Fireground Contaminant Exposure Control Approaches and Health & Safety Officer Continuing Education
Final Report by:
Jamie McAllister, Ph.D., P.E. andJames
University of Maryland, College Park
Milke, Ph.D., P.E.Department of Fire Protection Engineering
UMD FPE Student Research Team: Curtis Fagan and Emma Hansen
MFRI Research Team:
Darl McBride
Funded by:
Department of Homeland Security/United States Fire Administration, 2020 Fire Prevention and Safety (FP&S) Grant Program, DHS-20-GPD-044-00-97
September 2022
EXECUTIVE SUMMARY
Studies have shown that firefighters are exposed to a variety of contaminants during fire suppression, overhaul, training, investigation, and even while at the fire station. Studies have also shown that routine exposure to contaminants can leave firefighters vulnerable to occupational illnesses, some of which are fatal Recently, the International Agency for Research on Cancer identified the occupational exposure of firefighters as “carcinogenic to humans (Group 1)”. NFPA 1500, Standard on Fire Department Occupational Safety, Health, and Wellness Program, requires that fire departments have written policies to address and mitigate the risks associated with “exposure to products of combustion, carcinogens, contaminants, and other incident-related health hazards”. NFPA 1500 also requires the fire chief to assign a health and safety officer (HSO) to develop and manage these programs, and the HSO is required to meet the qualifications set forth in NFPA 1521, Standard for Fire Department Safety Officer Professional Qualifications
As research on contaminant exposure and occupational diseases continues to evolve, it is important that the HSO remain current with the general knowledge, skills, and job performance requirements of their position. Ensuring personnel have a means to obtain their HSO certification and to remain current in their knowledge is an important component in the success of a fire department’s health and safety program. Unfortunately, there are only six states and one federal agency which offer the NFPA 1521 HSO certification. Moreover, there are no certifying entities which provide HSO continuing education or recertification; the lack of training resources significantly hampers the HSO’s ability to remain current in their knowledge, skills, and abilities, as is needed to effectively execute the requirement within NFPA 1500. This project aimed to address this vulnerability by providing HSOs with training on the current state of the art in contaminant exposure control (CEC) and by learning from the successes and challenges faced by health and safety (H&S) personnel in the development, implementation, and management of CEC polices.
The primary goals of this study were to (1) identify current national and regional approaches used in the development, implementation, and management of CEC policies, (2) train H&S personnel and leadership on these current approaches, and (3) establish action items to address current challenges faced by HSOs in the development, implementation, and management of CEC policies. These goals were accomplished through the completion of four tasks: (1) a review of NFPA standards and industry best practices, (2) a review of regional and national current practices, (3) a regional training and workshop, and (4) a final report and national training.
A review of NFPA standards highlighted the evolution of CEC requirements in these documents.
The most comprehensive content on processes for CEC were found in the newest editions of NFPA 1500 and NFPA 1851; however, the Lavender Ribbon Report (LRR), which was more commonly referenced by H&S personnel, serves as a comprehensive industry best practices documents that provides 11 steps aimed at reducing contaminant exposure and preventing firefighter cancer. There were 101 respondents to the online survey which was conducted to better understand the current climate related to fire department CEC policies. The largest percentage of respondents were from career fire departments and urban jurisdictions. The largest percentage of respondents said their department had a policy addressing post-fire PPE decontamination, followed by a policy addressing post-fire personal hygiene and a policy addressing post-fire atmospheric monitoring. Approximately 20% of respondents said their department had no CEC policy at all.
Policies from 31 departments were reviewed as part of this study. It was noted that many policies pre-dated 2018, and therefore, were unlikely to capture the evolving CEC requirements in the codes and standards. Moreover, many policies did not reference NFPA standards, particularly NFPA 1500, suggesting that these standards did not provide the basis for the requirements within the policies. Consistent with the survey responses, the largest percentage of policies addressed post-fire PPE decontamination with the smallest percentage of policies addressing post-fire atmospheric monitoring. Moreover, only three of 31 policies included requirements for airpurifying respirators (APRs), many policies did not define post-fire atmospheric monitoring levels, and most policies were silent on PPE off-gassing hazards. Although no policy met all the requirements set forth in the current NFPA standards, it is important to recognize that any efforts to reduce contaminant exposure is better than doing nothing at all.
The workshop breakout sessions and responses from attendees provided a snapshot of the successes and challenges faced by H&S personnel in their CEC journey. The following recommendations for future initiatives were developed based upon these discussions.
• Define an exposure, as it is currently unclear what types of fires trigger the requirements for decontamination, e.g., some departments only perform decontamination when there is a working fire dispatch, but what about smaller fire events like food on the stove?
• Implement CEC procedures at training academies, recognizing that procedures used by instructors and students for decontamination may be different than what is used on a scene because the hazard is more easily quantifiable in training More research is needed to quantify hazards from training fires.
• Recognize that CEC applies to more than just the suppression firefighter, but fire investigators, instructors, and others who may be exposed to contaminants.
• Introduce new Knowledge, Skills, and Abilities (KSAs) for Firefighter 1 to include training on what is in smoke, the health impacts from contaminant exposure, the importance of decontamination, and how to decontaminate.
• Introduce new KSAs for Fire Officers to include a better understanding of the safety culture message and cancer awareness- safety is the most important priority.
• Introduce new KSAs to HSO/ISO to include methods for CEC policy development, implementation, and management, understanding products of combustion, cancer, and associated health hazards and preventative measures.
• Provide formalized continuing education resources to HSOs and others.
• Develop methods to evaluate exposure data to revisit and improve policy and practices.
It is believed that focusing on these initiatives will aid the fire service and H&S personnel therein, to further their programs, reduce firefighter exposure to harmful contaminants, and reduce occupational illnesses in the fire service.
Section 1: Introduction
A career in the fire service presents a variety of unique occupational hazards including exposure to fire contaminants. Studies have shown that contaminant exposure can occur during suppression, overhaul, training, investigation, and even while at the fire station. The products of combustion created during a fire event are numerous and copious and include compounds such as carbon monoxide (CO), hydrogen cyanide (HCN), nitrogen oxides (NOx), sulfur dioxide (SO2), hydrogen halides, and an array of semi-volatile and volatile organic compounds (SVOCs and VOCs) Some of these compounds are asphyxiants and irritants and many are carcinogenic, such as aldehydes and polycyclic aromatic hydrocarbons (PAHs).
Studies have shown that routine exposure to fire effluents experienced by firefighters can leave them vulnerable to occupational cancers. According to the IAFF, cancer is the leading cause of career firefighter line of duty deaths in the U.S. with 75% of career firefighter deaths being attributed to cancer between 2015 and 2020 (IAFF, 2022). Further, a firefighter’s risk of developing certain cancers has been shown to be higher when compared to the civilian population (Laroche and L’Esperance, 2021). According to Jahnke et al (2021), the overall cancer risk in the firefighter population is 9-14% with increases in individual cancer risk as high as 100% for certain types of cancers, e.g., mesothelioma. Recently, the International Agency for Research on Cancer identified the occupational exposure of firefighters as “carcinogenic to humans (Group 1)” indicating that there is “strong mechanistic evidence that occupational exposure as a firefighter exhibits multiple key characteristics of carcinogens in exposed humans.” (IARC, 2022).
While there is an abundance of evidence demonstrating a clear relationship between firefighter occupational exposure and cancer susceptibility, there is only one nationally recognized standard 1 which aims to provide comprehensive requirements and guidance directed at reducing firefighter contaminant exposure. To-date, NFPA 1500 (2021), Standard on Fire Department Occupational Safety, Health, and Wellness Program, is the only consensus standard which comprehensively addresses fire service health and safety (H&S) and provides requirements for post-fire and postincident contaminant exposure mitigation. NFPA 1500 requires that fire departments have written policies and standard operating procedures, a written occupational safety, health, and wellness policy, and a risk management plan which addresses “exposure to products of combustion, carcinogens, contaminants, and other incident-related health hazards”. NFPA 1500 requires the fire chief to assign a health and safety officer (HSO) to develop and manage these programs, and the HSO is required to meet the qualifications set forth in NFPA 1521 (2020), Standard for Fire Department Safety Officer Professional Qualifications.
As research on contaminant exposure and occupational diseases continues to evolve, so will the requirements within NFPA 1500 and future standards 2. Given the significance of the responsibilities placed on the HSO, it is critical that their knowledge, skills, and abilities continue to evolve. NFPA 1521 (2020) requires the HSO to “remain current with the general knowledge, skills, and JPRs for each qualification level.” However, a review of the International Fire Service Accreditation Congress (IFSAC) and ProBoard (also known as the National Board of Fire Service
1 The term standard, which is different from a guide or best practice, is intended to mean a document developed by a consensus body that contains requirements that must be followed to achieve an intended outcome.
2 NFPA 1585, Standard for Exposure and Contamination Control is currently under development.
Professional Qualifications or NBFSPQ) databases show there are only six state-level certifying entities and one federal certifying entity that offer the NFPA 1521 HSO certification (see Appendix A). Moreover, there is no certifying entity which provides HSO continuing education or recertification; this significantly hampers the HSO’s ability to remain current in their knowledge, skills, and abilities, as is required to effectively execute the requirement within NFPA 1500. This project aimed to address this vulnerability by providing HSOs with training on the current state of the art in CEC and by learning from the current successes and challenges faced by H&S personnel.
Section 2: Research Objectives
The primary goals of this study were to (1) identify current national and regional approaches used in the development, implementation, and management of contaminant exposure control (CEC) policies, (2) train H&S personnel and leadership on these current approaches, and (3) establish action items to address current challenges faced by HSOs in the development, implementation, and management of CEC policies.
