Firefighter health and workplace initiatives featured Jan. 26

Finding time and priority for our health is key for firefighters and fire managers. This week, we offer four activities for you to pick and choose or preferably quadruple-up, starting with two online meetings on Jan. 26 that will highlight initiatives to improve firefighter working conditions.

(1) On Thursday Jan. 26, 1 pm EST, Fire Engineering and Vector Solutions will host a webinar with Chief Todd LeDuc (Ret.), Chief Strategy Officer for Life Scan Wellness Centers, and Frank Leeb, Deputy Assistant Chief with FDNY, on “The Impact of Occupational Cancer: How to Reduce Exposure & the Role of Early Detection.”

The announcement notes that “The International Agency for Research on Cancer (IARC) recently updated its classification of the firefighting occupation to Group 1, ‘carcinogenic to humans,’ after conducting a new international study that found sufficient evidence linking cancer risk to the occupation. The danger is real, but there are strategies and resources that can reduce risk, enhance survival, and support firefighters.”

(2) Later on Thursday (and on Pacific Time), the Grassroots Wildland Firefighters offer their quarterly update starting at 5:30 pm PST. Register here or find out more at their home page at This quarter’s updates will likely discuss recent legislation concerning preemptive cancer coverage in the Federal Firefighters Fairness Act and other Grassroots WFF initiatives, as well as the announcement by outgoing president Kelly Martin of the incoming board, which features Luke Mayfield – President, Riva Duncan – Vice President, Bobbie Scopa – Secretary, and Jami Egland – Treasurer. Kudos to Martin’s work with GRWFF and wishing for continued success to the new board.

(3) In related health news, this past week the U.S. Fire Administration announced the pending opening of the National Firefighter Registry.

As the USFA notes, “By adding your information to the National Firefighter Registry (NFR), you can help researchers better understand how your work affects the risk of getting cancer and how to lower this risk. According to National Institute for Occupational Safety and Health (NIOSH) research, cancer is a leading cause of death among firefighters, and research suggests firefighters are at higher risk for certain types of cancers when compared to the general population.”

A direct link to the NIOSH NFR website is at Initially the Registry was anticipated to open this past fall; it’s now scheduled to open this winter for confidential sharing of cancer diagnoses and work histories. As the NFR notes, “The more firefighters who sign up for the registry through its secure web portal, the more information researchers will have to learn about cancer in the fire service and how to protect firefighters from developing cancer in the line of duty.”

(4) Finally, a reminder –- there’s an opportunity to learn more of cancer and PTSD risks while adding a cancer/health donation. See our article Share a few hours for cancer awareness (and help fund our profession’s response) for more – and if you need an extra incentive, remember that the Vector-Solutions sponsored donation deadline is Jan. 31.

Share a few hours for cancer awareness (and help fund our profession’s response)

NFPA1851 training, Vector video. Areas of operation include wildland firefighting.
Screenshot of NFPA 1851 training video by Vector Solutions, focused on areas of operation where carcinogens can impact PPE and increase firefighter exposure.

For the past day or so I’ve been dropping into a cancer awareness training video hosted by Vector Solutions. I was recruited in part by Vector’s pledge to donate to the Firefighter Cancer Support Network for every completed course. About halfway through the two-hour course, guided by NFPA 1851’s “Cancer-Related Risks of Firefighting,” I paused the screen, as I have many times, this time at the list of cancers linked to firefighting … and typed out the systemic locations and types of cancers … genitourinary, kidney, testicular, brain, head and neck, non-Hodgkins lymphoma, thyroid, and — as the narrator notes — “skin cancer, especially in wildland firefighters.”

After that I stopped taking breaks, following the chapters that explored the risks and protective actions we can take against them — all the time noting that while fire is fire, NFPA 1851 is by definition a standard focused on “Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting.” While many in the field are cross-qualified in structure and wildland firefighting, of equal concern — whether we’re responding in turnouts or wildland PPE — is that many key cancer risks are shared across the structural and wildland communities.

For instance, there is the caution in this training against skin exposure. While those in wildland fire are so often cautioned to protect our airways, the skin exposure to airborne carcinogens and char can be significant in wildland firefighting. The training notes the formidable cocktail of chemicals released in structural fire suppression — and though the vectors and hazards are different, take a moment to compare the protective components of turnouts and SCBAs to wildland Nomex and bandanas. And as the training notes, “For every 5 degrees F increase in skin temperature, there is a 400% increase in the absorption capability of our skin.” And exposed skin is a conduit for carcinogens to bioaccumulate in fat cells and lipids.

Skin exposed to carcinogens can lead to bioaccumulation in fat cells. Screenshot: NFPA 1851 Section training.
Skin exposed to carcinogens can lead to bioaccumulation in fat cells. Screenshot: NFPA 1851 Section training.

To explore the connections between cancer and firefighting, Vector Solutions connected us with Chief Todd LeDuc (@ToddJLeDuc), retired from Broward County Fire Rescue, board member for the International Association of Fire Chief’s (IAFC) Safety Health & Survival Section, and editor of “Surviving the Fire Service.” We’ll have more from our conversation with Chief LeDuc in upcoming posts, but what’s key for now is the importance of awareness noted by LeDuc. Firefighters — structural and wildland — face increased cancer risk, and we should prioritize early detection and treatment while integrating immediate risk reduction. Leduc’s core advice for structural and wildland firefighters?”Get the carcinogen off the body as soon as we can.” He shared the concept to “Shower within an hour” after exposure to clean carcinogens from skin exposed to smoke — or more immediately (and more timely and feasible in wildfire work) is to use wet wipes to clean off during a break.

