Exposure Reduction for Aggressive Fire Departments

Note: This article is part of the Firehouse 2024 Cancer Awareness and Prevention Supplement. To read the entire supplement, click here.

Undoubtedly, firefighting is a profession that’s laden with inherent risks. One of the most significant risks is exposure to carcinogens. According to IAFF, as of 2023, 72 percent of line-of-duty deaths of career firefighters were caused by cancer. Firefighters face a 9 percent greater risk of being diagnosed with cancer and a 14 percent greater risk of dying from cancer compared with the general population. The importance of comprehensive strategies for mitigation, including a focus on decontamination, PPE usage, personal hygiene and health monitoring, can’t be overstated.

Numbers don’t lie
Research into firefighter cancer has become a critical area of focus, with an aim of understanding and combating the greater risks that members face. Studies identified numerous carcinogens, such as benzene, formaldehyde and polycyclic aromatic hydrocarbons (PAHs), that can be present in fire environments, which can be absorbed through the skin or inhaled.

The National Institute for Occupational Safety and Health has been at the forefront of this research, conducting extensive cohort studies to quantify cancer incidence among firefighters. Moreover, the Firefighter Cancer Cohort Study, programs by the Firefighter Cancer Support Network and other efforts are pivotal in providing data, resources and support to mitigate these risks. These efforts emphasize the importance of regular health screenings, advanced PPE technology, and comprehensive decon procedures to reduce exposure and improve long-term health outcomes for firefighters across the spectrum of the service.

Occupational risks
Every firefighter wants to be the first one through the front door with the nozzle or the one who comes down the ladder having saved a baby from the second-floor bedroom at 2 a.m. However, with great reward comes risk. As firefighters, we can’t avoid those risks, but we do have options to help to mitigate the effects of exposure once our main objectives are completed. Recognizing these risks is the first step toward implementing effective mitigation strategies, which can help to safeguard firefighters’ health and longevity in their career.

Firefighting exposes individuals to numerous carcinogens that are present in smoke, soot and other hazardous materials that are encountered during fire suppression activities. Continuous exposure without implementation of proper decon and protective measures significantly increases the likelihood of developing cancer and other health issues. These risks include respiratory diseases, cardiovascular problems and chronic conditions that stem from prolonged exposure to harmful substances.

Initial exposure reduction
Wet decon practices are essential for firefighters to remove a substantial portion of surface contaminants after they operate on the fireground. Studies indicate that wet decon can remove as much as 85 percent of contaminants, whereas dry methods are less effective, removing about 23 percent of such substances.

Preliminary exposure reduction involves using water and cleaning agents to remove toxins from the skin and gear immediately after exposure. This initial step doesn’t replace the need for advanced cleaning but significantly reduces the amount of contaminants that can be transferred to other environments or absorbed through the skin.

PPE cleaning
Regular and thorough cleaning of PPE is vital in the effort to reduce exposure to hazardous contaminants.

Contaminated gear should be bagged and transported outside of the passenger compartment of apparatus to prevent off-gassing and continued exposure. Even when bagged, contaminated gear can release harmful substances, which makes proper transportation and storage critical. Proper cleaning protocols help to ensure that gear is safe for reuse and to reduce the long-term health risks that are associated with repeated exposure to carcinogens and other toxins.

Advanced cleaning involves comprehensive procedures that are aimed at removing soiling and contamination that’s associated with combustion products. These procedures ensure that deep-seated contaminants are effectively removed, to maintain the protective qualities of the gear.

According to NFPA guidelines, turnout gear should be cleaned using washers that are rated for a maximum of 100 G. Currently, the next edition of NFPA 1850: Standard on Protective Ensembles for Structural and Proximity Firefighting and Self-Contained Breathing Apparatus (SCBA) aims for a water temperature no hotter than 120 degrees Fahrenheit. Detergents that are used should have a pH of 6.0–9.5.

PPE must be cleaned at least twice per year and after every exposure, with an annual inspection to ensure gear integrity.

