Chris Thain, G3 Systems Business Development Manager, looks at the risk of cancer among firefighters

A seminar held on 22 November 2022 at Cranfield University, organised by John Lord, MD of Simtrainer UK and Alisdair Couper, MD of Terberg DTS, brought more than 140 Fire Officers from services around the UK together with Scientific researchers and Suppliers to discuss the cancer risks faced by those in the fire service. The seminar’s purpose was to spread important knowledge and to raise awareness and understanding of the risks posed by carcinogenic ultrafine particles (UFP) contamination and to discuss better ways to manage and mitigate this insidious health issue.

This hard hitting one-day seminar drove home the message that the incidence of cancer among firefighters is rapidly increasing and that the fire sector must act now to better protect its personnel from this malignant, life-threatening disease.

The key-note presentation was made by Anna Stec, Professor in Fire Chemistry and Toxicology at the University of Lancashire. Professor Stec has worked in the field of Fire Chemistry for over 20 years of and for the past six years has been researching and reporting upon the carcinogenic properties of fire emissions and their derived toxicology particularly in respect to firefighting. Commissioned by the UK Fire Brigades Union, this independent research seeks to understand the link between firefighters’ occupational exposure to toxic fire effluents, and cancer and other diseases.

The report not only provides evidence of the heightened risk faced by firefighters through their work, but also delivers clear and authoritative guidance to fire and rescue services across the UK about the measures they can take to minimise firefighters’ exposure to contaminants.

Exposure to ultrafine particles

Professor Stec explained that any products of combustion, from the smouldering embers of a wildfire to the exhaust gases from an aircraft jet engine on an airport stand, will emit large quantities of carcinogenic UFP, both in gaseous and particulate forms.

UFP are lighter than air and can travel significant distances from the actual source of combustion, and can deposit or condense in large quantities, particularly on the clothing, equipment and appliances used by firefighters when dealing with an incident. Furthermore, the fire-retardant chemicals used on modern fire kit will ‘gas off’ when subjected to extremely high thermal temperatures, again emitting carcinogenic UFP.

Abby Hannah, a Biomedical Scientist focussing on particulates at Stedfast Barrier Technologies informed the audience that these ‘ultra-fine’ can easily be breathed into the lungs if inadequate or no respiratory protection is being utilised, resulting in the possibility of lung cancers developing.  

They can also be ingested with food and drink if hands are not cleaned prior to eating or drinking, resulting in stomach cancers and finally, these particulates are very easily absorbed into exposed skin and then into the bloodstream, if proper barrier protection is not worn or is not decontaminated properly after exposure to combustion, either at an incident or during live fire training. This can lead to skin cancers, brain cancer, leukaemia, testicular cancer, breast cancer, bladder cancer, Non-Hodgkin’s Lymphoma, and many other fatal cancers.

Thorough Scientific Research

Professor Stec and her team at UCLAN have conducted thorough scientific research over the past six years to establish the types, quantity, and dispersion of UFP affecting firefighters in the United Kingdom. 22 Fire Stations were swabbed for UFP, with over 1000 samples taken from work surfaces, fire kit, appliances and from skin samples, and the results analysed at the University of Lancashire. It was discovered that high quantities of UFP were omni-present in Fire Stations, not only in the appliance bays and fire kit storage areas, but also in the officers’ offices, around their desks and computer keyboards etc.

Helmets, flash hoods, gloves and fire kit were obviously highly contaminated, as were SCBA and respirator filters. It is highly recommended that BA should not be removed prematurely or donned too late.

It was also worrying that often firefighters or technicians would clean SCBA sets and replace filters back at the Fire Station without wearing RPE when doing so. It was stated that the smell of smoke in a Fire Station was indicative of odourless Benzene UFP contamination that was 50% higher than the maximum safe level. Good ventilation is essential in Fire Stations and particularly in any areas where fire kit is stored.

