We often get inquiries about how to determine if turnout clothing that had been exposed to different chemicals is still serviceable. Of course, none of these questions are identical and each situation is unique. The circumstances of exposure vary tremendously, as does the level of detail provided to describe what exactly happened to the clothing in question.
As the fire service becomes more astute to understanding the hazards associated with persistent contamination, these questions are important, and better guidance is needed for making decisions relative to the continuing safety of firefighter PPE.
Understanding and characterizing fireground exposures
The reality is that all structural fires are hazardous materials incidents because the soot and fire gases that emanate from the fire scene are certainly considered immediately dangerous to life and health (IDLH). Some of exposure substances are simply the products of combustion from the myriad building contents that decomposed, creating a variety of toxic chemicals in various forms that include gases, liquids and solid particles.
While every fire is different, there is a general expectation that most structural fires involve a range of different substances, some of which will remain on the fireground.
Concerns generally arise when there are large volumes of various chemicals or unusual products that are present, which adds to the hazards of the fire. Such circumstances will often be encountered during industrial fires and outside residential areas, with many exceptions. Undoubtedly, fire departments become concerned in these situations because there is uncertainty if the unique chemical exposures have caused undue damage to the PPE, or if advanced cleaning will not remove the specific substances believed to be present.
When there appears to be an unusual aspect to a structural fire, fire personnel need to determine whether circumstances apply that may warrant specialized cleaning or a larger discussion related to the continued serviceability of the PPE.
Firefighter PPE contamination types
Different types of contamination generally fall into four categories:
- Bulk chemicals
- Asbestos and other designated hazardous substances
- Body fluids and other microbial contamination
- Products of combustion
Exposure to chemicals can occur at any emergency scene, particularly where various types of oils, greases and lubricants are used. Many residential structural ﬁres include a variety of cleaning agents and other products contained in garages, kitchens and other portions of a house where direct liquid exposure to the chemical in its bulk form can occur. Structural ﬁres at commercial facilities, particularly those involved in manufacturing, can likewise include a variety of chemical substances in containers that break open and result in exposure to ﬁreﬁghters in gas/vapor, liquid or solid form.
Depending on the nature of the speciﬁc chemical and its respective hazards, contamination of the ensemble and ensemble elements can occur and remain as persistent contamination that advanced cleaning procedures may or may not be able to remove. Specialized cleaning is often recommended for bulk chemical contamination and could require inquiries to the chemical supplier as well as the manufacturer of the respective protective ensemble or ensemble elements.
Depending on the hazards associated with the speciﬁc chemicals, usually identified on a Safety Data Sheet (SDS) for the chemical, the extent of contamination, or the lack of available decontamination procedures, organizations might conclude that the risk for reuse of the ensemble or ensemble elements outweighs any beneﬁts of retaining the clothing even if it appears to be clean and free of contamination. Generally, this takes judgment from a knowledgeable person to determine continuing risks for use of gear contaminated, and may require some testing of the gear to provide full confidence that no residual hazardous chemical still is present in the gear, a topic we’ll discuss in Part 2 of this article.
Asbestos and other designated hazardous substances
Certain types of common contaminants [e.g., asbestos, opioid drugs (fentanyl)] and parasites (e.g., bed bugs) can require specialized cleaning or treatments for their removal from ensembles and ensemble elements. These substances are called out separately from bulk chemical exposures because there is some industry history and experience for addressing ensembles and ensemble elements contaminated with them.
In particular, asbestos warrants special attention because of the direct link between asbestos exposure and mesothelioma, and the elevated risk to ﬁreﬁghters. Decontamination of ensembles and ensemble elements that have been exposed to fentanyl powders requires use of certain procedures that prevent exposure to ﬁreﬁghters and others handling the element. Conventional washing of protective ensembles and ensemble elements that have been exposed to bed bugs will fail to kill all eggs that remain in the clothing.
Ensemble and ensemble element exposure to these substances requires special consideration and often entails specialized cleaning procedures or treatments for their removal. As with bulk chemicals, the ability to effectively remove the contamination can be uncertain and, therefore, in some cases, disposal of the gear may be warranted.
Body fluids and other microbial contamination
Body ﬂuids, such as blood, vomit and various secretions, are often encountered in providing emergency patient care or rescue of victims at an emergency scene. These ﬂuids must be treated as potentially infectious; therefore, ensembles and ensemble elements contaminated with body ﬂuids must be subject to sanitization or disinfection, where disinfection represents a greater efﬁciency in removing potentially infectious microorganisms.
Other biological contaminants can include methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difﬁcile (C. difﬁcile) from medical victim contact and Escherichia coli (E. coli) from ﬂood water contact. These contaminants require disinfection or sanitization of ensembles and ensemble elements to reduce the microbial threat where exposure has occurred.
Disinfection or sanitization might precede advanced cleaning or be part of the advanced cleaning process since soils associated with many body ﬂuids must also be removed. It is important to recognize that disinfection or sanitization generally only affects the viability of the microbial contamination and might not remove other associated soils, such as dried blood, body ﬂuids or other liquids/solids in which the microbial contamination is found.
Products of combustion
Generally, all ﬁres where entry is made while wearing self-contained breathing apparatus (SCBA) will expose ensembles and ensemble elements to products of combustion. The smoke particles and ﬁre gases easily penetrate and contaminate clothing. Depending on the length of exposure and degree to which ﬁreﬁghters are exposed, the levels of contamination from products of combustion will vary, but will always require advanced cleaning.
Preliminary exposure reduction (PER) or gross decontamination should be undertaken to remove some forms of surface contamination as well as to minimize the transfer of exterior contaminants to the ﬁre ﬁghter or other surfaces, such as apparatus seats and ﬁre station work/living areas prior to advanced cleaning. However, PER is not cleaning, and additional steps are needed full clean the clothing.
It is important to note that ordinary fires are just as capable as producing some forms of unusual and, in particular, persistent contamination, which can create problems with the clothing or other PPE items. Even in a residential fire, certain substances can be encountered that pose continuing hazards. If suspected, then a detailed assessment of the clothing is warranted, and specialized cleaning may be needed.
Characterizing the exposure is clearly an important first step. If it is possible to identify certain substances for concern, then better decisions can be made to decide how to handle the PPE and the extent of the overall problem. It is also important at this stage to recognize when help is needed. If you seek assistance from others, then it important to have enough information to allow assessments to be made.
Knowledgeable individuals will want to know the answers to the following questions:
- What specific substances were you exposed to, to the level of detail that you can provide?
- How were you exposed; were these substances on fire, did you simply operate in an area where there were broken containers, were you splashed or did chemical mix with the hose runoff?
- Where on your gear were you exposed – all over or just certain portions?
- How long were you exposed on the fireground in contact with the substance(s)?
- Did you note any effects on your gear during or after the exposure?
- Did you feel any effects on your skin or other potential health problems as a result of the exposure?
- Was your gear rinsed or subject to preliminary exposure reduction at the scene? Was it washed afterwards?
- What is the current disposition of the PPE? Where and how is it being stored?
- Who within the department is a good individual to follow up on for these questions?
These are just some basic questions; these may lead to other questions.
In the next installment, we’ll go into more detail for how to best answer the questions as well as take further actions.
The views of the author do not necessarily reflect those of the sponsor.