By Angie Bell
irefighting these days feels like competing in the Hunger Games.
In the Hunger Games, combatants knew they would face 23 other unlucky lottery losers, each fighting to the death to save their own lives.
So, fighters pre-planned and trained for those 23 known, obvious life threats.
But then, whoa, once in the Arena, the Head Gamemaker had some surprises in store. He unleashed a tsunami, or deadly hornets. Or rolled out toxic fog. Or hid landmines near supplies. Or enticed a starving participant to eat poisonous berries.
Hunger Games combatants pre-planned for 23 known perils but could not imagine what other dangers loomed.
For centuries, firefighters trained hard to survive the most obvious life threat – fire.
Fire (and the various ways it can trick, trap, and kill you) is the hand-to-hand combatant we know and train to face, so we can stay calm and safe in burning structures.
But for more than a decade now, firefighters have realized the most insidious life threat we face is cancer.
Maybe before awareness increased, cancer seemed to be in another “Zone” of the Arena – like those berries someone was dumb enough to eat but we would never.
But then more and more cancer studies could not be ignored, so firefighters did what they do – started pre-planning and training to prevent cancer with known.
Steps to Fight Cancer
Our worn gear stays contaminated and sheds carcinogens. Departments prohibited bringing bunker gear into living areas and bought fancy extractors to launder the gear instead of our personal washing machines.
Contaminated or wet gear means fire crews have no PPE for the rest of a shift, which compromises protection of the district? Departments bought second sets of gear, and municipalities scrambled to fund their purchase.
Breathing products of combustion causes cancer? Departments mandated air quality monitoring and that firefighters stay on air during salvage, overhaul, and investigations.
Contaminants soak into our skin and cause cancer? Departments added on-scene decon and provided wipes in each apparatus. Firefighters know they now must shower within the hour, during which departments now allow crews to stay out of service.
So, the fire service has some counterpunches, some solutions to fight occupational cancer. Various “solutions” were not perfect; they can involve very high cost or discouraging fireground logistical hurdles. The highest hurdle might be convincing a bunch of really strong folks to admit they are not invincible and need to embrace inconvenient extra work after a job.
A new enemy in our gear locker
But most recently, a combination of toxic fog plus raging hornets plus poisonous berries has descended upon the fire service. And we do not yet have a counterpunch, in fact we are still trying to pin down the problem.
Our turnout gear contains PFAS.
Not our gear! It keeps us safe, allows us to survive unsurvivable environments. As rookies, we practice donning and doffing it a million times and I admit I had a friend take a ton of pictures of me in my very first set.
Our bunker gear – thrown on for everything from a fully-involved working fire to a medical call that interrupted our workout – could possibly be harming our health.
A final verdict is still very much out on a causal link between PFAS and firefighting occupational cancer, but the news has rocked the profession and left millions of firefighters scrambling for answers on how to best protect themselves.
PFAS, the new nemesis?
As a reformed hazmat technician nerd, I know most firefighters’ eyes glaze over when you toss around long words containing “-alkyl’ and multiple syllables. But hang in there, because if we are going to advocate for safer turnout gear, we need to educate ourselves about what we have worn our whole careers.
According to the U.S. Food and Drug Administration: “Per- and polyfluoroalkyl substances (PFAS) are a diverse group of human-made chemicals used in a wide range of consumer and industrial products. PFAS do not easily breakdown and some types have been shown to accumulate in the environment and in our bodies. Exposure to some types PFAS have been linked to serious health effects.”1
You may also see references to PFOA (Perfluorooctanoic Acid) and PFOS (Perfluoro octane Sulfonate) which are types of PFAS.
It is crucial to point out this is a very new field – the first true research studies of gear seem to have been conducted in 2018, which is like a millisecond in terms of scientific research. Some doubt whether PFAS are really that unhealthy – government health agencies are conservative in their statements about the dangers of PFAS. Progressing from there, some question whether the PFAS in turnout gear really hurt firefighters.
We hope more scientists will urgently delve into this topic and not only address our concerns but provide us with reasonable alternatives.
As conservative as the federal government has been, the FDA website does say, “While the science surrounding potential health effects of bioaccumulation is developing, exposure to some types of PFAS have been associated with serious health effects.”2
The Utah Department of Environmental Quality states: “Some, but not all, studies in humans with exposure to PFAS have shown that certain PFAS may:
• Affect growth, learning, and behavior of infants and older children
• Lower a woman’s chance of getting pregnant
• Interfere with the body’s natural hormones
• Increase cholesterol levels
• Reduce the immune response
• Increase the risk of cancer
• Change liver function
• Increase the risk of pregnancy-induced hypertension/preeclampsia
• Increase the risk of thyroid disease”3
They’ve got us surrounded
PFAS have been around for almost a century now, used to increase resistance to stains and water, in everything from fabric to paint to personal care products. Water-resistance helps protect firefighters from steam burns while the oil-resistance protects against permeation by some chemicals.
