NOT JUST SMOKE

Sub-Officer/Paramedic Terry Dent outlines the toxins that put firefighters in danger, and how DFB can work together to reduce the risks

In 2016, while researching topics for my dissertation, I came across a quotation from The World Health Organisation International Research on

Cancer Working Group, who in 2007 classified firefighting as

“possibly carcinogenic to humans”.

Being a firefighter for nearly 29 years at that time, this caught my attention. The article suggested that

“further research should be carried out to increase comprehension of what risks are involved”.

I carried out a survey to ascertain the level of awareness Dublin firefighters had of how different toxins can enter their bodies. As you would expect, their understanding of the dangers of smoke inhalation was very high, but awareness of other ways toxins can enter their bodies was not as high, nor was the importance of personal hygiene, cross contamination of fire contaminates and regular PPE laundry.

Most of the research data in this article comes from fire services around the world such as the USA, Canada, Australia and the Nordic countries, primarily Denmark, who for many years have been promoting education to make their firefighters more aware of the long-term health risks when exposed to the types of carcinogenic material produced during a fire.

LONG-TERM RISK

It’s this long-term health risk that can reduce peoples’ understanding of the dangers. The latency period may be many years after exposure, and this may be one of the reasons firefighters develop bad habits such as not keeping SCBA on “after the fire is out”, during the damping down phase, or not using high-quality face masks as much as they should. This lack of understanding can

Firefighters in smoky fire conditions

also lead to a lack of awareness around the dangers of bringing highly toxic and carcinogenic material we work in back to where we “live”.

In November 2020, Professor Anna Stec from the University of Central Lancashire completed an in-depth research project commissioned by the UK Fire Brigade Union (FBU), involving 10,000 serving firefighters, and unfortunately it discovered 4.1% of respondents had previously been diagnosed with a cancer. This is compared with lower than 1% for the same amount of the general population. Of these, three quarters have served for at least ten years before receiving their diagnosis. More than half are under the age of 50 and a fifth are under 40.

Professor Stec said: “In my opinion, there is a direct link between firefighters’ occupation and cancer.” She added that her research showed that firefighters showed above average

rates for several types of cancer. Of those diagnosed, 26% have skin cancer, followed by testicular cancer (9%) and head and neck cancer (5%). A copy of the report can be found at https://www.fbu.org.uk/publication/ minimising-fi refi ghters-exposure-toxicfi re-effl uents. In parts of Canada, the United States, and Australia, they have introduced Presumptive Legislation to recognise certain cancers as occupational diseases amongst fi refi ghters. In the UK, it has so far been concluded that there is not enough evidence to link occupational exposure to carcinogenic fi re effl uents and the higher risk of cancers, which means that if a fi refi ghter believes their illness is work-related, they are required to prove it in each case. This would also be the case in Ireland at the moment.

TOXINS

The amount of man-made materials now being used in building construction has led to much higher levels of toxins and carcinogenic material being produced at fi res. The chemical composition of the smoke generated at a standard house or vehicle fi re includes numerous toxic compounds, including: • Polycyclic Aromatic

Hydrocarbons (PAHs); A group of more than 1,000 different chemicals released from burning coal, oil, petrol/diesel, rubbish, tobacco, wood, etc. Their soot particles land on our PPE, exposed areas of skin, or are inhaled. When they dissolve,

PAH particles can be absorbed into others to form many more unknown toxic compounds. There is more toxic material produced at the “smouldering” stage of the fi re, when a lot of fi refi ghters have removed their SCBA. These toxins can be absorbed into fi refi ghter’s bodies in three main ways: • Inhalation; by the early removal of SCBA during the damping down phase. • Ingestion; some of the airborne material can make it into the throat and stomach of fi refi ghters where it is then absorbed into the blood stream through the digestive system. • Absorption; Particles some small enough to penetrate the skin by diffusion. In the USA, the National

Institute for Occupational Safety and Health (NIOSH), together with the Centre for Disease

Control and Prevention (CDC), (2013) describe how toxins can be absorbed by dermal absorption.

