There has been some buzz in the fire service recently that some of the chemicals used in the manufacturing of the materials that are part our protective bunker gear may cause cancer. So I thought I would share my perspective on this issue, along with some facts, to help clear up the confusion.
The problematic dirty gear badge of honor
To be clear, the highest scientific or technical qualifications I have related to bunker gear is that I have worn it since 1973, at which time it consisted of a leather helmet, orange gloves, rubber pull-up boots (that we only pulled up to keep our jeans or work pants dry) and a “duck” (canvas-like material) fire coat. For air, when needed, we used a 10-minute officer’s SCBA or a 20-minute “regular” SCBA. And “when needed” meant, "Uhhh, umm, choke-cough-puke; OK, I can't breathe, time to mask up.”
When the fire was out and companies went home, cleaning our gear was the last thing we thought of. The hose? ABSOLUTELY! That damn hose better be clean, the bosses would tell us, but us? Our gear? Nah. Actually, back then our department helmets were painted yellow, but my company took great pride in the fact that most of ours were black due to the soot.
I'll never forget the day in early-1978 when we all showed up at the firehouse and the fire district superintendent had directed a maintenance staffer go to each of our five firehouses to wash our gear. Helmets, too. To keep us healthy. What?
Our helmets had been touched! They were cleaned and repainted! THIS. WAS. WAR!
Back then, we never gave much thought to what we were breathing – or wearing. We went to fires and did our job. The dirtier we were, the better it was.
We didn’t know what we didn’t know.
We didn’t make the connection then, but we know better now
My first thought about firefighter occupational cancer was long after some dear friends and brothers died from it. Wonderful friends with whom I went to many fires, like Louie Scida, Lee Strickland and many, many more, were getting cancer, but we never made the connection.
Cigarette smoking? Absolutely. But firefighting? We never really connected it, but also accepted the fact that it was part of doing the job. You breathed smoke. After all, we were called “smoke-eaters.” Gulp.
Fortunately, due to fact-based science and validated unbiased research, we now know that what we respond to can cause cancer. We also know that the vehicle exhaust in our firehouses and at scenes is dangerous. On the other hand, I also knew that we, as firefighters, were not doing all we could to minimize our exposure to the bad stuff.
We still have that problem and because of that, we make ourselves an easy target for those who still argue against the science.
How did I know? I’ve seen it myself. I’ve seen the videos, the news, etc. We still fail to wear our masks, hoods and the other things the experts tell us we need to wear. For example, I was recently sent a video and photos of a suburban New York firefighter working at a dwelling fire, on the roof, in street pants, shoes, a bunker coat and helmet. That's the problem. And quite honestly, until we take personal ownership, where officers act like officers and chiefs act like chiefs with a zero-tolerance policy toward undisciplined fireground operations, we won't minimize this problem. And we will keep feeding those who fight against us. And we will keep rotting away from cancer.
The PFAS/PFOA connection – and concerns
One of the ways this issue has surfaced recently connects to concerns that have been voiced about possible hazards of trace amounts of PFAS chemicals in firefighting turnout gear.
So, what is PFAS? I will try to keep this as simple as possible.
As was explained by FireRescue1 columnist Dr. Sara Jahnke – director of the Center for Fire, Rescue and EMS Health Research at the National Development and Research Institutes – in her column PFAS exposure and risks: Your questions answered, PFAS (per- and polyfluoroalkyl substances) are a very broad group of chemicals that have been used in a variety of industries, and can be found in food packaging, cleaning products and nonstick products.
Technically speaking, even polymers like Teflon are considered PFAS. There are thousands of PFAS chemicals, but only a limited number of PFAS chemical have been deemed harmful to human health. These include perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS), which sound and look a lot like PFAS but happen to be very specific PFAS chemicals. Due to concerns about exposure and potential health effects, the EPA formed a PFOA Stewardship Program designed to eliminate the use of PFOA along with other long-chain PFAS in manufacturing in the United States.
Separating fact from fiction: How exposure occurs
So now, the problem facing the fire service is to understand what is dangerous and what is not, as a whole lot information gets pushed out to us.
