A Firefighter’s Risk of Developing Cancer is Twice That of Any Other Profession

Smoke produced by fires today is much more dangerous than in years past. In the past, furnishings were made from natural products such as wood, cotton, wool, silk, glass and metal, which produced harmful smoke when burned. Modern furnishings are made with plastics, foams and other petroleum based synthetic materials that increases the production of smoke and creates 10 times the toxic gases of natural products.


When natural products such as cellulose or wood are burned, toxic products produced include acrolein and aldehydes. Today, synthetic materials create toxins such as carbon monoxide, phosgene, formaldehyde, benzene, nitrogen dioxide, dioxins, polynuclear aromatic hydrocarbons and hydrogen cyanide. Firefighter deaths have increased from the exposure of these toxins with the main two being hydrogen cyanide (HCN) and carbon monoxide (CO) which are called the “toxic twins.”

HCN is a colorless gas that smells like almonds and is almost twice as dangerous as CO. This toxin affects the blood, cardiovascular system and the central nervous system. Exposure to HCN can cause firefighters to have an altered level of consciousness, lose focus and to act irrational. There are reports of firefighters fighting with or avoiding rescuers after an exposure to HCN as well as going further into the structure that leads to injury or death.

CO is a colorless and odorless gas that is produced from incomplete combustion. CO attaches to the hemoglobin in the red blood cell 200 to two 250 times more readily than oxygen. When the hemoglobin is saturated with CO, it cannot reach the body’s cells, tissues or organs, which will result in suffocation. Free radicals are formed when hypoxemia is caused by chronic exposure to CO. These free radicals cause oxidative stress to cells and tissues, which can lead to Parkinson’s disease, atherosclerosis, Alzheimer’s disease as well as other neurological and cardiovascular diseases.

Smoke created from synthetic material is a mixture of chemical gases and other particulates that are created during pyrolysis or thermal composition. Exposure to this toxic mixture of chemicals and carcinogens can lead to the development of cancer in firefighters. A firefighter can be exposed to this toxic mixture in the form of soot when it is disturbed and inhaled.

A firefighter’s risk of developing cancer is twice that of any other profession. According to the International Association of Fire Fighters, the leading cause of line of duty deaths of firefighters is cancer. The more experienced firefighters have a greater chance of developing cancer. Research has shown approximately 10 types of cancers that are closely related to the fire fighting profession. Three of the most common that affect firefighters are testicular cancer, non-Hodgkin’s lymphoma and prostate cancer. A NIOSH study concluded a higher risk of cancer in the digestive, urinary and respiratory systems of firefighters. The development of malignant mesothelioma in firefighters is two times more likely than any other profession.

Risk reduction efforts to protect firefighters from the exposure of toxins from smoke created by synthetic materials have to occur prior to, during and after the fire. The recommended areas to reduce the exposure are education, using proper personal protective equipment (PPE), interior and exterior fireground operations, overhaul, rehab, scene decontamination, equipment decontamination as well as decontamination of the firefighter.

Prior to the fire, firefighters should be educated to the organization’s standard operating guidelines (SOGs). If no SOGs exist, the fire department administration needs to create policies and procedures or SOGs to reduce the risk of firefighter exposure to smoke. Firefighters should be educated to the hazards contained within the smoke and refreshed on these hazards annually. This education should include signs and symptoms of toxic exposure, how to correctly monitor hazardous atmospheres as well as the organizations decontamination policies.

Company officers need to be rigid and consistent regarding the use of proper PPE during fireground operations. Typical exposures to toxins from smoke are from inhalation and skin absorption. Turnout gear protects firefighters from dermal exposure while in contact with fire and smoke while self-contained breathing apparatus (SCBA) protects the firefighter from respiratory injury during fire fighting operations.

Inhalation of smoke on the scene of a fire is a common occurrence. To reduce the exposure of toxic smoke from the fireground, a firefighter should always utilize a SCBA during interior fire suppression activities in immediately dangerous to life or health (IDLH) atmospheres. Current research has shown that a firefighter should have respiratory protection up to 30 feet from the structure as the toxins in smoke have been monitored at IDLH levels.

Removing SCBA during overhaul operations is a common practice for firefighters. However, exposure to toxins and carcinogens from materials off gassing and disturbed soot will occur. To protect firefighters, SCBAs should be worn during overhaul operations unless the atmosphere has been metered and the CO and HCN levels are below IDLH levels. Metering the IDLH atmosphere to ensure when the removal of SCBAs is safe during overhaul operations should be mandatory.

