Firefighter hood contamination: Efficiency of laundering to remove PAHs and FRs

Biomonitoring of polycyclic aromatic hydrocarbons exposure and short-time health effects in wildland firefighters during real-life fire events

Human biomonitoring data retrieved from real-life wildland firefighting in Europe and, also, worldwide are scarce. Thus, in this study, 176 Portuguese firefighters were biomonitored pre- and post- unsimulated wildfire combating (average:12-13 h; maximum: 55 h) to evaluate the impact on the levels of urinary polycyclic aromatic hydrocarbons hydroxylated metabolites (OHPAH; quantified by high-performance liquid chromatography with fluorescence detection) and the associated short-term health effects (symptoms, and total and differentiated white blood cells). Correlations between these variables and data retrieved from the self-reported questionnaires were also investigated. Firefighters were organized into four groups according to their exposure to wildfire emissions and their smoking habits: non-smoking non-exposed (NSNExp), non-smoking exposed (NSExp), smoking non-exposed (SNExp), and smoking and exposed (SExp). The most abundant metabolites were 1-hydroxynaphthalene and 1-hydroxyacenaphthene (1OHNaph + 1OHAce) (98-99 %), followed by 2-hydroxyfluorene (2OHFlu) (0.2-1.1 %), 1-hydroxyphenanthrene (1OHPhen) (0.2-0.4 %), and 1-hydroxypyrene (1OHPy) (0.1-0.2 %); urinary 3-hydroxybenzo(a)pyrene was not detected. The exposure to wildfire emissions significantly elevated the median concentrations of each individual and total OHPAH compounds in all groups, but this effect was more pronounced in non-smoking (1.7-4.2 times; p ≤ 0.006) than in smoking firefighters (1.3-1.6 times; p ≤ 0.03). The greatest discriminant of exposure to wildfire emissions was 1OHNaph + 1OHAce (increase of 4.2 times), while for tobacco smoke it was 2OHFlu (increase of 10 times). Post-exposure, white blood cells count significantly increased ranging from 1.4 (smokers, p = 0.025) to 3.7-fold (non-smokers, p < 0.001), which was accompanied by stronger significant correlations (0.480 < r < 0.882; p < 0.04) between individual and total OHPAH and total white blood cells (and lymphocytes > monocytes > neutrophils in non-smokers), evidencing the impact of PAH released from wildfire on immune cells. This study identifies Portuguese firefighters with high levels of biomarkers of exposure to PAH and points out the importance of adopting biomonitoring schemes, that include multiple biomarkers of exposure and biomarkers of effect, and implementing mitigations strategies.

Preliminary analyses of accumulation of carcinogenic contaminants on retired firefighter ensembles

Personal protective equipment (PPE) is designed to protect firefighters from hazards encountered on the fire scene, including heat and products of combustion. Decontamination practices for firefighter turnout gear have been developed to remove combustion products and other contaminants from the fabric of structural firefighting ensembles (i.e., turnout or bunker gear). Chronic exposures to residual polycyclic aromatic hydrocarbons (PAH) are a contributing cause of firefighter cancers. To identify and quantify residual contamination of PAH, samples were taken from two individual decommissioned structural firefighting ensembles and analyzed by layer (outer canvas shell, moisture barrier, and the thermal protective liner) for (1) textile integrity via field emission scanning electron microscopy and (2) quantity of PAH contamination by high-pressure liquid chromatography with ultraviolet/fluorescence detection. The results of these analyses show the presence of the PAH compounds pyrene (35% of the total mass of PAH), phenanthrene (21%), benzo(a)pyrene (14%), and benzo(a)anthracene (14%) which present a risk for dermal absorption. The data also revealed that PAH penetration through the layers of the firefighting ensemble was strongly inhibited by the moisture barrier layer.

Urinary concentrations of organophosphate esters and associated health outcomes in Korean firefighters

Although firefighters are at an increased risk of occupational exposure to chemicals, such as flame retardants, research on the exposure of Korean firefighters to organophosphate esters (OPEs)-a group of emerging flame retardants-remains limited. Therefore, in the present study, OPE metabolite concentrations in the urine samples of 149 former and current Korean firefighters were measured. Based on the data obtained, the estimated daily intakes (EDIs) of OPEs were calculated. Subsequently, the association between the urinary concentrations of OPE metabolites and the potential determinants of OPE exposure and health outcomes (e.g., obesity and serum lipids) was investigated. We found that bis(1-chloro-2-propyl) phosphate (BCIPP) and bis(2-chloroethyl) phosphate (BCEP) were the most prevalent urinary OPE metabolites, with median concentrations of 2.33 and 1.80 ng/mL, respectively; these concentrations were higher than those reported previously in other countries, such as the USA and China. Moreover, their parent compounds-tris(1-chloro-2-propyl) phosphate (TCIPP) and tris(2-chloroethyl) phosphate (TCEP)-exhibited EDIs of 126 and 94.8 ng/kg bw/day, respectively. Unlike the high detection rate of bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) in other populations, its detection rate in this study was low (6.7%), suggesting regional differences in the exposure pattern of OPEs among countries. Furthermore, occupational characteristics, such as recent participation in firefighting activity, were identified as determinants of the urinary concentrations of OPE metabolites. Total OPE metabolites were inversely associated with body mass index and positively associated with high-density lipoprotein cholesterol. Overall, our findings demonstrate that Korean firefighters are highly exposed to several occupation-related OPEs. Further prospective studies will help elucidate the potential health implications of occupational exposure to OPEs among firefighters.

