Transcript
Estimated 17 min reading time.
Welcome to the USFA Podcast, the official podcast of the U.S. Fire Administration. I'm your host, Teresa Neal.
Our guest today is Dr. Brittany Hollerbach. She is an Associate Scientist and Deputy Director of the Center for Fire Rescue and EMS Health Research at NDRI USA. Dr. Hollerbach received her Ph.D. in kinesiology from Kansas State University and completed a postdoctoral research fellowship at Skidmore College under the direction of Dr. Denise Smith where she focused on cardiovascular disease in the fire service.
Dr. Hollerbach has extensive experience working with the fire service on a number of federally funded firefighter studies examining behavioral health issues which include obesity, nutrition, physical activity, sleep, substance abuse, and mental health. Welcome to the podcast, Dr. Hollerbach.
Thank you so much for having me on.
So, I think every conference I've been to recently, you've been there to talk about women's health and other issues, and that is awesome. And so, I wanted to ask you can you tell me about your research into women's health?
Yeah, absolutely. So, I have to say my boss, Dr. Sara Jahnke, has really started the path into the research on women's health and the fire service. Like, even, I think, absolutely 10 years ago, we weren't looking at women's health in the fire service. Five years ago, we really started to look at women's health.
And if you look at, like, the number of publications published on women's health, specifically, it's just exponentially grown, which is really exciting for women firefighters but for the entire fire service, right? Because we're just better able to understand the fire service as a whole. So, our research is focused on a number of different things.
A lot of the things you read at the beginning from my bio, we've looked at in men and women firefighters. So, we've looked at, you know, cardiovascular health, and especially when I worked up with Denise, that is her specialty, is looking at cardiovascular health in men and women firefighters. And so, that one we've looked at weight status, overweight and obesity, some different behavioral health factors like alcohol, substance use, diet, nutrition, injuries.
Recently, the IARC Monograph came out and classified firefighting as a Class 1 carcinogen. So, that impacts both men and women firefighters. And there's so much that we've looked at. One thing is bullying and harassment and the experience of women in the fire service. And then how that experience may impact their health, their mental health, their physical health and then reproductive health.
And a lot of times when you mentioned reproductive health, folks think specific to women. And I'm always like, "hey guys, it takes two people to make a baby." Like —
Yeah —
Both men and women's reproductive health systems can be impacted by the occupation.
So, it's been really interesting for me to be able to research all of these things and see the differences between men and women and also the similarities, right? Like I think oftentimes we're more alike than we are different.
Yeah. So, how is it different, exactly, then the other research that you do?
Yeah, absolutely.
So, one thing is I think that there is often a perception that women aren't built to do the job of firefighting. And obviously not everyone has that perception, but we hear it, right? We hear it, "oh, they're just not built to do the job." And as I look through the research, I'm like, you know, they're actually built to do the job.
Like, we see lower rates of adverse cardiovascular health issues, cardiovascular disease, as well as hypertension and high blood pressure, high cholesterol and the inflammatory markers that we're seeing elevated among men firefighters. We don't see them as prevalent among women in the fire service. Women also have lower rates of overweight and obesity. They tend to be a little bit stronger. They have really good lung health.
I always think, women have — most women, I'll say most — have upper body strength lower than a man's upper body strength, but our lower body strength and with the core and everything — because we're made that way so that we can have children and whatever — is stronger.
And so, it's just a way of doing it different. I know Rachael has — I think I mentioned it on probably several podcasts — Rachel's saying that women can do it. It just looks different, but it's the exact same thing. You get the same outcome, but it just looks a little bit different as you're doing it.
Absolutely. And so, we were just at the Women in Fire Conference last week, and that was one thing that kept coming up, especially on the HOT (the Hands-on Training) ground.
How awesome it is to learn from other women these different techniques. The fire service is very traditional. So, they tend to teach a skill in perhaps one way or one or two ways, whereas women might finesse it a bit differently.
