FCSN White Paper

DOING IT

RIGHT

REDUCING CANCER IN THE FIRE SERVICE THE ROLES FIREFIGHTERS & ADMINISTRATORS PLAY IN KEEPING FIREFIGHTERS CANCER FREE

SEPTEMBER 2024

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DESIGNED BY CRACKYL MEDIA INC.

THE

WORK GROUP DR. JEFFEREY BURGESS

Director, Center for Firefighter Health Collaborative and Research Professor, Mel and Enid Zuckerman College of Public Health University of Arizona, Firefighter Cancer Support Network Health and Wellness Advisory Council

CURTIS DUNN

Vice President West Firefighter Cancer Support Network, Ret. Lieutenant, Arlington (TX) Fire Department

DR. KENNY FENT

Director, NIOSH National Firefighter Registry for Cancer, FCSN Health and Wellness Advisory Council

Ten years later, FCSN convened a group of thought leaders and experts in this field to assess how far we’ve come in the past decade and what still needs to be done. The 2023 work group comprised:

TIM GRAVES

Fire Protection Specialist at New York State Office of Fire Prevention and Control Firefighter Contamination Reduction and and program director at Cancer Prevention

JOHN GULOTTA

Captain, Safety and Wellness Research Liaison, City of Tucson Fire Department

DR. MICHAEL HAMROCK

Internal medicine and addiction medicine at St. Elizabeth’s Medical Center, Firefighter Cancer Support Network Health and Wellness Advisory Council

GAVIN HORN

Board President, Firefighter Cancer Support Network, and Ret. Fire Chief, Pasadena, CA

Research Director, Fire Safety Research Institute, UL Research Institutes; member, Firefighter Cancer Support Network Health and Wellness Advisory Council

ORION GODFREY

KEPRA JACK

BRYAN FRIEDERS

Captain, Goodyear (AZ) Fire Department, Professional Firefighters Arizona State Cancer Coordinator

DR. JUDITH GRABER

Associate Professor, Rutgers, the State University of New Jersey University, School of Public Health

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In 2013, the Firefighter Cancer Support Network assembled a group of experts to tackle firefighter cancer. They met and published Taking Action Against Cancer in the Fire Service.

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Chief Operating Officer at HeartFit for Duty, LLC

DR. SARA JAHNKE

Chief Operating Officer and Senior Scientist Center for Fire, Rescue, and EMS Health Research, Firefighter Cancer Support Network Health and Wellness Advisory Council

DOING IT RIGHT: REDUCING CANCER IN THE FIRE SERVICE

SCOTT JENNIE

National State Director Firefighter Cancer Support Network, Retired Laguna Beach Fire Department

DR. CHRISTINE KANNLER

Dermatologist, Firefighter Cancer Support Network Health and Wellness Advisory Council

ED KLIMA

Managing Director, First Responder Center for Excellence

MARIA KOEPPEL

Associate Research Scientist for NDRI

GARY KRICHBAUM

Managing Director of the National Fallen Firefighters Foundation

FRANK LEEB

Deputy Assistant Chief - Chief of Safety FDNY

DR. CANDICE MCDONALD

Deputy Chief Executive Officer National Volunteer Fire Council

BRYAN ORMOND

Assistant Professor at Textile Protection and Comfort Center at North Carolina State University

RUSSELL OSGOOD

Vice President Education, Outreach, and Research Firefighter Cancer Support Network, Chief Ogunquit (ME) Fire Department

JEFF PAULEY

Member and Immediate Past Chairman, Health & Safety Committee, International Association of Arson Investigators

LISA RAGGIO

Executive Director Firefighter Cancer Support Network

JOE SCHUMACHER

COO Firefighter Cancer Support Network / Cancer Survivor / Ret. Captain, City of Fairfax (VA) Fire Department

DR. DENISE SMITH

Skidmore College Tisch distinguished professor, professor of health and human physiological sciences department and director first responder health and safety laboratory

LAURIE VANDESCHOOT

Instructional Design Specialist for NDRI

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RECOMMENDATIONS The work group came away with two recommendation tracts for reducing firefighter cancer. While there is some overlap between the two, the broad recommendations are aimed at:

1 WHAT FIREFIGHTERS CAN DO ON AND OFF THE JOB TO REDUCE THEIR OWN RISKS.

2 WHAT FIRE DEPARTMENT LEADERS AND LOCAL GOVERNMENT LEADERS CAN DO TO REDUCE THEIR FIREFIGHTERS’ CANCER RISKS.

These recommendations apply equally to career firefighters and noncareer firefighters who reside somewhere in the part time, paid on-call and volunteer sectors.

They include structural, wildland, WUI, airport and industrial firefighters.

UNTIL THERE IS A PROVEN CURE OR VACCINE FOR CANCER, THE PATH FORWARD WILL BE ONE OF CONTINUOUS LEARNING AND ADJUSTMENT TO EQUIPMENT, POLICIES AND PRACTICES BASED ON THAT LEARNING TO BEST MITIGATE OUR FIREFIGHTING-RELATED CANCER RISKS.