Given that the HSO is a critical component in the success of a fire department’s H&S program, the lack of attention to continuing education needs of the HSO introduces vulnerability to the entire H&S framework. It also negatively impacts an HSO’s ability to develop, implement, and manage H&S requirements effectively and knowledgeably. This project aimed to address this vulnerability by identifying HSO continuing education needs, as the HSO is a critical component in the fire service’s goal to reduce firefighter contaminant exposure.
Moreover, this project aimed to evaluate existing health and safety policies and challenges faced by HSOs in developing, implementing, and managing policies. It is recognized that requirements in a standard may not effectively translate to the firegrounds. If a requirement cannot be reasonably and practically implemented on the fireground, it is likely to be ignored which is detrimental to firefighter H&S The objective of this research was to identify the number of departments following the requirements within NFPA 1500 and to identify successes and challenges faced by departments when attempting to implement requirements in the field
Section 3: Methodology
The project included four tasks (1) a review of NFPA standards and industry best practices, (2) a review of regional and national current practices, (3) a regional training and workshop, and (4) a final report and national training. More specifically, Task 1 included a) a review of NFPA standards to identify current requirements and historical changes related to CEC and b) a survey of fire service publications to identify guidance on CEC best practices. The objective of Task 1 was to collect information on requirements and industry best practices to utilize in the training developed in Tasks 3 and 4.
Task 2 included a review of U.S. career, combination, and volunteer fire department policies on CEC to identify a) standards or guidance documents referenced in the policies b) policy types, e.g., post-fire atmospheric monitoring, PPE decontamination, personal hygiene, etc., and c) policy practices compared to NFPA requirements. The objective of Task 2 was to identify current approaches in exposure control which, in combination with Task 1, informed the training provided in Tasks 3 and 4.
Task 3 included a) the development of training which presented the findings from Tasks 1 and 2, b) the hosting of a training event at the Maryland Fire and Rescue Institute (MFRI) designed to educate H&S personnel and leadership on the research findings, and c) the hosting of a MFRI workshop bringing together H&S personnel and leadership from DC, MD, and VA. The breakout sessions were focused on (i) identifying policy success measures, (ii) identifying resources needed to develop, implement, and manage a CEC policy, (iii) identifying challenges hampering departments from developing, implementing, or managing a CEC policy, and (iv) identifying current training and continuing education needs to better equip HSOs in the performance of their duties. Task 3 also served to provide training to H&S personnel and HSOs to keep them current on topics related to CEC The main objective of Task 3 was to identify successes and challenges faced by H&S personnel and leadership as they develop, implement, and manage their programs. These experiences helped to define action items aimed at assisting fire service professionals in overcoming program challenges and informed certifying entities of future training needs. In addition, these action items can be used by USFA to identify priority funding initiatives.
Task 4 included a) a comprehensive report of findings including action items developed at the workshop, b) a revised Task 3 training module incorporating workshop findings, c) presentation of the findings to the NFPA 1585 committee, d) posting of the revised training module and final report to MFRI website for national access and outreach, and e) presentation of the findings at the NFPA annual conference. The objective of Task 4 was to disseminate the project findings to provide continuing education resources to H&S personnel and leadership throughout the U.S. Further, a presentation of project findings to the NFPA 1585 committee informs future efforts to improve the NFPA standards.
Section 4: Analysis & Discussion
This section of the report presents the findings from the Task 1 review of NFPA standards and best practices, Task 2 review of fire department policies, and Task 3 MFRI workshop.
4.1 Task 1- NFPA Standards and Industry Best Practices
In Task 1, NFPA standards were reviewed to identify current requirements and historical changes related to CEC. Fire service publications were also reviewed to identify guidance on CEC best practices. Table 1 provides a full list of all standards reviewed for this task.
Table 1: List of NFPA Standards Reviewed in Task 1
NFPA 1500 Standard on Fire Department Occupational Safety, Health, and Wellness Program
Editions: 2021, 2018, 2013, 2007, 2002, 1997, 1992, 1987
NFPA 1501 Standard for Fire Department Safety Officer
Editions: 1987, 1977
NFPA 1521 Standard for Fire Department Safety Officer Professional Qualifications
Editions: 2020, 2015, 2008, 2002, 1997, 1992
NFPA 1561 Standard on Emergency Services Incident Management System and Command Safety
Editions: 2020, 2014, 2008, 2005, 2002, 2000, 1995, 1990
NFPA 1584 Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises
Editions: 2022, 2015, 2008, 2003
NFPA 1700 Guide for Structural Fire Fighting
Editions: 2021
NFPA 1851 Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting
Editions: 2020, 2014, 2008, 2001
Only standards containing substantive content on CEC were reviewed as part of Task 1. NFPA 1550, Standard for Emergency Responder Health and Safety, and NFPA 1585, Standard for Exposure and Contaminant Control, were not reviewed as part of this task, because the standards are still under development. The standards are discussed, however, in the “Future of Standards” section of this report.
A keyword search of each standard, and its various editions, was performed for the following terms: carcinogen(s), carcinogenic, contaminant(s), contamination, contaminated, decontamination, toxic, toxicant, gross decontamination, preliminary exposure reduction, routine cleaning. Sections containing these terms were reviewed to determine when the terms first appeared in the standards. Additionally, relevant sections were reviewed to determine how requirements associated with these terms have changed (if at all) in the various editions of the standards. The following sections highlight important changes made to the standards as it relates to CEC.
4.1.1 NFPA 1500
The first edition of NFPA 1500, then titled Standard on Fire Department Occupational and Health Program, was published in 1987. Seven editions of the document have been published since 1987 with the first edition being 35-pages and the current 2021 edition spanning 111-pages. The first edition included the term “contaminant” which was defined as “A harmful, irritating, or nuisance material foreign to the normal atmosphere.” Although post-fire CEC procedures were not introduced into the standard until 2018, the risks associated with exposure to products of combustion were recognized in the first edition of the standard. In the “Origin and Development” section of the document, the NFPA committee stated:
“In addition to the direct line-of-duty deaths, there is growing concern with the number of fire fighters who suffer disabling injuries or develop occupational diseases and conditions that often have debilitating or fatal consequences and force them to discontinue their fire service activities. The link between respiratory and heart diseases and fire service careers has been well documented and established. There is growing evidence of a similar link to cancer and related diseases, derived from occupational exposure to carcinogens, toxic products of combustion, and hazardous materials.”
Hence, the first edition of the standard, published over 35-years ago, raised concerns about fire service contaminant exposure; however, the requirements within the first edition of standard were focused on the proper use of respiratory protection to prevent exposure to toxicants during fire suppression activities The first edition of the standard pre-dated research which explored more complex, and perhaps, less obvious routes of exposure to fireground contaminants, such as dermal absorption or inhalation due to PPE off-gassing. As such, there was no mention of decontamination of PPE or personal hygiene. Additionally, there was no mention of data collection systems to maintain records of individuals exposed to toxicants or testing and monitoring programs for exposed individuals 3
The scope of NFPA 1500 and the contents of the document were significantly expanded in 2018 to include requirements specifically addressing post-fire CEC. The scope expanded to include not just fire suppression, rescue, and related activities (i.e., the scope of the 1987 edition), but EMS, HazMat, Special Operations, Fire Investigation, and Fire Inspection. The 2018 edition introduced the term “fireground contaminants” which was defined as “Airborne, dermal, ocular, or respiratory hazards consisting of products of combustion, carcinogens, toxic chemicals, ultrafine particles, and other incident health hazards.” Additionally, text was revised to require that risk management plans and safety and health policies address “products of combustion, carcinogens, and fireground contaminants, and incident-related health hazards.” The revised standard also required that the fire department implement a data collection system to include “records of known or suspected exposure to products of combustion, carcinogens, fireground contaminants, and incident related hazards” and maintain data for 15 years.
The 2018 edition of NFPA 1500 also introduced training requirements to ensure personnel had an awareness of the risks associated with exposure to contaminants and advised that respiratory protection should not be compromised “in IDLH, potentially IDLH, or undefined or hazardous atmospheres ” and that air-purifying respirators (APRs) should be used during overhaul operations. The document included a new chapter, Chapter 14, titled “Exposure to Fireground Toxic Contaminants”. The new chapter included specific requirements for APRs. The use of an APR, rather than SCBA, was deemed acceptable if all the following conditions were present: 1) 30 minutes or more post-extinguishment, 2) No active overhaul, 3) positive pressure ventilation in place, and 4) continuous air monitoring with hydrogen cyanide (HCN) at or below 4.7 ppm and carbon monoxide (CO) at or below 35 ppm. The standard also required that the Authority Having Jurisdiction (AHJ) provide a Standard Operating Procedure (SOP) for post-incident decontamination to include PPE doffing, PPE decontamination, and personal hygiene. Wiping
3 There is mention of testing and monitoring programs for exposed individuals in the Appendix (as a recommendation), but this information was not presented in the main text of the document as a requirement.
skin off immediately after doffing PPE and showering within an hour was indicated as a requirement.
Further refinement of decontamination requirements was rolled out in the 2021 edition of NFPA 1500. Definitions were expanded to include “Preliminary Exposure Reduction”, a term originating from NFPA 1851, and “Gross Decontamination”. Preliminary Exposure Reduction was defined as “Techniques for reducing soiling and contamination levels on the exterior of the ensemble or ensemble element following incident operations.” Gross Decontamination was defined as “A phase of the decontamination process where significant reduction of the amount of surface contamination takes place as soon as possible, most often accomplished by mechanical removal of the contaminant or initial rinsing from handheld hose lines, emergency showers, or other nearby sources of water.” The standard also clarified that the “Hot Zone” was the location on the firegrounds where “a risk of exposure to contaminants” is possible and that contaminated PPE should be removed “immediately” from service. The standard also replaced the term “AHJ” with “the fire department” to clearly identify the entity responsible for written policies on post-incident contaminant control. Personnel training requirements were also expanded to include initial and on-going training in “the risks of exposure to products of combustion, carcinogens, contaminants, and other incident-related health hazards.”
