Cancer and the San Diego Fire-Rescue Department

firefighters, cancer,

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

firefighters smoke cancer cold brook prescribed fire

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:

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. (UPDATE March 25, 2019. A version of the legislation was signed into law. The Centers for Disease Control has more information. We expect to write more about this later, in articles tagged “cancer registry“.)

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.”

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.

Study finds firefighters more likely to get two types of cancer

According to a recently published study, firefighters in three major municipal fire departments were more likely to be diagnosed with lung cancer and leukemia than the general population.

Researchers examined the firefighting exposure and medical histories of 20,000 firefighters with over 1,300 cancer-related deaths and 2,600 cancer incidence cases in Chicago, Philadelphia, and San Francisco who were on duty between the years 1950 and 2009. This was one of the largest studies of its kind, and was the first to relate the time elapsed during fire runs to cancer risk.

Among eight types of cancers examined, they found slight, but statistically significant positive exposure–responses for lung cancer and leukemia risk. The researchers wrote:

These findings contribute to the evidence of a causal association between firefighting exposures and cancer.

The study did not address the health effects on wildland firefighters who, unlike structural firefighters, do not have access to an effective breathing apparatus to provide them clean air to inhale into their lungs. There could also be significant differences between the harmful effects of vegetation smoke and that produced by materials in structure fires.

Some wildland firefighters, especially those on hand crews, are routinely exposed to smoke-filled air for hours each day when assigned to a large fire, sometimes for 14 days. At other times they can be stationed in a smoky environment 24 hours a day for weeks at a time when inversions trap smoke. This frequently occurs in northwestern California, for example on the Six Rivers, Klamath, and Shasta-Trinity National Forests. In those cases even non-firefighters working in administrative positions at the Incident Base have been adversely affected by breathing contaminated air.

As we wrote in January, 2011:

There needs to be a concerted effort to conduct a similar study on wildland firefighters. It should be led by a physician/epidemiologist and should evaluate the long term health and occurrence of cancer and other diseases among wildland firefighters. There is a lot of grant money out there and it should be possible to get some of it pointed towards this overlooked niche of firefighting.

Other articles on Wildfire Today tagged cancer and firefighter health.

9/11 health care bill does not cover firefighters’ cancer

Remember the huge battles to get the bill passed to provide health care for the firefighters that were suffering from medical issues after working in the debris from the towers that fell during the 9/11 attacks? Most of us felt a huge relief when the “S. 1334: James Zadroga 9/11 Health and Compensation Act of 2009“ was finally passed. We wrote about it several times, with the latest being HERE.

It turns out that the bill, or at least the way the provisions are being interpreted, does not cover the treatment of cancer for the firefighters that worked on the debris pile. Cancer — you would think this would be close to the number one condition covered for the people that worked in that toxic environment.

John Howard, the World Trade Center Health Program administrator, said in a statement that cancer would not be covered because there is not adequate “published scientific and medical findings” that a causal link exists between September 11 exposures and the occurrence of cancer in responders and survivors. So if we wait, and study the link for another, what, 20 or 30 years we can prove it then?

This is a disgrace.

Jon Stewart of the Daily Show, in a piece named “I Thought We Already Took Care of This S@#t”, expresses his opinion on the issue. The clip has profanity, but it is bleeped out.

NorthJersey.com has more details about this development.

Meanwhile, the Canadian government has a vastly different approach. For years the provinces of Alberta and Manitoba have had presumptive coverage for a list of conditions for firefighters. If they are diagnosed with one of the cancers on the list, it is considered an occupational disease and they may be eligible for workers compensation benefits. In fact, Alberta expanded their list in May to include prostate, breast, skin and multiple myeloma, bringing the total to 14 types covered under the Workers Compensation Board. Their government acknowledges that firefighters are at a greater risk of contracting cancer than the general public, and it can be difficult or impossible to prove that a particular case of cancer was caused by a specific incident or exposure, on or off the job.

The future of wildland fire smoke research

JFSP smoke research planThe Joint Fire Science Program (JFSP) has released their plan for wildland fire smoke research. The 58-page document outlines their priorities for funding smoke research through 2015.

Much of the emphasis appears to be directed at how to deal with the public’s perception and tolerance of smoke. Smoke is becoming an increasingly sensitive subject to the population due to larger wildfires burning for longer periods of time, concern about the effects of wildfire smoke on global warming, and prescribed fires continuing to be an important tool for land managers.

