In recent years, several organizations have recognized the firefighting profession's unique and substantial work-related health hazards, including cancers, heart disease, chronic respiratory illnesses and post-traumatic stress disorder (PTSD).
For example, in 2022, the International Agency on Research for Cancer formally classified firefighting as a group 1 carcinogenic occupation , emphasizing the critical need to prioritize access to regular screening and medical surveillance.
Since then, the National Fire Protection Association (NFPA) has issued an all-inclusive standard for comprehensive annual health screenings, and the Texas Legislature has implemented HB 198 , known as the Wade Cannon Act, which directs communities to provide periodic health screenings to firefighters.
Healthcare barriers persist despite policy advancements
These efforts, however, overlook the majority of firefighters in the United States — volunteer firefighters. Adoption of the NFPA standard, for example, is optional, and HB 198 is only for career firefighters.
Now, one of the first studies specifically aimed at volunteer firefighters has quantified the gap between good intentions and persistent barriers to healthcare for volunteer firefighters in Texas.
The researchers, all with the USA Center for Rural Public Health Preparedness , housed in the Texas A&M University School of Public Health at Texas A&M Health , found that just over one in four volunteer firefighters in Texas has an annual health screening.
"This is significant because volunteer firefighters make up about two-thirds of the state's firefighting workforce, including most of rural Texas," said lead author Samikshya Badal, a graduate student with the USA Center at the time of the study.
She said these firefighters face a double burden. Like most rural Texans, they struggle with limited access to healthcare, long wait times and inadequate resources, while also experiencing far more numerous and serious health issues than the general population.
Biggest barriers: Cost, insurance and knowing where to go
For the study, the team conducted an online, cross-sectional survey in English and Spanish with 326 volunteer firefighters in Texas from August to September 2024.
They provided demographic information and answered 29 questions related to their participation in occupational health screenings and perceived barriers to screenings.
Statistical analyses found that 86 (26.4%) of the 326 volunteer firefighters reported receiving an annual occupational health screening.
The top barriers for not getting them were cost, not knowing where to obtain screenings, lack of health insurance, lack of available screenings through healthcare providers and time constraints.
Bundling proven interventions could reduce barriers to healthcare
Based on these findings, the team also identified possible interventions that have proven successful in reducing healthcare barriers for others.
"We know that early detection leads to early treatment and an overall better quality of life," Badal said. "For rural firefighters, a logical and proven strategy would be to meet them where they are: in their communities and fire houses."
The researchers suggest combining the following tactics:
- Nontraditional approaches. These might be screenings through partnerships between volunteer fire departments and health organizations and through telehealth services and mobile medical clinics, with the involvement of professionals who could help patients navigate more complicated processes.
- More information. These could be health education campaigns that educate firefighters and their families about their health risks and the importance of regular screenings.
- Standardization of the NFPA's voluntary standards. The NFPA screening requirements lack detailed protocols, resulting in inconsistent implementation that costs volunteer firefighters time and money. Standardization would make screenings faster and more efficient.
As an example, Badal said firefighters could get screened without the burden of traveling long distances and then get their results in a follow-up telehealth consultation. If they need to see a specialist after that, a patient navigator could help them take the next steps.
"This approach would save volunteer firefighters significant time and other resources compared to making them travel numerous times to a brick-and-mortar clinic, which could be hours away," Badal said. "Bundling these approaches would help improve their health and better protect the communities they serve."
The study was published in Workplace Safety and Health and was developed through work funded by a Texas A&M Health Seed Grant . Others involved in the study were Matthew Boyce , Hannah League , Mayra Rico and Jason Moats .
By Ann Kellett, Texas A&M University School of Public Health