Trying to avoid PFAS might feel useless, because of the sheer volume of them in thousands of consumer products including cookware, cosmetics, personal care products (shampoo/lotion), dishwasher and laundry detergent, and food packaging like fast food wrappers, pizza boxes and microwave popcorn bags.
However, you can avoid PFAS in consumer products with a bit of effort. Make popcorn with an air popper instead of the microwave. Cooking in cast-iron pans harkens back to the earliest days of firefighting (but rookies, dear sweet heaven please ask a vet how to wash one!). Googling “PFAS free” cosmetics and cleaning products – and just about anything you put on your body – yields many options.
But as we know, staying out of turnout gear is flat-out not an option for firefighters. Even at “retirement home” stations, gear-free days are not guaranteed.
So, what is a firefighter to do?
Don’t wear gear if you don’t have to
Unnecessary donning of turnout gear falls into two categories: 1) “It’s so easy” and 2) “You never know.”
“It’s so easy” to jump into your gear when your workout gets interrupted, and you do not want some poor syncope patient waking up to your very short workout shorts.
“It’s so easy” to stay in jammies and throw turnout pants on in the middle of the night, rather than put your uniform back on, belt and tucked-in-shirt and all.
Coveralls, or “multi-response PPE” could be a good, low-cost alternative to the convenience of turnout gear in either case.
And then we have “You never know” if you may face a fully involved structure despite being dispatched on a fire alarm, right? “You never know” if an incomplete 911 dropped because residents fleeing a house ablaze abandoned their phones in their rush to escape.
“You never know” if an MVA might present you with a subject-trapped who needs extrication. Or at the very least, you have to navigate a ton of broken glass at almost every wreck so wear your gear to be safe.
Sound familiar? But now you know you could possibly increase your cancer risk every time your skin contacts that gear, maybe convenience is not worth it. And maybe there is a better system to assess whether conditions warrant wearing it at all.
One North Carolina safety officer told me, “I have started telling guys, the standard says you have one minute to put your gear on. It does not say you have to do that before you roll. Get there, see what you have got, and whether you need that gear or not.”
Now, realizing the fire service is based on planning for worst-case scenarios, “You never know” will be a tough mindset to overcome. When we get to that MVA subject trapped, it seems unthinkable to tell them to stay calm for just one more minute while we don our gear.
But if you have done this job for a minute, you know the ratio of fender-benders to true extrications is low, and at some point, you have to choose what you are willing to risk your life for.
In their statement in the fall of 2022, the International Association of Firefighters and the Metropolitan Fire Chiefs Association included the following on the Safety Advisory checklist:
“Do not wear turnout gear on responses where this level of protection is not necessary. (Wearing all PPE and SCBA during firefighting, overhaul, and while working in smoke is still the best first line of defense when it comes to limiting exposures to fireground contaminants.)4
Check into PFAS free alternatives
Manufacturers are scrambling to catch up to the revelations about turnout gear. Right now, at least one company is making outer shells without PFAS, and while the Alliance does not endorse any brands, we applaud departments who have brought together committees to research all options.
We will certainly address innovations in turnout gear in coming articles, and welcome emails and messages from readers who learn of new products.
Continue to Educate Yourself and Stay
Tuned for Progress
The Alliance has scheduled a day-long workshop concerning “PFAS in Turnout Gear” at the Mid-Winter Chiefs’ Conference in Concord in February.
Dr. Bryan Ormond, Ph.D. in Fiber, and Polymer Science is an assistant professor at N.C. State University who will be leading a half-day workshop addressing the subject. Dr. Ormond is part of the Textile Protection and Comfort Center (TPACC) at N.C. State, which analyzes thermal protection and chemical resistance of turnout gear. He has spent the last few years of his career on several studies to better protect firefighters such as the effect of UV rays on your hood’s durability and ways to check gear more thoroughly for contaminants after fire exposure.
Look to our social media pages in the coming weeks for links to the live stream so you and your crew can catch Dr. Ormond’s expertise. We will also record it to allow for widespread viewing.
PFAS in turnout gear is a relatively new issue in our occupation, with many complex factors, and will require vigilance just like every other cancer risk factor firefighters face. Know your normal, know your risks, and do what you can to protect yourself. Be safe.
Angie 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.
1. “Per- and Polyfluoroalkyl Substances (PFAS),” USDA website, https://www.fda.gov/food/chemical-contaminants-food/and-polyfluoroalkyl-substances-pfas
3. State of Utah DEQ “Health Effects of PFAS,” https://deq.utah.gov/pollutants/health-effects-of-pfas