Firefighter decontamination challenges: Knowledge versus practice

Do firefighters in the U.S. fully recognize the benefits of post-fire cleaning and decontamination of themselves and their equipment to reduce the risk of developing cancer? Common wisdom would say yes, given the amount of information that’s been promulgated by fire service organizations like the IAFC and IAFF as well as non-fire service organizations like the Fire Fighter Cancer Foundation and the Firefighter Cancer Support Network.

Firefighter cancer awareness is not enough

In 2018, T.R. Harrison and his colleagues, collected data for a research study to see how well firefighters were using their knowledge of the risk (awareness) and changing their work behaviors and practices to the desired results (those identified as reducing the cancer risk). The researchers surveyed 482 firefighters from four Florida fire departments examining their attitudes, norms and perceived barriers to field decontamination processes. Here’s a snapshot of the findings:

“Overall, firefighters reported positive attitudes, beliefs, and perceived norms about decontamination, but showering after a fire was the only decontamination process that occurred regularly, with field decontamination, use of cleansing wipes, routine gear cleaning, and other behaviors all occurring less frequently. Firefighters reported time and concerns over wet gear as barriers to decontamination.”

The study’s results showed that while firefighter attitudes were overwhelmingly favorable toward cleaning gear (knowledge), their actual decontamination and cleaning behaviors (doing) did not follow at the same level. This is somewhat like the divergence between attitude and behavior in other areas of health and safety concern, such as public attitudes and behaviors related to using a phone to talk or text while driving.

 

Firefighter decontamination

One of the major pushes in firefighter decontamination has been reducing the absorption of toxic and carcinogenic particles through the skin. Gross decontamination after exiting the hazard area, prompt removal of PPE, and cleaning skin on the head and neck have been identified as ways to reduce that source of contamination.

Perhaps more importantly, the prompt showering (within an hour) upon arrival back at the fire station with a change into clean clothes has been identified as the desired result. But Harrison and his researchers found that only 64% of the firefighters in the survey reported showering within an hour. More alarmingly, 10% of the surveyed firefighters reported that they never showered after a fire or rarely did so.

Harrison and his team also found that other proactive approaches to firefighter decontamination at the emergency scene (e.g., protective hood swaps and gross decontamination for everyone who worked in the hazard area) were still considered to be a “new” practice and had not been widely adopted.

Cleaning turnout gear

While those study findings may cause one to scratch their head, here’s another one that will have you wondering, “What are they thinking?”

Take the routine cleaning of bunker gear back at the station following interior structural firefighting—should be a standard practice in every fire department, right? So, why did only 72 of those 482 firefighters surveyed (15%) say that they routinely cleaned their PPE back at the station following a fire?

Firefighters participating in the survey indicated high levels of concern about the time it took to launder gear (e.g., only one washer/extractor at a station) and the negative impact of having wet gear (because they only had one set of PPE) on job performance (wet gear is harder to don and increases the potential for steam burns when worn during a subsequent fire).

Changing firefighter attitudes and behaviors for compliance

The article, How to increase firefighter PPE and SCBA compliance, is relevant to this discussion. Replace all references to “firefighters not complying with standard operating guidelines (SOGs) regarding proper use of their PPE and SCBA” with “firefighters not doing what they need to do to protect themselves from exposures to toxins and carcinogens,” you’ll see that they are two sides of the same coin.

Most of us think of progress or improvement as the spread of enlightened thinking: Give people the information, provide some training, and the problem is solved. In the fire service culture, where so much emphasis is placed on education and training for skills development, we’ve come to believe that to change the culture of a fire department, we can do it by appealing to the sense of right and wrong in our people (e.g., who wouldn’t want to protect themselves from cancer?).

But if we really want to make meaningful and lasting improvements in the fire service culture, we may gain more ground by stopping our efforts at tapping into people’s desire to be good or virtuous. Rather, we should focus on something less lofty and, quite frankly, harder to admire: an individual’s powerful drive to fit in with the current and “accepted” cultural norms.

Here are two powerful tools from How to increase firefighter PPE and SCBA compliance for fire department leaders:

  1. Support a firefighter’s individual will. When an individual firefighter’s knowledge of occupational risk compels them to comply with measures to reduce exposure to chemicals, chemical compounds and carcinogens, despite these other pressures, it’s because of their individual will.Fire department leaders can strengthen an individual’s will by regularly providing good training and education on safety practices and the potential risks of their work. Firefighters who truly understand the what, why and how regarding these new procedures and work practices—to protect them from exposure to toxic materials and carcinogens—are better prepared to resist negative pressure from others who choose not to comply.
  2. Lead by example. Fire department leaders—from the company officer to the fire chief—should always comply with measures to reduce exposures to toxins and carcinogens when they’re on the scene and back at the fire station.The study group that looked at why firefighters don’t comply with PPE and SCBA policies learned that firefighters are more inclined to wear their PPE when leaders set a personal example by wearing their own PPE. They found that organizational solidarity was a powerful tool for showing that those leaders promote and embrace the organization’s safety policies.

