Three Simple Ideas to a Healthier Fire Service

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This is the last of three columns in which we revisit issues related to attaining the goal of a healthier fire service. The first installment (March 2011) covered effects of stress and overexertion on firefighters. The second column (May 2011) looked at the impact obesity has on firefighters. This month’s column focuses on firefighters’ on-the-job exposure to toxins.

Every year, firefighters die of various forms of cancer that may be due to their exposure to toxins during their firematic duties. There is no established mechanism for identifying fatalities that result from cancer that develop over long periods. They may be related to occupational exposure to hazardous materials or toxic products of combustion. It has proved to be very difficult to provide a complete evaluation of an occupational illness as a causal factor in firefighter deaths due to multiple issues such as the exposure of firefighters to toxic hazards is not sufficiently tracked, delayed long-term effects of such toxic hazard exposures and the exposures firefighters may receive while off duty.

Fire science establishes new and important facts every year that should guide our fire ground activity. Dr. Basri is a member of the American College of Occupational and Environmental Medicine, which brings together his professional practice of internal medicine and cardiology with his work with the fire service. As he was reading the Journal of Occupational and Environmental Medicine for August 2010, he came across an article that is a milestone for the fire service. This article describes a study done by the University of Cincinnati, Underwriters Laboratories Inc. and the Chicago Fire Department. The study found that 70% of particulates released during fires are ultra fine, invisible and so small that they are inhaled into the deepest parts of the lung. Researchers found that products of combustion included very fine toxic particles that are in the highest concentrations during overhaul.

This means that after we knock down the fire and transition into the overhaul phase, we let down our guard by taking off our self-contained breathing apparatus (SCBA). This research is so compelling because for the first time, the quantitative burden of ultra-fine toxic particulate matter is established to show the size and distribution of these toxins. If we take into account that routinely we take off our SCBA because we do not visualize this airborne threat, we become vulnerable to extreme danger.

In terms of our cumulative risk as firefighters to carcinogens, our current methods of overhaul dramatically increase our exposure. This is an issue of leadership responding to the new science and appropriately mandate use of the SCBA during overhaul. It is also our mutual responsibility to educate all firefighters as to the risk and to encourage them individually to choose to wear SCBA during overhaul. Firefighters often choose to lighten their load after strenuous firefighting and take off the SCBA and extra gear to perform the tasks of overhaul. However, more range of motion for overhead activity is not a fair balance to the risk incurred.

Furthermore, it is medically proven that the finer the particulate matter inhaled, the more likely it is to reach deeper into the lung tissue. This increases the risk that the particles which are toxic products of combustion may remain trapped within the lung tissue in the smallest air sacs, called the alveoli of the lung. This is where these toxic particles can do the most damage and be most resistant to the natural defense mechanism of the lung.

The upper portion of the lung and airway from the pharynx in trachea down into the chest is lined by fine hairs or cilia that oscillate to remove trapped particles. Therefore, the smallest particles of toxic material that would reach deep into the long are most likely to remain there and be absorbed into the tissue. Over the course of one’s firefighting career, this cumulative risk will increase several forms of lung disease and potentially lung cancer.

This study in the Journal of Occupational and Environmental Medicine also suggests that the rate of line-of-duty heart attacks for firefighters may be related to the burden of toxins inhaled during overhaul. This becomes more of a risk to those individuals who may not be in the best of health or have pre-existing coronary artery disease.

Therefore, it is imperative that all firefighters change their attitude about doing overhaul without protective SCBA. Our standard operating procedures (SOPs) must reflect the new research which clearly shows that we are putting ourselves in danger unnecessarily and at almost every structure fire. Again, it becomes an issue of leadership to change the way things are done to reduce the risk to our firefighters. This is the challenge of leadership.

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