Cancer can be caused by what we eat, drink, breathe or smoke as well as from our environments. This includes the many carcinogens found on the fireground and in our station working environment.
According to a 2013 National Institute for Occupational Safety and Health (NIOSH) study, firefighters have a 9% higher risk of being diagnosed with cancer and a 14% higher risk of dying from cancer than the general public.
Some departments are tracking even higher rates among their members. Cancer caused 67% of the Boston Fire Department’s line-of-duty deaths between 2002 and 2014. Between 2008 and 2010, 32% of Miami-Dade Fire Rescue firefighters were diagnosed with some form of cancer or received cancer treatment; of those members who died since 1952, 35% died from cancer and 10% from cardiac arrest.
Clearly, cancer has become a major problem in the fire service.
According to data from the International Association of Fire Fighters, 61% of the LODDs for career firefighters since 2002 have resulted from occupational cancer. In 2016 alone, 70% were attributed to cancer.
We know carcinogens make it past our PPE and onto our skin. In 2015, Jeffrey Stull reported the dramatic results of a fluorescent aerosol screening test (PDF). Photos illustrated how carcinogens get through our PPE, particularly the hood, and the interfaces between jacket and pants and between pants and boots. The study’s results have prompted a number of PPE design changes and revised cleaning practices, both on the fire scene and afterward.
PPE Cleaning
Kenny Fent’s recent study of on-scene gross decontamination showed that using soap, water and a brush was approximately 85% effective in removing the soot and polycyclic aromatic hydrocarbons on PPE after interior firefighting. The VOCs that were present off-gassed in around 20-30 minutes.
Since 2013, the Firefighter Cancer Support Network (FCSN) has urged departments to implement gross decon on scene to reduce firefighters’ exposures. To allay concerns about the potential for steam burns following gross decon, Palm Beach County (Florida) Fire Rescue conducted a series of training burns (YouTube). After interior firefighting, it tested gross-decon procedures and multiple reentries into the firefighting environment. Even after multiple fires and multiple decons in the same gear, no members suffered burns.
Dry decon—using a brush to remove soot and other debris while on air—is an option for crews operating in colder temperatures where wet decon may not be advisable. However, departments in Ohio, Vancouver and Ottawa have used water without any adverse effects (YouTube).
Many departments also provide cleaning wipes to begin the personal decon process immediately. Fent’s research showed cleaning wipes could reduce PAH contamination on neck skin by a median of 54%. His research also showed much higher contamination on the hands than previously thought, and some departments are considering frequent glove swap-outs.
The Jacksonville (Florida) Fire Department implemented an innovative program that rotates in fresh crews to do overhaul. At the same time, it sends its first-in crews back to the stations for showers. Jacksonville’s policy states that all PPE, including SCBA, shall be worn throughout the overhaul process. There is no discussion on this policy!
A number of fire departments have begun a one-for-one hood swap after every fire. Some still only have one set of turnout gear per firefighter, but two sets of PPE are increasingly common to facilitate getting into clean gear after every fire. One department has three sets per person.
Additionally, some departments use color-coding systems to provide a visual reference as to which set of gear is in use. In any case, all PPE must be barcoded and tracked thoroughly to prove that gear was cleaned and inspected according to NFPA standards. Departments as large as FDNY have begun implementing many of these changes (YouTube).
Note: The 2018 edition of NFPA 1500, Standard on Fire Department Occupational Safety, Health, and Wellness Program, features major changes regarding PPE and gross decon, as does the proposed 2019 edition of NFPA 1851 due out later this year.
At the Station
Next, let’s look around our stations and make some important changes. In 2018, the U.S. Fire Administration rewrote a document on the Safety and Health Considerations for the Design of Fire and Emergency Medical Services Stations (PDF).
Do you have direct-source-control exhaust systems, such as hoses connected to the truck exhaust? Are they working and being used properly? Diesel exhaust was classified as a known human carcinogen in June 2012 (PDF). Having a system but not enforcing its use does nothing!
Where do you store your PPE when it’s not being used? Is it in a separate room vented to the outside and with closed doors, or is your gear sitting right next to your apparatus and absorbing all the carcinogens from your diesel exhaust?
Where are your ice machines located? Are they being bathed with the same diesel exhaust? Just because you filter your water does not mean you filtered the carcinogens from the truck bays.
A number of departments have implemented a station design with red, yellow and green zones similar to a hazmat response:
- All contaminated or potentially contaminated gear is left in the red zone; this includes PPE, tools, trucks, etc.
- The green zone is for living and sleeping quarters. No contaminated gear is allowed within this area.
- The yellow zone is the transition zone between green and red zones, usually a hallway or airlock system, where airflow controls the direction of air to the red zone.
Miami-Dade Fire Rescue, Coral Springs-Parkland (Florida) Fire Department and others have implemented the clean-cab apparatus concept. With this design, contaminated PPE is never allowed into the cab area.
Some departments also do not allow SCBA or tools in the cab; instead, they are typically kept in an exterior compartment. This is an immediate gathering point for crew members, who are quickly briefed by the officer after reviewing the scene. Once firefighters are released from the incident, they go through gross decon. All PPE is bagged and sealed, and the crews are sent back to the stations to shower and change into their second set of PPE. Additionally, the clean-cab concept calls for two sets of flashlights: yellow ones for EMS and allowed in the cab, orange ones for fires that never go in the cab.
Making a Change
Not all of these methods are possible in every department; some of these ideas may be difficult to accept. But we must make changes to reduce the number of members being diagnosed with cancer.
There is no question that we have a cancer problem in the fire service and that we must revise some of our practices. We must do something differently or continue to lose our brother and sister firefighters—and possibly ourselves—to cancer.
If you don’t know a member with cancer, consider yourself lucky! I personally knew and worked with 115 of the 121 members of Miami-Dade Fire Rescue who have succumbed to this dreaded disease. Trust me as a cancer survivor myself: cancer is not something that you or your loved ones want. And it is certainly not a hero’s death!