editor’s opinion ❘ by bobby halton
Whenever we gather to discuss cancer in the fire service, several things usually are said. First is that we need to change firefighters’ behavior and attitudes, and second is that these behaviors and attitudes are linked to the incidence of cancer among firefighters being significantly higher than that of the general population. The issue with behavior often centers on firefighters with dirty gear and beat-up, worn fire helmets. The conversation usually connotes a condescending tone, implying that the prevailing reason the morally deficient firefighters wear said offending gear is that they are trying to send a message that they are salty or seasoned.
Virtue signaling that one is upset by their appearance allows the offended to affirm that they would not and do not support firefighters wearing dirty gear. They are concerned for the wearers’ health and worry about the message wearing dirty gear sends to the uninitiated who regard the experienced with respect. These good folks are being absolutely genuine; they are good people, but most of them have missed the point. They are often the ones who control the work environment “bosses.” When bosses complain and blame the troops, they are not being bosses—they are being defensive.
We are well aware that during firefighting we are exposed to carcinogenic materials and, as a consequence, we exhibit a higher rate of several types of cancers. Robert Daniels, Ph.D., and the folks at the Centers for Disease Control and Prevention (CDC) have provided us with excellent analysis to conclusively prove a causal association between firefighting and cancer. They also reminded us that participating in some modifiable behaviors such as smoking, poor diet, and lack of exercise can put us at higher risk than firefighting. The CDC reporting also provided numbers that support we suffer higher incidences in several cancers; however, the numbers were not as significant as we had previously believed. The previous studies, it stated, were imperfect, as was the CDC’s, and more studies are needed to better understand the risk and its depth and significance.
Folks who make studies, who study trends and reporting, are quick to remind us, “What gets measured gets manipulated.” We should be clear that the manipulation is not always done intentionally or maliciously; it often occurs with the best of intentions. Our biases can cloud our thoughts, and outcomes can lead us to make links and conclusions that may or may not be there. And, of course, numbers can support funding, recognition, and other incentives that can cause folks to fudge the numbers.
All that really matters is this: Firefighting and cancer have a relationship; how causal it is doesn’t matter if you get sick. Whether the incidence of your cancer is significantly higher or lower doesn’t matter if you are the one who was genetically susceptible, the statistical outlier.
This leaves us with behavior modification as our only avenue to improve the situation. Or is it? Do firefighters wear dirty gear because they want to project an image or exhibit some type of bravado? That may certainly be the case in some instances but clearly not all. Firefighting is, as Mike Rowe would say, a “dirty job”: Pulling ceiling; crawling in dirty, contaminated water; and searching through burnt-out rooms for citizens get us dirty—it is a given.
When bosses complain at conferences and symposiums about their firefighters wearing dirty gear, is it about firefighters’ health or the bosses’ reputations? Condemning the firefighters’ behavior is simply pointing the finger away from where it should point: the leadership. When the firefighters are targeted as the problem, the bosses are absolved of any responsibility and their virtue is unblemished in their eyes. This attitude is reinforced when we proclaim that 88 percent of accidents are human caused, completely disregarding all the complexity of our work, all the shortcomings of our systems, training, and the sincerity and righteousness of those who made those decisions (called mistakes in hindsight).
Attacking the firefighter behavior-based approach blames the firefighters themselves for their injuries and illnesses. These behavior-based approaches have not been proven to be effective—quite the contrary. If you want to change firefighters’ behavior, don’t target behavior. Target the conditions, the system under which it happens. Those conditions are not the firefighters’ responsibility; they are ours—the leadership, in large part.
If we are serious about firefighter health and safety, rather than blaming, measuring, punishing, and rewarding, what if we focused on increasing our educational efforts, improving our troops’ knowledge, and giving them the proper tools and equipment at the right time? What if we recognized the reality of a “dirty job” and balanced it with an industrial hygiene response—eliminate the conflict with a resolution? Why not design safety into the system?
Firefighters are highly trained and invested individuals who are intelligent and motivated and do not come to the aid of others to become sick themselves. What if we move away from 1930s gas attendant work clothes and start wearing utilities, fatigues that we can wear to everything except firefighting? We can even assume the blue Digi-camo “colors” the Navy is moving away from, surplus looking for a home. We can issue firefighting personal protective equipment (PPE) like tools, storing sized units in lockers for use only when we go downrange to fight fire. After an engagement, dirty gear is collected by the organization and returned to storage compartments after decontamination is completed. Equipment decon is part of taking up; showers are part of taking up.
PPE can remain personal if the organizational leadership finds that simpler, but the care, storage, use, and maintenance of that gear are primarily management’s responsibility, not entirely the firefighters’. We all are against cancer; we are all concerned about firefighters’ health. Behavior modification isn’t the answer. Fix the system. The firefighters aren’t the problem; the system created the problem. New problems require new thinking; that is leadership. Blaming is virtue signaling and dereliction of duty on our part.