Bench-Scale and Full-Scale Level Evaluation of the Effect of Parameters on Cleaning Efficacy of the Firefighters' PPE

The National Fire Protection Association (NFPA) 1851 document provides guidelines for firefighters on the care and maintenance of their PPE, including decontamination practices. Firefighters are exposed to various toxic chemicals during fire suppression activities, making effective decontamination crucial for their safety. This study evaluated the efficacy of different washing parameters, including temperature, time, and surfactants, on cleaning outer-shell material contaminated with nine targeted compounds from three different functional groups: phenols, polycyclic aromatic hydrocarbons (PAHs), and phthalates. The study was conducted on both bench-scale and full-scale levels, with contaminated swatches washed in a water shaker bath in the bench-scale evaluation and full-sized washer extractors used in the full-scale evaluation. The results showed that bench-scale washing demonstrated similar trends in contaminant removal to full-scale washing. Importantly, the study highlighted the complexity of removing fireground contaminants from the personal protective ensemble (PPE). The findings of this study have practical implications for the firefighting industry as they provide insight into the effectiveness of different washing parameters for PPE decontamination. Future studies could explore the impact of repeated washing on PPE and investigate the potential for developing more efficient decontamination strategies. Ultimately, the study underscores the importance of ongoing efforts to ensure the safety of firefighters, who face significant occupational hazards.

Qualitative Assessment of Off-Gassing of Compounds from Field-Contaminated Firefighter Jackets with Varied Air Exposure Time Intervals Using Headspace GC-MS

Firefighters are exposed to a complex mix of volatile and semi-volatile compounds from burning construction materials, consumer products, and other elements during fire suppression and rescue. These compounds can be absorbed onto the gear worn by firefighters and, depending on their volatility, can be released from the gear under different conditions. Few studies have focused on the off-gassing of toxic compounds from firefighters' gear, particularly in terms of qualitative analysis methods. This study introduces a novel qualitative analysis method using headspace gas chromatography-mass spectrometry (HS-GC-MS) to assess off-gassing from field-contaminated jackets at regular intervals. Our findings show that certain compounds, such as acetic acid and di-ethyl-hexyl-phthalate (DEHP), remained present even after the gear were allowed to air out for 48 h. The persistent off-gassing of chemicals, even under ambient conditions, raises concerns about potential hazards that could pose risks for personnel in the vicinity of contaminated gear, including inside fire stations. The implications of these findings extend beyond fire stations and may have significant public health implications for firefighters who are repeatedly exposed to these compounds over time.

Biomonitoring of firefighting forces: a review on biomarkers of exposure to health-relevant pollutants released from fires

Occupational exposure as a firefighter has recently been classified as a carcinogen to humans by International Agency for Research on Cancer (IARC). Biomonitoring has been increasingly used to characterize exposure of firefighting forces to contaminants. However, available data are dispersed and information on the most relevant and promising biomarkers in this context of firefighting is missing. This review presents a comprehensive summary and critical appraisal of existing biomarkers of exposure including volatile organic compounds such as polycyclic aromatic hydrocarbons, several other persistent other organic pollutants as well as heavy metals and metalloids detected in biological fluids of firefighters attending different fire scenarios. Urine was the most characterized matrix, followed by blood. Firefighters exhaled breath and saliva were poorly evaluated. Overall, biological levels of compounds were predominantly increased in firefighters after participation in firefighting activities. Biomonitoring studies combining different biomarkers of exposure and of effect are currently limited but exploratory findings are of high interest. However, biomonitoring still has some unresolved major limitations since reference or recommended values are not yet established for most biomarkers. In addition, half-lives values for most of the biomarkers have thus far not been defined, which significantly hampers the design of studies. These limitations need to be tackled urgently to improve risk assessment and support implementation of better more effective preventive strategies.

Use of Preliminary Exposure Reduction Practices or Laundering to Mitigate Polycyclic Aromatic Hydrocarbon Contamination on Firefighter Personal Protective Equipment Ensembles

Chronic health risks associated with firefighting continue to be documented and studied, however, the complexity of occupational exposures and the relationship between occupational exposure and contaminated personal protective equipment (PPE) remains unknown. Recent work has revealed that common PPE cleaning practices, which are becoming increasingly more common in the fire service, are not effective in removing certain contaminants, such as polycyclic aromatic hydrocarbons (PAHs), from PPE. To better understand the relationship between contaminated firefighter PPE and potential exposure to PAHs, and to gain further understanding of the efficacy of cleaning practices, we used a standardized fire exposure simulator that created repeatable conditions and measured PPE surface contamination levels via wipe sampling and filters attached to firefighter gear worn by standing mannequins. This study examined the effects of repeated (40 cycles) PPE cleaning (laundering and on-scene preliminary exposure reduction (PER) techniques) and repeated exposures on PAH concentration on different surfaces. Further exploration included examination of contamination breakthrough of turnout jackets (comparing outer shell and interior liner) and evaluation of off-gassing PAHs from used gear after different cleaning treatments. When compared by jacket closure type (zipper and hook and dee), total PAH concentration wiped from gear after exposure and cleanings showed no significant differences. Regression analysis indicated that there was no effect of repeated exposures on PAH contamination levels (all sampling sites combined; before fire 10, 20, and 40; after fire 1, 10, 20, and 40; p-value > 0.05). Both laundering and on-scene PER significantly reduced contamination levels on the exterior pants and helmets and were effective at reducing PAH contamination. The jacket outer shell had significantly higher PAH contamination than the jacket liner. Both laundering and wet soap PER methods (post-fire) are effective in reducing surface contamination and appear to prevent accumulation of contamination after repeated exposures. Semi-volatile PAHs deep within the fibers of bulky PPE are not effectively reduced via PER or machine laundering, therefore, permitting continued off-gassing of these compounds. Further research is needed to identify the most effective laundering methods for firefighter turnout gear that considers the broad spectrum of common contaminants.

Contamination of UK firefighters personal protective equipment and workplaces

Firefighters' personal protective equipment (PPE) is a potential source of chronic exposure to toxic contaminants commonly released from fires. These contaminants have also been found in fire stations. However, little research characterises the routes via which fire contaminants travel back to fire stations. The UK Firefighter Contamination Survey provides information on firefighters' PPE provision, decontamination, and storage practices. All serving UK firefighters were eligible to take part in the survey, which comprised 64 questions. A total of 10,649 responses were included for analysis, accounting for roughly 24% of the UK's firefighting workforce. Results revealed that most firefighters (84%) de-robe contaminated PPE/workwear after re-entering the appliance cab. There was a significant decreasing tendency to send PPE for cleaning after every incident with increasing seniority of role, length of service, and fire attendance frequency. Around one third of firefighters cleaned PPE after every incident. A number of issues were linked to external professional cleaning services, e.g. shrinkage, fit, turn-around time, and stock of reserve/pooled PPE. PPE storage was found to be a potential source of cross contamination, with almost half of firefighters (45%) indicating clean and dirty PPE is not stored separately. More than half of firefighters (57%) stored fire gloves (an item sent for professional decontamination by only 19% of firefighters, and never cleaned by 20%) within other items of PPE such as helmets, boots and tunic/trouser pockets. The survey's results can be used to target gaps in decontamination measures within UK Fire and Rescue Services.

