The cancer risk for firefighters: A South African perspective - By Lenny Naidoo

By Lenny Naidoo and Jackie de Billot, Vanguard Fire and Safety

Firefighters around the world face unique occupational hazards, one of the most alarming being their increased risk of developing cancer. Research from the Centre for Disease Control and Prevention (CDC) and the National Institute for Occupational Safety and Health (NIOSH) indicates that firefighters have a nine percent higher risk of being diagnosed with cancer and a 14 percent higher risk of dying from cancer than the general population. Given these troubling statistics, it begs the question: What would the percentage be for South African firefighters and could it be even higher?

The firefighting environment: a cancerous cocktail

Modern homes, vehicles and commercial buildings are constructed using an array of synthetic and plastic materials. When these materials burn, they release harmful chemicals, including carcinogens like polycyclic aromatic hydrocarbons (PAHs), a group of over 100 chemicals known to cause cancer. South African firefighters face the same exposure to these toxins, which can be inhaled or absorbed through the skin. As buildings burn, the situation becomes even more hazardous when materials such as asbestos and diesel exhaust are introduced into the environment.

Wearing proper personal protective equipment (PPE), including self-contained breathing apparatuses (SCBA), is crucial for firefighters to reduce exposure to these dangerous chemicals. However, even with PPE, toxic substances can still penetrate turnout gear, exposing firefighters to carcinogenic risks.

The global risk: a global phenomenon

Studies conducted on first responders to catastrophic events like the World Trade Centre (WTC) attacks on 11 September 2001, revealed heightened levels of clonal haematopoiesis among firefighters. Clonal haematopoiesis occurs when a blood stem cell makes cells with the same genetic mutation, leading to blood cancers. This condition underscores the potential for devastating longterm health consequences faced by first responders and more alarmingly, it could be a growing issue for South African firefighters too.

The National Firefighter Registry: a step toward prevention

In 2018, the US Congress established the National Firefighter Registry (NFR), which tracks firefighters’ health and exposure data to study the links between workplace exposures and cancer. While this initiative is still in its early stages, it offers hope for identifying and mitigating cancer risks. South Africa does not yet have a comprehensive national registry but it is clear that the country could benefit from similar tracking mechanisms.

The current state in South Africa: Gaps in standards and legislation

South African firefighters are subject to the Occupational Health and Safety Act (OHSA), which mandates that employers ensure a safe work environment. Yet, firefighting is inherently risky and the environment is often uncontrollable. While South Africa’s fire services adhere to international safety standards, there is still a lack of robust national protocols to document exposure during every turnout or specialised medical screening after hazardous material exposure. Furthermore, there are no comprehensive national standards for entrylevel firefighter medical or physical assessments.

Research and development in firefighter health rely heavily on international reports, which fail to fully address local conditions or specific risks faced by South African firefighters.

Reducing cancer risk: What can South African firefighters do?

Despite the heightened risks, there are proactive steps that South African firefighters can take to reduce their exposure to carcinogens and improve their health outcomes.

1. Reduce exposure to diesel exhaust:

• Maintain and use diesel exhaust containment or removal systems in fire stations.• Ensure apparatus engines are not idling inside stations.• Keep bay doors open before starting fire engines and until engines are off after returning to the station.

2. Proper PPE and SCBA maintenance

• Follow NFPA 1851 and manufacturer’s instructions for cleaning and maintaining PPE after every fire.• Test and maintain SCBA daily to ensure proper function.• Use SCBA and remain on air through the end of overhaul operations and during any smoke exposure.• Ensure decontamination of gear on the scene before returning to the station.

3. Clean yourself after every fire

• Wash exposed face, hands and neck as soon as possible with wet wipes or soap and water at the fireground.• Shower as soon as possible after returning to the station and cleaning equipment.• Change into clean clothes after showering.

4. PPE storage and handling

• Store contaminated PPE in airtight containers to prevent cross-contamination in fire stations.• Only store gear in designated areas, away from living and sleeping quarters.

5. Always wear PPE and SCBA

• Do not rely solely on gas detectors to decide when to wear PPE. Contaminated particles linger even after a fire is out.• Wear full PPE and SCBA during overhaul, as well as at car fires or trash fires.

6. Talk to your doctor

• It’s vital for firefighters to discuss their occupational history with healthcare providers. Inform your doctor about your work exposure, even if you’re retired or changing providers.• Discuss cancer screening, including early age screening and more frequent check-ups, to monitor any changes.

7. Track your exposure

• The International Association of Firefighters (IAFF) recommends that firefighters keep a personal record of exposures and incident responses. This documentation could be crucial for identifying long-term health effects.

Task Force Tips: A solution for decon

Recognizing the growing concern about cancer rates among firefighters, Task Force Tips has developed innovative solutions aimed at improving firefighter safety through enhanced decontamination (decon) processes. Decon is vital in reducing the lingering effects of harmful chemicals that firefighters are exposed to during and after firefighting operations. Task Force Tips’ decontamination solutions include:

• Decon Pack: This is an effective tool designed for the immediate decontamination of firefighters right at the fire scene. The Decon Pack provides a quick, efficient way to begin the decontamination process, reducing the exposure time to hazardous materials before the firefighter even leaves the scene.

• Crew Protect: This device is installed in the cab of the fire truck during the return to the station. It works by cleaning the air within the cab, helping to eliminate toxins and particulates that can linger after a fire. This ensures that firefighters and their crews are not breathing in harmful chemicals on their way back to the station, providing an additional layer of protection.

• Station Protect: Designed for use in the storage area where PPE is kept, Station Protect helps to clean the air and reduce emissions of volatile organic compounds (VOCs) and particulates. This product is especially beneficial in areas where firefighter gear is stored, preventing the contamination of the firehouse environment and minimising exposure to harmful substances.

These solutions are part of a growing push to prioritise decontamination as a standard practice in fire services. The ability to start the decontamination process at the fireground, in transit and in the fire, station is essential to reducing the long-term health risks faced by firefighters.

The importance of healthy lifestyle choices

Adopting a healthy lifestyle can further reduce the risk of cancer and other diseases. Maintaining good nutrition, engaging in regular physical activity and avoiding tobacco and alcohol are key strategies for mitigating the longterm health impacts of firefighting.

Conclusion: The need for change

The risks of cancer faced by South African firefighters are undeniable but there are tangible steps that can be taken to mitigate these risks. Increased awareness, stronger national standards, improved PPE protocols and regular health check-ups are essential for safeguarding the well-being of those who serve and protect the nation.

Firefighters’ health should be prioritised, ensuring that they are not only equipped to save others but also empowered to protect their own futures.

As we continue to honour the brave men and women of South Africa’s fire services, it’s imperative to support efforts to improve safety protocols, enhance health surveillance and mitigate the long-term risks associated with their noble work.