CANCER IN THE FIRE SERVICE DOES NOT DISCRIMINATE BASED ON PAY OR LACK OF PAY. CANCER IS AN EQUAL-OPPORTUNITY THREAT, AND MOST MITIGATION TACTICS ARE APPLICABLE ACROSS VARYING FIRE DEPARTMENT STRUCTURES WITH SOME ALLOWANCES NECESSARY. Until there is a proven cure or vaccine for cancer, the path forward will be one of continuous learning and adjustment to equipment, policies and practices based on that learning to best mitigate our firefighting-related cancer risks.

This is a process that will be in a constant state of change, which can be a challenge when seeking buy-in from firefighters, instructors and administrators. Concise, consistent and digestible solutions are what we want. It makes policies easier to write, fund and enforce. It makes it more likely best practices will become common habits.

Yet, we are still learning the intricacies of firefighting’s link to cancer, and still learning the best ways to reduce incidents of cancer. The fire service will need to remain simultaneously committed to current best practices and adaptable to change as we learn more about this deadly relationship.

This process will involve more research. That will require funding for new research projects and participation by the fire service in existing ones like the National Firefighter Registry for Cancer.

IT WILL INVOLVE BAKING STATE-REQUIRED CANCER PREVENTION INTO THE CAKE AT THE FIRE INSTRUCTOR AND FIRE ACADEMY LEVEL SO THAT IT IS INGRAINED IN THE ENTIRE CURRICULUM RATHER THAN AFTER A FIREFIGHTER HAS RECEIVED A DIAGNOSIS.

LEARN MORE ABOUT THE NATIONAL FIREFIGHTER REGISTRY FOR CANCER

FIREFIGHTERCANCERSUPPORT.ORG

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STEP ONE FOR EVERY FIREFIGHTER IS TO IDENTIFY THEIR PERSONAL “WHY.” IT CAN BE POWERFULLY INSPIRING TO DEFINITIVELY ANSWER WHAT IS THEIR MOTIVATING FACTOR TO LIVE AS LONG AND WITH THE BEST HEALTH POSSIBLE.

PART 1:

HOW FIREFIGHTERS CAN

REDUCE

CANCER RISKS FIREFIGHTERCANCERSUPPORT.ORG

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KNOW THE “WHY” Step one for every firefighter is to identify their personal “why.” It can be powerfully inspiring to definitively answer what is their motivating factor to live as long and as healthy as possible.

Yes, we are complex creatures, and many of us will have multiple “whys.” Yet, putting a name and image to one critical “why” will serve as a touchstone for sticking to best practices when that is not the path of least resistance.

That “why” could be an important person.

It could be a partner you want to grow old with, children or grandchildren with whom you want to share their life accomplishments. It could be a life mission, such as furthering a cause you believe in. It could be religious conviction.

WE NEED TO TAKE AN HONEST INVENTORY OF WHAT MATTERS TO US AND IDENTIFY HOW THAT MOTIVATES US TO LIVE A LONG, HEALTHY LIFE. We need to remind ourselves of our reason to live — that “why” — when we are tempted to do things that could interfere with that purpose.

Some are still prone to not wearing full PPE in IDLH environments — possibly because it is cumbersome or they want to fit in with an existing culture of outdated practices. This is just one example of how we do things against our own best interest. Drinking amounts of alcohol that damage the body is another. The same goes for unhealthy dietary choices, failing to exercise and use of tobacco.

Drinking alcohol and chewing or smoking tobacco are the leading causes of cancer in the US. It seems like identifying a “why” shouldn’t be necessary. Cancer, even when it doesn’t kill, causes

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DOING IT RIGHT: REDUCING CANCER IN THE FIRE SERVICE

a great deal of physical, emotional and financial pain.

And statistics continue to show that firefighters are at a greater risk (9%) of developing cancer and are 14% more likely to die from cancer than the general public.1 Rationally, avoiding that level of discomfort and even death should be motivation enough. Yet when you consider how confident science is and how accepting the general public is that tobacco use directly causes cancer, you would think that no firefighter would use tobacco. Of course, that is not the case. Many firefighters use tobacco and alcohol as a form of stress relief, which it can provide in the short term.

And there are other examples of knowing the changes we need to make to mitigate cancer risks, but still need to make.

For example, in 2013 the work group advised that firefighter hoods be laundered regularly and not worn around the neck and throat when not in use, because studies have shown that carcinogenic material migrates from hoods and is absorbed through the skin. Yet in 2023, hood washing and improper use remained an issue.

THIS IS WHY THE “WHY” QUESTION IS CRITICAL TO LASTING BEHAVIOR CHANGE IN THE FIRE SERVICE. WE NEED TO SIMULTANEOUSLY ACCEPT THAT WE ARE NEITHER IMMUNE FROM CANCER NOR DESTINED TO DEVELOP IT. We are also not alone — we need to work together to empower and support each other to make these changes together. Having a solid, motivating “why” will help with the acceptance of and the discipline to follow best practices — both on and off the job.

AWAY FROM THE STATION We are learning more and more about the interrelatedness of illnesses and injury. Cancer, heart disease, mental health injury, physical injury and other serious illnesses are increasingly linked as contributing factors to one another.2 The bad news is that unhealthy behaviors have a compounding risk for multiple problems beyond cancer. The good news is that when we change to healthy behaviors, they have a positive multiplying effect.

The big hitters in the lifestyle category are alcohol use, unprotected sun exposure, inadequate sleep and exercise, unhealthy diet, tobacco use, obesity and stress. The following is a look at the role each of those play.

