Toxicity threat for UK firefighters February 2021

The job of a firefighter is widely associated with a fit and healthy lifestyle – working a physically demanding job and undertaking annual fitness assessments – but the reality brings a number of hidden risks. A growing body of research from around the world since the tragedy of 9/11 suggests that firefighters have an increased risk of developing long-term illnesses such as cancer and heart disease compared to the general population.

Until now, the UK has been slow to conduct its own research into the effects of long-term exposure to fire effluents on health, making it nearly impossible to link long-term health conditions to the job of being a firefighter. But in November 2020, the University of Central Lancashire (UCLan) published a ground-breaking and detailed best practice report highlighting their extensive research into the subject.

The project was commissioned and funded by the Fire Brigade Union (FBU). General Secretary Matt Wrack writes in his introduction: ‘This report not only provides evidence of the heightened risk faced by firefighters through their work, but also delivers clear and authoritative guidance to fire and rescue services across the UK about the measures they can take to minimise firefighters’ exposure to contaminants’.

Independent Research

The independent research was conducted by Professor Anna Stec, a world leader in the area between fire safety and public health and an expert witness to the Grenfell Tower Inquiry. Professor Stec and her team of researchers from UCLan collected a wealth of information from fire and rescue services across the country, including over 10,000 responses to a national firefighter survey and decontamination policies provided by 80 per cent of the nation’s fire and rescue services.

Fires produce a mixture of toxic, irritant and carcinogenic chemicals that vary depending on the materials being burned. They can be released in the form of particulates (including aerosols, dusts, fibres, smoke and fumes) or gases and vapours. Some of the effluents can cause an immediate reaction, known as acute toxicity, but most have much longer-term adverse effects on health, causing conditions which are more complex and develop slowly, such as cancer, cardiovascular conditions and neurological disease, known as chronic toxicity. Repeated exposure over time increases the likelihood of developing long-term health conditions, and the kind of exposure pathways firefighters will experience are inhalation, dermal absorption through the skin, and ingestion.

Statistics in the report show that four per cent of all the firefighters who completed the survey have already been diagnosed with cancer and of those firefighters most had served between 15-19 years before diagnosis. The three most common forms of cancer among those with a diagnosis are skin, testicular, and head and neck.

As worrying as these figures might initially sound, the research conducted is a positive and thorough investigation for the ongoing benefit of firefighters’ long-term health. Indeed, the results, although unable to control the inherent toxicity of fire effluents, offer stringent measures to control the quantity of toxins that firefighters are exposed to, both during the incident and long after it. The recommendations that have been published as a result will undoubtedly ensure safer management of all fire effluent contamination. They include for firefighters:

• Respiratory protective equipment should be worn at all times while firefighting. It should be the last item of PPE removed after decontamination.
• PPE that is suspected of being contaminated should be transported back to the station in an airtight container in the lockers, not in the cab of the appliance.
• Avoid eating, drinking or smoking with unwashed hands whilst wearing, or after de-robing PPE that may be contaminated.
• After attending a fire incident, all personnel should change into a set of clean, dry clothes, ideally before re-entering the appliance.
• PPE should be clean and should be thoroughly decontaminated after every incident to avoid a build-up of toxic contaminants.
• Protect areas of exposed skin and airways when cleaning soiled PPE/equipment, including wearing respiratory protection and gloves.
• Shower within an hour when returning to the station from an incident or following a live fire training exercise.
• Regular health screening and recording attendance at fire incidents over the course of a firefighter’s career is strongly advised and will be key to long-term monitoring and management of health.

For fire and rescue services:

• Every fire and rescue service must have fully risk-assessed decontamination procedures and ensure all relevant staff are trained in implementing these procedures.
• All fire service personnel should receive regular and up-to-date training on the harmful health effects of exposure to toxic fire effluents and how these exposures can be reduced, minimised or eliminated.
• All fire and rescue services should have policies in place for the routine care, maintenance, inspection and professional cleaning of PPE.
• Establishing and strictly maintaining “designated zones” within the fire station must be a priority for preventing cross-contamination. PPE should never be worn in areas of the station designated a clean zone (eg kitchens, living quarters etc) and should be stored away from personal items.
• To reduce secondary exposures, appliance cabs and equipment from emergency response vehicles should be cleaned and decontaminated on a regular basis, especially after incidents where exposure to any combustion products occurred.

“There used to be a real badge of honour mentality amongst firefighters; they were proud of their dirty, battered kit”

Former Firefighter Andy Thompson

Contaminant Warnings

Andy Thompson is a recently retired Dorset and Wiltshire firefighter and Brigade Organiser for the FBU and is one of the firefighters who completed the UCLan survey. He feels this report will bring positive change to the Fire and Rescue Service.

Throughout his career, Andy has witnessed a real turnaround in attitudes towards decontamination and safety in the workplace. “Years ago, before my time in the service, fires like house fires would burn more natural materials, but more recently we are dealing with a lot more plastics and carcinogenic materials, like from car fires. Being an FBU official I would always encourage the guys to shower straight after an incident.”

As an FBU Brigade Organiser, Andy used to frequently travel between fire and rescue stations to promote the work of the FBU and would often deliver information leaflets warning of the harmful contaminants in fire effluents and encouraging more stringent decontamination policies. He has seen some quite relaxed attitudes over the years: “I’ve been on a shout where there are two firefighters in full PPE tackling the fire, and one other holding back to manage the truck. When it’s over, the two in PPE get back in the truck, still in full gear, and the third person is coughing all the way back to the station from the fumes! There used to be a real badge of honour mentality amongst firefighters; they were proud of their dirty, battered kit.”