Research from 10,600+ UK firefighters has shown that 84% attended fires without wearing RPE, 82% admitted to eating or drinking while in their PPE (fire kit) and 63% admitted to not washing their hands before doing so. Only 58% changed fully changed their uniform/workwear following attendance at an incident.

Exposure Prevention

It is essential for firefighters to remove contaminated fire kit as quickly as possible after use and to bag it up in plastic bags, ready for professional decontamination. Dirty fire kit should be stowed in a ‘dirty zone’ on the appliance, not in the crew cabin, which should be designated as a ‘clean zone’.

Efforts should be taken to ensure that dirty fire kit and clothing does not cross-contaminate clean fire kit and clothing. This may mean Fire and Rescue Services investing in additional fire kit and workwear for all firefighting staff.

Fire kit and workwear should be professionally laundered, either on station using washing machines and detergents designed for the purpose or sent to an outsourced OEM/service provider/laundry that can handle UFP contaminated clothing. This will also avoid firefighters taking contaminated clothing home to be laundered, thus exposing their families to this unseen carcinogenic hazard.

It is also strongly advised that FRS encourage all operational personnel to record and monitor their attendance at fire incidents over the course of their career to maintain an ‘Exposure Log’.

Early detection can have a significant impact on cancer survival rates. Of firefighters diagnosed with cancer, 92% were diagnosed at terminal stage. Only 8% receive an early diagnosis. This is why it is essential for all firefighters to have regular, early health screening.

Preventative health screening programs should be initiated annually for all firefighting staff and firefighters actively encouraged to ensure that their Doctors/GP’s register their occupation on their medical records.

Firefighters should ask their Doctor/GP for a blood test highlighting the common clinical markers for cancer detection. Firefighter Instructors should be tested biannually.

It was also emphasised that following a trial in Edmonton, Canada, an effective health screening programme can be more cost effective for the employer in the long run as staff medical problems caught early are less costly to the organisation over the longer term.

Recommendations for Firefighting Personnel

Respiratory protective equipment (e.g., SCBA) should always be worn whilst firefighting This should also include during salvage and turning over activities and other activities undertaken by FRS personnel (and/or others) after firefighting has been completed, but whilst the building contents are still ‘gassing off’. Respiratory protective equipment (RPE) should be one of the last items of PPE removed during de-robing (after decontamination).

PPE that is suspected of being contaminated should be transported back to the station or workplace in an air-tight container to prevent cross-contamination. “Scrub then grub” – Avoid eating, drinking, or smoking with unwashed hands whilst wearing, or after de-robing PPE that may be contaminated.

After attending a fire incident, all personnel should change into a set of clean, dry clothes as soon as possible, ideally before re-entering the appliance (or any other vehicle). PPE should be clean and should be thoroughly decontaminated after every incident to avoid a build-up of toxic contaminants. PPE should be inspected for wear and damage on a regular basis and replaced as necessary.

It is important to protect areas of exposed skin and airways when cleaning soiled PPE/equipment. This requires appropriate respiratory protection (e.g., face masks or face coverings) and gloves. “Shower within an hour” when returning to the station from an incident or following a live fire training exercise.

Regular health screening and recording attendance at fire incidents over the course of a firefighter’s career is strongly advised and will be key to the longer-term monitoring and management of health.

Recommendations for Fire and Rescue Services

Every Fire and Rescue Service (FRS) must have fully risk-assessed decontamination procedures (en-route to, during and after fire incidents), and ensure all relevant staff are trained in implementing these procedures. All FRS personnel should receive regular and up-to-date training on the harmful health effects of exposure to toxic fire effluents, and how these exposures can be reduced, minimised, or eliminated.

All FRSs should have policies in place for the routine care, maintenance, inspection, and professional cleaning of PPE. Finally, establishing and strictly maintaining “designated zones” within the fire station must be a priority for preventing cross-contamination. PPE should never be worn in areas of the station designated a clean zone (e.g., kitchens, living quarters etc.) and should be stored away from personal items.

This article was originally published in the March edition of IFSJ. To read your FREE digital copy, click here.