Firefighter on the Cerro Paledo Fire in New Mexico, May, 2022 by Blake McHugh.
Last week President Biden signed H.R. 6943, the Public Safety Officer Support Act, into law. The legislation expands death and disability benefits under the Public Safety Officers’ Benefits (PSOB) program to include first responders who die by suicide or are disabled by traumatic experiences.
The new law will:
Allow public safety officers to seek disability benefits for PTSD linked to severe trauma by directing the PSOB to designate work-related PTSD and acute stress disorders as a line of duty injury for eligible officers as well as those who are permanently disabled as a result of attempted suicide; and
Allow families of public safety officers who die by trauma-linked suicide to apply for death benefits by directing the PSOB to presume that suicides are a result of job duties in certain traumatic circumstances where there is evidence that PTSD or acute stress disorder would be the cause of the injury.
The bill states that first responders or their survivors may qualify for benefits if their suicide or post-traumatic stress disorder was related to being exposed to “a harrowing circumstance posing an extraordinary and significant danger or threat to the life of or of serious bodily harm to any individual.” There are other requirements and details which are in the copy of the five-page bill below:
We asked scientists how the findings apply to wildland firefighters
A crew from Minnesota mopping up on the King Fire east of Placerville, California in 2014. Incident Management Team photo.
The International Agency for Research on Cancer (IARC), the cancer agency of the World Health Organization (WHO), has evaluated the carcinogenicity of occupational exposure as a firefighter.
A Working Group of 25 international experts, including 3 Invited Specialists from 8 countries was convened by the IARC Monographs program for a meeting in Lyon, France.
After thoroughly reviewing the available scientific literature, sufficient evidence led the Working Group to classify occupational exposure as a firefighter as carcinogenic to humans.
A summary of the final evaluations has now been published. The detailed assessment will be published in The Lancet Oncology in 2023 as Volume 132 of the IARC Monographs.
Evidence for cancer in humans
The study found that occupational exposure as a firefighter causes cancer. There was sufficient evidence for cancer in humans for mesothelioma and bladder cancer.
There was limited evidence for cancer in humans for the following cancer types: colon cancer, prostate cancer, testicular cancer, melanoma of the skin, and non-Hodgkin lymphoma.
Strong mechanistic evidence
The evaluation of the mechanistic evidence was based on exposures associated with fighting structure and wildland fires. There was strong mechanistic evidence in exposed humans that occupational exposure as a firefighter exhibits 5 of the 10 key characteristics of carcinogens: “is genotoxic”, “induces epigenetic alterations”, “induces oxidative stress”, “induces chronic inflammation”, and “modulates receptor-mediated effects”.
Exposure of firefighters
Firefighters are exposed to a complex mixture of combustion products from fires (e.g. polycyclic aromatic hydrocarbons, volatile organic compounds, metals, and particulates), diesel exhaust, building materials (e.g. asbestos), and other hazards (e.g. heat stress, shift work, and ultraviolet and other radiation). In addition, the use of flame retardants in textiles and of persistent organic pollutants (e.g. per- and polyfluorinated substances) in firefighting foams has increased over time.
This mixture may include many agents already classified by the IARC Monographs program in Group 1 (carcinogenic to humans), Group 2A (probably carcinogenic to humans), and Group 2B (possibly carcinogenic to humans). Dermal exposure, inhalation, and ingestion are common routes of exposure, and biomarker studies among firefighters have found enhanced levels of markers of exposure to polycyclic aromatic hydrocarbons, flame retardants, and persistent organic pollutants.
Most studies of firefighter health evaluate structural firefighters. We asked Dr. Kenny Fent and Dr. Kathleen Navarro of the National Institute for Occupational Safety and Health (NIOSH) questions about how these findings apply to wildland firefighters. Here is their joint response:
Summary of IARC Evaluation for Wildland Firefighters
The IARC evaluation of Occupational Exposure as a Firefighter included a review of the available scientific literature on occupational exposures, cancer epidemiology and the key characteristics of carcinogens. The evaluation did not differentiate between structural and wildland firefighters in making the determination of carcinogenicity. This is because the working group was not able to differentiate structure fire exposures (and other exposures) from wildfire exposures for firefighters in at least some of the cancer cohort studies that were included the evaluation.
In addition, many of the studies that provided the evidence of carcinogenicity included the evaluation of the key characteristics of carcinogens (intermediate health outcomes on the pathway to cancer). These included studies of wildland firefighters working on wildfires and prescribed fires.
Lastly, the exposure studies reviewed supported that both structural and wildland firefighters were exposed to similar types of carcinogens. As a result, the definition of “occupational exposure as a firefighter” for the IARC evaluation was kept broad and included a variety of hazards resulting from fires (e.g., structure, wildland, and vehicle fires) and other events (e.g., vehicle accidents, medical incidents, hazardous material releases, and building collapses).
