This study will take three to four years to complete. The main steps are:

1. Collection of information on firefighters using personnel records - Completed
2. Collection of data on indicators of exposure from department records - Completed
3. Collection of data on heart disease risk factors using a survey - Completed
4. “Linkage” of the firefighter data to health data on heart disease in the BC Linked Health Database - Completed
5. Analysis the of data - Ongoing (All data has now been received; analysis on all data is complete, but additional analyses will be performed)

1. Collection of information on firefighters using personnel records
All people employed for at least one year between April, 1984 and March, 2002 by the participating organizations will be included in the study. Information on work history for each fire fighter starting from the date of first employment in the fire department will be assembled in a database by the participating municipalities. Start date, end date, position (e.g. firefighter, battalion chief), fire station, and, when possible, company (e.g. engine company 2, ladder company 3) will be collected for each position held.

2. Collection of data on indicators of exposure from department records
In order to estimate exposure, participating fire departments will be asked to provide, or to assist us in collecting, information on the:

• Number of runs (emergency responses) per year for each fire station and/or fire company;
• Breakdown of the nature of these runs (e.g. residential fire, auto, false alarm, etc…);
• Characteristics of the geographic area covered by the fire stations (e.g. single family residences, high-rise apartment complexes, commercial and industrial facilities);
• Layout and design of each fire station, including decommissioned stations;
• Type of firefighting equipment (diesel versus gasoline) and respiratory protection equipment used over time.

3. Collection of data on heart disease risk factors using a survey
A survey will be distributed to 1,000 current and retired firefighters. The questions will be on tobacco use, diabetes, high cholesterol, hypertension, family history of heart disease, and other risk factors for heart disease. Results from the survey will be compared with the Canadian Community Health Survey (CCHS) conducted by Statistics Canada.

4. “Linkage” of the firefighter data to health data on heart disease in the BC Linked Health Database

In order to identify heart disease hospitalizations and deaths, information on firefighters and firefighting exposures will be linked to health records held by the UBC Centre for Health Services and Policy Research. Also see protection of privacy.

5. Analysis of the Data
The analysis for this study will consider:

• acute forms of heart disease (such as acute myocardial infarction or unstable angina);
• chronic forms of heart disease (such as stable angina pectoris, other chronic forms of ischemic heart disease, or arteriosclerotic cardiovascular disease); or high blood pressure disease.
• Indicators of exposure will be developed based on a combination of the work history data and the information from fire departments. As a first step, we will develop the following indicators of exposure:
• The duration of employment in all firefighting positions – as an indicator of general employment;
• The approximate number of runs (duration (yrs) of employment in firefighting positions x runs/year for each position/station) – as an indicator of general firefighting activity.

These two approaches will be used in combination with other potential determinants of exposure: specific firefighting positions, specific type of fires, type of company (engine vs. ladder), and other factors that may influence exposure. For example, duration of employment in each station, type of station (e.g. “open” between garages and working/living area versus “closed”), and use of diesel trucks could be used to develop an indicator of diesel exposure.

The analysis will investigate rates of heart disease (hospitalizations and deaths) and compare these rates to the working-age population of BC. The analysis will also compare rates of heart disease among firefighters with potentially higher levels of exposure to those with lower levels.