One aspect of wildfire smoke that Wildfire Today has written about frequently is the short and long term effects of smoke on the health of firefighters. On April 23, 2010 we covered the study that NIOSH and the U.S. Fire Administration are conducting about cancer among structural firefighters. We called out the land management agencies and the firefighting associations:

There needs to be a concerted effort to conduct a similar study on wildland firefighters. It should be led by a physician/epidemiologist and should evaluate the long term health and occurrence of cancer and other diseases among wildland firefighters. There is a lot of grant money out there and it should be possible to get some of it pointed towards this overlooked niche of firefighting.

Followups to that article are HERE and HERE.

The JFSP five-year plan does mention research on the effects of smoke on wildland firefighters, but at times it seems like an afterthought. For example, the objective for one of four research themes, “Smoke and Populations”, sometimes includes the “impact of smoke on populations” (page 26), and in other places it is described as “impact of smoke on populations and fire fighters” (page 21).

However, the plan does list some specific “Smoke Science Foci” that may benefit firefighters:

  • 2011: (SSP T3 -2): Epidemiological research/literature review to determine human health risk from high PM loadings.
  • 2011 (SSP T3-4): Fire fighter smoke health hazards: trends in health and exposure.
  • 2012 (SSP T3-5): Review of epidemiological research to determine human health risk from high PM, high ozone and high aromatic hydrocarbon loadings with a focus on synergisms between pollutants.

We hope that the “foci” turns into actual research.

Congressional Fire Service Caucus and the 9/11 First Responder Bill

(Scroll to the bottom to see updates)

I ran across a news article about Senator Joesph Lieberman (I-CT) accepting the nomination to serve as one of the seven or eight Co-Chairs of the Congressional Fire Services Caucus, a nonpartisan group of more than 320 members of congress which:

…unites Republicans and Democrats in support of fire service legislation that benefits all first responders.

Peter King
Rep. Peter King

In perusing the Caucus’s web site, which is run by the Congressional Fire Services Institute, it turns out that Rep. Peter King (R-NY) is the Chairman of the Caucus. His name rings a bell as the off-camera Representative to which Rep. Anthony Weiner (D-NY) was directing his anger in the video we posted on July 30, 2010. (Here is a link to another video about that encounter.)

The heated rhetoric between the two members of congress concerned a procedural delay introduced by Rep. King which initially prevented the passage in the House of the 9/11 First Responder Health Care Bill, officially known in the Senate as “S. 1334: James Zadroga 9/11 Health and Compensation Act of 2009“. Rep. King sought to delay the passage of the bill while Rep. Weiner angrily recommended passage. The bill would provide health care costs for 9/11 rescue workers, sickened after exposure to the toxic smoke and debris. Finally, the House passed the bill in September.

Recently, however, Rep. King has come out strongly in favor of the 9/11 First Responder Health Care Bill. In fact, he is one of the few Republicans to openly support it, and on December 7, 2010 wrote a letter to his Republican colleagues asking for their votes in the Senate.

There is still a chance that the bill will receive an up or down vote in the Senate before the session ends this year. Votes have been prevented previously by a Republican filibuster. If it is not passed by the Senate this year, the slate will be wiped clean and it will have to be re-introduced in both the House and the Senate next year.

But you can help get the bill passed. CALL YOUR SENATORS! Here is a list of their phone numbers.

If you are still undecided about helping firefighters, check out Jon Stewart’s position on the issue of health care for 9/11 first responders.

=============================

UPDATE @ 4:37 p.m. MT, Dec. 20, 2010:

The Wall Street Journal has the latest news about the bill.

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UPDATE @ 9:00 p.m. MT, December 21, 2010:

This bill is gathering more attention thanks to Jon Stewart. It appears that there are enough votes now in the Senate to pass a slightly revised version. BUT. There is one Senator that says he will hold it and prevent its passage. That esteemed individual is Senator Tom Coburn (R-OK).

In an interview on Fox News Coburn said two of his reasons for killing the bill are:

1. The bill has not been through a committee yet and there have been no hearings.

WRONG. A committee that Coburn is on held hearings on the bill, but Coburn chose not to attend.

