The firefighter cancer epidemic: Protect yourself and your crew

Over the past few years, it has been increasingly clear that the fire service is facing an epidemic. Cancer has quickly become the leading health threat facing firefighters.

Almost every firefighter has been impacted by cancer in some way, whether it is their own diagnoses or someone they know. For me, my life completely changed four years ago when my doctor told me I had B-cell non-Hodgkin’s lymphoma. Adding to my shock was the revelation that this is the fastest growing cancer in the fire service.

As firefighters, we do our jobs to help others and protect our communities. In our enthusiasm to serve, we often forget about our own health and safety. This leaves us vulnerable to numerous risks, with cancer being at the forefront.

What we must remember is that the health and safety choices that we make as first responders impacts not only us, but our crew, our families, and our communities. We owe it to ourselves and to those we care about to do everything we can to protect ourselves so we can continue to be there for them.

The good news is that there are specific actions that every firefighter can take to lessen their risks of cancer.

Higher cancer rates

It is true that cancer affects all people, not just firefighters. However, the rate of cancer in firefighters far outpaces the rate for the general population.

Dozens of studies have been conducted in many different nations to determine if there is a correlation between firefighting and cancer. The findings have made clear that firefighters have a higher risk for many types of cancer.¹

A multi-year study of U.S. firefighters completed in 2015 by the National Institute of Occupational Safety and Health (NIOSH) found that firefighters have a greater number both of cancer diagnoses and cancer-related deaths. In addition, firefighters are more likely to get certain types of rare cancers, such as malignant mesothelioma. Another key finding was that firefighters are getting certain cancers at a younger age than would be expected in the general population.²

Summarizing the findings of multiple studies, the Firefighter Cancer Support Network states that firefighters are at increased risk of the following types of cancers: testicular, multiple myeloma, non-Hodgkin’s lymphoma, skin, prostate, malignant melanoma, brain, colon, leukemia, and breast cancer.³

Why cancer?

The fireground today is not the same as it was 50 years ago. The synthetic materials used in the majority of today’s home goods burn hotter, faster, and more toxic. Firefighters are at risk when they breathe in the smoke and soot, absorb it through their skin, and carry it on their gear.

In the past, firefighters often prided themselves on dirty, sooty gear and would take protective equipment off immediately after the fire was out (if they were even properly wearing their PPE and SCBA in the first place). We now know these types of behaviors result in harmful, cancer-causing exposure to the firefighter. Change must be made in how responders approach firefighting so that they are not exposing themselves, their crew, and their family to dangerous carcinogens.

Uniting against cancer

Fire service organizations have come together to address the cancer epidemic and provide guidance to firefighters and leadership on specific actions they can take. The Fire Service Occupational Cancer Alliance was created to unite organizations under the common goal of preventing firefighter cancer.

It is clear that there are specific actions firefighters can take to protect themselves from occupational cancer. We can no longer ignore the dangers and pretend that certain behaviors – like wearing dirty gear – won’t kill us.

In 2017, the National Volunteer Fire Council (NVFC) and International Association of Fire Chiefs’ Volunteer and Combination Officers Section (VCOS), in coordination with other fire service organizations, developed a list of 11 actions firefighters can take to mitigate their risks. In November of that year, members of the NVFC Cancer Focus Area, including myself, and the VCOS Cancer Task Force met at the Symposium in the Sun in Clearwater, FL, to discuss ways in which both cancer groups, working together as one, can take these 11 Best Practices for Preventing Firefighter Cancer and expand on each with more detail. The discussions led to the development of three joint webinars that would lay the foundation for the Lavender Ribbon Report.

Authored by members of the NVFC Cancer Focus Area and VCOS Cancer Task Force, the Lavender Ribbon Report: Best Practices for Preventing Firefighter Cancer provides specific information about each of the 11 mitigation actions and how individuals and departments can implement each of these actions. The title was chosen because lavender is the symbol of general cancer awareness and represents all cancers.

Mitigating your risks

The 11 Best Practices for Preventing Firefighter Cancer are as follows:

1. Full personal protective equipment (PPE) must be worn throughout the entire incident, including SCBA during salvage and overhaul.
2. A second hood should be provided to all entry-certified personnel in the department.
3. Following exit from the IDLH, and while still on air, you should begin immediate gross decon of PPE using soap water and a brush, if weather conditions allow. PPE should then be placed into a sealed plastic bag and placed in an exterior compartment of the rig, or if responding in personal vehicles, placed in a large storage tote, thus keeping the off-gassing PPE away from passengers and self.
4. After completion of gross decon procedures as discussed above, and while still on scene, the exposed areas of the body (neck, face, arms, and hands) should be wiped off immediately using wipes, which must be carried on all apparatus. Use the wipes to remove as much soot as possible from head, neck, jaw, throat, underarms, and hands immediately.
5. Change your clothes and wash them after exposure to products of combustion or other contaminants. Do this as soon as possible and/or isolate in a trash bag until washing is available.
6. Shower as soon as possible after being exposed to products of combustion or other contaminants. “Shower within the Hour.”
7. PPE, especially turnout pants, must be prohibited in areas outside the apparatus floor (i.e. kitchen, sleeping areas, etc.) and never in the household.
8. Wipes, or soap and water, should also be used to decontaminate and clean apparatus seats, SCBA, and interior crew area regularly, especially after incidents where personnel were exposed to products of combustion.
9. Get an annual physical, as early detection is the key to survival. The NVFC outlines several options at www.nvfc.org. “A Healthcare Provider’s Guide to Firefighter Physicals” can be downloaded from www.iafc.org/healthRoadmap.
10. Tobacco products of any variety, including dip and e-cigarettes, should never be used at anytime on or off duty.
11. Fully document ALL fire or chemical exposures on incident reports and personal exposure reports.

These actions should be adopted by departments as standard operating procedures and strictly adhered to at all times. Download a poster of the best practices to hang at your station as well as the Lavender Ribbon Report for more guidance on each practice from the NVFC web site at www.nvfc.org/cancer.

What’s next?

We continue to make strides in the right direction. Awareness about the cancer epidemic is growing, and the culture is shifting in many departments towards one that embraces health and safety.

In the U.S., a law was recently passed that will create a national registry of firefighters to collect relevant history and occupational information to track links between occupational exposures and cancer. This data will help researchers and fire service organizations better understand the risks and needs relating to occupational cancer.

This is not something that can wait – we must take action now! I have seen too many of my friends and colleagues battle this disease, and sadly it is a battle some have lost. Be proactive in preventing firefighter cancer, and together we can turn the tide and stop this epidemic.

For more information, go to www.nvfc.org/cancer

References

1. LeMasters et. al. (2006, November). Cancer Risk Among Firefighters: A Review and Meta-analysis of 32 Studies. Retrieved from http://www.iaff.org/hs/PDF/Cancer%20Risk%20Among%20Firefighters%20-%20UC%20Study.pdf
2. NIOSH (2016, July). Findings from a Study of Cancer among U.S. Firefighters. Retrieved from https://www.cdc.gov/niosh/pgms/worknotify/pdfs/ff-cancer-factsheet-final.pdf
3. Firefighter Cancer Support Network (2013, August).Taking Action Against Cancer in the Fire Service. Retrieved from https://firefightercancersupport.org/wp-content/uploads/2017/11/taking-action-against-cancer-in-the-fire-service-pdf.pdf