FEATURE | Firefighting: A Toxic Profession
FIREFIGHTING
A TOXIC PROFESSION
Today’s Fires Are
More Dangerous than Ever
BY DAWN BOLSTAD-JOHNSON
O
n day one of fire training academy, firefighters learn that firefighting is a mentally taxing and toxic profession and that
they are likely to die 10 years earlier than if they
had chosen any other career. In the U.S., we lose
about 100 firefighters to line-of-duty deaths
each year, a statistic that is flat regardless of how
many improvements are made to the system of
personal protective equipment (PPE), or “turnout
gear," used by firefighters. These line-of-duty
deaths do not typically capture the cancer deaths
that may be related to the countless toxic exposures that firefighters accumulate over their 20plus years of service.
Some experts believe that the improvements to firefighter PPE are actually posing new hazards to firefighters
because they allow firefighters to expose themselves to
fires for longer periods. With the older equipment, career
firefighters knew that they had to leave a fire when the tips
of their ears started to burn—about 20 minutes in the heatintensive fire environment. New equipment provides longer
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The Synergist ■ October 2013
Firefighting: A Toxic Profession | FEATURE
periods of thermal protection, which is pushing firefighters to use
larger air bottles so they can work longer.
But heat is not the only hazard that firefighters face. Turnout gear provides protection from heat, but not from chemical
or particulate exposure. Fire conditions are full of nanoparticles, and the health hazards of nanoparticle exposure are
not fully understood. Further, skin as a route of entry for
toxic materials has not been well-reviewed, though it is the
elephant in the room that no one’s talking about. And the
hazards don’t end there.
Toxicity of Today’s Homes
The contents of our homes have changed drastically over the
years, and we’ve increased the level of toxicity in our homes
exponentially. Fifteen years ago, we did not have flat-screen
TVs, smartphones, computers, and so on. Building materials have
changed as well; oriented strand board (OSB), particle board, and
injected, expandable foams with chemical names that are difficult to pronounce are among the more modern materials.
Flame retardants, which are often injected into plastics, foams,
and fabrics to protect items from catching fire, are another major
contributing factor to this increased toxicity. Currently, no regulations limit the amount of decabromodiphenyl ether (deca-BDE),
a popular brominated flame retardant, that can be injected into
a material. Exposure to flame retardants is a concern not only
for firefighters, but for the general public as well. This stuff is
so prevalent that as plastic items decay, deca-BDE is released
into our house dust, and we are eating it. There have also been
reports that this material is found in the cord blood of newborn
babies. Even so, it is not on the radar of regulators—let alone
firefighters.
The modern materials in our homes have also increased the
toxicity of today’s fires, and we don’t know how these acute exposures impact firefighters’ health. And modern materials aren’t
the only concern; even structures built with legacy materials
such as wood and cotton can create a toxic, carcinogenic environment during a fire.
In November 2009, Underwriters Laboratories, a global independent safety science company, conducted a side-by-side
comparison of two simulated living room fires—a modern furnished room and a legacy furnished room—and filmed the resulting fires. The modern furnished room, which was filled with
synthetic materials, burned to flashover—the condition in which
the gases generated from the fire catch fire themselves—in less
than four minutes from the time of ignition. In contrast, the
legacy furnished room, complete with cotton-filled couches and
a wood frame, did not reach flashover conditions for nearly 30
minutes. The video is available at https://www.ul.com/room_fire/
room_fire.html.
If your home has modern synthetic furnishings and is filled
with electronics, like many homes today, you may not have time
to get out if there is a fire—and that’s due to the fire alone, not
its toxicity. By the time the firefighters arrive, four to five minutes from the time of dispatch, they will be exposing themselves
to the aftermath of a very toxic fire.
October 2013 ■ The Synergist
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FEATURE | Firefighting: A Toxic Profession
Firefighters Love Fires
Just as surgeons like to perform surgery,
firefighters love to fight fire. However,
the majority of calls these days are for
emergency medical services (EMS): heart
attacks, car accidents, falls, and so on.
An informal review of 911 calls revealed
that the total fire-related call volume for
a metropolitan EMS fire department may
represent only 10 percent of all calls to
a 911 dispatch center. That 10 percent
included small fires such as food burning on the stove and car fires, as well as
more challenging structure fires. Firefighters live for “good” fires, and since
those only come along once in a long
while, firefighters want to maximize
their time fighting the blaze.
