Pride, honor, tradition—three words that form the backbone of the entire firefighting profession. Traditions live long and can create resistance to cultural change. But over the last 40 years, the firefighting profession has gone through many cultural changes. The biggest effect of this change has occurred in major metropolitan departments.
A very broad and simple way to define culture in the firefighting profession is patterned ways of thinking based on traditional and historical ideas. These learned behaviors, handed down from one generation of firefighters to the next, are deeply embedded, and change does not come easy in a profession that prides itself on these shared assumptions.
One of these “shared assumptions” was handed down to me when I entered the San Francisco Fire Department (SFFD) in the early 1970s. Nearing the end of my probation, having been passed up on pump operations, I was given the opportunity to put my skills to work driving and operating the engine company to which I was assigned.
On my first watch as a driver in this downtown company, I was pulled aside by the regular driver and told, “Don’t let any engine company beat us in to a working fire.” I was aware of the drill: If you are first due, be sure you arrive on the scene first; if you are second due, beat out the first-due engine company. That race no longer takes place. That small cultural facet transitioned into a “common sense” cultural change that was enforced by disciplinary action. If you blew a red light or drove recklessly fast to a working fire, you had to face the consequences. I’m sure this change has saved lives.
A new enemy
We are now faced with one of the most important cultural changes in the history of the firefighting profession. This one cultural change can and will have a profound effect on the health of firefighters. This change encompasses a multi-faceted approach to reduce toxic chemical exposures on the fireground, in the fire house and in our everyday lives in order to reduce the cancer epidemic currently facing members of our profession.
When the San Francisco Firefighters Cancer Prevention Foundation was formed in 2006, we knew that we had a major problem on our hands. We seemed to be attending funerals on a monthly basis for firefighters who had succumbed to this insidious disease.
At Station 1, where I was the captain of Rescue 1, five firefighters contracted transitional cell carcinoma (TCC), all within a six-year period. TCC is a common form of bladder cancer. A rarer form of TCC (1 in 100,000 diagnosed) is found in the kidney. Two out of the five of us had that cancer. I was one of them.
I am sorry to say three out of the five have since lost their lives to TCC.
Seeking data
We tried to gather statistical information about elevated rates of cancer in our profession but found very few science-backed studies. We contacted the Department of Urology at the University of California, San Francisco (UCSF) and told them about our concerns with TCC. They were extremely concerned about our statistical information.
In conjunction with the Department of Urology UCSF, we put together our first major study and screening. We screened over 1,200 active and retired firefighters. During the screening, we identified two retired firefighters and one active firefighter with TCC. The study, written by Dr. Kirsten Greene, one of the principal investigators of the study, was published in The Journal of Urology in 2008. This was our first step to show a direct correlation between our profession and elevated rates of cancer.
What changes were being made at that time to reduce toxic chemical exposures in our department? The answer was basically none.
We funded another study in 2012 to look at the blood chemistry of 12 firefighters after two separate working fires. The study showed extremely high levels of polybrominated diphenyl ethers (PBDEs) in the blood of all 12 firefighters. These are organobromine compounds that are used as flame retardants in a wide array of products. The PBDE compound that was found at high levels was decabromodiphenyl ether. The EPA has classified this congener as a possible human carcinogen. This was another eye-opening warning that major cultural changes had to be made in order to reduce toxic chemical exposures.
San Francisco has the largest group of female firefighters (well over 200) of any major metropolitan city department in the United States. Among our 40- to 50-year-old female firefighters, we are seeing breast cancer rates that are six times the national average. A first-of-its-kind study is currently underway looking at the blood chemistry of 80 female firefighters compared to 80 female office workers in San Francisco. Preliminary results will be published shortly.
The final study that drove home the necessity for change was the National Institute for Occupational Safety and Health (NIOSH) Fire Fighter Cancer Study, which began in 2010 and concluded in 2014. It looked at the causes of death of a cohort of close to 30,000 firefighters from San Francisco, Chicago and Philadelphia, dating back to 1950. “The results showed higher-than-expected rates of certain types of cancer than the U.S. general population.”1 The findings showed that firefighters were at higher risk of digestive, oral, respiratory, urinary system cancers and twice the rate of malignant mesothelioma. The direct correlation was also made with the amount of time spent at fires and an increased rate of lung cancer diagnosis or death, as well as an increased chance of leukemia with the number of fire runs.
