Line of duty injuries or deaths has resulted from several sources including structure fires, automobile accidents, heart attacks and high blood pressure. Because of these events and ailments, firefighters typically pay higher life and health insurance rates than the average person. But over the past couple of decades, a silent killer is growing exponentially in this profession.
Cancer. We’re a public safety design firm well into our fifth decade of working with fire departments. Unfortunately, over the past 20 years we’ve watched the number of fire-fighting friends that have been impacted by cancer greatly increase. A rural VFD in Virginia that we are working with illustrates this point, and serves as an example of what many departments are facing.
Over the past two years, this 30-member volunteer department has had four members battling cancer. That’s nearly 15 percent of the members. In fact, according to both the Journal of Occupational and Environmental Medicine and the American Cancer Society Cancer Statistics Center, across eight of the most commonly diagnosed cancer types — on average — firefighters are 43 percent more likely than the general population to develop cancer. These eight types of cancer are colon, stomach, brain, testicular, skin, prostate, myeloma and non-Hodgkin’s lymphoma.
In order to better understand these staggering occurrence rates, we need to travel back to high school chemistry class and name the contaminants that are causing all this havoc. We’ll call these known carcinogens “the perpetrators.” They include carbon monoxide, formaldehyde, butadiene, isocyanates, benzene, nickel, arsenic, nitrogen dioxide, acrylonitrile, toluene and numerous other hydrocarbons. There are many other elements encountered at the fire-grounds, but these are some of the most recognized carcinogens. Even those of us not in the firefighting industry encounter these perpetrators from time to time and most of us don’t end up with cancer. The problem for first responders is the repeated cycle that they are exposed to these carcinogens. First, they respond to a scene where these elements are present. They are exposed to them. Then the responder returns to the station, contaminating many items there and possibly at home. Then, with the next call, the cycle happens all over again, day after day.
The fire ground and the rescue call can include dozens of sources of these dangerous elements. When you think about the materials contained in buildings, cars, and furnishings today compared to 50 years ago, the dangers are easy to understand. Just the predominance of plastics in so many products today is mind-boggling. So it’s not just a fire at a chemical plant that should concern us. Consider all the carcinogens listed above that are encountered in a house fire or a car fire. And the elements you will encounter “dumpster diving” to extinguish a dumpster fire can be nearly unlimited, and certainly unknown.
Plus, it doesn’t have to be just combusted particles specifically from a fire. We all remember the great white clouds of particles that swept across Manhattan on 9/ll. That dust included asbestos and many other known carcinogens.
Most of these elements or particles are so microscopic that they are invisible to the human eye. The smoke particles that are seen are usually much larger than the most dangerous carcinogens. Because the elements are largely unseen, necessary care to exposure is often not practiced. What you don’t see can kill you! And to the point of this discussion, many of these “perpetrators” are carried back to the firehouse.
There are three major methods how these contaminants enter the human body. They can be ingested, inhaled or absorbed.
Ingestion is easy to imagine once you think about it. Ingestion simply means that the contaminants are carried via saliva or mucus to the digestive system. If food or beverages consumed at the fireground has been exposed, then eating or drinking them will put the contaminants to your digestive system. Even if just the containers or wrappers are exposed, ingestion is highly likely. At prolonged events at a fire ground, rehab areas often provide food and beverage. But have the refreshments been exposed to contaminants? And how often have you just wiped the soot off of the water bottle before taking a drink?
Inhalation would be the most recognized form of contamination, because we often see so much smoke on the scene, and it irritates the throat and eyes. With this method of contamination, the elements enter the respiratory system through the nose or throat. It is often thought that the elements are eliminated through coughing, sneezing or even swallowing. But the contaminants make their way into the lungs, which deliver them to the heart and the rest of the body through the blood. But this is why you wear SCBA, right? Doesn’t that solve the inhalation problem?
Every second on the fireground without the SCBA mask being worn is a second of exposure. Just because the responder is not in thick smoke does not mean the danger is past. Until they are completely clear of the fireground AND everything that was exposed at the fire ground, off gassing of contaminants on the PPE and equipment is occurring and being inhaled. Even on scene rehab can be dangerous while wearing the exposed PPE.
Skin absorption is the least suspected of the three methods of entry into the body. Many are surprised because most of the body is covered by PPE during the fire response. But while PPE does well at keeping flame and heat away from the body, it still allows a great deal of smoke and particles to the skin, thus absorption. Studies reveal that every place on the body where different articles of clothing interface, there are higher levels of smoke contamination. Once these contaminants are on the skin, they can be absorbed into the body and bloodstream. Making absorption more troublesome are the statistics showing that for every five degrees in human skin temperature the absorption of carcinogens through the skin increases by 400 percent.
