"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.

"I work in a business where I see line of duty death reports all the time. I'm like, I don't want you to die."

Nicole Prorock keeps the books for the National Fallen Firefighters Foundation and the First Responder Center for Excellence. She is also a volunteer firefighter, EMT, and station officer with the New Market District Volunteer Fire Company in Frederick County, Maryland. The person who accounts for America's fallen firefighters spends her nights riding the ambulance, and she has one goal: fewer names to count.

Greg and Amy sit down with Nicole at the FRCE Mental Health and Wellness Symposium in Iowa to talk about the losses that hit closest to home, including suicides at her own fire station, and why you can never tell from the outside what someone is carrying on the inside. Nicole shares her path from CPA to firefighter, the brother she lost to leukemia at 21, and the promise she is keeping on her fiftieth birthday: racing the Ironman World Championships in Kona as a fundraiser in his memory.

She also explains the volunteer fire service most of the public never sees: the unpaid overnight crews, the fundraising for gear and apparatus, and what it takes to keep a suburban community covered when the career staff goes home at six.

And she says the most radical thing anyone has said on this show: that she wants FRCE's prevention work to put the Fallen Firefighters Foundation out of business.

SUPPORT NICOLE'S IRONMAN FUNDRAISER https://ironmanfoundation.donordrive.com/participants/4273

This episode is dedicated to Battalion Chief Joshua D. Laird, Frederick County Division of Fire and Rescue Services, who died in the line of duty on August 11, 2021. "Just do the right thing."

This episode discusses suicide and mental health. 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.

LINKS National Fallen Firefighters Foundation: https://www.firehero.org First Responder Center for Excellence: https://firstrespondercenter.org Battalion Chief Joshua D. Laird memorial: https://www.firehero.org/fallen-firefighter/joshua-d-laird/

Unseen Exposures is presented by SPOKE, a documentary about occupational cancer in the fire service. Learn more at https://www.spokemovie.com

Follow the show, and if this episode moved you, a rating and review helps more firefighters find it.

The number one killer of firefighters isn't fire. It's their own hearts.

Kepra Jack was an ER nurse and pre-hospital coordinator, married to a firefighter, when a 44-year-old friend didn't wake up for shift change. That question, why are healthy people having cardiac events, became 15 years of first responder medicine: a primary care practice built for police, fire, EMS, dispatch, military, and their families, annual medicals for departments of every size, and national work with the IAFF, IAFC, and NFPA.

Kepra owns HeartFit For Duty and is a founding member and vice president of Science to the Station, the nonprofit connecting fire service researchers with the firefighters their work is meant to protect. In this conversation: the 2022 decision that classified firefighting itself as a carcinogen, why 83 percent of fire service research has happened in the last two decades, the bro science problem at the kitchen table, what families never get taught about supporting their firefighter, NerdStock (the fire service science conference that ends with a circus), and the three things anyone can start today: real food, a primary care doctor, and actual sleep.

Her closing challenge: establish with a mental health provider before you need one. And it is never too late to change your risk factors.

Resources: science2station.org, and reach Kepra at kepra@heartfitforduty.org

This episode is brought to you by SPOKE, our Founding Premier Sponsor and Film Partner. Watch the trailer at spokemovie.com

Dena Ali was a police officer for five years before an episode of Rescue Me showed her that women could be firefighters. Eighteen years later, she's a Battalion Chief with the Raleigh Fire Department, founder of North Carolina's statewide peer support team, Program Manager of Behavioral Health for the First Responder Center for Excellence, and author of Hope Out of Darkness: A Guide to First Responder Mental Wellness.

Recorded live at the FRCE Health and Wellness Symposium at the University of Iowa, this conversation covers the ideas at the center of her book: hope as a cognitive skill built through struggle, the surprising research on play and humor, psychological safety as the freedom to fail (with lessons the fire service can steal from NASA after Columbia), and the practical mechanics of peer support, from the kitchen table conversation after a bad call to asking someone directly whether they're thinking about suicide.