PART 1: HOW FIREFIGHTERS CAN REDUCE CANCER RISKS

CURB ALCOHOL The International Agency for Research on Cancer (IARC) classifies alcohol as a cause of human cancer group 1 carcinogen3, as it now does the occupation of firefighting4 — both are listed as Group 1 carcinogens. For the past decade, scientists have collected data on alcohol consumption among firefighters. There is a high rate of heavy use and binge drinking.5 Alcohol metabolizes into acetaldehyde, which most researchers say is the leading cause for the increase in risk.5 The safest bet is to not drink any alcohol.6 If you do drink, limit the amount per session to one drink if you are female, and two drinks if you are male. One drink is 12 ounces of beer, 5 ounces of wine or an ounce of spirits. Keeping a drink diary helps you track and reduce how much you drink each day. Be intentional about how much you intend to drink and compare that with what you actually drank. It can be difficult to change what you don’t measure. Importantly, support your fellow firefighters when they choose to drink less alcohol — or none at all.

1/2 DAILY DRINK MAX

BE SUN SMART IARC also classifies ultraviolet radiation as a cause of skin cancer (melanoma and malignant non-melanoma cancer). The sun, sunlamps and tanning booths are all sources of ultraviolet radiation that damages the skin. The risk for melanoma, the most serious form of skin cancer, is increased with exposure to UV radiation from all sources.7 Taking steps to protect ourselves against UV can be difficult on the job. That makes it doubly important to mitigate the risks when off duty.

Limit the amount of time spent in the sun and protect your skin by using sunscreen with sun protection factor (SPF) of at least 15 — some doctors recommend a minimum 30 SPF. In addition to your face, apply sunscreen to all exposed areas, which may include ears, neck and hands. Reduce your time in the sun, especially between mid-morning and late afternoon, and avoid other sources of UV radiation, such as tanning beds.

Keep in mind that UV radiation is reflected by sand, water, snow and ice, and can pass through windshields and windows.8 Wear clothing that protects your skin. This includes hats, long sleeved shirts and long pants made from tightly woven fabric or fabrics rated with an ultraviolet protection factor.

Wear sunglasses that block UV radiation to protect the skin around your eyes.

The NFPA recommends that firefighters get screened for skin cancer once a year.

This is a simple and effective tool for reducing the risk of dying from skin cancer.

Melanoma found early is highly treatable. To locate a dermatologist in your area, visit the American Academy of Dermatology.

15 AT LEAST SPF

LEARN MORE ABOUT THE AMERICAN ACADEMY OF DERMATOLOGY

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PATIENTS WHO SLEPT LESS THAN 6 HOURS PER NIGHT BEFORE THEIR CANCER DIAGNOSIS WERE

PRIORITIZE SLEEP Sleep disruption is part of the job, and a part that many of us take home after the shift or call.

Research is showing a link between poor sleep and cancer — as well as heart attacks, obesity, anxiety, depression and suicide.9 A cancer research center in Seattle found that patients who slept less than 6 hours per night before their cancer diagnosis were 50% more likely to die from the disease than people who slept 7 to 8 hours per night.9 Nowadays, you can’t turn around without bumping into a list of good sleep hygiene habits.

That said, sleep is so critical to cancer mitigation and overall health and longevity that they are worth repeating.

50% MORE LIKELY TO DIE FROM THE DISEASE THAN PEOPLE WHO SLEPT 7 TO 8 HOURS PER NIGHT.

THE MAYO CLINIC OFFERS THESE TIPS: 10 Make your bedroom dark, quiet and at a cool temperature.

If you cannot sleep, do not use electronics.

Limit exposure to bright light in the evenings and turn off electronic devices at least 30 minutes before bedtime.

Do not eat a large meal before bedtime: if you are hungry, eat a light, healthy snack.

Exercise regularly and maintain a healthy diet.

Avoid consuming caffeine in the afternoon or evening.

Get up at the same time every day, even on days off and during vacations.

Avoid consuming alcohol before bedtime.

Set a bedtime that is early enough for you to get at least 7 to 8 hours of sleep.

Keep a consistent sleep schedule.

GET PHYSICAL The popular saying among health advocates is that “sitting is the new smoking.” We’ve known for a long time that a sedentary lifestyle was bad for overall health. Recent research is linking low levels of activity with increased risks of, among other things, shortened lifespan, cardiovascular disease and some types of cancers.11 Hence, the comparison to smoking.

In fact, the National Institute of Health lists seven types of cancer where there is strong evidence linking increased incidence with lower physical activity.11 The collateral benefit of being more physically active is that it improves other cancer risk factors. For example, more active people are less likely to be overweight and more likely to have better sleep patterns.

The minimum weekly amount of activity adults should hit is 150 to 300 minutes of moderate exercise, 75 to 150 minutes of high-intensity exercise, or an equivalent combination of the two.11 Some firefighters should be able to hit those numbers on shift. For those at busy houses, those without fitness equipment or those who are part time or paid on-call, those exercise targets will need to be hit off duty.

Exercise works, NIH says, by reducing obesity, reducing inflammation, preventing high blood levels of insulin and by improving the immune system.11 There is no shortage of plug-and-play fitness programs to meet almost every fitness level and goal. Many of those are tailored to firefighters. One example is IAFF’s Fit To Thrive program.12 That program grew out of the IAFF and IAFC Wellness Fitness Initiative and the two groups’ Peer Fitness Trainer program.

