Simple Tools to Help Firefighters to Reduce Cancer Risk

Firefighters across the United States know that the odor of a fire lingers long after the flames were extinguished. Soot that’s on gear, residue that’s on skin and particles that are embedded in a fire apparatus’ cab carry invisible hazards, many of which are linked to long-term health risks, such as cancer. Although awareness of these risks has
grown, translating knowledge into action remains a challenge.

One low-cost, high-impact solution quietly is gaining traction: the “decon bucket,” which is better known in Florida as the “Green Bucket.”

In a recent analysis of survey responses from 371 Florida firefighters, Sylvester’s Firefighter Cancer Initiative at the University of Miami found that a simple five-gallon bucket that’s stocked with baby wipes, liquid soap and other basic supplies is making a measurable difference in firefighter behavior. Most importantly, firefighters are using it.

Lifesaving potential

The Green Bucket is designed to be an integral part of preliminary exposure reduction (PER), which is the seven-step post-fire gross decontamination process. After responding to a fire, firefighters can use the bucket to remove surface contaminants from their gear, tools and exposed skin.

The method isn’t complex, doesn’t require advanced training and can be done on the fireground or at the station. What makes it remarkable isn’t the technology but the uptake: 91.1 percent of surveyed firefighters were adopters of the decon bucket, and 93.8 percent reported using it at least occasionally after fire incidents. Even more striking, nearly 60 percent reported using the decon bucket after every fire.

Who uses the bucket?

Two independent surveys were administered by Sylvester’s Firefighter Cancer Initiative to study Green Bucket usage among Florida firefighters. Usage patterns varied slightly between the two groups. The initial study (156 survey respondents), which was conducted among Florida fire service leaders (i.e., company officers and chiefs), showed nearly universal adoption and regular use. The second study (215 survey respondents), which surveyed a broader group of rank-and-file personnel, still reported strong usage, but with more variability in consistency.

Experience played a role: Firefighters who have 10 or more years of service (68 percent of all of the survey respondents) were nearly six times more likely to adopt the Green Bucket than those who have less than 10 years of service. This difference was statistically significant. Fire service leaders (53 percent of all of the survey respondents), including lieutenants and captains, also showed higher adoption rates compared with  those of firefighters and EMTs.

This trend suggests that institutional knowledge and leadership buy-in are powerful drivers of behavioral change. The more seasoned the firefighter, the more likely that individual is to recognize long-term health risks and to take action to mitigate those risks. There are several possible reasons for this difference in usage patterns. For example, older firefighters might be more proactive about taking care of themselves for their family’s sake, or they might be more motivated to participate in exposure-reduction behaviors, because they know another firefighter who was diagnosed with cancer.

Barriers to adoption exist

Despite encouraging results, the data also revealed gaps. Approximately 9 percent of surveyed firefighters hadn’t adopted the decon bucket. Among nonadopters, the most common behaviors included never using the decon bucket supplies (60.6 percent) and rarely or never refilling the bucket (65.6 percent).

Ethnicity emerged as an important factor. Hispanic firefighters appeared less likely to use the Green Bucket compared with non-Hispanic firefighters. However, this difference wasn’t statistically significant. These disparities might reflect differences in training access, communication gaps or resource availability within departments.

For departments that aim for universal adoption, these findings are critical. Targeted outreach, particularly to younger and newer firefighters as well as underrepresented groups, might be key to closing the implementation gap.

The winning attribute

When asked how easy it is to use the decon bucket, 98.3 percent of users responded that it was either “very easy” or “somewhat easy.” Although the PER process itself often is described as burdensome in other contexts, PER with the Green Bucket was considered easy by a large majority of users. Most reported that it takes no more than 10 minutes to complete the seven-step gross decon, and nearly half said that it took no more than five minutes.

Convenience matters. For an intervention to gain traction in the fire service, it must not interfere with operations or morale. Although it might take a little time and training to make the Green Bucket a routine part of post-fire practices, most firefighters report satisfaction with the process and feel the benefits are worth the extra effort. More than 86 percent of respondents to the survey said that they definitely would continue to use it, and 99 percent would recommend it to a colleague.

Why the bucket works

The science behind PER is clear: Removing toxic soot and fireground chemicals from gear and skin reduces the amount of carcinogens that are absorbed by the body. Harmful substances can enter a firefighter’s body through inhalation, ingestion and skin absorption. Immediate decon disrupts these pathways.

This is why a stocked $30 bucket (including wipes and cleaning supplies) can function as an effective cancer-prevention tool. However, the Green Bucket is more than just another piece of gear. It’s a behavioral nudge. It makes the healthy choice the easy choice.

Leadership from the field

Fire service leaders are positioned uniquely to model and reinforce personal decon behavior. In our study, firefighters who are in leadership positions were significantly more likely to be Green Bucket users. Departments that incorporate gross decon into their standard operating procedures (SOPs), that provide supplies regularly and that train crews during onboarding saw higher usage rates.

One Florida fire officer put it best: “When the buckets are stocked and inspected, they get used. When the captain uses it, the crew follows.”

Study to standard practice

Our study findings demonstrate that simple interventions can drive widespread change when deployed thoughtfully. Although high-tech solutions, such as wearable sensors and advanced filtration systems, often grab headlines, it’s the low-cost, high-yield tools, such as the decon bucket, that might have the most immediate effect on firefighter health.

Departments that are looking to implement this approach can start small:

• Assign a decon bucket to each vehicle or crew.
• Develop an SOP that outlines which unit/member is responsible for setting up the decon station so that it’s ready when crews exit.
• Train on proper use during department drills.
• Include decon bucket use in after-action checklists.
• Refill supplies regularly and track use across time.

Culture change

In a profession in which bravery is a given and cancer is an ever-present risk, tools that protect firefighters without slowing them down are rare and valuable. The decon bucket stands out, not because of its complexity, but because of its simplicity. It’s a tool that firefighters can use, want to use, will use and will benefit from using.

As the fire service continues to confront occupational cancer, these findings offer a clear takeaway: Culture change doesn’t always require sweeping reform. Sometimes, it just takes a bucket—a green bucket.