Cancer incidence amongst UK firefighters

Firefighters suffer an increased risk of cancer from exposures to chemicals released from fires. Our earlier research has found that fire toxicants not only remain on firefighters' PPE, but are also tracked back to fire stations. The UK Firefighter Contamination Survey assesses firefighters' risk of developing cancer due to occupational exposure to fire toxins. Over 4% of surveyed firefighters were found to have a cancer diagnosis, with the age-specific cancer rate up to 323% higher (35-39 year olds) than that of the general population. Firefighters who had served ≥ 15 years were 1.7 times more likely to develop cancer than those who had served less time. Firefighters were at least twice as likely to be diagnosed with cancer if they noticed soot in their nose/throat (odds ratio (OR) = 2.0, 1.1-3.5), or remained in their PPE for more than four hours after attending a fire incident (OR = 2.3, 1.1-5.2). Also associated with an increased likelihood of cancer was: eating while wearing PPE (OR = 1.8, 1.2-2.7); failing to store clean/dirty PPE separately (OR = 1.3, 1.0-1.7); working in a station that smells of fire (OR = 1.3, 1.0-1.8) or not having designated (separated) clean and dirty areas (OR = 1.4, 1.1-1.7); using an on-site washing machine to launder fire hoods (OR = 1.3, 1.0-1.7); feeling that cleaning is not taken seriously at work (OR = 1.5, 1.2-2.0).

Firefighters' Clothing Contamination in Fires of Electric Vehicle Batteries and Photovoltaic Modules-Literature Review and Pilot Tests Results

The electric vehicle (EV) market, together with photovoltaic (PV) installations continues to develop at a pace. However, there are concerns that EV and PV installation fires may create more harmful substances than other types of fire. PV modules and car battery fires emit a range of carcinogenic and highly toxic compounds that are not yet fully understood and may pose a threat to firefighters' health. This also raises the question of the impact on firefighters' clothing and the safe handling and cleaning after such fires. This article presents a literature and standards review of the firefighters' protective clothing maintenance and cleaning. It also contains test results showing that firefighters' clothes accumulate harmful substances after fighting these types of fires. Pilot tests for the presence of polycyclic aromatic hydrocarbons (PAHs) and formaldehyde showed that levels exceeded limits in all clothing samples. For example, the cobalt level was 24 times higher than that considered safe in the test carried out with car battery fire. Although it is recognized that liquid carbon dioxide (LCO₂) methods of cleaning may be more effective than traditional water washing, further research on cleaning efficiency for clothing containing substances emitted from car battery and PV modules fires is required.

Hierarchy of contamination control in the fire service: Review of exposure control options to reduce cancer risk

The international fire service community is actively engaged in a wide range of activities focused on development, testing, and implementation of effective approaches to reduce exposure to contaminants and the related cancer risk. However, these activities are often viewed independent of each other and in the absence of the larger overall effort of occupational health risk mitigation. This narrative review synthesizes the current research on fire service contamination control in the context of the National Institute for Occupational Safety and Health (NIOSH) Hierarchy of Controls, a framework that supports decision making around implementing feasible and effective control solutions in occupational settings. Using this approach, we identify evidence-based measures that have been investigated and that can be implemented to protect firefighters during an emergency response, in the fire apparatus and at the fire station, and identify several knowledge gaps that remain. While a great deal of research and development has been focused on improving personal protective equipment for the various risks faced by the fire service, these measures are considered less effective. Administrative and engineering controls that can be used during and after the firefight have also received increased research interest in recent years. However, less research and development have been focused on higher level control measures such as engineering, substitution, and elimination, which may be the most effective, but are challenging to implement. A comprehensive approach that considers each level of control and how it can be implemented, and that is mindful of the need to balance contamination risk reduction against the fire service mission to save lives and protect property, is likely to be the most effective.

Correlates of positive thyroid peroxidase antibodies among firefighters: A cross-sectional-study

Context

Exposure to endocrine disrupting chemicals (EDCs) are associated with underactive thyroid glands, and possibly autoimmunity. Firefighters are exposed to EDCs from flame retardants; however, the prevalence and risk factor associations of thyroid antibodies among firefighters are unknown.

Context

We aimed to determine the prevalence of thyroid peroxidase antibodies (TPOAb) and associated sociodemographic and occupational risk factors among firefighters.

Methods

Firefighters attending professional health and safety conferences between November 2018 and January 2020, and with no prior diagnosis of thyroid disease were invited (n = 278) to submit a health survey, blood samples, and complete a thyroid ultrasound. The survey assessed for sociodemographic and occupational characteristics, including a history of familial thyroid disease, smoking, firefighter tenure, and job rank, radiation exposure, and mitigation practices of occupational exposures. Serum thyroid peroxidase antibody (TPOAb) was also assessed.

Results

Approximately 39.9% of firefighters evaluated had a positive TPOAb test. The mean age for those TPOAb positive was lower than those who tested negative (41.4 ± 7.9 vs 43.1 ± 7.9 years, P = 0.07) but this difference was not significant. Firefighters with a family history of thyroid disease had a statistically significant higher prevalence of TPOAb compared with those without a family history (60.0% vs 37.5%, P = 0.02); this association remained significant after adjusting for sociodemographic and occupational factors (odds ratio 2.99; CI, 1.31-6.85).

Conclusion

The prevalence of TPOAb is high among firefighters in our study, and family history is a significant determinant of testing positive for TPOAb. Firefighters may benefit from TPOAb and thyroid stimulating hormone tests, and screening for family history of thyroid disease at baseline employee medical check-ups. This finding suggests the need for further studies.

