Study shows firefighters’ exposure to smoke increases disease risk

Depending on the type of work performed and the number of years of exposure, the increased risk can be 22 to 39 percent.

Above: Smoky conditions on the Legion Lake Fire in Custer State Park in South Dakota, December 12, 2017. Photo by Bill Gabbert.

Originally published at 6:02 p.m. MT, February 6, 2018.

After collecting data from wildland firefighters in the field, a group of researchers concluded that firefighters’ exposure to smoke can increase the risk of mortality from lung cancer, ischemic heart disease, and cardiovascular disease. In this first section we cover what is in vegetation fire smoke, and after that we have details about the additional mortality risk faced by firefighters who can’t help but breathe the toxic substances.

What is in the air that firefighters breathe?

There have been many studies about smoke dating back to the 1988 NIOSH project at the fires in Yellowstone National Park. Most of them confirmed that yes, wildland firefighters ARE exposed to smoke and in most cases they quantified the amount.

In 2004 Timothy E. Reinhardt and Roger D. Ottmar  found a witches’ brew of methyl ethyl bad stuff that firefighters are breathing. All of these are hazardous to your health:

  • Aldehydes (volatile organic compounds); can cause immediate irritation of the eyes, nose, and throat, and inhalation can cause inflammation of the lungs. Short-term effects include cough, shortness of breath, and chest pain. The most abundant aldehyde in smoke is formaldehyde. When formaldehyde enters the body, it is converted to formic acid, which also is toxic.
  • Sulfur dioxide (SO²); causes severe irritation of the eyes, skin, upper respiratory tract, and mucous membranes, and also can cause bronchoconstriction. It forms sulfuric acid in the presence of water vapor and has been shown to damage the airways of humans.
  • Carbon monoxide (CO); As CO is inhaled it displaces O2 as it attaches to red blood cells and forms COHb. COHb reduces the ability of the blood to carry oxygen and causes hypoxia (a condition in which the body does not receive sufficient oxygen). Due to their strenuous work, wildland firefighters often have increased respiratory rates, which will increase the amount of CO being inhaled when smoke is present. COHb has a half-life (the time it takes half of the COHb to dissipate from the body) of about 5 hours. Symptoms of CO exposure include headaches, dizziness, nausea, loss of mental acuity, and fatigue. Prolonged, high exposure can cause confusion and loss of consciousness
  • Particulate matter; Respirable particulates are a major concern as they can be inhaled into the deeper recesses of the lungs, the alveolar region. These particles carry absorbed and condensed toxicants into the lungs
  • Acrolein; may increase the possibility of respiratory infections. It can cause irritation of the nose, throat, and lungs. Long-term effects can include chronic respiratory irritation and permanent loss of lung function if exposure occurs over many years.
  • Benzene; can cause headaches, dizziness, nausea, confusion, and respiratory tract irritation. Although the human body can often recover and repair damage caused by irritants, prolonged exposure from extended work shifts and poorly ventilated fire camps can overwhelm the ability to repair damage to genes and deoxyribonucleic acid (DNA).
  • Crystalline silica; can cause silicosis, a noncancerous lung disease that affects lung function. But OSHA classifies it as a carcinogen.
  • Intermediate chemicals; have been shown to cause a variety of health problems including bronchopulmonary carcinogenesis, fibrogenesis, pulmonary injury, respiratory distress, chronic obstructive pulmonary disease (COPD), and inflammation.

One of the more recent research efforts, from 2009 to 2012, was led by George Broyles of the U.S. Forest Service, National Technology and Development Program, in Boise, Idaho. They collected data in 11 fuel models in 17 states on initial attack, prescribed burns, and large project fires. The group measured carbon monoxide (CO) with electronic datalogging dosimeters and particulate matter using air pumps and filters.

carbon monoxide exposure firefighters
Data from the 2009-2012 wildland firefighter study led by George Broyles. “TWA” stands for Time Weighted Average. CO is carbon monoxide. OEL is Occupational Exposure Limits.

Monitoring carbon monoxide (CO) can be important, and is also fairly easy to do and not terribly expensive. Researchers have found that it can be a surrogate for the primary irritants of concern in wildland smoke near the combustion source. If CO is present, it’s almost certain that the smorgasbord of nasty stuff is in the air.

wildfire smoke monitoring firefighters
Jon Richert displays the various devices the National Technology Development Center research crews use to measure the amount of smoke firefighters deal with during wildfire suppression. This equipment was used in 2016 in a different but similar study than the one described in this article.
Diffusion tube
Diffusion tube.

Electronic CO monitors are available for $100 to $300. Another option is the little disposable CO monitors called diffusion tubes. With the holder they are about the size of a dry erase marker. Many are made by Drager, and for eight hours can record the cumulative CO. You can’t get an instantaneous reading, but the total hourly exposure can be monitored. They cost about $13 each. If one or two people on the crew carry them it can provide a heads up if the air quality is really bad.