Another resource that uses the existing tools within your department is Firefighter Functional Fitness: The Essential Guide to Optimal Firefighter Performance and Longevity by Dan Kerrigan and Jim Moss. Kerrigan teaches the National Volunteer Fire Council’s on-demand webinar Creating a Health and Fitness Program in Your Department.13

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DOING IT RIGHT: REDUCING CANCER IN THE FIRE SERVICE

THE MINIMUM WEEKLY AMOUNT OF ACTIVITY ADULTS SHOULD HIT IS

150-300 MINUTES OF MODERATE EXERCISE

PART 1: HOW FIREFIGHTERS CAN REDUCE CANCER RISKS

IN ONE STUDY, EXCESS WEIGHT WAS FOUND TO BE THE CAUSE OF CANCER IN

EAT RIGHT AND HYDRATE A healthy diet provides your body with the nutrients you need to thrive physically and mentally. It also means you are not consuming things harmful to your health and that increase your risk for some types of cancer. The gold standard is a diet made up of vegetables, leafy greens, fruit, nuts and beans, whole grains, lean proteins, high-quality fats and water.8 On the opposite end of the scale are highly processed foods, sugar, red and highly processed meats, white-flour carbohydrates, fast food and sweetened beverages.8 A low nutritional-quality diet will eventually lead to cellular damage and eventually organ damage. It also contributes greatly to poor cardiovascular health, poor brain function and, of course, cancer. An unhealthy diet can also lead to weight gain, which itself is tied to increased risk of cancer.

4.7% 9.6% OF MEN

OF WOMEN

And the fire service has a weight problem. Firefighters are more likely than the general population to be overweight or obese.14 According to the Centers for Disease Control and Prevention, being overweight or obese increases your risk of getting cancer. Overweight people are twice as likely to develop many cancers, including kidney and liver. As weight goes up, so too does the correlation to cancer. For example, endometrial cancer is seven times more likely in obese individuals.15 One US study looking at new cancer incidents between 2011 and 2015 found that excess weight was the cause in 4.7% of men and 9.6% of women.15 There are theories about why those who are overweight are more likely to develop cancers.

Fat tissue and fat cells play a role in hormone production, cell growth and metabolic regulators, increased inflammation and increased blood insulin levels.

Making smart food choices about what you eat and how much you eat is critical to keeping weight off and eliminating the increased cancer risk.

TOBACCO

TAMP OUT TOBACCO

WILL GIVE YOU CANCER

Tobacco is the leading cause of cancer and death from cancer in the general population.

There is no safe level of tobacco use. Immediately quitting tobacco use reduces cancer risk and increases life expectancy. These facts hold true for smoked and smokeless tobacco (such as chew and spit), the latter being related to increased risk of mouth, esophageal and pancreatic cancers. Even those who quit smoking at the time of a cancer diagnosis reduce their risk of dying from the cancer.16 Firefighters are less likely to smoke cigarettes than the general population, but are more likely to smoke cigars or use smokeless tobacco.

This is not squishy science or uncertain findings. Tobacco will give you cancer.

Don’t use tobacco — at all, ever.

Accepting that is easy; acting on it after years or decades of tobacco use can be difficult.

There is help. Tobacco addiction is treatable and curable.

Firefighters who are diagnosed with cancer could be at greater financial risk if they are tobacco users. Firefighting cancer presumption laws vary by state. Yet, firefighter tobacco use is an argument made to show that firefighting was not a primary cause of cancer and that benefits should be denied.

EXPLORE ONE COLLECTION POINT OF AVAILABLE RESOURCES

FIREFIGHTERCANCERSUPPORT.ORG

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WORK TO REDUCE

DE-STRESS Stress, especially chronic stress, is less tangible regarding its role in firefighter cancer than the more hard-and-fast facts related to tobacco use. Like tobacco use, poor diet and sedentary lifestyle, chronic stress contributes to other poor health outcomes that can contribute to cancer. For example, stress may lead you to smoke or drink, which will increase your cancer risks.17

STRESS WHEN OFF DUTY

While this topic has been studied by scientists, researchers have struggled to find the mechanism necessary for stress to cause cancer. A promising 2019 study did show that stress hormones could wake up dormant tumor cells as well as provide the right environment for their growth.17 As research continues, firefighters should focus on ways to reduce stress when off duty.

That is, live in a healthy way, rather than turning to alcohol, excessive eating or other behaviors that may do long-term harm.

As with exercise programs, there is no shortage of stress relief and stress reduction options. Some, such as engaging in regular physical fitness activities, will have added benefits to protecting firefighters from cancer. Other options range from therapy sessions with a certified professional counselor – to even owning a dog.17, 18 There is no magic solution for stress relief and some firefighters may need to try multiple options to get the results they need.

SCREENING CAN DETECT CANCER

EARLY CANCER SCREENING Cancer screening can detect cancer early, increasing the likelihood of successful treatment, and in some cases if found early, precancerous lesions can be removed, preventing the cancer from even starting.

Both the US Preventative Services Task Force and the NFPA have recommendations for cancer screening for some of the types of cancer that firefighters are at increased risk of getting (for example colon, prostate and melanoma).

