Colorado bill could improve health coverage for firefighters

EMTThe state of Colorado already has a law that establishes a list of presumptive illnesses for firefighters, covering cancer of the brain, skin, digestive system, hematological system, and genitourinary system.

New legislation introduced on March 10, SB 17-214 would allow an employer to participate in a voluntary firefighter cancer benefits program as a multiple employer health trust to provide benefits to firefighters by paying contributions into the established trust. It would establish a schedule of minimum payments, or award levels, ranging from Level Zero ($100 to $2,000) up to Level Ten ($225,000). The diseases covered would be the same five as in the existing law (above).

Full time firefighters with 5 years of service would be covered as well as volunteers with 10 years.

It is sponsored by three Democrats and one Republican. No action has been taken on the bill since it was introduced nine days ago, and it is possible that the provisions could change if and when it passes.
Thanks and a tip of the hat go out to Bean.
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Editorial: Montana legislature fails to pass firefighter health bill

The following editorial was written by Dick Mangan.

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As someone who has been involved in wildland fire since the mid-1960s, and who is currently on the Missoula Rural Fire Board of Trustees, I’m really disgusted with the Republicans on the House Business and Labor Committee who voted to “table” the vote on SB 72 which would give Workers Comp coverage to firefighters who develop job-related cancer. For those of you unfamiliar with legislative terms, to “table” a Bill can be translated into “I don’t have the intestinal fortitude (Guts) to actually vote up or down on this issue, so I’ll vote to do nothing”.

Several of these Legislators offered meaningless “feel good” comments about firefighters, like Rep. Steve Gunderson of Libby who said “I take my hat off to firefighters” and Bigfork Rep Mark Noland who called firefighters “courageous….. so grateful for your service.” But then Noland went on to say “but they do know. They do enter this with their eyes open. This is what they chose.”

So, soldiers and police officers die in the line of duty, and that’s OK too? They know the risks, and make the choice, just like firefighters. Maybe we should extend that logic to State Legislators: JFK, RFK, George Wallace, Ronald Reagan and Gabby Giffords were politicians killed and/or wounded doing their jobs. So, if a Montana legislator should suffer a similar fate, should we just tell them and their families that “they entered with their eyes open”?

I must pause this blast to give credit to Republican Senator Pat Connell of Hamilton who introduced the Bill in the Senate (where it passed) and to Rep Sue Vinton of Billings, the only Republican House member to vote in its favor.

Firefighters, structural and wildland, volunteer and paid, frequently put their lives on the line to protect lives and property. Too bad some of our State Legislators can’t walk a mile in their fire boots.

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Dick Mangan retired from the U.S. Forest Service Technology & Development Center in Missoula, Montana in 2000 with more than 30 years wildfire experience. He is a past President of the International Association of Wildland Fire.

Montana legislature rejects firefighter health bill

One Senator who opposed it said “it is something they’re going into with their eyes wide open”.

Above: A firefighter works in smoke on the Water Tower Fire in South Dakota, March 16, 2016. Photo by Bill Gabbert.

On Wednesday a Montana legislative committee voted down a bill that would have provided benefits for firefighters who developed a lung disease on the job. Republican Mark Noland of Bigfork said firefighters “know what they’re doing”, and:

That is their profession, that is what they chose, and we do not want to, you know, slight them in any way, shape or form, but it is something they’re going into with their eyes wide open.

That is asinine, ridiculous, reprehensible, and irresponsible.

Rep. Mark Noland
Rep. Mark Noland of Bigfork, MT.

He is assuming that when firefighters began their careers they knew there was a good chance they would damage their lungs. If that is common knowledge now, or was 20 years ago when the firefighter signed up, why haven’t the employers already established coverage for presumptive diseases? There is a great deal we do not know about the effects of breathing contaminated air on structure, vehicle, and wildland fires.

Many agencies and government bodies have already established a list of presumptive diseases that will enable health coverage for firefighters. For example the British Columbia government recognizes at least nine “presumptive cancers” among firefighters, including leukemia, testicular cancer, lung cancer, brain cancer, bladder cancer, ureter cancer, colorectal cancer, and non-Hodgkins’s lymphoma.

