Allow Us to Re-Introduce the North Carolina Firefighter Cancer Alliance

Angie Bell

The International Association of Fire Chiefs (IAFC) made a splash in August when they announced, “Recent studies have shown all three layers of the protective clothing contain Per and Polyfluoroalkyl Substances (PFAS) chemicals, which have been linked to cancer – the leading cause of firefighter deaths.”

NBC News followed up with a prime-time story the same evening, spotlighting PFAS in turnout gear and kicking off a flurry of conversations through the nation’s departments.

Firefighters took to social media immediately with questions, demands, some palpable anxiety, and plenty of memes that were morbid, ironic, angry, or a combination of all three. 

Interest in – and distress about – firefighter cancer has surged, and strong people who like to think they’re invincible have frantically stepped up the search for ways to protect themselves.

The North Carolina Firefighter Cancer Alliance (NCFCA) has had an eye on this topic for many months. As we have since 2017, we will aggressively educate and advocate for our state’s firefighters. 

The NCFCA has connected with an assistant professor at a prominent North Carolina University, whose field is literally described as “firefighter protection.” He has been examining PFAS in turnout gear as part of his specialty – textile engineering, chemistry, and science textile protection. 

We have scheduled a day-long workshop concerning “PFAS in Turnout Gear” in early 2023, details of which we will be posting on our social media pages, our website, and in our next column in this journal. 

However, research on PFAS in turnout gear is relatively new, with many complex factors. The eye-opening IAFF announcement dropped right before the deadline for this column, our first since before Covid. So, we decided it would be best to re-introduce the NCFCA to Journal readers instead of tackling this complicated topic as near strangers.

Our regular social media posts will frequently address new revelations about PFAS in turnout gear, along with general cancer awareness/prevention education, support for cancer patients, and occasional dad jokes for Friday Funnies.

The Alliance encourages all first responders and their supporters to follow us on Instagram, Facebook, and Twitter (handles in the bio). 

“No One was Listening”

A few Concord firefighters gathered in a bar in 2017 and fretted about a “new” pervasive worry … occupational cancer.

Of course, the problem wasn’t new for firefighters who had watched friends and teammates suffer and die early. But statistics proved the reality of a glaring grim trend — cancer was killing far more firefighters than all other lines of duty deaths.

“A few of us tried to raise the alarm, but it felt like no one was listening,” said Alliance founder Travis McGaha. “Our friends were dying. I didn’t understand folks online turning a blind eye to the problem. We felt we had to band together to form a safety net people didn’t know they needed.”

A couple of the firefighters present had endured their own cancer battles, so they brought personal grudges to the cause. Then, jotting down ideas on cocktail napkins, the firefighters decided to form a nonprofit to help North Carolina firefighters who had received a cancer diagnosis. Not only that, but they also wanted to raise awareness of the risks and minimize them.

The Grim Facts

Some days Alliance members wonder if our message is landing with firefighters or if we sound like Charlie Brown’s teacher, droning on with cancer information. By now, everyone should be able to quote the bleak statistics:

The IAFF stated cancer caused 61% of career firefighter’s Line of Duty Deaths from Jan. 1, 2022-Dec. 31, 2016.1 

A huge NIOSH survey found firefighters have a 9 percent higher risk of receiving a cancer diagnosis than the general U.S. population and a 14 percent higher risk of dying.2

Firefighters’ risk of contracting Mesothelioma is double that of the general population, and they have a statistically higher incidence of many other cancers like skin, colon, prostate, pancreatic, thyroid, etc. 

But even if some firefighters don’t want to acknowledge the painful reality, the highest medical authority on the planet recently did. 

In an announcement that will greatly impact all active and retired firefighters, the International Agency Research on Cancer (IARC) released findings that prove “occupational exposure as a firefighter as “carcinogenic to humans” (Group 1) based on “sufficient” evidence for cancer in humans.”

According to a release by the National Fire Protection Agency (NFPA), the previous classification was “as a possible carcinogenic…”.

The IARC is the gold-standard specialized cancer research agency of the WHO. The IARC published the findings in the June 30, 2022, issue of the Lancet, which can be found in its entirety at (Registration is free.)

“I can’t express how huge this declaration is,” said McGaha, a 16-year veteran of the Concord Fire Department. “The World Health Organization confirming similar studies should increase the urgency with which we support our heroes and first responders, medically and legislatively.”

Baby Steps to Attack the Problem

The fire service isn’t known for embracing change, so the Alliance began by brainstorming baby steps to encourage departments to implement new tactics which would easily fit into their normal routine and budget.

They created and released the Concord Fire Department Decontamination Model video on YouTube, emphasizing the importance of removing toxins from firefighters as soon as possible after a structure fire. 

The video provides a checklist for crews to protect themselves as much as possible during and after a fire, from closing all windows of responding apparatus to keep out smoke to showering within an hour to having separate, sealed rooms to clean dirty gear. 

