The fire service’s greatest health risk: PGI Safety’s case for treating cancer as operational risk
Iain Hoey
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Andy Slater, Managing Director for EMEA and Asia Pacific at PGI Safety, outlines exposure routes and daily hygiene steps for operational crews
Firefighter cancer risk has shifted from emerging concern to operational reality, driven by clinical evidence, national mortality data and lived experience across the service.
While awareness has grown, many brigades still struggle to convert research into everyday practice that reduces exposure, improves early detection and embeds long-term behaviour change.
Education, practical intervention and credible collaboration have therefore become central to closing that gap.
Andy Slater, Managing Director for EMEA and Asia Pacific at PGI Safety, has focused on translating evidence into frontline action through education, PPE development and shared ownership.
Drawing on sustained engagement with firefighters, clinicians and industry peers, Andy has helped shape initiatives aimed at cancer prevention, early screening and cultural change.
IFSJ Editor Iain Hoey spoke with Andy about how education, culture and practical solutions can improve firefighter health outcomes.
You have described cancer as the most serious health threat facing the fire service today. What evidence and lived experience led you to that view?
Cancer is now recognised as the leading cause of line-of-duty deaths among firefighters, surpassing acute incidents like fires or structural collapse.
In the UK, studies show firefighters face significantly higher mortality from certain cancers, with prostate cancer up to 3.8 times higher, leukaemia 3.17 times and oesophageal 2.42 times than the general population, and overall cancer mortality 1.6 times higher.
Internationally, organisations such as the IAFF report that occupational cancer accounts for around 70 to 80 percent of line-of-duty deaths in recent years.
Lived experience reinforces this: I have heard from firefighters diagnosed after years of service, often linking symptoms to repeated exposure.
Collaborations with advocates like John Lord, who survived cancer and now champions awareness through seminars, and Robbie Burns, whose personal testimony has moved entire rooms, have shared stories of colleagues affected young or posthumously.
The WHO’s IARC reclassified occupational firefighting as carcinogenic to humans in 2022, and UK surveys showing elevated diagnoses, including in younger age groups, confirm this is a real and ongoing epidemic we can address through better protection and practices.
How do firefighters encounter carcinogenic exposure, and where can daily practice reduce risk most effectively?
Firefighters encounter carcinogens primarily through inhalation of smoke and particulates, dermal absorption via skin contact with soot and toxins, especially on the neck, groin and wrists, and ingestion from hand-to-mouth transfer or contaminated gear.
Modern fires increasingly involve plastics and synthetics that release toxic chemicals such as PAHs, benzene and PFAS, which linger on PPE, appliances and within stations.
The greatest opportunities lie in consistent day-to-day decontamination protocols: immediate post-incident hygiene, showering within the hour, on-site laundering, particulate-blocking hoods to reduce neck exposure, separating clean and dirty zones in stations and appliances, and avoiding eating or storing gear in contaminated areas.
Simple changes, such as not taking PPE home and adopting breathable barrier fabrics, can dramatically cut absorption.
At PGI, we focus on gear that balances protection with comfort to encourage consistent use, turning these practices into routine habits that save lives over the long term.
How have your education and knowledge-sharing initiatives evolved in practice?
Education started with raising basic awareness of contaminants and has developed into targeted, evidence-based seminars such as the Invisible Risk series.
Early sessions focused heavily on the “why”, including exposures and statistics, but feedback showed firefighters needed the “how”: practical decontamination steps, PPE selection guidance and station culture changes.
We refined the approach by incorporating real firefighter stories, scientific input from toxicology experts, interactive gear demonstrations and emphatic presentations by Robbie Burns.
Collaborations with peers such as John Lord and Robbie have broadened reach, attracting hundreds from fire services, regulators and suppliers.
What works best are actionable takeaways, such as clear post-incident hygiene protocols, combined with peer-led discussions that build buy-in.
Post-seminar engagement has been strong, with firefighters sharing stories of changed behaviours, deeper understanding of PPE requirements and proactive steps such as pursuing SNOMED codes.