And yeah, so, I love that. And Rachael Staebell is a 100% correct. Like, there are so many ways, different ways to do things. And it's not just a male/female thing. It's like, not everyone is a 6 foot 5, 200-pound male. Like, even shorter men need to do things differently, right?
You just work with what your body mechanics can allow.
I want to talk about the research, but that's one of the things. We recently came back from Australia. And while we're in Australia, there was a Champions of Change round table and they kind of focused on PPE. And through that conversation, we really said, we need to stop saying male PPE, female PPE.
We needed to start saying fit for purpose PPE, regardless. Because when you differentiate male and female, then it's like, "well, we don't have as many females, we only have 4% or whatever the percentage is at the time of women fighting. So therefore, it's not advantageous."
Well, there were people talking about times where sometimes the female pants will fit better on some male, so they'll be better fit for purpose wearing what's called female pants. And so, it's not about that.
When I was in the military, everybody got a uniform. The uniform was the uniform. There was no male or female uniform. The fit wasn't important so much because that wasn't that PPE type of thing. It should be the same thing with the fire service. It should just be the uniform is the uniform. And does it fit you perfectly? How does it fit you?
Because what you're wearing is actually going into a fire and you need that protection. And so how do we protect each person best for them, regardless of what their sex is? And so, yeah, I'll get off my pedal stool now.
No, I 100% agree. Like, there's men that are super ripped, right? And if you're very muscular, sometimes the bunker gear doesn't fit you well either. Like, it's not just a male/female thing. It's a tall, short, wide, not wide, like every body is different. And so, we have to start making gear — and to be honest, I really think that the gear companies have come a long way over time.
And I think we need to do a better job of when we're going out for specs, for your department gear, you need to have that conversation and find out what the gear company offers. And if you need different sizing for different people, is that available? I think oftentimes perhaps departments don't even know what is out there.
So, having that conversation and educating yourself as the person who's doing the bidding. And asking questions from your gear of like, "hey, what do you offer? And how is it different? And what different sizes or fits or cuts do you offer?" And allowing that conversation to start.
Out of that round table that they did in Australia, I think that's one of the things they're trying to come out of it is a best practice in tendering. And being able to say, "this is what we're looking for." So, that when you sit down with the companies and say, "this is what we're looking for, regardless of what you call it, we're looking for this. Can you do this?" Because if it's put out that way, and if it's put out by large groups of people that same way, industry will respond.
You know, there are things that we didn't have before, but we've said over and over again, we need it like this, and all of a sudden somebody somewhere figured it out. We're able to do that, you know. So, it shouldn't be that hard.
So, I know that you research communications and you're very passionate about making sure that fire safety and messaging around health and safety research gets to the fire service.
And I know that you work a lot with, you said earlier about, Dr. Jahnke about fire. You all do the Science to the Stations. Through AFG, through other things, there's a lot of research out there, but it never trickles down to the people that are actually on the ground.
It still stays as a paper somewhere sitting up on the shelf. And you're passionate about getting that information so that the fire service, each person in the fire service understands what that research means.
Absolutely. Yeah. That's one of the things that I think has been more so a topic of conversation in the last couple of years.
There are phenomenal researchers across the United States and across the globe, honestly. And we're, the researchers are finally starting to connect, which is huge, that's a starting point. But the researchers as a group are starting to realize, "hey, we need to do a better job of translating and disseminating our important research findings to the fire service, to the boots on the ground."
And even that there's such a spectrum of it needs to go to leadership, or it needs to go to union management. It needs to like labor management. It needs to go to administration. It needs to go to city managers. It needs to go to training. It needs to go to the line firefighters.
Even once you get it to the fire service, there's so many layers that we have to be like cognizant of. And so, that's one of the things that I think is so important is thinking through what does that messaging mean? Right? And the messaging to a firefighter might look different than the messaging to city administration or the fire chief or chief level officers.
And so, thinking through all of that, right? Like, it's not just slapping some fire graphics on it, putting it out, right? Like, you have to make it appealing and that might look different to each kind of level of the fire service. So, one thing that Dr Jahnke and our group has started is Science to the Station, a Health and Wellness Alliance.