White Light-Photolysis for the Removal of Polycyclic Aromatic Hydrocarbons from Proximity Firefighting Protective Clothing

The presence of polycyclic aromatic hydrocarbons (PAHs) on firefighters' personal protective equipment is a concern. One form of preventing from these compounds is to decontaminate proximity firefighting protective clothing (PFPC). Traditional decontamination methods do not promote total removal of pollutants and alter the properties of PFPC. The objective of this work was to evaluate the effectiveness of white light-photolysis (WLP), an advanced oxidation process (AOP), for removing PAHs from PFPC, while maintaining the integrity of the fabric fibers. Experiments were carried out, varying reaction time and concentration of H₂O₂. With WLP (without H₂O₂), it was possible to remove more than 73% of the PAHs tested from the outer layer of PFPC in 3 days. The WLP provided the greatest removal of PAHs, compared with the most common mechanical decontamination techniques (laundering and wet-soap brushing). The fibers' integrity after exposure to the white light was evaluated with infrared spectroscopy and scanning electron microscopy/energy dispersive X-ray spectrometry. In addition, a tearing strength test was performed. No remarkable fabric degradation was observed, indicating a possible, routine-compatible, simple, and inexpensive method of decontamination of PFPC, based on photolysis, which is effective in the degradation of PAHs and maintains the integrity of fabric fibers.

Associations between Awareness of the Risk of Exposure to Pollutants Occurring at Fire Scenes and Health Beliefs among Metropolitan Firefighters in the Republic of Korea

Firefighters are repeatedly exposed to various pollutants that occur at fire scenes. There are three levels of exposure: primary exposure to pollutants, secondary exposure to pollutants on personal protective equipment (PPE), and tertiary exposure to contaminated fire stations and fire engines due to pollutants on PPE. Therefore, it is important for firefighters to be aware of the risk of exposure to pollutants and to practice health behaviors such as appropriate PPE management. No clear association has been established in the existing literature between firefighters’ risk perception level and their health beliefs about the health impact of awareness of exposure to hazardous substances at fire scenes. This study aims to evaluate the relationship between awareness of the exposure risk to primary, secondary, and tertiary pollutants and health beliefs. It was designed as a cross-sectional study, in which a web-based survey was conducted from 13 May to 31 May 2021. The analysis was conducted in 1940 firefighters working in the Seoul metropolis who agreed to participate in the research. Participants who perceived susceptibility were likely to be aware of the primary (adjusted odds ratio (AOR) = 2.10, 95% confidence interval (CI) 1.16–3.80), secondary (AOR = 2.77, 95% CI 1.77–4.32), and tertiary (AOR = 2.73, 95% CI 1.85–4.03) exposure risks. Participants who perceived barriers were unlikely to be aware of the risk of exposure to primary (AOR = 0.67, 95% CI 0.49–0.91), secondary (AOR = 0.77, 95% CI 0.61–0.96), and tertiary (AOR = 0.75, 95% CI 0.62–0.91) pollutants. Educational intervention is recommended to improve perceived susceptibility and awareness of the risk of exposure to pollutants and reduce perceived barriers. Consequently, educational intervention is expected to positively impact firefighters’ management of appropriate PPE. We confirmed an association between occupational exposure risk and firefighters’ health beliefs. In the health belief model (HBM), health beliefs that affect health behavior also affect awareness of the exposure risk level. Therefore, an intervention for health beliefs can also be used to raise job-related exposure risk awareness. Regular training on the health impacts of fire scenes is necessary for both newcomers and incumbents to enable firefighters to better recognize the risks of each occupational exposure level. Additionally, laws and regulations are necessary for the removal of harmful substances that contaminate PPE, such as self-contained breathing apparatus (SCBA), during exposure to a fire scene. Our research can be used as a basis for improving fire policies and education programs in the future.

Perceptions of Occupational Cancer Risk and Prevention Among Dominican Republic Firefighters: A Qualitative Study

OBJECTIVES

Characterize occupational cancer risk perceptions and attitudes toward cancer prevention practices among firefighters in the Dominican Republic.

METHODS

Focus group discussions and key informant interviews were conducted in June 2019 among firefighters from three fire departments. Themes were inductively created using a qualitative descriptive approach.

RESULTS

Thirty-seven firefighters were interviewed with a group mean age of 36.2 ± 10.3 years, of which 97.3% were male, and 37.1% worked at least 10 years. Six themes emerged: 1) availability of personal protective equipment (PPE); 2) toxic exposure during fire suppression; 3) work-related stress; 4) lack of workplace health promotion activities; 5) Dominican culture impacts medical checkups; and 6) expensive medical copays limits healthcare access.

CONCLUSION

Dominican firefighters are willing to adopt cancer prevention practices, however organizational barriers (ie, PPE availability, cultural barriers, and health promotion practices) limit engagement.

Characterizing exposure to benzene, toluene, and naphthalene in firefighters wearing different types of new or laundered PPE

The fire service has become more aware of the potential for adverse health outcomes due to occupational exposure to hazardous combustion byproducts. Because of these concerns, personal protective equipment (PPE) manufacturers have developed new protection concepts like particulate-blocking hoods to reduce firefighters' exposures. Additionally, fire departments have implemented exposure reduction interventions like routine laundering of PPE after fire responses. This study utilized a fireground exposure simulator (FES) with 24 firefighters performing firefighting activities on three consecutive days wearing one of three PPE ensembles (stratified by hood design and treatment of PPE): 1) new knit hood, new turnout jacket and new turnout pants 2) new particulate-blocking hood, new turnout jacket and new turnout pants or 3) laundered particulate-blocking hood, laundered turnout jacket and laundered turnout pants. As firefighters performed the firefighting activities, personal air sampling on the outside and inside the turnout jacket was conducted to quantify exposures to volatile organic compounds (VOCs) and naphthalene. Pre- and immediately post-fire exhaled breath samples were collected to characterize the absorption of VOCs. Benzene, toluene, and naphthalene were found to diffuse through and/or around the turnout jacket, as inside jacket benzene concentrations were often near levels reported outside the turnout jacket (9.7-11.7% median benzene reduction from outside the jacket to inside the jacket). The PPE ensemble did not appear to affect the level of contamination found inside the jacket for the compounds evaluated here. Benzene concentrations in exhaled breath increased significantly from pre to post-fire for all three groups (p-values < 0.05). The difference of pre-to post-fire benzene exhaled breath concentrations were positively associated with inside jacket and outside jacket benzene concentrations, even though self-contained breathing apparatus (SCBA) were worn during each response. This suggests the firefighters can absorb these compounds via the dermal route.

