Firefighter Cancer: What Are We Missing?

By Thomas N. Warren

Not long ago I was attending a funeral for a captain from my fire department who died from cancer. His death, like all cancer deaths, was recognized as a line-of-duty death. Virtually every member of the department was in the cathedral in our dress blue uniforms as we paid tribute to our fallen brother. It was truly a moving experience to see the cathedral overflowing with firefighters and police officers from our city and neighboring communities. There were more firefighters than I cared to count with red, swollen eyes marching in procession. It was especially difficult for me, as I was not only the assistant chief of the fire department, but the captain had been someone I had known and worked alongside for more than 30 years. We started out together in the fire academy and worked in neighboring fire companies for many years. We often responded to the same fires and many times found our assignments complementing the other's work. For example, I would be opening the roof as he was stretching a handline to fire floor, or his engine company would lay feeder lines to our tower ladder. His promotions through the ranks were a bit slower than mine; he liked to say he wanted to savor every assignment, and he did, earning the respect of everyone in the department during his career. The only firefighters that left his company were the ones who were promoted. I would mention to him often that he would make an excellent battalion chief because he knew our business so well and all the firefighters respected his abilities; but it was not to be.

I had to choke back the tears many times as the bagpipers played and different family members rose to say a few words in remembrance of their time together. Fire officers and members of his engine company also rose to describe the man they served with, allowing everyone in the cathedral a glimpse into his firehouse life. The stories were emotional and my mind began to wander, thinking about the firefighters who were diagnosed with cancer during the last few years. The department lost eight firefighters through early retirements to cancer, and this was the second cancer death of an active member. As I sat there among all the somber firefighters, I began to wonder why this is happening to us and, perhaps more, importantly what are we missing?

STEPS TAKEN

As a department, we felt we were doing everything possible for the well-being of our firefighters. We developed a joint health and safety committee and, through that committee, we redesigned our personal protective equipment (PPE), making it more ergonomic and lighter. The department purchased extractors, dryers, and cleaning agents for each fire station and required each member to wash their PPE regularly. Chief officers are required to inspect all PPE on a semi-annual basis and recommend replacements well before the PPE is too worn. The health and safety committee also developed safety-related training programs that were delivered to each member of the department. The department sponsored an annual safety and survival conference to promote health-related presentations as well as fireground survival techniques. Members of our department could attend this two day conference free of charge.

The department added the National Fire Protection Association (NFPA) Standard 1521 on safety officer certification to the fire officers' academy and trained all fire officers to this level. This change placed not just one certified safety officer at the scene of every fire or emergency but placed a certified safety officer at every phase of any operation we engaged in.

Through a federal grant, the department switched over to the 800 MHz radio system and issued every riding position on every fire company a portable radio. Through the Fire Act Grant program, we were able to install exercise equipment in every fire station (treadmill, elliptical, stationary bike and universal weight station). We were in the beginning phase of switching from 30-minute air tanks to the 45-minute tanks and formalized an air management program. Each member was trained in the use of the 45-minute tanks and, more importantly, why the extra air was there (not to work longer or harder but to have clean air to enter and exit the hazard zone).

The Department began an annual NFPA 1582 physicals program, which was very successful and uncovered health issues in many members of the department, such as detecting leukemia in two of our members. Additionally, the department offered annual flu shots and vaccines for other strains of the flu. Like many departments, we installed vehicle exhaust removal systems for every vehicle housed in every fire station. We also installed a vehicle exhaust removal system at our automotive repair garage that was capable of handling several vehicles at the same time.

The department developed and instituted an infection control policy to limit the spread of communicable diseases among our members and an accidental needle stick procedure. Health-related standard operating procedures and policies became study material for all promotional exams to ensure that these policies were ingrained in every fire officer's knowledge base.

The department acquired gas-detection equipment, enabling our firefighters to monitor the air quality when operating at fires and emergencies. Chief officers are continually trained to maintain an awareness of the physical condition of all fire companies operating at fires and emergencies and to rotate and rehab all fire companies. Our dispatch policies now place more firefighters on fire scenes more quickly than we did in years past. When I was a young firefighter, a fire in a typical three story-wood frame building would call for three engines, two ladders, a chief and an EMS unit, if one was available. This brought a total of 18 to 20 firefighters to the fire. Today, for the same fire in a three-story, wood frame building we send three engines, two ladders, two chiefs, one heavy rescue, one RIT company, one EMS unit, and a safety company. Today's response brings a total of 29 to 32 firefighters to the fire, all of whom have carefully defined responsibilities. Chief officers are also encouraged to request additional companies early if they feel extra companies may be needed. This change has clearly enhanced the safety of all firefighters operating at fires today and minimizes any exposures that may cause cancer.

I sat in the cathedral going over in my mind all the things we have done in the name of firefighter health and safety and came back to my original question: What are we missing? Is there anything more we can do? Are these cancers the effect of the firefighting we did years ago? When will the changes we are making today have the desired effect of reducing our number of cancer diagnoses? Will this be our future; attending the funerals of our colleagues for years to come before the trend reverses?

These are truly disturbing questions that should scare us all. I don't think any of us have the answers to all these questions, but we can't walk away from them either. As chief officers, we are to a large extent the stewards of the health of our firefighters. It is our responsibility to ensure that every firefighter has the best safety equipment available and it is the responsibility of every fire officer to ensure that the safety equipment is used properly at all times. The stakes are too high to take this responsibility lightly or let funding issues or political concerns get in the way of providing the best for our firefighters. When we fail our firefighters in this regard, we also fail the families of our firefighters.

I'm sure that everyone in the fire service agrees with this concept, but there may be a disconnect with regard to the actual execution of this responsibility. At our level, we do not have the knowledge and expertise required to conduct the scientific research that is necessary to solve the cancer problem, but we do have a shared responsibility to do what we can on a daily basis. This is where we need to concentrate our efforts. Fire chiefs must ensure that state of the art fire safety equipment is available to every firefighter; annual physicals are conducted; and that health and safety training programs are in place. These health and safety training programs must be presented on a regular basis with the goal of becoming part of the culture of the fire department and not simply another required lecture that has to be endured. Fire officers must ensure that all safety equipment and protocols are complied with. Labor organizations must work collaboratively with fire chiefs in honestly evaluating and improving safety equipment and health related policies on a regular basis. Health and safety issues should never be viewed as a bargaining tool or as leverage. These may appear to be small steps, but only the members of the fire service are able to take these steps, not the cancer researchers or fire service vendors. Our priority is to reduce cancer diagnoses and this is our share of the total responsibility towards that goal.

With all the accomplishments and all the progress we have made, we all know that we still work in a very dangerous and volatile environment; this will never change. We will never know what exposure the captain encountered during his career that caused his cancer or how long ago it was; we only know that something he was not aware of took his life, and we have to do something about it.


Thomas N. WarrenTHOMAS N. WARREN has more than 40 years of experience in the fire service in both career and volunteer departments. He recently retired as assistant chief of department of the Providence (RI) Fire Department after 33 years of service. He has a bachelor's degree in fire science from Providence College, an associate degree in business administration from the Community College of Rhode Island, and a certificate in occupational safety and health from Roger Williams University.

  

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