Systemic exposure to PAHs and benzene in firefighters suppressing controlled structure fires

Addressing the need for individual-level exposure monitoring for firefighters using silicone samplers

BACKGROUND

Firefighters are occupationally exposed to hazardous chemical mixtures. Silicone passive sampling devices capture unique exposures over time with minimal impact to the participant and allow for the analysis of a broad chemical space.

OBJECTIVE

Silicone dog tags were worn by firefighters while on- and off-duty to measure individual exposures, identify potential occupational exposures, and assess their relation to occupational variables including fire response frequency, rank, and years as a firefighter.

METHODS

Fifty-six firefighters were recruited from two fire departments with relatively high and low call volumes in the Kansas City metropolitan area to wear two different silicone dog tags as passive samplers while on- and off-duty. Each dog tag was worn for a cumulative 30-day exposure period. Extracts of the dog tags were analyzed with gas chromatography, mass spectrometry methods for 43 flame retardants (FRs), 21 volatile organic compounds (VOCs), 42 polychlorinated biphenyls (PCBs), and 63 polycyclic aromatic hydrocarbons (PAHs).

RESULTS

Ninety-two total chemicals were detected, with eight chemicals not previously reported in firefighter exposure studies. Based on the magnitude and frequency of increased exposure in on-duty dog tags, relative to paired off-duty dog tags, five PBDEs and sec-butylbenzene were identified as potential occupational exposures; sec-butylbenzene and PBDE 49 have not previously been reported in firefighter exposure studies to the authors' knowledge. Multivariate analyses for these six compounds indicated that firefighter rank, fire response rates, and years in the fire service were poor indicators of increased occupational exposure. The greatest on-duty exposures to PBDEs were found in the low-call volume department among operational firefighters. Dog tags from firefighters at the high-call volume department accounted for 75% of PCB detections; one particular fire response may have contributed to this. Additionally, there was measurable similarity in total chemical exposure profiles between paired on- and off-duty tags for some firefighters.

IMPACT

This study used personal silicone passive samplers in the configuration of dog tags worn around the neck to quantify firefighter occupational exposure in on-duty samples relative to paired off-duty samples for several chemical categories: flame retardants, VOCs, and PCBs. Five PBDEs and sec-butylbenzene were identified as potential occupational exposures, however their prevalence in on-duty tags was not associated with frequency of fire responses, firefighter rank, or years the firefighter has been in the fire service. Additionally, similarity between chemical exposures in on- and off-duty tags from the same firefighter invites further investigation into individual behaviors influencing occupational and para-occupational exposures.

Measurement of Polycyclic Aromatic Hydrocarbons (PAHs) on Indoor Materials: Method Development

Wildfire smoke penetrates indoors, and polycyclic aromatic hydrocarbons (PAHs) in smoke may accumulate on indoor materials. We developed two approaches for measuring PAHs on common indoor materials: (1) solvent-soaked wiping of solid materials (glass and drywall) and (2) direct extraction of porous/fleecy materials (mechanical air filter media and cotton sheets). Samples are extracted by sonication in dichloromethane and analyzed with gas chromatography-mass spectrometry. Extraction recoveries range from 50-83% for surrogate standards and for PAHs recovered from direct application to isopropanol-soaked wipes, in line with prior studies. We evaluate our methods with a total recovery metric, defined as the sampling and extraction recovery of PAHs from a test material spiked with known PAH mass. Total recovery is higher for "heavy" PAHs (HPAHs, 4 or more aromatic rings) than for "light" PAHs (LPAHs, 2-3 aromatic rings). For glass, the total recovery range is 44-77% for HPAHs and 0-30% for LPAHs. Total recoveries from painted drywall are <20% for all PAHs tested. For filter media and cotton, total recoveries of HPAHs are 37-67 and 19-57%, respectively. These data show acceptable HPAH total recovery on glass, cotton, and filter media; total recovery of LPAHs may be unacceptably low for indoor materials using methods developed here. Our data also indicate that extraction recovery of surrogate standards may overestimate the total recovery of PAHs from glass using solvent wipe sampling. The developed method enables future studies of accumulation of PAHs indoors, including potential longer-term exposure derived from contaminated indoor surfaces.

In vitro data for fire pollutants: contribution of studies using human cell models towards firefighters' occupational

Firefighters are the principal line of defense against fires, being at elevated risk of exposure to health-relevant pollutants released during fires and burning processes. Although many biomonitoring studies exist, only a limited number of human in vitro investigations in fire risk assessment are currently available. In vitro studies stand out as valuable tools to assess the toxicity mechanisms involved following exposure to fire pollutants at a cellular level. The aim of the present review was to contextualize existing in vitro studies using human cell models exposed to chemicals emitted from fire emissions and wood smoke and discuss the implications of the observed toxic outcomes on adverse health effects detected in firefighters. Most of the reported in vitro investigations focused on monocultures respiratory models and exposure to particulate matter (PM) extracts collected from fire effluents. Overall, (1) a decrease in cellular viability, (2) enhanced oxidative stress, (3) increased pro-inflammatory cytokines levels and (4) elevated cell death frequencies were noted. However, limited information remains regarding the toxicity mechanisms initiated by firefighting activities. Hence, more studies employing advanced in vitro models and exposure systems using human cell lines are urgently needed taking into consideration different routes of exposure and health-related pollutants released from fires. Data are needed to establish and define firefighters' occupational exposure limits and to propose mitigation strategies to promote beneficial human health.

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.

Effectiveness of dermal cleaning interventions for reducing firefighters' exposures to PAHs and genotoxins

Firefighters are exposed to carcinogenic and mutagenic combustion emissions, including polycyclic aromatic hydrocarbons (PAHs). Fire service and firefighter cancer advocacy groups recommend skin cleaning using wipes or washing with detergent and water after exposure to smoke, although these strategies have not been proven to reduce exposures to harmful combustion products such as PAHs. This study assessed dermal decontamination methods to reduce PAH exposures by firefighters participating in live fire training scenarios. Study participants (n = 88) were randomly assigned to an intervention group (i.e., two types of commercial skin wipes, detergent and water, or a control group who did not use any skin decontamination). PAHs were measured in personal air (during the fire) and dermal wipe samples (before and after fire suppression and after dermal decontamination). PAH metabolites and mutagenicity were measured in urine samples before and after fire suppression. Airborne PAH concentrations during the fire ranged between 200 and 3,970 μg/m³ (mean = 759 μg/m³, SD = 685 μg/m³). Firefighters had higher total PAHs and high-molecular-weight PAHs on their skin after the fire compared to before (1.3- and 2.2-fold, respectively, p < 0.01). Urinary PAH metabolites increased significantly following exposure to the training fires by 1.7 to 2.2-fold (depending on the metabolite, p < 0.001). Urinary mutagenicity did not differ significantly between pre- and post-fire for any of the decontamination methods. Detergent and water was the only intervention that removed a significant amount of total PAHs from the skin (0.72 ng/cm² preintervention vs. 0.38 ng/cm² postintervention, p < 0.01). However, fold changes in urinary PAH metabolites (i.e., pre- vs. post-exposure levels) did not differ among any of the dermal decontamination methods or the control group. These data suggest that despite on-site attempts to remove PAHs from firefighters' skin, the examined interventions did not reduce the internal dose of PAHs. Future work should investigate preventing initial exposure using other interventions, such as improved personal protective equipment.