Organophosphate and Organohalogen Flame-Retardant Exposure and Thyroid Hormone Disruption in a Cross-Sectional Study of Female Firefighters and Office Workers from San Francisco

Occupational exposures to flame retardants (FRs), a class of suspected endocrine-disrupting compounds, are of health concern for firefighters. We sought to characterize exposure to FR compounds and evaluate their association with thyroid hormone levels, a biomarker of early effect, in female firefighters and office workers in San Francisco. In a cross-sectional study, we measured replacement organophosphate and organohalogen FRs in spot urine samples from firefighters (N = 86) and office workers (N = 84), as well as total thyroxine (T4) and thyroid-stimulating hormone in plasma for 84 firefighters and 81 office workers. Median bis(1,3-dichloro-2-propyl)phosphate (BDCPP) levels were 5 times higher in firefighters than office workers. Among firefighters, a doubling of BDCPP was associated with a 2.88% decrease (95% confidence interval -5.28, -0.42) in T4. We did not observe significant associations between FRs and T4 among office workers. In the full group, intermediate body mass index and a college education were associated with higher FR levels. The inverse association observed between FRs and T4 coupled with the lack of studies on women workers and evidence of adverse health effects from FR exposure─including endocrine disruption and breast cancer risk─warrant further research on occupational exposures and identification of opportunities for exposure reduction.

Evaluation of fireground exposures using urinary PAH metabolites

BACKGROUND

Firefighters have increased cancer incidence and mortality rates compared to the general population, and are exposed to multiple products of combustion including known and suspected carcinogens.

OBJECTIVE

The study objective was to quantify fire response exposures by role and self-reported exposure risks.

METHODS

Urinary hydroxylated metabolites of polycyclic aromatic hydrocarbons (PAH-OHs) were measured at baseline and 2-4 h after structural fires and post-fire surveys were collected.

RESULTS

Baseline urine samples were collected from 242 firefighters. Of these, 141 responded to at least one of 15 structural fires and provided a post-fire urine. Compared with baseline measurements, the mean fold change of post-fire urinary PAH-OHs increased similarly across roles, including captains (2.05 (95% CI 1.59-2.65)), engineers (2.10 (95% CI 1.47-3.05)), firefighters (2.83 (95% CI 2.14-3.71)), and paramedics (1.84 (95% CI 1.33-2.60)). Interior responses, smoke odor on skin, and lack of recent laundering or changing of hoods were significantly associated with increased post-fire urinary PAH-OHs.

SIGNIFICANCE

Ambient smoke from the fire represents an exposure hazard for all individuals on the fireground; engineers and paramedics in particular may not be aware of the extent of their exposure. Post-fire surveys identified specific risks associated with increased exposure.

Per- and polyfluoroalkyl substances (PFAS) and total fluorine in fire station dust

Per- and polyfluoroalkyl substances (PFAS) are a class of over 4700 fluorinated compounds used in industry and consumer products. Studies have highlighted the use of aqueous film-forming foams (AFFFs) as an exposure source for firefighters, but little is known about PFAS occurrence inside fire stations, where firefighters spend most of their shifts. In this study, we aimed to characterize PFAS concentrations and sources inside fire stations. We measured 24 PFAS (using LC-MS/MS) and total fluorine (using particle-induced gamma ray emission) in dust from multiple rooms of 15 Massachusetts stations, many of which (60%) no longer use PFAS-containing AFFF at all and the rest of which only use it very rarely. Compared to station living rooms, turnout gear locker rooms had higher dust levels of total fluorine (p < 0.0001) and three PFAS: perfluorohexanoate (PFHxA), perfluoroheptanoate (PFHpA), and perfluorodecanoate (PFDoDA) (p < 0.05). These PFAS were also found on six wipes of station turnout gear. By contrast, the dominant PFAS in living rooms was N-ethyl perfluorooctane sulfonamidoacetic acid (N-MeFOSAA), a precursor to perfluorooctane sulfonate (PFOS) that still persists despite phase-outs almost two decades ago. The Σ24 PFAS accounted for less than 2% of fluorine in dust (n = 39), suggesting the potential presence of unknown PFAS. Turnout gear may be an important PFAS source in stations due to intentional additives and/or contamination from firefighting activities.

Characterizing exposures to flame retardants, dioxins, and furans among firefighters responding to controlled residential fires

Firefighters may encounter items containing flame retardants (FRs), including organophosphate flame retardants (OPFRs) and polybrominated diphenyl ethers (PBDEs), during structure fires. This study utilized biological monitoring to characterize FR exposures in 36 firefighters assigned to interior, exterior, and overhaul job assignments, before and after responding to controlled residential fire scenarios. Firefighters provided four urine samples (pre-fire and 3-h, 6-h, and 12-h post-fire) and two serum samples (pre-fire and approximately 23-h post-fire). Urine samples were analyzed for OPFR metabolites, while serum samples were analyzed for PBDEs, brominated and chlorinated furans, and chlorinated dioxins. Urinary concentrations of diphenyl phosphate (DPhP), a metabolite of triphenyl phosphate (TPhP), bis(1,3-dichloro-2-propyl) phosphate (BDCPP), a metabolite of tris(1,3-dichloro-2-propyl) phosphate (TDCPP), and bis(2-chloroethyl) phosphate (BCEtP), a metabolite of tris(2-chloroethyl) phosphate (TCEP), increased from pre-fire to 3-hr and 6-hr post-fire collection, but only the DPhP increase was statistically significant at a 0.05 level. The 3-hr and 6-hr post-fire concentrations of DPhP and BDCPP, as well as the pre-fire concentration of BDCPP, were statistically significantly higher than general population levels. BDCPP pre-fire concentrations were statistically significantly higher in firefighters who previously participated in a scenario (within the past 12 days) than those who were responding to their first scenario as part of the study. Similarly, firefighters previously assigned to interior job assignments had higher pre-fire concentrations of BDCPP than those previously assigned to exterior job assignments. Pre-fire serum concentrations of 2,3,4,7,8-pentachlorodibenzofuran (23478-PeCDF), a known human carcinogen, were also statistically significantly above the general population levels. Of the PBDEs quantified, only decabromodiphenyl ether (BDE-209) pre- and post-fire serum concentrations were statistically significantly higher than the general population. These results suggest firefighters absorbed certain FRs while responding to fire scenarios.

