The Portugal Faculty of Medicine at the University of Porto (FMUP) has released research showing elevated cardiovascular risk among firefighters, a finding that could reshape occupational health protocols for the country's approximately 30,000 active firefighters. The study, which tracked 60 firefighters from northern Portugal between 2021 and 2023, identified biomarkers that signal chronic inflammation and DNA damage directly linked to wildfire combat.
Why This Matters
• Cardiovascular threat confirmed: Levels of C-reactive protein exceeded thresholds set by the American Heart Association and the CDC, indicating heightened risk of heart disease.
• DNA damage detected: Urinary biomarkers showed increased genetic damage in bladder cells following wildfire exposure.
• Policy implications: The findings support calls for mandatory medical surveillance, stricter decontamination protocols, and potential reclassification of firefighting as a high-risk profession eligible for early retirement.
The Study and Its Scope
Researcher Filipa Esteves, working with the Portugal National Health Institute Dr. Ricardo Jorge (INSA), designed a two-phase investigation to isolate the health effects of wildfire smoke. The cohort consisted primarily of male firefighters (80%), with an average age of 35 and 16 years of service. Nearly half were members of Equipas de Intervenção Permanente (EIP), the full-time contracted crews that form the backbone of Portugal's emergency response system.
Phase one collected baseline blood and urine samples before the wildfire season. Phase two sampled the same individuals immediately after they fought active forest fires, analyzing systemic inflammation markers and extracting buccal cells to quantify DNA strand breaks.
What the Blood Tells Us
The results were stark. After firefighting operations, systemic inflammation biomarkers surged significantly, according to the study's conclusions. C-reactive protein levels—used clinically to assess inflammation and predict cardiovascular events—remained above recommended safety thresholds in both phases, suggesting that even baseline exposure carries chronic risk.
The research also identified a positive association between these inflammation markers and exposure to polycyclic aromatic hydrocarbons (PAHs), toxic compounds released during combustion. PAHs are known carcinogens and are absorbed through inhalation and skin contact, even through protective gear.
Damage to DNA was most pronounced in urothelial cells lining the bladder, a worrying signal given that bladder cancer is already recognized as an occupational hazard in firefighting. Chromosomal instability and genotoxic damage markers rose after wildfire intervention, underscoring the biochemical toll of prolonged exposure to smoke and particulates.
What This Means for Residents
For anyone living in Portugal, this research has immediate relevance. The country's firefighters—many of them volunteers—are the frontline defense against wildfires that threaten rural and suburban communities every summer. If these professionals face cumulative health risks that go unmonitored, the sustainability of the firefighting workforce itself is in question.
The Portugal National Emergency and Civil Protection Authority (ANEPC) currently mandates periodic medical inspections for firefighters under Decree-Law 241/2007, but the new findings suggest that existing protocols may not capture slow-developing cardiovascular and oncological risks. The Social Protection Fund for Firefighters (FPSB) finances these check-ups, yet access remains inconsistent, particularly for volunteers who often skip routine occupational health visits.
In 2026, the government allocated €321 M to emergency and civil protection in the national budget, with €231 M earmarked for capacity building. This includes reinforcing the Special Rural Fire Combat Device (DECIR) and expanding EIP crews. However, health surveillance infrastructure lags behind operational investment.
Recommendations from the Frontlines
Esteves, who completed her doctorate at FMUP in 2025 and continues this line of inquiry, has issued a series of preventive recommendations grounded in the biomarker data. Her advice mirrors protocols already in use in parts of Northern Europe, but implementation in Portugal remains patchy.
Key interventions include:
• Immediate decontamination: Removing contaminated personal protective equipment (PPE) on-site, followed by washing the face, neck, hands, and wrists with soap or cleansing wipes before eating, drinking, or traveling back to the station.
• Full station decontamination: A complete shower and proper storage of contaminated PPE and tools in designated "dirty zones" with adequate ventilation. Stations should enforce clear spatial separation between contaminated and clean areas.
• Medical biomonitoring: Regular blood and urine tests to track inflammation markers, lipid profiles, and genotoxic indicators, especially for firefighters with more than 10 years of service or frequent wildfire exposure.
• Operational pauses: Scheduled rest breaks and adequate recovery time between shifts, particularly during multi-day wildfire campaigns.
• Lifestyle support: Structured programs promoting physical fitness, balanced nutrition, and stress management, given that poor baseline health compounds occupational risk.
The European Context
Portugal's firefighters are not unique in facing these hazards. Across the European Union, around 51% of firefighters are likely exposed to formaldehyde, and respiratory diseases linked to smoke inhalation—including asthma, chronic obstructive pulmonary disease (COPD), and mesothelioma—are recognized occupational illnesses. The EU Strategic Framework on Occupational Safety and Health 2021–2027 emphasizes prevention and early intervention, but member states vary widely in enforcement.
In Portugal, a 2013–2014 assessment of 7,500 volunteer firefighters found that 60% were overweight, with 23% classified as obese. Musculoskeletal injuries, sleep disturbances, and mental health issues are also prevalent. Yet occupational health teams remain scarce or nonexistent in many volunteer corps, which make up the majority of Portugal's firefighting force.
The International Labour Organization (ILO) Convention 187, ratified by Portugal, calls for a national preventive culture in occupational safety. The ILO's forestry safety code specifically addresses firefighter exposure to carcinogens and the need for risk assessment protocols.
Funding and Policy Shifts
Starting July 2026, monthly subsidies for Emergency Medical Stations (PEM) operated by fire brigades will increase 23%, from €8,760 to €10,800. This follows a 31% hike in 2025 and reflects the fact that firefighters handle roughly 90% of pre-hospital emergency medical response in Portugal.
The Portugal Transformation, Recovery, and Resilience Plan (PTRR), approved in June 2026, includes reform of fire brigades as a core objective. A proposal by the Portuguese Communist Party (PCP) in July 2025 sought formal recognition of firefighting as a profession of risk and rapid wear, which would enable early retirement and hazard pay. That proposal has not yet been enacted, but the research from FMUP adds empirical weight to the argument.
Moving Forward
Esteves emphasizes that the interventions she recommends are not theoretical—they are evidence-based measures with documented efficacy in reducing contaminant absorption and mitigating long-term health impacts. "When applied in an integrated and continuous manner, these measures reduce health risks and contribute to the longevity and quality of life of firefighters," she stated in the study summary.
For Portugal, the challenge lies in translating research into practice across a fragmented system that mixes career and volunteer firefighters, rural and urban brigades, and varying levels of municipal support. The biomarker data provides a baseline for accountability, but without systematic implementation and follow-up, the cardiovascular and oncological risks identified in this study will likely persist.
The Portugal Ministry of Health and ANEPC have jointly issued a health promotion manual for firefighters, but the next step must involve enforceable standards, funded biomonitoring programs, and integration of decontamination protocols into operational doctrine. With wildfire seasons growing longer and more intense, the health of the people who fight them is not just a labor issue—it is a matter of national resilience.