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.

Exposure and Risk Assessment of Korean Firefighters to PBDEs and PAHs via Fire Vehicle Dust and Personal Protective Equipment

In this study, the levels of polycyclic aromatic hydrocarbons (PAHs) and polybrominated diphenyl ethers (PBDEs) were characterized in firefighters' personal protective equipment (PPE) (i.e., jackets, pants, hoods, and gloves) and vehicle dust wipe samples to assess the exposure and potential risk of firefighters to these combustion-related toxic pollutants. The mean levels of ∑PBDEs in the fire vehicle dust samples (778 and 449 pg/cm² for pump trucks and command cars, respectively) were significantly higher than those in the private vehicles (31.2 pg/cm²) (Kruskal-Wallis test, p < 0.05), which was similar to the ∑PAH levels (521, 185, and 46.8 pg/cm² for pump trucks, command cars, and private vehicles, respectively). In the case of firefighters' PPE, the levels of ∑PBDEs and ∑PAHs in used jackets and pants were found to be, respectively, 70- to 2242-folds and 11- to 265-folds higher than those in their unused counterparts. Biomass/petroleum combustion was found to be the main source of PAH contamination in fire vehicle dust and used PPE in the present study. Both carcinogenic and noncarcinogenic risks via vehicle dust ingestion and dermal absorption from wearing of PPE were within permissible limits, although the relative risk evaluation showed that PAH/PBDE absorption via wearing of PPE could pose a higher likelihood of carcinogenic and noncarcinogenic risks than the ingestion of pollutants via fire vehicle dust, warranting the need for appropriate management of firefighters' personal protective ensembles.

Exposure to PAHs during Firefighting Activities: A Review on Skin Levels, In Vitro/In Vivo Bioavailability, and Health Risks

Occupational exposure as a firefighter is a complex activity that continuously exposes subjects to several health hazards including fire emissions during firefighting. Firefighters are exposed to polycyclic aromatic hydrocarbons (PAHs), known as toxic, mutagenic, and carcinogenic compounds, by inhalation, dermal contact, and ingestion. In this work, a literature overview of firefighters' dermal exposure to PAHs after firefighting and data retrieved from skin in vitro/in vivo studies related to their dermal absorption, bioavailability, and associated toxicological and carcinogenic effects are reviewed. The evidence demonstrates the contamination of firefighters' skin with PAHs, mainly on the neck (2.23-62.50 ng/cm²), wrists (0.37-8.30 ng/cm²), face (2.50-4.82 ng/cm²), and hands (1.59-4.69 ng/cm²). Concentrations of possible/probable carcinogens (0.82-33.69 ng/cm²), including benzopyrene isomers, were found on firefighters' skin. PAHs penetrate the skin tissues, even at low concentrations, by absorption and/or diffusion, and are locally metabolized and distributed by the blood route to other tissues/organs. Lighter PAHs presented increased dermal permeabilities and absorption rates than heavier compounds. Topical PAHs activate the aryl hydrocarbon receptor and promote the enzymatic generation of reactive intermediates that may cause protein and/or DNA adducts. Future research should include in vitro/in vivo assays to perform a more realistic health risk assessment and to explore the contribution of dermal exposure to PAHs total internal dose.

Evaluation of potential toxicity of smoke from controlled burns of furnished rooms - effect of flame retardancy

It has been reported that incorporation of fire retardants into home furnishings and electronics increases the toxicity of smoke produced during combustion in house fires. Studies have been limited to exercises in analytical chemistry but the biological effects of emissions, particularly regarding chronic toxicity, have not been investigated. The combustion of furnishings with and without chemical flame retardants (FR) regarding (1) ignition resistance and fire progression, (2) chemical composition of smoke (analytical chemistry), and (3) toxicity was compared. Data demonstrated that flame retarded furnishings slowed the generation of toxic levels of acutely toxic gases. The potential chronic toxicity of smoke was assessed using the ToxTracker® assay. Smoke samples from rooms with less flame retarded furnishings exhibited a lesser response in this assay than smoke samples from rooms with flame retarded furnishings. Chemicals associated with activation of the aryl hydrocarbon receptor (AHR), namely benzo[b]fluoranthene, benzo[a]anthracene, benzo[a]pyrene, chrysene, and indeno[1,2,3-cd]pyrene, were not found in smoke from more flame retarded furnished rooms, but were present only in smoke from rooms with less flame retarded furnishings. In conclusion, smoke resulting from combustion of flame retarded furnishings did not increase indicators of potential chronic toxicity hazards relative to non-flame retarded furnishings.

Biological monitoring for exposure assessment of volatile organic compounds by Korean firefighters at the fire site

The VOCs and metabolites in urine for exposed VOCs were evaluated for firefighters who participated in the actual fire fighting to determine whether firefighters were exposed to hazardous chemicals, which is the basic data on cancer risk of firefighters. When the fire extinguishing time is long, the concentration of benzene, PHEMA, and toluene among VOCs and metabolites in the case of fire suppression, rescue, and fire investigation work, which is estimated that the exposure of hazardous substances generated from the fire site at the time of fire suppression was large, significantly increased. In the case where the number of urination is 2 or less, the concentration of TZCA, toluene, and benzene among VOCs and metabolites was significantly increased compared to the number of urinating more than 2 times. In the concentration of VOCs and metabolites in urine corrected with creatinine, the concentrations of toluene and PHEMA in urine were significantly higher. The concentration of PHEMA in urine was higher in the group who participated in the fire suppression for more than 11 hours (long time) than the group who participated in the fire suppression for a short time.

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.

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.

Urinary Metabolites of Polycyclic Aromatic Hydrocarbons in Firefighters: A Systematic Review and Meta-Analysis

Firefighters are intermittently exposed to complex, mixed pollutants in random settings. Of those pollutants, PAHs (polycyclic aromatic hydrocarbons) are the most commonly studied and best understood. PAH exposure can occur via multiple routes; therefore, the levels of hydroxylated metabolites of PAHs in urine have been used as a biomonitoring tool for risk assessment. We performed a systematic review and meta-analysis of the literature to estimate the levels of urinary hydroxylated PAH (OHPAH) among firefighters, determine risk attributions, and, finally, evaluate the scope of preventive efforts and their utility as diagnostic tools. The meta-regression confirmed increases in OHPAH concentrations after fire activities by up to 1.71-times (p-values: <0.0001). Samples collected at a time point of 2−4 h after a fire suppression showed a consistent, statistically significant pattern as compared with baseline samples. The National Fire Protection Association (NFPA) standard 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments lists various health examinations, including a urinalysis for occupational chemical exposure if indicated and medical screening for cancers and cardiovascular diseases. Biomonitoring is a valuable screening tool for assessing occupational exposure and the results of this meta-analysis support their inclusion in regular health screenings for firefighters.