Is mesothelioma only caused by exposure to asbestos, and are wildland firefighters generally exposed to it?
Yes, mesothelioma is caused by exposure to asbestos. Asbestos exposure is generally rare among wildland firefighters, with the exception for wildland firefighters who commonly encounter built environments (especially buildings constructed before the 1970s), areas with contamination (e.g., Libby, MT) or naturally occurring asbestos. A past NIOSH Health Hazard Evaluation reported that exposure to total asbestos fibers in air were less than the lowest occupational exposure limits while conducting a prescribed burn. However, the highest concentrations measured were during tasks with greater plant and soil disturbance and where water was not used (e.g., fire line construction and dry mop-up).
Dr. Kenny Fent leads the National Firefighter Registry at NIOSH and was the chair of the exposure characterization subgroup for the IARC working group.
Dr. Kathleen Navarro leads the Wildland Firefighter Safety and Health program at NIOSH and was a Representative of a national health agency for the IARC evaluation.
Development of a wildland fire respirator. Two versions are being tested, with the filter being carried on the chest hip. Department of Homeland Security photo.
A working group for the International Agency for Research on Cancer, the cancer agency of the World Health Organization, has just “classified occupational exposure as a firefighter as carcinogenic to humans.” Part of the reason is the toxic gasses firefighters are exposed to.
Wildland firefighters working on a vegetation fire can’t wear the conventional self contained breathing apparatus used by structural firefighters. It is too bulky, heavy, and only lasts 10 to 30 minutes.
In an effort to provide less carcinogenic air to wildland firefighters, the Department of Homeland Security’s Science and Technology Directorate is developing a respirator capable of removing airborne hazards present in the wildland firefighting operating environment. They are working with the International Association of Firefighters, National Fire Protection Association, International Association of Fire Chiefs, U.S. Forest Service, and local Colorado fire departments to develop and test the Directorate’s Wildland Firefighter Respirator (WFR). It contains a HEPA filter module that will remove very fine particulates, and a carbon sorbent to remove toxic gases. The team is investigating wildland firefighter-approved designs like the Radio Carrier and Hip-Mounted units shown in the photo below.
Development of a wildland fire respirator. Two versions are being tested, with the filter being carried on the chest hip. Department of Homeland Security photo.
The WFR was designed around a lightweight mask covering just the mouth and nose. It relies on filtration, designed to go a whole shift before needing to be changed.
“Our system pushes clean air to firefighters using a powered blower with HEPA and carbon filters,” said S&T Program Manager Kimberli Jones-Holt. The system connects to the half-mask through a lightweight, flexible breathing hose to provide clean air and draws in air from the bottom of the unit to prevent rain or water infiltration.
“The filters were also designed to be inexpensive and easily replaced at $5 to $10 each,” Jones-Holt continued.
It uses an electric blower to force filtered air to the mask, relying on AA batteries for power.
The DHS says if wildland firefighters use respiratory protection, their careers could be significantly extended, leading to a more educated and experienced workforce capable of more efficient operations, with lower medical bills and training costs.
Creates the presumption that federal firefighters who become disabled by certain serious diseases contracted them on the job
Firefighter on the Cerro Pelado Fire in New Mexico, May, 2022. IMT photo.
Today the House of Representatives voted 288-131 to approve and advance the Federal Firefighters Fairness Act, H.R. 2499, a bipartisan measure authored by Rep. Salud Carbajal (D-CA) that ensures federal firefighters receive the same access to job-related disability and retirement benefits as state, county, and municipal firefighters.
The legislation would create the presumption that firefighters who become disabled by certain serious diseases contracted them on the job, including heart disease, lung disease, certain cancers, and other infectious diseases.
Federal firefighters do not have signed legislation establishing the presumption that local firefighters have in 49 out of 50 U.S. states– and are forced to identify specific exposures that may have caused their illness. This burden of proof makes it extraordinarily difficult for federal firefighters to qualify for workers comp and disability benefits related to their work.
The measure would improve benefits for more than 20,000 federal firefighters across the U.S., with about 16,000 of them being wildland firefighters. It would apply to “personnel who have been employed for a minimum of 5 years in aggregate as an employee in fire protection activities.”
The diseases covered under the legislation, if passed by the Senate and signed by the President, are:
Bladder cancer, brain cancer, chronic obstructive pulmonary disease, colorectal cancer, esophageal cancer, kidney cancer, leukemias, lung cancer, mesothelioma, multiple myeloma, Non-Hodgkin lymphoma, prostate cancer, skin cancer (melanoma), testicular cancer, thyroid cancer, and a sudden cardiac event or stroke while, or not later than 24 hours after engaging in certain fire-related activities described in the bill.