So, while we know that firefighters’ knowledge may not always translate into action, we as leaders must also understand that the new habits are not formed overnight. In fact, James Clear reports that, “on average, it takes more than 2 months before a new behavior becomes automatic—66 days to be exact. And how long it takes a new habit to form can vary widely depending on the behavior, the person, and the circumstances.”

Thus, for these key behaviors necessary to reduce the risks associated with interior structural firefighting to become the new habits, first-line leaders (e.g., company officers) must set the stage and model the correct behavior, and most importantly, be persistent. As one of my mentors frequently said, “The company officer must be unyielding when it comes to the safety and welfare of our people.”

Also know that there are multiple approaches to impact their behaviors to better protect themselves. Key to this is understanding individual drives and the importance of individual will.

The views of the author do not necessarily reflect those of the sponsor

References

Avsec, R. P. (2014, July 31). Changing the Fire Service Culture. Retrieved from Talking “Shop” 4 Fire and EMS: http://www.fireemsleaderpro.org/2014/07/31/changing-fire-service-culture/

Clear, J. (2018, June 14). How Long Does it Actually Take to Form a New Habit? (Backed by Science). Retrieved from James Clear: https://jamesclear.com/new-habit.

Harrison, T. R., Wendorf Muhamad, J., Yang, F., Morgan, S. E., Talavera, E., Caban-Martinez, A., & Kobetz, N. (2018). Firefighter attitudes, norms, beliefs, barriers, and behaviors toward post-fire decontamination processes in an era of increased cancer risk. Journal of Occupational and Environmental Hygiene, 15(4), 279-284.

It’s in the smoke: cancer-causing compounds and contaminates

Every firefighter today should know that smoke is dangerous. However, the visible particles of combustion that we see as smoke are just the tip of the fire scene contamination iceberg. There are several toxic substances and carcinogens firefighters need to be aware of and protect against present in smoke.

We are now learning that firefighters and fire investigators need nothing less than the maximum level of respiratory protection during fire overhaul activities. The typical structure fire today involves the high temperature destruction of many types of plastics, foams, various species of wood, fabrics and other materials.

Gases and particulates liberated from these burning materials often contain toxic, reactive and otherwise unhealthy chemicals that are both inhalation hazards and skin absorption hazards.

Phoenix exposure study

Researchers from the University of Arizona and Arizona State University collaborated with the Phoenix (Ariz.) Fire Department in a study to characterize firefighter exposures during fire overhaul operations at 25 structure fires.

During those overhaul evaluations, air quality monitoring found the following substances or compounds exceeded published ceiling values promulgated at the time by the American Conference of Governmental Industrial Hygienists and the National Institute for Occupational Safety and Health:

  • Acrolein. Acrolein produces intense irritation to the eye and mucous membranes of the respiratory tract. Acute exposures may result in bronchial inflammation, resulting in bronchitis or pulmonary edema.
  • CO. CO is present in all fire environments as a product of incomplete combustion and decreases the oxygen transport of the blood, which results in an inadequate supply of oxygen to the tissues.
  • Formaldehyde. Formaldehyde is classified as a probable carcinogen and adverse health effects due to formaldehyde may occur after exposure by inhalation, ingestion or skin contact. Eye irritation can occur at concentrations of 0.01-2.0 ppm, irritation of the nose and throat at 1.0-3.0 ppm, and severe respiratory symptoms at 10-20 ppm.
  • Glutaraldehyde. Glutaraldehyde is a potent sensory irritant with the capability to cross-link or fix proteins.

In addition, these harmful substances exceeded published short-term exposure limit values:

  • Benzene.
  • Nitrogen dioxide.
  • Sulfur dioxide.

Oregon overhaul study

In a report published in 2011, “A Study on Chemicals found in the Overhaul Phase of Structure Fires using Advanced Portable Air Monitoring available for Chemical Speciation,” researchers focused on direct gas readings during overhaul, measuring these gases over an extended period in comparison to CO, and compiling data to understand post-fire event airborne hazards.

Over an eight-month period, researchers collected and analyzed data during the overhaul phase of 38 structure fires. They learned that the following chemicals or compounds exceeded NIOSH Immediately Dangerous to Life and Health levels: nitrogen dioxide, acrolein, CO, arsenic and mercury.

