This past April, the National League of Cities (NLC) fired a shot across the bow of the fire service when it released a report titled, “Assessing State Firefighter Cancer Presumption Laws and Current Firefighter Cancer Research.” It has been generally accepted, based on past reports and anecdotal evidence, that firefighters are more at risk to get cancer than the general population. However, the NLC report states, “There is concern that conclusive evidence is lacking to demonstrate a causal relationship between firefighting and cancer.”
The report provoked statements of outrage from fire service organizations, which described it as propaganda and compared it to denials by tobacco companies that smoking could cause cancer.
The report was produced for NLC by TriData, a division of System Planning Corporation, located in Arlington, Va. Until this report was released, TriData had been recognized as one of the premier consulting companies for the fire service for over 25 years.
There are excellent independent studies that have formed the basis for many industry standards. Good studies provide a roadmap to service, product or policy improvement. There is considerable value in having an outside independent third party provide insight and recommendations to organizations. And there are many credible consultants who provide truly independent and objective reports.
Following The Money
Before going into the risks of cancer for firefighters, it is important to note the general nature of third party or “independent” studies. Rule number one: Follow the money. Determine who paid for the study and whether it reinforces the position of the study sponsor. Then ask whether the study would have been released if the outcome differed from the position of the entity that paid for it.
Clearly, the NLC has a financial stake in opposing cancer presumption legislation. Presumption means there is a probability that an injury or disease is work-related. Currently 28 states and seven Canadian provinces have enacted presumption legislation for firefighters who get cancer. There is pending legislation in eight other states.
The cost of state-mandated firefighter cancer presumption laws is actually borne by local municipalities. This is clearly stated in the NLC study, along with several other economic factors. For example, firefighter benefits often extend into the retirement years. This is especially troublesome to the NLC as volunteer firefighters often retire much later or become “members for life.” The report also describes the difficulty in projecting the short and long-term costs of cancer treatment.
But perhaps most troubling to the NLC is the higher costs of medical care under workers compensation laws compared to those under health management systems. This is attributed to fewer controls on the distribution of care for workers compensation costs. For example, the report states that workers compensation rates have risen at twice the rate of health management systems, and the trend will likely continue. Moreover, the report states that because cancer is prevalent in the general population, many firefighters with cancer would have contracted cancer even if they had worked in a different profession.
The report goes on to raise the issue of fairness to employees other than firefighters who may be exposed to hazards. And the report states it is very difficult to fight presumption legislation because of the “high esteem in which firefighters are held and the respect the public has for the risks they face.”
The NLC study makes a strong case for additional studies. This is the lifeblood of consulting firms. They rarely submit a report that does not leave the customer wanting for more. And a consulting firm that conducts a study is the likely candidate to continue with additional studies. The NLC study’s executive summary concludes by identifying eight policy questions that deserve “additional consideration” and five recommendations. The recommendations are:
- Undertake a large, longitudinal study of firefighters that tracks the same type of information on the same subjects at multiple points in time.
- Establish a national firefighter cancer database that collects detailed data on firefighters diagnosed with cancer.
- Establish public-private partnerships to guide cancer research.
- Work with the Congressional Fire Services Caucus to secure funding for a clearinghouse for fire service research.
- Encourage unbiased research at institutions of higher learning.
Those are reasonable recommendations, but they could be designed to delay decisions on cancer presumption legislation for years.
Several fire service organizations and leaders challenged the NLC report when it was issued for that reason and others, among them that the study’s review of research on cancer and firefighters was incomplete and defective.
The International Association of Fire Chiefs and the International Association of Fire Fighters issued a very strong joint statement denouncing the report. “The new paper produced for NLC by TriData is not credible and is reminiscent of the strategy and spin once used by the tobacco industry, which denied for years that smoking causes lung disease and that nicotine is addictive,” the joint statement said. ” The NLC’s paper is just as intellectually dishonest today as those cigarette company claims were back then.”
The statement also declared, “The NLC’s propaganda is seriously flawed and must be tossed aside when investigating the need for presumptive laws for firefighters and certain types of cancer.”
The U.S. Fire Administration also released a statement raising serious doubts about the report.
However, because the report is now published and available to bureaucrats and politicians, it will be used to try to counteract future presumption legislation. In Pennsylvania, politicians and a newspaper, the Wilkes-Barre Citizens’ Voice, have already used it to oppose a cancer presumption bill.
In these economic times, the doubt cast by the NLC study may be all that is needed to deter presumption legislation.
The report states that technological advancements such as self-contained breathing apparatus and increased enforcement of personal protective equipment policies have reduced the risks of cancer for firefighters. While this is obvious, there was no mention in the report or in any of the published rebuttals about the risks of working with contaminated gear and equipment. No doubt the by-products of combustion are laden with potential cancer causing agents.
Several years ago, Portland (Ore.) Fire & Rescue had an analysis conducted of chemical effluent in their in-service turnout gear, and the report clearly indicated the chemical hazards encountered by firefighters. Imagine the numbers that would be revealed if similar analyses were conducted on fire hose. The report underscores the advantages and the need to clean gear and equipment. The report also indicates that cleaning is not 100 percent effective. In addition, there will always be an exposure time between contamination and cleaning.
The National Fire Protection Association 1851 Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting prescribes the measures fire departments should take to select, clean, store, repair and retire their PPE. (There will be more on this in a later column.)
Firefighters are clearly exposed to more cancer causing agents than the general population. And, it’s not just while fighting fires. Hopefully the day will come when firefighters will not be more likely to get cancer, but that day is not imminent.
If you know any firefighters who are battling cancer, please refer them to the Fire Fighter Cancer Foundation (www.ffcancer.org). It’s a noble cause.
Editor’s Note: Robert Tutterow, who has 30 years in the fire service, is the Charlotte (N.C.) Fire Department health and safety officer. He is a member of the National Fire Protection Association (NFPA) Fire Department Apparatus Committee and is on two other NFPA committees, the Structural and Proximity Firefighting Protective Ensemble Technical Committee and the Technical Correlating Committee for Fire and Emergency Services PPE.