A low cost, easy-to-assemble, open-source modular mobile sampler design for thermal desorption analysis of breath and environmental VOCs

Exhaled breath vapor contains hundreds of volatile organic compounds (VOCs), which are the byproducts of health and disease metabolism, and they have clinical and diagnostic potential. Simultaneous collection of breath VOCs and background environmental VOCs is important to ensure analyses eliminate exogenous compounds from clinical studies. We present a mobile sampling system to extract gaseous VOCs onto commercially available sorbent-packed thermal desorption tubes. The sampler can be connected to a number of commonly available disposable and reusable sampling bags, in the case of this study, a Tedlar bag containing a breath sample. Alternatively, the inlet can be left open to directly sample room or environmental air when obtaining a background VOC sample. The system contains a screen for the operator to input a desired sample volume. A needle valve allows the operator to control the sample flow rate, which operates with an accuracy of -1.52 ± 0.63% of the desired rate, and consistently generated that rate with 0.12 ± 0.06% error across repeated measures. A flow pump, flow sensor and microcontroller allow volumetric sampling, as opposed to timed sampling, with 0.06 ± 0.06% accuracy in the volume extracted. Four samplers were compared by sampling a standard chemical mixture, which resulted in 6.4 ± 4.7% error across all four replicate modular samplers to extract a given VOC. The samplers were deployed in a clinical setting to collect breath and background/environmental samples, including patients with active SARS-CoV-2 infections, and the device could easily move between rooms and can undergo required disinfection protocols to prevent transmission of pathogens on the case exterior. All components required for assembly are detailed and are made publicly available for non-commercial use, including the microcontroller software. We demonstrate the device collects volatile compounds, including use of chemical standards, and background and breath samples in real use conditions.

Assessment of Volatile Compound Transference through Firefighter Turnout Gear

There is high concern about the exposure of firefighters to toxic products or carcinogens resulting from combustion during fire interventions. Firefighter turnout gear is designed to protect against immediate fire hazards but not against chemical agents. Additionally, the decontamination of firefighter personal protective equipment remains unresolved. This study evaluated the feasibility of a screening method based on headspace-gas chromatography-ion mobility spectrometry (HS-GC-IMS) in combination with chemometrics (cluster analysis, principal component analysis, and linear discriminant analysis) for the assessment of the transference of volatile compounds through turnout gear. To achieve this, firefighter turnout gears exposed to two different fire scenes (with different combustion materials) were directly analyzed. We obtained a spectral fingerprint for turnout gears that were both exposed and non-exposed to fire scenes. The results showed that (i): the contamination of the turnout gears is different depending on the type of fire loading; and (ii) it is possible to determine if the turnout gear is free of volatile compounds. Based on the latest results, we concluded that HS-GC-IMS can be applied as a screening technique to assess the quality of turnout gear prior to a new fire intervention.

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.

Combustion products generated in simulated industrial fires

Studies of firefighter exposure to combustion products have focused predominantly on real or simulated residential structure fires, with few investigations considering industrial fire scenarios. This study measured the atmospheric concentrations of a variety of volatile organic compounds (VOCs), acid gases, and polycyclic aromatic hydrocarbons (PAHs) produced during fires in simulated industrial premises, as well as the deposition of PAHs onto the structural firefighting ensembles worn by the firefighters involved in extinguishment activities. Ingress of these combustion products into the structural firefighting ensembles during firefighting was also measured. Benzene concentrations of up to 23 mg/m³ and total PAH concentrations ranging from 1.7 to 8.6 mg/m³ were observed in personal air samples collected outside the structural firefighting ensembles, as well as a variety of acid gases including hydrogen chloride and hydrogen cyanide. Most combustion products detected outside the structural firefighting ensembles were also detected inside the ensembles, although often at much lower concentrations. The degree of protection observed was not uniform across all the combustion products investigated, with lower levels of protection found for gaseous combustion products such as benzene, xylene, hydrogen cyanide, and hydrochloric acid as compared with PAHs. Deposition of a variety of PAH compounds was observed on the outer surface of the structural firefighting ensembles, with total PAH concentrations ranging from 161 to 347 ng/cm². While similar combustion products are involved in firefighter exposures during residential and industrial fires, deposition rates of PAHs, may be substantially higher during industrial firefighting. This research provides evidence supporting fireground decontamination measures for management of contamination of structural firefighting ensembles and equipment worn or carried by firefighters during firefighting activities. Further research is required to investigate the potential for dermal deposition of PAHs during actual industrial fire responses, and characterize which stages of fire and firefighting operations contribute the most to firefighters' exposure to particular contaminants.

Exposure to fire smoke in fire training structures: A prospective observational study

The aim of this study was to assess the level of exposure to and contamination by smoke within a population of firefighter instructors. We performed a prospective observational study from September 17 to September 26, 2018, using environmental samples and urinary biomarker analysis. Occupational exposure limits (OELs) were never exceeded, except for carbon monoxide for the fire attack training chamber and formaldehyde and carbon monoxide for the fire box. As regards to urinary biomarkers, we observed that 1OHP and 1-naphtol did accumulate. The pre-post analysis showed an acute exposure exceeding the BRVs of benzene, 1-hydroxypyrene and naphtol, except for 3-benzo[a]pyrene which was undetectable in half of the cases. Even if values were reassuring, an effort could be made to improve the working conditions and reduce contamination by rethinking the respiratory protection and improving PPE quality.

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.

Associations between polyfluoroalkyl substance and organophosphate flame retardant exposures and telomere length in a cohort of women firefighters and office workers in San Francisco

BACKGROUND

Environmental chemical exposures can affect telomere length, which in turn has been associated with adverse health outcomes including cancer. Firefighters are occupationally exposed to many hazardous chemicals and have higher rates of certain cancers. As a potential biomarker of effect, we assessed associations between chemical exposures and telomere length in women firefighters and office workers from San Francisco, CA.

METHODS

We measured serum concentrations of polyfluoroalkyl substances (PFAS), urinary metabolites of flame retardants, including organophosphate flame retardants (OPFRs), and telomere length in peripheral blood leukocytes in women firefighters (N = 84) and office workers (N = 79) who participated in the 2014-15 Women Workers Biomonitoring Collaborative. Multiple linear regression models were used to assess associations between chemical exposures and telomere length.

