Health Effects of Smoke Exposure in Wildland Firefighters

Wildland firefighters play a critical role in protecting communities and natural resources, yet comparatively little research has examined the occupational health risks associated with repeated smoke exposure. This narrative review analyzed documented health effects, contributing exposure determinants, and mitigation strategies across 38 studies meeting pre-specified inclusion criteria. Included studies were predominantly quantitative field investigations evaluating pulmonary, cardiovascular, metabolic, and chemical exposure outcomes. Consistent findings documented decreased lung function, elevated oxidative stress, increased carbon monoxide (CO) exposure, and cumulative cardiovascular risk. Wildland firefighters were associated with polycyclic aromatic hydrocarbon (PAH) levels 2.2–26.7 times higher than controls. Prescribed burns produced CO concentrations 233% higher than off-fire-line days. Cardiovascular disease accounts for approximately 45% of annual line-of-duty fatalities among U.S. firefighters. Contributing factors included career duration, fire type, and operational role. Altogether, these findings underscore the severe, multi-system health risks faced by wildland firefighters and highlight a pressing need for modern mitigation strategies and firefighter-specific protective technologies to safeguard long-term health.