The time has come to change the way we think about protecting ourselves from the hazards of the fire environment. We have to adapt our standard operating procedures (SOPs) to look beyond surviving the immediate hazards that we encounter at every incident scene. We have to place the same emphasis on protecting ourselves from potentially lethal health consequences that may not show up for several years after the incident.
That time really arrived several years ago, but we know that it takes time to absorb new information and adjust our thinking before we are ready to change our actions. When we look at all of the information that has been placed in front of us over the past decade relating to firefighter cancer rates, chronic diseases and shortened life spans, the reality should be obvious. The long-term health hazards are just as deadly as burns, asphyxiation and traumatic injuries.
The medical professionals have told us we are routinely exposed to a variety of carcinogens and other contaminants at fires, even relatively minor and seemingly non-threatening fires. If those substances find their way into our bodies, they can plant the seeds that are likely to evolve into a long list of debilitating, life-threatening and life-shortening diseases. We don't even have to inhale them or swallow them — simply getting them on our skin could be sufficient exposure to produce long-term consequences. The facts are evident and the impact is so severe that we should be directing every possible effort toward reducing any avoidable exposure to any of those potentially harmful agents.
When we think about the fire environment, breathing apparatus is the most obvious and probably the most important component of our protective system. We make a direct connection in our minds between respiratory protection and the term immediately dangerous to life and health (IDLH). We know that we have to wear breathing apparatus to protect our lungs and breathing passages from the atmospheric hazards that are capable of causing immediate death, but do we give the same thought to protecting ourselves from things in that atmosphere that may cause death several years from now?
A properly trained 21st-century firefighter wouldn't even think about conducting an interior fire attack or working inside a smoke-filled building without a self-contained breathing apparatus (SCBA), but when do we start using air and when do we think it is safe enough to remove our masks?
When we are going into a burning building, do we wait until we encounter moderate or heavy smoke before we "mask-up" or do we start using air when we encounter the first hint of smoke? Knowing that our air supply is limited, we are often tempted to wait until we really need an SCBA before we start using it. We don't want to shorten our working time by using some of that precious stored air before it is absolutely necessary, so we conveniently ignore light to moderate smoke and wait until we encounter heavier smoke before we start using our SCBA.
The same thought process applies when the fire is knocked down. It is always tempting to remove our masks as soon as the smoke lifts and it is usually much easier to conduct overhaul without the encumbrance of an SCBA. We like to think that the danger goes away with the visible smoke and assume that a little residual contamination can't really be dangerous.
If we are on the roof of a burning building, we feel secure standing back a few feet and watching smoke escape and dissipate into the atmosphere. We assume that the smoke won't hurt us unless we make a special effort to inhale the heavy concentration close to the point where it is escaping. Once that smoke has been diluted by some fresh air, we tell ourselves that it is probably safe enough to breathe. The same old thinking told us it was OK to attack a car fire without a mask, as long as we kept our faces out of the really bad smoke.
It's All "Bad Stuff"
The point where we have to make a significant change in our thinking is the way we characterize smoke. We used to think of smoke as a substance that comes in a variety of colors and thicknesses. We may see heavy, dark smoke at one fire and wispy gray smoke at another fire, but we tended to think of it as just different varieties of smoke. A lot of heavy smoke was obviously bad, but a little bit of light smoke shouldn't be harmful.
That way of thinking would make sense if we could be sure that the "bad stuff" is only present in the really thick, nasty smoke that obscures our vision. Some of us used to believe that as long as we could see where we were going, the atmosphere must be safe to breathe. We also used to think that carbon monoxide (CO) was the critical factor and as long as the CO level was below the published IDLH threshold, it was OK to work without a mask. We were comfortable blowing some black stuff out of our respiratory passages and comparing the black streaks on each other's faces after a successful battle with the Red Devil — a little soot couldn't be harmful and getting dirty is an unavoidable part of the job.
Now we know that smoke is really a complex mixture of particles, droplets, fibers, molecules and other microscopic components that can find their way into our respiratory, digestive and circulatory systems through several different paths. Once they get into our fertile interior biological systems, they can plant themselves in locations where they can start a process that eventually leads to a life-threatening disease.
We have to stop thinking about "smoke" as the problem and start thinking about all of those individual microscopic components within the smoke as potential sources of future disease. Those individual microscopic components represent the same types of risks that we associate with blood-borne pathogens. Once we change our focus to the microscopic level, we will recognize the importance of doing everything feasible to prevent the contamination of our vital systems.