It was just three weeks ago, on April 19, when the Office of Workers’ Compensation Programs (OWCP), in FECA Bulletin No. 22-07, established a list of cancers and medical conditions for which the firefighter does not have to submit proof that their disease was caused by an on the job injury.
The medical conditions covered under the OWCP bulletin as of last month are:
Hypertension, coronary artery disease, chronic obstructive pulmonary disease, pulmonary fibrosis, asthma, or a sudden cardiac event or stroke.
The OWCP list includes six conditions that are not in H.R. 2499: buccal cavity/pharynx cancer, larynx cancer, hypertension, coronary artery disease, pulmonary fibrosis, and asthma.
H.R. 2499 covers one disease not in the OWCP list, skin cancer, an important addition, especially for wildland firefighters whose work requires being outside most of the time. The bill includes a method for adding other diseases within a three-year period, including breast cancer, if supported by scientific evidence.
The pending legislation had 203 co-sponsors in the House, an extraordinarily large number of representatives who stated early-on that they were in favor of the bill and wanted to help get it passed.
The next step is the Senate, a place where many bills go to die. Senators Tom Carper (D-DE) and Susan Collins (R-ME) are the lead sponsors of a bipartisan companion bill there. It has 12 co-sponsors, only two of which are Republicans. With a 50-50 Dem/Rep balance and a requirement for 60 of the 100 Senators to vote yes, the passage is not a foregone conclusion, in spite of overwhelming approval in the House.
“We know fire fighters are routinely exposed to carcinogens on fire scenes. Sadly, our brothers and sisters in federal service are too often denied the benefits they deserve when needed the most,” said International Association of Fire Fighters (IAFF) General President Edward Kelly. “The Federal Firefighter Fairness Act brings the federal government in line with the 49 states that recognize the deadly link between firefighting and cancer.”
The National Firefighter Registry (NFR) that is supposed to collect data on a voluntary basis to better understand the link between workplace exposures, cancer, and other chronic diseases among firefighters, hopes to begin testing the enrollment system “in the coming months,” according to an update from the leader of the Registry, Kenny Fent.
That is the gist of the message sent by Mr. Fent today, with no other significant details about the registry itself. But he announced three additions to the NFR Subcommittee, one of which is Tom Harbour, the former Director of Fire and Aviation for the US Forest Service. Three members of the Subcommittee are stepping down, including Chuck Bushey who also has a wildland fire background. Mr. Fent said the purpose of the Subcommittee is to “provide independent advice and guidance.”
Almost four years ago the Firefighter Cancer Registry Act of 2018 which passed July 7, 2018required that the National Institute for Occupational Safety and Health (NIOSH), an agency within the Centers for Disease Control and Prevention (CDC), establish a Firefighter Cancer Registry. Firefighters on the ground have yet to see any concrete examples of the effort, other than changing the name to just “National Firefighter Registry.”
Last year Congress made another attempt to get the registry started by adding a provision into the Tim Hart Wildland Firefighter Classification and Pay Parity Act, legislation which would also accomplish several things to improve the pay and working conditions of federal wildland firefighters. (We covered that legislation in another article.) But the Tim Hart Act has not made it out of committee since it was introduced in the House October 19.
Our take
The National Firefighter Registry has the potential to develop data that documents the health effects of fighting fire. Personnel considering it as a profession could make a better-informed decision in their career choice. And those tactical athletes who have been breathing smoke while working in one of the most physically demanding professions, could have facts to back up claims for treatment of conditions likely caused by the job. Congress and the Office of Worker’s Compensation Programs (OWCP) could better establish presumptive disease policies so that firefighters would not have to attempt to prove that certain cancers or their damaged lungs, knees, or back, were a result of their employment with the government.
Congress must exercise their oversight responsibility and hold hearings if necessary to strongly encourage Kenny Fent, the leader of the FR, to make every effort possible to establish the registry sooner rather than later.
It’s been almost four years.
Firefighters are biased toward action. They know how to get stuff done. Let’s get the NFR done.
When Sophia Huston started working as a hotshot — a specialized wildland firefighter with advanced technical training — she was 19 and didn’t know what she was getting herself into. She was physically fit and worked out regularly, but she wasn’t ready for preseason training, when the U.S. Forest Service, the agency she worked for, weeds out the unprepared with intense and physically demanding drills. “You’re going on hikes with full gear and chainsaws,” she said. “I weigh about 115 pounds and I’m carrying about upwards of 80 pounds of gear up a hill. I’m feeling the stress on my body and joints. I’m waking up in the middle of the night to eat food because I can’t get enough calories in.”
Shortly after the training began, Huston got what would be her last menstrual cycle of the fire season. She’s been working in fire for six years now and hasn’t gotten her period for the past three years, which she speculates is due to lack of sleep, poor quality of food, and the physical strain of the job. She doesn’t know what the long-term repercussions of working in the fire service are on her health and fertility. “I just know it’s not good for you,” she said. “It’s not very conducive to fertility and reproductive health.” New research suggests that Huston’s hunch is spot-on.
