Does Aggressive Firefighting Mean Unhealthy Firefighting?

BY DAVID HULTMAN AND STEFAN MAGNUSSON

IS IT POSSIBLE for firefighters to maintain a high level of aggressive firefighting while also following cancer prevention best practices? Yes, it is—if proper protective gear is used and the “chain of contamination” is broken.

We sometimes find firefighters throughout the ranks who want to reduce their exposure to potentially harmful fire contaminants but are hesitant for fear they might have to shift away from offensive firefighting methods at an incident. There is a perception that using aggressive tactics leads to increased contamination of personnel and equipment. Therefore, since the notion is to reduce exposure as much as possible, we should avoid such aggressive tactics, right?

Not necessarily. There are indeed valid points in optimizing procedures during attack that will help avoid unnecessary or excessive contamination. Still, it is inevitable that some level of contamination will occur for firefighters who efficiently perform their duties, including during aggressive firefighting. This does not necessarily have to be a major issue because the majority of significant exposure-reducing health benefits can be achieved after the operation is concluded.

We know we should always use personal protective equipment (PPE) to shield our respiratory system and skin when working in a smoke-filled environment. We also must work responsibly, rather than recklessly, and ensure that we have the best equipment and conditions to safeguard our health. However, there is data suggesting that the majority of exposure to potential carcinogens does not even occur at the incident scene.

Assuming that firefighters encounter toxic substances around once a week on average through calls, exercises, training, or handling contaminated equipment, they will have 50 exposures each year, or around 2,000 exposures over an entire career. (A conservative estimate would be just one exposure per week.) Of course, the actual number of occasions is normally many times more.1 International research reports that secondary exposure constitutes a significant part of the total exposure during drills and emergency fires.2, 3 This is evidenced by measured levels in workspaces, in the breathing zones (the zone within a 10-inch radius of nose and mouth), through skin deposition samples, and with varying levels of metabolites of polycyclic aromatic hydrocarbons (PAH) in urine samples where different work tasks have been isolated.

Dräger Safety
1. Following cancer prevention best practices 2 doesn’t require shifting away from aggressive firefighting. (Photo courtesy of Dräger Safety.)
Upper Providence
2. Packing and cleaning contaminated gear take extra effort but benefit us in the long run. [Photo courtesy of Upper Providence Township (PA) Fire Department.]

In addition, it is crucial to consider all instances when firefighters are in contaminated spaces or handling nonsanitized equipment without having even participated in a specific incident. Even if the concentrations of contaminants are lower than they are during actual firefighting, the frequency is higher and exposure time longer than during the more obvious active incident exposures. There are reasons to conclude that the majority of an individual’s total cumulative dose comes from secondary exposure.

Breaking the Chain of Contamination

When analyzing the dangers of secondary exposure, it is important to note the concentrations of hazardous particles that can occur in various areas within a fire station. Research has shown that by leaving contaminated items in a separate room or building before entering the locker room, there was a 200 times decrease in the total concentration of PAH.4 Simply separating the storage of contaminated bunker gear from clean locker rooms can reduce PAH by a factor of 200 (all else being equal). This is what is referred to as “breaking the chain of contamination.” This approach, with its effect on minimizing or eliminating cross-contamination, applies not only to locker rooms but also to vehicles, station uniforms, workout clothes, bedding, offices, kitchens, and more.

While theoretically it may be possible to completely protect firefighters from exposure to harmful substances, the practicality of responding to accidents or fires will sometimes necessitate entering an extremely unhealthy work environment. Everyday incidents, which are more frequent than large, spectacular fires, likely contribute the most to total exposure to harmful substances. Even when using all equipment and tools, it is impossible for a fire department to maintain a completely sterile and hazard-free work environment. But, with sensible precautions and basic tools, you can make marked improvements, especially when you do so consistently over time.

Upper Providence
3. Consistently bagging contaminated gear postfire helps minimize crosscontamination. (Photo courtesy of Skellefteå Fire Department.)

Focus on the Total Exposure and Low-Hanging Fruit

The total contamination dose depends on how long individuals are exposed (time), what they are exposed to (compounds, concentration, distance, shielding), and how often (repetition). The perception might be that we seldom respond to fires significant enough to expose us to substantial amounts of toxins. The reality is that we are more likely to encounter a greater volume of contaminants from the overall number of small fires we handle than from the fewer large fires. Exposure to hazardous substances can also occur not only during our own emergency responses and training exercises but also when we encounter contaminated equipment following primary exposures if proper decontamination measures are not in place.