Her hardest-won stance: first responders are not victims. They carry more protective factors than most people, and the solutions in her book are human solutions, not just fire service ones.

Content note: this episode includes frank discussion of suicide. If you or someone you know is struggling, call or text 988 (US) any time.

Get the book: Hope Out of Darkness at fireengineeringbooks.com or Amazon.

First Responder Center for Excellence: firstrespondercenter.org

This episode is brought to you by SPOKE, our Founding Premier Sponsor and Film Partner. Watch the trailer at spokemovie.com

IN MEMORY OF
SENIOR FIREFIGHTER JOSH LULL
RALEIGH FIRE DEPARTMENT · RESCUE 16 · C-SHIFT
END OF WATCH APRIL 19, 2026

Firefighters are exposed to death on a scale the public never sees.

Victor Stagnaro has spent his career making sure the fire service never forgets its own, and fighting to shrink the list of names read each year.

Victor is the CEO of the National Fallen Firefighters Foundation and leads its affiliate, the First Responder Center for Excellence. Before that: 25 years with the Prince George's County Fire/EMS Department, and a relationship with the Foundation dating back to the late 1990s as incident commander for the National Fallen Firefighters Memorial Weekend.

Recorded live at the FRCE Health and Wellness Symposium at the University of Iowa, this conversation goes to the places the fire service is only now learning to talk about: cancer and suicide now recognized as line-of-duty deaths, and why the number of names honored each year is growing. The scholarships and children's grief camp that carry Fire Hero families forward. The culture conversation about risk and the cowboy mindset. What daily exposure to death does to firefighters and the people who love them. And what actually works when a department decides to build peer support, told through the story of Charleston and the FDNY.

His challenge to every firefighter at the symposium: don't just come to learn. Decide what you're going to do with it.

Support the mission:

National Fallen Firefighters Foundation: firehero.org

First Responder Center for Excellence: firstrespondercenter.org

This episode is brought to you by SPOKE, our Founding Premier Sponsor and Film Partner. Watch the trailer at spokemovie.com

"The bottom line is I care because I'm tired of losing my friends."

Chief Frank Leeb spent more than three decades in the FDNY, rising to Deputy Assistant Chief and serving as Chief of the Fire Academy, Chief of Training, and Chief of Safety before retiring in 2024. He has been a volunteer firefighter with the East Farmingdale Fire Department on Long Island since 1983. Today he leads the First Responder Center for Excellence, and he has one message for the fire service: if leadership is not protecting its people from what they cannot see coming, leadership is not doing its job.

Greg and Amy sit down with Chief Leeb at FRCE 2026 in Iowa to talk about the toll nobody puts on a recruiting poster: friends lost to suicide, careers hollowed out by PTSD, and cancer moving through firehouses in numbers the fire service is only beginning to confront. They discuss the World Health Organization's reclassification of firefighting as a Group 1 carcinogen, why the dangers of this job do not discriminate between career and volunteer, and what it actually means for a chief to protect a firefighter's blind side.

Chief Leeb is the author of the best-selling book Cornerstones of Leadership: On and Off the Fireground and co-author of 30 Fires You Must Know.

This episode discusses suicide and mental health. 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.

GUEST LINKS

Cornerstones of Leadership (book): https://fireengineeringbooks.com/frank-leeb/

First Responder Center for Excellence: https://www.firstrespondercenter.org

RESOURCES MENTIONED

IARC classification of firefighting as Group 1 carcinogen (WHO, 2022): https://www.iarc.who.int

Firefighter Cancer Support Network: https://firefightercancersupport.org

Unseen Exposures is presented by SPOKE, a documentary about occupational cancer in the fire service. Learn more at https://www.spokemovie.com

Follow the show, and if this episode moved you, a rating and review helps more firefighters and families find it.

Music: White Mountains by Zambolino

Source: https://freetouse.com/music

Royalty Free Music (Free Download)