The fire service is full of problem-solvers who create survivors. No matter the issue or severity of the problem, the people we serve depend on us showing up to do the right things to help them survive their situation. And while we are always focused on service, we must also think about how WE can survive our own situations, whether personal or professional. After all, “everyone goes home” is NOT just a slogan. It is part of our mission.
Engineering health and safety
Training, standards development, after-action reports and counseling/therapy are all part of the survival equation. Clearly, the less-practiced preventative piece of the pie is counseling/therapy, as we are still working to destigmatize behavioral health topics.
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But we have seen faster progress in other areas. From integrated smoke alarms and residential sprinklers to lightweight truss placards on buildings and public education programs, we have championed engineered solutions to make our lives better and our communities safer — surviving and thriving in action. Similarly, we’ve implemented extensive rapid intervention training, embraced minimum standards, and worked to promote firefighter strength and nutrition.
These solutions are part of the process of prevention by design, that is, creating systems and processes that prevent the hazard from occurring in the first place, or at least greatly reduce the likelihood. (Let’s not forget, there is a healthy — or sometimes unhealthy — dose of politics involved in such processes, but the process is how we make things better.)
Let’s consider some data that puts prevention by design in action in perspective. These are average annual statistics of common calls over the past 50 years:
| 1974 | 2024 | % CHANGE | Source | |
| Fire deaths | 12,000 | 4,371 | - 65% | USFA |
| Roadway deaths | 45,534 | 42,514 | - 7% | Insurance Institute for Highway Safety |
| Shooting deaths (non-suicide) | 10,000 | 17,927 | + 79% | Pew Research Center |
| Suicide deaths | 27,600 | 49,000 | + 79% | CDC |
| Cancer deaths | 358,961 | 611,720 | + 70% | CDC |
| Cardiovascular deaths | 695,000 | 941,600 | + 35% | CDC |
| U.S. population | 212,532,000 | 340,100,000 | + 60% | TBD |
These numbers prove that prevention by design works. The fire death rate drop can be directly attributable to the 1974 establishment of the U.S. Fire Administration, the work of the NFPA, and the introduction of the concept prevention by design. When you dig into the numbers further, we can see the direct impact of smoke alarms and sprinklers: Nearly 62% of fire deaths today occur in homes without working smoke alarms, and 85% of the deaths occur where there are no sprinklers.
Looking at roadway incidents, the 1968 federal mandate for seatbelt installation certainly contributed to the reduction in deaths. Today, 49 states require adult seatbelt use – New Hampshire remains the only standout. Since 1968, seatbelt use has shown a 45% reduction in roadway death likelihood. Of course, there’s a human factor at play here — whether we actually wear the seatbelt.
Traffic roundabouts on the other hand are a prevention by design feature that forces safer driver behavior (slowing down), and we’ve seen intersection fatalities reduced by 80%. While I know a lot of people don’t like roundabouts, the improvements in life safety are undeniable.
Unfortunately, many of the other situations we respond to have grown exponentially. What’s missing? Two things: 1. Leadership and 2. solutions that take the human factor out of the decision-making process. I know that taking away a person’s decision-making ability is rarely a popular solution. But I strongly believe it is our responsibility to advocate for safety, and I often quote General Colin Powell’s saying, “Being responsible sometimes means pissing people off.”
Incremental progress
How do we turn the tide for what’s best for us physically and personally? We must focus on our personal 360. We need to talk to each other, recognize when someone needs help, and take action.
There is no single cancer or behavioral health answer, at least not yet. The fire service has not been able to engineer our way out of these boxes. While there have been some great successes in early cancer detection, there has been little success in engineering a cure for cancer. Similarly, the behavioral health arena is very much a work in progress.
Subject-matter experts have been working hard on incremental solutions. One of the most significant standards tools recently has been NFPA 1580: Standard for Emergency Responder Occupational Health and Wellness. NFPA 1580 provides the framework for fire departments to establish a comprehensive occupational health and wellness program for firefighters, including fitness/nutrition and, to some degree, mental health.
