By Robert Tutterow
In August 2013, the Firefighter Cancer Support Network (FCSN) issued a white paper titled Taking Action Against Cancer in the Fire Service. The white paper was an output of a workshop conducted in April 2013 with more than 30 participants and reviewers representing a cross-section of the fire service and subject matter experts.
The 13-page report lists numerous statistics that illustrate the complexity of cancer in firefighters. These include several reports that firefighters are more prone to develop cancer than the general population, despite the fact that firefighters are in better physical shape than the general public. One of the participants, Dr. Grace LeMasters from the University of Cincinnati, said, “Pinpointing the cause of cancer is extremely difficult because firefighters are not exposed to just one agent. They are exposed to multiple cancer-causing agents. Because of the multiple exposures and the multiple routes of exposure-they inhale carcinogens and carcinogens are absorbed through the skin-it is also highly unlikely for firefighters to get only one type of cancer.” The report clearly states that the two routes of greatest concern for carcinogens to enter the body are through the lungs [failure to wear self-contained breathing apparatus (SCBA) during overhaul] and skin absorption.
Apparatus and Equipment Connection
Now, what about apparatus and equipment as they relate to cancer? The report credits manufacturers for the many products that help minimize firefighter cancer risks. These include turnout gear cleaning equipment, diesel exhaust extraction systems, SCBA, and decontamination equipment and supplies. However, the white paper is quick to point out that manufacturers should refrain from advertisements that show firefighters wearing soiled, contaminated (i.e., carcinogen-laden) personal protective equipment (PPE), including helmets.
Consider the following scenario that occurs on a daily basis in many fire departments in the United States. The department responds to a working fire. Following the working fire, the members board the apparatus, still wearing their contaminated gear, and return to the station. A bit later in the day, they get a nonfire call, such as an EMS call. They board the apparatus and immediately sit on the cross-contaminated apparatus seats. On arrival at the scene, they administer patient care while wearing contaminated clothes. Is it time to think about a cover for the apparatus seat while wearing PPE? Think toilet seat cover.
At first this idea might seem a bit absurd, but further contemplation will reveal some validity to the concept. Although that might not be the solution, it is an example of how the fire service needs to focus on ways to minimize the risks of cancer. Another approach is issuing nonstructural response PPE for the bulk of the emergency responses. This could keep contaminated structural PPE out of the apparatus cabs and isolated in a dedicated compartment. The white paper also calls on manufacturers to support funding to develop curricula for training materials to address firefighter cancer awareness and prevention.
The white paper calls on architects to understand and address design for cancer concerns in new and renovated fire stations. This includes floor plans with a “workflow” that has a decontamination area adjacent to the apparatus floor, overall station air exchange, dedicated storage areas for PPE, and overall design and features that address the firefighter who has just returned from a fire as contaminated.
The report goes on to identify further research needs and calls on all fire service organizations to work together in “taking action against cancer in the fire service.” The report concludes with 11 immediate actions firefighters can take to protect against carcinogens. These are as follows:
- Use SCBA from initial attack to the conclusion of overhaul. Not wearing SCBA in both active and post-fire environments is the most dangerous voluntary activity in the fire service today.
- Perform gross field decon of PPE to remove as much soot and particulates as possible.
- Use wet wipes to remove as much soot as possible from your head, neck, jaw, throat, underarms, and hands immediately and while still on the scene.
- Change your clothes and wash them immediately after a fire.
- Shower thoroughly after a fire.
- Clean your PPE, gloves, hood, and helmet immediately after a fire.
- Do not take contaminated clothes or PPE home or store it in your vehicle.
- Decon fire apparatus interior after fires.
- Keep bunker gear out of living and sleeping quarters.
- Stop using tobacco products.
- Use sunscreen or sun block.
Strikingly, none of these recommendations require additional budget allocations, nor do they require special training. All they require is common sense hygiene habits.
ROBERT TUTTEROW retired as safety coordinator for the Charlotte (NC) Fire Department and is a member of the Fire Apparatus & Emergency Equipment editorial advisory board. His 34-year career includes 10 as a volunteer. He has been very active in the National Fire Protection Association through service on the Fire Service Section Executive Board and technical committees involved with safety, apparatus, and personal protective equipment. He is a founding member and president of the Fire Industry Equipment Research Organization (F.I.E.R.O.).