In plain English, the average person can be exposed to certain dangerous PFAS chemicals, such as PFOA and PFOS by:
- Drinking contaminated municipal water or private well water;
- Eating fish caught from water contaminated by PFAS (PFOS, in particular);
- Eating food that was packaged in material that contains PFAS; and
- Using some consumer products, such as non-stick cookware, stain-resistant carpeting, and water-repellent clothing.
Research has suggested that exposure to PFOA and PFOS from today’s consumer products is usually low, especially when compared to exposures to contaminated drinking water.
Some products that may contain PFAS chemicals include:
- Grease-resistant paper, fast food containers/wrappers, microwave popcorn bags, pizza boxes, and candy wrappers;
- Nonstick cookware;
- Stain-resistant coatings used on carpets, upholstery and other fabrics;
- Water-resistant clothing;
- Cleaning products;
- Personal care products (shampoo, dental floss) and cosmetics (nail polish, eye makeup); and
- Paints, varnishes and sealants.
When it comes to fire service-specific issues, firefighters may be exposed to PFAS through exposure to the combustion of products containing the substances on the fireground (e.g., stain-resistant carpet and upholstery) – in other words, in the smoke. Firefighters may have also been exposed to PFAS through firefighting foam. PFOS was used in the manufacturing of firefighting foam through 2001. Since then, U.S.-based manufacturers have used other short-chain PFAS in an effort to be safer.
Getting to the heart of the issue, Jahnke explains the connection to bunker gear: “Historically, PFAS also has been used in our bunker gear, although in what has been considered a stable state. PFAS were used in stain/water-repellent fabrics within the layers of bunker gear to make gear water-resistant and reduce moisture-related skin burns and to protect us from steam. While the long-chain version of the chemicals have been eliminated in the production process, it is possible that legacy gear manufactured before the regulations were put in place still contain the legacy chemicals. Whether the chemical is then entering the body of firefighters from absorption, inhalation or ingestion from their bunker gear and, if so, how is unclear. Additional research is currently underway.”
It’s important to remember that we respond to very bad environments filled with all kinds of carcinogens. Chemicals can enter our bodies through inhalation, skin absorption or ingestion. We've known that for a while – the very smoke-filled environments we work in provide that exposure. Even fully geared up, on air and no exposed skin, the smoke gets through the bunker gear and into our systems; however, keep in mind how bad it would be without the proper use of your gear. Smell the shower after a working fire. It smells like smoke because as protected as you may be, the smoke gets "into" us through skin absorption.
Our gear, which protects us at many levels, is still the best way to protect us in all environments we must work in. And to be clear, if we are not cleaning our gear or ourselves after a fire, then you and I will literally be eating the contamination, so ingestion is a real exposure threat to us.
Reality check: Risks of wearing vs. not wearing gear
While there may be some risk of exposure to PFAS while wearing PPE, the risk of not wearing gear on the fireground is significant, known, proven and obvious. And from my perspective, we don't want to attempt to solve one perceived issue, while compromising our safety in other well-known areas.
For example, we regularly face exposure to toxic chemicals, such as battery acid, hydraulic acid, chlorine, gasoline and AFFF foams, along with smoke and sticky oily soot from fires. Changes to our gear cannot be allowed to reduce protection against these hazardous materials, for our own protection and health.
We also have to make sure that if changes are made, the repellents will be as good – or better – than we currently require for firefighter protection. We are not repelling water on a little kid’s raincoat. We, as firefighters, need significant protection on gear that can be properly cleaned. We also need gear that allows our bodies to release heat. So any changes must meet or exceed our gear’s ability to protect us from body heat, elevated core temperatures and related stress.
Bunker gear may be a problem, and good folks representing fire service interests are determining if there is a problem and, if so, what the solution is. We need the fire service leadership associations to support research and investigation, which will take time so that we end up with even better gear that ultimately results in our increased safety and survivability.
Allegations about the risks to firefighters from PFAS in turnout gear has created little stir with most firefighters who understand that there may be a problem, and that it is being evaluated, led by groups such as the IAFF and IAFC, but that to not use and wear their gear is unthinkable and absurd.
