Fireground Operations: Occupational Cancer Risk
Reducing exposure to cancer-causing contaminants during fireground operations is a critical component of firefighter safety. In 2019 Seventy-five percent of the names added to the IAFF Fallen Fire Fighter Memorial Wall in Colorado were firefighters that died from occupational acquired cancer. This is the leading cause of line-of-duty deaths.
It’s an obvious fact that firefighters are repeatedly exposed to environments that are filled with known and unknown chemicals, carcinogens, toxins, and infectious diseases. Finding ways to avoid exposure or minimize risk is an important part of firefighter safety and health.
Research studies on firefighter exposure to contaminates focused on PPE surface and skin testing for Polycyclic Aromatic Hydrocarbons (PAHs), as well as Volatile Organic Compounds (VOCs) and Hydrocyanide (HCN). Both VOCs and HCN found on contaminated gear can off-gas creating another exposure pathway. Contamination can occur at all stages of fire response when any amount of smoke is present for any duration of time.
Some Fireground Positions Increase Exposure Risk
Researchers determined that firefighter personal protective ensembles will absorb volatile organic compounds (VOCs) and that PAHs may go through or around PPE or cross-transfer later from the PPE to the skin during removal. They also determined what types of exterior and interior operations increased exposure, and which areas of the body tend to be the most contaminated.
Understanding when, where and what kind of exposures happen can encourage compliance and best practices. This information can also be useful to officers at the scene when prioritizing decontamination, or when developing SOPs for cleaning procedures, decon, or other safety policies.
Take-Aways from the 2017 Study on Fireground Contaminants
A study of fireground contaminants published in 2017 focused on PAH contamination on turnouts and skin after structure fire operations. Researchers took samples from the PPE and the skin before and after exposure.
- A firefighter’s PPE, neck skin, and hand skin were most prone to PAH contamination.
- The amount of contamination varied by work assignment.
- The inside “Attack” operators and inside “Search” teams experienced the most PPE and skin contamination.
- The search team has more hand contamination than neck contamination due to exposures around gloves.
- The outside “Vent” team had the highest frequency of detectable PAH on their neck.
- Researchers concluded this was due to the inconsistent use of hoods and recommended wearing Nomex hoods to reduce neck skin exposure, even while working on exterior assignments.
Reducing Exposure on the Fireground
The risk of occupational exposure to cancer-causing agents will never be eliminated, but there are many things that organizations and their members can do to reduce risk. First, individuals must take personal accountability for their own health by doing whatever is within their control to reduce exposure on the fireground.
Each member should prioritize their health on and off the job. This is done by following a healthy lifestyle, maintaining physical fitness, getting regular medical check-ups, and avoiding any unnecessary exposures on the fireground.
Also important is the proper use of PPE, SCBA, and performing gross decontamination at the scene. This can help to minimize a member’s exposure to toxic products of combustion. Firefighters should wipe off their face, neck, and hands as soon as possible, remove contaminated gear, and shower after returning to the station.
On Scene Rehab Includes Decontamination Activities
Fire service agencies can further protect members by creating SOPs for rehab that prioritizes health and safety. On-scene Rehab policies have been evolving over the years. Current best practices suggest that a formalized rehab be established at EVERY fire ground operation.
Common rehab activities such as rest, recovery, hydration, cooling, nourishment, and medical monitoring continue to be essential at the fire scene. Now SOPs add decontamination to the process as an additional way to protect firefighter health.
Types of Decontamination
The extent of decon will depend on the status of the operation, ambient temperatures, and location of rehab. Recommendations include at a minimum, that all members should wipe off or wash their neck, face, and hands to minimize any prolonged contact of contaminants with skin.
Cleaning wipes were found to be helpful for quick wiping of the face and neck on the fireground, not all wipes were equally effective. However, some were found to remove PAH contamination levels from neck skin by about 54%.
Research also detailed what type of decontamination was most effective. The study found that wet decon is more effective than dry or air-based decon. Wet decon using dish soap, water, and scrubbing was the most effective method for removing PAH from turnout gear while in the field. In this process, an average of 85% of PAH contamination was removed. Dry brushing was found to remove only 23%.