One Bad Seed Can Kill
There is no law of physics that requires all of the potentially toxic particles and molecules to remain within the heavy smoke cloud. Every visible or invisible component of smoke is a free agent that can define its own path within the atmosphere. When we walk into situations where there is just a little bit of smoke in the atmosphere, we could be inhaling the one seed that evolves into cancer months or years from now.
If we really want to protect ourselves in the long term, we will "mask-up" at the entry point, before we need an SCBA to enable us to penetrate where we want to go. If there is any indication of smoke or contaminants in the air, we should be using our certified pure air supply, whether it is a minor kitchen fire, a smoky basement fire, a car fire in the middle of a parking lot or an outside trash fire. The simple strategy should be "Don't breathe smoke — or anything else that may be harmful."
A conscientious respiratory protection plan should ensure that every potential exposure to contaminated air — even slightly contaminated air — is avoided. That approach requires a significant adjustment in the way we manage our air and manage fireground operations. We have to be prepared to cycle crews into and out of the fire environment at a rate that is directly proportional to their operating time "on air." If we plan on maintaining an interior operation beyond the duration of a single cylinder, we will need to have a backup crew ready to go in and replace each crew when it is time to come outside.
When we incorporate a realistic approach to air management, we can predict and keep track of the time that a crew can operate on air before they have to be replaced. That time should be calculated on the assumption that they will be coming out of the hazardous area before the low-pressure alarms on their SCBA are activated. The days of waiting until the alarm sounds to think about exiting should also be in the past.
We will also need a reliable system to replace or refill air cylinders at a rate equal to the consumption rate. If we run out of air at the fire scene, we cannot keep on operating in a mode that exposes our firefighters to any level of smoke. Air supply has to be viewed in the same manner as water supply. We cannot change the rules and allow ourselves to work without respiratory protection because we failed to establish an adequate system to meet the demand for air.
Respiratory protection is only one aspect of a systematic approach to minimize our potential exposure to fire scene contaminants. We also have to recognize that our protective clothing, tools and equipment become contaminated with every exposure to a hazardous environment. We have to clean our stuff to remove those contaminants, unless we think it is safe to continually re-expose ourselves to those potentially deadly products.
When a requirement for annual cleaning of all protective clothing was incorporated into National Fire Protection Association (NFPA) Standard 1851, the immediate reaction of many firefighters was to add it to the list of unnecessary, expensive and inconvenient arbitrary regulations that are making our lives unbearable. In most fire departments, a firefighter who walks around in sparkling clean turnouts is quickly recognized as a rookie or branded as a sidewalk spectator who avoids getting close enough to the action to get dirty. The salty old jake who finally wears out a set of grungy old turnouts will look for the first opportunity to get the new set dirty enough to regain the respect that is due. Now, NFPA wants us to keep our clothing clean and send it out for certified cleaning and inspection every year — what next?
If we think about the kinds of contaminants that are absorbed into our clothing and equipment, we will quickly recognize that the time has come for that thought process to be abandoned. We have to adjust our behavior to coincide with our new understanding of the hazards of our work environment. Our protective clothing must be professionally cleaned on a regular schedule — immediately if it is obviously contaminated. The clothes we wear to a fire, under our protective clothing, should be removed promptly and isolated from the family laundry to avoid sharing those contaminants. We should shower after every fire to remove any traces of contaminants from our bodies, before it is absorbed through the skin. We should also recognize the importance of keeping our apparatus and equipment clean. Maybe the old white-glove inspection program was more important than we ever thought.
Most of our focus on firefighter safety over the past several years has been directed toward the "Everyone Goes Home" message. It is time to look beyond just going home and work on going home healthy and uncontaminated.
J. GORDON ROUTLEY served as fire chief in Shreveport, LA, assistant to the fire chief in Phoenix, AZ, and safety officer in Prince George's County, MD. He is currently the technical advisor to the fire chief in Montreal, Quebec, and provides consulting services to fire departments and fire service-related organizations in the U.S. and Canada, with an emphasis on firefighter health and safety. Routley is also the liaison representative for National Fallen Firefighters Foundation (NFFF) and is on the board of directors of the International Association of Fire Chiefs (IAFC) Safety, Health and Survival Section.