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:

Research on firefighters that is not Open Access should be boycotted

For Throwback Thursday, here’s an article we originally published in 2011:

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Open Access logo
Open Access logo

We all hate paying for something and then not receiving what we paid for. That is what is happening now to taxpayers who pay for government-funded research and then have no access to the findings.

We have ranted about this before, and documented another example a few days ago when we discovered that it will cost us $41 to obtain a copy of the findings from research conducted by the University of Georgia. Associate Professor Luke Naeher and others found that  lung function decreases for firefighters who work on prescribed fires for multiple days and are exposed to smoke. Further, it showed that respiratory functions slowly declined over a 10-week season.

This is not the only research that has explored the effects of smoke on wildland firefighters, but it may significantly add to the limited body of knowledge we have on the topic. We won’t know, however, unless we pay a second time in order to see their conclusions.

Researchers at some organizations receive pay raises and promotions based partially on the “publish or perish” meme. A system that requires researchers to publish in journals that are not completely open to the public, is antiquated and has no place in 2011 when a paper can be published in seconds on the internet at little or no cost.

Some of the research that has been conducted on firefighters requires a great deal of cooperation from the firefighters, including for example, ingesting core temperature monitors, carrying a drinking water system that monitors every drink they take, and even lubricating and then inserting a rectal thermistor probe attached to wires.

The Boycott

There is no reason for firefighters to go to extreme lengths to help researchers advance the researcher’s career paths unless the firefighters can receive some benefits from the project. So, we are jumping on the idea proposed by Rileymon in a comment on the University of Georgia article:

Maybe it’s time to suggest that firefighter/research subjects boycott new research studies unless the findings are put into the Public Domain?

Here is what we are proposing:

  1. Firefighters, administrators, and land managers should not cooperate with researchers unless they can be assured that findings from the research will be available to the public at no charge immediately following the publication of the findings, or very shortly thereafter.
  2. Researchers should conform to the principles of Open Access.
  3. Scientists who assist in the peer review process for conferences or journals should pledge to only do so only if the accepted publications are made available to the public at no charge via the internet.

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UPDATE February 22, 2017: There is a sign that the new Trump administration will be even less transparent than his predecessor. A great deal of data is now unavailable on the White House open data portal. It is possible this is just an unannounced temporary change…. we’ll see.

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More information:

 

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.”

How much sleep do tactical athletes need?

sleep firefighter
Tom Sadowski, El Cariso Hotshots, 1972. Photo by Bill Gabbert.

Charles Palmer, an associate professor at the University of Montana who studies performance psychology of wildland firefighters, has called them “tactical athletes”. Mr. Palmer, who spent 20 years as a firefighter and smokejumper, has said:

These aren’t people who ride around in trucks and squirt water on stuff — this is really demanding from a lot of different angles. You travel around, you have to perform, they’re getting very little downtime, they have nutritional challenges … physically you have to perform really well.

A study of wildland firefighters during suppression activities in Spain found that heart rates ranged from 116 to 133 beats per minute depending on the length of the work. Researchers in Australia measured heart rates of firefighters operating hand tools that were 95 percent of their predicted maximal.

When we read an article at the Monday Morning Quarterback about managing the sleep of professional football players, we could’t help but make the comparison between those athletes and the ones who fight wildfires for a living.

According to the piece by Jennie Vrentas, an increasing number of NFL teams are emphasizing an adequate amount of sleep for their players. Below are some excerpts from the article:

A good night’s sleep is directly tied to key factors such as reaction time, mental alertness, muscular recovery and converting what you’ve recently learned into memory. That’s why the science of slumber has become one of the hottest trends in the NFL: Teams are no longer leaving it to chance that their multimillion dollar investments will manage sleep cycles all on their own.

The Dolphins and Patriots have dark rooms at their practice facilities so players can take naps. Eagles players fill out a morning questionnaire on their tablets, self-reporting how long and how well they slept the previous night.