Additionally, the 2021 edition of NFPA 1500 introduced changes to APR use. Whereas the 2018 edition indicated APR use was acceptable 30 minutes or more after fire extinguishment, the 2021 edition extended this time to 2 hours. Occupational exposure recordkeeping was also extended from 15 years to 30 years. Lastly, it was recognized that personnel performing PPE cleaning operations should also be protected from contaminants, and as such, should wear disposable gloves, protective garments, and APRs with P-100 cartridges.
4.1.2 NFPA 1501 and 1521
The first edition of NFPA 1521, Standard for Fire Department Safety Officer Professional Qualifications, was published in 1992. NFPA 1521 was predated by two editions of NFPA 1501, Standard for Fire Department Safety Officers, that were published in 1977 and 1987. Five editions of NFPA 1521 have been published since 1992 with the first edition being 18-pages and the current 2020 edition expanded to 64-pages. The first edition of the standard designated one person, the Safety Officer (SO), to oversee fire department safety The concepts of Incident Safety Officer (ISO) and Health and Safety Officer (HSO) were not introduced into the standard until 1997. In the first edition, qualification of the SO included Fire Officer I, understanding the laws regulating occupational safety and health, the hazards of firefighting, management of safety and health programs, and health and physical fitness factors affecting firefighters. The first edition of the standard did not mention contaminants, decontamination, carcinogens, products of combustion, or cancer.
The 2008 edition of NFPA 1521 mentioned atmospheric monitoring and gross decontamination in the Structure Fire Safety Report template in the Appendix. The appendix also mentioned the following regarding cancer:
“A.4.2.3 The health and safety officer should recognize health and safety hazards and know how to reduce the severity of those hazards. Health and safety hazards can include, but are not limited to, respiratory hazards, cancer, and heart disease. They can also include exposure to communicable diseases and hazardous materials, apparatus and vehicle issues, traffic safety, heat stress, and hazardous energy.”
However, there was no mention of CEC or the need for the SO to have specific knowledge, skills, or abilities related to this topic. The job performance requirements and necessary knowledge and skills of the HSO were significantly expanded in the 2020 edition of the standard, however, there is no mention of CEC or related topics. While the standard requires the HSO to have knowledge of Chapters 4, 6, 7, 8, 9, 10, 11, and 12 in NFPA 1500, Chapter 14 (Exposure to Fireground Toxic Contaminants) is excluded. The current edition of NFPA 1521 does include the following for the ISO:
“Identify incident environmental conditions and contaminates, given an incident or planned event, so that identified hazards can be communicated to the IC and division and/or group supervisors, and the need for contamination control procedures for PPE, personnel hygiene, and utilized equipment can be determined and implemented, prior to incident departure, to help prevent continued exposure and cross contamination from known and potential contaminants.
(A) Requisite Knowledge. Common byproducts of combustion and pyrolysis including toxic chemicals, biological pathogens, particulate matter, and aromatics; NFPA 1851; AHJ SOP/Gs for on-scene PPE contamination control and cancer prevention; methods and levels of equipment cleaning as prescribed by equipment manufacturers.
(B) Requisite Skills. Ability to evaluate fire, smoke, and environmental conditions, determine member exposures to those conditions, and communicate contamination judgements to the IC and tactical work members; recognize issues of equipment contamination with regards to use, transportation, separation, and storage during incident operations and demobilization; judge contamination reduction efforts and develop further exposure-prevention measures, where necessary, and communicate those measures to members.”
The HSO is required to lead the efforts in development, implementation, and management of their department’s CEC policies. Hence, it would seem critical that the HSO have the same or greater knowledge of contaminants and exposure reduction as does the ISO
4.1.3 NFPA 1561
There have been seven editions of NFPA 1561, Standard on Emergency Services Incident Management System and Command Safety, published since the document’s inception in 1990. Issues related to CEC were not addressed until the most recent edition of the document, which was published in 2020. In the current edition, under Section 5.9.7.4, the Safety Officer is required to “Develop preventive measures for IC consideration to further reduce responder exposure to hazards” and “Ensure that contaminated personnel, tools, hose, equipment, and PPE are processed
in accordance with contamination-reduction SOPs prior to being returned to service.” There are no other requirements or guidance within the document related to CEC.
4.1.4 NFPA 1584
There are four editions of NFPA 1584, Standard on the Rehabilitation Process for Members During Emergency Operations and Training Exercises. The most recent edition, published in 2022, introduced the terms contamination, gross decontamination, and preliminary exposure reduction; previous editions of the standard were void of these terms. In the 2022 edition, contamination is defined as “The accumulation of products of combustion and other hazardous materials on or in an ensemble element that includes carcinogenic, toxic, corrosive, or allergycausing chemicals, body fluids, infectious microorganisms, or [chemical, biological, radiological, or nuclear defense] CBRN terrorism agents.” Language was added to require procedures to be in place for “contamination control” whenever a risk of exposure is present. Additionally, the standard requires that preliminary exposure reduction be conducted in accordance with NFPA 1851 if personnel are exposed to “a contaminant during incident operations or training exercises that pose a potential safety or health risk to members”. The 2022 edition added requirements for hazard control zones, i.e., hot, warm, and cold, and “on-scene personal hygiene”. Personnel are instructed to wipe exposed skin areas with soap and water or skin wipes. Post-incident recovery and demobilization also includes a requirement for “A plan for station, apparatus, protective clothing, and equipment decontamination.” and nitrile gloves are to be worn when decontaminating apparatus and equipment.
4.1.5 NFPA 1700
The first and current edition of NFPA 1700, Guide for Structural Fire Fighting, was published in 2021 Because the document is a guide rather than a standard, the information contained within it is recommendations rather than requirements. There are several sections within the document that discuss products of combustion, contaminants, carcinogens, and cancer. Guidance on contaminant exposure control is mostly provided in Chapter 11, Exposure and Hygiene Considerations The CEC approaches presented in NFPA 1700 are aligned with those in NFPA 1500, albeit NFPA 1500 provides a more prescriptive approach to CEC as would be expected in a standard. NFPA 1700 also addresses CEC topics that are only tangentially covered in the appendix or not covered at all in NFPA 1500. These topics include PPE off-gassing and the recommendation that fire engine cabs be kept closed during firefighting operations and aired out after operations have ceased. The term gross decontamination is utilized in the Guide. The term preliminary exposure reduction does not appear in the Guide.
The first edition of NFPA 1851 was published in 2001. Three editions of the document have been published since 2001 with the first edition being 30-pages and the current 2020 edition expanded to 119-pages. In the Appendix of the 2001 edition of the standard, the committee cautioned readers on the hazards of contaminated PPE, stating:
“
Health risks of soiled or contaminated ensembles and ensembles elements
Soiled or contaminated ensembles and ensemble elements can expose fire fighters to toxins and carcinogens that enter the body through ingestion, inhalation, or absorption. Repeated small exposures to some contaminants can add up over time and cause health problems.
Although great emphasis is placed on safety to avoid injury or inhalation hazards while working on the fire ground, many of the toxins which lead to health risks are being carried away from the fire scene on personal protective equipment used to by the firefighter.
Toxins that a fire fighter will come in contact with can be, trapped within the fibers of soiled ensembles and ensemble elements or absorbed into the materials themselves. Contact with the soiled ensembles and ensemble elements increases the risk of the toxic contaminants being introduced into the body.”
Further, Chapter 5 of the standard outlined routine cleaning and decontamination procedures to include, when possible, cleaning of PPE at the incident scene. The following steps for decontamination were outlined in Section 5.2.3 of the 2001 edition:
“(1) When possible, initiate cleaning at the incident scene,
(2) Brush off any dry debris,
(3) Gently rinse off debris with a water hose,
(4) If necessary, scrub gently with a soft bristle brush and rinse off again,
(5) If necessary, spot clean utilizing a utility sink,
(6) Inspect for soiling and contamination and repeat process if necessary.”
The standard also required, in Section 5.2.4, that advanced cleaning be used if routine cleaning failed to render the PPE “sufficiently clean”. Of note is that PPE decontamination requirements were present in the first edition of NFPA 1851, but they did not make their way into NFPA 1500 until 17 years later. The 2001 edition of the standard also indicated, in Section 2.5, that the “organization” was responsible for developing an SOP to “minimize the public’s exposure to soiled and contaminated structural fire fighting protective ensembles and ensemble elements”; this requirement was later modified in the 2008 edition of the standard, in Section 4.5, to recognize that both the public and personnel should be afforded protection from contaminates.
In the 2020 edition of the standard, the requirements for PPE cleaning and decontamination were modified (see Chapter 7) and the term Preliminary Exposure Reduction (PER) was introduced in place of Gross Decontamination. The committee indicated that this was done to remove the “inference that gross decontamination might be the only activity needed to render clothing safe for reuse and free from contamination”. Additionally, the term “Products of Combustion” was introduced in the definition section and several places within the document. Flow charts for “Approach for Deciding Handling, Cleaning, and Disposition of Ensemble Elements” and “Approach for Addressing Specific Types of Contamination” (see Figure 1) were also added to the standard.