Additionally, three compounds were present at or above the Oregon OSHA Short Term Exposure Limit or NIOSH Recommended Exposure Level – Short Term levels: nitrogen dioxide, hydrogen chloride and CO.

Finally, these chemicals were found present at or above the Oregon OSHA Permissible Exposure Limit Time Weighted Average: arsenic, acrolein, benzene, CO, formaldehyde, glutaraldehyde, hydrogen cyanide, hydrogen chloride, mercury, ozone O3 and nitrogen dioxide.

Where are the contaminates coming from?

Among the chemicals researchers suspect can be harmful are:

  • Benzene, found in furniture wax.
  • Formaldehyde, found in cleaning materials.
  • Hydrogen cyanide, used in the manufacture of synthetic fibers, stick- and stain-resistant coatings and flame-retardants added to the foam inside furniture.

When flame retardants and other compounds burn, they create reactive oxygen species – molecules that bind to DNA and cause mutations that can lead to cancer.

“Think about smoke as a bunch of carcinogens, because that’s basically what it is,” Virginia Weaver, a professor of environmental health at Johns Hopkins University, said. “The more synthetics there are in the home, the more chemicals are present in the smoke, and the more chemicals that are carcinogens.”

Protective actions for firefighters

Following the lungs, the skin is the body’s second largest organ in area and it is highly absorptive. Some areas of skin are more permeable than others, specifically the face, the angle of the jaw, the neck and throat and the groin. Skin’s permeability increases with temperature and for every 5-degree increase in skin temperature, absorption increases by 400 percent.

Firefighters can reduce their risk for exposure through the following actions:

  • Never breath smoke.
  • Wear all appropriate PPE while in the hazard area.
  • Undergo gross decontamination immediately upon leaving the hazard area.
  • Cleanse the hands, face, neck, and throat with soap and water or disposable wipe immediately upon doffing PPE.

Reducing exposure to these toxins and contaminates can save lives.

Step in the right direction: Decontamination of PPE must include boots

Shoes can be gross. We wear them everywhere. They collect everything – dirt, bacteria, germs, chemicals and mold spores, just to name a few – as we wear them throughout the day. And, then, most of us walk straight into our homes without removing them, only to transfer all that contamination to our carpets and rugs.

GROSS DECONTAMINATION OF FIREFIGHTER BOOTS

Imagine what your firefighting and station boots track into the station: road debris, petroleum residue, contaminated mud and dirt, blood and body fluids. While many fire stations have non-carpeted surfaces for easy cleaning, most dormitory areas are still carpeted. So, what’s in your carpet?

Hopefully, your fire department prohibits bunker pants and boots in the living quarters of your station. But, do you still walk into the kitchen at 2:00 a.m. after returning from a call wearing your bunker pants and boots? Be honest.

We’re paying more attention to conducting gross decontamination of our firefighting protective ensemble components before leaving the fire scene, and that’s a good thing. But what about your firefighting boots? Are they getting a good scrubbing, and not just a rinse from the water flowing down from above?

WHAT DO THE GUIDELINES SAY ABOUT CLEANING FIREFIGHTER BOOTS?

NFPA 1851: Standard on Selection, Care, and Maintenance of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting doesn’t provide specific guidelines for cleaning firefighter boots to the degree that the standard addresses cleaning for turnout coats and pants.

According to Pat Freeman, technical services manager at Globe Manufacturing, for normal cleaning, such as surface debris from a structural fire, Globe advises their customers to use a soft sponge or rag with warm water to remove surface dirt, and then rinse thoroughly with clear water.

“Although we normally advise against using soap or detergents for everyday cleaning, if a boot requires specialized cleaning, we would recommend a very mild dishwashing detergent solution be used sparingly, and then the footwear rinsed off as soon as possible,” Freeman said. “It is permissible to use a soft bristle brush to scrub any dirt or debris off the surface. We do not recommend submerging the boots completely into water.”

Freeman also said that following cleaning, boots should be allowed to air dry. Firefighters should avoid using high heat drying apparatus, such as mechanical driers used for turnout coats and pants, as these can also reduce boots’ service life, especially for leather boots.

“Regular inspection, care and cleaning of all protective ensemble elements is critical to firefighter health and safety,” Freeman said. Firefighters work and walk around in structural fireground environments and come in contact with liquids such as acids, gasoline and hydraulic fluids, to name just a few.

“Departments must include boot cleaning at as high a priority as all other structural firefighting protective ensemble elements.”