The diffusion takes place by three methods. The fi rst is Intercellular

Lipid Pathway, when chemicals enter the body through the lipidfi lled spaces between skin cells. The second is Transcellular Permeation when toxins permeate cell to cell, diffusing directly through the outer skin. The third is through hair follicles and glands, and although this pathway is usually insignifi cant because the surface area is small, slower permeating chemicals may employ this pathway during the initial stage of absorption.

the body more easily through skin cells, and are stored in fatty tissues where they can cause mutations leading to tumours. • Volatile Organic Compounds; organic chemicals with very low boiling points, resulting in evaporation even at room temperature. They are the smells we get from our PPE off-gassing. An example is formaldehyde, which has a boiling point of -19°C. National

Cancer Institute researchers have concluded exposure to formaldehyde may cause leukaemia, particularly myeloid leukaemia. (American Cancer Society; May 2014). • PVC Plasticisers; Found in thousands of household items. Di(2ethylexyl) phthalate (DEHP) was found in much higher levels than any other plasticiser. It was found on every item of fi refi ghters’ PPE tested, in the USA. It was added to the European Chemicals Agency (ECHA) list of “Substances of very high concern”.

Unfortunately for fi refi ghters, skin’s permeability increases with temperature and for every 5 degree increase in skin temperature, absorption increases by 400%. It is worth reading this fact again. So, it’s not “just Smoke” - Along with these individual toxins/ compounds, there is also the risk from the synergetic affect which causes these compounds to break down as they are burning and joining with

Toxins and carcinogens commonly released by fi res

PARTICLE EXPOSURE AND PPE

The International Association of Firefi ghters commissioned full particle exposure testing at the Research Triangle Institute in North Carolina. A volunteer was kitted out in full fi refi ghting PPE with SCBA and placed inside a particle-laden chamber, then asked to perform movements similar to ones done while fi refi ghting, such as raising arms, crouching down, bending and twisting. Afterwards, his PPE was removed by volunteers who were careful not to cross-contaminate his body. Around the neck area (through his fl ash-hood) had some of the highest skin absorption levels. The torso at the waist level where the jacket met the leggings, and his hands were also contaminated, but what surprised the researchers was that contamination was seen as high up as the groin area. This was probably caused by the “bellows” effect: when the fi refi ghter crouched down, he expelled the clean air that was inside his leggings, resulting in contaminated air being drawn inside the leggings when he stood up. Firefi ghters must understand what their PPE was designed to protect them from. Thermal protection is its main function. It is not a gas-tight suit. At this time, fi refi ghter PPE can reduce but cannot stop these particles getting onto their skin. The table below was devised by Dr Stuart Baxter, a leading dermatologist in the USA. It shows the absorption rates for different parts of the body. Firefi ghters should note the high rates of absorption for the groin area and the jaw, forehead and scalp. It shows the importance of using wet-wipes immediately after fi refi ghting, along with taking a full body shower as soon as possible. The shower should be just warm, not hot water to avoid skin temperature rising again. • 51% greater chance of non-Hodgkin lymphoma • 39% greater chance of skin cancer • 32% greater chance of brain cancer • 28% greater chance of prostate cancer • 22% greater chance of stomach cancer • 21% greater chance of colon cancer Cincinnati University head researcher Grace LeMasters stated: “Firefi ghters are exposed to numerous cancer-causing substances. We feel that the protective gear

CANCER RATES

Soot can penetrate PPE because of its small size, illustrated here by the red particles. The University of Cincinnati carried out a three-year study, “Cancer Risk among Firefi ghters: A Review and Meta-analysis of 32 Studies” which was completed in 2005, and the results of that study concluded that fi refi ghters have a: • 102% greater chance of contracting testicular cancer than any other type of worker • 53% greater chance of multiple myeloma that protects them from acute exposures, such as heat and carbon monoxide, doesn’t protect them from the chemical residues that cause cancer.” (It must be noted that PPE has improved signifi cantly since this study) In the USA, the accepted overall increased risk for a fi refi ghter to develop a cancer is 9% (NIOSH) compared with the general public. (https:// fi refi ghtercancersupport.org). But this must be added to the Irish Cancer Association fi gure of one in every two people living in Ireland contracting cancer at some stage in their life. Unfortunately, the chances of a fi refi ghter dying of a cancer is 14% above the general population once they are diagnosed. In San Francisco (which has one of the highest ratios of female fi refi ghters) the Women Firefi ghter Biomonitoring Collaborative Study (http:// womenfi refi ghyerstudy.com) in conjunction with Berkeley University carried out research in 2013 to determine why there is a 15% above average breast cancer rate for premenopausal female fi refi ghters, six times higher than the national average. Current studies are focused around

exposure to three specific toxins: flame retardants found on most household furniture, prefluorinated chemicals (PFCs) which make fabrics resistant to water and staining, and Diesel Exhaust gases. Studies have found exposure to these chemicals contribute to the development of mammary gland tumours.