RESULTS

Regression results revealed significant positive associations between perfluorooctanoic acid (PFOA) and telomere length and perfluorooctanesulfonic acid (PFOS) and telomere length among the whole cohort. Models stratified by occupation showed stronger and more significant associations among firefighters as compared to office workers. Among firefighters in models adjusted for age, we found positive associations between telomere length and log-transformed PFOA (β (95%CI) = 0.57(0.12, 1.02)), PFOS (0.44 (0.05, 0.83)), and perfluorodecanoic acid (PFDA) (0.43 (0.02, 0.84)). Modeling PFAS as categories of exposure showed significant associations between perfluorononanoic acid (PFNA) and telomere length among firefighters. Significant associations between OPFR metabolites and telomere length were seen for bis (1,3-dichloro-2-propyl) phosphate (BDCPP) and telomere length among office workers (0.21(0.03, 0.40)) and bis (2-chloroethyl) phosphate (BCEP) and telomere length among firefighters (- 0.14(- 0.28, - 0.01)). For OPFRs, the difference in the direction of effect by occupational group may be due to the disparate detection frequencies and concentrations of exposure between the two groups and/or potential unmeasured confounding.

CONCLUSION

Our findings suggest positive associations between PFAS and telomere length in women workers, with larger effects seen among firefighters as compared to office workers. The OPFR metabolites BDCPP and BCEP are also associated with telomere length in firefighters and office workers. Associations between chemical exposures and telomere length reported here and by others suggest mechanisms by which these chemicals may affect carcinogenesis and other adverse health outcomes.

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.

Regularization of least squares problems in CHARMM parameter optimization by truncated singular value decompositions

We examine the use of the truncated singular value decomposition and Tikhonov regularization in standard form to address ill-posed least squares problems Ax = b that frequently arise in molecular mechanics force field parameter optimization. We illustrate these approaches by applying them to dihedral parameter optimization of genotoxic polycyclic aromatic hydrocarbon-DNA adducts that are of interest in the study of chemical carcinogenesis. Utilizing the discrete Picard condition and/or a well-defined gap in the singular value spectrum when A has a well-determined numerical rank, we are able to systematically determine truncation and in turn regularization parameters that are correspondingly used to produce truncated and regularized solutions to the ill-posed least squares problem at hand. These solutions in turn result in optimized force field dihedral terms that accurately parameterize the torsional energy landscape. As the solutions produced by this approach are unique, it has the advantage of avoiding the multiple iterations and guess and check work often required to optimize molecular mechanics force field parameters.

Detecting Chemical Vapor Diffusion through Firefighter Turnout Gear

Firefighters are exposed to burning materials that may release toxic partial combustion and pyrolysis products into the environment, including compounds listed as priority pollutants by the United States Environmental Protection Agency (EPA). A novel passive sampling dosimeter device containing firefighter turnout gear as a diffusion membrane and an activated charcoal strip (ACS) for volatile analyte collection was designed and used to monitor potential exposures of firefighters to volatile organic compounds. Solvent extracts from the ACS and turnout gear diffusion layer were analyzed using Gas Chromatography–Mass Spectrometry (GC-MS) to determine the diffusion of compounds from burned substrates through firefighter turnout gear and compound adsorption to the turnout gear. The compounds in these samples were identified using target factor analysis (TFA). An activated carbon layer (ACL) was added to the dosimeter between the turnout gear and the ACS. The presence of combustion and pyrolysis compounds identified on the ACS in the dosimeter was reduced.

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.

Exposure and Absorption of PAHs in Wildland Firefighters: A Field Study with Pilot Interventions

Objectives

There is limited knowledge of exposure to polycyclic aromatic hydrocarbons (PAHs) in wildland firefighters, or of the effectiveness of interventions to reduce this. This study of wildland firefighters assessed whether PAHs were present and considered respiratory protection and enhanced skin hygiene as possible interventions.

Methods

1-Hydroxypyrene (1-HP) was measured in urine samples collected pre-shift, post-shift, and next morning from wildland firefighters in Alberta and British Columbia. Skin wipes, collected pre- and post-shift, were analysed for eight PAHs. Breathing zone air samples were analysed for 11 PAHs. As pilot interventions, participants were randomized to either normal or enhanced skin hygiene. A sample of volunteers was assigned to a disposable N95 mask or a half facepiece mask with P100 organic vapour cartridge. Participants completed a brief questionnaire on activities post-shift and respiratory symptoms.

Results

Non-smoking firefighters (66 male and 20 female) were recruited from 11 fire crews. Air sampling pumps were carried for the full shift by 28 firefighters, 25 firefighters wore masks (14 N95 and 11 P100); 42 were assigned to the enhanced skin hygiene intervention. Sixty had hot spotting as their main task. Air monitoring identified PAHs (benzo(b,j,k)fluoranthene in particulates, phenanthrene in the gaseous phase) for 6 of the 11 crews. PAHs (largely naphthalene) were found post-shift on 40/84 skin wipes from the hand and 38/84 from jaw/throat. The mean increase in 1-HP in urine samples collected after the shift (compared with samples collected before the shift) was 66 ng g⁻¹ creatinine (P < 0.001) with an increase over the shift found for 76% of participants. 1-HP in next morning urine samples was significantly lower than at the end of shift (a reduction of 39.3 ng g⁻¹: P < 0.001). The amount of naphthalene on skin wipes was greater at the end of the shift (post) than at the start (pre). The mean post–pre weight difference of naphthalene on skin wipes taken from the hand was 0.96 ng wipe⁻¹ (P = 0.01) and from the jaw/throat 1.28 ng wipe⁻¹ (P = 0.002). The enhanced skin hygiene intervention lead to a larger reduction in 1-HP between end of shift and next morning urine samples but only for those with naphthalene on skin wipes at the end of shift. The difference in 1-HP concentration in urine samples collected before and after the shift was reduced for those wearing a mask (linear tend P = 0.063, one-sided). In multivariable models, 1-HP at end of shift was related to gaseous phase phenanthrene, estimated from air sampling [β = 318.2, 95% confidence interval (CI) 67.1–569.2]. Naphthalene on hand skin wipes reflected work in hot spotting during the shift (β = 0.53, 95% CI 0.22–0.86).

Conclusions

This study provided evidence of PAHs in the air and on the skin of many, but not all, fire crew. Absorbed PAHs, reflected in 1-HP in urine, increased over the shift. Results from the pilot interventions suggest that enhanced skin hygiene would reduce absorption post fire where PAHs had been accumulated on the skin, and that masks could be effective in reducing PAH inhalation exposure. Interventions to reduce PAH absorption are supported by the pilot work reported here and warrant further evaluation across a full fire season.

