By Karen Kucher
The San Diego Tribune
SAN DIEGO — Long before he became San Diego's fire chief, Brian Fennessy would wear his crusty, soot-covered helmet like a badge, proof he worked at one of the city's busiest fire stations. He thought it gave him credibility and earned him the respect of peers.
Now he knows his dirty gear harbored the toxins and carcinogens that haunt the scene of a fire — and that they might well revisit him in the future as cancer.
"I figure that's what's going to get me," said Fennessy, who has been a firefighter since 1978. "When I worked for the Forest Service, man, we sprayed fuel breaks with chemicals that aren't even allowed anymore. We inhaled that stuff; we were exposed to all kinds of bad stuff.
"I figure it is just a matter of time before I'm diagnosed."
At many fire departments around the country, chiefs like Fennessy are working to change the culture of the fire service, encouraging firefighters to take steps to better protect themselves from dangerous fumes, smoke and soot.
Cancer is the leading cause of firefighter line-of-duty deaths in the U.S., according to the International Association of Fire Fighters. In the past five years, more than 60 percent of the names added to the Fallen Fire Fighter Memorial Wall in Colorado were cancer-related deaths, the organization says. The wall lists the names of more than 7,600 fallen firefighters.
Several studies looking at the association between firefighting and cancer have found higher rates of some types of cancers in firefighters compared with the general population, including cancers involving the respiratory, digestive and urinary systems.
The largest cancer study of U.S. firefighters to date, done by the National Institute for Occupational Safety and Health, looked at the health records of 30,000 firefighters in three U.S. cities between 1950 and 2009. It found those firefighters had a modest increase in cancer diagnoses (a 9 percent increase) and cancer-related deaths (a 14 percent increase) compared with the general population.
Such research — along with repeatedly hearing of colleagues in the fire service being diagnosed with cancer –he called it a "drumbeat" of calls — prompted Fennessy to green-light his department's cancer-prevention program just a few months after he was appointed San Diego's chief in 2015.
In the 18 months since the effort began, program manager Kurtis Bennett said about a dozen employees have been diagnosed with cancer.
Fire officials say they want to see a "paradigm shift," where firefighters will speak up if a colleague shows up wearing dirty gear.
"It's not going to be the roof caving in on you, or falling off the ladder — that's not going to be what kills you," Fennessy said. "It is going to be cancer."
Concerns about health risks aren't new
Firefighters have long worried about how their jobs were affecting their health, although much of the early focus was on lung cancer and other respiratory ailments caused by breathing in smoke.
The dangers of soot were known way back in 1775 when it was linked to the first case of occupational cancer. A doctor noticed chimney sweeps in Britain were being stricken by a particular form of the disease.
In 1982, California became the first state in the country to adopt a presumptive law that makes it easier for firefighters to prove that their cancer is work-related, giving them access to workers' compensation and survivor benefits for their families.
That law was prompted by the deaths in 1973 of two Whittier firefighters who responded to a hazmat incident and died of a rare form of cancer within weeks of each other six years later, said Carroll Wills of the California Professional Firefighters union.
Cancer awareness has become a priority for many firefighting agencies, addressed at professional conferences and by industry groups. A bill has twice been introduced in Congress that would create a voluntary national firefighter cancer registry, which officials say would track those diagnosed with the disease and assist future research efforts.
In 2013, the nonprofit Firefighter Cancer Support Network published an industry white paper, calling firefighter cancer "a looming personal catastrophe for each and every firefighter." The group, which provides mentoring and assistance to firefighters who are diagnosed, declared cancer the most dangerous and unrecognized threat to the health and safety of the country's firefighters.
The group offered tips to minimize exposure to cancer-causing substances; all of the suggestions were incorporated in San Diego's cancer awareness and prevention program.
San Diego's training kicks off with an emotional 8 1/2 -minute video that shares the stories of a dozen firefighters who have been diagnosed and treated for cancer. Bennett, who has trained all 900 of the department's firefighters, said the room always gets quiet after the group watches the video.
In his sessions, Bennett warns firefighters that they can be exposed to a lifetime of toxins in a very compressed period of time, inhaling them or absorbing them into their skin.
"The key to reducing the incidence of cancer is changing our culture and changing what a professional firefighter looks like," Bennett said. "For years, we esteemed the 'smoke-eater' look of soot-covered faces. That was, to some degree, killing us."
San Diego's fire stations are gradually being equipped with commercial-grade washing machines that can better clean dirty turnouts; they long have had equipment that vents diesel exhaust from firetrucks out of the buildings. Special wipes kept on engines allow firefighters in the field to clean their heads, necks, throats, underarms and hands before they get back to the station to shower.
Firefighters are issued two sets of protective pants and jackets so they always have access to clean ones. They are supposed to take off dirty gear as soon as possible and keep it away from where they sleep and out of personal vehicles.
Everyone has two protective hoods and captains carry spares so firefighters can change them out when they get wet or dirty.
Some departments are pursuing other methods in their quest to protect firefighters.
The Carlsbad Fire Department is outfitting four of its six stations with dry saunas and bicycles, known as chemical detox saunas. It is the second agency in California to purchase the units, said Mary Murphy, who manages emergency medical services for the department.
After a fire, Carlsbad's firefighters will take a shower and then ride the bikes until they work up a good sweat. The idea is they'll sweat heavy metals and other toxins out of their skin.
One firefighter who put a towel under the bike when he rode it after a fire told Murphy: "Whatever it was that came out of me was black and it was on the towel."
Veteran firefighter Todd Bechtel, a captain in the Ocean Beach station, said he's seeing younger colleagues embracing the safety recommendations as they go about their days. After a recent fire, everyone in his station grabbed clean turnouts before the next call.
"It's a great program," he said. "I believe in it. I follow it."
Bechtel, a firefighter for 26 years, was diagnosed with prostate cancer a few years ago after a routine checkup. He underwent surgery and radiation, but recently learned his cancer has returned.
Like others, he would sleep with his pants next to his bunk, take off his mask as soon as flames were knocked down and wear his flash hood over and over without washing it. He wonders if the interrupted sleep cycles typical in a busy station and other stresses also played a role.
"When the question is asked of me, do I think it was work related, with all the stuff put in front of me, I can't see how it wasn't work related," he said. "But you never know."
Despite his concerns, for his part Fennessy said he wouldn't discourage any of his three children if they wanted to become firefighters. But, he said, he would want them to be careful about which department they chose to work for.
"Shame on the departments that aren't paying attention to what's going on in our business, in our profession right now," he said. "I'd want my kids to be part of an organization that made taking care of their firefighters a priority."
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