Effects of firefighting hood design, laundering and doffing on smoke protection, heat stress and wearability

Firefighter hoods must provide protection from elevated temperatures and products of combustion (e.g. particulate) while simultaneously being wearable (comfortable and not interfering with firefighting activities). The purpose of this study was to quantify the impact of (1) hood design (traditional knit hood vs particulate-blocking hood), (2) repeated laundering, and (3) hood removal method (traditional vs overhead doffing) on (a) protection from soot contamination on the neck, (b) heat stress and (c) wearability measures. Using a fireground exposure simulator, 24 firefighters performed firefighting activities in realistic smoke and heat conditions using a new knit hood, new particulate-blocking hood and laundered particulate-blocking hood. Overall, soot contamination levels measured from neck skin were lower when wearing the laundered particulate-blocking hoods compared to new knit hoods, and when using the overhead hood removal process. No significant differences in skin temperature, core temperature, heart rate or wearability measures were found between the hood conditions. Practitioner Summary: The addition of a particulate-blocking layer to firefighters' traditional two-ply hood was found to reduce the PAH contamination reaching the neck but did not affect heat stress measurements or thermal perceptions. Modifying the process for hood removal resulted in a larger reduction in neck skin contamination than design modification. Abbreviations: ANOVA: analysis of variance; B: new particulate-blocking hood and PPE (PPE configuration); FES: fireground exposure simulator; GI: gastrointestinal; K: new knit hood and PPE (PPE configuration); L: laundered particulate-blocking hood and PPE (PPE configuration); LOD: limit of detection; MLE: maximum likelihood estimation; NFPA: National fire protection association; PAH: polycyclic aromatic hydrocarbon; PPE: personal protective equipment; SCBA: self-contained breathing apparatus; THL: total heat loss; TPP: thermal protective performance.

Evaluation of Interventions to Reduce Firefighter Exposures

OBJECTIVE

Evaluate the effectiveness of firefighter exposure reduction interventions.

METHODS

Fireground interventions included use of self-contained breathing apparatus by engineers, entry team wash down, contaminated equipment isolation, and personnel showering and washing of gear upon return to station. Urinary polycyclic aromatic hydrocarbon metabolites (PAH-OHs) were measured after structural fire responses before and after intervention implementation. Separately, infrared sauna use following live-fire training was compared to standard postfire care in a randomized trial.

RESULTS

The fireground interventions significantly reduced mean total urinary postfire PAH-OHs in engineers (-40.4%, 95%CI -63.9%, -2.3%) and firefighters (-36.2%, 95%CI -56.7%, -6.0%) but not captains (-11.3% 95%CI -39.4%, 29.9%). Sauna treatment non-significantly reduced total mean PAH-OHs by -43.5% (95%CI -68.8%, 2.2%).

CONCLUSIONS

The selected fireground interventions reduced urinary PAH-OHs in engineers and firefighters. Further evaluation of infrared sauna treatment is needed.

Health Risks of Structural Firefighters from Exposure to Polycyclic Aromatic Hydrocarbons: A Systematic Review and Meta-Analysis

Firefighters have an elevated risk of cancer, which is suspected to be caused by occupational and environmental exposure to fire smoke. Among many substances from fire smoke contaminants, one potential source of toxic exposure is polycyclic aromatic hydrocarbons (PAH). The goal of this paper is to identify the association between PAH exposure levels and contributing risk factors to derive best estimates of the effects of exposure on structural firefighters' working environment in fire. We surveyed four databases (Embase, Medline, Scopus, and Web of Science) for this systematic literature review. Generic inverse variance method for random effects meta-analysis was applied for two exposure routes-dermal and inhalation. In dermal, the neck showed the highest dermal exposure increased after the fire activity. In inhalation, the meta-regression confirmed statistically significant increases in PAH concentrations for longer durations. We also summarized the scientific knowledge on occupational exposures to PAH in fire suppression activities. More research into uncontrolled emergency fires is needed with regard to newer chemical classes of fire smoke retardant and occupational exposure pathways. Evidence-based PAH exposure assessments are critical for determining exposure-dose relationships in large epidemiological studies of occupational risk factors.

Off-Gassing of Semi-Volatile Organic Compounds from Fire-Fighters' Uniforms in Private Vehicles-A Pilot Study

Firefighters' uniforms become contaminated with a wide range of chemicals, including polycyclic aromatic hydrocarbons (PAHs), organophosphate flame retardants (OPFRs), and polybrominated diphenyl ethers (PBDEs). Laundering practices do not completely remove PAHs, OPFRs, and PBDEs from firefighting uniforms. This residual contamination of firefighting ensembles may be an ongoing source of exposure to firefighters. Firefighters are known to occasionally store firefighting ensembles in private vehicles. This study aimed to assess whether a firefighting uniform in a vehicle could act as a source for PAHs, OPFRs, and PBDEs to vehicle users. The shell layers of four laundered firefighting uniforms were sampled non-destructively. Three of these uniforms were heated in a laboratory oven (40, 60, and 80 °C) while the fourth was placed in a private vehicle on a summer day and off-gassing samples were collected from the uniforms. The off-gassing results for PAHs and OPFRs were relatively consistent between laboratory oven and the in-vehicle sample with ∑₁₃ PAHs in off-gas ranging from 7800-23,000 ng uniform^-1 day^-1, while the ∑₆ OPFRs off-gassed was an order of magnitude lower at 620-1600 ng uniform^-1 day^-1. The off-gassing results for PBDEs were much lower and less consistent between the experiments, which may reflect differences in uniform history. Currently, there is limited understanding of how PAHs, OPFRs, and PBDEs off-gassed from firefighting uniforms influence firefighter exposure to these chemicals. These findings suggest that firefighting ensembles off-gassing in private vehicles could be a relevant source of PAHs, OPFRs, and PBDEs that contributes to firefighters' exposure and that this warrants further investigation.