If you get an occupational health screening exam from your fire department, some of these screenings may be included. All firefighters should make sure their primary healthcare provider knows that they are a firefighter and exposed to carcinogens that the general public is not on a regular basis, and talk to them about their cancer screening options.19

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DOING IT RIGHT: REDUCING CANCER IN THE FIRE SERVICE

PART 1: HOW FIREFIGHTERS CAN REDUCE CANCER RISKS

ON SHIFT OR

ON CALL

BEFORE THE TONE DROPS

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For all firefighters, the preventative measures are much the same as they are for off-duty.

That means making good diet choices, prioritizing sleep and exercise, reducing stress where possible and taking a hard pass on all tobacco products.

Both career and noncareer firefighters need to ensure their PPE is clean and in proper working order. This task is likely more regimented for career firefighters who should be checking their gear at the start of the shift. Noncareer firefighters need to make a routine for checking their PPE — and should avoid transporting their PPE in personal vehicles, or, when they must transport it, keeping it in a tightly sealed container.

ON SCENE Wear full PPE throughout the entire call. It takes courage to do this when others on the department are not wearing SCBA during overhaul (or during the fire). It takes courage to set the example — to be the change.

Another change many departments will want to look at is having breathing protection for engineers and pump operators and for investigators picking through the debris.

We are now seeing signs that both those roles are at an increased risk from cancer due to the smoke and material off-gassing on the fireground.20 This applies to vehicle fires as well. Researchers are still working to understand the toxicity of smoke and fumes from batterypowered vehicle fires. The best practice is full protection.

gently scrubbing using soap with surfactants (chemicals that cut grease) and rinsing the soap off the fully donned firefighter before leaving the scene can remove 85% of polycyclic aromatic hydrocarbons (PAHs) deposited on PPE surfaces as well as other fireground materials such as flame retardants.21 Using a nonalcohol wet wipe on face, neck and hands can remove 54% of PAHs from skin surface.21 Some recommendations call for removing and bagging the dirty gear prior to getting back on the apparatus, then stowing it in rear compartments away from crew members. This is the time to ditch the hood as well, as toxins have been shown to move from the dirty hood and where they can be absorbed through the neck and throat.22

Post-fire, on-scene gross decontamination has gone from a novel idea to an easy and widely used practice. Hosing off PPE,

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AFTER THE CALL Clean the PPE in a washer/extractor with approved detergent or use an independent service provider that cleans and repairs PPE. Follow the guidance in NFPA 1851, 1852 and 1585.

Clean your body. “Shower within the hour” is catchy and easy to remember. The goal is to clean yourself head to toe as soon as possible after completing fireground tasks. That cleaning interrupts the transfer — through inhalation, ingestion or absorption — of the stuff on your body that is trying to get in your body where it can really do some damage.

Document your exposures with an exposure-tracking system. While exposure trackers are designed to help you prove a cancer diagnosis is work-related, it can have an unintended benefit for prevention. By recording each exposure, you will be more aware of the contaminants that you work in — chemicals that can eventually get on and in you. That measurable

knowledge, like counting calories or hours of sleep, may further motivate you to take additional precautions on scene.

Exposure tracking can be done old school with a handwritten journal where firefighters log the time and place of each exposure incident, including the work they performed. In the event of a cancer diagnosis, this can be cross referenced against fire department incident data.

Exposures can also be tracked on various apps.

The National Fire Operations Reporting System and the International Public Safety Data Institute have an app backed by both the IAFC and IAFF.23 Using both an electronic record keeping app and a handwritten journal can be a useful backup in case something happens to one.

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12 STEPS TO PREVENT CANCER

In 2013, the work group identified 12 steps that firefighters should take to reduce their risk of getting cancer. In 2023, the new group reexamined, revised and reissued those steps. In short, the preventative measures are still valid and still need wide-spread acceptance. In addition to these updated recommendations, all firefighters should strive for high-quality sleep, exercise and diet.

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Use SCBA from initial attack to finish of overhaul. Not wearing SCBA in both active and post-fire environments is the most dangerous voluntary activity in the fire service today.

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Shower thoroughly after a fire.

Keep bunker gear out of living and sleeping quarters.

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Do gross field decon on PPE to remove as much soot and particulates as possible.

Clean your PPE, gloves, hood and helmet immediately after a fire.

Stop using tobacco products (this includes smoked, chewed and vaped products).

DOING IT RIGHT: REDUCING CANCER IN THE FIRE SERVICE

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Use alcohol-free wet wipes or baby wipes to remove as much soot as possible from head, neck, jaw, throat, underarms and hands immediately and while still on the scene.

Do not take contaminated clothes or PPE home or store them in your vehicle.

Use sunscreen or sunblock and have an annual skin cancer screening.

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Change your clothes and wash them immediately after a fire.

Decon fire apparatus interior after fires.

Get a medical examination annually.

The importance of a yearly physical cannot be overstated — early detection and early treatment are essential to increasing survival.

PART 1: HOW FIREFIGHTERS CAN REDUCE CANCER RISKS

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WHEN WE ASSUME A LEADERSHIP ROLE, WE ASSUME RESPONSIBILITY FOR THE WELLBEING OF THOSE WHO SERVE UNDER US. WE ARE BOTH MORALLY RESPONSIBLE AND, TO SOME EXTENT, LEGALLY RESPONSIBLE FOR THEIR HEALTH AND SAFETY.

