Establishment of firefighter cancer registry is progressing

Bill GabbertMarch 27, 2019March 28, 2019Uncategorizedcancer registry, firefighter health, smoke & health

The next step is to collect input from firefighters and stakeholders on an approach to the Registry including potential enrollment methods

A firefighter works a blaze in Northern California. Photo courtesy CAL FIRE. — A firefighter works a blaze in Northern California during the fires in Wine Country in 2017. Photo courtesy of CAL FIRE.

(UPDATED at 10 a.m. MDT March 28, 2019)

The Request for Information about the new National Firefighter Registry described below was published today. The National Institute for Occupational Safety and Health (NIOSH), an agency within the Centers for Disease Control and Prevention (CDC), is requesting input about three possible enrollment strategies. Specifically, NIOSH is asking for input on how to maximize participation for the Registry. The comment period will close on May 28th, 2019.

The process for leaving a comment is convoluted. They ask you to click on this link and then you have to search for the appropriate issue. I searched for “National Firefighter Registry” which brought up 208 results. When I checked today it was the first one.

When found, you have to click in the search results on “Comment Now”(over on the right) Maybe THIS will take you directly to the comment form.

Keep in mind that any information (e.g., personal or contact) you provide on the comment form may be publicly disclosed and searchable on the Internet and in a paper docket. But you don’t have to leave your name or email address.

(Originally published at 2:41 p.m. MDT March 27, 2019)

In April, 2017 a bill was introduced in Congress that would establish a registry to track the occurrence of cancer among firefighters. A version of the bill was finally signed into law on July 7, 2018. Now, eight months later it appears that the creation of the registry is some distance from becoming a reality, but we can report some progress.

The legislation called it a Firefighter Cancer Registry, but it appears that the name has changed to National Firefighter Registry — a vague term which does not provide a clue about the purpose.

Kenny Fent is the Team Lead for what will become the National Firefighter Registry Program. Mr. Fent is a Research Industrial Hygienist with the National Institute for Occupational Safety and Health, a division of the Centers for Disease Control and Prevention. He told us that soon the agency will post a Request for Information (RFI) to the Federal Register regarding the Registry. During a 60-day period they will seek input on an approach to the Registry including potential enrollment methods. All stakeholders, including firefighters, will be encouraged to review the document and respond with comments.

Once the Registry design is finalized, CDC/NIOSH will begin enrollment. Where possible, CDC/NIOSH will collect work history and exposure records to explore the relationship between exposures and cancer. They will also link with state cancer registries to confirm diagnoses. Findings will be shared through scientific publications and communications to stakeholders and the public.

Previous studies, including a study completed by the National Institute for Occupational Safety and Health (NIOSH) in 2014, have highlighted firefighters’ increased risk for certain cancers compared to the general population. However, few previous studies have collected data about wildland firefighters, volunteer firefighters, or sufficient numbers of female and minority firefighters in order to draw conclusions regarding their risk of cancer.

In one study that collected 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 by 22 to 39 percent. The project only looked at the wildland fire environment, and was not a long term study of firefighters’ health.

The ultimate goal of the Registry is to better understand the link between workplace exposures and cancer among firefighters. The Registry will include all U.S. firefighters, not just those with a cancer diagnosis. The Registry also has the potential to provide a better understanding of cancer risk among subgroups such as women, minorities, and volunteers, and among sub-specialties of the fire service like instructors, wildland firefighters, and arson investigators.

From the Registry information, CDC/NIOSH will estimate an overall rate of cancer for firefighters. They might find certain groups of firefighters are at a higher risk of cancer than others based on level of exposure, geography, gender, or other factors. They may also find that certain protective measures are associated with a reduced risk for cancer, which could provide additional evidence and support for specific control interventions.

The Registry will be completely voluntary, and no one can force a person to join.

All active and retired as well as volunteer, paid-on-call, and career firefighters will be encouraged to join the Registry, regardless of their current health status.

CDC/NIOSH promises that they will always maintain participants’ privacy and will never share personal information with an outside organization including fire departments, unions, or other researchers without permission of the individual.

Study shows firefighters’ exposure to smoke increases disease risk

Bill GabbertFebruary 6, 2018August 25, 2019Uncategorizedcancer, cancer registry, firefighter health, research, smoke & health14 Comments

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.

