By Dr. Bill Jenaway
When emergency responders sign up to assist local fire and rescue services, often the last thing on their mind is the fact that they could be injured, contract a chronic illness, miss time at work or even be killed. Despite what volunteers may initially think, this is a very real possibility of illness or injury while firefighting.
Chief officers of emergency service organizations have to be aware of exposures, controls and protection methods necessary to keep responders as safe as possible and ensure that they are able to respond at the top of their game. When it comes to the risk of cancer, however, many chief officers do not have training or a deep level of understanding. Despite this fact, firefighter cancer has come to be viewed as more impactful than any other safety issue fire service personnel face.
The hazard of cancer to firefighters
Firefighter cancer is a looming potential catastrophe for each and every firefighter – volunteer or paid – and their organization. Cancer is considered to be the most dangerous and unrecognized threat to the health and safety of our nation’s firefighters.
Multiple studies conducted by hospitals, institutions of higher learning, fire service agencies and NIOSH have repeatedly demonstrated evidence and biological plausibility indicating statistically higher occurrence rates of multiple types of cancers among firefighters than compared to the general U.S. population, including:
- Testicular cancer
- Multiple myeloma
- Non-Hodgkin’s lymphoma
- Skin cancer
- Prostate cancer
- Malignant melanoma
- Brain cancer
- Colon cancer
- Breast cancer
Controlling firefighter cancer risks
Risk control techniques widely utilized today include: risk avoidance, loss prevention, loss reduction, segregation of exposure and risk transfer.
In the case of exposure to carcinogens, much of the general risk control practice centers upon attempting to avoid the risk altogether. Unfortunately, an emergency responder is instead “rushing into the exposure area while others rush out.” Therefore, pre-planning to avoid potential exposure as much as possible involves understanding critical information before entering a hostile environment ripe with cancer causing agents.
Once you enter a hot zone, the ability to avoid exposure to the carcinogen is minimized. Therefore, risk avoidance is nearly impossible for fire service personnel.
If it is necessary for personnel to enter a hot zone, then educating those personnel to recognize hazards becomes critical. These firefighters must also use all levels of personal protective equipment to protect them from any form of absorption, adsorption, inhalation or ingestion. Available entry route options must be considered and also protected to reduce the probability of any additional exposure to carcinogens.
Preventing exposure to potential carcinogens starts with understanding your own body. A physical exam to assure you are cancer free when starting the job is important to establishing your personal baseline of health and monitor changes as you age and are exposed to various risks during your fire and EMS career.
Physicals also assist with early detection of cancer and facilitate action to manage the cancer. In addition, in states with cancer presumption legislation, proving that you were cancer free at one point in your career is an important component of attesting cancer was contracted on the job. The same is true for documenting incident reports where any exposure to carcinogens may have occurred.
Education is the next step, so that you can understand the types of cancers that can be contracted, what types of exposures may result in these cancers occurring, and what methods can be provided in order to prevent or limit exposure. The Firefighter Cancer Support Network has developed a list of 11 immediate actions to protect yourself from cancer.
WHAT IMMEDIATE ACTIONS CAN I TAKE TO PROTECT MYSELF?
1. Use SCBA from initial attack to finish of overhaul. (Not wearing SCBA in both active and post fire environments are the most dangerous voluntary activity in the fire service today.)
2. Complete gross field decon of PPE to remove as much soot and particulates as possible.
3. Use Wet-Naps or baby wipes to remove as much soot as possible from your head, neck, jaw, throat, underarms and hands immediately and while still on the scene.
4. Change your clothes and wash them immediately after a fire.
5. Shower thoroughly after a fire.
6. Clean your PPE, gloves, hood and helmet immediately after a fire.
7. Do not take contaminated clothes or PPE home or store them in your vehicle.
8. Decon fire apparatus interior after fires.
9. Keep bunker gear out of living and sleeping quarters.
10. Refrain from using tobacco products.
11. Use sunscreen or sunblock.
Protecting yourself with personal protective equipment is a key form of loss reduction. While the equipment in and of itself will not eliminate the exposure, knowing why it is used and then actively using it will help you from being exposed to a higher level of contaminants and related carcinogens. Protective equipment will NOT eliminate exposure and follow-up activities such as washing your hands and face, as well as cleaning all gear and equipment thoroughly after each incident will additionally help protect you from exposure.
In other workplaces and environments, isolating an area of hazard or separating the risk into smaller amounts, known as segregating exposure may be beneficial to limiting risk, but this is extremely difficult when you have to enter any hostile environment where risk is present. Therefore, prevention, education and protection features play a dominant role in protecting yourself.
Also, while it may be feasible to transfer risk in some workplaces, that alternative is limited in the fire and EMS community. While hazardous materials teams may be a method to transfer operations to and thus transfer exposure, firefighting, vehicle-related incidents and even exposure to vehicle exhaust in the station are unavoidable and necessitate an approach to prevention, education and protection of personnel.
One available method of transferring risk, however, concerns financial risk as various insurance programs are now available to provide financial benefits for “critical illness” or “cancers.” These programs vary in their benefit offerings and costs and require consult with appropriate insurance professionals to determine eligibility, value and cost.
Finally, when someone is told that they have cancer, many thoughts go through their mind, including: how do I tell my family, my friends and my boss? Even before they begin treatment, protocols or recommended medical procedures, they will need to inform a few people about what is occurring. Some will feel an urgent need to communicate while others will want to wait. In either scenario, it is important that people affected tell others when they are ready.
In the fire service industry, we not only must be ready to be told that someone has cancer, but we must know how to respond to and support those who contract the disease. Responding well to this situation can help everyone to better cope.
Taking it home
Talking with your physician or visiting The American Cancer Society and The Firefighter Cancer Support Network can provide assistance for firefighters and their families who are coping with cancer from diagnosis and treatment to recovery. Peer-support members can also play a critical role in helping those dealing with cancer to work through the process. Remember: understanding how to respond when someone advises you they have cancer helps everyone cope with the situation.
We are just beginning to understand the horrific magnitude of this problem, the depth of our naiveté surrounding it, the challenges involved and the changes required in education, training, operations, medical screenings and personal accountability to more effectively address cancer in fire service.
The Firefighter Cancer Support Network has been extremely proactive in developing prevention programs, communication tools and response efforts. Contact them for additional details.
VFIS Newsletter (2016). Talking about and responding to firefighter cancer
VFIS Newsletter (2014). What is the firefighter cancer problem? Retrieved from
Firefighter Cancer Support Network resources
About the author
William F. Jenaway, Ph.D., CFPS, CSP, CFO, CTO is Vice President of Education, Training and Consulting for VFIS, the country’s leading insurer of fire and EMS agencies. A 40-plus year veteran with over 30 years as a Chief Officer in the fire/EMS service, he has worked his entire career in managing risk for clients and his fire department. Bill is also an adjunct professor in the Public Safety program in the Graduate School of St. Joseph’s University in Philadelphia.