And through Science Alliance, I like to call it like the Google for the fire service. We're hoping that it can be this kind of one stop shop where people can come and find information that they're looking for. So, we're partnering with all the different research teams as well as occupational medical folks and health and wellness folks and medical directors, and X, Y and Z, trying to get everybody all on one page.
And that way, similar to Google, right? If you don't know something, you Google it. But that can be kind of difficult if you're looking for firefighter specific research. Then you're going through like, "oh, this search returned millions of results." Like, I'm not looking through millions of results.
Or that you're not sure that you're getting back the results for the right — I've heard some things traveling, of some research and I'm thinking, "wow, I don't know if that's really best practice." You know, or just because they're —
Right. Is this evidence based?
Yeah, and so this way they're getting something that's evidence based. You know that it's been vetted that the research — I mean you all are a tight team and you kind of work together no matter whether you're at NDRI or wherever. You're all working together and trying to make sure that the fire service gets the right information.
Absolutely. Absolutely. Yeah, and the fire service research community is one that's really interesting. I think a lot of times academics can be competitive and I don't see that in fire service research. I think they're all so on the same page. And so, it's funny. It's almost ancestral in that folks are like, this person is working with this person on this project.
And this person is working with this person on a project. Everybody knows what's going on and everybody knows everybody, but that's a wonderful thing, right? That you're connected in so many different realms. So, you're not redoing the same project that was just done, but instead you're building on it.
And if this group did this project and found this question — because oftentimes, as you know, research, you answer 1 question, and then you're left with 5 more that you're interested in. And so, for all collaborating together, then there's that many more people to go and answer these next step questions.
And I've also seen within the fire service research is that everyone's very open to saying, "oh, you don't want to talk to me about that. You want to talk to somebody completely different in a different section." You're not working with that person right now, you're on a different study, but you will send them to that. Nobody feels like they have to be the guru and answer all questions.
If they don't know, they'll say, no, it's not me, but I'll tell you who it is. And this is how you contact them. And they can tell you, this is what they're doing. You really know each other enough to give the best answers to the fire service and direct them to the right people instead of, like you said, the competition of somebody asked me a question, I have to have the answer and I just have to fudge it along if I don't know where to go. So, I think that's awesome.
No, absolutely. It's humbling to be in a community of people that are so intelligent. Cause I'm like, "oh my gosh, I don't know nearly as much as all of these people." And yet, then you kind of learn that your knowledge comes in the strength of the people you surround yourself with.
So, it's kind of cool. Like, yeah, if I don't know something, I bet you I know somebody who does. So, there's that.
So, what topics are you working on right now? I know you said the communications part of it, but what topics are you working on in research right now?
So, we're doing a little bit of everything.
I have one project on which I'm an early career investigator. It was funded by FEMA, and it was to look at the perceptions of protective strategies for COVID. And I was super excited, am still super excited. I was super excited writing the application, and then the project has been so interesting because it got funded in 2021.
So, we're asking these questions like as COVID is evolving, right? And you're asking people their perceptions of masking and of vaccination and of distancing and all the strategies that we deployed during COVID. And it's so interesting because there was division amongst folks in the United States, and we see that in the fire service as well.
And there's all kinds of underlying reasons for why folks believe one way or believe a different way, believe, for example, that masks are protective, or I don't think masks are protective. And what I found in a lot of the interviews was that I think we're so much more similar than we think, oftentimes.
Especially early on in the pandemic, there became this like, "oh, that person's a mask wearer." What does that mean? But then you realize, like, so many people were talking about masks and whether or not they were useful. And it wasn't so much that we disagreed that masks were useful.
We could agree that masks are only useful if worn properly, right? Like, an N95 should be fitted to your face, and it should fit very snugly. And so, someone that's wearing their mask over their mouth, but not their nose, that's not helpful. Or like the mask, if it's worn around your neck is not helpful.
