(This is part two of a two part series.)
Over the past couple of decades, a silent killer is growing exponentially in the fire-fighting profession. Cancer. The number of firefighting friends that have been impacted by cancer has greatly increased over the past 20 years.
Part 1 Recap
According to the Journal of Occupational and Environmental Medicine, along with the American Cancer Society Cancer Statistics Center, across eight commonly diagnosed 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-Hodgkins lymphoma.
The perpetrators are the known carcinogens that firefighters encounter regularly. They include carbon monoxide, formaldehyde, butadiene, isocyanates, benzene, nickel, arsenic, nitrogen dioxide, acrylonitrile, toluene and numerous other hydrocarbons. The problem for first responders is the repeated cycle that they are exposed to these carcinogens. They respond to a scene where these elements are present. They are exposed. They return 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.
Most of these elements or particles are so microscopic that they are invisible to the human eye. But what you don’t see can kill you!
There are three major methods how these contaminants enter the human body. They can be ingested, inhaled or absorbed. Ingestion simply means that the contaminants are carried via saliva or mucus to the digestive system. With inhalation, the elements enter the respiratory system through the nose or throat. Then the contaminants make their way into the lungs, which deliver them to the heart and the rest of the body through the blood.
Skin absorption is the least suspected of the three methods of entry into the body. Once the dangerous contaminants are on the skin, they can be absorbed into the body and bloodstream.
The station culprits are those items found at the station that were contaminated on the fire scene, or even at the station. They include elements such as;
- The exterior and interior of apparatus returning to the station
- Vehicle exhaust and everything it contaminates, including ice machines, vending machines, and laundry equipment housed in the bays
- Props used for station training
A major problem found at the station is the unintended exposure to dangerous carcinogens due to the apparatus room being used for other activities, such as; physical training, meetings, watch desks or counters, meals or “secondary Dayrooms.”
Now that we have discussed the problem, the perpetrators, and the station culprits, let’s look at some opportunities for making a difference through the way that we think about the layout of a new or existing station. First, let’s categorize the areas of the station based on their hazard. There are three major zones to the station. The Hot Zone is the high hazard or most contaminated areas of the station. This includes the apparatus bays and all areas that house or generate contaminants. The Cold Zone is the low hazard spaces. These are the areas where all sources of the contaminants are to be kept out. This includes most of the living or human occupied portions of the station. The third zone is the Transition Zone. This is exactly what it sounds like, the real estate where you pass from Hot to Cold, and where you try to make impassible barriers to the contaminants.
All properly designed or reconfigured stations will have the three zones occurring in the proper linear order; Hot to Transition to Cold, or Bays to Transition to Living Spaces. With this knowledge, consider your own station, or stations you’re familiar with. For example, the station with the apparatus bays in the middle, administrative spaces on one side of the bays, and living spaces on the other side of the bays — often referred to as a “saddlebag” station — puts the Hot Zone in the center, with the Cold Zones on each side, with little to no Transition Zones. The occupants are constantly passing through the high hazard space to get to the other low hazard space.
Our goal here is to identify design strategies for making the station layout better in regards to contaminants. These strategies fall into two major categories. First, we must contain the contaminants. Then we must separate the facility occupants from the contaminants.
Since we have identified engine exhaust as the major contaminator from within, controlling exposure to diesel exhaust is a critical strategy. There are several methods for controlling diesel exhaust in the apparatus bays. Some of these include; filtration devices mounted to the apparatus engine, mechanical air evacuation systems (fans and louvers), air filtration systems and source capture systems. Each method has specific advantages and disadvantages. It is not our purpose today to cover the pros and cons of each method, but one or more of the methods should be utilized to eliminate or control the dangerous contaminants introduced into the building through engine exhaust.
The Transition Zone
Developing or expanding the Transition Zone is an important approach in both containing the contaminants and separating the occupants from the contaminants. Space will not allow us to discuss all items that can be addressed in the Transition Zone, but several ideas are easily identified.
A dedicated Decontamination Area is paramount. The proper equipment that allows for the cleaning, treatment, and drying of all items that have been contaminated should be included in this decon area. Often the decon room includes, or is adjacent to, the laundry area made for contaminated PPE or other articles.
As previously implied, a dedicated PPE Room is not just about protecting PPE anymore. This space accommodates the drying, off-gassing and storage of potentially dangerous sources of contaminants. Proper drainage, heating and ventilation should be provided.
If possible, a separate “dirty” toilet/shower room should be included in the Transition Zone. This will allow personnel contaminated from working in the Hot Zone access to a restroom facility without contaminating toilet/shower rooms in the living areas of the station. It also allows a contaminated responder returning from a call the ability to shower and change prior to entering the Cold Zone.
Other items that should be considered for the Transition Zone include;
- Signage that prohibits PPE or other gear beyond this zone
- A boot cleaning station
- A walk-off mat
- Hand sinks or at least, hand sanitizer stations
- Enclosed accommodations for the ice machine and vehicle coolers
- Easily accessible EMS storage
All spaces within the Transition Zone should have a separated HVAC zone that does not allow return air into the Cold (Living) Zone heating and cooling. Consideration should be given to sealing both ends of the Transition Zone, leading to the Hot and Cold Zones.
What can departments do to better “contain the contaminants” and separate occupants from the contaminants if it is still years before you can afford a new station or major renovations? Focus on the items that we’ve identified as the greatest hazards, along with the items that are easy, and inexpensive, to address. Look at how you are addressing vehicle exhaust. Some of the most common grant opportunities for fire departments cover vehicle exhaust systems. Evaluate how you clean, dry and store PPE. Can you separate it away from all other zones in the station? Consider your decontamination spaces and practices, along with how they can be improved. Determine if your ice machine and vending machines are properly located and protected from dangerous exhaust. Make sure your physical training occurs outside of the Hot Zone. Install hand sinks, sanitizer stations, boot washes, walk-off mats and signage at all doors leading into the Living Zone.
We all want emergency workers to go home safely to their family at the end of their shift. But with the concerning statistics on firefighter cancer that is surfacing, we need to make every effort to assure a long, healthy life spent with their children and grandchildren.