Boston’s Mission to Prevent Cancer

The Boston Fire Department (BFD) has a long and storied history, one that I—and every member of the Department—is immensely proud of. Like every organization, the BFD from time to time needs to reevaluate itself in order to understand its strengths, identify its weaknesses and formulate a plan to meet present and future challenges. For many years, the BFD lacked the adequate executive leadership and the support of the City’s administration to successfully accomplish this. Fortunately, that changed when Joe Finn was appointed as fire commissioner/chief of department in July 2014.

New division, new focus

Through a wholesale review of the BFD, it was determined that the department lacked a comprehensive framework to ensure the safety, health and welfare of the membership. Finn wasted no time in creating the Safety, Health and Wellness Division, which was focused on making the department the foremost as it relates to the health and well-being of the membership and that would also be empowered to undertake research and development of new equipment and tactics. In creating this new division, the commissioner set the department on a new course and committed to having actions speak louder than words. 

I had the great fortune of being placed in charge of the Safety, Health and Wellness Division. With the help and guidance of the commissioner, Local 718, the IAFF and, most importantly, the membership, we began to formulate a plan to deal with the many challenges that firefighters face from a health and safety perspective. Through our analysis, we determined that cancer, cardiac issues, joint and muscular injuries were major issues that needed to be addressed. Comprehensive plans to deal with each of these issues were developed and implemented. One key element was the Firefighter Cancer Awareness and Prevention Program.

Cancer as the major threat

Occupational cancers are ravaging the BFD and the fire service in general. Statistically, 6 out of every 10 Boston firefighters will face a cancer diagnosis at some point in their lifetime, and some of them will not survive it. As a firefighter, I came onto this job understanding that going home at the end of a tour was not guaranteed. We accept that some things are outside of our control. Buildings collapse, explosions occur, equipment fails, and while always tragic, they are not always preventable. What about things we can control? Do we not have an obligation to ourselves, our families and our friends to take the steps necessary, even if sometimes a little inconvenient, to ensure our long-term health? I would argue we should. At the BFD, we began looking at our cancer issue and decided enough was enough and something had to be done.

We had to first start by educating the membership about the problem and, in doing so, change the way our firefighters think. As a firefighter, we tend to make decisions based on what is going to kill me immediately. We put on a mask when we can’t breathe anymore, and we take it off as soon as it looks like there is just enough oxygen to support life again. The same can be said of turnout gear, hoods or other life safety devices. When the immediate threat is eliminated, we relax and get comfortable. What we have come to learn is that when that immediate threat is gone, the threat does not end. Fire creates carcinogens; that is an indisputable fact. It does not matter if you are burning a pallet, straw or an entire living room set. The byproducts of combustion may change in amount, but generally they are still present. Over time and multiple exposures, they build up in the body and you are eventually sitting in front of a doctor getting news you never thought you would get. 

In order to educate our membership, we felt that creating a video and releasing it through social media would help us reach young and old firefighters alike. Partnering with embryocreative, we produced a first video that was designed to raise awareness. (The video can be viewed at http://tinyurl.com/BFD-vid1.) We wanted to show the effect that cancer has not only on the members but also the families and friends. Many members suffering from late-stage cancer agreed to tell their painful stories, and families re-opened wounds to illustrate the profound loss they experienced. Commissioner Finn, Local 718 President Rich Paris and Dr. Michael Hamrock all participated and added their stories and experiences.

Simultaneously, as we began the video production, we were also implementing changes in the department in regards to reducing exposure to carcinogens. The department completed a bunker gear census and found more than 75 percent of all bunker gear was not compliant. At the same time, we began an NFPA 1851-compliant inspection and cleaning program. Old and non-compliant gear was removed from service and new gear was issued. All members at this time have two fully compliant sets of bunker gear that are cleaned and inspected at least annually by an independent service provider (ISP). We also made cleaning of the bunker gear a requirement after a member works at a fire. This was initially through the ISP, but in partnership with the Kathy Crosby-Bell and the Last Call Foundation, extractors are being installed in every firehouse. The extractors give the membership another option in cleaning their gear. Firefighters can now choose to clean their gear themselves or send it out to be cleaned. We issued two hoods to each member and will shortly begin the process of issuing another set of boots and gloves to each member. New SOPs were issued regarding when and for how long masks should be worn. Post-incident cleaning wipes are available on every piece of apparatus, and we are currently working on a comprehensive post-incident decontamination policy. 

