"We need to start thinking about the people the same way. The biggest asset you have is the people."

Dr. Sara Jahnke has spent nearly twenty years studying firefighter health. She directs the Center for Fire, Rescue and EMS Health Research at NDRI-USA, she is president of Science to the Station, and she sits on the board of the National Fallen Firefighters Foundation. She was also raised by a fire chief, from kindergarten through her senior year of high school, which is the part that explains the rest.

She calls herself a full-time nerd. She's actually the person connecting nearly everyone working on this problem.

In this conversation, she walks through what the research says now, and some of it is not what the fire service assumes. Firefighting was re-evaluated by the International Agency for Research on Cancer and classified as a known carcinogen, and she explains what that process looks like from the inside and why it changes what is possible in legislation. Shift work carries its own classification. Sleep consistency, not just sleep quantity, turns out to be an independent risk factor for illness and death. Elevated blood pressure raises your risk of a cardiac event on the fireground twelvefold.

But she is just as interested in what is going right. Smoking rates in the fire service are now lower than the military and lower than the general population, and she argues the mechanism was peer pressure, crews deciding this is not who we are. Divorce rates for men in the fire service came back lower than the general population across forty-three departments from Maine to Guam, a result her analytics team ran repeatedly because nobody believed it. For women in the fire service, the same data came back high, and she says so plainly.

Greg and Sara get into sleep, nicotine pouches, shift schedules, start times, why "cleared for duty" is not the same as healthy, and what a department actually owes the people who work for it. Amy asks the questions that pull all of it out of the echo chamber.

Sara also talks about 360 Responder Health, Medical and Safety, the clinic model she built with Kepra Jack and Denise Smith, and about Science to the Station 2026 in Kansas City, November 3rd through 5th, the gathering she still calls Nerdstock.

This episode is dedicated to Firefighter/EMT Mark Mansfield, Overland Park Fire Department, end of watch April 6, 2002.

"It's easy to say 343, 344. But it's really one loss, three hundred and forty-four times."

Frank Leeb spent nearly thirty-two years in the FDNY and retired as a Deputy Assistant Chief in June 2024. He is now Managing Director of the First Responder Center for Excellence. He is also the only person we asked to come back.

This conversation was recorded just after the twenty-fifth anniversary of September 11th, and Frank told us something we did not expect: he had not talked about his day anywhere else. Not in an interview, not on another show. He walks us through all of it, hour by hour. The six a.m. train into the city with his son-in-law and a member of his volunteer department. The moments of silence outside quarters at 76 Engine, where he was captain. The firemen's memorial five blocks away, where firefighters from Florida, Texas, Italy, London, Vermont and Oregon had come to stand. Headquarters in Brooklyn at two in the afternoon, because when you make staff chief, headquarters becomes your last firehouse. The bagpipes at sunset outside Ten House, and the band leader calling into the crowd for people to shout the names of who they were honoring. And then, near eleven at night and running on nothing, a subway ride to Queens to stand in a kitchen for a friend's last tour, because that is what you do.

He got home at one thirty in the morning. He left at six.

Frank also does the arithmetic the fire service has been doing quietly for twenty-five years: 343 lost that day, 344 counting the fire patrol member, 453 since from occupational illness, and 152 more added to the memorial wall who were already retired on September 11th and came back to help anyway. Approaching a thousand people. The FDNY ceremony could not be held at St. Patrick's Cathedral this year because the cathedral is not big enough.

Amy, who was living in New York that morning, asks him the question underneath the whole day: does it fill your cup, or does it empty it? His answer is the reason this episode exists.

He also talks about his friend Tony Mastrelli, who died at fifty-eight of occupational illness in November 2024, and whose memorial shirt Frank is wearing while we talk.

This episode is dedicated to Firefighter Anthony "Tony" Mastrelli, FDNY Ladder 56 and East Farmingdale Fire Department. 1991 to 2024.

MENTIONED IN THIS EPISODE

Frank Leeb's books, including In the Mouth of the Dragon: Toxic Fires in the Age of Plastics, second edition, co-authored with Deborah Wallace. https://fireengineeringbooks.com/search.php?search_query=leeb

"The Story of the List" by retired FDNY Captain Frank Leto, on how scribbled names on yellow legal pads became the department's official missing and deceased list. Frank calls it the one must-read piece on September 11th this year. https://www.firerescue1.com/fdny/the-story-of-the-list

First Responder Center for Excellence, free online training: https://firstrespondercenter.org

Unseen Exposures is presented by SPOKE: https://www.spokemovie.com

Music: White Mountains by Zambolino Source: https://freetouse.com/music Royalty Free Music (Free Download)

"I never realized until I was doing this presentation how much marrying him really contributed to me being a therapist."

Maggie Riback is a Licensed Mental Health Counselor. She is also married to a volunteer firefighter, and she has been learning the fire service from inside a marriage for sixteen years.

She is not a first responder. She does not currently have first responders in her caseload. That is exactly why this conversation goes somewhere the others haven't: Maggie is the person on the other side of the door, the one who watches someone leave in the middle of the grocery run with no idea when he is coming back or who will walk in when he does.

Greg and Amy sit down with Maggie in Iowa to talk about the early call that lasted three hours, when she was too new to the relationship to ask if he was okay without feeling dramatic. They get into the way "I'm fine" functions as a complete sentence in the fire service, and the routine she and her husband built so she can read the answer without asking the question. Greg shares the percentage system he uses with his wife, and the two of them work out why the deal is different when you meet someone before the academy versus after.

Maggie also does the thing almost nobody does on a podcast: she explains how to actually find a therapist. What to ask on the free consultation. Why some of what surfaces in a directory search is paid placement. Why not every therapist works with trauma, and why you should ask that out loud before you book.

And she answers the fear underneath all of it, the one that keeps firefighters out of the chair. Not that therapy won't work. That it will, and that what it finds will take the job away.

This episode is dedicated to Chief Patrick Walsh, East Farmingdale Fire Department. A legend among legends. Gone, but never forgotten.

This episode discusses mental health, trauma, and alcohol use. If you or someone you know is struggling, call or text 988 (Suicide and Crisis Lifeline), or call the Fire/EMS Helpline at 1-888-731-3473. You are not alone.