The purpose of this study was to evaluate user perceptions of firefighter personal protective equipment (PPE) to determine ways to improve PPE design and function for both male and female firefighters. No previous studies have included both male and female firefighters in identifying user needs. It is critical to consider the entire PPE that a firefighter wears in his or her work environments, due to the various items worn simultaneously, to ensure a system that is fully functional and minimizes impact on wearer work performance and comfort. A total of 12 focus group interviews were conducted of career and volunteer firefighters, utilizing 67 males and 22 females. Urban and rural companies were represented from five different states. To obtain more in-depth data than the focus group interviews allowed, three firefighters participated in individual follow-up interviews. All interviews were recorded, transcribed, and analyzed using thematic analysis methods to draw comparisons of perceptions and user needs shared by both male and female firefighters. Both male and female firefighters identified a number of similar concerns such as excessive weight of the PPE, heat stress, overprotection for non-fire calls, garment fit and restricted mobility, compression burns, and problems donning the PPE quickly. They also indicated concern about specific firefighter clothing features that did not function well for them, including pockets, fasteners, knee and suspender padding, as well as the durability of the materials used in the PPE. Further study is needed to determine optimum design changes that can improve firefighter PPE to maximize wearer protection, performance, and comfort.