Firefighting and cancer
16 Dec 2019

"The evidence on firefighters´cancer is clear. What are senior management & WHS waiting for?"


"What are we waiting for"? asks Shan Raffel, one of the world´s top instructors CFBT on his YouTube channel about this video, which serves to remind us of the issue concerning firefighters´cancer and the recent research linking the toxicity of smoke and soot to several workplace related illnesses.

Edited by CTIF Information Coordinator Björn Ulfsson
The video above is a short 3 minute summary of the toxins firefighters are exposed to during callout and training, and the relatively easy steps management can implement to help minimize this exposure by proper hygienic routines dealing with and cleaning contaminated tools, off gassing turnout gear and sooty helmets. 
The below video, "From Knowledge to Practice" is about an international teaching project in Ottawa, Canada, where several iCFBT concepts within firefighter training, originally originating in Sweden, was attempted to be brought into a North American fire fighting context. Towards the end of the video, some basic cleaning and handling techniques for dirty fire gear is described, as well as a summary of the reasons why to do it, described by project leader Peter McBride in 2016.


"The evidence is very clear. Every Fire Service in the world should be practicing hot/warm/cold zone management and basic gross fireground decontamination. It costs nothing and can significantly reduce firefighter exposure to carcinogenic and teratogenic substances such as VOC's and PAH's that accumulate in the PPE and PPC after exposure to structure fires", writes Shan Raffel, international fire behaviour trainer from Brisbane, Australia.

However, the concept of cleaning helmets, bunker gear and tools already on the fire scene, before bringing dirty gear back in to  the truck or the station, is hardly anything new. The working method "Healthy Firefighters" was first developed in Sweden in the early 2000s, and has been expanded upon primarily in parts of Canada, United States, Australia and Belgium. 

However, even though the concept is simple, implementing the proper procedures takes effort, determination and will mean that some extra time needs to be allotted after the call out.

Paradoxically, quite often, firefighters themselves are the ones resisting the extra work and effort needed to keep contaminants off the body and out of the fire station after callouts. Therefor, a strong determination is often needed within management to not only encourage but to enforce proper cleaning and handling procedures for used firegear. 

It has long been established that there is a connection between the firefighting profession and the risk of suffering from serious illness. Already in 2007, the World Health Organization established the connection between the firefighting profession and various forms of cancer - testicular cancer, prostate cancer and cancer of the lymphatic system.

Stefan Magnusson and David Hultman
Text by Stefan Magnusson and David Hultman. Photos by Johan Eklund, except for page 19, David Hultman and page 25, Claes-Håkan Carlsson.

The result was reached by a work group consisting of 24 researchers from ten different countries (Straifet al. 2007).

From the Book Healthy Firefighters, by Stefan Magnusson and David Hultman:

"Many questions remain unanswered and ambiguity surrounds the issue of how firefighters are affected by their work environment over time. The context is complex, as so many different factors work in combination to affect firefighters’ health.

According to research, the health risks entailed by firefighters’ work situation not only lead to cancer, but other health problems such as fertility disorders, cardiovascular diseases, asthma and allergies (LeMasters et al. 2006).

If we summarise firefighters’ conditions, we can distinguish a number of health factors that are known and well documented."

This article represents Chapters 1 and 2 of the book Healthy Firefighters. You can download the entire book as a PDF at CTIF.org here

"Firefighters often work in shifts with irregular hours and thereby irregular stress patterns.

Firefighters expose themselves to extremely hard physical strain and thermal stresses for short periods.

Being a firefighter is associated with an identity rather than a profession, which leads to long employment.

This in turn lays the foundation for occupational illness.

No one can know exactly which substances or combination of sub- stances individual firefighters are exposed to, nor the extent to which this happens. For unknown substances, there are no hygienic threshold values. It is not possible to establish what dose or how long an individual must be exposed to unknown combustible gas particles in order for it to be harmful.

It is therefore difficult to introduce health checks that provide an early warning of imminent illness. Some of the diagnostic methods available today for these types of illness are still not perfected and not entirely reliable. One example is the PSA test for prostate cancer (Cooper et al. 2004).

Attempts to diagnose illness at an early stage may therefore lead to unnecessary medical treatment and anxiety in the individual. The types of cancer concerned here are difficult to anticipate and detect in their preliminary stages. At the same time, the connection between a heightened risk of illness and the firefighting profession has been proven. (LeMasters et al. 2006).

A reasonable conclusion from this must therefore be that it is important to minimize the occasions on which firefighters come into contact with unknown matter and substances. Theoretically, it should be possible to completely protect fire- fighters from exposure to harmful substances.

In practice, how- ever, firefighters attending the scene of an accident/fire are sometimes forced to enter an extremely unhealthy work environment if they are to be able to carry out their work. Such situations not only arise in the event of large, spectacular fires but also smaller and more everyday incidents.

These everyday incidents are so frequent that they likely constitute the major portion of the total exposure to harmful substances. Even if the employer were to use all available means to improve the firefighters’ situation, the work environment could not be completely sterile and free from harmful situations and particles. With common sense and simple tools,however, clear improvements can be achieved for firefighters.

Thus far, there has been a lack of a compilation of effective measures for reducing the quantity of foreign substances in fire- fighters’ work environment. This book contains examples and solid advice on how firefighters and organizations can achieve an improved work environment with very simple means and thereby also better health for the firefighters.

The ”Healthy Firefighters” project and the Skellefteå Model‌‌
Sweden is no exception when it comes to problems facing firefighters across the world. Firefighters’ work environment is a global problem and several types of cancer are classed as an occupational illness for firefighters in Canada, Australia and parts of the USA (Forrest, A.2012).

Strong measures are required in order to quickly and adequately effect changes to the current situation. Back in 2006, Swedish employee and employer organizations came together over the issue in a collaborative project which took the name “Friska brandmän” (Healthy Firefighters).

At a fire station of average size in the northern part of the country, a model was created within the scope of the project with which to address the health risks. This work method came to be known as the Skellefteå Model, after the location of the emergency services where the method was developed.

The Skellefteå Model received the prestigious “Good practice award” from the European Agency for Safety and Health at Work in 2011 and thus became internationally acclaimed and recognised. Together with the European Trade Union Institute (ETUI), the European Federation of Public Service Unions (EPSU) has had the Skellefteå Model in its action programme since 2012. The programme names the model the Skellefteå Model. The Skellefteå Model is also referred to as The Swedish Way in international contexts.

Focus on being exposed to unknown substances
This book looks at the link between the firefighting profession and the risk of suffering from serious illness as a result of being repeatedly subjected to unknown harmful substances. It also discusses proposed measures for handling this."


This article represents Chapters 1 and 2 of the book Healthy Firefighters. You can also download the entire book as a PDF at CTIF.org here