The Invisible Enemy

By Keith Tyson, Firefighter Cancer Support Network

Cancer in the fire service is our current reality, but we are beginning to better understand firefighters’ increased risks and cancer’s devastating toll.

Cancer can be caused by things we eat, drink, breathe and absorb, including numerous carcinogens found in our fireground and station working environments.

• According to a 2013 National Institute for Occupational Safety and Health (NIOSH) study of approximately 30,000 firefighters, firefighters have a 9 percent higher risk of being diagnosed with cancer and a 14 percent higher risk of dying from cancer than the general public. (1)

• According to data from the International Association of Fire Fighters (IAFF), 61 percent of the Line of Duty Deaths for career firefighters since 2002 have resulted from occupational cancer. In 2016, 70 percent of the Line of Duty Deaths were attributed to cancer.

• Some fire departments are tracking even higher cancer rates among their members. Cancer caused 67 percent of the Boston Fire Department’s LODDs between 2002 and 2014.

• Between 2008 and 2010, 32 percent – nearly one third – of Miami-Dade Fire Rescue (MDFR) firefighters were diagnosed with cancer or received cancer treatment. And of the 343 MDFR members who died since 1952, 121 (35 percent) died from cancer and 52 (10 percent) died from cardiac arrest.

We now know carcinogens make it past our personal protective equipment (PPE) and onto our skin. In 2015, Jeffrey Stull reported the dramatic results of a Fluorescent Aerosol Screening Test (FAST),(2) funded by the IAFF. Photos from the test illustrated how carcinogens get through our PPE, particularly the hood, as well as the interfaces between jacket and pants and between pants and boots. The results of that FAST have prompted a number of PPE design changes as well as revised cleaning practices, both on the fire scene and afterward.

PPE Cleaning

Let’s talk about some of these methods. Kenny Fent’s recent study, (3) of on-scene gross decontamination (decon) showed that using soap, water, and a brush was approximately 85 percent effective in removing the soot and polycyclic aromatic hydrocarbons (PAHs) on PPE after interior firefighting.

Since 2013, the Firefighter Cancer Support Network (FCSN) has urged departments to implement gross decon on scene to reduce firefighters’ exposures. To allay concerns about the potential for steam burns following gross decon, Palm Beach County (Florida) Fire Rescue conducted a series of training burns. After interior firefighting, it tested gross decon procedures and multiple re-entries into the firefighting environment. Even after multiple fires and multiple decons in the same gear, no members suffered burns. (4)

Dry decon – using a brush to remove soot and other debris while on air – is an option for crews operating in colder temperatures where wet decon may not be advisable. However, even here departments have used water without adverse effects. (5)

A number of fire departments have begun a one-for-one hood swap after every fire. Many departments also provide cleansing wipes to begin the personal decon process immediately.

Fent’s 2017 research showed cleansing wipes could reduce PAH contamination on neck skin by a median of 54 percent. (3) Fent’s research also showed much higher contamination on the hands than previously thought, and some departments are considering frequent glove swap-outs.

The Jacksonville (Florida) Fire Department implemented an innovative program that rotates in fresh crews to do overhaul. At the same time, it sends its first-in crews back to the stations for showers. Jacksonville’s policy specifically states that all PPE, including self-contained breathing apparatus (SCBA), shall be worn throughout the overhaul process.

Some departments still only have one set of turnout gear per firefighter, but two sets of PPE are increasingly common to facilitate getting into clean gear after every fire. At least one department has three sets per person. Some departments use color-coding systems to provide a visual reference to which set of gear is in use. In any case, all gear must be barcoded and tracked thoroughly to prove that gear was cleaned and inspected according to National Fire Protection Association (NFPA) standards.

Departments as large as FDNY have begun implementing many of these changes. (6) Note: The 2018 edition of NFPA 1500, Standard on Fire Department Occupational Safety, Health, and Wellness Program, (7) features major changes regarding PPE and gross decon.

At the Station

Next, let’s look around the fire stations and make some important changes. Do you have direct source control exhaust systems (e.g. hoses connected to the truck exhaust), and are they working and being used properly? Having a system but not enforcing its use does nothing! Diesel exhaust was classified as a known human carcinogen on June 12, 2012. (8)

Where do you store your PPE when it’s not being used? Is it in a separate room vented to the outside and with closed doors, or is your gear sitting right next to your apparatus and absorbing all the carcinogens from their exhaust systems? Where are your ice machines located? Are they being bathed with the same diesel exhaust and subsequently being ingested into your body? Just because you filter your water does not mean that you filtered the carcinogens from the truck bays. Also, just because you use it “only for our water coolers” does not make it any safer to drink or chill your water: ice does melt!

A number of departments have implemented a fire station design with red/yellow/green zones similar to a hazmat response.

• All contaminated or potentially contaminated gear is left in the red zone; this includes PPE, tools, trucks, etc.

• The green zone is for living and sleeping quarters. No contaminated gear is allowed within this area.

• The yellow zone is the transition zone between green and red zones, usually a hallway or airlock system, where airflow controls the direction of air to the red zone.

The Coral Springs-Parkland (Florida) Fire Department and others have implemented the “clean cab” apparatus concept. With this design, contaminated PPE is never allowed into the cab area.

Additionally, some departments do not allow SCBA or tools placed in the cab. Instead, they are typically located in a curbside compartment. It’s a gathering point for crew members who are quickly briefed by the officer on arrival on scene. After firefighters are released from the incident, they go through gross decon, as previously discussed.

All PPE is bagged and sealed, and the crews are sent back to the stations to shower and swap into their second set of PPE. Additionally, the “clean cab” concept calls for two sets of flashlights, yellow ones for EMS and orange for fires, that also never go in the cab.

Make a Change

While I fully recognize that not every one of these methods is possible in every single department, we must begin to make changes to reduce the numbers of members being diagnosed with cancer. There is no question that we have a cancer problem in the fire service. There is no question we must revise some of our practices. We must do something differently or continue to lose our brother and sister firefighters – and possibly ourselves – to cancer.

Keith Tyson, Vice President of Education and Research for the nonprofit Firefighter Cancer Support Network, retired from Miami-Dade (Florida) Fire Rescue in 2008 after serving 34 years as a firefighter/paramedic. Within six months, he was diagnosed with prostate cancer and skin cancer. In 2009, Tyson formed FCSN’s Florida chapter, and he continues to serve as FCSN’s Florida State Director. He has delivered FCSN’s cancer-prevention training to thousands of firefighters in Florida and across the United States. Tyson is FCSN’s liaison to the University of Miami Firefighter Cancer Initiative.

References: 1. Daniels, Robert D, “Firefighter Cancer Rates: The Facts from NIOSH Research,” CDC NIOSH Science Blog, May 2017; 2. RTI International, “Fluorescent Aerosol Screening Test (FAST) Test Report,” January 2015; 3. Fent KW, Alexander B, Roberts J, et al, “Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures,”, October 2017; 4. Palm Beach County Fire Rescue, “Post Fire on Scene Decon Confidence Burn”; 5.; 6.; 7. NFPA, Standard on Fire Department Occupational Safety, Health, and Wellness Program, August 2018; 8. International Agency for Research on Cancer, “IARC: Diesel Engine Exhaust Carcinogenic,” WHO, June 2012.