If you run on four hours of sleep a night for a week, it’s the same as drinking a six-pack and then going to work.

“The average athlete probably needs eight to nine hours of sleep, given their physical demands,” [Washington team physician Anthony] Czeisler says, and even more if you can get it. “I wish I could say there’s a shortcut, but if you are going to be a professional athlete, you need to pay careful attention to sleep.”

A single all-nighter, or a week spent getting just four hours of sleep a night, can make one’s reaction time nearly three times slower.

The article refers to studies completed on football and basketball players, but there has also been research on how sleep affects wildland firefighters. In a study of firefighters in Australia during a four-day simulation of an assignment on a wildland fire, it was found that after two nights of being restricted to four hours of sleep their performance on a hand-eye coordination task declined. However their work output remained about the same even after consecutive nights of restricted sleep.

In a related study in Australia, Grace Vincent, a PhD student at Deakin University reported:

The firefighters report [that while working on actual fires they get] only about four to five hours sleep per night. They have trouble sleeping due to other people snoring in locations such as cabins, tents or the floor of school gyms.  Some are simply so wired after spending the whole day in emergency-mode, that they can’t switch off.

This is consistent with research in the United states, in Technology and Development Publication, Wildland Firefighter Health and Safety Report, Issue Number 13, Summer 2009:

…Sleeping in fire camp can be a challenge. Noise from generators, vehicles, and other firefighters all contribute to sleeplessness. Because almost all wildland firefighters need to sleep either in fire camps or in spike camps, they sleep in tents, on the ground, and in hot, smoky, and dusty conditions. Shift work interferes with sleep, especially for those on night shift.

Sleep log data were collected on members of five incident management teams at fire camps in California and Montana during 2008. [Note from Bill: this data appears to be from overhead team members in fire camp, not “tactical athletes” out in the field.] Data for 140 team members (36 percent female, 64 percent male) indicated that they averaged 6.1 hours of sleep, ranging from 3.5 to 9.0 hours per night. On average, team members went to bed at 9:30 p.m. They reported being awakened an average of 2.2 times per night, awakening from zero to six times per night. When team members were asked to rate the quality of their sleep, the average was 6.6 on a 10-point scale. Nearly one-fourth (23.8 percent) reported feeling tired when they woke, while 53.6 percent felt somewhat rested, 20.2 percent felt rested, and 2.4 percent felt very rested.

Eight hours of rest between work periods is inadequate because only 50 to 75 percent of the rest period is devoted to sleep. Thus it is advisable to have longer rest periods (10 to 14 hours) so workers have time for adequate sleep.

Total sleep deprivation for 1 week has led to cognitive impairment when work requires multitasking. In driving, accidents increase as sleep duration is decreased. In tasks requiring judgment, risky behaviors emerge when sleep is limited to 5 hours per night.

Behavioral alertness and a range of cognitive functions, including sustained attention, and working memory deteriorate when nightly sleep is limited to between 4 and 7 hours. Decisionmaking skills, such as the ability to assess risk, assimilate changing information, and revise strategies to solve problems based on new information are likely to suffer.

Eight hours of rest between work periods is inadequate because only 50 to 75 percent of the rest period is devoted to sleep. Thus it is advisable to have longer rest periods (10 to 14 hours) so workers have time for adequate sleep.

What about naps?

The same publication recommended naps when possible, but the length is important:

Naps restore alertness, enhance performance, and reduce the risk of mistakes. To avoid waking up groggy and exhausted, workers should nap for 20 to 30 minutes OR for longer than 90 minutes. A one-hour nap places you in the middle of deep sleep, making it difficult to wake up. You will be disoriented and clumsy, might make poor decisions, and could be at risk of an injury. A 20-minute nap ends before you descend into deep sleep; a 90-minute nap catches you rising out of deep sleep.