He continues to talk about a safer Fire and Rescue Service and the changes to come: “There is more training in place now about the dangers of contaminants, but the problem, moving forward, will be the funding. Each brigade is funded differently and has different needs in terms of developing their stations and equipment to follow the report guidelines. Some will need new trucks with more space for extra lockers, and others will need big re-developments to include the recommended zones.”

Cancer Diagnosis

Graham Rooms, now 56, is a retired Operational Response Officer for Devon and Somerset. In May 2019, three months prior to his retirement, Graham experienced some changes in his urination which prompted him to see a doctor. They conducted a blood test to measure the amount of prostate specific antigen (PSA), and the results were slightly higher than the normal range. He was tested again three weeks later, and his PSA score had rocketed an abnormal amount for such a short time span.

The next three months leading up to Graham’s retirement involved a series of investigations, including a high-risk biopsy on his birthday in September. In early October Graham was officially diagnosed with high grade aggressive prostate cancer. What should have been a time of well-deserved retirement celebrations quickly spiralled into a year of uncertainty, surgery and radiotherapy.

Graham also completed the firefighter survey for the UCLan team and since his diagnosis has taken a personal interest in the subject: “I have certainly done some research into the links between cancer and firefighting, and I know that in America, parts of Canada and parts of Australia they consider it an occupational disease now. I saw the job of a firefighter listed in one article as one of the risk factors for developing prostate cancer! … If there is a link it needs to be clearly identified and dealt with. I don’t want people to go through the same as I have.”

During his time in service, Graham was aware of the dangers of smoke inhalation, and precautions were taken to prevent this. “We were taught to avoid the smoke, but not the other contaminants.” He remembers times when the muster bay was filled with the smell of smoke from dirty kit following a fire. It seemed that decontamination after the event of a fire was not considered as serious as avoiding the inhalation of smoke during the fire. “Decontamination was always associated with hazardous materials, like chemicals being spilt.”

Graham is still being monitored following his radiotherapy treatment in June 2020 and is surrounded by a network of support. “Devon and Somerset FRS, since my diagnosis, have tried to raise the profile of prostate cancer, and there is a push now for more medical screening for firefighters. I definitely endorse the report’s recommendation that there should be annual health screening.”

“If there is a link it needs to be clearly identified and dealt with. I don’t want people to go through the same as I have”

Former Fire Officer Graham Rooms

Health and Safety Monitoring

Ahead of the release of UCLan’s report, the House of Commons Environmental Audit Committee recommended that the Health and Safety Executive (HSE) implement the recommendations on improvements to firefighters’ working environments. The government has since confirmed that it will instruct the HSE to monitor ongoing research and ensure that individual fire and rescue services identify risks to firefighters.

This is very encouraging news, and when I asked the HSE for a statement as to how the suggested recommendations to fire services across the UK might be monitored going forward, they promptly responded: ‘Fire and rescue services have duties to prevent and control risks (so far as reasonably practicable) to health from their employees’ exposure to hazardous substances, and the Health and Safety Executive expects fire and rescue services to ensure that measures are in place to control exposure and minimise contamination, as this may lead to risks to health. Such measures would include the provision and maintenance of suitable personal protective equipment, facilities for storing and cleaning such equipment and providing information, training and appropriate supervision to their employees on potential risks.

‘The Health and Safety Executive is monitoring the progress of all current research which seeks to improve the working environment for firefighters and will ensure that fire and rescue services continue to identify and control risks to their employees’.

The UCLan research team have now moved onto the next stage of their ongoing research project and have begun testing the toxicity of firefighters’ working environments. In a similar research project in the USA in 2019, a research team from the Sylvester Comprehensive Cancer Centre at the University of Miami doused firefighters at the Palm Beach County Fire Rescue in an invisible dye to emulate soot particles and asked the firefighters to simulate a typical working day. Afterwards, the researchers used an ultra-violet light to follow in their footsteps and see how far the powder had travelled. The light picked up traces of the powder throughout the station, including the rest and kitchen areas and, most worryingly, back into one firefighter’s home and onto his son.

Dr Alberto Caban-Martinez led the experiment and says: “Decontamination is such an important aspect of post-incident response. I hope this [experiment] will raise awareness and discussion about how we can improve decontamination within the Fire Service.”

The publication of the UCLan report is the beginning of a new chapter for the UK Fire Service. If the detailed recommendations can be implemented in fire services across the country then firefighters will be less at risk from exposure to harmful contaminants, and many lives will undoubtedly be better protected.

References:

1. FBU article summarising the report:
   https://www.fbu.org.uk/news/2020/11/23/urgent-action-needed-protect-firefighters-cancer-scientists-find
2. Matt Wrack’s statement on the report:
   https://www.fbu.org.uk/circular/2020hoc0629mw/toxic-fire-effluents-and-risk-health-firefighters-important-new-research
3. USA research into firefighters and cancer:
   https://www.nfpa.org/News-and-Research/Resources/Emergency-Responders/Health-and-Wellness/Firefighters-and-cancer
4. Swedish firefighter health and safety report:
   https://www.msb.se/siteassets/dokument/publikationer/english-publications/healthy-firefighters-the-skelleftea-model-improves-the-work-environment.pdf
5. FBU video on YouTube:
   https://www.youtube.com/watch?v=94o8tEE_ywk
6. USA video on YouTube showing spread of contaminants using invisible powder:
   https://www.youtube.com/watch?v=UFzP1rQJWSQ
7. Interview with Andy Thompson, retired firefighter and FBU brigade organiser for south west.
8. USA Multi-city National Research effort – a 30-year study of 10,000 firefighters.
   https://www.ffccs.org/
9. https://prostatecanceruk.org/prostate-information/prostate-tests/psa-test
10. Interview with Graham Rooms, retired Operational Response Officer.