Assessing decontamination and laundering processes for the removal of polycyclic aromatic hydrocarbons and flame retardants from firefighting uniforms

Firefighter uniforms protect firefighters from exposure to potentially harmful chemicals including a range of semi-volatile organic compounds (SVOCs). Contaminated uniforms can become a secondary source of firefighters' exposure to these chemicals. There is inconsistency on the removal efficiency of SVOCs during the cleaning, laundering and field decontamination of firefighting uniforms. Therefore, this study aims to assess how effective decontamination and laundering processes are in reducing firefighter uniforms as a vector for transport and exposure to SVOCs. Firefighters who had attended a controlled house fire and simulated container burns had their uniforms sampled pre- and post-laundering. Clean station wear was laundered with contaminated uniforms and after a load of contaminated uniforms to assess inter and intra load contamination. Surface wipes were collected from uniforms across 12 fire stations, after they had returned from a laundering provider. Concentrations of 13 polycyclic aromatic hydrocarbons (PAHs), six organophosphate flame retardants (OPFRs) and seven polybrominated diphenyl ethers (PBDEs) were measured in the collected samples. The concentrations of ∑₁₃ PAHs in firefighters uniforms ranged between 0.063 and 43 μg g^-1, while concentration of ∑₆ OPFRs were between 0.061 and 90 μg g^-1 with ∑₇ PBDEs concentrations being measured between 0.00054 and 0.97 μg g^-1.The highest concentrations of ∑₁₃ PAHs were measured on the outer layers of gloves at an average of 19 μg g^-1, with the highest ∑₆ OPFRs concentrations being measured in the middle layers of gloves at an average of 31 μg g^-1. The highest ∑₇ PBDEs concentrations were measured on the shell layers of turnout jackets at 0.42 μg g^-1. The significant reduction in ∑₁₃ PAHs after laundering or decontamination was only found in 3 of the 16 sampled areas from firefighting uniforms. No significant differences were found in the between pre- and post-laundering concentrations of ∑₆ OPFRs or ∑₇ PBDEs in firefighting uniforms. The current laundering techniques do not appear to effectively remove PAHs, OPFRs and PBDEs at the measured concentrations from firefighters' uniforms. Further research is required to assess if chemical exposure though firefighting uniforms poses a health risk to firefighters and to develop methods for the removal of SVOCs from firefighting uniforms.

Work Conditions and Practices in Norwegian Fire Departments From 1950 Until Today: A Survey on Factors Potentially Influencing Carcinogen Exposure

BACKGROUND

Meta-analyses have shown firefighters to be at an increased risk of several cancer types. Occupational carcinogen exposure may explain these increased risks. This study aims to describe Norwegian fire departments' work conditions from 1950 until today, focusing on factors relevant for potential occupational carcinogen exposure.

METHODS

With the help of a reference group, we developed a questionnaire on topics related to occupational exposure to carcinogens for the period 1950-2018. Selected Norwegian fire departments provided department-specific responses.

RESULTS

Sixteen departments, providing fire services for 48% of the Norwegian population as of 2019 and mainly consisting of professional firefighters, responded to our questionnaire. The introduction of synthetic firefighting foams, more regular live fire training, the introduction of chemical diving, and a higher number of diesel-driven fire service vehicles were identified as changes thought to increase exposure to occupational carcinogens. Changes thought to decrease exposure included the switch from negative to positive pressure self-contained breathing apparatuses, the use of self-contained breathing apparatuses during all phases of firefighting, the use of ventilating fans during firefighting, increased attention to flammable materials used during live fire training, increased attention to handling and cleaning of turnout gear and other equipment, and installment of exhaust removal systems in apparatus bays.

CONCLUSION

Norwegian fire departments' work conditions have seen several changes since 1950, and this could influence firefighters' occupational carcinogen exposure. A peak of carcinogen exposure may have occurred in the 1970s and 1980s before recent changes have reduced exposure.

Polybrominated Diphenyl Ether and Organophosphate Flame Retardants in Canadian Fire Station Dust

Fire fighters are at a high risk for exposure to toxic chemicals during and subsequent to fire suppression activities. In the Canadian Fire Station Dust Study (CFSDS) we measured 19 polybrominated diphenyl ether (PBDE) and six organophosphate flame retardant (OPFR) chemicals in dust collected in 2017-18 by vacuuming the living quarters of 24 Canadian fire stations from four provinces. The predominant flame retardant (FR) was BDE-209, with a median concentration of 7060 ng/g, which was a magnitude higher than medians of the major congeners of the pentaBDE formulation measured at 620 ng/g (Σ₅ BDE-47, 99, 100, 153 and 154). OPFR median concentrations exceeded those of pentaBDE and were on the same order of magnitude as BDE-209, with TCIPP, TDCIPP and TPHP as the dominant OPFRs with median concentrations ranging from 2350 to 4780 ng/g. Fire station age and carpeting were significantly correlated with select OPFRs and PBDEs. Furthermore, fire stations that also vacuumed equipment bays and fire truck interiors had median concentrations that were a magnitude higher (BDE-209: 81,700 ng/g) and two to three-fold higher (TCIPP, TDCIPP and TPHP) than fire stations that excluded those areas. FR concentrations in CFSDS dust were higher but on the same order of magnitude as Canadian residential dust and significantly lower than dust collected from Canadian WEEE dismantling. CFSDS FR concentrations were also significantly lower than those we reported in our 2015 U.S. fire station dust. Our data reflect the downward trend of PBDEs following their phase out and a shift toward OPFRs as replacements.

Flame retardants, dioxins, and furans in air and on firefighters' protective ensembles during controlled residential firefighting

INTRODUCTION

Structure fires that involve modern furnishings may emit brominated flame retardants (BFRs) and organophosphate flame retardants (OPFRs), as well as brominated and chlorinated dioxins and furans, into the environment.