Also presented in the research were the secondary exposure risks. Contamination caused by the off-gassing of protective gear in enclosed areas is an inhalation hazard. Once a firefighter is out of the IDLH environment, their PPE releases VOC into the air. Although the hazardous levels largely dissipate within 24 minutes it is advised that contaminated PPE be removed as soon as possible, and the decon process started.
When doffing contaminated gear firefighters should use nitrile gloves to avoid further exposure. PPE should NOT be worn or stored inside the passenger cab of the apparatus when returning from a fireground operation. Instead, it should be bagged and/or transported in an outside compartment of the apparatus.
Another secondary contaminates risk can be caused by turnouts that are not cleaned frequently. Toxins can build up with each fire response creating an additional risk of exposure to the firefighter, other crew members, and wherever they are worn, such as the apparatus cab.
Hands should be cleaned again after on-scene gross decontamination, especially before eating or drinking to prevent ingestion risk. Clean hands also help to prevent contamination of the apparatus and the station house.
The company officer’s actions, attitude, and commitment to his crew may be the most influential force in changing behavior when it comes to exposure reduction and good decon habits. If this is your role, lead by example.
IAFF’s Best Practices to Reducing Exposure
Although it is impossible to avoid exposure to smoke and other contaminants on the fireground, there are some significant steps that firefighters can reduce their exposure. The following are recommendations from the IAFF on ways that firefighters can reduce their exposure from the start of an incident until they return to the station.
Arrival & Set Up
- Stage vehicles and command post uphill and upwind to the fire when practical.
- Protect apparatus from contamination by keeping windows closed, and heat or AC off.
- To reduce diesel exhaust fumes, don’t leave vehicles running if they are not involved in firefighting operations.
- Staging areas, RIC teams, or crew members not directly involved in current activities, should be upwind or away from smoke.
- Crew members should wear SCBA anytime they are in areas where they are exposed to products of combustion or hazardous materials.
Protection During Operations & In Rehabilitation
- All personnel engaged in firefighting shall utilize an SCBA from the initial attack through an overhaul. SCBA should be used any time smoke or products of combustion are present.
- Any time a firefighter exits an IDLH zone should exchange their contaminated hood for a clean one, every time.
- Rehab should be established at every fireground scene and located in a “cold zone” away from any products of combustion.
- Decontamination such as washing hands, neck, and face, and removing PPE should occur as part of rehab activities.
- Contaminated gear should not be worn into the rehab area.
Considerations During Overhaul & On-Scene Decontamination
- SCBA should be used during any operation performed inside the structure, and for the duration of an overhaul.
- On-scene gross decontamination shall be performed to remove potentially harmful contaminants before the removal of the firefighting ensemble.
- SCBA should be worn during gross decontamination and be the last item to be removed and cleaned.
Decon Activities at the Station
- Contaminated turnouts should be cleaned, including hood, gloves, boots, and helmets by following NFPA 1851 or your department’s SOPs.
- Firefighters should shower within an hour of returning to quarters or as soon as practical.
- Wash and wipe down apparatus to eliminate possible areas of contamination, from boots, hands, or exposure from the scene.
Again, because different fireground operations result in varying levels of contamination, departments might consider prioritizing decontamination of personnel on scene, and the laundering for gear based on a firefighter’s assignment.
Stay Informed & Stay Safe
Cancer and cancer-causing agents may never be eliminated from the fire service, but armed with more information and continued awareness, firefighters and their agencies can reduce occupational exposure on the fireground.
Research continues on this important topic, and best practices will continue to be reviewed and updated but regardless, the hazards at the fireground will always be part of the job. Your department can set policies and procedures, but ultimately, it’s up to you to protect your health and safety.
- Fent KW, Alexander B, Roberts J, Robertson S, Toennis C, Sammons D, Bertke S, Kerber S, Smith D, Horn G. Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. J Occup Environ Hyg. 2017 Oct;14(10):801-814. DOI: 10.1080/15459624.2017.1334904. PMID: 28636458
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