Occupational cancer has quickly (too quickly!) become the leading cause of fire service line-of-duty deaths (LODDs) in the United States.
As such, the International Association of Fire Chiefs (IAFC) , the International Association of Fire Fighters (IAFF) and the Firefighter Cancer Support Network (FCSN) partnered to designate January as Firefighter Cancer Awareness Month. Their stated goal was to provide firefighters and fire departments with the tools, guidance and direction necessary to develop cancer prevention protocols and programs to support those firefighters who have heard those dreaded words: “You have cancer.”
According to the IAFF, in 2019, more than 75% of the firefighter names added to the IAFF Fallen Firefighter Memorial Wall of Honor in Colorado Springs, Colorado, were IAFF-member firefighters who died from occupational cancers. Those are cancers presumed to be linked to exposure to the chemicals, chemical compounds and carcinogens present in the smoke firefighters encounter when conducting interior fire suppression operations in today’s structures.
So, what did you and your fire department do to recognize Firefighter Cancer Awareness Month? More importantly, what are you and your department doing now, going forward past January?
Here you’ll find a compilation of several resources related to firefighter cancer – resources you can share with your members as you seek to incorporate cancer awareness and prevention efforts through the rest of the year.
“YOU HAVE CANCER”
What's it like to be a firefighter diagnosed with cancer? What are the thoughts and emotions that come with such significant news? How does a firefighter and their family and their colleagues “get through” a cancer diagnosis and treatment?
Most of what we know about firefighters and their increased exposures to chemicals, chemical compounds and carcinogens, plus the elevated rates of certain cancers compared to the general population, has come from research that has focused almost exclusively on male firefighters. But cancer really doesn’t discriminate based on gender, does it?
In “You can’t save anybody if you don’t save yourself first: 4 firefighter cancer stories,” four firefighters share their reflections on their diagnosis, support systems, treatment, recovery, and what they saw as their path going forward.
Additionally, Deputy Chief Brian Cronin details the process that led to his throat cancer diagnosis in his riveting first-person account, “Hope for the best, prepare for the worst: A deputy chief’s cancer story.” He also shares his ‘lightbulb’ moment about underestimating the number of toxic fires we face and how much greater the number of our exposures may be.
PROPER PPE USE
The design and care of PPE is an essential piece of the cancer prevention puzzle, plus measures to reduce potential exposures in places you might not have considered yet.
Today’s structural firefighting ensemble creates a “micro-atmosphere” surrounding the firefighter. This is a key factor in the development of heat stress, which can ultimately lead to a sudden cardiac event, heat illnesses (e.g., heat exhaustion or heat stroke), early onset of fatigue, or impaired cognitive function.
But there’s also a cancer exposure component to a firefighter “heating up” inside their PPE. In “Skin's role in firefighter rehab,” Chief Bruce Evans wrote, “The skin is very porous and extremely vascular with a lot of small blood vessel, sweat glands and pours that can all act as potential pathways for toxins to enter the body …. More significant is how these chemicals embed in the pores that open to help thermo-regulate heat stress during firefighting operations. With every 5 degrees that body temperature rises, skin absorption rates increase by as much 400 percent.”
My bosses always told me, “Don’t bring me a problem without at least one feasible solution.” So, here are two:
- “The next cultural shift: When to wear structural gear”: In this piece, we explore the need for fire departments to provide their personnel with PPE alternatives for situations where it’s not practical for firefighters to wear their structural firefighting ensemble for emergency responses other than structure fires.
- In “PPE assessment: Size-up your call types to determine your gear needs,” I provided an answer to the question: How should fire departments approach such a paradigm shift [providing PPE alternatives] in their operations? Just like they do for any fire emergency they roll up on: Conduct a thorough size-up of the situation. In this article, we provided some guidance and direction on what that size-up should entail.
Here are what I consider to be a couple takeaways from these articles related to proper PPE use. First, fire departments need to provide PPE options beyond that of the structural firefighting ensemble that’s designed for an extremely specific purpose – interior structural firefighting.
Second, fire departments should start that process by using the tools contained in NFPA 1851: Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting, particularly explanatory material contained in Annex A of the standard, to make their alternative PPE selections in a way that is both operationally effective and cost effective.
