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The risk of cancer is significantly higher among emergency medical services (EMS) clinicians and firefighters compared with the general population. 1–3 This increased risk is attributed in part to environmental exposure and hazardous situations they encounter in their line of work.1 2 Despite longstanding policies to identify and mitigate many occupational risks, one critical area remains underexplored: clinician risk based on personal behaviour, specifically smoking cigarettes (tobacco). Smoking not only compounds long-term cancer risk but also reduces the functional lung capacity clinicians need to perform duties effectively.3 4 To address this gap, we aimed to understand EMS clinician smoking prevalence and evaluate associations between workplace smoking policies and on-the-job smoking behaviour.