Tommy Baekgaard Kjaer - A lecture on Cancer and other Occupational Diseases affecting Firefighters
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Firefighter´s Cancer: "Most of the toxic exposure occurs when you take off your BA mask - the toxins enter through your skin, through your nose and through your mouth"
- Tommy Backgaard Kjaer, President of the Danish Firefighters´ Cancer Organization
In the video above, Tommy Backgaard Kjaer - President of the Danish Firefighters´ Cancer Association - lectures about the Danish study and gives engaging and valuable recommendations for how to stay safe from toxins, CO2 contamination and other trauma on the fire ground.
The lecture was presented at the CTIF Seminar "Fire, Rescue & New Challenges" in Brussels, November 12, 2018. Video filmed and edited by Björn Ulfsson, CTIF News.
It is recommended to watch this video full screen set to full resolution (HD 1080p) so that you can more easily see the text and diagrams in the presentation.
The facts in this article and the basis of the text is from a study published by The Danish Firefighters Cancer Association BFC, in October 2017.
The full Report can be downloaded below in this post.
Most of the exposure occurs when taking the mask off
During controlled training at Beredsskabstyrelsen, (the Danish Emergency Management Agency DEMA) it appears that when using full respiratory protection properly, the user is protected against the ingestion of particles through the breath.
However; at the time when the respiratory protection is removed after the end of smoke diving/firefighting, and in areas considered safe zones, the exposure to harmful substances increases considerably.
An increased occurrence of certain heart diseases and an increase of certain types of cancers must be ascribed to the very hard work environment during smoke diving/firefighting in the form of increased body heat, high heart rates and the intake of carcinogens.
These carcinogens primarily enter through the skin but also via the mouth and the nose.
Between 3% and 442 % increased risk
Out of 17 types of cancer a varied over-representation at firefighters is seen compared to the general population from 4 to 427%, 15 of them are on 10% or above. Adding a 15% HWE, the numbers grow to 27 different types of cancer from 3 to 442% whereof 22 are over 10%.
It is worth noticing that common skin cancer is not included in the study but earlier numbers show 531 cases.
Internationally it is assessed that HWE is in a place from 10 to 25% and is an expression of firefighters’ expected better health in relation to the general health. This, basically, better health may be due to the fact that firefighters are going through a thorough health check already before the employment and that they throughout the employment must be in a relatively good shape.
There can be variations of cancer cases through the decades as it can be seen that it may be when looking at the form of employment, full time, part time and volunteer, but it is not a parameter that should be a decisive factor in a legislation made of presumptive legislation but more likely the function as a firefighter.
The same should be applicable when it comes to cardiovascular diseases.
"There should no longer be any doubt that there is a correlation between Danish firefighters’ work/working conditions and the long term development of types of cancer and cardiovascular diseases - which calls for a presumptive legislation", says the report in the Conclusion.
Contaminated gear contaminate the trucks and the station
It is a known problem that gear that has been used in a firefighting incident for the most part are put back on the vehicle and thus over time is contributing to a contamination of the vehicle and the fire station which in almost all cases in Denmark are designed in an unsuitable way in relation to clean and dirty areas/zones as well as in many places there is a lack of, or insufficient, cleaning facilities both for gear, PPE, vehicles and facilities (shower, sauna and locker room) for the crew. In many places there is insufficient vent of the vehicles’ diesel exhaust and some places vent does not exist apart from the natural ventilation when the gates are opened.
Photo above: Shelley Miller, Valdosta Fire Department sergeant, gears up during aircraft live fire training, April 27, 2016, at Moody Air Force Base, Ga. Firefighters broke into groups and took turns combating the fire as they would in the field. (U.S. Air Force photo by Airman 1st Class Janiqua P. Robinson/Released)
There is a connection between being a firefighter and increased risks of developing certain cardiovascular diseases and several types of cancer, according to a Danish study of firefighters using BA equipment during offensive firefighting.
In a Bio-monitoring study, a group of firefighters´exposure to harmful particles and risk of cancer was analyzed.
The biomonitoring study was of 53 young non-smoking firefighter trainees during firefighter training at the (the Danish Emergency Management Agency, DEMA) where the exposure was examined for cancers and cardiovascular diseases.
Bio-markers were collected from the skin, urine and blood and the function of blood vessels and lung function was also tested.
The study found that there are connections between being a firefighter and developing certain cardiovascular diseases and several types of cancer.
The study also found there is a severe strain on the heart is during smoke diving and other forms of firefighting using a breathing apparatus.
There is also a connection between the exposure of tar substances (Pyrene and PAHs) with damage to the DNA.
The weight of the gear is also a problem
Physical stress load: A weight measure of firefighters gear shows how much firefighters are loaded with already before they are doing the actual firefighting efforts (psychical stress and strain).
Interrupted sleep can pose health risks
Firefighters must sometimes be on stand by during 24 hours of the day and must respond to alarms/calsl during the night even after having worked the whole day and evening. Not being able to wake up in a calm manner when the alarm sounds is a heavy strain for the body and the circadian rhythm of the individual is disturbed.
This interruption and strain is suspected of increasing load on the cardiovascular and for having a relation to certain types of cancer.
Recommendations for Prevention and Future studies:
- A law that recognizes over represented cancers as occupational disease for firefighters. Internationally called "Presumptive legislation. Fair act for firefighters".
- Introducing better preventive procedures that reduce firefighters´ exposure to harmful particles and gases at the site of injury. This is about all used PPE and equipment.
- Introduction of logistics for proper handling of contaminated equipment from the site of injury.
- The introduction of procedures for the correct handling of contaminated PPE and equipment from the site of injury, the arrangement of laundry rooms in clean and unclean areas as well as safe and efficient washing and decontamination machines.
- Correct design of fire stations in clean and unclean areas.
- Introduction of direct point extraction from vehicle exhaust.
- Correct locker room and washing conditions for personal cleaning after insertion.
1. Rinse off soot – 2. sauna for sweating – 3. rinse of sweat – 2. regular finishing wash (with soap)
- Special appropriations earmarked for improvements to the above measures and equipment where it may be missing.
- BFC is working on a digital logging system for accurate and personal documentation of all incidents and strains, both physical and mental (easy and simple to use by firefighters and ambulance professionals regardless of location and conditions). This documentation may contribute to future epidemiological and other studies. (BFC would like to receive sponsorship and help for faster development and publishing).
- A study that must identify the general public health of Danish firefighters relative to the population, thus obtaining a more accurate figure for "Healthy Workers Effect" and thus their real starting point for developing certain diseases and disorders. Internationally estimated from 10 to 25%. BFC estimates the general health status of Danish firefighters to be 15% better than the average population. Such a study could formally be carried out by the Statens Institut for Folkesundhed (National Institute of Public Health).
- Studies of toxicity from different types of fires in Denmark through the collection of material from fires. Analysis and mapping of causes of fire spread. Measurement and analysis of toxicity from specific materials that are essential for fire and spread.
The Danish Firefighters Cancer Association BFC (BrandFolkenes Cancerforening) works with the above subjects, both nationally and internationally, either in collaboration with sister organizations, researchers, firefighters, various organizations and producers with an interest in improving fire protection and/or improving the working environment, including through work procedures and development of new products.
BFC is a 100% volunteer non-profit association without any special interests and we call on all the country's fire brigade associations and others who are not already part of the work to join.
BFC is still available with our knowledge and advice.