Like we had pulled it down at some point and never pulled it back up. Not helpful. So, it was so funny doing the interviews 'cause I thought, oh my gosh, I think we're so much more similar than we give ourselves credit for. And we tend to divide ourselves, whether it's by party lines or by whether you're vaccinated or unvaccinated or whether you choose to wear a mask or don't wear a mask.
And it's like, regardless, I think we all want the same thing. We all want our firefighters to be safe. We want the public to be safe. And we want to be safe when we go home at the end of the day. And so, I think that is really what kept coming up in the interviews. So, that's one thing that I'm working on.
And that project is getting ready to end. We're in like our 6-month, no cost extension period. So, we're wrapping up different parts of the study, and we're thinking about getting papers out both to, as you talked about earlier, both academic journals, but most importantly to the fire service to talk about our findings.
And so, that's really what got me super interested in science communication. Because I think it's things like that where we just need to understand the fire service and underlying beliefs in order to message appropriately and understand, okay, what are they feeling? And are there fears or reservations to why they believe certain information?
And how can we speak to that?
Sometimes it's just being able to tell somebody the full story and not just telling them mask. Like, it's the rule. You have to do it. And people are like, wait, I need more. I need more. And I'm a rule follower by nature. So, if somebody says you need to do this, I'm just like, okay, I'll do it.
And so, then when I hear somebody else who's going, "no, I'm not going to do it," automatically, it puts that barrier between us instead of understanding. Maybe they just need some more information or maybe I really truly need more information and I just did it without questioning and don't really know why I'm doing it.
So, I think sometimes we need to have that.
I think especially firefighters, we want to know the why. Like, why do I breach the door this way? Why do we do vent, enter, search? Why is COVID an issue? And COVID or not, I mean, same thing with the flu. Why do we get flu vaccines? Why do we protect against certain respiratory diseases?
Why? We want to know the why. So, yeah, that's huge.
Any other ones that you're working on besides?
Yeah. There's so much happening. So, one of the things I would be remiss if we didn't talk a little bit about is cancer. I think I mentioned earlier that the IARC ruling came out in 2023 and classified firefighting as a Class 1 carcinogen. So, carcinogenic to humans. And so, we're talking a lot about cancer risk in the fire service. And first, more research is needed. I'll always say that, but —
There will always need more.
So, we always need more research, but it impacts both men and women firefighters. The IARC ruling came out and was very clear this impacts career, aid on call, volunteer, men, women, structural, wildland, industrial firefighters, like, everybody's included. And so, with that being said, it's so important to get folks to sign up for the NFR, the National Firefighter Cancer Registry.
It's the largest effort ever undertaken to understand and reduce the risk of cancer among U.S. firefighters. It's open to everybody and it's so important. So, it's not just for folks who have cancer or who are at risk for cancer, it's every firefighter. The point is so that, as researchers, we have the largest sample size possible.
That's the best way for us to be able to see these biomarkers for cancer over time. And so, it'll connect folks death records and be able to identify if a firefighter death was associated with cancer. Currently, if you're retired, for example, occupation states retired, not retired firefighter.
So, it's often very difficult to connect one's occupation with their cause of death.
Even with the volunteers. When you go to the doctor, you're telling them what your day job is and they don't know that you are also a firefighter. So, even when you go for your physicals, there's a whole other area they need to handle because of that firefighting.
And they might not even know.
Yes. And I love that you brought that up. We have some resources on the Science Alliance, such as an occupational guide that you can take to your physician. And this is important, again, for career or volunteer firefighters, because not all physicians are aware of the job tasks related to firefighting.
Some are amazing and are very occupationally aware, but not all. And so, it's so great to have a conversation starter. Because I don't know about the rest of the fire service, but I'm not even sure if I went to my doctor, I think I'd be like, "yes, I'm a firefighter. And I lift heavy stuff and, I have gear — "I don't know. I think it's helpful to have those little bullet points of, "oh, yeah, and here's the job tasks that I'm required to do, and this is what the research says I'm at risk for," and then the doctor can briefly look over it. And it can start a conversation for the two of you to have, so you might think about earlier testing or things the doctor may not regularly ask you about or test based on your age.
