Moving Cancer Education Forward

While we seem to be identifying and talking about the occupational cancer problem, there are only minimal guidelines or suggestions on solutions and even less guidance on actual implementation. Many fire departments and chiefs are getting frustrated at determining how to implement these suggestions, especially under limited budgets. A quick review of the studies reveals an elevated incidence of certain cancers, an overall elevated risk of all cancers and that cancers occur in the same organ sites in general.

Firefighters are exposed to various carcinogens at fire scenes and at the fire station. These carcinogenic exposures can include various metals, chemical substances, minerals, toxic gases, diesel exhaust and soot. Soot and diesel exhaust are both classified by the International Agency for Research on Cancer (IARC) as Group 1 Carcinogen or Known Carcinogenic to Humans. NIOSH has determined that soot and Polycyclic Aromatic Hydrocarbons are some of the major causal carcinogenic exposures for firefighters .

Carcinogens can be introduced to the body in one of three ways: Inhalation, ingestion or transdermal absorption. Even while wearing traditional full personal protective ensembles, firefighters experience systemic (body system) exposure to PAHs and other aromatic hydrocarbons that likely occur through:

• Transdermal (through the skin) exposure specifically around the neck as a result of the lower protection of structural firefighting hoods
• Nonuse or misuse of PPE and SCBA
• Inhaling the off-gassing of VOCs while removing protective clothing , in rehab or riding in apparatus cabs
• Bare hands while removing personal protective equipment.

Organizational culture is the learned behaviors, values, beliefs and assumptions that are shared among a group. It is learned over time and generally passed down from member to member. The perceptions and culture of an organization affects its ability to adapt and change. Images of soot covered faces and dirty turnout gear has always been seen as a badge of honor. The failure to wash gear and clean our equipment and to walk around the fire station in turnouts appeared cool and macho. Our culture has glorified this behavior and in effect has bathed us in these carcinogens and extended our exposure. The fire service has long had a tendency to resist change due to our tradition and culture. We must understand this culture and each individual department’s specific needs to be able to properly address this issue.

In a recent consultation, I had a chief tell me that he had attended a cancer class with a group of firefighters. The bulk of the presentation was numbers and statistics on LODDs and described as gloom and doom. It depressed his firefighters to the point that they left disheartened at the lack of hope for change. They were disappointed that the few guidelines given were costly and focused on paid firefighters with no guidance to implementation for volunteers and small departments with limited budgets. In order to effect change, individuals must be properly educated on the whole issue. This education should be focused on the how as much as the why. Firefighters must have a greater understanding of cancer prevention, in order to change their underlying assumptions and culture. This learning must then be converted to policies and procedures that in turn can create a new, safer culture. The problem we are facing now is that many are being educated on the cancer problem and told what they need to do, but not how to do it. This leaves a lot of questions and eventually leads to inaction. A person’s perception of the possibility of getting a disease and its severity affects their willingness to engage in preventive behavior. While that is what most of our cancer education has been trying to do, it’s time to move from just numbers and statistics to actual operations and guidelines.

Another issue we face is that most departments don’t begin to research the problem, accept its reality or seek information until after they receive a diagnosis or it impacts them directly. Most firefighters are apathetic to the issue until there is a personal impact such as their own diagnosis or that of a close friend or coworker. Progress is being made in NFPA standards to help with this, but most of those are still a year or two out from release.

The North Carolina Firefighter Cancer Alliance has decided that we have talked about the problem, the statistics and the numbers long enough. The Alliance has developed and implemented Cancer 2.0, the Upgrade. The Cancer 2.0 focus is on two major parts; The Cancer Blueprint for Change and the Concord Decontamination Model. The Cancer Blueprint for Change is an education program that uses the word CANCER to identify specific actions and behaviors that can be taken to address the problem. The Cancer Blueprint is Clean gear, Annual physicals, Nutrition, Cross contamination, Exposure and Record keeping. Within Cancer 2.0, the Alliance discusses alternative and inexpensive methods and includes discussion on station design, clean cab concept and on scene gross decontamination.

The Concord Decontamination Model was born in 2014 following several cancer diagnoses that occurred as Concord Fire Department was revising its guidelines on Personal Protective Equipment and Respiratory Protection. The idea was to create a process and equipment for on scene decontamination that was inexpensive and simple. This is how the Orange Bucket or Cancer Bucket developed.

The North Carolina Firefighter Cancer Alliance is dedicated to the prevention of cancer exposures in the fire service through education, support and screenings. Our goal is to help change the culture of the fire service so as to help reduce the cancer risks and address the dangers facing our firefighters. The idea behind the NCFCA is to create a focus on individual department’s needs and to be able to cater education, guidelines and support locally. Use of canned presentations is effective at getting basic information out, but with the varying makeup and types of departments, a more personal approach is necessary. One on one consultation and discussion can aid departments in reviewing various options and determining the best ones for them along with development of SOGs.

In addition to effective education, the NC FCA has long term goals to increase peer support and patient response systems as well. The Alliance is in partnership with Atrium Health’s (formerly Carolinas Healthcare) Levine Cancer Institute in developing a peer support program using models that LCI already has in place modified for firefighters. We are taking this model and creating a training program for survivors and others who wish to help their brothers and sisters in peer support and assistance.

Orange Bucket or Cancer Bucket

The Alliance has partnered with LCIs Project T.O.M (Taking on Melanoma) since early in its inception in providing information and direction. Project T.O.M is a free health screening program engineered by LCI that originally focused on melanoma in the fire service but quickly spread to include prostate, head and neck, lung and other sites. These screenings can be requested at individual departments and are being held at various conferences and fire schools.

Occupational Cancer in the fire service is a major issue that needs to be addressed. We not only need to discuss the problem and what causes it, but we need to start actually making a difference and changing our attitudes, behaviors and processes. We have talked numbers and concepts for too long. It’s time to start making changes and working together. In our next article we will discuss the Cancer Blueprint and some options on implementation. While this can help meet our goal of effective education, we encourage one on one consultation or in person training to help with better understanding. Check out our website at www.ncfirefightercancer.org.

Josh Simpson is a 20-year veteran of the volunteer and career fire service. He is an Executive Board Member of the North Carolina Firefighter Cancer Alliance and heads the Education Outreach. He is a battalion chief with the City of Concord Fire Department serving in the operations division and previously spent four years as the department safety officer. Simpson is also a captain with West Stanly Fire Department. Simpson is a Level III Fire Instructor teaching at several colleges covering Firefighter, RIC, Fire Officer, Instructor and Driver Operator. He has been teaching about occupational cancer in the fire service for several years.

References for this article available upon request.