Research links wildfire smoke with cardiac arrest in men

smoke prescribed fire firefighter
A firefighter is enveloped in smoke while working on a prescribed fire in Hot Springs, SD, March 30, 2013. Photo by Bill Gabbert.

Researchers in Australia have found a link between smoke from bushfires and cardiac arrest in men over 35 in the population of metropolitan Melbourne. We would like to see a study done of wildland firefighters who breathe far more smoke than the residents of Melbourne.

Below is an excerpt from Medicalxpress.com:

Men over 35 have an increased risk of cardiac arrest if exposed to poor quality air from bushfires, a new study has found.

Monash University research using data from Ambulance Victoria’s Victorian Ambulance Cardiac Arrest Registry (VACAR) investigated the links between out-of-hospital cardiac arrests and bushfire smoke exposure in metropolitan Melbourne during the 2006-07 bushfire season.

The study, published in the latest edition of Environmental Health Perspectives, found an association between exposure to forest fire smoke and an increase in the rate of out-of-hospital cardiac arrests.

Monash University researchers led by Dr Martine Dennekamp, Department of Epidemiology and Preventive Medicine, saw greater increases in the number of men over 35 years old experiencing cardiac arrests but did not see a significant association in women over 35.

Dr Dennekamp said exposure to smoke from forest fires was a significant health issue in many countries, and it was important to raise community awareness.

“The problem is likely to get worse in the future, as we can expect fires to become both more frequent and more severe,” Dr Dennekamp said.

The state and federal governments not only employ the most wildland firefighters in the United States, but they would also be the ones to fund research like this. One would think they would have a disincentive to discover environmental conditions on the job that adversely affect the health of their employees. Don’t ask the question if you don’t want to know the answer, right? Mitigating the hazard of smoke for firefighters on a wildfire would be extremely difficult. But the least these employers should do is determine exactly the nature and scope of the hazard, and support their employees, and former employees, who suffer from life threatening diseases caused by their jobs.

There have been some papers written and some research has been completed on wildfire smoke, but what is needed is a thorough long term study on wildland firefighters conducted by epidemiologists. Something we first called for in 2010.

A very well known and respected Hotshot Superintendent advised me to frequently complete a CA-1 accident form after breathing lots of smoke on a fire. If you don’t, perhaps 10, 20, or 30 years later it might be hard to convince your employer that one or more of the following conditions were caused by your job: leukemia, testicular cancer, lung cancer, brain cancer, bladder cancer, ureter cancer, colorectal cancer, and non-Hodgkins’s lymphoma. All of those are recognized by the British Columbia government as an occupational hazard for firefighters; they are called presumptive cancers. But the United States government does not.

Other articles on Wildfire Today tagged cancer and firefighter health.

Former firefighter sues fire truck manufacturers for hearing loss

From the New York Post:

A former FDNY firefighter is suing several fire truck manufacturers for $150,000, claiming he’s suffered permanent, “irreversible” hearing loss because the sirens in the engines he rode were too loud.

Curtis O’Steen, who served from 1966 to 1981, said the companies sold trucks and engines that were in “defective condition” and didn’t protect firefighters from the shrill sirens.

“The crew compartments of the vehicles lacked sufficient sound insulation or other noise dampening measures that would lower the intense noise,” according to the recently filed Manhattan Supreme Court lawsuit.

O’Steen, who lives three hours north of New York City in Delaware County, is also suing company Federal Signal whose “Q-Siren” and “e-Q2B” sirens were used on the fire trucks.

UPDATED at 3:45 p.m. MST, March 3, 2015:

After having to remove two comments that violated our guidelines for comments, I feel compelled to add to this post.

I have no idea if the firefighter suffered a degradation in his hearing caused by sirens. Anyone can sue almost anyone for almost anything. And if they choose to use the court system, it does not mean they will win their suit.

However, it is a fact that some sirens produce noise levels that exceed the limits issued by OSHA and the NFPA. Examples of similar issues about sirens are here, here, and here.