When one thinks of firefighters, the most obvious occupational hazards that come to mind are heat and flames. While both can be deadly, an even more insidious hazard could be threatening the lives of firefighters: the fumes given off by the furniture, building materials and electronics in our homes and businesses.
"The modern materials in our homes and workplaces have increased the toxicity of today's fires, and we don't know how these acute exposures impact people's health," said Dawn Bolstad-Johnson, MPH, CIH, CSP, director of health, safety, environmental and quality for PHI Air Medical in Phoenix. "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."
One of the first things cadets at fire academies across the country are told is that their lifespan probably will be a decade shorter than if they'd chosen a different career. Approximately 100 firefighters die in the line of duty each year, but many more succumb to heart attacks and illnesses like cancer.
According to Bolstad-Johnson, the level of toxicity in American homes and workplaces has increased exponentially over the last 15 years, and firefighters often wait to click in their self-contained breathing apparatus (SCBA) until they reach the fire and smell the smoke. What they should be doing, said Bolstad-Johnson, is clicking in the SCBA as soon as they fasten their turnout gear to enter the fire.
Firefighters spend anywhere from 12 to 16 weeks at a fire academy, learning how to fight fires and read fires. While most of their training focuses on fighting fires, the reality is that most firefighters see very few large fires each year.
"In Phoenix – and this is very rough data – there might be 160,000 911 calls for the fire department. Less than 10 percent of those are actual fires and that's spread out between all the fire stations," said Bolstad-Johnson, who spent nearly 20 years as an industrial hygienist with the Phoenix Fire Department. "They spend all this time practicing to fight fires and mostly what they respond to are EMS calls about car accidents and football injuries. And out of the 14,000 fire calls they do get, many are related to food on the stove or self-extinguish themselves before the fire department gets there."
So when they actually get to fight a "big" house or building fire, she added, they want to spend as much time as possible in the building, doing what they've trained so hard to do. But the "bottles" for their SCBAs contain a limited amount of air. The earlier they click over to the SCBA, the less time they have fighting the fire. By waiting until they are in the building, breathing in smoke and potentially dangerous gases, they give themselves an additional five minutes of firefighting.
What they don't think about is that in those five minutes before they click over to the SCBA, the smoke they're inhaling contains formaldehyde, cyanide, carbon monoxide, dioxins, polynuclear hydrocarbons, decabromodiphenyl ether and other gases.
"They keep asking for bigger bottles," said Bolstad-Johnson. "Thirty minutes, 45 minutes, 60 minutes. That way, they can be in the fire longer, which would result in them being exposed longer in that toxic soup."
Bolstad-Johnson said that firefighters who have been on the job for 30 years remember when SCBA were first introduced. Usually, one apparatus was issued for an entire crew of a truck. "It sat in a box in the middle of the truck and if you took it out, you were a wimp," she was told.
"They all had heavy mustaches and beards," said Bolstad-Johnson. "They were ‘smoke eaters.' The facial hair provided some filtering for them. It was almost a sense of pride not to use the SCBA. That's changed now, thankfully."
A report released in December 2013 by the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention and NIOSH, "Evaluation of Dermal Exposure to Polycyclic Aromatic Hydrocarbons in Fire Fighters," noted that firefighters involved in the study wore their SCBA correctly, but still were registering exposures to certain chemicals.
Researchers studied firefighter exposures to airborne polycyclic aromatic hydrocarbons (PAHs) and other aromatic hydrocarbons generated during controlled burns during live fire training.
The researchers evaluated three controlled structure burns (one per day), with five firefighters participating in each burn. They sampled PAHs, volatile organic compounds (VOCs) and particulate in air, and collected breath and urine samples before and after each burn. They analyzed the breath samples for aromatic hydrocarbons and the urine samples for PAH breakdown products. They took wipe samples on firefighters' skin to measure PAH contamination before and right after each burn and measured VOCs released from turnout gear before and after each burn. Finally, they tested the SCBA equipment to make sure it worked properly.
The researchers detected possible cancer-causing PAHs and VOCs in the air, noting that some PAH air levels were above occupational exposure limits during overhaul (the after-fire environment when firefighters rake through debris to ensure that piles are not continuing to smolder). While VOC levels were below occupational exposure limits during overhaul, some VOCs were released from the firefighters' gear after the fire response (but were well below occupational exposure limits).
Levels of benzene, an aromatic hydrocarbon, in firefighters' breath were higher right after the burns than before. However, firefighters did not have elevated levels of benzene breakdown products in their urine.
Most firefighters were wearing their SCBA correctly; exposure to PAHs and benzene probably occurred through dermal exposure, according to the researchers.
"We found that PAHs and benzene entered firefighters' bodies even though they wore full protective ensembles during controlled burns," they noted. "The biological levels we measured were generally comparable to levels in occupational groups with low exposures to these compounds. Firefighters should wear full protective ensembles during all stages of a fire response and wash hands and shower soon afterwards."
After the Fire
Improvements to turnout gear and other personal protective equipment like gloves, boots and helmets allow firefighters to stay longer in the flames and heat, noted Bolstad-Johnson. Years ago, firefighters knew it was time to get out and take a break when they felt the tops of their ears burning. Now, the only thing that limits their time in the fire is the amount of available air in their SCBA. And SCBAs only are effective when the firefighters are wearing them.
In addition to waiting until the last minute to click them on, firefighters "remove their self-contained breathing apparatus [immediately] after the fire is extinguished, because they no longer perceive that a hazard is present," said Bolstad-Johnson.
However, the dangers to the firefighters' health often are present even after a fire is extinguished. Hazardous levels of carcinogens that are not easily detected by our human senses (irritation, taste and smell) can accumulate to levels above published occupational exposure limits in the poorly ventilated areas of homes and commercial buildings. Arson investigators often are exposed to hazards as well, noted Bolstad-Johnson, depending on how soon after the fire they begin their investigations. Riding back in the truck wearing contaminated gear can increase the chances of exposure, as can storing the equipment in the firehouse without hosing it off.
"Firefighters who have worked a big fire say they can smell it on themselves for as long as three days after the fire, and that's after they've taken several showers," said Bolstad-Johnson. "The smell emanates from their pores; their families can smell it. It smells like they've been standing around a campfire."
She said firefighters need to educate themselves about the various hazards commonly associated with fires and by wearing their SCBA and PPE such as turnout gear in an after-fire environment.
"As health and safety is increasingly promoted in the fire service, there is now a heightened awareness about the [respiratory and dermal] exposures faced by firefighters. They need to know what they are exposed to and how to protect themselves as building materials and the contents inside our homes become less organic," said Bolstad-Johnson.