The flow charts include steps for incidents involving PPE contamination and specifically contamination related to products of combustion. The document specifies that dry or wet PER steps are to be performed on contaminated PPE “immediately after exiting the emergency scene” while on air, and that PPE is to be removed, bagged, and sent for advanced cleaning after PER. The current edition also includes requirements for verification of organization, ISP, cleaner, or manufacturer cleaning process for removal of products of combustion, i.e., 50% or greater average cleaning efficiency.
4.1.7 Future of Standards
NFPA is currently in the process of consolidating standards, including some standards applicable to CEC. According to NFPA, the standards consolidation project aims to increase unity between different technical committees, resolve conflicting information within standards, eliminate the need to purchase multiple standards, and resolve difficulty in planning and scheduling various technical committee meetings. The consolidation effort applies to the standards that cover “operational concerns, professional qualifications for responders, and the care, selection and maintenance of PPE”. The project is stated to benefit anyone who uses NFPA Emergency
Response and Responder Safety (ERRS) standards. Efforts began in 2020 and are projected to end in 2025. Table 2 provides a list of relevant codes that will be consolidated.
Current Standards
NFPA 1500, 1521, 1561
NFPA 1581, 1582, 1583, 1584
NFPA 1851 and 1852
Table 2: ERRS Consolidation Plan
Proposed Draft Standard (Consolidated)
NFPA 1550- Standard for Emergency Responder Health and Safety
NFPA 1580- Standard for Emergency Responder Occupational Health and Wellness
NFPA 1850- Standard on Protective Ensembles for Structural and Proximity Firefighting and Self-Contained Breathing Apparatus (SCBA)
NFPA 1500, 1521, and 1561 will be consolidated into NFPA 1550. NFPA 1581, 1582, 1583, and 1584 will be consolidated into NFPA 1580, and NFPA 1851 and 1852 will be consolidated into NFPA 1850. NFPA 1700, Guide for Structural Fire Fighting, will remain a single document. Additionally, a proposed standard, NFPA 1585, Standard for Exposure and Contamination Control, is under development. The purpose of the standard is to “provide minimum criteria for exposure and contaminant control in emergency services facilities, in emergency vehicles and apparatus, during procedures at an incident scene, and at any other area where emergency service members are involved in routine or emergency operations.” Further, the standard is stated to apply to a broad range of entities including “public, military, private, and industrial emergency services departments providing law enforcement, rescue, fire suppression, fire investigation, and emergency medical services, as well as other emergency services and special operations.”
4.1.8 Industry Best Practices
One of the most visible, comprehensive industry best practice documents that provides guidance on CEC is the Lavender Ribbon Report (LRR) The report is the work product of a joint cancer committee formed by the International Association of Fire Chiefs’ Volunteer and Combination Officers Section (IAFC-VCOS) and the National Volunteer Fire Council (NVFC). The text was first released in 2018 with an update released in 2021. The guidance in the report is aimed at preventing firefighter cancer. The document details eleven best practices to achieve this goal, as follows:
1. “Full 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 POVs, 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.”
The LRR also discusses PER and provides estimated costs for implementation of each best practice Further, the LRR cross-references related immediate action steps published by the Firefighter Cancer Support Network (FCSN, 2013). Messages and approaches like those in the LRR were also found in resources from the Fire Responder Center for Excellence (FRSE), NFPA’s Campaign for Fire Service Contamination Control (Stull, 2018), and trade magazines and news sources, such as Firehouse, Fire Engineering, and FireRescue1.
4.2 Task 2- Current Practices
Task 2 included a review and comparison of career, combination, and volunteer fire department policies on CEC. Policy types and referenced NFPA standards were identified, and policy practices were compared against NFPA 1500 requirements. The findings from Task 2 were incorporated into the training provided in Tasks 3 and 4.
4.2.1 Survey
As a first step, an online survey was conducted to better understand the current climate related to fire department CEC policies. The survey targeted participation from H&S personnel involved in the development, implementation, or management of CEC policies. H&S personnel were asked to complete a short survey and, if applicable, submit copies of departmental CEC program documents. Specifically, participants were asked to provide copies of policies or programs addressing the following:
• Post-fire atmospheric air monitoring and respiratory protection (i.e., policy establishing when SCBA use can be discontinued),
• PPE decontamination, and
• Personal hygiene (wipes, showering, etc.)
The survey was advertised on MFRI/UMD social media outlets (LinkedIn, Facebook, etc.). In addition, the International Association of Fire Fighters (IAFF) and National Volunteer Fire
Council (NVFC) circulated an announcement about the survey in their newsletters and on their social media sites. Survey participants were asked the following questions:
Table 3: Survey Questions
Information Requested or Question
Q1: Please provide the following about your fire department.
Q2: Please provide your contact information.
Q3: If needed, may we contact you with follow up questions?
Q4: Are you responsible for managing Health & Safety in your department?
Q5: If yes, do you currently have a Health and Safety Officer certification from an agency with NFPA 1521 accreditation through ProBoard or IFSAC?
Q6: Is your fire department career, volunteer, or combination?
Q7: Which of the following would best describe the community your Fire Department serves?
Q8: What aspects are covered in your department's contaminant exposure control policy or program? (Select all that apply)
Entry Choices
Name of Fire Department, County/City/Town, and State/Province
Submitter Name, Position or Title, Email Address, and Phone Number
Yes or No
Yes or No
Yes or No
Career, Volunteer, or Combination
Urban, Suburban, Rural, Industrial, Federal Jurisdiction, or Other (please specify)
Post-Fire Atmospheric Monitoring, Post-Fire Personal Protection Equipment (PPE) Decontamination, Post-Fire Personal Hygiene (e.g., cleaning skin with wipes, showering), PostFire Apparatus and Equipment Decontamination, None, my department has no procedures or policies related to post-fire contaminant exposure control
Q9: Please upload a copy or all department policies or programs that address the control measures selected in Question #8
Upload policies
In total, 101 individuals responded to the survey. Although the survey was directed at H&S personnel, only 14 of the 101 participants were responsible for managing H&S in their departments and only 19 of the 101 participants had the HSO certification. Figures 2 through 4 show the results for responses to questions 6 through 8.
As shown in Figure 2, the largest percentage of participants were from career fire departments followed by combination and volunteer, respectively As shown in Figure 3, the largest percentage of participants were urban departments followed by suburban and rural departments, respectively. Lastly, as shown in Figure 4, the largest percentage of respondents said their department had a policy addressing post-fire PPE decontamination, followed by a policy addressing post-fire personal hygiene and a policy addressing post-fire atmospheric monitoring. Approximately 20% of respondents said their department had no CEC policy at all
4.2.2 Policy Review
Policies from 31 departments (30 U.S. departments and 1 Canadian department) were reviewed as part of this study. An internet search was conducted to locate publicly available policies to supplement the number of policies submitted via the survey portal Policies were obtained from career, combination, and volunteer departments as well as various jurisdiction types; the distribution is shown in Table 4.
Policies were obtained from 18 different states, indicated in red on the map of the United States shown in Figure 5.
Table 5 provides a summary of the types of policies provided by each surveyed department. A department was considered to have a policy on Post-Fire Atmospheric Monitoring, if in the policy, it was required that some type of measurements be performed to quantify the hazard level in the atmosphere. Departments that specified the use of monitoring devices but did not specify gases to be assessed or threshold levels were also considered to have a Post-Fire Atmospheric Monitoring policy. Absent production of a written policy, departments were assumed to not have a policy on the subject matter.
Table 5: Policy Type Review
The following observations were made after reviewing the policies:
Department #1
• Department provided two policies- Safety officer and OSH program
• Department policy which outlines the roles of the Safety Officer
• Department has an Occupational Safety and Health Program (2013)
o Program references NFPA 1500, 1521, 1041, 1021, 1403, 472, 1901, 1904, 1911, 1914, 1581, 1971, 1981, 1976, 1999, 1991, 1992, 1993, 1982, 1983,
o Only mentioned fire suppression, rescue, and related activities (unclear if it applies to fire investigators, instructors, etc.)
o SCBA required if environment is hazardous, suspected of being hazardous, or may rapidly become hazardous.
Members can remove SCBA or wear APRs when O2 more than 19.5%, CO less than 35 ppm, and 10% LEL of organic vapors.
o Structural firefighting protective clothing shall be cleaned after every fire
o FD shall provide for cleaning of contaminated PPE- cleaning service or designated washing machine
No policy for post-fire PPE decon or equipment decon
No policy for wipe or shower.
Department #2
• Policies from 2020
• Department provided four policies- Personal Protective Firefighting Gear Maintenance, Post Incident Decon, Protective Hood Exchange, Respiratory Protection
• Reference made to NFPA 1851
• Department has policy for PPE maintenance which includes gross decon, wet or dry, on-scene, use of med gloves prior to handling gear, isolation of contaminated gear to prevent cross-contamination of apparatus cab and station
• Department has a separate policy just for post incident decontamination, i.e., a contamination reduction strategy
o Decon kits
o Protection of employees performing decon
o Wet or dry decon of PPE after leaving IDLH (FF to remain on air)
o Decon of equipment
o Packing of gear for travel- take to logistics for exchange or back to station for washing.
o Keep contaminated gear out of rehab area.
o Use wipes for gross decon and in rehab
o Change uniform
o Shower within an hour
• Hood exchange program
• Respiratory protection program
o Use of PPV during 60-90 minute off-gassing phase
o Leave on SCBA through completion of overhaul
o Only remove SCBA when told to do so, per direction of IC and Safety Officer
o No mention of APR, no specific reference to acceptable levels
o Monitoring required for LEL, O2, CO, and H2S before letting residents back in
Department #3
• Policy from 2018
• Department provided one policy on fire scene decon/cancer reduction
• Policy mentions gross decon of PPE and skin decon at fire incident, PPE bagging and clean cab concept, PPE washing and hood laundering or exchange, showering and changing clothes, use of SCBA during overhaul
• Policy does not mention APRs and does not mention use of atmospheric monitoring.