The Station Culprits
So how do the fireground perpetrators become the firehouse culprits? Let’s consider how the contaminants are either transported to the station from the fire ground, or even how some contaminants are generated at the station.
PPE that has been exposed to carcinogens is commonly introduced back into the station. Most methods of decontamination used on PPE today still results in some level of off gassing for hours, if not days. So wherever used PPE is stored in the station, there will likely be some level of contamination.
The exterior AND interior of the apparatus returning to the station has likely been exposed to dangerous contaminants. While most departments do an excellent job of keeping the apparatus clean, complete decontamination of these carcinogens is very difficult and rare.
Think of all the equipment housed on and in your apparatus. It is easy to understand how the items that were actually used during the response could have been exposed to contaminants, but even the items that stayed packed away on scene could be exposed. Much attention is often given to the decontamination of PPE, but how often are portable radios, tripods or hose given decontamination attention? Air packs and helmets get just as contaminated as PPE and require special attention for decontamination. All of these items unaddressed, result in the cross contamination of air and elements in the station.
The greatest station culprit that generates the contaminants at the station is vehicle exhaust. Much has been discussed over the past few decades regarding fuel exhaust contaminants in the station and how it impacts PPE stored in the vehicle bays, but only recently has adequate attention been given to how these same carcinogens actually impact the human occupants in the facility. These indoor, running engines do more than just impact inhalation in the bays.
Remember the other two means of contaminants entering the body? They are ingestion and skin absorption. Vehicle exhaust inadequately addressed can lead to a wide range of potential contamination. It is very common to find ice machines in the vehicle bays. Reports show that OSHA has begun cracking down on this practice, and for good reason. The filtration system in an icemaker depends on the purity of the air being supplied to the machine. If the air around the icemaker contains contaminants, then the ice produced likely will as well, which can lead to eventual ingestion of the carcinogens.
Vending machines in the vehicle bays also have a similar problem. The cans, bottles, or cartons inside the machine can be contaminated with exhaust fumes, which can lead to human ingestion and/or skin absorption. Laundry equipment exposed to exhaust contaminants is also in danger of producing contaminated “clean” laundry.
One of the most beneficial trends in station design over the past few decades has been the inclusion of training props and opportunities. Many of these training opportunities occur in and around the vehicle bays. This important practice can result in two challenges to dangerous contamination. First, the props used for training are often items that have previously been exposed to contaminants, and have not been adequately treated. Secondly, this training in the vehicle bays is an area or zone that contains and often generates its own dangerous contaminants.
The desire to perform rigorous decontamination and cleaning of equipment is often negated if the station does not have proper areas for the practice. If contaminated items are brought to the station kitchen sink for cleaning, all station personnel are in danger of ingesting and absorbing the contaminants when preparing and consuming meals later.
Over the years, the vehicle bays of the station have been remembered fondly for all of the “non-apparatus” activities. It is rare to find a station over 10-20 years old that does not have some level of physical training occurring in the apparatus bays. Weights, exercise machines, basketball goals, cross-fit equipment, etc., are all common sights in bays across America. Departmental and community meetings, even bingo sessions are held in the apparatus bays regularly. Some departments still have operational watch desks or counters in the open vehicle bays. When the department has a station meal with a large group, it is often served in the vehicle bays. Very often open or unused areas of the vehicle bays accommodate seating, tables, even TVs, serving as a “secondary dayroom” for station personnel. In light of the new recognition of carcinogens and their effect on fire fighters, providing space for all these activities away from the bays is even more important.
While we concentrate in this article on the constantly reoccurring exposure to firefighters of carcinogens, there is also concern regarding unintended exposure to civilians at the station. Open house/tour days are a great way to show the community why the department is worthy of their support. But who has an open house or tour without taking the visitor through the highly contaminated apparatus bays? Many times refreshments, kids programs, even bands are set up in the bays. Engine rooms still serve as polling places in many communities. Fund raising events and meals often utilize the very large, beneficial space found in the bays.
Now that we have identified the health challenges of a contaminated station in part one, please join us next issue for part two, which will include ideas on containing and correcting the issues through proper station design or reconfiguration. Or contact me at www.fire-station.com with questions or comments.
Since 1988, Ken Newell, AIA, LEED AP BD+C, IAFC, has earned a national reputation for the programming and design of Public Safety Facilities that are functional, practical and budget-conscious. He has been directly involved in the planning and design of over 275 Fire Stations, EMS Stations and Public Safety Training Facility projects designed by Stewart-Cooper-Newell Architects. Since 2000, his practical approach to station design has led to him being a featured speaker at national Fire Station Design Symposiums and State Fire Conferences.