The Cancer Blueprint for Change

One of the North Carolina Firefighter Cancer Alliance principal beliefs is that the fire service has talked about cancer statistics long enough and it is time for action. The Alliance’s education program, Cancer 2.0, has two major parts; The Cancer Blueprint for Change and the Concord Decontamination Model. The Cancer Blueprint for Change focuses on specific actions and behaviors that can be taken to address the issue. It uses the word CANCER to identify these actions: Clean gear, Annual physicals, Nutrition, Cross contamination, Exposure and Record keeping.

Clean Gear is the New Cool

Clean gear encompasses several concepts. First, we have to end that the dirty contaminated gear look is cool culture. We must implement proper maintenance and gear laundering. Clean gear is the new cool and must become the new Badge of Honor for health and wellness. We must start our shift or incident with clean gear and end it the same way. We need to ensure that our gear laundering and inspection guidelines meet NFPA 1851, Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting.

In situations where completely meeting NFPA 1851 is difficult, we must attempt to meet as much of the intent as possible. Clean gear also covers on scene decontamination which we will discuss more in another article and will be included in the next edition of NFPA 1851.

The use of Independent Service Providers (ISP) is encouraged. NFPA 1851, defines ISPs as verified by a third-party certification organization to conduct any one or a combination of advanced inspections, advanced cleaning, basic repair or advanced repair services.  However, some departments struggle with cost and affording the use of an ISP. Some alternative options include:

• Advanced Cleaning using a gear extractor or any lift and drop washer
• Completing and recording a self-inspection after an Advanced Cleaning
• Basic cleaning can be effective using a mop sink, trash can or large storage container
• Be sure to use appropriate PPE
• Follow the guidelines and intent of NFPA 1851

Departments should provide a second set of gear to all members so that they have a backup set to wear during laundering and drying. Many departments struggle with limited budgets. An option to address this is to determine the average sizes of your members and purchase a set or two of each size to keep in storage for use. One set of gear could cover multiple sizes even if it’s a size or two too big. This gear could be a basic spec or less expensive set than the frontline gear. It can also use a contrasting color of reflective trim to help identify it as a reserve set and ensure it is returned once the frontline gear is complete.

Each member should be issued at least two hoods and two sets of gloves. This allows the use of a clean hood before reentering a fire or before the next incident. This aids in not handling a contaminated hood or placing it against our bare skin. An alternative option is a hood and glove swap program. In this option, a chief or safety officer carries a bucket or container of spare hoods and gloves and swaps them out for dirty ones at fires. The dirty gear is then taken back to the station, laundered and placed back in the bucket for the next incident. In the case of volunteer or small departments, this bucket or container could be placed on the engine company, support truck or rehab unit.

Annual Physicals

Annual Physicals should be offered through the fire department. These should be NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments compliant. Options for this include:

• Contract with the local medical center
• Contract with an occupational medicine provider
• Contract with a third-party company specializing in NFPA 1582 physicals, or
• Visit your primary care physician, explaining that you are a firefighter and you have an increased risk of occupational cancer using the Healthcare Providers Guide to Firefighter Physicals that can be found at https://www.fstaresearch.org/resource/?FstarId=11591. Most insurance policies cover a well visit or physical each year.

Fire departments with small budgets, should explore grants and other funding. North Carolina, for example, allows use of excess money in a department’s Firefighters Relief Fund to pay for physicals.

Nutrition

Nutrition is a very broad topic that includes total overall health to aid in fighting off carcinogens and other diseases.