PART 2:

PROVIDING THE

RIGHT TOOLS FOR FIREFIGHTER HEALTH

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ASSUMING RESPONSIBILITY When we assume a leadership role, we assume responsibility for the wellbeing of those who serve under us. We are both morally responsible and, to some extent, legally responsible for their health and safety. That responsibility is as applicable to health, including cancer risk, as it is to vehicle and equipment safety. It is as applicable to the department’s chief officers as it is to the municipality’s elected officials and to federal and state officials.

AS MUCH AS WE MIGHT LIKE TO, WE CANNOT CREATE A PERFECT PROTECTIVE CANCER BUBBLE AROUND OUR FIREFIGHTERS. We can’t do that anymore than we can prevent all line-of-duty injuries.

Conversely, we cannot leave cancer outcomes purely to chance. Neither can we put all of the onus on the individual firefighters to reduce their cancer risk.

T H E K E Y TO S U C C E S S I S F I R I N G O N A L L C Y L I N D E R S , W H E R E I N D I V I D UA L F I R E F I G H T E R S A R E D O I N G A L L T H E Y CAN TO MITIGATE CANCER RISKS, AND THOSE IN CHARGE ARE PROVIDING TOOLS, SETTING EXPECTATIONS AND REMOVING BARRIERS TO IMPLEMENTATION. Success can be seen in positive labor management collaboration.

Without both sides working together to combat the risks the issue is not likely to progress in a positive trend. Here’s a look at what leaders can do to get peak performance out of that cancer-mitigation engine.

COMPANY OFFICERS

CHIEFS AND CHIEF OFFICERS

Company officers have the most profound impact on firefighters’ cancer risk.

They not only enforce the policy, but they have a unique opportunity to mentor firefighters on the best practices outlined in Part 1. Street level officers are the first link in the chain, setting the cultural tone in the firehouse and on the fireground, guided by the chief officers who have the opportunity to direct the change needed to reduce the cancer epidemic.

Of all the officials from local to federal, chiefs and chief officers have a profound impact on firefighters’ cancer risk. They set both the policies and examples. They set the leadership and cultural tone. Two ways chiefs and chief officers prevent firefighter cancers are:

SET THE POLICIES, SET THE CULTURE ENGINEER FOR PREVENTION

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PART 2: PROVIDING THE RIGHT TOOLS FOR FIREFIGHTER HEALTH

SET THE POLICIES,

SET THE CULTURE Policies are not a bag of magic dust that makes everything perfect and grand. But they are a necessary building block for running the department the correct way.

exhaust capture system (if applicable) when it is in the bay. This will reduce firefighters’ exposure to diesel exhaust, a known carcinogen. 24 These policies should include paid access to early-detection cancer screening and annual physicals for both career and volunteer firefighters.

Chiefs need to review all existing policies and update where necessary to ensure those that can focus on cancer prevention, actually do. For example, a policy could require post-exposure decontamination be incorporated into training and all fire responses.

Or an apparatus daily inspection policy should include requirements to pull the rig out of the bay while it is running, to connect the

As we stated in Part 1, both the U.S. Preventative Services Task Force and the NFPA have recommendations for cancer screenings for some of the cancers that firefighters have a greater risk of getting. Some examples include colon, prostate and melanoma.

POLICIES TO MITIGATE RISKS A chief could consider policies that impact other factors that influence cancer risk as well, including alcohol use, tobacco use, physical activity and diet. Tobacco and alcohol are the number one causes of non-occupationally related cancer in the U.S. A chief might consider:

BANNING

STARTING

ALL TOBACCO PRODUCTS FROM THE FIRE STATION INCLUDING SMOKELESS TOBACCO (CHEW)

SUPPORTED PHYSICAL FITNESS TRAINING OPTIONS

LIMITING OR ELIMINATING ALCOHOL WHEN YOU CAN

Perhaps a chief could go so far as to hire a nutritionist to educate firefighters on how to make healthy meals they will enjoy together.

Because increased cancer risk is built into nearly everything we do, the prevention measures also need to be built in across the board. Be sure that education on the policies and the best-practices they cover is available and ongoing. Ensure all the “why are we doing this” questions are addressed. Look for ways to blend cancer prevention with other education topics (such as tactics). Embedding the education will get the message across better than isolating education on cancer prevention best practices and the supporting policies.

One way to get to policies that are highly inclusive of cancer prevention measures and make the leap from formal requirements to daily practices, is to include rank-and-file firefighters in policy creation. This labor management collaboration rule making is a mainstay in the private/civilian sector.

“A team should be involved in new company policies from the creation phase,” Tiersa Smith-Hall of the Hartling Group wrote in Forbes. “Statistics and surveys show that employees are more willing to accept and support policies in which they are involved. This can be done through surveys and focus groups where input is welcomed.”25 Fire department leaders who want policy to become practice must hold firefighters accountable for following them. That’s step one for going from policy as an idea to policy as a practice. All good leaders know this.

Step two is for the leaders to lead by example. Leading by example will improve morale, build trust, foster a better culture and increase productivity.

