Here is this quarter’s pop quiz. Aside from heart disease, which can have a number of underlying precipitating factors, what is the deadliest disease in the United States? The answer is malignant neoplasms. What are those? We often refer to them as cancer or as some call it, the big “C.” Cancer is a disease in which abnormal cells divide uncontrollably and destroy body tissue. The biggest cause of malignant neoplasms (or cancer) is DNA damage. Believe it or not, our body experiences tens of thousands of new DNA damages per human cell, per day. That is why we come wired with DNA repair genes, but even these can become damaged by diet related agents or exogenous agents, such as smoke, radiation, metals, viruses and other genotoxins. For firefighters like us, we are perhaps also wired to consider only that which will immediately harm us. We run into a burning building, hit the fire, and emerge unscathed without a thought of what might hurt us 30 years from now, tomorrow, or even five minutes into the future. In the fire service, we are used to dealing with acute risks and not so good at dealing with chronic risks.
If you are reading this and do not know anyone that has had cancer or lost a loved one to cancer, you should consider yourself extremely lucky.
One of the jobs I held when I was younger was pumping gas and cleaning vehicle windows at a full-service gas station. No one ever told me that the fumes I was breathing were harmful. It was assumed I would never inhale enough gasoline fumes to pass out and die. Therefore, we disregarded the acute risks of gasoline fumes. However, we know that gasoline fumes are a chronic hazard. Repeated exposure to even small doses over a long period of time can cause DNA damage and ultimately lead to cancer. While we often discuss the fuel packages we encounter in today’s structure fires in terms of heat release rates, we have only recently begun to talk about their potential to produce cancer-causing smoke. Gone are the days of our natural fuel packages made of wood and cotton. Today, our polyurethane, polyethylene, etc. materials not only produce high heat release rates — which is our acute risk and are often occurring inside energy efficient construction designed to prevent temperature exchanges with the outside environment — but they also produce very nasty byproducts of combustion including carbon monoxide, hydrogen cyanide, Sulphur dioxide, nitrogen dioxide and hydrocarbons. These are the chronic risks that we are just beginning to pay attention.
If you are reading this and do not know anyone that has had cancer or lost a loved one to cancer, you should consider yourself extremely lucky. How do we operate in the presence of these materials? First, we need to recognize that structure fires — and car fires and trash fires — which produce these chronic risks, are becoming high hazard, low frequency events for us in the fire service. My department ran 9,000 calls last year and only 113 of those were structure fires, which is 1.3 percent. The Fire Department of New York (FDNY), the largest and busiest fire department in the U.S. ran 2,015,084 calls last year and only 26,491 of those were structure fires. Do the math on that and you will find it comes out to 1.3 percent. So, since we are only spending a little more than one percent of our time on these calls, perhaps we need to start thinking of them as hazardous materials incidents. In fact, many of us are currently using air monitors at structure fires to determine the presence of carbon monoxide and/or hydrogen cyanide. Here is the problem with that. You could be giving your crews a false sense of security unless you are also monitoring for Sulphur dioxide, nitrogen dioxide, hydrocarbons, etc.
While our personal protective equipment (PPE) provides us some protection, it too has its limitations. Let’s consider our routes of exposure — like we do at a hazardous materials incident. The toxic byproducts of combustion can enter our bodies through inhalation, skin absorption and ingestion. The use of structural PPE provides some protection from skin absorption. The use of self-contained breathing apparatus (SCBA) can help prevent inhalation and/or ingestion, but many are not aware of when or how long to wear one. Atmospheres that produce these cancer-causing products of combustion can be present up to 30 feet from the structure or container involved. Additionally, the materials may be present in the air long after the smoke dies down. While your PPE and SCBA will protect you to some degree, it becomes heavily saturated with these materials. Not only should your PPE be decontaminated, you should be decontaminated also — see these structure fires really are hazardous materials incidents.
Clean your gear in an extractor, swap your flash hood out — which covers the particularly vulnerable parts of your body (head, face, neck), and take a shower as soon as you get a chance. If you do not immediately have a chance to shower, consider using wipes to decontaminate at the scene. Do not ride with contaminated PPE in the same compartment as you. To do so runs the risk of inhaling the toxic particulates that have been absorbed by your PPE. This applies to firefighters in rehab also. Contaminated PPE should be doffed and placed up wind of the rehab area or in an area where a fan is blowing potential contaminants on the PPE away from the rehab area. If a second set of PPE is available, you should switch into the second set — while your first set is decontaminated. If a second set of PPE is not available, consider washing it at the end of your shift. It is very likely that, in the absence of proper decontamination, that you will transport these toxic contaminants to your home. Make no mistake, this will put your family at a higher risk for developing cancer.
We have come a long way since the days of me pumping gas. Back then, I was taught how not to get burned up while fighting fires. Today, it is important that you consider the long-term effects of our business. We have very few firefighters being “burned up” every year; however, more than half a million people will die from cancer this year. Of those, firefighters are at a higher risk due to the chronic risks we are exposed to at every fire. Consider using the recommendations above to minimize your risk and protect yourself, your co-workers and your family.