Departments have adopted better practices that reduce cross-contamination and encourage earlier health checks.
How can SNOMED codes improve screening and earlier clinical intervention for firefighters?
SNOMED CT codes allow GPs and NHS systems to record a patient’s occupation as firefighter, using code 106382009, and occupational exposure risks, such as 16090571000119109.
This flags elevated cancer risk in electronic records and prompts clinicians to consider occupational factors during consultations.
In practice, this enables targeted screening, including earlier PSA testing, faster referrals for symptoms that might otherwise be dismissed and inclusion in enhanced monitoring.
After promoting SNOMED codes through seminars, several firefighters secured rapid PSA checks, leading to early-stage diagnoses in some unfortunate cases.
Catching cancer very early delivers far better outcomes.
We urge firefighters to request that their GP adds these codes.
It is a simple administrative step with significant impact, as better data leads directly to earlier intervention and improved outcomes.
How do mental and behavioural health challenges interact with cancer risk and long-term outcomes?
PTSD, shift-work stress and burnout are prevalent within the fire service and interact strongly with physical risks.
Chronic stress weakens the immune system, potentially accelerating disease progression, while behaviours such as poor sleep, smoking, alcohol use or skipping health checks compound exposure effects.
Stress can also lead to complacency in decontamination, with firefighters rushing post-incident routines or failing to change contaminated gear properly.
Over time, this creates a cycle where poorer mental health worsens physical outcomes and cancer diagnoses add psychological burden.
Addressing mental and physical wellbeing together helps reduce overall risk, as healthier firefighters are more vigilant about exposure and early detection.
Why do you view inclusion, particularly for women, as a practical safety issue?
Inclusion is a safety imperative.
Women firefighters face risks linked to ill-fitting PPE designed for male builds, which can increase exposure through gaps, and research suggests higher risks for certain cancers, including bladder.
Hormonal factors and reproductive health considerations add further complexity.
This focus also widens to other blue light responders, particularly police and ambulance staff working fire scenes, where correct PPE and RPE fit is critical.
Exclusionary cultures deter reporting concerns or seeking help, delaying interventions.
By prioritising inclusive gear, diverse voices in training and addressing gender-specific risks in seminars, protection improves for all.
I have been fortunate to have individuals such as Dany Cotton and Michelle O’Toole contributing to this important conversation around women’s health and inclusion within the fire service.
How have peers such as John Lord and Robbie Burns shaped this work?
Collaboration underpins credibility.
John Lord, a retired station manager and cancer survivor, has been pivotal through his Invisible Risk seminars and advocacy, including promoting SNOMED codes.
His work has driven personal action, early diagnoses among attendees and wider engagement, including with retired firefighters and international audiences.
Robbie Burns, a serving watch manager, shares his personal bladder cancer journey through powerful, emphatic presentations at PGI seminars.
His testimony brings urgency and authenticity, inspiring immediate behaviour change.
Feedback consistently highlights improved daily practices, better PPE choices and proactive health steps.
Together with PGI’s technical solutions and support from industry colleagues, this peer-driven approach builds trust and motivates adoption across services.
My personal and sincere thanks also go to Mick O’Briand and Chris Thornton from Biggin Hill Airport for their tireless support.
What should the wider sector learn about improving firefighter health outcomes?
Change happens through shared ownership across firefighters, unions, manufacturers, researchers and regulators.
Education must be evidence-based, drawing on UK studies, IARC classifications and real operational data, while being delivered accessibly with practical tools and lived experience.
Sustained investment is needed in prevention, including improved PPE standards, mandatory decontamination protocols, universal SNOMED use and routine health surveillance.
Engagement following our seminars has led to behaviour change, heightened awareness of PPE and health needs, rapid PSA checks and early-stage cancer detections.
Shared ownership ensures no one waits for top-down mandates.
By combining data, lived experience and practical solutions, the sector can build lasting momentum and treat cancer as an operational risk that demands proactive, collective action.