Nutritional epidemiology is faced with the challenge of estimating overall diet quality and adherence, along with how this relates to health outcomes. Several dietary assessment tools exist for the Mediterranean dietary pattern. Additionally, we recently validated a clinical study Mediterranean Diet Scoring System (MDSS). Firefighters are a population that faces additional challenges. The leading cause of mortality in firefighters remains cardiovascular, so improving diet is important. Our prior studies have found that blood pressure (BP) surges that firefighters experience are dependent on call type and occupational activity and that firefighters are interested in learning healthy dietary patterns. The purpose of this pilot study was to compare the PREDIMED study screener, MEDI-Lifestyle score, and MDSS. A secondary purpose was to examine relationships between these scores with health outcomes. 15 firefighters (36.3±9.5 yrs) completed surveys, a health history, and a 6-week Mediterranean diet and tactical training intervention. Physiological testing included BP, BMI, ambulatory BP monitoring during a 12-hr work-shift, and fitness testing. Each firefighter was assigned a wellness coach who provided weekly dietary training, answered questions, and tracked diet and exercise progress throughout. Data was self-reported by firefighters through a clinical study website. Firefighters had elevated BP (128.7±9.4 /77.6±7.0 mmHg), overweight BMI classification (29.9±3.2 m/kg 2 ), and low fitness (VO 2 30.1±4.4 ml/kg-min). Firefighters scored low on all scales with MEDI-Lifestyle score of 2.9±1.0 out of 7, a PREDIMED score of 6.3±2.3 out of 14, and overall MDSS of 67.1±16.8 out of 102 possible points. We found direct relationships between the screening tools, but sample size is too small to establish significance. MEDI-Lifestyle (r = -0.44) and MDSS (r = -0.6) were inversely related to depression scores (p<.05). MDSS was inversely related to SBP surge with fire-calls (r = -0.6, p<.05). During the work-shift, firefighters experienced BP levels in the hypertensive range (145.5±14.1 /87.8±15.8 mmHg) and extreme BP surges when alarms sounded (21.6±11.8 /15.2±12.8 mmHg). Firefighters with higher DBP had higher overall ambulatory BP levels (r = 0.7, p<.01), higher BP surges (r=0.6, p<.05), and higher overall occupational BP levels (r = 0.7, p<.01). It seems that multiple screening tools are effective at assessing a Mediterranean dietary pattern. Further research is needed to examine dietary adoption and related health outcomes in firefighters. A full study is needed to better understand the relationship between different Mediterranean diet screeners. Furthermore, it needs to be investigated where the relationship lies with DBP and overall cardiac health in firefighters. Subclinical diastolic dysfunction may exist and if undiagnosed, it could lead to cardiac incidents.