Department #4
• Policy date 2014
• Department provided two policies on Air Monitoring (Post Fire) and Diesel Exhaust Extraction
• SCBA until air monitoring shows it is safe to remove
• Air monitoring after ventilation and overhaul
• Ventilate until CO < 35 PPM, HCN < 5 ppm
• Immediate action if H2S > 10 PPM, LEL > 10%, O2 < 19.5%
Department #5
• Policy date (under development)
• References NFPA 1851
• Only duty wear in cold zone at station
• Clean and sanitize work area
• Wear SCBA during overhaul
• Gross Decon of PPE and use of wipes
• Shower within an hour
• Contaminated gear not allowed in apparatus cab. Only cleaned helmets, SCBAs, radios are allowed back in the cab
• NFPA 1851 referenced for decon of equipment at station
• Decon apparatus cab
• Document exposures
Department #6
• Policy date is 2016
• Policy is for fireground gross decon procedures, wipes, and recommends shower but does not indicate within an hour.
• Wash apparatus with soap and water, wipe interior surfaces
• Wash hoses with soap and water
• Personnel cleaning or handling contaminated gear to wear gloves, N95 masks and eye protection
• No mention of APR or post-atmospheric monitoring
• No NFPA reference
Department #7
• Policy revised in 2021
• Discusses gross decon, use of wipes, bag PPE at scene, and shower
• No mention on equipment or apparatus decon
• No mention of APR or post-atmospheric monitoring
• No NFPA reference
Department #8
• Policy 2017- Atmospheric Monitoring
• Policy 2019- Post-fire Decon
o SCBA should remain on
o Hood exchange
o Fire wipes during rehab
o PPE in plastic bag transported back to quarters
o Personnel shower
o Decon of equipment at station
• Monitor for HCN, LEL, O2, and CO after all smoke and visible particulates are removed via ventilation and personnel intend to remove SCBA (HCN less than 4.7 ppm and CO less than 35 ppm)- no mention of APR
Department #9
• Policy on Occupational Contaminant Exposures (revised 2020)- gross decon, PPE in bag and transported in exterior compartment, PPE cleaning after incident- use of skin wipes and weekly hood washing, apparatus cleaning, shower within an hour
• Policy on Respiratory Protection during overhaul operations (2017)- monitor for CO, HCN, H2S, O2, LEL- 0 ppm for all otherwise IDLH (O2 must be 20.9%)- Phase 1
• Phase 2- 90-minute duration- SCBA or SABA and full PPE is required
• Phase 3- after 90 minutes- use of APR
Department #10
• Policy on Post Incident Exposure Reduction and Decontamination (2019 edition)
o Requirements for individuals performing exposure reduction
o Decon while on air
o Wet decon, dry decon
o Bag gear
o Advanced cleaning
o Wipes
o Showering
Department #11
• Policy on Respiratory Protection 2010 (no atmospheric monitoring mentioned)
• Policy on Rehab and Care- 2019 (mentions on-scene decon and hood cleaning)
• Policy on PPE (2019)- references routine and advanced cleaning- no mention of onscene decon requirement
• Subpolicy on PPE (2019) indicates that PPE exposed to contaminants not removed by routine cleaning should go to ISP for cleaning- no on-scene cleaning reference.
• Policy on storage and wear of PPE in quarters (2019)- prohibits bringing gear into kitchen, living areas
• Policy on transport of gear (2019)- focus on bloodborne pathogens, use of gear bag
• PPE Decon policy (2019)- focus on blood or potentially infectious contaminants- not on-scene.
Department #12
• Policy on PPE (2017)
• NFPA 1851, 1971 referenced
• In case of PPE gross contamination- PPE shall be cleaned on scene and thoroughly cleaned upon return to station- no mention of process
Department #13
• Policy on Post Fire Decon- 2018
o Dry and wet decon, fire wipes, plastic bags for gear- issued clean hood and gloves before leaving scene, wash gear upon returning, shower within an hour
o Gross decon equipment and wipe apparatus surfaces
Department #14
• Policy on Cancer Prevention- 2019
• Respiratory protection from initial attack through completion of overhaul
• Use of PPV to blow off harmful material when doffing their PPE after exiting IDLH
• Wet wipes at rehab center
• Gross decon prior to leaving scene- wet or dry decon, seal PPE in plastic bag if having entered IDLH, transported in rear compartment- clean gear at station after incident- use N95 and gloves when removing gear
• Decon apparatus with wipes
• Shower
• Respiratory protection policy 2021
o Does not include HCN measurement
o SCBA for 24 hours- discretion of IC on "small fires..where structure does not elevate above ambient temperature.."- may allow for APR or PAPR use during overhaul or other post-fire operations
o Use APR after 24 hours and monitor atmosphere.
Department #15
• Policy on Cancer Awareness/Prevention-2019
• Decon of clothing and equipment before returning to quarters
o Clean bunker gear with water prior to leaving scene
o In cold weather where freezing is a concern, members can be dry deconned using a hand-held brush to remove all loose particles and soot from the gear prior to being bagged.
o Remove gear and bag prior to leaving the fire scene.
o Contaminated gear should be cleaned in extractor in a timely manner following contamination.
Members handling contaminated gear for cleaning shall wear an N95 mask and disposable gloves for protection.
• Wipe skin prior to eating/drinking on fire scene
• Wipe skin immediately after doffing respiratory protection and PPE
• Shower as soon as possible after being exposed to products of combustion or other contaminates.
• Apparatus seats should be cleaned and decontaminated regularly, especially after incidents where firefighters were exposed to products of combustion.
• Full bunker gear and SCBAs shall be worn through overhaul operations when products of combustion and/or gases and vapors are present. No measurements or duration indicated.
• Annual cancer screenings as part of department physicals
• Cancer Awareness training provided on a regular basis.
Department #16
• Policy on Firefighter Decon- 2016
• Responsibility of Incident Commander to ensure appropriate decon of firefighters and equipment
• Responsibility of Company Officer to ensure appropriate respiratory protection
• Gross decon immediately after exiting IDLH atmosphere
o Individuals performing decon should wear eye protection, N95 mask, and EMS gloves
o Crews should perform while still on SCBA air
o Wet decon- rinse gear, wipe hood, face piece, and regulator, wipe skin
o Dry decon- brush off gear, wipe face piece, wipe skin
o Rinse hoses and equipment prior to placing back on apparatus
o PPE not required to keep the company in service should be bagged. IC should make replacement PPE available as soon as possible
• In-station decon and cleaning
o Individuals performing decon should wear eye protection, N95 mask, and EMS gloves
o Wash all equipment with soap and water
o Wash apparatus with soap and water. Wipe cabs and passenger compartments
o Shower
o Wash gear and PPE
Department #17
• Policy on SCBA Use- 2019
o SCBA required anytime subjected to a hazardous contaminated atmosphere until IC determines SCBA no longer needed
o At a minimum, for 60 minutes following extinguishment and until CO level is confirmed to be below 35 ppm
• Policy on Cancer Risk Reduction- 2019
• Gear should be laundered immediately
• If possible, pull back personnel during 60-minute cooling period after initial fire knockdown.
• Gross decon on scene
o Rinse down with hose and soap
o Bag gear and SCBAs for transport back to station
• Deconned SCBAs should be left outside of apparatus to dry and off-gas.
Department #18
• Policy on PPE- 2021
o Damaged, deteriorated, or contaminated PPE to be evaluated by the Health & Safety Officer
• Policy on Health Hazard Exposure Record- 2016
o To be completed by IC
o Health hazard exposures include, but are not limited to, exposure to any type of hazardous material, including smoke byproducts.
• Respiratory Protection Program- 2021
o Personnel operating in an IDLH atmosphere shall use an SCBA respirator.
o The IC and SO may authorize the removal of SCBA respirators after atmospheric testing has determined that there is no further respiratory hazard.
Department #19
• Policy of Post-Fire Incident Decon- 2019
• Decon following exposure to IDLH for greater than 10 minutes or ½-cylinder consumption.
• On scene decon-Remain in full PPE and on SCBA
o Stand in front of PPV fan to remove debris for 1 minute.
o Spray with hose to rinse gear, SCBA, and facepiece.
o Stand in front of PPV fan again for 1 minute
• After doffing PPE
o Bag gear
o Do not transport inside vehicle cab.
o Wipe skin
• Shower as soon as possible
• Wear gloves while removing bagged equipment for cleaning.
• Clean used equipment, including SCBA
Department #20
• Cancer Prevention Policy- 2018
• Decon on scene
o While on air and in full PPE, brush, or spray gear with water
o Wipe skin
o Swap hood
• Transport used gear outside of cab or bag and place in cab
• Launder gear as soon as possible
• Shower
• Clean contaminated hose, SCBA, and tools and decon interior of cab with wipes
• Firefighters in the Hot Zone to remain in full PPE with SCBA - on air, from initial knockdown through overhaul, or until multi-gas meter readings permit breathing ambient air.
• Personnel entering the fire ground post-overhaul should wear N95 masks and gloves.
• In an ongoing database, firefighter and fire investigator activity will be logged relative to duration, frequency, proximity to Hot Zone and fuel types at fire incidents.