Differential DNA Methylation by Hispanic Ethnicity Among Firefighters in the United States

Firefighters are exposed to a variety of environmental hazards and are at increased risk for multiple cancers. There is evidence that risks differ by ethnicity, yet the biological or environmental differences underlying these differences are not known. DNA methylation is one type of epigenetic regulation that is altered in cancers. In this pilot study, we profiled DNA methylation with the Infinium MethylationEPIC in blood leukocytes from 31 Hispanic white and 163 non-Hispanic white firefighters. We compared DNA methylation (1) at 12 xenobiotic metabolizing genes and (2) at all loci on the array (>740 000), adjusting for confounders. Five of the xenobiotic metabolizing genes were differentially methylated at a raw P-value <.05 when comparing the 2 ethnic groups, yet were not statistically significant at a 5% false discovery rate (q-value <.05). In the epigenome-wide analysis, 76 loci exhibited DNA methylation differences at q < .05. Among these, 3 CpG sites in the promoter region of the biotransformation gene SULT1C2 had lower methylation in Hispanic compared to non-Hispanic firefighters. Other differentially methylated loci included genes that have been implicated in carcinogenesis in published studies (FOXK2, GYLTL1B, ZBTB16, ARHGEF10, and more). In this pilot study, we report differential DNA methylation between Hispanic and non-Hispanic firefighters in xenobiotic metabolism genes and other genes with functions related to cancer. Epigenetic susceptibility by ethnicity merits further study as this may alter risk for cancers linked to toxic exposures.

Lipid peroxidation metabolites associated with biomarkers of inflammation and oxidation stress in workers handling carbon nanotubes and metal oxide nanoparticles

The purpose of this study was to assess the effects of lipid peroxidation with occupational exposure to different types of nanomaterials (NMs). In this cross-sectional study, urine and exhaled breath condensate (EBC) samples were collected from 80 NM-handling workers [30 workers handling nano-titanium oxide (nano-TiO₂), 28 handling nano-silicon dioxide (nano-SiO₂), 22 handling carbon nanotubes (CNTs)], and 69 controls (office workers) from 2010 to 2012. Urinary 8-isoPGF_2α, 2,3 dinor-8-isoPGF_2α, PGF_2α, and EBC 8-iso PGF_2α were measured as lipid peroxidation biomarkers in 2013. A significant positive correlation was found between 8-isoPGF_2α, 2,3 dinor-8-isoPGF_2α, PGF_2α, and total isoprostane in urine. Furthermore, significant positive correlations were noted between EBC 8-iso PGF_2α and urinary 2,3 dinor-8-isoPGF_2α (Spearman correlation r = 0.173, p = 0.035). Exposure to nano-TiO₂ resulted in significantly higher levels of urinary 8-isoPGF_2α, 2,3 dinor-8-isoPGF_2α and PGF_2α, even after controlling for confounding factors. Moreover, significant associations and exposure intensity-response relationships between EBC 8-iso PGF_2α and NMs were observed in workers, whether handling nano-TiO₂, nano-SiO₂, or CNTs. Among them, the significant trends were identified based on the intensity of risk levels. These results provided evidence that exposure to nano-TiO₂, nano-SiO₂, and CNTs may lead to lipid peroxidation in EBC. For routine biomonitoring purposes, this finding, which came through noninvasive methods, may be useful for workers exposed to NMs.HighlightsData regarding the effects of nano-titanium oxide (nano-TiO₂), nano-silicon dioxide (nano-SiO₂), and carbon nanotubes (CNTs) on lipid peroxidation in workers are limited.8-Iso PGF_2α in exhaled breath condensate of workers exposed to nanoparticles was higher than that of office workers.Exposure to titanium oxide (TiO₂) and silica (SiO₂) may lead to lipid peroxidation, as indicated by 8-isoPGF_2α, 2,3 dinor-8-isoPGF_2α, and PGF_2α.Examination of lipid peroxidation in EBC has seems to be a useful technique for noninvasive monitoring of workers exposed to nanoparticles.

Associations between polyfluoroalkyl substance and organophosphate flame retardant exposures and telomere length in a cohort of women firefighters and office workers in San Francisco

BACKGROUND

Environmental chemical exposures can affect telomere length, which in turn has been associated with adverse health outcomes including cancer. Firefighters are occupationally exposed to many hazardous chemicals and have higher rates of certain cancers. As a potential marker of effect, we assessed associations between chemical exposures and telomere length in women firefighters and office workers from San Francisco, CA.

METHODS

We measured serum levels of polyfluoroalkyl substances (PFAS), urinary metabolites of flame retardants, including organophosphate flame retardants (OPFRs), and telomere length in peripheral blood leukocytes in women firefighters and office workers who participated in the 2014-15 Women Workers Biomonitoring Collaborative. Multiple linear regression models were used to assess associations between chemical exposures and telomere length.

RESULTS

Regression results revealed significant positive associations between perfluorooctanoic acid (PFOA) and telomere length and perfluorooctanesulfonic acid (PFOS) and telomere length among the whole cohort. Models stratified by occupation showed stronger and more significant associations among firefighters as compared to office workers. Among firefighters in models adjusted for age, we found positive associations between telomere length and log-transformed PFOA ( β (95%CI) = 0.57(0.12, 1.02)), PFOS (0.44 (0.05, 0.83)), and perfluorodecanoic acid (PFDA) (0.43 (0.02, 0.84)). Modeling PFAS as categories of exposure showed significant associations between perfluorononanoic acid (PFNA) and telomere length among firefighters. Significant associations between OPFR metabolites and telomere length were seen for bis(1,3-dichloro-2-propyl) phosphate (BDCPP) and telomere length among office workers (0.21(0.03, 0.40)) and bis(2-chloroethyl) phosphate (BCEP) and telomere length among firefighters (-0.14(-0.28, -0.01)). For OPFRs, the difference in the direction of effect by occupational group may be due to the disparate detection frequencies and levels of exposure between the two groups and/or potential unmeasured confounding.

CONCLUSION

Our findings suggest positive associations between PFAS and telomere length in women workers, with larger effects seen among firefighters as compared to office workers. The OPFR metabolites BDCPP and BCEP are also associated with telomere length in firefighters and office workers. Associations between chemical exposures and telomere length reported here and by others suggest mechanisms by which these chemicals may affect carcinogenesis and other adverse health outcomes.

Impact of select PPE design elements and repeated laundering in firefighter protection from smoke exposure

As the Fire Service becomes more aware of the potential health effects from occupational exposure to hazardous contaminants, personal protective equipment (PPE) manufacturers, and fire departments have responded by developing and implementing improved means of firefighter protection, including more frequent laundering of PPE after exposures. While laboratory testing of new PPE designs and the effect of laundering on PPE fabric provides a useful way to evaluate these approaches, laboratory scale testing does not necessarily translate to full garment protection. Utilizing a fireground smoke exposure simulator, along with air and/or filter-substrate sampling for polycyclic aromatic hydrocarbons (PAHs) and benzene, this pilot study tested the chemical-protective capabilities of firefighting PPE of different designs (knit hood vs. particulate-blocking hood, turnout jacket with zipper closure vs. hook & dee closure), including the impact of repeatedly exposing and cleaning (through laundering or decontamination on-scene) PPE 40 times. Overall, PAH contamination on filters under hoods in the neck region were higher (median PAHs = 14.7 µg) than samples taken under jackets in the chest region (median PAHs = 7.05 µg). PAH levels measured under particulate-blocking hoods were lower than levels found under knit hoods. Similarly, zippered closures were found to provide a greater reduction in PAHs compared to hook & dee closures. However, neither design element completely eliminated contaminant ingress. Measurements for benzene under turnout jackets were similar to ambient chamber air concentrations, indicating little to no attenuation from the PPE. The effect of laundering or on-scene decontamination on contaminant breakthrough appeared to depend on the type of contaminant. Benzene breakthrough was negatively associated with laundering, while PAH breakthrough was positively associated. More research is needed to identify PPE features that reduce breakthrough, how targeted changes impact exposures, and how fireground exposures relate to biological absorption of contaminants.

