Q&A: Taking a stand against firefighter occupational cancer

Fire Chief Nathan J. Trauernicht loves the fire service. It has been his life’s passion.

But like so many firefighters, Chief Trauernicht’s career has included the pain of loss: “For years, I lost friends made during my career to cancer and thought to myself, ‘Oh how sad to lose them to cancer, must’ve had a family history ….’ Now the first thing that goes through my head is, ‘What were the exposures that caused this and what could have been done to prevent this loss?’ With this new question, and perspective, I want to dedicate the remainder of my career to preventing the loss.”

Chief Trauernicht is not alone. More and more fire service organizations are turning their focus to firefighter occupational cancer prevention. One event in particular – the 2019 Firefighter Safety Stand Down – encourages departments to suspend all non-emergency activity from June 16–22 to focus on training and education related to the Stand Down theme: “Reduce Your Exposure: It’s Everybody’s Responsibility.” The event is sponsored by the International Association of Fire Chiefs (IAFC) and the National Volunteer Fire Council (NVFC).

FireRescue1 connected with Chief Nathan J. Trauernicht – fire chief of the University of California Davis Fire Department (UCDFD) and at-large director on the IAFC Safety Health & Survival Section board – to discuss this year’s cancer-focused Safety Stand Down and what firefighters can do to protect themselves and their brother and sister firefighters from experiencing an occupational cancer diagnosis.

FireRescue1.com: Firefighter occupational cancer prevention seems like an issue that took a long time to get the attention it deserves. Why do you think it took so long for it to become a major focus of attention?

Chief Nathan J. Trauernicht: As an industry, I think we can all agree, it took a long time to make cancer prevention a priority. Unfortunately, even with all we now know, it still isn’t a top priority for everyone.

Why did it take so long? Because we tend to universally accept all risks (known and unknown) by taking the job of firefighter, and thus we have perpetuated a culture where we opt to not acknowledge the validity – the very real implications – of the hazardous environments we operate in. If we have already made the decision to accept all consequences, regardless of the opportunity to reduce risk when we can, then of course in that context it makes sense that it has taken a long time for firefighter occupational cancer to become an issue of significance.

Perhaps the greatest irony is that as I discuss the issue of firefighter occupational cancer with those outside of the fire service, everyone basically says, “Duh, how did you all not know that the stuff created when fire burns causes cancer?” What do you say to that?

How do you focus on cancer prevention at your department?

At the UCDFD, we have a committee tasked specifically with researching, developing and implementing programs and services that support firefighter health and wellness.

The first major initiative when the group was formed in 2016 was to create and implement a firefighter occupational cancer exposure reduction program. Their work so far has resulted in the implementation of:

• Annual NFPA-compliant medical physicals for all employees
• Post-fire decontamination standard operating guidelines (SOGs)
• A second set of structural and wildland PPE for all employees, including a second hood
• Adoption of the recommendations of the IAFC Volunteer and Combination Section (VCOS)/NVFC Lavender Ribbon Report Recommendations
• Adoption of best practices from the Washington State Council of Fire Fighters (WSCFF) “Healthy In – Healthy Out” program
• Participation in the California Professional Firefighters (CPF) Personal Exposure Reporting System
• No PPE allowed in the station other than in the apparatus bay
• Creating clean command vehicles by discontinuing the use of SUVs and moving to pickups with contaminated gear storage solutions separate from the passenger compartment
• And much more!

UCDFD is also in the process of joining the National Fire Operations Reporting System (NFORS) Exposure Reporting System.

What are the top three practices that you would advise departments immediately implement to help prevent toxic exposures?

It isn’t possible to only pick a top three when it comes to what our firefighters should be doing to protect themselves and others. The Lavender Ribbon Report released by the IAFC-VCOS and the NVFC identifies 11 practices that will help to start addressing the exposure risk.

Beyond those practices, the message that needs to be sent and heard is that each person, in each department, needs to do ANYTHING and EVERYTHING they can to minimize their exposure to the products of combustion.

If I were going to make a “top three broad recommendations” around the topic of firefighter occupational cancer, they would be:

1. Educate yourself and those around you about firefighter health risks, what exposure is, and how you can help each other reduce opportunities for exposure on every fire call;
2. Hold yourself and those around you accountable to follow best practices and recommendations that always reduce exposure – on the call, in the fire truck, at the station, everywhere; and
3. Recognize that even if you can’t do EVERYTHING, the fact that you and your fellow firefighters are doing SOMETHING will make a difference in your cumulative exposure!

It is also important that every time you are exposed to a hazard, you should be recording it. This not only helps you take preventive measures and communicate risks to your healthcare provider, but also helps you receive the proper benefits in the event of a cancer diagnosis.

What apparatus-specific practices do you recommend?

Departments should be paying attention to developments involving the clean cab concept to reduce any potential secondary and tertiary exposures to carcinogens. The concept sets a high standard so the cab can be universally considered a safe, clean place for personnel that is free of contamination. At its core, the clean cab is to ensure that no equipment used in active firefighting is housed, bracketed or otherwise kept in the interior passenger compartment of any response vehicle.

Keys for keeping the cab clean:

• Implement post-fire gross decontamination of firefighters and equipment prior to leaving the scene to reduce the transfer of toxins and harmful products back to the fire station;
• Prior to leaving the scene, store PPE in department-approved bags that are at least 6-mm thick. Twist, tape, then gooseneck (folded over on itself and then twisted and taped) the bag opening to minimize secondary exposures to any off-gassing; and
• When practical, all bags should be secured on the outside of the apparatus and not inside the passenger cab.