Low work ethic and inefficient systems are outgrowths of not leading by example.26 You need all of these if you want a culture of members who follow cancer best practices because they want to and who help police themselves for compliance.

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ENGINEER FOR

PREVENTION Many of the contaminants that firefighters encounter during their daily routine and emergency responses can be tracked back to the fire stations where they live throughout their shifts when not responding to a call.

The study was replicated in Canada where it demonstrated the same findings. Daily exposure to diesel exhaust in the firehouse can also contribute to the development of cancer.

In a study of dust samples in 26 fire stations in five states, Shen and colleagues29 documented phosphorous-containing and polybrominated diphenyl ether flame retardant levels that were higher than those previously reported in homes and other occupational settings around the world.

ANALYSIS OF THE KITCHEN AND BUNKROOM WALLS AND FURNITURE IN FIREHOUSES REVEALS A TREMENDOUS AMOUNT OF DIESEL EXHAUST PARTICLES. 29

THE 3 E’S OF MAKING CHANGE Engineering is one of the often used three E’s of making changes to worker health and safety — the other two being education and enforcement. Where we can use engineering or design to mitigate cancer risks, we must.

ENGINEERING

A TEAM SHOULD BE INVOLVED IN NEW COMPANY POLICIES FROM THE CREATION PHASE,

EDUCATION

This, of course, is much easier when building a new fire station and have no budgetary limitations. This is where you build in things like proper PPE decontamination, laundry and storage systems. This is when you can best plan for diesel exhaust removal and how to use the HVAC system to keep carcinogens out of the firehouse eating, sleeping and living areas.27 In many cases, existing fire stations can be retrofitted with equipment to protect firefighters. The cost may be harder to absorb as it is not baked into a new building plan. And depending on the scope of the retrofit, it can be more disrupting to the normal operations of the firehouse.

AS AN INVESTMENT, NEW OR RETROFITTING MAKES FINANCIAL SENSE. THE NATIONAL CANCER INSTITUTE’S RECENT ESTIMATE OF

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DOING IT RIGHT

ENFORCEMENT

THE AVERAGE COST OF CANCER TREATMENT AND DRUGS PER PATIENT WAS MORE THAN $42,000, WITH SOME TREATMENTS EXCEEDING MORE THAN $1 MILLION. There is also a moral imperative to investing in prevention. One study showed that one in five adults diagnosed with cancer are carrying at least $10,000 in debt due to the cancer diagnosis — and that’s after insurance.

CANCER PATIENTS WERE 2.5 TIMES MORE LIKELY TO DECLARE BANKRUPTCY THAN THOSE WITHOUT CANCER; THOSE WHO DECLARED BANKRUPTCY WERE MORE LIKELY TO DIE FROM THE DISEASE THAN THOSE WHO DID NOT. 28

PART 2: PROVIDING THE RIGHT TOOLS FOR FIREFIGHTER HEALTH

T0 TAKE POLICY FROM

IDEA TO PRACTICE 1

HOLD FIREFIGHTERS ACCOUNTABLE FOR FOLLOWING POLICIES

BY 2 LEAD EXAMPLE

LOCAL, STATE AND FEDERAL

RESPONSIBILITIES MUNICIPAL OFFICIALS Local government structures will vary greatly by state and sometimes county. But, these local officials often fall into hired, appointed or elected positions. They can be hired or appointed by elected officials, such as town or county managers, for their expertise in managing government. And of course they include elected mayors, council members, commissioners and other positions.

leaders to fund everyone’s pet project is intense. There’s no question that funds are limited — dangerously limited in many parts of the country.

tool, which is critical at a time when agencies are competing for the best firefighter candidates and lateral moves between departments are more common.

YET, FUNDING MEASURES DESIGNED TO REDUCE THE RISK OF CANCER AMONG FIREFIGHTERS IS A LIFE-OR-DEATH ISSUE.

All of the mentioned recommendations require funding. Some of that funding will fall within the fire chief’s budget and control. Other items will not. There is no question that the pressure on municipal

And it is one that is easy to get behind. It is easy to support because, as shown previously, it makes financial sense to prevent cancer rather than to treat it. Cancer prevention measures are also a recruiting and retention

It is important that local officials work with their local, state and federal government partners to educate them on the need so they can obtain dedicated funding and legislation to reduce firefighter cancer risk. State and national firefighters’ associations are an important resource that local officials can turn to make those connections, to understand the issues and to get help communicating the importance of those issues.

STATE AND FEDERAL OFFICIALS Fire chiefs and local officials will be limited in what they can do to prevent firefighter cancer and help those with a diagnosis if there is insufficient support from state and federal officials and agencies.

These fire department officials should be working with those at the local, state and even federal level for establishing and locating additional financial resources. This may be in the form of grants (such as those from the Federal Emergency Management Agency) or creating special funding buckets that dedicate money for fire departments to engineer more prevention into their fire stations and operations.

Sadly, the best preventative measures will not head off all cancer in firefighters. Because of that, we need state and federal officials to put real teeth into laws protecting firefighters once they are diagnosed with cancer.

