center of Excellence Advisory Board Member

Chief Strategy Officer, Life Scan Wellness Centers

Broward County Fire Rescue Service

Gerald E. "Pete" Crawford

Battalion Chief of Safety

City of Memphis Fire Services

Julienne Little, DO

MED-1 Occupational Health Services

Benjamin Eovaldi, DO, MPH

Preventive Medicine Resident

UMass Chan Medical School

John Dominguez, DO

Phoenix Fire Department

Gautam J. Desai, DO, FACOFP dist.

Professor and Chair, Department of Primary Care

Kansas City University

Michael G. Hamrock, MD

Primary Care and Addiction Medicine

Steward St. Elizabeth’s Medical Center

Former Firefighter and Medical Examiner

Boston Fire Department

Kepra Jack RN-BSN, OHC, CHC

COO, Co-founder, Owner

HeartFit For Duty, LLC

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