Smoke Exposure and Respirator Use Among Wildland Firefighters: A Narrative Review.

Climate change contributes to warm, dry conditions, which leads to longer and more active fire seasons. Wildland firefighters work long hours in smoky conditions without regulations requiring respiratory protection. Wildfire smoke has many toxic components, including high levels of fine particulate matter (PM). Regular monitoring for short- and long-term health outcomes in wildland firefighter populations is uncommon. However, extrapolating from knowledge about the individual components of smoke, it is likely that the firefighters' health is negatively affected. Firefighters are routinely exposed to dangerous levels of smoke, which may lead to both acute and chronic health consequences. Current guidelines from Occupational Safety and Health Administration (OSHA), the U.S. Forest Service (USFS), and the Interagency Standards for Fire and Fire Aviation Operations do not recommend respirator use for wildland firefighters. The methodologies used to quantify exposure and harm likely underestimate actual risks. Although there are no respirators that can filter all known harmful components of wildfire smoke, this review examines the potential benefit of respirator use by reducing some of the most harmful components of the smoke. Smoke exposure among wildland firefighters needs to be further characterized and quantified. Regulations should be reassessed to accurately reflect the exposure and potential harm that firefighters face. This narrative review gathers information from peer-reviewed scientific literature, government publications, news articles, and personal conversations with both public- and private-sector professionals. The objectives are to describe the likely health effects of wildland firefighting, evaluate the evidence behind current respiratory protection guidelines, and propose potential solutions.