Queensland Fire and Emergency Services, (Australia) and NIOSH (USA), carried out independent studies in relation to off-gassing from firefighter PPE, and both found raised levels of VOCs off-gassing from the PPE. NIOSH concluded that there was a direct relationship between the concentrations of the off-gassing chemicals and the analysis of exhaled breath samples taken from firefighters for traces of Benzene, Toluene, Ethylbenzene, Xylenes and Styrene, while “concentrations of Hydrogen Cyanide (HCN) were found to be ten times higher than any other compound present”.

QFES, however, discovered that the concentrations of chemicals off-gassing returned to normal levels after the PPE had been laundered.

WHAT CAN WE DO?

While a lot of the information in this article seems very negative for firefighters, the aim is to raise awareness of the environment firefighters work in, and the types of toxins they are exposed to.

The Hazmat decontamination policies that exist in Dublin Fire Brigade are without question more than adequate for decontaminating firefighters if responding to that type of incident. But now we must understand that due to the amount of man-made materials involved in domestic, vehicle, skip/rubbish fires and long exposure during wild fires, we need to consider these exposures as just as harmful to our health.

FIRE CONTAMINATE GUIDELINES:

• Wear your full PPE at all incidents, including wearing BA at vehicle fires, facemasks at wildfires (Min.

FFP3), and during the damping down phase of the incident • Remove as much heavy contamination

from PPE before leaving the fire ground, and wash any equipment used at scene • Heavily contaminated and/or soiled PPE should not be worn on the appliance returning to station, and the OIC should inform the

ERCC that the crew require decontamination and PPE change • Flash-hoods should be washed on a regular basis • Correct transporting of PPE in private vehicles, using sealed or zipped bags, such as those issued by DFB • PPE should be checked for cleanliness as well as damage, and sent for laundry regularly • Keep equipment and appliances free from contamination, and keep living and administration areas in your station free from cross contamination • Shower using warm water, as soon as possible • Do not leave motors running inside engine bays, as diesel exhaust gases are classified as a

Group 1 carcinogen, the same group as Asbestos • Try to maintain a healthy weight and be aware of alcohol intake and diet

EXPOSURE TRACKING

The establishment of an exposure tracking system would be a way to help build a profile for each firefighter’s exposure to dangerous toxins which they may have during their careers. They have been developed in the USA, Canada and some countries in Europe.

The National Fire Operations Reporting System (NFORS) Exposure Tracker App, developed by the International Public Safety Data Institute (IPSDI) offers firefighters in the US a way to track incidents and maintain an up-todate data set of their exposure to harmful contaminants, the data from which will help researchers better understand how occupational cancers and other hazards are contracted.

It would be a great benefit in developing this programme if I could gather information about firefighters who have contracted a cancer while still serving or in retirement to help build a profile of how this illness has affected any of them, past or present. Obviously, I am fully aware that this type of personal information is highly sensitive, but if you would be interested in taking part in an anonymous survey, please go to this link: https://consultation.dublincity.ie/ learning-and-development/ab3c9c7f or scan the QR code below. I would like to get as many retired members to take part as possible.

THE FUTURE

Going forward, I’d like to recruit representatives in every station to help coordinate further awareness and education on this topic with a oncea-year cancer awareness program displaying posters and literature. The Movember Movement run by firefighters is a great example of keeping this topic to the forefront of people’s minds on an annual basis.

Getting people to change the bad habits that have become the norm is not easy and will not change overnight. We need people to help roll out this programme, people who are genuinely interested in firefighter’s health. It will be a long-term investment, but if we can make small changes to the way we do things, we can not only enjoy a long and healthy career, but also a long and healthy retirement.

If you are interested in becoming involved, get in touch with myself and I will be happy to talk to you about where we are hoping to go in the future.

All information correct at time of research.