Department #21
• PPE Decon policy- 2016
• Decon on scene
o Brush off gear and rinse with water
• Bag gear and transport outside of cab
• SCBA worn throughout overhaul regardless of CO level readings
o Remain on air for at least 2 minutes after exiting structure
• Wash hands and face prior to entering rehab
• Personnel performing decon to wear gloves, N95 mas, glasses, Tyvek suit
• Clean hose and equipment from apparatus
• Shower at station
• References NFPA 1851
Department #22
• Post-Fire Decon Policy- 2019
• Gross decon on scene
o Remain on SCBA
o Wash gear with soap and water and rinse
o Wipe skin and wash hands
• Bag gear and do not place gear in cab
• Wash hose, tools, SCBA, and equipment with soap and water
o Allow hose and gear to off-gas in well-ventilated area for 2 hours before handling
• Shower within an hour
• Replace with clean clothes
Department #23
• Fireground Exposure Reduction Policy- 2019
• Gross decon on scene
o Remain on SCBA
o Rinse off gear
o Remove and brush off gear, wash, while wearing EMS gloves and eye protection
o Clean skin
o Bag gear
o Clean off hose lines before reloading
• Decon apparatus cab
• Shower within an hour
• Replace with clean clothes
• Complete Toxic Exposure form
Department #24
• Atmospheric Monitoring Devices (AMD) Policy and Procedure- 2019
• Does not specify to be used for post-fire atmospheric monitoring but specifies the following for identifying hazardous atmospheres:
o AMD to monitor O2, % LEL, CO, and H2S.
o O2 less than 19.5% or greater than 23.5% requires SCBA and PPE for entry
o H2S greater than 10 ppm requires SCBA and PPE for entry
o CO greater than 35 ppm requires SCBA and PPE for entry
• Operational Decon Policy and Procedure- 2019
o Gross decon on scene
One minute rinse down while on SCBA or dry decon, if necessary, with brush and wipe down
Wipe skin
Bag gear and do not place in cab
Personnel in the contaminated area should utilize respiratory protection when working where smoke may be present or during the decontamination process.
o Decon at station
Shower within an hour
Decon apparatus cab
Wear gloves, respiratory protection PPE during cleaning of equipment/gear
Department #25
• PPE Policy- 2021
• Use washers/extractors to routinely clean and decon turnout gear.
• No gross decon or on scene decon mentioned
• References NFPA 1500, NFPA 1581, NFPA 1851
Department #26
• Gross decon-2020
• Rinse and wash gear with cleaning solution
• Remove gear and bag
• Wipe skin
• Shower at station
Department #27
• PPE Cleaning and Decon Policy- 2020
• References NFPA 1851 (2020)
• On scene decon
o Remain on SCBA, perform wet mitigation
o Stand in front of PPV fan for 1 minute
o Remove SCBA, mask, hood, and gloves. Wipe skin
o Bag gear and do not place in cab of apparatus
• Decon at station
o Clean tools, equipment, and gear.
o Decon apparatus cab
o Shower, don clean uniforms
• Wear gloves, N95 mask, etc. when cleaning, handling contaminated gear
Department #28
• Structural PPE Policy-2020
o References NFPA 1851
o Do not transport contaminated gear in apparatus cab
o Advanced gear cleaning twice/year
o Remain on SCBA during overhaul and until clear of Warm Zone and IDLH atmosphere
o On-scene decon
Rinse or brush off gear
Remove gear and wipe skin
Bag coat, pants, and hood and transport outside of cab
Clean helmets, boots, and SCBA before placing in cab
o At-station decon
Shower within an hour
Don clean clothing
Wear gloves while cleaning gear
• Arson PPE Policy (for investigators)-2020
o Gross decon on scene
Wipe skin
Decon boots, tools, and equipment and store outside passenger area or in approved airtight container
On-scene gear exchange or transport used gear in sealed bag outside of passenger compartment or approved airtight container
o Post-scene
Shower within 30 minutes
Clean hood, gloves, and boots
Department #29
• Cancer Reduction Measure Policy- 2017
• Use nitril gloves when cleaning
• Remain on SCBA until finish of overhaul
• On scene
o Gross decon of PPE to remove soot and particulates
o Wipe skin
o Wash off equipment prior to replacing on apparatus
o Do not transport exposed hose in crew compartment
• At station
o Clean PPE and SCBA in accordance with NFPA 1851
o Clean tools, equipment, and interior and exterior surfaces of apparatus
o Shower and change into clean clothes
Department #30
• Post Fire Gross Decon Procedure- 2019
• On scene decon
o Remain on SCBA
o Use brush and cleaning solution to clean PPE
o Follow NFPA 1851 for cleaning PPE
o Can go off air and doff PPE
o Wipe skin
o Bag exposed PPE and do not place in apparatus cab
o Clean SCBA, tools, radios before placing back in cab
• At station
o Shower within an hour
o Follow NFPA 1851 to decon equipment and PPE
o Decon apparatus cab
o Use extractor washers and commercial dryers as outlined in NFPA 1851 to clean gear
Department #31
• Emergency Scene Wash Down Manual- 2019
• On Scene decon
o Remain on SCBA
o Wash off gear and scrub with soap and water, rinse
o Bag gear
• Use gloves and other appropriate PPE when handling gear back at the station
After reviewing the above detailed policies and as noted in Table 5, many policies were created prior to the 2018 edition of NFPA 1500. The 2018 and 2021 edition of NFPA 1500 introduced significant changes in the approaches used for CEC. As such, policies pre-dating 2018 would be unlikely to capture the evolving requirements in the codes and standards. Moreover, many policies did not reference NFPA standards, particularly NFPA 1500, suggesting that these standards did not provide the basis for the requirements within the policies.
Regarding content, 9 of 31 policies addressed post-fire atmospheric monitoring, 27 of 31 policies addressed post-fire PPE decontamination, 23 of 31 policies addressed post-fire personal hygiene, and 18 of 31 policies addressed post-fire apparatus and equipment decontamination. Notably, most policies recognized the need for use of SCBA during overhaul, however, there was infrequent consideration for respiratory protection requirements thereafter, e.g., re-entry after overhaul. Only three of 31 policies included requirements for APR use, many policies did not define post-fire atmospheric monitoring requirements, and most were silent on PPE off-gassing hazards Of departments that did address APR use, Department #9’s policy laid out a three-phase process and APR use based upon the 90-minute rule in NFPA 1500 (2018), and Department #14 required SCBA use up to 24 hours post-fire and APR thereafter (exceeding NFPA 1500 requirements). While no policy met all the requirements set forth in the current NFPA standards, it is important to recognize that any efforts to reduce contaminant exposure is better than doing nothing at all.
4.3 Task 3- Regional Training and Workshop
Task 3 included the development and delivery of training in the form of a regional workshop. The regional workshop, hosted by MFRI, aimed to educate H&S personnel and leadership on the findings of this study. The workshop included breakout sessions designed to bring together H&S personnel and leadership from DC, Maryland, and Virginia. The breakout sessions focused on (i) identifying policy success measures, (ii) identifying resources needed to develop, implement, and manage an exposure control policy, (iii) identifying challenges hampering departments from developing, implementing, or managing an exposure control policy, and (iv) identifying current NFPA 1521 training and continuing education needs to better equip HSOs in the performance of their duties. In addition to providing H&S personnel with continuing education, Task 3 also identified successes and challenges faced by H&S personnel and leadership in the development, implementation, and management of their CEC programs.
4.3.1 Workshop Structure
The workshop was a two-day event, and the schedule is shown below.
Fireground Contaminant Exposure Control Workshop: Day 1 (May 23, 2022)
0845
1045
Chief Randy Krause- Port of Seattle Fire Department and NFPA 1500 Chairperson
4.3.2 Breakout Sessions
Attendees were placed in two groups. Each group was provided with identical question sets and assigned a leader and a scribe. The questions were asked in terms of what is happening in their department or what should be happening in their department. Attendees provided input on how their organization should be addressing issues and answered questions for each type of CEC issue, e.g., Post-Fire Atmospheric Monitoring (PFAM), PPE (and Associated Equipment) Decontamination, and Personal Hygiene.
4.3.2.1 Workshop- Day 1
Day 1 questions centered on four topics a) Policy Development, b) Policy Implementation, c) Policy Management, and d) Current Practice and National Standards. Attendees were advised that many of the questions were phrased in terms of what is happening or should be happening, as it was recognized that not all organizations have CEC policies in place. For those with active policies, attendees were advised to provide input on how their organization should be addressing issues, if they believe that changes were needed. The questions and responses (shown in the boxed areas) were as follows:
Topic A: Policy Development
1. Who was (is, should be) responsible for CEC policy development in your organization?
• Committee based- Started with HSO leading the way in some cases and then transitioned into committee-based scenarios- boots on the ground were part of the committee in some departments
2. Did (does, should) your organization utilize subject matter experts to assist in CEC policy development? If so, were they internal or external to your organization?
• No- we did research online and found other organizations that had gone through the process, Lavender Ribbon report was a good resource.
• Used internal subject matter experts
3. What level of education, certification, or training, was (is, should be) required of those responsible for CEC policy development? What training have you personally received related to CEC policy development?
• Everyone should have HSO or ISO certification, however, HSO/ISO certification did not prepare them for policy development. It was more of a self-education process.
4. Was (is, should) your CEC policy developed by one person or a team of people?
• Committee driven
5. Did (is, should) your organization involve those with "boots-on-the-ground" when developing CEC policies?
• Some departments did involve “boots-on-the-ground” while others did not, but all attendees agreed that they should play a role in development and be given an opportunity to provide input.
6. Did (is, should) your organization circulate a draft CEC policy for review by those impacted? If so, who was (is, should be) asked to provide input?
• Responses varied within groups- Some attendees said policy went to executives only for review; others found out about it for the first time when they received it in their email.
