That firefighters are at a higher risk of contracting cancers is now becoming widely established. As mentioned in the paper ‘Firefighters and cancer: Where are we and where to now?’* two separate long-term studies on cancer risk in firefighters in three US cities and five Nordic countries showed statistically significant increases for all cancers. Worryingly, a new finding emerged from both studies showing an increase in mesothelioma, likely to be because of the asbestos exposure occurring when buildings burn, during clean up and also perhaps a result of the asbestos protective gear which used to be widely worn by firefighters.
An increasing awareness worldwide of higher cancer incidences in firefighters has in Sweden resulted in concerted efforts to lower exposure to potential contaminants, and is leading to changes in policy and behaviour as regards protective clothing and other equipment such as fire hose and vehicles.
In Sweden this has resulted in the so-called Skellefteå Model – Better Health for Firefighters.
As described in the free-to-download document Friska Brandmån published by the Swedish Civil Contingencies Agency (www.healthyfirefighters.com) the Skellefteå Model is a points system that exemplifies and describes how firefighters can avoid hidden dangers in their working day with the use of simple routines and logical flows.
The goal of the model is for the firefighters to avoid serious illness as a result of long-term and repeated contact with foreign substances. The model is based on the principle “from one alarm to the next”, which summarises the cyclic activities of firefighters called into duty.
The model is based on the premise that firefighters’ perception of their safety does not always correspond with a real situation that could involve invisible dangers.
It is a team approach that requires firefighters to take individual responsibility for their routine to the extent that any deviation could expose themselves and their colleagues to invisible hazards. In summary, the model requires a degree of change in both daily routine and in the care and maintenance of contaminated clothing.
In the Skellefteå world, when the alarm bell rings firefighters are wearing clothing and equipment that has been decontaminated from the previous alarm. The response vehicle’s cabin is clean and free of contaminated material. The model recommends vehicles are parked in an area where there is little risk of contamination during the incident, with doors and shutters closed when not in use. Personnel wear respiratory protection even when at a distance from the incident – and this includes those involved in follow-up or investigation operations. Upon completion of the incident personnel take off their contaminated clothing and pack it away separately, which ensures not only that contact with contaminants is minimised, but that the vehicle cabin is also free of contaminants. Back at the station, the encapsulated contaminated clothing is laundered in an area separate to normal laundry, in a room with a ventilation system that prevents contaminated air escaping. Gloves, helmets and boots can be cleaned in an industrial dishwasher. Firefighters are encouraged to wash and shower as soon as possible.
The Skellefteå model fills an important gap in the protection of firefighters because, as it points out, despite the known risks there are few (if any) other practical documented action programmes.
The Model’s authors admit that it is highly unlikely that firefighters will ever work in an environment completely free from hazardous substances; nor would it be practically possible, but they point out that no firefighter should have to risk unnecessary ill health or suffering in their attempts to save human lives, property and the environment due to a neglected working environment.
A new generation of fire suits
Gothenburg Fire Brigade in Sweden is one of the first fire brigades in the world that has attempted to put in practice a programme to reduce the risk to its firefighters.
Katarina Appelqvist, Head of Procurement at Gothenburg Fire Brigade, says that the Skellefteå model and the Nordic study into firefighter cancer incidence have both lead to lengthy discussions in the Swedish fire service regarding the risk of contamination that firefighters are exposed to. ‘There is still no clear answer how big that risk is, and we feel we need to know more to identify how to eliminate or reduce the risks.’
Gothenburg therefore began its own project, building on the Skellefteå principles that had shown that although PPE was important, so was the way firefighters worked and how they maintained and cared for the equipment before, during and after a fire. ‘Our goal was – and is – to make the environment cleaner for firefighters and all personnel that handle the materials.’
As a result, when the time came to begin the procurement process for new fire kit Gothenburg’s tender clearly outlined a fire fighting protective suit with a difference. It had to include a detachable outer shell that after an incident could easily be removed by the firefighter without any assistance.
Viking, an international supplier of fire fighting clothing, had some experience of detachable layers. In some countries such as the US, it is mandatory to supply detachable liners, explains Viking sales director Keld Valentin: ‘We already knew about the technology, and we just had to turn it around so instead of a detachable liner we had a detachable shell.
‘Gothenburg set out the parameters for a development project: they wanted a suit that would allow the firefighter to remove the outer shells of the jacket and trousers and put them in a dissolvable laundry bag. And the remaining inner layers had to be fully weather-protective suit for the way home.’ The fact that the waterproof/breathable membrane is contained in the inner garments means the firefighter is protected from the weather as well as other potential contaminants such as petroleum products and bodily fluids.
Appelqvist explains that there are some significant benefits to having such a suit. If the outer layer gets damaged then it can be more easily and more economically replaced compared to purchasing an entire new fire suit. Laundry costs are higher as a result of the new regime, admits Appelqvist, ‘But it makes repairs and visual inspection much easier. And also a good thing is that when it comes to the chemical finish on the outer shell, we are now able to reimpregnate the outer layer only, preventing the chemicals reaching inside of the inner lining and the membrane. We also wanted to avoid this chemical finish coming into contact with the skin of the firefighter.’
Viking recommends that chemical reimpregnation takes place after 5 to 30 washes, depending on the type of treatment applied to the outer shell material and Valentin adds further that with the new suit it is possible to wash the inner and outer layer separately and thereby avoiding cross contamination from the outer to the inner layer and reducing drying time. Also, he adds, separate reimpregnation of the outer shell avoids the scenario of accidentally impregnating the inner layers, subsequently reducing the breathability of the thermal barrier and membrane.
Although the new suit is still to be distributed to every single one of the firefighters in Gothenburg Fire Brigade, Appelqvist reports that the firefighters are satisfied with the suit. ‘We are all very happy and proud to be in an organisation that is willing to try new ideas. But we are not done yet, and we will keep improving the suit together with Viking.’ Reaching a totally safe working environments or inventing a fire suit that is 100% effective is probably impossible, admits Appelqvist, but there are many other ways to reduce risk: ‘We have to look at the whole picture including how we train our firefighters, how they use their equipment, and what their routine is after fires etc. By identifying risks on multiple levels we can in the end reduce the time that a firefighter is exposed.
‘It is us, the buyers, that have to ask for innovative solutions otherwise the market will not come up with them. We have to take full advantage of these opportunities when making a tender, even if development costs are high in this business.’
The future looks bright for the concept of the detachable liner. Valentin says that Viking has received a lot of interest from many European fire departments and training centres: ‘Everyone with a vested interest in health and safety is really open to this product because it could be truly behaviour changing for an organisation.’
For many firefighters wearing dirty fire fighting kit has become emblematic of the heroic nature of the job. This, believes Valentin, has to change. ‘Particularly in the USA more firefighters regard it is a badge of honour to wear dirty kit – and it shouldn’t be.’ As word spreads about the invisible risks that firefighters are exposed to and the positive steps that fire brigades can take to minimise exposure, dirty kit could indeed become a thing of the past.
* Lin Fritschi, School of Public Health, Curtin University, Bentley, Western Australia, Australia and Deborah C Glass, Monash Centre for Occupational and Environmental Health, SPHPM, Monash University, Melbourne, Victoria, Australia.
STOP PRESS: Cofounder of the Healthy Firefighters project and creator of the Skellefteå Model Stefan Magnusson will be presenting at the PPE & Duty of Care Forum taking place on the 2nd of February 2016. For more information click here.