OBJECTIVES

The goal of this study was to quantify the airborne and personal protective equipment (PPE) contamination levels of these compounds during controlled residential fires in the U.S., and to evaluate gross-decontamination measures.

METHODS

Bulk-sampling was done to confirm the presence of flame retardants (FRs) in the furnishings used in 12 controlled residential structure fires. Area air samples were collected during the fires and PPE wipe samples were collected from the firefighters' turnout jackets and gloves after firefighting. For each fire, half of the jackets were decontaminated and the other half were not.

RESULTS

Of the BFRs and OPFRs measured in air during the fire period, decabromodiphenyl ether (BDE-209) and triphenyl phosphate (TPP) were the most abundant, with medians of 15.6 and 408 µg/m³, respectively, and were also detected during overhaul. These and several other BFRs and OPFRs were measured on PPE. Some gloves had contaminant levels exceeding 100 ng/cm² and were generally more contaminated than jackets. Air and surface levels of the brominated furans appeared to be higher than the chlorinated dioxins and furans. Routine gross decontamination appeared to reduce many of the BFR contaminants, but results for the OPFRs were mixed.

CONCLUSIONS

Structure fires are likely to result in a variety of FRs, dioxins, and furans into the environment, leading to PPE contamination for those working on the fireground. Firefighters should wear self-contained breathing apparatus during all phases of the response and launder or decontaminate their PPE (including gloves) after fire events.

Concentrations of Particulate Matter and PM-Bound Polycyclic Aromatic Hydrocarbons Released during Combustion of Various Types of Materials and Possible Toxicological Potential of the Emissions: The Results of Preliminary Studies

The aim of this study was to compare the concentrations of particulate matter (PM) and PM-bound polycyclic aromatic hydrocarbons (PAHs) during the combustion of various types of materials (i.e., oak, beech, and pine wood, polypropylene, polyurethane, paper, cotton, and oriented strand board (OSB)), and to compare the carcinogenic, mutagenic, and toxic potential of the emissions during the burning of these materials. Personal portable sampling devices were used to collect samples and to determine concentrations of PM4, total suspended particles (TSPs), PM-bound PAHs. The samples were collected during controlled fires under laboratory conditions. The highest PM concentration was recorded during the burning of polyurethane (PM4-1818 mg/m3, TSP-2800 mg/m3), while the highest concentration of PAH mixture was recorded when burning OSB (628.5 µg/m3 PM4-bound; 791.2 µg/m3 TSP-bound PAHs). Thus, the highest carcinogenic (85.5 µg/m3), mutagenic (68.2 µg/m3) and toxic equivalents (26.4 ng/m3) of the PAH mixture were noted during OSB combustion. Carcinogenic potential (CP) of PAH group was determined mainly by phenanthrene (CP on average 21.6%) and pyrene concentrations (13.3%). The results of the study express possible adverse effects from PM-bound PAHs released during combustion for firefighters and other people staying near a fire site.

Analysis of the Effectiveness of Decontamination Fluids on the Level of Biological Contamination of Firefighter Suits

The scope of tasks of chemical and ecological rescue procedures includes prevention of terrorist attacks with biological weapons. After each action, firefighters are obliged to clean and disinfect their outfits to prevent the potential spreading of harmful microorganisms. This study aimed to analyze the effectiveness of decontamination fluids used to disinfect firefighter's suits. Two types of clothes were analyzed: special combat clothing (NOMEX), and the heavy gas-tight chemical type 1a suit. Swabbed places were cut out and sterilized mechanically using detergent and alcohol. Each time, smears were made on sterile glass, fixed in pure ethanol and stained using the Gram method. After this, the staining samples were air dried and photographed under a light microscope at magnification 1000×. Each smear was made in triplicate and the relative number of stained microorganisms was analyzed using ImageJ software. The results showed that detergent significantly decreased the number of pathogens in the chest area on the NOMEX suit and the type 1a-gas-tight clothing and was more effective than alcohol, especially in case of the NOMEX suit. In conclusion, the detergent was more efficient in decontaminating the NOMEX outfit than the heavy gas-tight clothing, whose surface was better cleaned by the alcohol.

The occurrence of PAHs and flame-retardants in air and dust from Australian fire stations

Firefighters are exposed to a wide range of chemicals whilst on duty, including polycyclic aromatic hydrocarbons (PAHs), organophosphate flame-retardants (OPFRs), and polybrominated diphenyl ethers (PBDEs). These groups of chemicals are related to combustion emissions. PAHs are formed during combustion. OPFRs and PBDEs are flame-retardants and are inadvertently released during combustion. Exposure to these chemicals occurs when attending fire scenes, and firefighters can track these chemicals back into fire stations leading to further exposure. The objective of this study was to understand the concentrations of PAHs, OPFRs, and PBDEs in fire stations, to evaluate factors that affect chemical concentration, and to assess how air and dust could contribute to firefighters' relevant exposure risk. Concentrations of 13 PAHs, 9 OPFRs, and 8 PBDEs were quantified in fire station dust (n = 49) and air (n = 15) samples collected between November 2017 and February 2018. The median ∑₁₃PAH concentration was 15 ng m^-3 and 3.1 µg g^-1 in air and dust, respectively, while the median ∑₉ OPFR concentration was 56 ng m^-3 in air and 84 µg g^-1 in dust, and ∑₈ PBDE had a median concentration of 0.78 ng m^-3 in air and 26 µg g^-1 in dust. The estimated daily intakes through dust and air for ∑₁₃ PAHs, ∑₉ OPFRs, and ∑₈ PBDEs in firefighters were 3.6, 17, and 1.6 ng (kg body weight)^-1day^-1, respectively. The worst-case estimated daily intakes were only 2% of the reference dose for individual chemicals. Pearson's correlations with chemical concentration for several PAHs, OPFRs, and PBDEs were found between the number of years since fire stations were last renovated, as well as the storage locations of firefighting ensembles. These results suggest chemicals are brought back to fire stations from fire scenes and that they are accumulating in fire stations. They also suggest soiled firefighting ensembles are a source of these chemicals in fire stations and that their proximity to the rest of the station determines the extent to which they contribute to chemical concentrations in fire stations.