Smoke, heat, fire-suppressing chemicals, and the physical exertion required to put out and control fires all have effects on humans, but the body of published research on how firefighting affects health is astonishingly small. Studies have shown that being exposed to smoke in general is linked to lung cancer and cardiovascular disease. But little is known about the cumulative impacts of fighting fires year after year, whether soot and other compounds can get absorbed through the skin and cause health problems, and how, exactly, smoke impacts the body in the long-term.
The ways in which fighting fire, and fire itself, affect women are even less understood. Women make up a tiny fraction of the national fire service, both in structural fire departments — the local departments that put out house fires — and the wildland crews that fight fires that occur in the wilderness and areas where wildland meets urban zones. They operate in a system that was built for and around men. And despite evidence that even short-term smoke exposure can affect pregnancy outcomes, female firefighters receive little to no information from their employers on how fire could impact fertility or pregnancy. “Nobody says, ‘smoke is bad, don’t stand there,’” Megan Saylors, a career wildland firefighter for a federal agency, told Grist. “It’s just such an accepted part of our work environment.”
A recent study published in the journal Environmental Health builds on the slim body of research on how work in the fire service specifically affects the reproductive health of women, and trans and nonbinary people who can get pregnant. By analyzing nearly 2,000 pregnancies in more than 1,000 female firefighters, the study found that self-reported miscarriage was 2.3 times more common among female firefighters than it was among female nurses, a cohort that is exposed to similar chemicals and work strains. Twenty-two percent of female firefighters miscarried, compared to 10 percent of female nurses.
The study found that, overall, volunteer firefighters had increased risk of miscarriage compared to career firefighters. And volunteer wildland firefighters had nearly three times the risk of miscarriage compared to career wildland firefighters. Less than 5 percent of career firefighters are women, and 84 percent of the female firefighters in the U.S. are volunteers, which means a disproportionate percentage of the women who fight fires in the U.S. may be at increased risk of miscarriage.
Alesia Jung, a postdoctoral student at the University of Arizona and the lead author of the study, told Grist that she was surprised by the results of her research. She had initially hypothesized that career firefighters would present with the highest risk of miscarriage, because those women are exposed to fires more often than volunteers. “Generally the assumption is that career firefighters who generally respond to more fires in a year would have greater occupational exposures than volunteer firefighters who typically serve smaller communities and may have a smaller amount of fire responses,” she said. “So it was really interesting to see that volunteer firefighters appeared to have a greater risk of miscarriage, and this did vary by wildland firefighter status.”
Jung said that more research needs to be done on why firefighters face such high rates of miscarriage and what can be done to better protect them. Current and former firefighters agree.
Saylors, who has worked on crews based in Alaska, southern Nevada, southern Utah, California, and Oregon, says she’s never worked for a department that had policies or advisories in place to inform women about the risks of the job to their pregnancies. “I know women who were still working on a fire engine doing wildland stuff eight months pregnant. But then you have other people who, as soon as they find out they’re pregnant, they stop doing operational stuff,” she said. “Structural departments and wildland agencies struggle with, what do we do with those women? When do we no longer go put out the fire? When do we no longer go help with a prescribed fire during pregnancy?” Saylors said federal firefighting agencies should collect and conduct research on fertility and put policies in place to protect employees based on that research.
Zora Thomas, a seasonal wildand firefighter working for the Forest Service, told Grist she wasn’t surprised that wildland firefighters face an increased risk of miscarriage due to the requirements of the job. “Exposure to smoke is so ubiquitous and unavoidable, and wearing a respirator really isn’t practical or even possible due to the intensity and duration of our working days,” she said. “It doesn’t surprise me that the obvious occupational hazards we face would have some impact on health and pregnancy, and I would expect that there are also impacts to male reproductive health.”
There’s some evidence that the fertility of male firefighters is also jeopardized by smoke and other hazards of the job. A 2019 study of Danish male firefighters found full-time firefighters were at greater risk of infertility than a comparison group of men in the military. Another study published in October that tracked male fertility in the general population following 10 days of unprecedented hazardous smoke in Oregon during the 2020 fire season found that semen quality greatly deteriorated following the onset of hazardous air quality. “Among male firefighters, reproductive issues are also a topic of concern,” Jung said. She hopes that future studies will help isolate the factors behind firefighters’ fertility problems and shift the status quo so women, and men, are better protected on the job.
Huston isn’t waiting around for the Forest Service to figure out how to better protect women. In December, she finished her sixth season as a hotshot in California. It’ll be her last. “I’m sad to leave but at the same time, I realized this year that I really care about my health, it’s one of my core values and almost everything we do seems to compromise my health,” she said. “Firefighting is a part of my life that I’m very thankful for, but I’m ready to get out.”