Apparatus modifications:

• Hot water tee-off: Some departments have designed and retro-fitted a quick-connect fitting on the pump panel to give a constant flow of hot water for gross decontamination at the fire scene by teeing off of the pump intercooler line that runs behind the panel. Utilizing tank water crews can quickly rinse off soot and debris. A quick-connect coupling added to a washer hose allows users to control the spray.

What PPE-specific practices do you recommend?

• Full PPE must be worn throughout the entire incident, including an SCBA during salvage and overhaul.
• A second hood should be provided to all entry-certified personnel in the department.
• Following exit from the immediately dangerous to life or health (IDLH) and while still on air, you should begin immediate post-fire gross decon of PPE using soapy water and a brush if weather conditions allow. PPE should then be placed into a sealed plastic bag and placed in an exterior compartment of the rig, or if responding in personally owned vehicles (POVs), placed in a large storage tote, thus keeping the off-gassing PPE away from passengers and self.
• PPE, especially turnout pants, must be prohibited in areas outside the apparatus floor (i.e., kitchen, sleeping areas) and never in the household.

What do you see as some of the biggest obstacles for departments trying to manage cancer risks – funding, culture, tradition?

Aside from those obstacles mentioned, we need firefighters brave enough to be champions of the cause. We need to continue to explore methods to speed the decon process and more quickly return units to service. We need more research to better understand the correlation between specific exposures and their impacts on our health.

I don’t want to minimize the obstacles of funding, culture and tradition by calling them manufactured, but here are some realities from my perspective:

Funding: There are a lot of low-cost and no-cost options out there that will help start reducing exposure. Spend some time on the 2019 Safety Stand Down website and it won’t take more than a few minutes to see that there a lot of practices that won’t break the bank but will save your life.

Culture/tradition: There are two things I keep hearing from those not embracing the idea that we collectively need to act:

1. “It’s too late for me. I’ve already been exposed to too much and making changes now won’t make a difference.” My response: Everything that you can do to protect yourself DOES have the ability to reduce your risk profile. Science proves that exposure mitigation measures of any quantity can and do impact potential outcomes.
2. “We are spending too much time trying to avoid risk; this is the job and we all just need to get it done. Less talk, less worry, more action!” My response: Let’s pull our heads out of the sand. The job still isn’t safe even with doing the things discussed here. There is still plenty of risk to go around. Doing a few things to keep yourself healthy doesn’t make you any less of a firefighter. If you won’t do it for yourself do it for your family, or for someone who loves you, or who relies on you, do it for someone who needs you around for as long as you can be.

Why did the IAFC-SHS and NVFC choose cancer prevention as this year’s Safety Stand Down theme?

The 2018 Safety Stand Down focused on annual medical physicals for firefighters. The annual physical is the cornerstone of all thing’s related to firefighter health. So, as we sought to continue to build on last year, we wanted to highlight the connection to firefighter occupational cancer risk and all the work being done around it. This was the right time, right place, to have the conversation.

The theme focuses on how it’s “everybody’s responsibility.” What is the chief’s role in emphasizing cancer awareness and prevention? What is the company officer’s role?

Everyone at every rank shares the same role in this: Be an advocate, model the way, and hold each other accountable. It doesn’t matter if you’re the chief or the newest firefighter, those three things should be done by everyone, every day, on every call. It’s going to take the village to make a lasting change that will save firefighter lives for generations to come.

How will your department recognize this year’s Safety Stand Down?

The UCDFD will be using the resources we have gathered for this year’s stand down to:

• Have “crew conversations” about exposure risks, what we are doing well, what could be improved, and where we need to focus our efforts to see the most impact.
• Watch webinars and podcasts developed for the Safety Stand Down that reinforce key messages and action items that we can put into practice every day.
• Review academic and scientific studies and research to enhance and expand our factual knowledgebase on the scope of cancer risk and what has been scientifically shown to make a difference to reduce it.

Earlier you referenced the Lavender Ribbon Report on Best Practices for Preventing Firefighter Cancer. Can you tell me a little more about this report?

The Lavender Ribbon Report is a summary of best practice solutions to implement in your department to prevent cancer. IAFC-VCOS and NVFC aimed to keep this report focused and filled with tangible takeaways and solutions. Divided into 11 best practices, the report provides background information, statistics, resources and action items to put into place. The full report, which is an incredible resource, is available on the 2019 Safety Stand Down website.

What other cancer-related resources or projects is the IAFC working on?

The IAFC and many of its sections, divisions, committees and taskforces are working on collaborations addressing not only firefighter occupational cancer, but also firefighter health and wellness more globally.

Perhaps no one group has played more pivotal role in keeping firefighters safe than the IAFC Safety, Health, and Survival Section. IAFC-SHS has a reputation for being on the leading edge of projects and initiatives that ensure firefighters go home at the end of each shift.

The IAFC-SHS/NVFC partnership to deliver the Safety Stand Down has resulted in an impressive collection of firefighter cancer-related resources for individuals and departments to use.

Is there anything else you’d like to add about the issue of cancer in the fire service?

Most of us don’t like having hard conversations. We like to avoid confrontation; we want to keep the peace. But sometimes a hard conversation is the best thing we can have with someone to show them just how much we care.

If you believe in the brotherhood/sisterhood, or that the fire service is a family, show your co-workers how much they mean to you and why you don’t want them to be taken by preventable cancer.

Care enough to have a conversation.