By Samantha Liss
St. Louis Post-Dispatch
ST. LOUIS — There's an understanding among firefighters that dirty gear is a measure of toughness. The char from past fires is a way to garner respect and serves as a badge of honor.
But that badge, that dirty turnout gear, is now an ominous reminder of the perils of the job. And in an abrupt change of culture, the blackened gear is now considered an enemy.
Multiple studies show firefighters are at an increased risk for some cancers and cancer-related deaths due to the carcinogens they face when battling fires.
There's also a correlation between time spent at fires and an increased rate of lung cancers and related deaths. And the chance of leukemia increased with the number of fire runs, according to a series of studies that analyzed the health records of nearly 30,000 firefighters in three major metropolitan areas over a 60-year period.
In the last year, the St. Louis Fire Department has lost four of its members to aggressive forms of cancer, according to Fire Chief Dennis Jenkerson. These deaths prompted the department to take a close look at the literature around firefighters and cancers.
As a result, the St. Louis department and others across the country have made changes to procedures in an attempt to reduce the risk of cancer.
"Until the fire department changes the culture of how we act after a fire has been put out, we weren't going to affect this, I thought, at a very dramatic rate," Jenkerson said. "That's why it was important to start the process within ourselves."
Some of the changes come with a significant cost.
One of the biggest changes is the need to decontaminate the gear and trucks after a fire.
After leaving a fire, firefighters will be doused with water while in their gear to rid them of the particles that can cause cancer.
The time after a fire wasn't given much thought until recently.
"We were coming out with these carcinogens stuck to us. So we come outside of a fire and naturally guys are hot, they need a drink. They were taking a drink of water, a drink of Gatorade, whatever it might be, and rinsing it right down into their gut," Jenkerson said.
Now firefighters are supposed to use wipes on their hands, face and neck.
Because of the need to wash off the gear, all firefighters are supposed to have two sets of gear. The cost for a new set for each firefighter is about $1,500. So far, only a third of the more than 600 firefighters have a second set of gear.
A second set is needed in case they need to go immediately to another fire after cleaning the original set.
Another important component of battling risk is seeking preventive care, the chief said.
When firefighters go to their annual checkup, they're supposed to bring a note that explains the elevated risks they face when it comes to certain cancers.
The note asks that the firefighters receive certain screenings at earlier ages. For example, the department is asking health care providers to perform colonoscopies at age 40, a full 10 years before the recommended age.
The biggest hurdle, Jenkerson said, is changing the culture, but he's seen it happen before, albeit a bit slowly.
Nearly three decades ago when air masks were introduced, firefighters didn't want to wear them.
"I was part of that initial culture: 'We're tough firefighters, we don't need this,'" Jenkerson said.
Now, every firefighter wears a mask.
Stanley Newsome, who retired after 38 years, remembers the introduction of air masks, too.
"It was the mentality of who is the toughest, I think," Newsome said. "A lot of guys didn't want to wear them. Macho man, I guess that was what you would say."
Newsome, who has been retired now for 17 years, said when he was done fighting a fire it was commonplace to smoke a cigarette, drink out of the fire hose and have some food that was brought by volunteers.
"We were not informed of the hazards of those things," Newsome said. "It was a different time."
In one of the studies that analyzed nearly 30,000 firefighters from a 60-year period, researchers found increases in the rates of certain types of cancers and cancer-related deaths compared to the general population.
For example, there were higher rates of diagnoses for cancers associated with the stomach and intestines, lungs, prostate, bladder and mouth. There were twice as many firefighters with malignant mesothelioma, a cancer caused by asbestos, which used to be common in building materials.
These findings should change the way firefighters do their job in some instances, one of the studies' authors told the Post-Dispatch.
"My personal opinion is that you need to wear your (air mask) at the first phase of fire suppression through overhaul, which is when a lot of departments have policies to take off your gear," said Dr. Thomas Hales, an epidemiologist with the National Institute for Occupational Safety and Health. Overhaul is when firefighters inspect a building and pull down walls and other material to make sure there are no lingering flames.
"I understand why they want to take it off, but there are still carcinogens in that smoldering fire, and that's when they get most of their exposure," Hales said.
He noted the overhaul typically lasts longer than bringing the fire under control.
He wants firefighters to know there are things they can do at work and outside of work to lower their risk of cancer.
"They certainly shouldn't feel that it's inevitable that they're going to get cancer," Hales said. "You have to put the risk in perspective."
Knowing they're at a higher risk for cancer due to their job, it's even more important that they eliminate other risk factors by eating healthy, maintaining a healthy weight and avoiding tobacco products.
He said if they're still smoking cigarettes or using tobacco, "they're missing the boat."
"Smoking a cigarette is like going in a burning building to fight a fire without a mask 20 times a day."
"I don't mean to downplay the issue of firefighters and cancer, there is an association but to feel doomed is not accurate."