Discovery of firefighter chemical exposures using military-style silicone dog tags

Occupational chemical hazards in the fire service are hypothesized to play a role in increased cancer risk, and reliable sampling technologies are necessary for conducting firefighter chemical exposure assessments. This study presents the military-style dog tag as a new configuration of silicone passive sampling device to sample individual firefighters' exposures at one high and one low fire call volume department in the Kansas City, Missouri metropolitan area. The recruited firefighters (n = 56) wore separate dog tags to assess on- and off-duty exposures (n_dogtags = 110), for a total of 30 24 h shifts. Using a 63 PAH method (GC-MS/MS), the tags detected 45 unique PAHs, of which 18 have not been previously reported as firefighting exposures. PAH concentrations were higher for on- compared to off-duty tags (0.25 < Cohen's d ≤ 0.80) and for the high compared to the low fire call volume department (0.25 ≤ d < 0.70). Using a 1530 analyte screening method (GC-MS), di-n-butyl phthalate, diisobutyl phthalate, guaiacol, and DEET were commonly detected analytes. The number of fire attacks a firefighter participated in was more strongly correlated with PAH concentrations than firefighter rank or years in the fire service. This suggested that quantitative data should be employed for firefighter exposure assessments, rather than surrogate measures. Because several detected analytes are listed as possible carcinogens, future firefighter exposure studies should consider evaluating complex mixtures to assess individual health risks.

Understanding skin absorption of common aldehyde vapours from exposure during hazardous material incidents

The toxic release of aldehyde vapours during a hazardous material (HAZMAT) incident primarily results in respiratory concerns for the unprotected public. However, skin absorption may be an important concurrent exposure route that is poorly understood for this scenario. This study provides experimental data on the skin absorption properties of common aldehydes used in industry, including acetaldehyde, acrolein, benzaldehyde and formaldehyde, in gaseous or vapour form using an adapted in vitro technique. Two of the four tested aldehydes were found to penetrate the skin in appreciable amounts following 30-min exposure at HAZMAT relevant atmospheric concentrations: acetaldehyde (5.29 ± 3.24 µg/cm²) and formaldehyde (3.45 ± 2.58 µg/cm²). Whereas only low levels of acrolein (0.480 ± 0.417 µg/cm²) and benzaldehyde (1.46 ± 0.393 µg/cm²) skin penetration was noted. The aldehydes demonstrated differing levels of interaction with fabric. Formaldehyde and acetaldehyde adsorbed strongly to denim, whereas benzaldehyde and acrolein displayed no sink properties. However, denim was shown to be an initial protective barrier and reduced penetration outcomes for all aldehydes. This study provides important information to assist first responders and confirms the relevance of using physicochemical properties (e.g. solubility, molecular weight, partition coefficient) to predict skin permeation potential in the absence of empirical data during HAZMAT incidents involving different types of aldehydes.

Development of Fireground Exposure Simulator (FES) Prop for PPE Testing and Evaluation

Research on the performance of personal protective equipment (PPE) for the Fire Service is challenged by the ability to repeatedly and feasibly test new designs, interventions and wear trials in realistic conditions that appropriately simulate end use environments. To support firefighter PPE research and firefighter PPE acclimation/training, a multidisciplinary team has developed a low cost, easily replicable approach for simulating conditions commonly encountered by firefighters operating on the interior of a residential structure fire. The testing enclosure can be used with either stationary mannequins or firefighters conducting typical fireground activities, providing a method to study a wide range of PPE and physiological studies as well as training activities that may support developing new technologies and standardized testing opportunities. Environmental gas concentrations and firefighters' local temperatures were measured during trials and compared to data collected from simulated fireground activities and fireground responses with good agreement.

Cancer Perceptions Among Smokeless Tobacco Users: A Qualitative Study of US Firefighters

Background

Prevalence rates of smokeless tobacco (SLT) use among firefighters are remarkably high and substantially higher than similar occupational groups and the general U.S. population. The purpose of this study was to explore the perspectives of fire service personnel regarding cancer and its associations with tobacco and SLT use.

Methods

This descriptive study used a qualitative approach. Key informant interviews were conducted in 39 career firefighters and fire service administration from across the U.S. Discussion were recorded, transcribed verbatim and transferred to NVivo software for narrative analysis. Topics explored included cancer perceptions, attitudes and beliefs, and cultural factors related to SLT use behaviors. Results: Major themes that emerged among fire service personnel included concerns about cancer and its risk factors including firefighting tasks, such as fire overhaul operations, and from their lifestyle behaviors, such as alcohol and tobacco use. Firefighters also suggested a number of reasons for their increased SLT use, such as fire department tobacco-free policy and fire service culture.

Conclusion

The current study provides a rich foundation for future research, prevention, and intervention efforts for the fire service and research communities regarding tobacco and SLT use and cancer risk. Additional research on firefighters' cancer beliefs deserves future research in order to improve messaging about the risks of cancer due to firefighting.

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.

Integrating Exposure Knowledge and Serum Suspect Screening as a New Approach to Biomonitoring: An Application in Firefighters and Office Workers

Firefighters (FF) are exposed to recognized and probable carcinogens, yet there are few studies of chemical exposures and associated health concerns in women FFs, such as breast cancer. Biomonitoring often requires a priori selection of compounds to be measured, and so, it may not detect relevant, lesser known, exposures. The Women FFs Biomonitoring Collaborative (WFBC) created a biological sample archive and conducted a general suspect screen (GSS) to address this data gap. Using liquid chromatography-quadrupole time-of-flight tandem mass spectrometry, we sought to identify candidate chemicals of interest in serum samples from 83 women FFs and 79 women office workers (OW) in San Francisco. We identified chemical peaks by matching accurate mass from serum samples against a custom chemical database of 722 slightly polar phenolic and acidic compounds, including many of relevance to firefighting or breast cancer etiology. We then selected tentatively identified chemicals for confirmation based on the following criteria: (1) detection frequency or peak area differences between OW and FF; (2) evidence of mammary carcinogenicity, estrogenicity, or genotoxicity; and (3) not currently measured in large biomonitoring studies. We detected 620 chemicals that matched 300 molecular formulas in the WFBC database, including phthalate metabolites, phosphate flame-retardant metabolites, phenols, pesticides, nitro and nitroso compounds, and per- and polyfluoroalkyl substances. Of the 20 suspect chemicals selected for validation, 8 were confirmed-including two alkylphenols, ethyl paraben, BPF, PFOSAA, benzophenone-3, benzyl p-hydroxybenzoate, and triphenyl phosphate-by running a matrix spike of the reference standards and using m/z, retention time, and the confirmation of at least two fragment ions as criteria for matching. GSS provides a powerful high-throughput approach to identify and prioritize novel chemicals for biomonitoring and health studies.