What are the health effects of smoke exposure on a wildland fire?

Employers in most if not all workplaces are required to minimize hazards and provide a safe working environment. But of course it is impossible to totally eliminate all risks to firefighters. A cynic might assume that leadership in the wildland fire community may be hesitant to ask the question if they don’t want to hear the answer.

In spite of numerous studies confirming that yes, there is smoke where wildland firefighters work, there has been little in the literature that quantifies the effects on a person’s health. A new study published in August, 2017 contains a preliminary analysis addressing that question.

It is titled Wildland Fire Smoke Health Effects on Wildland Firefighters and the Public – Final Report to the Joint Fire Science Program. The authors are Joe Domitrovich, George Broyles, Roger D. Ottmar, Timothy E. Reinhardt, Luke P. Naeher, Michael T. Kleinman, Kathleen M. Navarro, Christopher E. Mackay, and Olorunfemi Adetona.

They used the field data collected in the 2009 to 2012 George Broyles study to extrapolate the physical and health effects on humans. The authors actually came up with numbers that indicate firefighters’ relative mortality risk for lung cancer, ischemic heart disease, and cardiovascular disease.
Continue reading “Study shows firefighters’ exposure to smoke increases disease risk”

NBC News: cancer among firefighters

Above: Firefighter working on a smoky wildfire at Buffalo Gap, South Dakota, March 3, 2016.

(Originally published at 10 p.m. MDT October 23, 2017)

This report by NBC News about the rising rates of cancer among firefighters exclusively shows the structural side of the job. Obviously they are exposed to different toxins than their wildland brothers, so it is unknown how much the data crosses over. One of the big differences between the two disciplines is that for structure and vehicle fires a breathing apparatus (BA) is always available. Firefighters on wildland fires NEVER have access to BAs, which only last for minutes, while they can be exposed to smoke for most of their shifts which on large fires are typically up to 16 hours. And wildland firefighters rarely have the opportunity to, as the video recommends, change clothes and shower within an hour after exposure.

In 2010 we began calling for the wildland fire agencies to conduct a study led by medical doctors and epidemiologists to evaluate the short and long term effects of smoke on firefighters. The federal agencies that should take the lead on this are the National Park Service, Bureau of Land Management, Bureau of Indian Affairs, Fish and Wildlife Service, and the Forest Service. State agencies with significant numbers of wildland firefighters need to also be involved.

It is possible that the agencies that employ firefighters do not want to expose the facts about the dangers of smoke. It could cost them money to change their practices, provide a safer workplace, and cover the costs of presumptive illnesses.

Various bills have been introduced in Congress that would establish a cancer registry for firefighters, but to our knowledge none have passed.

Here is an excerpt from an article we wrote March 17, 2017:


“On Wednesday [March 15, 2017] 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.

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.” [Update October 23, 2017: for example in an African country, Niger, many Americans have never heard of].


Government of Victoria proposes shakeup of fire services

The Country Fire Authority would become totally volunteer.

Daniel Andrews, the Premier of the Australian state of Victoria, is proposing a major overhaul of the fire services organizations. If legislation to enact the changes is passed, the Country Fire Authority (CFA) will become a volunteer-only agency when its paid employees merge with what has been the Metropolitan Fire Brigade (MFB) to morph into the newly-created Fire Rescue Victoria.

The Premier said, “These challenges have been made clear through a number of reviews in recent years, including the 2009 Victorian Bushfires Royal Commission.”

The MFB provides firefighting, rescue, medical, and hazardous material incident response services to the metropolitan area of Melbourne. The CFA, which provides firefighting and emergency services to rural areas of Victoria, has been mostly volunteer, with about 35,000 volunteers and over 1,000 paid professionals.

The Premier intends to sweeten the deal by promising more than $100 million to support volunteer brigades with additional training, equipment and facilities.

In addition (and this is big) the government intends to recognize presumptive cancers that are diagnosed among volunteers.

Below is an excerpt from a summary of the proposed fire services reorganization:

This recognises the challenges that firefighters have faced in accessing compensation for cancer arising from their service. The scheme will deliver equal access to compensation for career and volunteer firefighters.

It will apply to firefighters who have developed cancer because of their service and have been diagnosed since 1 June 2016. Rules that require volunteer firefighters to have attended a specific number of fires are problematic, so the scheme will instead mirror the approach taken in Queensland, which has no specific incident requirements.

Skeptics think one of the reasons for the major revamping of the agencies is the hope that it “will end a controversial dispute with the United Firefighters Union, which has fought bitterly with the government, the CFA, the MFB and volunteers over new pay deals”, according to an article at 9news.com.au.

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.
Typos or errors, report them HERE.

Editorial: Montana legislature fails to pass firefighter health bill

The following editorial was written by Dick Mangan.

****

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.

****

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.