While it is obvious that operations in hot zones require full firefighter PPE where hazards and risks are the greatest, many firefighters are unsure as to the type of PPE that should be worn in the warm zone. Given concerns for exposure to products of combustion that are either airborne or occur through contact with contaminated items, increased guidance is needed for defining what PPE should be worn outside the hot zone.
In their article, “What to wear: Firefighter PPE outside the hot zone,” PPE subject-matter experts Jeffrey and Grace Stull covered the subject of the appropriate level of PPE that firefighters should be using when working in the warm zone at a structural fire.
FIREFIGHTER PPE CARE AND CLEANING
Keeping firefighting PPE both clean and in serviceable condition is another topic that’s come to the forefront of firefighter cancer prevention efforts. As we’ve become more informed and educated about how firefighting PPE can harbor those chemicals, chemical compounds and carcinogens, many fire departments have taken a more proactive approach to reduce that risk. Those measures typically include initial contaminant reduction (ICR) on site and more frequent laundering of PPE back at the station.
But at what cost? What effect do these increased cleaning efforts have on your PPE? Can on-site ICR and more frequent laundering be having a detrimental effect on your PPE? Those were just some of the questions addressed by Gavin Horn and his team of researchers, summarized in “Research results: The impact of increased laundering on structural PPE.”
In “Head-to-toe PPE care: How to clean your gear and document the process,” I emphasized the importance of firefighters to document that they’ve done their job keeping their structural firefighting PPE clean and in good repair in accordance with the equipment’s original manufacturer and NFPA 1851.
Also, in “PPE cleaning products and processes: Ensuring the claims match the science,” the Stulls provide a simple checklist helps fire service leaders evaluate PPE technology and cleaning claims. In their piece, they wrote: “A host of innovative ideas and engineering has gone into several new products and related services, and we expect that these trends will continue as various groups endeavor to achieve the next state-of-the-art product. However, as much as we would all like to believe there is a ‘magic bullet’ out there or that we will discover the panacea to take care of all our nagging issues, the reality is that most improvements are incremental and it takes sound, correctly applied science to truly make the advancements for which we strive.”
This is certainly the case for PPE cleaning and decontamination. The industry is quickly moving forward with new technologically advanced products and services to provide for easier and more effective cleaning; however, in some cases, the science is not yet in place to support the claims being made.
In her article, “Studies examine how wristbands and dog tags can track fireground exposures,” Sara Jahnke, Ph.D., wrote about new technology that can track a firefighter’s exposure to toxins and carcinogens. The technology, developed by Dr. Kim Anderson at Oregon State University, uses a wristband that is “clean” – clear of chemical contamination – that firefighters can wear to track exposure to toxins. With feedback from focus groups of firefighters, they also developed a dog tag dosimeter for firefighters to wear both on and off duty because those firefighters felt the dog tags would be an easier way to collect carcinogens, particularly given that they hang closer to the neck area, which often sees more exposure and is particularly vulnerable to dermal absorption.
LIMITING EXPOSURE TO DIESEL EXHAUST EMISSIONS AND DIESEL PARTICULATE MATTER
Potential toxic exposures don’t exist solely on the fireground. As the driver/operator for a piece of fire apparatus, you have a significant responsibility for not only your own safety but also that of your fellow firefighters and officers. This responsibility goes beyond keeping yourself and your members safe while driving the streets of your jurisdiction; you must also look out for the health and wellness at the station.
That includes a focus on managing exposure to diesel engine exhaust emissions. In “Dangerous diesel: Managing health risks related to diesel exhaust emissions at the station,” we discussed several key concepts for reducing the risk that can result when diesel engine exhaust emissions are not appropriately managed. Those concepts included:
- Performing routine preventive maintenance of diesel engines to minimize emissions. Well-maintained diesel engines produce significantly lower levels of DE and DPM.
- Installing exhaust removal systems in the station.
- Ensuring that the exhaust capture system is used in accordance with the manufacturer’s recommendations 100% of the time. No exceptions.
- Inspecting the hoses and connections at least daily, preferably following each use, in accordance with the manufacturer’s recommendations.
- Immediately take the system out of service when you find a problem, then report the problem to your supervisor, and complete the necessary steps required by your department to get the problem repaired.
And most importantly, develop the mindset that using your station’s exhaust capture system is no more optional than wearing your SCBA.
So, as we continue forward into 2021, what are you and your fire department doing to help reduce the number of firefighters who will hear “You’ve got cancer”?