Rehab is another place on the fireground that firefighters could be exposed to toxins from off gassing material or soot. As stated, turnout gear protects the firefighter from dermal exposure of toxins during fire ground operations. Firefighter PPE are separate pieces of equipment and are not a concealed unit. For this reason, toxic smoke and soot can get inside the gear and stick to the outer garments of the firefighter, as well as contaminating the outside of each piece of the PPE. As firefighters work, their body temperature increases. Toxins absorb though the skin 400 percent more with every five-degree rise in body temperature.

When in rehab, contaminated turnout gear is off gassing, exposing the firefighter to toxins. All PPE should be removed and placed in the area away from rehab. After the PPE is removed, baby wipes should be used to decontaminate the face, the neck, and any other exposed body part that has been exposed to soot. Flash hoods should be changed out in rehab due to the contaminated material being in direct contact with neck skin.

After fire ground operations are complete, all firefighters that were exposed to toxins from the fire and smoke should complete a gross decontamination process. Basically this is where all firefighters are hosed off, removing any gross contaminants. The contaminated PPE should not be placed in the cab of the truck, which can contaminate the entire crew.

Upon returning to the station, all PPE should be decontaminated as soon as possible. Larger departments have the luxury of providing each firefighter with two sets of turnout gear which allows the contaminated PPE to be decontaminated as a firefighter has clean PPE to utilize for the rest of the shift. Many fire departments cannot afford to provide each firefighter two sets of gear, which means that the firefighter will have to wear contaminated gear until the end of the shift when it can be decontaminated. This causes the firefighters to be continuously exposed to the contaminated PPE, increasing the risk of illness.

After getting the apparatus back into a combat ready state, the firefighter should remove contaminated duty uniforms and immediately shower to remove toxins and carcinogens from the body. A clean uniform should be donned and the contaminated uniform be laundered immediately. Contaminated PPE or duty uniforms should never be worn home or in the living or sleeping quarters as contamination could occur.

Administration has three main courses of action that can be taken. First, all specialized equipment can be purchased, an annual educational program can be implemented, and SOGs can be created and utilized, which would reduce the exposure of toxin from smoke to the firefighters. Second, create and implement an annual education program and SOGs to reduce the exposure to toxin in smoke; budget for or write grants to purchase the specialized equipment needed to reduce the risk of exposure. 

Cancer Exposure Risks Survey

Last November Chief Garrett conducted a survey to interested fire departments. The survey had 10 questions. Below are the results.

  1. What type of department is your organization?
    Volunteer 38.89%, Combination 48.15%, Career 12.96%
  2. Does your department have SOGs that reduce the risk of a firefighter’s exposure to the toxins contained in smoke?
    85% Yes  15% No

    If so, what does it cover?
    Wear SCBA 34%, Air Monitoring 13%, Cleaning PEE 13%, Change out Flash hoods 2%, On Scene Decon 1%

  3. Does your department reduce the risk of firefighter exposure to toxins from smoke during rehab?
    78% Yes  22% No

    If so, how?
    Setup away from smoke 31%, New Flash hood 4%, Wiping exposed skin 4%, Air monitoring 2%, Gross Decon 1%

  4. Does your department meter for CO and HCN during overhaul or any other time to assess the need of wearing SCBA?
    69% Yes  31% No
  5. Does your department provide all firefighters with two sets of turnout gear to use if one set becomes contaminated and needs to be decontaminated?
    79% No   21% Yes

    If not, why?
    Overwhelming reason was cost.

  6. Does your department have an extractor or washing machine that properly decontaminates turnout gear?
    57% Yes  43% No

    If not, why?
    Overwhelming reason was cost.

  7. Does your department provide initial and annual refresher education on the toxins contained within smoke and their effects on firefighters?
    78% Yes  22% No
  8. Does your department require the firefighters to complete a gross decon on their PEE prior to leaving the scene?
    57% No 43% Yes
  9. Does your department allow contaminated turnout gear inside the apparatus cab returning from a fire or in any part of the living quarters after returning to the station?
    In Cab 36% Yes, 18% No
    In Station 39% No, 15% Yes
  10. What is your department’s policy on decontamination of the firefighter after the apparatus is back in service at the station?
    No policy 28%, Shower only 10%, Shower/Change Uniforms 10%, Just PEE 6%
Scott Garrett is a 30-year veteran of the South Carolina emergency services community and is currently the Fire Chief at Westview-Fairforest Fire Department. He is an adjunct instructor with the South Carolina Fire Academy, a certified South Carolina Paramedic instructor, served as a Senior Paramedic with Spartanburg EMS and is an IFSAC/Pro Board certified Fire Officer 4, Fire Instructor 3 and Hazardous Materials IC.References for this article are available upon request at editing@carolinafirejournal.com.

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