Authors of an article published at Crackyl, an e-magazine dedicated to professional firefighters’ health and wellness, say there is a profound lack of medical research examining firefighters’ health risks.
By Susan Enright.
University of Hawai‘i at Hilo Professor of Psychology Chris Frueh has co-authored an article published at Crackyl: Firefighter Lifestyle and Health Magazine, a website dedicated to professional firefighters’ lifestyle, health, and wellness. In the article, “Firefighter Syndrome: A Proposed Whole Systems Framework” (Aug. 9, 2023), Frueh and his co-authors argue there is a profound lack of medical research examining firefighters’ health risks and trajectories over time.
Two co-authors of the article, Isabella Zingray and Gina Rudine, are UH Hilo alumni who have worked with Prof. Frueh in recent years, including on a project with the SEAL Foundation. Ms. Rudine is now in the UH Hilo counseling psychology graduate program.
The firefighter investigation is an extension of Prof. Frueh’s work with military special operators. He is currently working closely with a Canadian firefighter group as part of a larger business effort to develop the solutions needed.
Additional co-authors of the firefighter article include Jadie Miller; Michelle L. O’Neill, Hon. BSc, ND; Brad Wylie; and Alok Madan, PhD, MPH.
The risks of being a career firefighter
In the article, the authors point out, “Firefighters respond to and mitigate a vast range of emergency situations. These include entering burning buildings, applying emergency first aid and CPR, deconstructing vehicles to access trapped civilians, 24-hour shifts, and many other critical duties to protect and rescue the communities they serve. They risk their lives and their health every day on the job.”
And yet, despite this risk, there is a profound lack of medical research into firefighters’ health. In fact, they say, firefighters are one of the least well understood highly-at-risk populations. Or to say it another way: “We know very little about the comprehensive health, wellness, and functioning of our firefighters.”
The authors then suggest taking a “whole systems approach” for firefighters, adapted from a framework that Frueh and colleagues have previously applied toward military special operators, known as “Operator Syndrome” (see published study), which they refer to in this study as “Firefighter Syndrome.”
- Learn more about Chris Frueh’s research on his website.
With searing clarity, Frueh and his coauthors make these points in their article: Firefighting involves regular exposure to chronic stress, lethal risks, and potential for a wide range of injuries, including traumatic brain injuries and toxic exposures. The researchers write that the “accumulation of these physiological, physical, psychological, and neuroendocrine injuries (i.e., high allostatic load) can lead to profound physiological changes upon the individual.”
“We believe it leads to a profession-specific constellation of interrelated medical, social, and psychological conditions,” write the authors. “A whole systems framework can help us better understand and address the complex needs of firefighters.” This framework includes the following context of life as a firefighter:
- Traumatic Brain Injury (TBI) and toxic exposures
- Hormonal dysfunction
- Sleep disturbance
- Obstructive sleep apnea / Central sleep apnea disturbances
- Chronic pain, orthopedic problems, headaches
- Substance use
- Post-traumatic stress disorder (PTSD)
- Worry, restlessness, stress reactivity, panic attacks
- Marital and family dysfunction
- Problems with sexual health and intimacy
- Being “on guard” and hypervigilant
- Memory, concentration, cognitive impairments
- Perceptual system impairments
- Disrupted hydration and nutrition
- Home-to-work transition difficulties
- Existential concerns
The authors then provide “tools” developed for firefighters to guide them in their healing. “The Firefighter Syndrome Questionnaire”—developed by the research team and can be downloaded from the article—is intended to help educate and guide firefighters back to safety.
Also provided in the article are guidelines for firefighters to use when seeking support and health care. Topics covered include suicide risk assessment, peer support, how to find and vet a primary care provider, and how to observe and evaluate lifestyle.
Story by Susan Enright, a public information specialist for the Office of the Chancellor and editor of UH Hilo Stories. She received her bachelor of arts in English and certificate in women’s studies from UH Hilo.