The fire itself and the overhaul afterwards exposes the firefighters to known carcinogens, such as formaldehyde and asbestos; and compels the firefighters to continue to wear their self-contained breathing apparatus (SCBA). The exposure to the carcinogens has been proven to increase cancer risk; but a more concerning fact is that the leading cause of on-duty death among firefighters is not directly related to the fires they fight, or the hazardous materials they are exposed to. It is actually an indirect result of the stressors that they face every moment that they are in the station: The number one cause of death of on-duty firefighters is cardiovascular disease (Soteriades, Smith, Tsismenakis, Baur, & Kales, 2011).
Cardiovascular disease is strongly correlated with stressful work environments, as well as other high-risk behaviors such as smoking and obesity. Soteriades et al studied cardiovascular disease specific to the firefighting industry and determined that other occupational hazards contributed as well, including physical exertion, shift-work, noise, smoke exposure, heat and dehydration. Of particular interest is that they found that on-duty cardiovascular events did not appear to be random: They were more frequent at particular times of the day and periods of the year. Not unexpectedly, events were overwhelmingly more frequent during strenuous duties compared to non-emergency situations. (Soteriades, Smith, Tsismenakis, Baur, & Kales, 2011)