The Invisible Enemy
There are a large number of studies today that review the carcinogenic hazards of firefighting. There is no question that firefighting and the higher risk of getting cancer go hand-in-hand. Washington is one of many states that understand this. It is a considered a “presumptive” state that recognizes that if a firefighter contracts cancer, it most likely was caused by the exposure to toxic chemicals such as Benzene, Hydrogen Cyanide and many other organics. It’s essential that we are aware of this fact and do what we can to reduce this risk, and if a firefighter contracts cancer what is required to get financial aid to help battle the disease.
In late 2007 the Agency for Toxic Substance and Disease Registry which is run by the CDC, correlated the connection between Benzene and cancer. As late as 2009, the League of Cities came out with statements saying there was not enough evidence to formulate an opinion. Today we know that is not true. In October of 2013 NIOSH released a study quantifying the elevated risk of cancer among firefighters (https://www.iaff.org/hs/PDF/Cancer%20Risk%20Among%20Firefighters%20-%20UC%20Study.pdf ). However it’s not only exposure to Benzene that can contribute to contracting cancer. Other organics along with heavy metals and particulates are contributing factors. Firefighters are routinely exposed to many of these combustion products during their careers.
With these exposures there is more than enough evidence to demonstrate that firefighters, by occupation, have a higher mortality rate and reduced life expectancy. Because of this we must actively work to reduce exposure levels which will then reduce these high risks. Not only should we look at reducing exposures but also look at where can we find resources to help should one contract cancer. So if we accept this fact what do we do next?
Let’s look at the exposure. OSHA sets limits of 1 ppm TWA (time weighted average) over an 8 hour period and a STEL (short term exposure limit) of 5 ppm for a maximum of 15 minutes. NIOSH REL (recommended exposure levels) is substantially lower at a TWA of 0.1 ppm and STEL of 1ppm. A very large study in the Journal of the National Cancer Institute has just been completed and it adds a new variable to the issue of Benzene exposure. This is highlighted in the term “ppm years of exposure”. In other words, Benzene exposure is a cumulative problem and so any exposure, no matter how small, accumulates over time. An article in the September issue of Occupational Health and Safety Magazine reported the following: "There is a set of results that shows workers with a cumulative exposure in the middle range of 0.348-2.93 ppm years, not only have a statistically increased risk of developing Chronic Myeloid Leukemia but in fact have a risk factor greater than three times that of unexposed workers". While more studies will help to give even more credibility we already know more than enough to take action to prevent or reduce exposure. We need to reduce the exposure through education and by establishing procedures that prevent exposure to toxic chemicals.
First let’s look at where the problem lies. There is an excellent white paper put out by the Firefighter Cancer Support Network (http://www.firefightercancersupport.org/wp-content/uploads/2013/08/Taking-Action-against-Cancer-in-the-Fire-Service.pdf) that explains the problem in depth and discusses some we need to take in order to reduce this high risk among firefighters. In this paper they review many of the actions we see regularly, such as firefighters working in active and overhaul fire environments with SCBA on their backs but no masks on their face, even though studies show that there are still potentially high levels of toxins. Firefighters will proudly wear dirty and contaminated turnout gear and helmets but again they are exposing themselves to toxins like Benzene from their gear. Firefighters climb into the cab of the engine and contaminate the seats. How often are these compartments decontaminated? Volunteers will put contaminated gear into the trunk of their cars then take them home further exposing themselves, family and friends to these toxic chemicals.
To reduce this continuous exposure, each department should establish an On Scene – Post Activity Decontamination Guideline to establish procedures for reducing a firefighter’s exposure to hazardous substances during training, suppression and overhaul activities, and to insure that clothing, tools and equipment are decontaminated prior to returning to quarters. The Snohomish County Fire Chiefs Association created an On Scene – Post Activity Decontamination Guideline, Document 60-05-09 (http://www.snocountychiefs.org/documents/60-05-09_decon_procedure.pdf) that can be used for developing your department’s specific document. Another good reference is an article by William Jenaway, Vice President of VFIS, entitled “Clean and Clear” in the November issue of Fire Chief Journal which describes a comprehensive maintenance and inspection program for turnout gear.
The Washington State Fire Chiefs Association with the help of EF Recovery has developed a very effective decontamination chemistry called Benz-Out, which is used to reduce a firefighter’s exposure to hazardous Volatile Organic Chemicals (VOC’s) before a firefighter removes his/her mask at overhaul. The longer firefighters are exposed to contaminants, the greater the hazard to health. If turnout gear is not properly maintained, exposure is much greater and more constant as the contaminants will continue to off-gas. Benz-Out is an environmentally sound chemistry that breaks down these contaminants and renders them non-hazardous. Benz-Out can be used to clean equipment and even decontaminate the truck cab and seats. This chemical has been studied for its ability to suppress and encapsulate VOC’s - especially Benzene. The decontamination chemical Benz-Out was tested by Tacoma Fire for its effectiveness and ease of use. The product is available through the Washington State Fire Chiefs Association by contacting EF Recovery (www.efrecovery.com ) and has been priced so the cost of application is inexpensive.
We have discussed what can be done to reduce exposure to these toxic chemicals, but what needs to happen should a firefighter develop cancer? Once a diagnosis has been made steps need to be taken to understand Washington’s Presumptive Law. Read the law and get help (http://apps.leg.wa.gov/rcw/default.aspx?cite=51.32.185 ) to make sure you can meet the required criteria. There is an excellent article distributed by the National Association of Workers’ Compensation Judiciary that discusses the legal aspects of presumptive laws. (http://www.nawcj.org/Images/archives/Comparative_Law/NAWCJ%20FIREFIGHTER%20PRESUMPTIONS%20Essay%20Table%202013.pdf)
This article helps us understand the importance for a department to maintain good records. The firefighter will have to supply evidence that they have been exposed for at least ten years. Many volunteer departments do not collect the list of individuals that were at a fire. Others may put it in the narrative but you can imagine how difficult it would be to gather that information in order to prove 10 years of fighting fires. The firefighter will need to show that they were given a qualifying medical examination upon becoming a firefighter that showed no evidence of cancer. It’s imperative for departments to do a good job of collecting and maintaining records.
Today it is very inexpensive to have the use of a good records management system. There are some good cloud-based systems available for a reasonable monthly fee. They are hosted systems that can be designed and used by even the smallest volunteer departments. Remember - today in everything we do in the fire service data is king. Without these records proving that the firefighter was exposed over the ten year requirement, it will be difficult to win a case.
Additionally, contact the Firefighter Cancer Support Network for guidance. Their objective is to provide assistance to all fire service members and their families in the event of a cancer diagnosis. http://www.firefightercancersupport.org/