Upper Providence
4. Making decontamination a habit is a good investment in your own health. (Photo courtesy of Healthy Firefighters.)

Understandably, it is tempting to forgo decontamination procedures in less than favorable conditions. Nobody is eager to use a complicated or time-consuming decontamination procedure postfire, in the middle of the night, or during bad weather. The routines must be kept simple. Without established protocols, we tend to accept a hazardous environment, reasoning, “It is just this one time.” Having a functional and simple decontamination routine and separating clean gear from contaminated gear can significantly reduce exposure. By making the routines a habit even after training and small fires—the common, everyday exposures—the total dose will drop dramatically.

Invest in Your Own Health

There are simple, routine things you do in your everyday life to stay healthy—for example, brushing your teeth. You brush once or twice a day not because you love doing it but because you know it’s good for you and you want to keep your teeth as you age. When your behavior becomes a habit, you rarely reflect on or question why you do it.

Packing up your contaminated gear at the incident scene and washing it require extra effort and time and are not fun or exciting. You may not look forward to postfire decontamination, but you should do it because you know it benefits you in the long run. It is the sacrifice you make today that will increase the chance for the precious reward of a long and healthy life in the future. Consciously avoiding and reducing exposure and making decontamination a habit are good investments in your own health.

There are many excuses to postpone or resist implementing a Preliminary Exposure Reduction routine, including believing it is more complicated than it is or it will compromise the quality of your operational work. It is crucial to take the first step in reducing exposure and not to postpone action until you can achieve perfection. You should implement decontamination routines and refine them over time, focusing on solutions rather than challenges.

The aim is to reduce exposure, and it can be done with as little impact as possible on your professional work or tactics. If you prefer aggressive interior fire attacks, keep doing them. You can combine all tactics with postfire decontamination and eliminate cross-contamination by separating clean gear from contaminated gear.

We know that the firefighting profession is associated with increased risks of certain diseases. To manage these risks, you don’t need to stop being firefighters. But you can make wise choices to decrease risks, opt out of unnecessary exposure, and take action to reduce the consequences of inevitable exposures.

What happens after the operation affects your health between alarms and before the next one. If you can break the chain of contamination, you reduce secondary exposure, regardless of the tactics used at the incident scene. If you are not doing it already, get started. Each day you don’t take action is a missed opportunity. ?

ENDNOTES

1. Magnusson s., Hultman D. “Healthy Firefighters-the Skelleftea Model improves the work environment.” Swedish Civil Contingencies Agency (MSB), Nov. 2014, msb.se.
2. Baxter, Stuart, et al. “Case study: Exposure of Firefighters to Particulates and Polycyclic Aromatic Hydrocarbons.” Journal of Occupational and Environmental Hygiene, vol. 11, 2014, bit.ly/3TYZEeV.
3. Fent, Kenneth, et al. “Systemic Exposure to PAHs and Benzene in Firefighters Suppressing Controlled Structure Fires.” Annals of Occupational Hygiene, vol. 58, 2014, bit.ly/3Nip2II.
4. Wingfors, Hakan, et al. “Utredning av Sekundarexponering av Brandpartiklar och PAH vid Brandmannautbildning.” Swedish Defence Research Agency, Dec. 2015, www.foi.se.

DAVID HULTMAN is a senior officer fire protection engineer and pursued his studies at Lulea University. Following his postgraduate education, he has held the role of district chief within the fire and rescue service in Sweden. He is also a certified fire investigator and holds positions on the Board of the Swedish Fire Protection Association and the Swedish Engineers Board.

STEFAN MAGNUSSON has dedicated his career to firefighting since the early 1980s and is the principal health and safety representative for Skelleftea Fire & Rescue. In 2006, he cofounded the Healthy Firefighters project and is the visionary behind the Skelleftea Model. Since 2007, he has delivered numerous lectures on the Healthy Firefighters project and the Skelleftea Model in Sweden and across Europe. He actively contributes to the Fire Fighter Cancer Foundation.

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