Firefighter cancer is a great concern of the fire service community. Among the contributing factors to firefighter cancer are the continual exposure to fire apparatus exhaust and the numerous carcinogens present at fire scenes. Arguably, apparatus emissions in the station are minimized through the use of ventilation systems; however, undisputed is the fact that there is no protection for the firefighters who must work on or near the fire apparatus once they arrive at an emergency scene.
Also debatable is the assumption that wearing personal protective equipment (PPE) prevents exposure to the carcinogens present at fire scenes-moreover, that is, if the PPE is continuously worn as intended throughout all phases of the incident from fire attack through salvage and overhaul and through completion of the fire reconstruction phase that determines fire origin and cause.
Thinking back to your fire behavior lessons, you will recall that the by-products of combustible materials, once heated, will decompose through pyrolysis and release carcinogens that rise until they hit the ceiling and stratify back toward the ground, or they cool and descend. Either way, the carcinogenic particles will land on your helmet, face piece, and other PPE items. The helmet, face piece, boots, and self-contained breathing apparatus (SCBA) are not as permeable as the Nomex® hood, bunker coat, and bunker pants, and they can usually be easily rendered safe through gross and technical decontamination at the scene before being placed back on the apparatus. Buddy decontamination practices should be used to make sure difficult-to-reach places are not missed. However, the more porous parts of the firefighters’ PPE (hood, bunker coat, and bunker pants) that become saturated with the dangerous carcinogens should be machine washed and dried per the manufacturer’s recommendations.
Despite using these safeguards to protect firefighters from job-related, cancer-causing elements, the reality is that firefighters will always be exposed to cross-contamination with fire scene carcinogens. For example, think about every fire to which you respond. The very first thing you instinctively do is remove your gloves. You do this so that you can have the dexterity of your fingers to quickly and easily locate and unfasten your helmet and face piece straps. Removing these two PPE items followed by your hood after interior operations at a working fire results in the immediate relief from stress, anxiety, and elevated body temperature. To continue the expediency of the body-cooling process, you quickly remove the bunker jacket. If the gloves are left on when doffing the PPE, it could likely take several minutes instead of seconds; therefore, the gloves will probably always be removed first. Unfortunately, in your quest to cool off, you just exposed yourself to cross-contamination.
The problem is that when firefighters take off their gloves to doff their PPE, rarely, if ever, do they immediately wash their hands. This simple lack of personal protection may be detrimental to their well-being and create a route for cross-contamination to enter the body. As previously mentioned, when you remove your PPE with bare hands, you have transferred the carcinogens from the PPE. If you then wipe the sweat away from your forehead, scratch an itch on your face, or rub your eyes, you have increased the possibility of exposure by absorption into your body. Another potential harmful situation is when food is brought in to feed the firefighters at a large fire. As soon as the firefighters’ unwashed hands touch the food, they have increased the possibility of body exposure by absorption.
Because of the high prevalence of firefighters unintentionally exposing themselves to the carcinogens through these cross-contaminating routes, we need a paradigm shift relative to our awareness of the hidden dangers associated with the lack of hand sanitation at fire scenes. Hand protection and sanitation at fire scenes should be given the same high-priority status as on medical scenes. The fire service community must seek ways to make hand sanitation easily accessible and available so that firefighters can immediately protect themselves after every contact with PPE whether it is decontaminated or not. One way would be to make sure that hand-washing stations are set up at fire scenes until they become available on all future emergency response vehicles.
Michael Gonzalez, Ph.D., MHS, EFO
Assistant Chief, Administration Tampa (FL) Fire Rescue