7. Does (should) your CEC policy apply to all position types subject to workplace exposures, e.g., firefighters, fire investigators, instructors, etc.?
• Intent was to apply to all position types but there is enough ambiguity that it may be ignored by some because it does not specifically identify them.
• Yes- it should include everyone, however, current policies do not clearly indicate that it applies to everyone.
8. Do you, personally, feel that you have been equipped with the right knowledge, skills, and abilities to tackle the health and safety challenges that your organization faces?
• HSO/ISO certification did not prepare them for policy development.
9. If your organization does have a CEC policy, identify what triggered its development and the biggest successes and challenges.
• Reactive response to the issue-cancer rates or in response to Lavender Ribbon report triggered development of policy.
10. If your organization does not have a CEC policy, identify the current challenges in developing a policy.
• Was not feasible for budget, insufficient staffing to develop policy, cost of equipment and gear.
• Cost of buying and maintaining second set of gear is the biggest problem with implementation of a policy- departments are dead in the water without second set of gear.
Topic B: Policy Implementation
1. Who is (should be) responsible for determining when CEC policy requirements are implemented at an incident?
• Incident Commander, Safety Officer, Company Officers
2. What is (should) the trigger point be for CEC policy procedures, i.e., how does your organization define an "exposure"? Does (should) your organization utilize a hierarchical approach to CEC based upon the extent of the exposure? Do you feel the exposure is easily quantifiable; and if so, how do (should) you quantify it?
• Trigger point might be working fire dispatch, although this is not specifically called out in policy
• The exposure is not easily quantifiable- everything could be an exposure. A judgment call must be made which is based on a qualitative assessmentaccuracy of the assessment is dependent on the Safety Officer having the proper KSAs.
• Company Officer may need special training to be able to identify when decontamination is required if Safety Officer is not dispatched on call.
3. What level of education, certification, or training, is (should be) required of those responsible for CEC implementation in the field?
• HSO and ISO
4. What challenges have (may) you faced in effectively implementing CEC policy requirements in the field? Specifically, has your organization experienced resistance to policy requirements?
• Yes, we have faced resistance People do not like change.
• Company Officer buy-in is very important to get younger generation to follow requirements.
• Fire academies need to implement CEC- lead by example and expose firefighters to the right way early.
5. How did your organization introduce your CEC policy to those responsible for implementing it in the field?
• Training was provided to those in the field
• Policy was sent through email and equipment was dropped off at stationNo formal training was provided.
6. If your organization has implemented a CEC policy, identity the biggest successes and challenges. How does this compare with other types of safety policies your organization has implemented, e.g., seat belts?
• Biggest success was implementation of CEC early at FA by one department
• Biggest challenge was cost
7. If your organization has not implemented a CEC policy, identify the current challenges prohibiting policy implementation. How does this compare with other types of safety policies your organization has implemented, e.g., seat belts?
• Funding sustainability
1. Who is (should be) responsible for CEC policy management in your organization?
• Department Fire Chief, HSO, and committee members.
• HSO chairperson with a committee of people
2. What is your organization doing to ensure those responsible for policy management remain current in evolving CEC requirements? Are (should) all employees afforded this same training?
• No continuing education requirements are currently in place. Most H&S are seeking out ad hoc training, like that provided by MFRI and through participation in Council of Governments (COG)
3. How does (should) your organization evaluate CEC policies to ensure they are effective in reducing risk?
• They do not and are unsure how to quantify risk reduction.
4. How does (should) your organization ensure that CEC policies do not become check-the-box exercises?
• They promote leadership influence; ensure that Company Officers are setting the tone.
5. Does (should) your organization promote a positive safety culture? If so, how?
• Avoid being a disciplinarian; it doesn’t work
• Getting out there and making sure personnel are implementing procedures and helping them to implement them.
6. Does (should) your organization use exposure data in a meaningful way to prevent reoccurrences and develop corrective actions?
• No, we are not doing well with this part.
Topic D: Current Practices and National Standards
1. Is an All-for-One approach to CEC appropriate? In what ways are organization facing the same challenges and how might they differ, e.g., career/combination/volunteer, urban/suburban/rural, geographic locations, structural/wildland/vehicle, firefighter/fire investigator/instructor, etc.?
• An all for one approach will not work; do the best you can.
• Each department should craft their own policy
• Although alternative guidance is needed for departments that cannot afford a second set of turnout gear.
2. Does (should) your organization adopt CEC requirements from a national standard, if so, which one? Are these requirements adopted into statutes (legal requirement) or used as best practices?
• Best practices were the approach used for development of policies; departments did not use NFPA standards as a resource.
3. Should CEC be a core element in and part of the required KSA's in Firefighter I certification?
• Yes- this should be incorporated in Firefighter 1 training; change starts at the lowest level.
4.3.2.2 Workshop- Day 2
Day 2 questions centered around three topics a) Steps to Success- Sharing what works, b) Addressing Challenges- Fixing what’s broken, and c) Future Initiatives Roadmap. Attendees were instructed to share their success stories to help other organizations that are in the process of CEC policy development, implementation, and management. Further, they were instructed to share what has not worked well in their organization's CEC policy development, implementation, and management process, as it could help other organizations to avoid the same issues. Lastly, they were instructed to consider the challenges they identified in Day 1 and propose a plan to resolve the issues The questions were as follows:
Topic A: Steps to Success- Sharing what works
1. List at least five things that you would identify as successes in your organization's policy development, implementation, and management journey.
• Understanding and clearly identifying the need for the program
• Sharing of information with all department personnel to let them know what the benefit is and why it is important
• Having others seeing the policy in-use (when you start doing it, others will do it too)
• Receiving and incorporating feedback from leadership, and particularly, from boots on the ground
• Providing training opportunities
• Sending message to recruits- first thing recruits hear is message on the hazards of being a firefighter
• Establishing a cancer advisory council- having a full range of service providers and not just white shirts
• Designing a logo that showcased the importance of the cancer reduction initiative.
• Sharing resources and R&D to be able to determine which products are most effective
a. How can we best share our successes?
• Reaching out to others within your department and region; building relationships; tapping into multi-jurisdictional resources, like the COG
b. Who is the audience, e.g., chiefs, safety officers, line officers, firefighters?
• Everyone in the fire service- safety must be everyone’s personal priority
• Starting with new employees is the best way to instill safety culture change.
• People that hold the purse strings need to be made aware of the need for a program and the benefits of the program.
c. What is the best way to reach the audience, e.g., magazines, social media, etc.?
• Social media- Twitter, Facebook, etc.
d. Who is best suited to lead the information-sharing effort, e.g., USFA, NFPA, IFCA, IAFF, NVFC, etc.?
• IAFF and NVFC are largest group that represents the boots on the ground.
• Everyone should play a role in this effort.
Topic B: Addressing the Challenges- Fixing what's broken
1. List at least five aspects that you would identify as challenges (or even mistakes) in your organization's policy development, implementation, and management journey.
• Determining what is obtainable as it is different for different departments- Are the policies that we are putting in place obtainable?
• Educating others, determining the best way to get the information out there and in what format (e.g., videos or face to face demonstration)
• Educating ourselves- determining how to explain to others why CEC is important.
• Facing resistance from the top- having someone in a position at the top of the organizations who is out of touch with the way the job has changed.
• Ensuring proper resource management and equipment is being used for its intended purpose, e.g., someone taking the garden hose for decon to use to wash down the apparatus.
• Identifying which products are the best products- One department did an evaluation on post-fire decon wipes and talked to partners in FDNY and Philadelphia to help with selection.
• Developing ways to share resources and research- many studies are internally funded by departments and no one else knows about them.
• Determining how clean is clean is still a challenge- it is difficult to determine which elements needs to be cleaned and how often they need to be cleaned.
a. How can we best share our challenges?
• Same responses as question 1a- Reaching out to others within your department and region; building relationships; tapping into multijurisdictional resources, like the COG
b. Who is the audience, e.g., chiefs, safety officers, line officers, firefighters?
• Same responses as question 1b
• Everyone in the fire service- safety must be everyone’s personal priority
• Starting with new employees is the best way to instill safety culture change.
• People that hold the purse strings need to be made aware of the need for a program and the benefits of the program.
c. What is the best way to reach the audience, e.g., magazines, social media, etc.?
• Same responses as question 1c- Social media- Twitter, Facebook, etc.
d. Who is best suited to lead the information-sharing effort, e.g., USFA, NFPA, IFCA, IAFF, NVFC, etc.?
• Same responses as question 1d
• IAFF and NVFC are largest groups that represents the boots on the ground.
• Everyone should play a role in this effort.
Topic C: Future Initiatives Roadmap
1. What is the goal?
• Better defining an exposure and understanding different levels. Is food on the stove an exposure? Is working fire dispatch the correct trigger to require CEC?
• Implementing CEC procedures at training academies, recognizing that procedures used by instructors and students for decontamination may be different than what is used on a scene because hazard is more easily quantifiable in training More research is needed to quantify hazard from training fires.
• Recognizing that CEC applies to more than just the suppression firefighter, but fire investigators, instructors, and others who may be exposed to contaminants.
• Introducing new KSAs for Firefighter 1 to include training on what is in smoke, the health impacts from contaminant exposure, the importance of decontamination, and how to decontaminate
• Introducing new KSAs for Fire Officers to include a better understanding of the safety culture message and cancer awarenesssafety is the most important priority.
• Introducing new KSAs to HSO/ISO to include methods for CEC policy development, implementation, and management, understanding products of combustion, cancer, and associated health hazards and preventative measures.
• Providing formalized continuing education resources to HSOs and others.