Another shared yet often hidden fire-service carcinogen is diesel exhaust, a Group 1 carcinogen (as is benzene). As the training notes, the state of California states that “diesel exhaust provides the highest cancer risk of any contaminate.” And as the narrator notes, diesel exhaust is “A real threat that is by and largely preventable, but for the cost” — the cost being that of pollution-trapping entrainment systems or finding alternative fuels and procedures for heavy-engines and generators.

And don’t forget to think of the impacts of 24-hour shift work has on our overall health, including an increased risk of cancer.

We will share additional posts during Firefighter Cancer Awareness Month, but in the meantime you might put aside two hours for the training. Complete the test (I passed at 80%) and “$1 will be donated [by Vector Solutions] to the American Cancer Society and Firefighter Cancer Support Network for each completed course.” Complete the PTSD course for another donation — and consider a matching donation to support firefighter safety in 2023.


Firefighter Cancer Awareness Month

January is Firefighter Cancer Awareness Month, and the International Association of Fire Fighters (IAFF) says that cancer is the leading cause of death among firefighters. Annual deaths from various forms of cancer account for more than 74 percent of the line-of-duty deaths added to the IAFF fallen firefighter memorial wall of honor each year.

The National Firefighter Registry program is finalizing its enrollment web portal, a voluntary registry of firefighters that collects occupational, lifestyle, and health information on firefighters to evaluate cancer rates and cancer risk factors in the U.S. fire service. The NFR was created by the Firefighter Cancer Registry Act of 2018 in response to growing evidence of carcinogenic exposures and increased risk for cancer faced by firefighters. The NFR is maintained by the U.S. National Institute for Occupational Safety and Health (NIOSH).

All U.S. firefighters, no matter their length of service, can participate in the Registry, including:

  • Active, former, and retired firefighters
  • Career, paid-on-call, and volunteer firefighters
  • Structural firefighters
  • Wildland firefighters
  • Industrial firefighters
  • Military firefighters
  • Instructors
  • Fire investigators
  • Other fire service members

The Firefighter Cancer Support Network (FCSN) provides public education on the issue of cancer risk for firefighters. For more than 16 years the FCSN has provided support for firefighters and cancer awareness logoEMS members who have been diagnosed with cancer. The website includes information to educate firefighters and raise awareness about why cancer cases are on the rise in the fire service and how to limit day-to-day exposures to carcinogens. Resources are available for firefighters diagnosed with cancer.

Since 2005, the nonprofit FCSN has provided assistance and one-on-one mentoring to thousands of cancer-stricken firefighters and their families. FCSN also delivers extensive firefighter cancer awareness and prevention training nationwide.

NBC News: smokejumper seriously injured on the job, diagnosed with cancer

Ben Elkind and family
Ben Elkind and family

Ben Elkind was seriously injured during a training parachute jump on May 15. During his ninth year as a smokejumper (with six years before that on a hotshot crew) he sustained a dislocated hip and pelvic fracture during a hard landing. During surgery at the hospital they found six fractures and placed three plates and 10 screws to repair the damage.

While Ben is unable to fight fires for an extended length of time, he will not be able to supplement his base income with the usual 1,000 hours of overtime each year which in the past he has depended on to support his wife and two small children.

And then during a full body CT scan a nodule was discovered on his thyroid — meaning, cancer. Ben told Wildfire Today the cancer was caught early and is very treatable.

We have written about Ben previously, but that was before we were aware of the cancer. And the other reason we’re bringing it up now is that yesterday NBC News published a nearly four-minute video story about Ben and other similar examples of injured wildland firefighters.

For more than the last year Ben has been very involved working to improve the working conditions of federal wildland firefighters, being proactive in educating the public and other firefighters about what they can do to improve the pay, classification, health, well-being, and processing of worker’s compensation claims (see photo below). In 2021 he wrote an article that was published in The Oregonian and Wildfire Today. And now he finds himself as one of the examples of what can happen on the job to a wildland firefighter that can seriously affect them and their family.

NFFE meets with Secretary of Labor
NFFE meets with Secretary of Labor in Washington, DC, March 16, 2022. L to R: Max Alonzo  (NFFE), Bob Beckley (NFFE), Hannah Coolidge (USFS Hotshot), Marty Walsh (Sec. Of Labor), Dane Ostler (USFS – Prevention), Ben Elkind (USFS – Smokejumper), Randy Erwin (NFFE – President), and Jeff Friday (NFFE).

There has been some progress during the last year in establishing a list of presumptive diseases for firefighters.

Pending 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. The bipartisan Federal Firefighters Fairness Act, H.R. 2499, passed the House in May and is now in the Senate.

In April 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.

Consider telling your Senators and Representative to pass the Tim Hart Wildland Firefighter Classification and Pay Parity Act, H.R.5631. The name of the bill honors smokejumper Tim Hart who died after being injured on a fire in New Mexico in 2021. (More about the bill.) And ask your Senators to pass the Federal Firefighters Fairness Act, H.R. 2499.

You may want to make a donation to the gofundme account set up by the Redmond Smokejumper Welfare Organization to assist Ben and his family.

Firefighting classified as carcinogenic to humans

We asked scientists how the findings apply to wildland firefighters

crew from Minnesota
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.

Respirator being developed for wildland firefighters

Wildland fire respirator
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.

Wildland fire respirator
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.

Thanks and a tip of the hat go out to Bob.