Helmets, boots, gloves and SCBA require regular cleaning to remove contaminants from them. Consistent and thorough cleaning routines are essential for maintaining the safety and effectiveness of the equipment. Additionally, the next edition of NFPA 1850 will require that SCBA units, just like other articles of PPE, be cleaned after every time that they are exposed to products of combustion.

For many of us, this stands in stark contrast to the fire service culture in which we were raised. Wearing dirty gear once was seen as a badge of honor or even a rite of passage. It symbolized that you weren’t just there for the T-shirt and that you were tough and had what it took to be a firefighter. Personally, I used to believe that it was impressive when my Bourkes eye shield would melt and curve downward, signaling that I was willing to push deeper toward the seat of the fire and could endure the heat in that environment. It was “cool”—until it was 3 a.m. during an extrication, and I was without proper eye protection.

Over the past several years, emphasis was placed on cleaning PPE, such as coats, pants and helmets. However, most departments weren’t cleaning SCBAs and instead placed them back on the trucks dirty. The SCBA is the dirtiest piece of equipment remaining after PPE, and the next edition of the standard is highlighting its importance.

Storage of clean equipment
Proper storage of clean PPE and equipment is crucial to prevent re-contamination. Clean gear should be stored out of direct sunlight, away from exhaust fumes and outside of living areas in the station.

When members are in their personal vehicle, airtight bags should be used to store gear in the trunk or bed, away from loved ones and personal belongings.

Proper storage practices help to maintain the cleanliness and safety of PPE and other equipment, to protect both firefighters and their family. A good rule of thumb is, if you can smell the gear, then you still are being exposed.

Personal hygiene
Personal hygiene practices are critical for exposure reduction. Firefighters should aim to shower within an hour of exposure to remove contaminants from their skin. Using wipes and soap to clean exposed skin areas immediately after leaving the fireground can reduce contamination risk further. That said, using wipes isn’t a substitute for a shower.

Regular showering and cleaning routines help to remove toxins that might have settled on the skin, to reduce the risk of absorption and long-term health effects.

Station uniforms
Increasingly, firefighters are encouraged to clean their uniforms at the station rather than risk bringing contaminated gear home. This practice helps to prevent carcinogenic contamination, which can cling to clothing, from being transported to the home environment, where they can pose a significant health risk to family members. This not only protects the firefighters themselves but also shields their loved ones from secondary exposure to hazardous substances.

Ensuring that station uniforms are cleaned in-house is a proactive step in minimizing the overall exposure to carcinogens and promoting a healthier lifestyle for firefighters and their family.

Documenting exposure
Consistent documentation of exposure incidents is essential for tracking exposure history in the fire service and informing future safety measures. All personnel must fill out an exposure report that documents the date, location, type of exposure, structure type, PPE used and any other relevant information. This documentation helps to identify patterns, to implement safety measures and to provide evidence for future health claims. Detailed exposure records are critical for understanding and mitigating long-term health risks that are associated with firefighting.

Aggressive & health-aware
I firmly believe in maintaining the aggressive nature of departments, as the North American fire service exemplifies a commitment to community service that surpasses many other cultures globally.

It isn’t my intention to suggest that firefighters avoid inherent risks or disregard the rewards of aiding those who are in need. However, there is no justification for departments and members to fail to support a cancer-reduction program.

A respected chief officer once remarked that the fire gets a vote. Although I wholeheartedly agree, it’s crucial to remember that doesn’t mean cancer gets a vote, too.

Implementing comprehensive exposure-reduction strategies, such as decon practices, advanced cleaning of PPE, avoiding cross-contamination, maintaining personal hygiene and documenting exposure incidents, is vital for safeguarding firefighters’ health and safety.

I often use the jelly bean analogy to illustrate the importance of cumulative small steps. Very few people can guess the amount of jelly beans that are in a jar: No one can predict how many exposures will lead to a cancer diagnosis. Therefore, it’s essential to seize every opportunity to limit exposure.

By adhering to these guidelines, departments can maintain operational readiness while prioritizing their personnel’s health and safety. Cultivating a culture of safety and awareness, along with regular decon and personal hygiene practices, can help to prevent cancer and other health issues. As a current or future leader, it’s your responsibility to create a safer and healthier working environment for all firefighters.