At a recent regional fire conference, an un-informed and unqualified firefighter presenting on fire operations commented, “The smoke isn't our problem; it's our bunker gear. Our gear is dangerous!” That's an example of how a little information through unqualified statements lacking career-specific unbiased scientific backing causes unnecessary and irresponsible confusion.
Numerous research studies have conclusively proven that exposure to smoke and other products of combustion on our fire scenes are directly related to our elevated risk of cancer. We know it. We see it. We taste it. And we know so many brothers and sisters dealing with it.
What can firefighters do to protect themselves?
We've heard it time and time again. There is much we can do RIGHT NOW, with most actions costing nothing or negligible expenses, to reduce our risk. With this in mind, give these suggestions some serious consideration:
- Limit wearing firefighting turnout gear as much as possible. While gear is important for protection on the fireground, it is probably not as important when picking up groceries or out in the community.
- Wear all your gear at a fire scene – no exposed skin!
- Consider protection for those operating around exhausts or outside, but still on the fire scene.
- Perform gross decon when you are out of the fire.
- Wipe up your body everywhere. Everywhere.
- Change your clothes and wash them.
- Keep ALL gear as clean as possible.
- Shower within the hour or as soon as you return to quarters. Volunteers? Wash at the firehouse before returning home and exposing your family.
- Chiefs, don't store the dirty gear in your SUV.
- Wipes, or soap and water, should be used to decontaminate the inside of the rig and all related tools and equipment.
- Keep gear out of living areas of the station and public places to limit exposures.
- Everyone gets issued a second hood. Wash them and keep them as clean.
- Get an annual firefighter physical, as early detection is the key to survival. The IAFC Safety Health & Survival Section has a Healthcare Provider’s Guide for those physicals that they will share with you.
- Tobacco products? You know the answer.
- Fully document all fire or chemical exposures. One option is through smartphone apps, like the one provided by the International Public Safety Data Institute.
Jahnke summed up the issue: "It should be noted that there is no specific evidence that any specific types of cancers are linked solely to exposure to certain PFAS chemical exposure. A wide range of known and suspected carcinogens have been measured on the fireground and are known to enter firefighters’ bodies through skin absorption and inhalation. Generally limiting exposures as much as possible is important in addition to contamination control associated with gear."
Support continued research
Make no mistake, more research must be done in order to put our concerns at rest. But we have a responsibility to make decisions based only on research by qualified independent parties, such as NIOSH, which have decades of experience in protective clothing safety research and have on staff the toxicologists and scientists who are qualified to do the appropriate studies. A rush to judgment without science-based evidence will needlessly frighten hundreds of thousands of concerned firefighters and is irresponsible.
We need to support the efforts of the IAFF, IAFC, NIOSH and other fire service organizations and qualified researchers who are studying firefighter gear before rushing to any judgment and potentially putting firefighters at increased risk of serious injury before the appropriate fire service endorsed studies have been completed.
One to watch: The University of Arizona has received a $1.5 million research grant to study the effects of PFAS in firefighting foam and gear on firefighter health. The primary objective of the study will be to identify the key PFAS exposure routes and compare different practices for limiting exposure at airport fire departments that use firefighting foam to battle aircraft fires.
Striking the proper balance
So, is our bunker gear dangerous? Compared to NOT using it? Absolutely not.
In my opinion, there is no reason to think we should change our behaviors of wearing our gear. I mean, consider not wearing it and trying to do the job we have to do.
If we follow the above suggestions and advice on minimizing our exposures, and encourage the researchers to keep us informed as they determine the facts on these coatings (and changes as determined), I think we're striking the proper balance between taking care of those who count on us, and taking care of ourselves, families and loved ones.
My thanks to the IAFF, IAFC Safety Health & Survival Section, IAFC Volunteer & Combination Officers Section, Dr. Sara Jahnke, the National Fallen Firefighters Foundation First Responder Center of Excellence, Lexipol and the Firefighter Cancer Support Network for information related to the protection of firefighters.