We encourage every department in the state to have their members watch the 11-minute video at as part of increased efforts at harm reduction. 

The NCFCA produced a website to expand further our reach and ability to get out information. The website – – features “Defending the Heroes,” another video to motivate firefighters to take cancer seriously.

“Smaller departments can use the ‘Heroes’ video to prove the need for budgets which pay for best practices, such as second sets of gear or exhaust removal systems,” McGaha said. 

Sadly, but not shockingly, Scott Hinson, one of the firefighters featured in the video, passed away since he gave his interview. Others have faced resurgences of their cancer. So again, Health and Wellness training can include viewing and discussing this 10-minute video with your crews. 

Reaching out to smaller departments in the state who don’t enjoy the same financial support, NCFCA provided “Model Buckets” in 2019. The models provided a prototype for departments to prepare their own low-cost buckets for fire scene decontamination.

Using the Alliance template and training, a small department can assemble a Decon Bucket for about $25, giving firefighters access to approved soap for their bunker gear, a brush, bags to sequester the wet gear, a short garden hose section with a nozzle, and a 2 ½ “to garden hose adapter. These simple tools help remove carcinogens right away, which is critical to reducing hazardous exposure.

Finally, having experienced first-hand the devastation of a cancer diagnosis, Alliance survivors set up a peer support program for firefighters diagnosed with cancer. We receive messages through social media and the website and strive to provide a safety net of emotional support as well as guidance through various legal and financial/insurance hurdles. Trained counselors await any firefighter in need.

Going Forward

If real estate’s mantra is “location location location,” a researcher’s mantra is “data data data.” Scientists have made progress in properly labeling firefighting as a carcinogenic occupation, thanks to a few studies dating back decades. 

In the grand scheme of science, however, analyzing firefighter cancer is brand new; a more comprehensive investigation is desperately needed.

Historically, tracking firefighter health meant time-consuming, labor-intensive, and repetitive contact with study participants. While it was good enough to prove the link between firefighting and cancer, future experiments can and should be broader and more comprehensive.

The NIOSH review, the largest to date, followed almost 30,000 firefighters in Chicago, San Francisco, and Philadelphia for almost 50 years, then drew conclusions from the health outcomes of those participants. 

The analysis only included three of the nation’s biggest organizations which tend to have more financial resources than smaller, rural departments. So, while it was an impressive effort, the findings were limited because massive differences exist between those massive departments and others around the country.

For example, cancer rates in smaller, rural departments could be even higher because their budgets are relatively limited and may not be enough to provide gar extractors to truly clean gear after fires or may not fund two sets of gear. 

These smaller departments rely on volunteers who may not be able to take days off to attend Decon training and, therefore, may not understand the importance of on-scene Decon or proper handling of gear to be washed.

Health and cancer screenings also cost a great deal of money, eating further into smaller departments’ budgets.

And, of course, the topic of PFAS in turnout gear hadn’t reared its ugly head yet.

On this front, the NCFCA has partnered to develop further an app called Health Exposures Analysis Tracking (HEAT). Created by a North Carolina family with literally centuries in the profession, the Firefighter Connect/HEAT app will be free to all firefighters and feature tracking of a firefighter’s personal health data and encounters with hazardous substances. 

It will help firefighters discern trends in their own health, but more globally, scientists can use the data to continue in-depth and specialized analyses (with personal information never transferred).

The app will have finished beta-testing and be ready to download this fall; follow our social media pages for more information. A future column will focus on the HEAT app and the important consequences of firefighter cancer data tracking.

Our other near-term plans include upgrades to peer support and a care package to guide firefighters through every step of a cancer diagnosis. We will also continue to help cancer patients receive their benefits provided by House Bill 535 through our partnership with Volunteer Firemen’s Insurance Services, Inc.® (VFIS)


The Alliance celebrated its fifth anniversary this summer, toasting its creation and accomplishments. We have weaponized individuals and departments across the state to fight occupational cancer with knowledge and tactical tools. Recent news like the WHO declaration gives us hope we are no longer screaming warnings into a deaf void.

But as the recent PFAS revelations show, we have just pulled up to the hydrant at the fully involved structure fire that is firefighter cancer. So, you all are only beginning a long battle for your lives, literally. 

But we won’t let you go through it alone. Please get in touch with us about educational information or if any of your department members have received a cancer diagnosis. Use your Alliance for tools to have the healthiest career possible. Be safe.

ANGIE BELLAngie Bell is a retired Captain, serving 17 years in the Asheville (North Carolina) Fire Department. She loves to hike the Western North Carolina Mountains with her dog, Murray, and takes care of goats when not volunteering for the NCFCA and other organizations.

Instagram: @ncfirefightercanceralliance


Twitter: @ncffcancerally


1. “Firefighters told to wear protective gear less to limit exposure to ‘forever chemicals’ linked to cancer,” NBC News, Aug. 24, 2022


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