So, yeah, I think education and guides like that are so important.
I know that they are important. I think last year I interviewed Alisa Arnoff, and I know you know her as well, and she said that sometimes for years, as soon as somebody said that they were pregnant, they were like, "okay, well, you can't be a firefighter."
Even the doctors would say, "well, you got to stop right now." Because they didn't understand exactly what you were doing as a firefighter and that some women, not all women, it's their choice whether how long they stay on the job before they decide to stop, that part of the firefighting.
And so, she said, in the beginning, they would just say, "oh, no, you have to stop right away." There's that conversation of "this is what the tasks are. This is what we're doing. I can stay on for 3, 4 months if I want." Whatever they choose to do.
Yeah, absolutely. And on the flip side, I think without education and resources, a lot of women chose to stay on the line when now that we have more education, they may make a different decision.
And it's just about education, right? I think as a firefighter, my perception was like, "oh, my bunker gear keeps me safe" and you don't realize how much might get through the bunker gear or how much residual. Like, if I take my gear off, then if I've already taken my gloves off, now there's cross contamination on my hands.
And there's so much to think about. So, I think it is exactly like you said, it's every person's choice. If we're trying to get pregnant, whether you're a male or a female, do I want to come off the line and increase our chances of fertility and conception? If you want to stay on the line, like that's also your choice, but let's arm everyone with the most education.
And speaking of reproductive health, we have a OBGYN specific guide for women to take to their OB and start that conversation. If we're talking about, "hey, I might want to get pregnant or I'm having difficulty getting pregnant" and guide their OB and talking to what it means to be a firefighter and what some of the risks are that you might face that aren't common for the general public, right?
Like increased exposure to heat and sleep disruption, thermodysregulation, lifting heavy equipment, fully encapsulating gear, the list goes on and on, right? So, it just helps you think a little bit more and help start that conversation.
So, you're making good decisions based on science.
Yes. Evidence-based science decisions.
Okay. Is there anything else you'd like to add today?
Oh, my gosh. I feel like there's always so much to talk about. No, I think we did such a good job of covering all the things. I think the biggest thing is to always ask more questions. More research is always needed.
And I think one thing that perhaps people don't know is how many questions we uncover when we answer a question and research. So, we're able to answer questions, we're absolutely checking boxes like, "yes, I was able to answer this question." But usually, we then have more questions from the research.
Like, "oh, great, we found this out. But why is this this way?" So, more research is always needed. And I think more than anything we're answering questions for the fire service. So, all the fire service that's listening to this podcast reach out to your researchers, to folks in your area, get involved in research. The fire service is why we do this.
We want to answer your questions. So, help us engage with researchers. Engage with folks in your community. That helps us determine what our next step research questions are, because we really want to answer, what are the burning questions for the fire service? Like, I was a firefighter. So, part of it is in my heart and I'm super excited about things, but I'm not a firefighter anymore.
So, I need the boots on the ground, the folks that are day in, day out to let us know, like, "hey, this is what's really important right now, and this is my huge question." And so, it should absolutely be this collaborative effort to push forward the research, which then should impact our policies and our practices and our standards and next step research and recruitment and retention and all of these things, should all be impacted and lumped together so that — it's like a cyclical process. We can continue to make the fire service better.
Well, thank you, Brittany. Thank you so much for being on the podcast. I love your passion. And every time I talk to you, I come back with so many ideas and get excited about not only what you all are doing with the research, but what all the researchers are doing and how much they care about the fire service.
Teresa, thank you for having me on. This is an honor to be on the USFA podcast. I'm so excited to be here and I'm clearly excited to do fire service research. It really is close to my heart. So, thank you for all that y'all do and for having me on today.
You can learn more about the research that we discussed and even more by going to ndri-usa.org. And if you have a story or a guest you would like us to interview, please email the show at fema-usfapodcast@fema.dhs.gov. Learn more about USFA at usfa.fema.gov or on social media by searching "@usfire". And until next month, stay safe.