2. Coburn said: “This is a bill that has been drawn up and forced through Congress at the end of the year on a basis to solve a problem that we didn’t have time to solve and we didn’t get done.”

WRONG. The bill was introduced in the Senate June 24, 2009, and was passed by the House on September 29, 2010, but has not been voted on in the Senate.

It is incredible that an idiot like this can single-handedly prevent our 9/11 first responders, some of whom are dying from exposure to toxic shit at the 9/11 site, to receive the health care they need.

Even if the Senate does pass this bill over the insane objections of Senator Dufuss Coburn, the House will still need to vote on the revised version, since it has been changed after they passed it in September.

More information:

  • Even Fox New’s Shep Smith took on Senator Coburn today for his stance on this bill. See the 37-second video HERE.
  • Shep Smith called many Senators who refused to talk with him about the bill. “We called a lot of Republicans today who are in office at the moment,” he said Monday afternoon. “These are the ones who told us ‘no’: Senators Alexander, Barrasso, Cornyn, Crapo, DeMint, Enzi, Grassley, Kyl, McConnell, Sessions, Baucus, Gregg, and Inhofe. No response from Bunning, Coburn, Ensign, Graham, Hatch, and McCain.”
  • We first wrote about this bill on July 30, 2010.
  • And we wrote more about it on December 17, 2010. That post has two videos in which Jon Stewart takes on the issue.
  • Call your two Senators (list of phone numbers) especially if one or both of them are Republicans, most of whom plan to vote against the bill.
  • Call Senator Tom Coburn’s office at (202) 224-5754.
  • A few hours after we wrote our second article about this issue on December 17, if you searched Google for “9/11 First Responder Health Care Bill”, that Wildfire Today article was the fifth one listed on the first page. Now there has been so much publicity about the issue that Wildfire Today does not show up in the first five pages of Google results.
  • This is the sixth time we have used the tag “idiot” for an article since January, 2008.

Help get the 9/11 First Responder bill passed

We generally don’t stoop low enough here at Wildfire Today to write about politics, but there is one issue that anyone who cares about firefighters should not ignore – the 9/11 First Responder Health Care Bill, officially known in the Senate as “S. 1334: James Zadroga 9/11 Health and Compensation Act of 2009“. It was introduced in the Senate June 24, 2009, passed by the House on September 29, 2010, but has not been voted on in the Senate. According to a CNN story, it is being filibustered by Republicans.

We first wrote about this bill on July 30, 2010 when Republicans in the House were fighting to kill the bill. In that article we included an amazing video showing Rep. Anthony Weiner (D-NY) ripping into another Representative who intended to use certain procedures to prevent a vote on the bill. Two months later it passed the House, with a vote of 268 to 160.

The bill is named after a deceased New York Police Department detective who died after having worked at the 9/11 ground zero site in the toxic atmosphere. It seeks to provide medical coverage for the hundreds or thousands of firefighters, police, and other responders who worked at the 9/11 sites and were breathing the air that EPA Administrator Christine Todd Whitman said on September 13, 2001 was “not of concern”. Her statement contradicted scientists’ data from the previous day, and other facts that came to light later.

The mainstream media has virtually ignored this issue for the last several months. Recently Jon Stewart of the Daily Show has taken up the cause in a big way.  On Thursday December 16 he said this:

The Daily Show With Jon Stewart Mon – Thurs 11p / 10c
Worst Responders
www.thedailyshow.com
Daily Show Full Episodes Political Humor & Satire Blog</a> The Daily Show on Facebook

He also interviewed a panel of four first responders, some of whom are suffering from illnesses caused by the work they did at the 9/11 site:

The Daily Show With Jon Stewart Mon – Thurs 11p / 10c
9/11 First Responders React to the Senate Filibuster
www.thedailyshow.com
Daily Show Full Episodes Political Humor & Satire Blog</a> The Daily Show on Facebook

Most people, if they watch these videos or read about the issue will be moved to take action to help these firefighters and other first responders.

What you can do

Call your two Senators (list of phone numbers)

Call minority leader Senator Mitch McConnell, (202) 224-2541. He has played a major role in preventing this bill from being voted on in the Senate.

One more video

One more Jon Stewart video about the 9/11 First Responder bill is below. It is from Monday, December 13. He starts talking about the bill at about the 2:00 minute mark.

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