The Montana legislation would have only covered one of these nine illnesses.

According to the Associated Press, Gov. Steve Bullock noted that 46 other states already have presumptive illness protections for firefighters.

When a person enlists in the military and they come home injured or permanently disabled, should we ignore them, saying they knew what they were getting into? Their “eyes were wide open”? How is treating firefighters injured on the job different? One could argue that they are both defending and protecting our homeland; one of them actually IN our homeland while the other may have been on the other side of the world.

Only one Republican on the House committee voted for the measure. Apparently in Montana treating firefighters injured on the job is a partisan issue.

The bill was previously passed by the Senate on a 33-14 vote. It is still possible that the bill could be brought up again by the House. If you want to follow the legislation, the text is HERE and you can track the progress HERE.

Cancer and the San Diego Fire-Rescue Department

Above: Screenshot from Jason Curtis’ film about San Diego firefighters and the occurrence of cancer.

The San Diego Fireman’s Relief Association has produced a short 8-minute documentary about the occurrence of cancer within the membership of the San Diego Fire-Rescue Department, interviewing 15 firefighters who talked about their job and the disease. Many of them looked back knowing what they know now, and wished they had done some things differently.

(UPDATE March 2, 2017: the film was available at the website of the company hired to make the film, but it has been removed until the cancer awareness program associated with it has been rolled out. It may be available again on YouTube or another site in two to three months, according to Robert Bunsold, a board member of the Relief Association.)

The San Diego FD primarily deals with structure fires. The mix of by-products of combustion they are exposed to is different from what a wildland firefighter works in, but unfortunately we don’t know what the significance of that difference is, if any. There are carcinogens in wood smoke but much work still needs to be done to determine the short and long-term effects on wildland firefighters.

Structural firefighters generally wear breathing apparatus (BA) when they are making an interior attack on a structure, and often when they are on the exterior. But wildland firefighters never wear BAs on a vegetation fire because it is not practical. They can be working on a fire miles from their truck for up to 16 hours, but the air bottles only last for minutes.

Some wildland firefighters wear a bandana or dust mask over their nose and mouth, thinking, incorrectly, that they provide some level of protection from particulates. And they have no effect on carbon monoxide and other dangerous gasses.

The smallest and most dangerous particulates in vegetation fire smoke are so small that if one was near an 8-foot high ceiling in a room with perfectly still air, it would take 8 hours for it to fall to the floor. These particles can easily go through a bandana or a cheap mask and make their way to the lungs. Much more expensive respirators with certain types of replaceable filters could provide better air, but they are hot to wear and create too much resistance as the air is forced through the apparatus.

wildfire firefighter smoke
A firefighter works in the smoke on the Water Tower Fire in Hot Springs, SD March 1, 2016. Photo by Bill Gabbert.

There is no registry that tracks their exposure or health during and after their careers. Another bill was introduced in Washington this month to create a registry, but the one introduced a year ago died a quick death, and this newest one has far fewer co-sponsors and so far looks unlikely to pass.

Washington Post writes about firefighters and cancer

Above: Members of a hotshot crew work in smoke on the Cold Brook Prescribed Fire, October 23, 2014. Photo by Bill Gabbert.

Very slow progress is being made toward recognizing the long term health risks of firefighters and more importantly, taking action to mitigate the effects.

This month another bill was introduced that would establish a national cancer registry for firefighters diagnosed with cancer, an occupational hazard that many organizations recognize as a presumptive disease in the profession. The bill is titled Firefighter Cancer Registry Act of 2017. A similar bill with 118 co-sponsors died a quick death in 2016, so there is little hope that this one will fare much better. This newest one has 12 co-sponsors as of today.

On Friday the Washington Post published an in-depth look at the topic in an article titled, Firefighters and cancer: Is a risky job even riskier? The authors interviewed several firefighters who have been diagnosed with cancer and laid out some of the health-related risks of the job.

