Hierarchy of Controls pyramid

Journal Article and Online Course Provide Methods for Implementing Effective Cancer Risk Reduction Solutions

August 1, 2022

The peer-reviewed journal article “Hierarchy of Contamination Control in the Fire Service”, co-authored by the Fire Safety Research Institute (FSRI), part of UL Research Institutes research engineer Gavin Horn, National Institute for Occupational Safety & Health (NIOSH) head of the National Firefighter Registry Kenneth Fent, Skidmore College professor and Illinois Fire Service Institute (IFSI) Research Scientist Denise Smith, and vice president and executive director of FSRI Steve Kerber, has been published in the Journal of Occupational and Environmental Hygiene. This narrative review synthesizes current research on fire service contamination control in the context of the NIOSH Hierarchy of Controls, a framework that supports decision-making based on implementing feasible and effective control solutions in occupational settings. 

Hierarchy of Controls


Description automatically generatedThe Hierarchy of Controls pyramid illustrates the sequence of most effective to least effective implementation methods of contamination control.

To supplement the article, identify key exposure risk reduction takeaways, and motivate firefighters to participate in the National Firefighter Registry (NFR), FSRI and our collaborators have also developed the “Comprehensive Cancer Risk Reduction Strategies for the Fire Service” online course as an interactive review of the Hierarchy of Controls framework. The course is designed to help fire departments better understand sources of contamination and methods of control in the fire service to take action and reduce risks. 

Research and understanding of how firefighting can impact cancer risk has evolved to the point that IARC has recently classified Firefighting as a Group 1 Known Carcinogen. This program and enrollment in the NFR can help fire departments start thinking about how to address and reduce that risk. The goal of these resources is to help fire departments and policy makers apply the Hierarchy of Controls framework and integrate current research and understanding into sound guidance on exposure control options for the fire service. Each level of the hierarchy is examined in detail, beginning with personal protective equipment (PPE) which the fire service has the most local control over, and ending with elimination, which may require higher level action, collaboration, and policy to implement. 

The international fire service community is actively engaged in the development, testing, and implementation of effective approaches to reduce exposure to contaminants and the related cancer risk. However, these activities are often viewed independently of each other and in the absence of the larger overall effort of occupational health risk mitigation. We hope these resources will begin to bridge this gap. 

To learn more about the research and current literature available on fire service contamination controls, check out the following FSRI research projects: 

National Firefighter Registry logo

Coming soon: The National Firefighter Registry


The National Firefighter Registry, or NFR, will be a database of health and occupational information on firefighters that can be used to analyze and track cancer and identify occupational risk factors for cancer to help the public safety community, researchers, scientists and medical professionals find better ways to protect those who protect our communities and environment. With voluntary participation from firefighters, the NFR will include information about firefighter characteristics, work assignments and exposure, and relevant health details to monitor, track and improve our knowledge about cancer risks for firefighters. To stay updated on our progress, click here to subscribe to the NFR Quarterly Newsletter.

Assessing the Cardiovascular and Chemical Risks Faced by Firefighters