California passes bills boosting mental health support for firefighters

The legislation addresses peer support and treatment for post-traumatic stress

Legion Lake Fire South Dakota
A firefighter at the Legion Lake Fire in Custer State Park, South Dakota, December 13, 2019. Photo by Bill Gabbert.

Yesterday the Governor of California signed into law two pieces of legislation that can improve support for the mental health of firefighters.

The California Firefighter Peer Support and Crisis Referral Services Act authorizes state, local, and regional public fire agencies to establish a Peer Support and Crisis Referral Program to provide an agency-wide network of peer representatives available to aid fellow employees with emotional or professional issues. The bill also provides that emergency services personnel have a right to refuse to disclose, and to prevent another from disclosing, a confidential communication between the emergency service personnel and a peer support team member, crisis hotline staff member, or crisis referral service.

A second bill, SB-542 Workers’ Compensation, classifies post-traumatic stress as an “injury”, like conventional physical injuries. This will allow compensation for hospital stays, surgery, medical treatment, disability indemnity, and death benefits.

The bills do not apply to federal employees, with a few exceptions for some NASA and Department of Defense firefighters in the state.

These bills are a step toward recognizing presumptive diseases or injuries that when suffered by a firefighter are presumed to be an on the job injury, and would be treated as such. Montana, British Columbia, Washington, and other jurisdictions have presumptive disease programs for firefighters. Of course the key is the list of diseases that are covered. Listing one or two would leave out the eight or ten others that can be caused by serving the public as a firefighter.

Montana becomes 49th state with some form of presumptive care for firefighters

Montana Governor to sign legislation today

With the passage of Senate Bill 160 Montana becomes the 48th state with some form of presumptive care for firefighters.

The Firefighters Protection Act lists 12 presumptive diseases for which it would be easier for a firefighter to file a workers’ compensation claim if they served a certain number of years:

  • Bladder cancer, 12 years
  • Brain cancer, 10 years
  • Breast cancer, 5 years
  • Myocardial infarction, 10 years
  • colorectal cancer, 10 years
  • Esophageal cancer, 10 years
  • Kidney cancer, 15 years
  • Leukemia, 5 years
  • Mesothelioma or asbestosis, 10 years
  • Multiple myeloma, 15 years
  • Non-Hodgkin’s Lymphoma, 15 years
  • Lung cancer, 4 years

The bill applies to volunteers and local fire departments in Montana, but not to federal firefighters. It is unclear if it affects those employed by the state government.

The federal government has not established a presumptive disease program for their 15,000 wildland firefighters.

At a bill signing ceremony Thursday afternoon Governor Bullock will issue a proclamation ordering flags to be displayed at half-staff in honor of all Montana firefighters who have lost their lives from a job-related illness in the line of duty.

Governor Proclamation Montana firefighters


In a related story from April 12, “British Columbia may expand firefighter occupational disease coverage to wildland firefighters”

British Columbia may expand firefighter occupational disease coverage to wildland firefighters

Minister calls firefighting dangerous, says it can have severe impacts to physical and mental health

Massachusetts firefighters British Columbia
Firefighters from Massachusetts board an aircraft on the way to the Elephant Hill Fire near Kamloops, British Columbia. Photo by Mass. Department of Conservation and Recreation.

The United States government does not have a presumptive disease policy for their 15,000 federal wildland firefighters, but British Columbia is seeking to expand their program.

From The Canadian Broadcasting Corporation:


Firefighters who have battled British Columbia wildfires, fire investigators, and fire crews working for Indigenous groups will be eligible for greater access to job-related health compensation under legislation introduced Thursday.

Labour Minister Harry Bains tabled amendments to the Workers Compensation Act that extends occupational disease and mental health benefits to more people who work around fires.

The proposed changes will expand cancer, heart disease and mental health disorder presumptions to include the three other job categories, because Bains says those workers are often involved in the traumatic issues related to fires.

Presumptive illnesses faced by firefighters are recognized under the act as conditions caused by the nature of the work, rather than having firefighters prove their issue is job related to receive supports and benefits.

Bains says the government expanded the presumptive job-related conditions last year to include mental-health disorders for police officers, paramedics, sheriffs, correctional officers and most urban firefighters. He says firefighting is dangerous work that can have serious impacts on an individual’s physical and mental health.

“They will enjoy the same coverage as the other firefighters — the first responders — receive as part of giving them certain cancer protections, heart disease and injuries and mental health,” Bains said during a news conference after the legislation was introduced.

“These steps are very necessary to ensure our workplaces are the safest in the country.”

NBC News: cancer among firefighters

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.

Rep. Mark Noland
Rep. Mark Noland of Bigfork, MT.

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].


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:

Cancer among Seattle firefighters

Wildfire Today has covered cancer among firefighters previously, but more information continues to be available about this risk.  Here is an excerpt from an article in the Seattle PI:

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

Cancer takes heavy toll on Seattle firefighters
City defends itself against charge it could do more

By KATHY MULADY AND CASEY MCNERTHNEY
P-I REPORTERS

Dave Jacobs started fighting fires when he was 20. It was the only job he ever
wanted. He battled brush fires in California, house fires in Oregon and fires of every kind in more than two decades with the Seattle Fire Department.
Now 57, Jacobs is fighting cancer.

Seattle firefighters cancer chartA year ago he was diagnosed with esophageal cancer. There are days when he can barely swallow a few spoons of soup. The disease has progressed to his liver and lymph system.

Cancer is a presumptive disease in firefighters — more than a third of Seattle firefighters hired before 1977 have developed some form of the illness. Under Washington law, seven forms of cancer are assumed to be job related when they are diagnosed in a firefighter.

But there are many other cancers that aren’t on the list, forcing men such as Jacobs to prove that their illnesses were job related to get workers’ compensation. Seattle firefighters say the city is not doing enough to help screen them for cancers and other health risks. City officials are sympathetic but question the effectiveness and cost of health screenings.

“My heart goes out to the other firefighters who have yet to be diagnosed,” Jacobs said. “This job is a killer.”

According to the International Association of Firefighters, more union firefighters died of cancer in 2007 than from heart attacks or fire-related injuries combined. Nationally, there were 38 union firefighters who died last year from cancer, 16 from heart attacks and 10 from fire-related causes. That trend is continuing in 2008.

It is assumed that if a Washington firefighter who was on the job for 10 years develops prostate cancer before age 50, or brain cancer, bladder or kidney cancer, malignant melanoma or several others, it was in the line of duty.
In this state, three of five active firefighters who died this year were cancer victims. The other two died fighting California wildfires.

Seattle Battalion Chief James Scragg — a survivor of the deadly Pang warehouse fire — died of lung cancer Jan. 17 at age 54. Seattle firefighter Tim Heelan, 43, also died in January after melanoma spread to his lungs and spine.

Marty Hauer, a Kent firefighter who traveled the nation teaching fitness seminars to other firefighters, stunned colleagues when he revealed that he had thymic carcinoma, a rare thymus gland cancer. He died in June at 41. Dozens of others are fighting the disease.

Of 975 firefighters hired in Seattle before 1977, about 350 have been diagnosed with cancer, and 43 of the men were younger than 60 when diagnosed, according to numbers from the Seattle Firefighters Pension Board.