Here is an excerpt from the article:

In 2015, the Centers for Disease Control and Prevention released the final results of what is currently the largest study of cancer risk among career firefighters ever conducted in the United States. The study of about 30,000 firefighters over a 60-year span showed that compared with the general population, firefighters on average are at higher risk for certain kinds of cancer — mainly oral, digestive, respiratory, genital and urinary cancers.

It is important to provide treatment to firefighters that have been injured on the job, including those suffering from diseases that were likely caused by working in a hazardous environment.

It is also important to take steps to reduce the hazard in the first place. For wildland firefighters who don’t have the luxury of breathing air carried in a bottle on their back, avoiding cancer-causing smoke can be difficult. But in some cases supervisors can minimize the number of firefighters that are forced to work in heavy smoke, or rotate them into areas where there is less. A crew can have a small carbon monoxide detector to identify excessive exposure to the dangerous gas, which on a fire would also be associated with the presence of particulates and carcinogens.

Here is another quote from the Washington Post article:

“Smoke on your gear and smoke on your helmet used to be a sign that you’re an experienced firefighter,” said Lt. Sarah Marchegiani of the Arlington County Fire Department. “But now people just recognize it’s a hazard and not worth it.”

Nevada BLM engine crew
A Nevada BLM engine crew in 2016. Inciweb photo. The faces were blurred by Wildfire Today.

An issue that always creates some controversy on Wildfire Today is the fact that some firefighters feel that refusing to change out of very dirty Nomex even when clean clothes or a laundry service are available proves to their colleagues that they are cool, or experienced, or skilled, or manly. The fact is, the contaminants that accumulate on clothing, personal protective equipment, and line gear are dangerous. Having it in contact with your skin can cause it to be absorbed into the body. If the firefighter’s environment is warm their pores will open which allows chemicals to be absorbed even more quickly. Everybody that is knowledgeable about the issue agrees. Contaminants can even build up to the point where the fire resistance of the fabric is compromised, especially if it includes chainsaw oil or the residue of drip torch fuel.

Firefighter Close Calls reports on injuries and accidents in the fire world and has written about the hazards of contaminated fire gear. Here is an example from earlier this week:

Firefighter Close Calls Tweet

And below is a better photo of the helmet:
Cairns dirty helmet firefighter

The fact that a major manufacturer of personal protective equipment for firefighters uses gear in their advertising that is probably contaminated with carcinogens, is an indicator of the difficulty in solving this health-related problem.

firefighters, cancer,
Screenshot from Jason Curtis’ film about San Diego firefighters and the occurrence of cancer.

Information about the hazards of wood smoke:

Legislation introduced to establish a national firefighter cancer registry

A bipartisan group of 76 Congressional Representatives have signed on as sponsors for legislation that would establish a national cancer registry for firefighters diagnosed with this deadly disease. The bill is titled Firefighter Cancer Registry Act of 2017.

Most firefighters know others in their profession who have suffered from and in some cases died of various forms of cancer.

The British Columbia government recognizes at least nine “presumptive cancers” among firefighters, including leukemia, testicular cancer, lung cancer, brain cancer, bladder cancer, ureter cancer, colorectal cancer, and non-Hodgkins’s lymphoma.

According to Congressmen Bill Pascrell of New Jersey and Chris Collins of New York:

…The creation of this registry would enable researchers to study the relationship between firefighters’ exposure to dangerous fumes and harmful toxins and the increased risk for several major cancers. In the future, this information could also allow for better protective equipment and prevention techniques to be developed.

“Public servants like our firefighters put their lives on the line every day for us,” said Congressman Chris Collins. “Unfortunately, firefighters see a higher rate of cancer than the rest of the public. This legislation will provide the Centers for Disease Control and Prevention (CDC) the tools they need to improve their data collection capabilities on volunteer, paid-on-call, and career firefighters. We hope that by creating a voluntary ‘Firefighter Registry’ that includes the many variables that occur over a firefighter’s career, the CDC will be able to better study this deadly trend. In the future, this information can be used to provide better safeguards and protocols for these brave men and women.”