Shifting perspective—and actions
Cultural changes began to take shape, but old habits die hard. In San Francisco—and I am sure we are not alone—there is still a lack of continuity among chief officers in charge at working fires to enforce wearing SCBAs throughout extinguishment and overhaul operations as well as air monitoring and to ensure that gross decontamination takes place. This information was gathered after talking to many chief officers in the field. Although most incident commanders do their best to see that the firefighters are protecting themselves, there are still some officers who pride themselves on being in the thick of it with no protection. The problem here is that they do not understand or accept the magnitude of the problem we are facing as a profession; for some, there is a degree of denial.
Let’s consider the importance of wearing an SCBA during overhaul operations right after the fire has been extinguished. I am sure we all realize that the contents of a typical structure fire is no longer a simple combination of wood-based products and natural materials. Every fire now must be treated as if it is a hazardous materials situation, as there is off-gassing of a multitude of toxins, including asphyxiants, acid gases, organic irritants, particulates, and of course the proven carcinogens of benzene, isocyanates, PCBs, polycyclic aromatic hydrocarbons (PAHs), dioxins, furans, arsenic, asbestos, formaldehyde, etc. What is even more disconcerting is the synergistic effect of these toxins and the possibility of their toxicity level increasing exponentially.
The toxic exposures that the men and women of our profession are now faced with are causing rare forms of cancers at younger ages. The so-called “badge of honor” that has been associated with a soot-covered face, a black toxic film covering the helmet and turnout gear, have been identified through scientific studies to be another vehicle to cause cancer for an extended period of time long after leaving the scene of a fire.
The 15–20-year latency period for contracting cancer is no longer a factor in the determination of a workers’ compensation case in San Francisco. If a firefighter contracts cancer after five years of being on the job, they are now covered.
We all now know what must be done. There have been numerous papers published with the proper steps to follow during and after any fire situation to reduce and possibly eliminate toxic exposures. Departments must become proactive and establish solid guidelines that are rigorously enforced at every incident.
One department that seems to be leaps and bounds ahead of everyone else is Boston. Per the NFPA Journal article “Facing Cancer” by Jesse Roman: “For years, Boston Fire had a well-deserved national reputation for being stubborn, old-school and needlessly resistant to change, often to the detriment of its members. In many companies, wearing self-contained breathing apparatus was optional or even seen as a sign of weakness. Leadership didn't seem to value personal protection, and the machismo prevalent in so many departments, where soot-covered smoke-eaters were regarded as the bravest and baddest of all firefighters, was rampant in Boston Firehouses.”2
Now leading the charge to protect its members is Fire Commissioner Joseph Finn. With financial support from the city and backing from union president Richard Paris, they have established a “full-court press” to limit a firefighter’s exposure to cancer-causing chemicals. Finn has established a Safety, Health and Wellness Division within the fire department to oversee and establish guidelines to protect its members.
Individual responsibility
The hard science is done. The direct correlation to toxic chemical exposures and high rates of cancer in our profession has been established. Several best practices have been identified for all departments to take advantage of to reduce and hopefully eliminate these exposures. But at this point, the bottom line rests with each individual firefighter to take their own personal responsibility to be sure that they are protected.
In the month I wrote this article, the SFFD has lost retired Division Chief Bill Shaughnessy, Division Chief Dennis Callahan, Battalion Chief Dave Haberlin and Lt. Larry Conrad to cancer. This has to come to an end.
References
1. NIOSH Fire Fighter Cancer Study Frequently Asked Questions. November 2013. cdc.gov/niosh/firefighters/pdfs/faq-nioshffcancerstudy.pdf.
2. “Facing Cancer.” NFPA Journal. May–June 2017. nfpa.org/news-and-research/publications/nfpa-journal/2017/may-june-2017/features/facing-cancer.
Sidebar: From the Chief
"Fires may look the same as years past, but building materials and furnishings contain countless new and extremely toxic chemicals. There is no denying it. Firefighters are dying and there is a direct link between the exposures and the disease." — San Francisco Fire Chief Joanne Hayes-White
