The dangers firefighters face are well known, but a new risk is sounding alarms among leaders in the service and leading to changes in the firefighting culture.
While no specific study has been done to look at Missouri firefighters, national studies by groups such as the National Institute for Occupational Safety and Health show firefighters are two times more likely to develop some sort of cancer than the general public.
Leaders of the fire service in the Show-Me State are taking those figures to heart and working to keep their fellow firefighters as healthy as possible.
"When I started in the '80s, if you had dirty gear and smelled like smoke you were a man's man. But by doing that, we were probably our own worst enemy," State Fire Marshal Tim Bean said. "We're finding out that the types of materials in structures have changed in the last 30 years. Our fires are hotter, burn faster, and are laced with all sorts of carcinogens and byproducts of the plastics that we have in our homes and businesses."
Studies show these byproducts saturate into firefighters' gear and eventually into their skin, Bean said.
"We've got to re-train ourselves, and that means start washing and decontaminating our gear when we get out of these situations," he said. "Many departments have wipes on all their engines and trucks, so immediately they can clean off gear to try to mitigate exposure. It's going to be a totally new learning curve. We've done it a certain way for so long."
From the division level, Bean said, they'll work on getting funding to educate firefighters about this.
"We've got 28,000 firefighters in Missouri, both professional and volunteer, so this is a very critical situation," he said. "Some of the larger departments have a funding mechanism that might allow for two sets of gear, but rural departments can't do that. People share. I came from where we got one set of gear and it has a shelf life. But some departments can't afford to change like they should, so they have to keep them for years. The more washing, the faster it breaks down and wears out."
Tracy Gray, head of special programs at the University of Missouri Fire and Rescue Training Institute in Columbia, said the institute has been working to promote cancer awareness for the past five years.
This coincides with one of the larger studies on cancer and firefighters, done in 2013 by the National Institute for Occupational Safety and Health, which looked at deaths among 30,000 firefighters in Chicago, Philadelphia and San Francisco. It found cancers of the respiratory, digestive and urinary systems accounted mostly for the higher rates of cancer seen in that group. The population of firefighters in the study also had a rate of mesothelioma two times greater than the rate in the U.S. population as a whole. Researchers said it was likely the findings were associated with exposure to asbestos, a known cause of mesothelioma.
"In some of the newer fire stations, they are actually putting in saunas," Gray said. "When they get back from a call, a firefighter can sit in the sauna and get the toxins sweated out. Now, with 70-80 percent of Missouri having volunteer firefighters, we're emphasizing them to take hot showers when they get home or at the fire house."
Gray said they are excited to see Gov. Eric Greitens support efforts to get cancer recognized as a workers' compensation issue for firefighters.
One finding of a report from the Fire Fighter Cancer Support Network in 2013, Gray noted, was the significant direct and indirect costs of a cancer diagnosis on a fire department.
"The loss of a qualified and experienced member, even for the time of treatment, includes training, overtime and backfill, and will increase insurance costs after a cancer event which adds to the costs of both the individual and the department," the report notes.
The report also noted many awareness and prevention efforts, including operational changes, are low cost and high impact.
"These must become a priority," the report notes. "If governing jurisdictions are proactive with funding, the wellness of firefighters will be enhanced and the overarching costs that accompany a cancer diagnosis can be better managed and even minimized."
Jefferson City Fire Chief Matt Schofield said his department has ramped up efforts to combat cancer risks over the past few years.
The department has adopted a multi-point plan with the top priority to get all firefighters a second set of turnout gear to switch out after each fire. They also get a new fire-retardant hood so contaminated hoods can be replaced on the scene.
Other parts of the plan call for transporting contaminated gear and equipment outside the cab of trucks or in airtight bags after a fire and decontaminating bunker gear and equipment on the scene with follow-up wipe decontamination in vulnerable areas with skin contact. Departments also are working to prevent dirty fire gear from cross-contaminating the living space at fire stations by establishing bunker gear exclusion areas at each station.
Some parts of the plan were addressed with installation of new equipment. Commercial gear washers were put in at Stations 1 and 3, and the hope is to add them at a potential new Station 2 and the Hyde Park Training Facility. These are used to wash bunker gear after each fire. Air contaminant scrubbers - to include fresh air intake - also have been installed in the truck bays at all fire stations.
Schofield said the plan calls for annual medical evaluations with blood work for early detection coupled with daily physical fitness expectations for all firefighters. The fire department safety committee and department leadership will continue to deliver exposure training to all firefighters and to monitor mitigation procedures, he added.
"We developed this plan so that individual firefighters are protected in the best way possible," Schofield said. "I want to emphasize that we will always be vigilant to keep up with new developments from studies so that we can continue to protect our firefighters as best as we can."