Occupational health risks in firefighters.

The Industrial Injuries Advisory Council (IIAC) invited the Institute of Occupational Medicine (IOM) to undertake a systematic review of the evidence relating to occupational health risks in fire-fighters, to assist the Council in advising the government on the prescription of industrial diseases. The primary research question to be addressed was: Are published epidemiological data indicative of a significantly increased risk of disease in those employed as a fire-fighter, and, if so, is this risk more than doubled compared to that in the general population? A search strategy was developed and agreed with the sponsor. Based on this, a number of electronic databases were searched, yielding a total of 678 references for potential inclusion. On retrieval of titles and abstracts an initial screening process was carried out by the research team working to specified guidelines. Where the relevance of the paper was not apparent from the title or, where available, the abstract, a conservative approach was taken and full publications were ordered to allow full text scanning. On completion of the screening process, potential publications were obtained for review and data extraction. Papers were scanned further at initial acquisition to ensure they fitted the inclusion criteria. Those that were included were reviewed and data extracted. Additional material, in the form of papers cited by those selected for review, was also obtained where relevant and added to the review. Extracted data were then collated into evidence tables to support the narrative review. Following drafting of the review a copy was made available to the reviewers of an unpublished review by the Canadian Industrial Disease Standards Panel (IDSP, 1994) on cardiovascular disease and cancer among firefighters. A note on this review has been added as Appendix D.