Exposure to Perfluoroalkyl Substances in a Cohort of Women Firefighters and Office Workers in San Francisco

Studies of firefighters have shown increased exposures to carcinogenic compounds and elevated rates of certain cancers compared to the general population, yet this research has focused almost exclusively on men. To address this gap, the Women Firefighters Biomonitoring Collaborative created a biological sample archive and analyzed levels of perfluoroalkyl substances (PFAS) among women firefighters (N = 86) and office workers (N = 84) in San Francisco. Serum samples were collected and analyzed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) to measure and compare PFAS levels between firefighters and office workers. 7 of 12 PFAS congeners were detected in the least 70% of the study population, and 4 congeners were detected in 100% of participants. In regression models comparing PFAS levels by occupation and adjusting for potential confounders, firefighters had higher geometric mean concentrations of PFAS compared to office workers PFHxS (2.22 (95% CI = 1.55, 3.18)), PFUnDA (1.83 (95% CI = 0.97, 3.45)), and PFNA (1.26 (95% CI = 1.01, 1.58)). Among firefighters, occupational position predicted exposure-firefighters and officers had higher PFNA, PFOA, PFDA, and PFUnDA levels compared to drivers. Women firefighters are exposed to higher levels of some PFAS compared to office workers, suggesting that some of these exposures may be occupationally related.

Skin Barrier Impairment due to the Occlusive Effect of Firefighter Clothing

At fire scenes, firefighters are exposed to potentially harmful substances. Besides inhalation of these products, also skin contamination and the risk of dermal absorption is getting more attention. In this perspective, skin barrier impairment due to the occlusive effect of firefighter clothes could enhance the risk of penetration of hazardous substances. The effect of a firefighter jacket and cellophane on the skin was studied in a paired comparison involving 16 volunteers. Biophysical parameters were measured before, immediately after and 30 min after ending the occlusion. Reflectance confocal microscopy was used to study the skin morphology. Immediately after wearing a firefighter jacket, Transepidermal Water Loss values were significantly increased. This is an indication of an occlusive effect of the firefighter jacket. The skin barrier was fully restored after 30 min after occlusion with cellophane or wearing a firefighter jacket.

Firefighters' absorption of PAHs and VOCs during controlled residential fires by job assignment and fire attack tactic

To better understand the absorption of combustion byproducts during firefighting, we performed biological monitoring (breath and urine) on firefighters who responded to controlled residential fires and examined the results by job assignment and fire attack tactic. Urine was analyzed for metabolites of polycyclic aromatic hydrocarbons (PAHs) and breath was analyzed for volatile organic compounds (VOCs) including benzene. Median concentrations of PAH metabolites in urine increased from pre-firefighting to 3-h post firefighting for all job assignments. This change was greatest for firefighters assigned to attack and search with 2.3, 5.6, 3.9, and 1.4-fold median increases in pyrene, phenanthrene, naphthalene, and fluorene metabolites. Median exhaled breath concentrations of benzene increased 2-fold for attack and search firefighters (p < 0.01) and 1.4-fold for outside vent firefighters (p = 0.02). Compared to interior attack, transitional attack resulted in 50% less uptake of pyrene (p = 0.09), 36% less uptake phenanthrene (p = 0.052), and 20% less uptake of fluorene (p < 0.01). Dermal absorption likely contributed to firefighters' exposures in this study. Firefighters' exposures will vary by job assignment and can be reduced by employing a transitional fire attack when feasible.

Management of Firefighters' Chemical & Cardiovascular Exposure Risks on the Fireground

The fire service research community around the world has focused substantial resources on reducing firefighter risk for sudden cardiac events and chemical exposures that may lead to cancer. Research presented here summarizes important lessons learned from a full-scale residential Fire Study that allowed quantification of the risks as well as the effectiveness of interventions to reduce those risks. To address fireground exposure concerns, personal protective equipment (PPE) and administrative controls exist. But, these controls are not always straightforward to apply. Leadership and management concerns with ongoing implementation of these controls are introduced and opportunities for change management are discussed. While research provides a solid basis upon which to institute policy and practice, fireground leadership and management is critical to ensure appropriate implementation.

Quantification of 16 urinary biomarkers of exposure to flame retardants, plasticizers, and organophosphate insecticides for biomonitoring studies

Chlorinated alkyl and non-chlorinated aryl organophosphate flame retardants (OPFRs) and some brominated flame retardants (FR) were introduced as replacements for polybrominated diphenyl ethers (PBDEs) after PBDEs phase-out in 2004 and 2013. Organophosphorous (OP) insecticides are mainly used in agricultural settings since the Food Quality Protection Act of 1996 phased-out most residential uses of OP insecticides in the United States. Urinary metabolites of FRs and OPs are known exposure biomarkers to FRs and OP insecticides, respectively. For large population-based studies, concurrent quantification of these metabolites using a small urine volume is desirable, but until now was not possible. We developed an analytical approach to quantify in 0.2 mL urine 10 FRs and six OP insecticide metabolites: diphenyl phosphate, bis(1,3-dichloro-2-propyl) phosphate, bis(1-chloro-2-propyl) phosphate, bis(2-chloroethyl) phosphate, dicresyl phosphates, dibutyl phosphate, dibenzyl phosphate, 2,3,4,5-tetrabromobenzoic acid, 2-((isopropyl)phenyl)phenyl phosphate, 4-((tert-butyl)phenyl)phenyl phosphate, dimethyl phosphate, diethyl phosphate, dimethyl thiophosphate, dimethyl dithiophosphate, diethyl thiophosphate, and diethyl dithiophosphate. The method relies on enzymatic deconjugation, automated off-line solid phase extraction, high-performance liquid chromatography, and isotope dilution tandem mass spectrometry. Detection limits ranged from 0.05 to 0.5 ng mL-1, accuracy from 89 to 118%, and imprecision was <10%. . This method is the first to quantify simultaneously trace levels of 16 biomarkers of FRs and OP insecticides in only four drops of urine. We confirmed the method suitability for use in large epidemiological studies to assess background and occupational exposures to these classes of environmental pollutants by analyzing 303 samples collected from the general population and a group of firefighters. FR metabolite and DAPs concentrations in the general population group were lower than in the firefighters group, and within the ranges reported in the U.S. general population and other non-occupationally exposed populations.