The self-contained breathing apparatus (SCBA) bottles that firefighters carry
on their backs may allow them only 20
minutes of air. To maximize their time
fighting fire, firefighters will wait to
“click in” the regulator for their SCBAs
until the moment they enter the door to
a structure fire. This practice may buy
them three to five additional minutes of
firefighting time, but waiting to smell
that first whiff of smoke means they are
inhaling air full of carcinogens—many
of which may be above ceiling values or
in an as-low-as-reasonably-achievable
(ALARA) category of exposure. While
SCBA provides the best protection available, this human factor—firefighters’ cultural practice—compromises that level of
respiratory protection.
Fire Overhaul
The danger isn’t gone once the fire is put
out: hazardous contaminants are present even after a fire is extinguished. In
the after-fire environment, firefighters
perform fire overhaul, the mop-up phase
of firefighting, during which they look
for hot embers and ensure that the fire
won’t rekindle.
About 15 years ago while working at
the Phoenix Fire Department, I learned
that firefighters were testing for the
presence of carbon monoxide (CO) after
a fire and using the level of CO as an indicator of when it was “safe” to remove
their SCBA. In other words, they were
operating under the impression that if
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The Synergist ■ October 2013
CO was at a low acceptable level, then
all other contaminants were low as well.
It’s no secret that CO is usually the
“killer gas” if a firefighter runs out of air.
CO is a byproduct of incomplete combustion and is found in elevated levels
at every fire, regardless of the contents
burning. The hemoglobin in our bloodstream—the protein in red blood cells
that carries oxygen—has a greater affinity for CO over oxygen by 240 times.
Too much exposure to CO produces a
condition of carboxyhemoglobin: instead
of delivering oxygen to the cells in the
body, the blood is delivering CO. This
can lead to a condition of hypoxia, a
shortage of oxygen in the body, followed
by severe confusion, combativeness, and
death from CO poisoning.
Although CO is a huge threat during
active firefighting conditions, once fires
are extinguished, CO usually disappears
fairly quickly. In my opinion, CO is not
the biggest health threat during fire
overhaul conditions. Although humans
are able to detect some harmful contaminants—acid gases, for instance, provide
great warning to avoid overexposure to
hazardous contaminants because they
affect mucous membranes—some of
the major health hazards at fire scenes
can’t be detected with your senses (for
example, known carcinogens such as
formaldehyde and toxic irritants such as
glutaraldehyde and acrolein).
After learning of this CO monitoring
practice, I asked a Phoenix Fire assistant
chief how they determined that CO was
the indicator gas for all other contaminants that may be present in an afterfire environment (also known as fire
overhaul). In other words, how did they
“What Is Taking Three Days to Get Out of My Body?”
Firefighters will tell you that, after a “good” fire, they can smell the fire for up to three
days. They smell it in the shower and on their pillow cases. Even their significant
others notice the telltale “eau de campfire” odor emitting from their pores. Firefighters have asked, “What is taking three days to get out of my body?” Unfortunately, no
one knows—but we might have an answer soon.
A few years ago, a female firefighter called me and explained that she had just
returned to work from maternity leave and that she was dispatched to a fire on her
first shift. She told me that she was breast-feeding and asked when it would be
safe to feed her baby. Before reaching me, she’d called
numerous resources for breast milk and breast-feeding,
but no one had any answers for her.
I contacted a colleague at University of Arizona
School of Public Health, Dr. Jeff Burgess, MD, MS,
MPH, and he agreed to organize a formal study to
identify what is getting into firefighters’ breast milk and
how long it takes to eliminate itself from their bodies.
We recruited lactating female firefighters to participate
in the study to “pump and dump” their breast milk for
several days following a firefight. It was no easy feat:
after we’d found our participants, they still needed to
be dispatched to a fire before we could begin sampling.
We had to wait so long to collect some samples—three years—that the firefighter
who’d asked the question that sparked the study had two more children in the
meantime.
Over the course of the study, we received breast milk from 10 fires. We collected a sample of baseline breast milk and samples immediately after the fire, at 24
hours, at 48 hours, and at 72 hours. The University of Arizona plans to analyze this
breast milk before the end of 2013.