Firefighter cancer presumption laws vary considerably state by state. This includes the definition of presumption, including what cancers are presumed caused by firefighting; the timing of the cancer diagnosis relative to last firefighting exposure; the compensation; as well as the processes to appeal and what firefighters can expect if a presumption of occupational cancer is overturned.30 The International Association of Fire Fighters’ Presumptive Health Initiative tracks the specifics of what is covered under presumption in each state and Canadian providence.31 The IAFF supports expanding the Public Safety Officer Benefit Program to cover lineof-duty deaths and permanent disabilities due to occupational cancer.32 In a perfect world, cancer mitigation efforts would work flawlessly all the time and

NO FIREFIGHTER WOULD HAVE TO SUFFER FINANCIAL TRAUMA AFTER A CANCER DIAGNOSIS. Federal lawmakers should enact legislation that creates nationwide minimum presumption rules, while allowing states to exceed those minimums. This is common practice for regulations ranging from environmental protection to transportation safety. State lawmakers would ideally go above and beyond those minimum federal requirements. That would both protect firefighters who have a cancer diagnosis and create additional incentives for state and local jurisdictions to build robust preventative measures into their fire departments.

AND THAT WILL GET US MUCH CLOSER TO THE PERFECT WORLD — ONE WHERE WE ARE DOING IT RIGHT.

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SOURCES 1 https://www.usfa.fema.gov/about/usfa-events/2023-10-10usfa-summit/firefighter-cancer/ 2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986368/ 3 https://www.wcrf.org/dietandcancer/exposures/ alcoholic-drinks 4 https://www.iarc.who.int/news-events/iarc-monographsvolume-132-occupational-exposure-as-a-firefighter/ 5 https://science-alliance.org/alcohol-monograph 6 https://www.iarc.who.int/news-events/iarc-handbooks-ofcancer-prevention-volume-20a-reduction-or-cessation-ofalcohol-consumption/ 7 https://cancer-code-europe.iarc.fr/index.php/en/ecac-12ways/sun-uv-exposure-recommendation/81-protect-sun-ineveryday-life 8 https://www.iaff.org/wp-content/uploads/Best-Practices-OffThe-Job-1.pdf 9 https://firefighterhealthsafety.org/health/sleep-wellness/ 10 h ttps://diet.mayoclinic.org/us/blog/2022/healthy-habits-fora-better-night-s-sleep/ 11 h ttps://www.cancer.gov/about-cancer/causes-prevention/ risk/obesity/physical-activity-fact-sheet 12 h ttps://www.iaff.org/peer-fitness/ 13 h ttps://www.nvfc.org/creating-a-health-and-fitness-programin-your-department-a-two-part-course-2/ 14 https://pubmed.ncbi.nlm.nih.gov/21386691/ 15 h ttps://www.cancer.gov/about-cancer/causes-prevention/ risk/obesity/obesity-fact-sheet 16 h ttps://www.cancer.gov/about-cancer/causes-prevention/ risk/tobacco 17 h ttps://www.mdanderson.org/publications/focused-onhealth/how-stress-affects-cancer-risk.h21-1589046.html 18 h ttps://www.health.harvard.edu/heart-health/the-heartfeltbenefits-of-pet-ownership

WE ARE ALSO NOT ALONE — WE NEED TO WORK TOGETHER TO EMPOWER AND SUPPORT EACH OTHER TO MAKE THESE CHANGES

TOGETHER.

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SOURCES 19 h ttps://www.iaff.org/wp-content/uploads/FFCancer_ CancerScreenings.pdf 20 h ttps://fsri.org/research-update/journal-article-addressesairborne-contamination-during-post-fire-investigations 21 https://pubmed.ncbi.nlm.nih.gov/28636458/ 22 h ttps://www.cdc.gov/niosh/hhe/reports/pdfs/2010-01563196.pdf?id=10.26616/NIOSHHETA201001563196 23 https://i-psdi.org/nfors-fire-exposure.html 24 h ttps://assets.website-files.com/64b9346df4252df 1681cba3e/64cd68930ee646f01dfdbf14_Diesel-ExhaustExposures.pdf 25 h ttps://www.forbes.com/sites/ forbeshumanresourcescouncil/2022/04/08/heres-when-andwhy-to-introduce-a-new-hr-policy/ 26 https://www.betterup.com/blog/leading-by-example

27 F ire Station Design: Architecture, Planning & Innovation, CRACKYL Magazine, Vol 1, 2024. CRACKYL.COM 28 h ttps://www.npr.org/sections/healthshots/2022/07/09/1110370391/cost-cancer-treatment -medical-debt 29 h ttps://assets.website-files.com/64b9346df4252df1681 cba3e/65d1ef0eb02225833a002008_FSCNIAFF_FactSheets_ Exposures.pdf 30 https://assets.website-files.com/64b9346df4252df1681cba3e

/64cd6c713a5c03dcf2925c60_FFCancer-PresumptiveLegislation-101-Fact-Sheet-2022-1-3.pdf 31 h ttps://www.iaff.org/presumptive-health/ 32 h ttps://www.iaff.org/news/iaff-calls-for-broad-strategy-toend-fire-fighter-cancer/

LEADING BY EXAMPLE WILL IMPROVE MORALE, BUILD TRUST, FOSTER A BETTER CULTURE AND INCREASE PRODUCTIVITY.

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FCSN RECOGNIZES AND DEEPLY APPRECIATES THE SUPPORT PROVIDED BY CRACKYL MEDIA INC. IN THE DESIGN, EDITING AND PRODUCTION OF THIS REPORT.