With all of these changes, we wanted to make sure the membership fully understood the changes and why they where being made. With the success of the first video, we believed that we should create the second video to outline all of the resources available to the membership to help in carcinogenic exposure. (The video can be viewed at http://tinyurl.com/BFD-vid2.) We were extremely lucky to have the support and participation of the same players from the first video, as well as Mayor Marty Walsh. In addition, Captain Joseph Adducci, himself a colon cancer survivor, spoke about the importance of taking the steps necessary to keep healthy. His ability to explain the issue from the perspective of somebody whose career has spanned decades illustrated the change in thinking required of veteran firefighters to ensure young firefighters take positive actions to stay active and healthy.

Thankfully, the message has resounded throughout the department, the country and the world. The videos have been viewed tens of thousands of times, and we have received messages from around the world. We are continuing to make changes, large and small, to ensure the safety of the membership. Cancer screenings are available to all members throughout their careers, in hopes of identifying cancers while they are still treatable. We recently completed an air-quality analysis in partnership with the Dana Farber Cancer Institute to fully understand the environment our firefighters are living in. We hope to have the results soon, and with them, make the firehouse a healthier environment. We are exploring diesel exhaust reduction devices in hopes of reducing the particulate matter firefighters are exposed to while operating in the firehouse. We are also looking at incorporating certain technologies into our bunker gear in the hopes of reducing particulate exposure, while not negatively affecting the breathability of the gear. While none of these are the complete solution, nor will they completely prevent the exposure to carcinogens, we hope that when taken as a whole they can make a significant reduction in the possibility of developing cancer. Only time will tell. 

Cardiac still an issue

Cancer is only one of the issues that are affecting firefighters. Cardiac issues are also occurring with alarming frequency. Some are minor events that are easily treated, while others result in sudden cardiac death. The reasons why firefighters are more susceptible to cardiac episodes is a hotly debated topic with no definitive answer. There are, however, things that we can do to keep ourselves healthy. To that end, the BFD has instituted a health and wellness program aimed at keeping firefighters healthy—mentally and physically. To accomplish this, the department partnered with O2X to create a total health program, specifically designed for firefighters. O2X was founded by a group of former Navy SEALs who sought to leverage the lessons learned in U.S. Special Forces. Through this program, our members get hands-on training in developing healthier lifestyles. This includes developing better eating habits, dealing with the emotional hardships encountered as a first responder, and workout routines custom tailored to age and physical condition. So far, reaction to the program has been positive, especially with younger firefighters. Older firefighters also have been receptive and are participating in large numbers. We hope that by giving firefighters the tools to lead healthier lives, we can have a positive effect on their total health leading to a healthier, more productive membership.

In addition to the policy and procedural changes within the department, a key part of our strategy is actively participating in the industry. The BFD has reached out to the world-leading academics and researchers to fully understand the challenges faced by firefighters. We are participating in several national studies aimed at understanding and improving firefighter health. We have forged relationships with other departments to share information. In addition, we recently hosted a symposium in conjunction with the IAFF specifically dealing with firefighter health and welfare. The symposium drew more than 350 participants from departments all over the country. Topics covered ranged from next generation bunker gear to substance abuse. We have been extremely encouraged and gratified by the feedback we have received and hope to hold other events in the near future. 

What’s ahead

While cancer and heart disease are currently our focus, we also are working diligently in other areas. One area is the development of new bunker gear specifications. We have felt for some time that the constant focus on thermal protection has had an adverse effect on a firefighter’s physiological health. Recent studies have shown to some extent that this view is justified. There is also the issue of particulates and how they contribute to health issues. We have begun working on understanding the physiological effect of bunker gear on the firefighter and how different composites increase or decrease physiological stresses on the body. We hope to use this information as part of our bunker gear selection process as another tool in evaluating our gear. In addition to TPP and THL concerns, we are also working on ways to protect firefighters more completely from the effects of particulate contamination. We have developed some testing protocols and are in the process of testing some simple additions to our gear that may have a big effect on the ability for particulates to penetrate the gear without adding weight or affecting the gear’s breathability.

Leading is about first understanding how to follow. We are taking the advice of scientists and the experiences of other departments to heart. This, combined with our own experiences, allows us to create appropriate policies and formulate better procedures, and more often than not, make the right decisions for the health and welfare of our firefighters. Unfortunately, the full benefits of all of our changes may take decades to fully realize; however, we are confident that the changes we are making today will have a profound impact on those who follow us in the future. In the end, it is up to each individual firefighter to embrace these changes. Much like building a house, we can provide the materials, but it takes skilled and knowledgeable men and women to make the house.