I think we’ve made good progress normalizing the fitness/nutrition discussions. There is still more to do. We need to become more involved in engineering behavioral health and cancer solutions because, let’s face it, our lives depend on it!
Cancer roundabouts
Wouldn’t it be phenomenal if we could replicate the roundabout life safety improvements (80% mortality reduction) in our behavioral health and cancer programs? There is no specific code, yet, to address these issues, and unfortunately, we continue to see indifference and misunderstanding amongst our ranks. While NFPA 1580 does address some cancer and mental health concerns, they are not comprehensive in those two areas — and we need to get comprehensive.
NFPA 1580 does arm us with solid information to help reduce carcinogen exposures — improved PPE standards, air monitoring guidance, and enhancements with decontamination awareness. Separately, NFPA 1585: Standard for Exposure and Contamination Control helps with station design guidance that is consistent with reductions in carcinogenic exposures. Unfortunately, none of these things are specifically retroactive nor compulsory for the fire service.
One area where we have gained significant ground can be found with programs like Life Scan Wellness and similar diagnostic companies.
Life Scan Wellness CEO Todd LeDuc (also a retired fire chief) highlighted the value of early detection. “While we haven’t been able to cure cancer, we have seen significant reductions in cancer growth and corresponding reductions in mortality through early detection. With respect to prostate cancer, we’ve seen the five-year survivability increase from 28% (late-stage detection) to 100% (early-stage detection). Lung cancer five-year survivability improves from 4% (stage 4 detection) to 53% (stage 1 detection). The importance of early detection cannot be over-emphasized!”
LeDuc also spoke to the investment angle: “Departments fight administrators to find funding for preventative measures. Those same administrators don’t bat an eye spending millions in benefits and long-term care after a diagnosis. An ounce of prevention is definitely worth a pound of cure.”
Behavioral health roundabouts
On behavior and mental health, I spoke with First Responder Center for Excellence (FRCE) Managing Director Frank Leeb and FRCE Program Manager for Behavioral Health Dena Ali to gain greater perspective. FRCE has become an industry leader in firefighter health and wellness arena, especially in the behavioral and cancer health spaces.
Chief Leeb agrees we’ve made great strides in safety and general wellness over the years. He observes that non-operational deaths (mostly related to cancer and behavioral health) continue to rise, while on-scene deaths continue to decline. That decline has been buoyed more by the National Fallen Firefighters Foundation’s 16 Life Safety Initiatives and many of the NFPA standards that have become institutionalized than by true prevention by design efforts.
Specific to the data in this space, Chief Ali noted, “Right now that data is sparce because we’ve really only begun to scratch the surface. I predict in 10 years we will see positive data, as long as we continue to show leadership.”
Wouldn’t it be amazing if we could show the same kind of roundabout success for cancer and behavioral health statistics?
When asked one thing fire chiefs could do to make a different, without hesitation Chief Leeb said, “Recognize that we are all part of the peer counseling equation — we can’t just sit around and wait for the peer support team to show up. We need to show up to and engage in a cancer or behavioral health situation in the same manner that we show up at a hazardous materials incident. We don’t simply refer the incident to the hazmat team and go back to the station. We do everything within our training expertise until the team arrives. Then we stay and assist until the situation is safe.”
Both Leeb and Ali agree we need to enhance the training we provide our responders to not only recognize issues but also deal with the issues from a position of empathy and support as part of the peer support solution. Imagine an environment where the kitchen table talks include the recognition of our cancer and behavioral health strengths and weaknesses.
Final thoughts
“We are not going to cure our way out of this crisis,” Ali said, quoting Dr. Eric Kane. That means we need to focus more on prevention, specifically prevention by design where we can engineer solutions on the front end to prevent the issue long-term.
So, what can we do to set the tone and influence our crews’ actions around cancer and behavioral health?
- Model our vulnerabilities and our behaviors
- Create supportive environments
- Wear PPE, properly — every time
- Follow your policies and procedures
Organizational leaders should always advocate for their people and communities, especially when they know the solutions — solutions that allow your firefighters to not only survive but to thrive.
What are you doing to model positive health and wellness for your firefighters? They’re listening, and they’re watching you whether you realize it or not. Do the right thing!
