"We now know” is the phrase I have been communicating to our 235 firefighters for the past year. This phrase is related to the dermal absorption of smoke and carcinogens into our skin and how this correlates directly to the fire service cancer issue. If you have been on the rig for 20 or more years, you know wearing your SCBA and seatbelt has been beaten into us by our mentors, officers, policies, and just about every fire service publication since the 1990s. What we did not know, but we now know, is the dermal absorption of smoke at car fires, dumpster fires, grass fires, and most importantly structure fires slowly seeped into our skin, exacerbating an already borderline health crisis called cancer. Our PPE manufacturers have spent millions in research on thermal protection, breathability, durability, and making sure our most valuable assets will survive a fire even in the most dire fire conditions. However, we all failed to realize the obvious, which is our PPE is not protecting us from the smoke, as our skin is like a sponge when we are sweating and trying to shed heat. We smell the smoke in our hair and on our skin for hours and sometimes days after a fire. At one time this was a badge of honor and now we know it is a portal for cancer.
A call to action
Living in the U.S., you have a 25 percent risk of fighting this cancer battle and in some metropolitan areas the risk is much higher depending on many other environmental and health factors. Almost every firefighter reading this article has a family member or friend who has fought the battle. Now enter the fire service and you instantly add 9 percent to that number, so we as a profession have around a 35 percent chance to deal with cancer personally. More studies are ongoing, and everything we wear and use on the fireground is being studied to minimize our exposures to the carcinogens in smoke, but unfortunately, we can only minimize the risk and not eliminate it.
So, “we now know” can and should be a call to action. I am hoping if you are reading this article, your department is already doing many, if not all, of the best practices. In 2018, we spent the latter half of the year educating our staff and firefighters about the various risks (inhalation, ingestion and absorption). We reviewed all of the major studies and attended multiple seminars and symposiums in an attempt to understand the data, so we could make a real difference in our firefighters’ health by adopting what the fire service has identified as possible best practices in the cancer fight. These best practices are supported by all of the fire service acronyms to include the International Association of Fire Fighters (IAFF), the International Association of Fire Chiefs (IAFC), IACF Volunteer and Combination Officers Section (VCOS) and the National Volunteer Fire Council (NVFC).
Locally, the Dallas County Fire Chief’s Association formulated a best practice model in an effort to help our Dallas County departments lead this fight and help educate their elected officials. Finally in 2019, we issued a change to our operations related to these best practices:
- All PPE and SCBA worn at all times if within the immediately dangerous to life or health (IDLH). Sounds simple but we all know what we do during overhaul and when we get fatigued.
- Turn off all apparatus that are not in use and make sure the windows are rolled up. Tremendous benzene levels are already in the smoke and why do we choose to make it worse with 8–10 apparatus running within 100 square yards of the fire scene?
- Mandatory personal exposure reduction (decon) with our decon system to immediately stop the off-gassing of our PPE.
- Mandatory use of a post-fire wipe immediately before entering rehab and throughout the duration of the fire.
- Mandatory glove and hood changes when exiting rehab. Hand and neck exposure are a main source of absorption, so we have multiple gloves and hoods to use.
- Fire crews involved in the fire fight and within the pressurized IDLH removed from the scene and to a shower within 90 minutes. This has been a challenge for the incident commanders (IC), and we are looking for a better way, but they do their best. The purpose is to try to eliminate as much of the carcinogens off the skin before they are absorbed and processed in the renal system.
- Hose not loaded on the scene and rolled and placed into a bag for proper cleaning. Clean hose loaded at the station.
- All tools and SCBA cleaned before reloading or bagged and cleaned at station.
- All PPE except the helmet and boots are bagged and sealed on scene, and the crews don their second set of gear when they return to the station. Many of our firefighters carry a “go bag” and change clothes on scene as well.
The challenges
So as you can see, some of this is challenging and can be expensive. Yes, it is, and in Grand Prairie, our crews are out of service when they leave the scene due to their PPE issues, equipment contamination, or they need to get showered within the 90 minutes. Personally, I will stand up in front of any citizen and argue the health and wellness of our firefighters is just as important as the citizen’s 9-1-1 call for help. We move other fire companies around the city to cover the gap to assist with this process in an effort to minimize response and reflex times. Fortunately, we are large enough to cover the gaps with other fire stations, and I certainly understand this is a major challenge for smaller departments. Our city manager knows our philosophy and 100 percent supports this mission, but I have spent a lot of time and energy educating the city council and city manager on the cancer issues within our profession, and I believe every fire chief should be doing this, especially if you have presumptive legislation and the cancer claim could be a worker’s compensation claim.
Changing tactics
Another change to mention that is really worthy of an entirely different conversation is related to our tactics. Our department is looking at the Tucson model and trying to consider “transitional attacks” more into our operations. I know, I know—this is quite the area of resistance in our culture, but I advocate that you can make all of the best practice changes mentioned earlier, and if we continue to place our men and women into a carcinogen-based situation, then they will still be exposed, thus the dermal absorption will still occur. Obviously, we cannot eliminate the exposures altogether due to rescues and other critical situations we face. However, we do enter the front door on occasion when we don’t have to, and I will continue to challenge our fire officers and ICs on why, when appropriate. As you can expect, this causes some anxiety as we all have been brainwashed to think the best method of attacking the fire is from the inside. Not to mention our one main excuse for going inside is, “Well, Chief, what if someone was inside?” We could debate and write pages on this subject, so I will simply end by stating that no longer do we need to be an “aggressive” fire department but more a “responsible” fire department as “we now know” and we cannot pretend we don’t know.
So what is your department doing to fight this battle? The next several years will be an interesting time for the U.S. fire service as more research and data hit our inbox. Our PPE is certain to change and improve and of course this means a budget impact. Our tools, hose and equipment will be easier to clean and safer to use while our apparatus are already nearing a clean diesel/clean cab concept.
This dermal absorption issue goes well beyond cancer and is possibly linked to Parkinson’s and fertility issues. I just hope and pray that our culture and attitudes will change as much as our technology has and we embrace this battle and do everything in our power to keep our people safe and healthy. Two weeks ago, a battalion chief told me, “Fires are no longer fun, and we actually are now dreading when the structure fire tones goes off.” I have thought about that conversation and can say that I am elated the troops are seeing a structure fire as a process related to their health and not a time to dig in and fight the beast.
About the Author
Robert Fite has been a firefighter/paramedic since 1988 serving first in Lancaster, TX, and then in Richardson, TX. Prior to becoming fire chief for Grand Prairie, TX, in 2012, he served as the fire chief in Georgetown, TX, since 2009. Fite is very proud of the recent accomplishments of the Grand Prairie Fire Department to include receiving the American Heart Association Gold Award for the 5th year in a row, being named a Heart Healthy community by the North Central Texas Regional EMS Council, and receiving the highest insurance rating of an ISO 1. All three of these accomplishments have a direct impact on the quality of life and safety of our citizens. Chief Fite is an executive fire officer graduate from the National Fire Academy, as well as a licensed paramedic and master firefighter. He has a master’s degree in human resource management from Midwestern State University and a bachelor’s degree in fire administration from Western Illinois University.