• Refined sugars and processed meat aid in cancer development by increasing systemic (whole) body inflammation
• Obesity, high cholesterol and high blood sugar can contribute to cancer development and growth.
• Diets high in fiber and Omega-3 Fatty Acids (avocados, salmon and nuts) can prevent cancer development
• Anti-oxidants such as phytonutrients (phenolic, flavonoids and carotenoids) found in fruits, vegetables and whole grains have been shown to reduce cancer 
• Proper hydration aids in digestion and flushing the body of toxins

Cross-Contamination

Cross-Contamination is defined in NFPA as the transfer of contamination from one item to another or to the environment. It is also commonly referred to as a secondary exposure. This can be due to a number of things to include:

• Not properly conducting on scene gross decontamination
• Improper removal of contaminated PPE such as removing respiratory protection first, using bare hands to remove clothing or leaving a contaminated hood on your neck
• Not washing hands before eating, drinking or using tobacco
• Wearing contaminated PPE into rehab areas
• Wearing contaminated PPE in apparatus cabs, station living areas, personal vehicles or homes
• Not cleaning gear and wearing it on later calls or using it in fire safety programs

Exposure Reduction

Exposure Reduction is anything to reduce or limit the exposure to a carcinogen. This includes time in the hazard and also the time the contamination is on the skin. Your skin should be protected from sun and UV damage by using sunscreen, long sleeves and hats to protect your natural barrier. Sun and UV damaged skin is less effective at blocking contaminates.

Diligent use of SCBA should occur during fire attack, overhaul, investigation and even decontamination. Air monitoring should be completed to minimum levels based off department guidelines, but also consider that most of the carcinogens don’t register on standard air monitors.

Diesel exhaust exposure should be reduced. The use of station exhaust removal systems, mechanical exhaust fans and idling policies should be used. Positioning of apparatus to reduce standing around the exhaust should be considered. Diesel exhaust has been found as much as 500 feet away from a vehicle based on weather. Consider the location of commonly used equipment (such as EMS bags) and don’t place it in apparatus compartments near the exhaust.

Limit the number of personnel on the scene that could be exposed to smoke. Leave personnel in Level One staging and position On Deck crews, Rapid Intervention Crews and manpower pools in areas not exposed to smoke. Command Officers, Safety Officers and pump operators should position out of the smoke and be prepared to utilize SCBA or air purifying respirators (APRs). Apparatus cabs should be left with windows up, cab and compartment doors closed and the AC or heat left off. This will reduce smoke and contaminates from entering the vehicle.

On the incident scene, personal body wipes should be used to remove as much soot and contaminates from the skin, primarily the neck, scalp, jaw, face, forearms and shin/calves. Shower as soon as possible, preferably within an hour of an incident exposure. This will help remove as many contaminates as possible and reduce the exposure time. The use of cool water can remove contaminates without opening the pores. Once the outer skin layer is clean, warmer water can be used to open the pores up to clean them out.  This can be aided by the First In, First Out policy. The first arriving units that are usually the dirtiest and most exposed should be released first to allow for cleaning equipment and showering. Another company can then be assigned to standby for investigators or assist as needed. A good workout following the incident can aid in speeding metabolism and causing sweat to open and flush the pores even more. There is discussion about the use of saunas to aid in this process. Although there have been no studies to prove it, several departments in Canada are doing this and claim effectiveness.

Reporting

Reporting or record keeping is the final step. Document any exposures in the event the worst-case scenario happens to you. Some departments have added it to their incident reports as a user field, others have created a written document to file manually. There are several paid apps you can place on your phone, while some union locals and state associations, mainly out west, are providing them free. The development of a standardized reporting system is another long-term goal of the Alliance. No matter the method you use, the important part is to actually use it and keep good records of dates, addresses, type of assignment, use of PPE, amount of time on the incident and any unusual factors.

The Cancer Blueprint is a tool to use to help guide preventive and post incident actions to help reduce the exposure to carcinogens. This has just hit the tip of the iceberg and 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.

References

Kiecolt-Glaser, J. K. (2010). Stress, food, and inflammation: psychoneuroimmunology and nutrition at the cutting edge. Psychosomatic medicine, 72(4), 365.

  Tete, S., Nicoletti, M., Saggini, A., Maccauro, G., Rosati, M., Conti, F., … & Salini, V. (2012). Nutrition and cancer prevention. International Journal of Immunopathology and Pharmacology, 25(3), 573-581.

  Liu, R. H. (2004). Potential synergy of phytochemicals in cancer prevention: mechanism of action. The Journal of Nutrition, 134(12), 3479S-3485S.