— Dawn Bolstad-Johnson
Firefighting: A Toxic Profession | FEATURE
know it's safe for firefighters to remove
their SCBAs if CO is low? His answer:
“Well, I don’t know. That’s just the way
we have always done it.”
In 1998, with the support of the Phoenix Fire Department, I set out to identify
contaminants of combustion present
during fire overhaul. The study, which
was published in the May 2000 issue of
the AIHA Journal, involved sampling 26
independent live house and commercial
fires. The data showed that CO does not
predict the presence of anything but CO.
There is no relationship between CO and
the numerous hazardous contaminants
we sampled, including polynuclear aromatic hydrocarbons (PNAs), benzene,
toluene, ethyl benzene, xylene, hydrochloric acid, acetaldehyde, acrolein,
benzaldehyde, formaldehyde, glutaraldehyde, isovaleraldehyde, nitrogen dioxide,
sulfur dioxide, and hydrogen cyanide.
Even now, 15 years later, firefighters’
behavior hasn’t changed much.
A Needed Cultural Change
Industrial hygienists are trained to look
for exposures that may cause disease
or injury, whereas firefighters are more
concerned with hazards that may take
their lives immediately—a collapsing wall
or building, running out of air during
an intense firefight, not being able to
find their way out of a burning building.
Firefighters should protect themselves
from the moment they arrive on the fire
scene. This includes clicking in their
SCBA regulator before walking to the
fire and not waiting until after they detect smoke and inhale their first whiff of
toxic air.
As firefighters’ protective gear improves, along with the technology to
predict some of the more obvious threats
to life, the focus may shift to the silent
toxic exposures that accumulate over the
career of a firefighter. Today, firefighters
who come on the job are each assigned
an SCBA. This is already a cultural shift
from 30 years ago, when firefighters
were considered to be “wimps” if they
used an SCBA at all. An SCBA used to
be “the thing that stayed in the box on
the truck.”
Post-fire Exposures: Arson Investigators
Arson investigators are a group of firefighters who don’t receive a lot of operational
support, such as resources for refilling their SCBAs at the scene of a fire. However,
most arson investigators don’t wear an SCBA or
turnout gear during their investigations. Investigators are on scene anywhere from an hour to more
than a week, depending on the complexity of the
investigation. At the scene, investigators disturb the
contents of the fire, thereby changing the geometry
of the debris pile and likely releasing pockets of
toxic gases that collected during the fire.
I’m currently working with the Phoenix Fire
Department to complete an arson investigator
study we began about two years ago. Preliminary
results show that levels of formaldehyde, a known
human carcinogen, are actually slightly elevated
over the levels of my original study 15 years ago.
Levels are consistently above the ceiling value of 0.1 ppm. The problem is that we
are using traditional industrial hygiene methods (pump and a tube), and the peak
exposures are not captured. These preliminary results also show that the theory
that airborne concentrations drop off as a function of time is not necessarily true,
and that gases collected in air pockets within debris piles can be released during
arson investigations.
— Dawn Bolstad-Johnson
Culture is slow to change, but as
health and safety is increasingly promoted in the fire service as well as in
the general population, there is now a
heightened awareness about the causes
of cancer, including chronic exposures such as those faced by firefighters. Young firefighters are healthy and
strong and want to sustain their health
into retirement.
Still, education is the key. Firefighters
need to know what they are exposed to
and how to protect themselves as building materials and the contents inside our
homes become more synthetic and less
organic.
Dawn Bolstad-Johnson, MPH, CIH, CSP, is director
of Health, Safety, Environment and Quality at PHI Air
Medical LLC in Phoenix, Ariz. She can be reached at
(602) 224-3519 or [email protected].
Suggested Readings
“Characterization of Firefighter Exposures during Fire
Overhaul,” AIHAJ (May 2000). Note: The National Fire
Protection Association’s safety recommendations for
firefighters include a reference to this study.
“Adverse Respiratory Effects Following Overhaul in
Firefighters,” Journal of Occupational and Environmental
Medicine (May 2001).
“Impact of Ventilation on Fire Behavior in Legacy and
Contemporary Residential Construction,” Underwriters Lab
(http://bit.ly/ulfire).
October 2013 ■ The Synergist
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