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

Bill GabbertOctober 23, 2017October 2, 2019Uncategorizedcancer, cancer registry, firefighter health, presumptive disease2 Comments

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.

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].

The biggest killer of America’s firefighters? Cancer.@tomcostellonbc has a full report tonight on @NBCNightlyNews. pic.twitter.com/TQ2fVzjsAy

— NBC Nightly News (@NBCNightlyNews) October 23, 2017

Two bills introduced in Congress that could affect wildland firefighters

Bill GabbertApril 27, 2017March 25, 2019Uncategorizedcancer registry, legislation2 Comments

Washington DC mall capitol — Washington, DC, December 13, 2015.

I have to admit that I have become a bit cynical about firefighter legislation. We dutifully report when a bill is introduced that specifically affects wildland firefighters, but they almost never progress beyond the committee stage. A person has to wonder why these bills are drafted if they stand so little chance of seeing the light of day. Is it because Congress is so dysfunctional that very few bills get passed at all unless they are absolutely critical to keeping the doors of government open? Or, do politicians simply want to get their name out there hoping voters will remember it the next time they are up for reelection? Maybe this year with both houses and the Presidency controlled by one party more can get done (he thought very optimistically).

Having said that, below we have information about two bills that were introduced in the Senate on April 26. They are both cosponsored by Senators Steve Daines (D-MT) and Maria Cantwell (R-WA). A handful of other Senators have said they intend to sign on as cosponsors.

S.949 – Wildland Firefighter Recognition Act

It would require the Director of the Office of Personnel Management to create a classification that more accurately reflects the role of wildland firefighters in the Departments of Interior and Agriculture. Their official title would become “Wildland Firefighter”. Employees currently employed, many of them with the title “Forestry Technician”, would have the choice of retaining their previous job series or moving to the new Wildland Firefighter series.

In a press release, the two Senators wrote:

Providing wildland firefighters with the proper title will improve recruitment efforts and morale and also give due recognition to those brave individuals who risk their lives to protect others’ and their property.

Text of the bill as of April 26, 2017. Track the progress of the bill.

S.950 – Wildland Firefighter Fairness Act

This bill has a number of provisions, some of which have been proposed before in various forms:

A pilot program would authorize the department Secretaries to allow seasonal employees to work beyond their 1,040-hour per year limit “in a given year if the covered Secretary determines the expansion to be necessary to stage fire crews earlier or later in a year to accommodate longer fire seasons.”
The incident qualification systems of the Departments of Interior and Agriculture would be merged into one, and no agency would be allowed to require additional competencies to become qualified for a position.
It would allow a firefighter who was injured and disabled on the job to retain the 20-year firefighter retirement track if they return to work in a non-fire position, rather than converting to the 30-year retirement program of ordinary federal employees. It would also allow the injured firefighter’s history of overtime pay to be considered as income for purposes of calculating worker’s compensation disability benefits.

In our April 20 interview with Dan Buckley, the National Fire Director for the National Park Service, he talked about the need for extending the terms of seasonal firefighters, the first item listed in the description of the above bill. That topic begins at 11:49 in the video.

Text of the bill as of April 26, 2017. Track the progress.

The legislation will be considered by the Senate Homeland Security and Governmental Affairs Committee. A source in D.C. who is not authorized to speak publically on this subject told me that the plan is to “staple” these two bills to others related to firefighting, such as the Firefighter Cancer Registry Act of 2017 introduced in February (which would include wildland firefighters) and the reauthorization of the Assistance to Firefighters (AFG) and Staffing for Adequate Fire and Emergency Response (SAFER) grant programs. The strategy is that if these (hopefully) non-controversial bills are stapled together they could be passed in the Senate with very little debate and a quick unanimous vote — perhaps two to three months from now.

One hurdle to overcome is the fact that little or no action can occur legislatively until the Administration first says yay or nay. And the politically appointed positions that would review these proposed bills are still vacant.

Now what?

If wildland firefighters have an opinion about this introduced legislation, they should contact their Senators and Representative.

Cancer and the San Diego Fire-Rescue Department

Bill GabbertFebruary 27, 2017August 25, 2019Uncategorizedcancer, cancer registry, firefighter health

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

Bill GabbertFebruary 25, 2017October 2, 2019Uncategorizedcancer, cancer registry, firefighter health, presumptive disease20 Comments

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.”

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:

And below is a better photo of the helmet:

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.