• Developing methods to evaluate exposure data to revisit and improve policy and practices
2. How can we achieve the goal?
• Disseminating this information to people that can make an impact, e.g., fire service leadership, fire researchers, standards committees, etc.
3. Who is responsible for leading the effort?
• Everyone
4.3.2.3 Main Takeaways and Other Insights
Based upon discussions and responses from workshop attendees, some takeaways are summarized below:
• A committee-based approach and resource sharing should be used to develop a CEC policy and those responsible for implementing the procedures in the field should be a part of the development process.
• Formal training (e.g., NFPA 1521 HSO certification) did not fully equip HSOs with KSAs needed to develop, implement, and manage a CEC policy
• Policy content was derived from policies created by other departments and the LRR. NFPA standards were not used as a resource in the policy development phase.
• A lack of sufficient staffing to develop policies, the cost associated with buying and maintaining a second set of gear, and funding sustainability are deterrents to CEC policy development, implementation, and management.
• Company officers play an important role in fireground safety culture. If they embrace CEC, others will follow.
• Change should start at the lowest level with new recruits. They should be introduced to CEC at the training academy.
• Safety must be everyone’s personal priority and every position in the fire service must play a role in CEC.
The future initiatives proposed by the attendees aim to address some of the concerns and challenges faced by attendees. The future initiatives are provided in the Conclusions section of this report.
An additional outcome of the workshop discussions was a realization that CEC and overall safety and health approaches are often perceived by personnel as a “gentling of the fire service”. Further group discussion on this topic highlighted an obvious conflict and challenge to the fire service safety culture, as detailed in Figure 6. An individual who willingly runs into a burning building by necessity must have a “risk tolerant” personality. As such, it would seem nonsensical to expect this same individual to possess a “risk adverse” mindset after firefighting is over; herein lies the safety culture challenge.
A proposed solution to this challenge is to reinforce that “Saving Others Requires Saving Yourself” and that we must save ourselves to avoid extinction. This same message is iterated in the LRR, which states “The fire service has a long, storied, and strong culture. This culture is built on bravery and courage and defined by life preservation with smart, aggressive fire suppression. We need to extend this culture to taking care of ourselves after the fire is out.”
As demonstrated in Figure 7, there are three critical components that firefighters must maintain to remain mission ready: behavioral health, physical health, and tactical health. CEC falls within the physical health category, as without CEC, the risk of developing an occupational illness increases which is a direct threat to the firefighter’s ability to serve.
4.4 Task 4- Report and National Training
The final report serves as a consolidated resource presenting the findings from this study. The final report will be made available for download on the MFRI website. The report will be accompanied by a video presentation of the research findings that can be used by fire departments for continuing education training. The findings from this study were presented at the 2022 Maryland State Firemen’s Association (MSFA) conference and to the NFPA 1585 Committee during its October 2022 meeting. To reach a larger national audience, the findings will also be presented at the 2023 NFPA Annual Conference in Las Vegas, NV. Further, the researchers intend to submit an article to a fire service journal or magazine to support further dissemintation of the research findings.
Section 5: Conclusions
The primary goals of this study were to (1) identify current national and regional approaches used in the development, implementation, and management of CEC policies, (2) train H&S personnel and leadership on these current approaches, and (3) establish action items to address current challenges faced by HSOs in the development, implementation, and management of CEC policies. These goals were accomplished through the completion of four tasks: (1) a review of NFPA standards and industry best practices, (2) a review of regional and national current practices, (3) a regional training and workshop, and (4) a final report and national training.
A review of NFPA standards highlighted the evolution of CEC requirements in these documents. The most comprehensive content on processes for CEC are found in the newest editions of NFPA 1500 and NFPA 1851; however, the Lavender Ribbon Report (LRR), which was more commonly referenced by H&S personnel, serves as a comprehensive industry best practices documents that provides 11 steps aimed at reducing contaminant exposure and preventing firefighter cancer. As part of the research project, an online survey was conducted to better understand the current climate related to fire department CEC policies. The largest percentage of the 101 respondents were from career fire departments and urban jurisdictions. The largest percentage of respondents said their department had a policy addressing post-fire PPE decontamination, followed by a policy addressing post-fire personal hygiene and a policy addressing post-fire atmospheric monitoring. Approximately 20% of respondents said their department had no CEC policy at all.
Policies from 31 departments (30 U.S. departments and 1 Canadian department) were reviewed as part of this study. It was noted that many policies pre-dated 2018, and therefore, were unlikely to capture the evolving requirements in the codes and standards. Moreover, many policies did not reference NFPA standards, particularly NFPA 1500, suggesting that these standards did not provide the basis for the requirements within the policies. Only 9 of 31 policies addressed postfire atmospheric monitoring, 27 of 31 policies addressed post-fire PPE decontamination, 23 of 31 policies addressed post-fire personal hygiene, and 18 of 31 policies addressed post-fire apparatus and equipment decontamination. Only three of 31 policies included requirements for APR use, many policies did not define post-fire atmospheric monitoring requirements, and most were silent on PPE off-gassing hazards. While no policy met all the requirements set forth in the current NFPA standards, it is important to recognize that any efforts to reduce contaminant exposure is better than doing nothing at all.
The workshop breakout sessions and responses from attendees provided a snapshot of the successes and challenges faced by H&S personnel in their CEC journey. The following recommendations for future initiatives were developed based upon these discussions.
• Define an exposure, as it is currently unclear what types of fires trigger the requirements for decontamination, e.g., some departments only perform decontamination when there is a working fire dispatch, but what about smaller fire events like food on the stove?
• Implement CEC procedures at training academies, recognizing that procedures used by instructors and students for decontamination may be different than what is used on a scene because the hazard is more easily quantifiable in training. More research is needed to quantify hazards from training fires.
• Recognize that CEC applies to more than just the suppression firefighter, but fire investigators, instructors, and others who may be exposed to contaminants.
• Introduce new KSAs for Firefighter 1 to include training on what is in smoke, the health impacts from contaminant exposure, the importance of decontamination, and how to decontaminate.
• Introduce new KSAs for Fire Officers to include a better understanding of the safety culture message and cancer awareness- safety is the most important priority
• Introduce new KSAs to HSO/ISO to include methods for CEC policy development, implementation, and management, understanding products of combustion, cancer, and associated health hazards and preventative measures.
• Provide formalized continuing education resources to HSOs and others.
• Develop methods to evaluate exposure data to revisit and improve policies and practices.
It is believed that focusing on these initiatives will aid the fire service and health and safety personnel therein, to further their programs, reduce firefighter exposure to harmful contaminants, and reduce occupational illnesses in the fire service.
Section 6: References
Firefighter Cancer Support Network (2013). Taking Action Against Cancer in the Fire Service, Retrieved from https://firefightercancersupport.org/resources/research-development/
First Responder Center for Excellence (2022), Resources: Cancer, Retrieved from https://www.firstrespondercenter.org/resources/cancer#sort=position&sortdir=desc
International Agency for Research on Cancer (2022), Volume 132: Occupational exposure as a firefighter, Retrieved from https://monographs.iarc.who.int/news-events/volume-132occupational-exposure-as-a-firefighter/
International Association of Fire Fighters (2022), January is Fire Fighter Cancer Awareness Month, Reducing the Risk of Occupational Cancer Through Awareness and Prevention, Retrieved from https://www.iaff.org/cancer-awareness-month/
Jahnke, S., Jitnarin, N., Kaipust, C., Hollerbach, B., Naylor, B., Crisp, C. (2021). Fireground Exposure of Firefighters: A Literature Review, Fire Protection Research Foundation, Quincym MA.
Laroche, E. and L’Esperance, S. (2021), Cancer Incidence and Mortality among Firefighters: An Overview of Epidemiologic Systematic Reviews, Int J Environ Res Public Health, 18(5): 2519.
NFPA 1500 (2021), Standard on Fire Department Occupational Safety, Health, and Wellness Program
Stull, J., Paul, P., Reynolds, J., Schmid, M., Tutterow, R., (2018). Recommendations for Developing and Implementing a Fire Service Contamination Control Campaign, Fire Protection Research Foundation, Quincy, MA.
Ensuring personnel have a means to obtain their HSO certification is an important component in the success of a fire department’s health and safety program. Two accrediting bodies 4 that accredit certifying entities, e.g., fire service training academies using NFPA professional qualification standards, are the International Fire Service Accreditation Congress (IFSAC) and ProBoard (also known as the National Board of Fire Service Professional Qualifications or NBFSPQ). Table 6 provides a summary of certifying entities accredited by IFSAC and/or ProBoard to provide the NFPA 1521 certification. Certifying entities that provide the HSO certification are displayed in red and certifying entities that provide the ISO certification are shown in black.
4 NFPA 1000, Standard for Fire Service Professional Qualifications Accreditation and Certification Systems defines an “Accrediting Body” as “A voluntary, nongovernmental association that administers accrediting procedures for entities that certify individuals to fire service professional qualifications standards, or programs granting degrees in nonengineering fire/emergency services–related fields.” Further, NFPA 1001 defines a “Certifying Entity” as “An organization that is accredited to award certification to individuals."
As shown in Table 6, there are only four certifying entities (8%) accredited through IFSAC and six certifying entities (10%) accredited through ProBoard to provide the HSO certification. In total, there are six states and one federal agency which offer the HSO certification. Of those entities that offer the HSO certification, only one offers the certification based on the current edition of NFPA 1521, i.e., the 2020 edition. While there are more certifying entities that offer the NFPA 1521 ISO certification, these agencies still only cover 21 states. In juxtaposition, every state has at least one certifying entity that offers Firefighter I and II certification.