Cancer. This simple six-letter word strikes fear into everyone who has been diagnosed with the dreaded disease, but too many members of the fire service are like the proverbial ostrich with their head buried in the sand: They act as though by ignoring the issue, they can make it go away or that it somehow won’t affect them.
Unfortunately, that is absolutely not the case. During my 34 years on the job, I knew that some of my fellow firefighters had suffered or died from some form of cancer. Frankly, I was like many of my fellow “ostriches,” ignoring the issues, thinking that it was “them, not me.” That is, until six months after my retirement at age 56, when the doctor sat me down and said, “I’m sorry to tell you, but you have prostate cancer. It is an aggressive form of cancer, and I strongly recommend surgery.”
With that diagnosis, my “retirement” changed dramatically. I began to really examine and understand what is happening within the fire service, and maybe even more importantly, what is not happening concerning our health and safety and the need to change some parts of our culture.
The Scope of the Problem
What I began to discover while doing my own research is that there have been quite a few research studies done on firefighters and cancer, including several major ones recently. Additionally, many fire departments around the country also have noticed that within the past five to 10 years this issue – one that we have ignored for so long – has become an epidemic in the fire service. How big is the problem, you ask?
Miami-Dade Fire Rescue (MDFR), one of the largest departments in the U.S., has been fortunate to work closely with its union members and their health insurance trust. Consequently, we have some unfortunate but very solid statistics to work from. The following information comes from United Health Care and our own union data in compliance with HIPAA regulations.
From 2008 to 2010, 32 percent of the department’s 2,000-plus active firefighters were diagnosed with some form of cancer. That’s one in three in only three years! This number represents 1,711 men and 307 women on active-duty status.
Some of the major cancers found among the men during this three-year period were: prostate (21), testicular (13), melanomas (12), brain/nervous system (eight), head and neck (eight), bladder (six), colon (four) and others. Cancers found among the women were: cervix (22), thyroid (12), breast (10), melanomas (four) and others. In a follow-up study in 2013, we found that 304 of the department’s 1,804 members (16 percent) and 45 percent of all retirees had been diagnosed with some form of cancer in that one year alone.
We have also been able to track the department’s deaths, going back as far as 1952. We found that of the 259 deaths within MDFR as of January 2014, 37 percent of all deaths could be attributed to cancer and 17 percent to cardiovascular causes. The take-away: We are losing more than twice as many firefighters to cancer than to cardiovascular causes.
Looking at 2008 to 2010, 53 percent (eight of 14) of the department’s deaths were caused by cancer in 2008, 41 percent (five of 11) in 2009 and 83 percent (five of six) in 2010. According to the CDC, only 23 percent of the general population in the U.S. died from cancer in 2010. This means that we lost almost twice as many members to cancer than the general public. (Incidentally, suicide is our third leading cause of all deaths, at 7 percent.) Yet for some reason, much of the fire service continues to argue that cardiac arrest is the leading cause of death in the fire service – it’s the “ostrich factor.”
We have also learned from the University of Cincinnati and several other studies that we are absorbing many chemicals and toxins directly through our skin – consider morphine or Nicorette patches – and that we must shower and decontaminate as soon as possible after a fire to remove the toxins from our skin. Many firefighters think, “It’s no big deal; it’s only soot.” Yet according to the International Agency on Research for Cancer, soot is a Group carcinogen, meaning that it is on the list of the worst possible carcinogenic offenders. The other dangerous byproducts of combustion we face on every fire include benzene, formaldehyde, styrene and vinyl chloride.
Pulling Our Heads Out of the Sand
What we are learning is that we must get our heads out of the sand and begin a major emphasis on cancer awareness, prevention and protection within the fire service. All too often, because we are “alpha dogs,” we feel this is not an important enough issue or that it won’t affect us. But far too often, we find ourselves in the doctor’s office getting a different message.
We must understand that although our PPE and SCBA are better than in past years, many firefighters are not even using this critical safety gear during overhaul. This at a time when study after study shows that we should be using PPE and SCBA more than ever, because today’s fires are far more toxic than fires in the past. The toxins released during overhaul are far worse, in many cases, than during an active burn. Wearing full PPE/SCBA during overhaul must be enforced by all officers-in-charge, no questions asked.
Jacksonville, Florida, has instituted an “overhaul team” concept that is, in my opinion, revolutionary and should be looked at as a new standard. Short version: A unit that was not on the original dispatch will be called in to do overhaul, and the overhaul crew must wear full PPE, no exceptions.
Because of hidden chemicals and carcinogens, every fire must be considered a hazmat incident, and we must begin to document our fires as exposures and place those documents in firefighters’ health files. This should be no different from an exposure to a TB or HIV patient, a needle-stick or an accidental exposure to a chemical environment. (I don’t care if you have a cancer presumption law or not. We must begin doing this for every firefighter in every department, without exception). Let the laws catch up, but without documentation, good luck on litigating your cancer presumption if needed.
Because of absorption issues, we must ensure that firefighters have clean PPE –including their Nomex hoods, gloves and helmets – and have a regular cleaning program in our SOPs. The research data is starting to add up. Dirty gear is more responsible for many of our issues than we thought in the past. Look at the types of cancers and possible exposure routes: 1) testicular and prostate cancer via dirty/contaminated pants, 2) thyroid cancer via dirty hoods, 3) brain and nervous system cancers via dirty helmets (When was the last time you cleaned your helmet and liners?), melanoma and skin cancers via all of the above. Again, the toxins are found in our PPE after a fire, and they are being absorbed through our skin as we sweat and our pores open up.
We must remove the diesel exhaust from our stations. Diesel exhaust is a known human carcinogen, yet we pump this toxin into our stations every single day. We open our station doorways after a truck has started and that exhaust blows into the station and pumps through our A/C units. By the way, open truck bay-doors are not an adequate ventilation system. So how does your department handle this daily toxin?
Annual mandatory comprehensive physicals that are nonpunitive are a must for the early detection of not only cancers, but also elevated blood pressure, abnormal EKGs and other workers’ comp issues. Management and staff need to understand that if these items are caught early, treatment options are more readily available and less expensive than when an issue is detected late. Stage 1 cancer is far easier to deal with than Stage 4, emotionally, physically and financially for all parties involved.
FCSN’s 2013 white paper, “Taking Action Against Cancer in the Fire Service,” provides other potentially lifesaving action steps for recognizing and reducing firefighters’ cancer risks. It’s available as a free download from firefightercancersupport.org
Call for Change
As I said, we must remove our heads from the sand and realize that this cancer issue has truly gotten out of control – it’s an epidemic in the fire service. We must either make changes in the way we do business or realize that we are dooming ourselves to a much higher risk of cancer than necessary. Ask any cancer survivors if they would change the way they did business in the past or if the would willingly do the same things all over again. I’ll bet you they’d say, “Make the changes.”
Change is difficult to accomplish, but we must do it now to help avoid hearing that six-letter word.
Keith Tyson was a firefighter/paramedic for Miami-Dade Fire Rescue for 34 years, retiring in 2008. He is now the vice president for education, research and outreach for the not-for-profit Firefighter Cancer Support Network, a national organization dedicated to helping fire/EMS personnel diagnosed with cancer. Tyson also is a prostate cancer survivor. He can be reached at KTyson@FCSN.net or at 786-351-3276.