Recovery and reactivity of polycyclic aromatic hydrocarbons collected on selected sorbent tubes and analyzed by thermal desorption-gas chromatography/mass spectrometry

This article describes the optimization of methodology for extending the measurement of volatile organic compounds (VOCs) to increasingly heavier polycyclic aromatic hydrocarbons (PAHs) with a detailed focus on recent sorbent tube technology. Although PAHs have lower volatility than compounds such as benzene, toluene, ethylbenzene and xylenes, these semi-volatile compounds can be detected in air and breath samples. For this work, PAHs were captured on sorbent tubes and subsequently analyzed using automated thermal desorption gas chromatography - mass spectrometry (ATD-GC/MS). While many different sorbent tubes are commercially available, optimization for airborne PAH sampling using sorbent tubes has not been previously considered. Herein, several commercially available sorbent tubes, including Carbograph 2 TD/1TD, Tenax TA, XRO-440, and inert-coated PAH tubes are compared to determine the relative recovery for eight PAHs commonly found in the environment. Certain types of sorbent materials were found to be better suited for PAH recovery during thermal desorption, and PAH reaction products were observed on several types of sorbent tubes, including graphitized carbon black sorbents with stainless steel tube materials. As such, selection of sorbent tube media should be carefully considered prior to embarking on a PAH study.

Exposures to air contaminants in compartment fire behavior training (CFBT) using particleboard fuel

Firefighters are exposed to a variety of combustion products during operational fires but also during live-fire training. As part of an on-going project investigating firefighter operational and training environments, this study measured the atmospheric concentrations of volatile organic compounds and acid gases outside and inside the structural firefighting ensembles worn by instructors during compartment fire behavior training using particleboard as a fuel. Atmospheric concentrations of benzene, formaldehyde, and hydrogen cyanide within the firefighting environment were observed to exceed Australian workplace exposure standards; although, the use of self-contained breathing apparatus throughout the training meant that atmospheric concentrations measured were not representative of firefighter inhalation exposures. Concentrations of air contaminants inside the structural firefighting ensembles during compartment fire behavior training were substantially lower than outside the ensembles, and much lower than those documented as potentially causing acute toxic effects in humans by dermal absorption from vapor. Although this study is focused on the generation of air contaminants in compartment fires, dermal absorption in these types of training environments may still constitute a potential route of low-level exposure to some combustion products.

Frequency of firefighters' heat-related illness and its association with removing personal protective equipment and working hours

The purpose of this study was to examine the frequency of firefighters' heat-related illness (HRI) in the line of duty with relation to resting/working hours and the behaviour of taking off PPE during rest periods based on nationwide survey (N=674). The results showed that 74.8% of firefighters experienced HRI symptoms and 5% of firefighters suffered from symptoms of HRI 20 times or more in a year. This study also showed a statistically significant correlation between working hours and removing PPE with the experience of HRI symptoms (p<0.05). In addition, removing PPE except the helmet was correlated with resting hours (p<0.001; Gloves: p=0.051), which indicates that removing PPE is related to resting time. This study revealed that firefighters routinely experienced mild HRI symptoms and the fatalities were just a tiny fraction. It is also emphasized that attention should be given on the significant role of taking off PPE during rest and on the standardized firefighters' rehabilitation followed by its application.

Impact of Fire Suit Ensembles on Firefighter PAH Exposures as Assessed by Skin Deposition and Urinary Biomarkers

Over the past 10 years, a number of safety measures for reducing firefighters’ exposure to combustion particles have been introduced in Sweden. The most important measure was the reduction in the time firefighters wear suits and handle contaminated equipment after turn-outs involving smoke diving. This study was divided into two parts, those being to investigate the level of protection obtained by multiple garment layers and to assess exposure during a standardized smoke diving exercise. First, realistic work protection factors (WPFs) were calculated by comparing air concentrations of the full suite of gaseous and particle-bound polycyclic aromatic hydrocarbons (PAHs) inside and outside structural ensembles, including jacket and thick base layer, during a tough fire extinguishing exercise using wood as the fuel. Second, during a standardized smoke diving exercise, exposure was assessed by measuring PAH skin deposition and levels of eight urinary PAH metabolites in 20 volunteer student firefighters before and after the exercise. The average WPF for the sum of 22 PAHs was 146 ± 33 suggesting a relatively high protective capacity but also indicating a substantial enrichment of contaminants with a risk of prolonged dermal exposure. Accordingly, in the second exercise, the median levels of skin-deposited Σ14-PAHs and urinary 1-hydroxypyrene significantly increased 5-fold (21 to 99 ng/wipe) and 8-fold (0.14 to 1.1 µmol mol⁻¹ creatinine), respectively, post exposure. Among the PAH metabolites investigated, 1-hydroxypyrene proved to be the most useful indicator of exposure, with significantly elevated urinary levels at both 6 h and 20 h after the exercise and with the strongest correlation to dermal exposure. Metabolites from two-ring and three-ring PAHs were eliminated faster while levels of 3-hydroxy-benzo[a]pyrene did not meet the detection criteria. The results from correlation studies indicated that dermal uptake was a major route of exposure in accordance with previous findings. To summarize, this study shows that some of the newly adopted protective measures were correctly implemented, and should continue to be followed and be more widely adopted.

Targeted GC-MS analysis of firefighters' exhaled breath: Exploring biomarker response at the individual level

Biomarker measurements can provide unambiguous evidence of environmental exposures as well as the resultant biological responses. Firefighters have a high rate of occupational cancer incidence, which has been proposed to be linked in part to their increased environmental exposure to byproducts of combustion and contaminants produced during fire responses. In this article, the uptake and elimination of targeted volatile organic compounds were investigated by collecting the exhaled breath of firefighters on sorbent tubes before and after controlled structure burns and analyzing samples using automated thermal desorption-gas chromatography (ATD-GC/MS). Volatile organic compounds exposure was assessed by grouping the data according to firefighting job positions as well as visualizing the data at the level of the individual firefighter to determine which individuals had expected exposure responses. When data were assessed at the group level, benzene concentrations were found to be elevated post-exposure in both fire attack, victim search, and outside ventilation firefighting positions. However, the results of the data analysis at the individual level indicate that certain firefighters may be more susceptible to post-exposure volatile organic compounds increases than others, and this should be considered when assessing the effectiveness of firefighting protective gear. Although this work focuses on firefighting activity, the results can be translated to potential human health and ecological effects from building and forest fires.

Urinary 1-hydroxypyrene and Skin Contamination in Firefighters Deployed to the Fort McMurray Fire

BACKGROUND

In May 2016, firefighters from the province of Alberta, Canada deployed to a fire that engulfed the urban area of Fort McMurray. During the first days of the fire, firefighters experienced heavy smoke exposures during greatly extended work shifts. Urinary samples were collected post-deployment from three fire services for estimation of 1-hydroxypyrene (1-HP) concentration, reflecting exposure to polycyclic aromatic hydrocarbons (PAHs), to determine the effects of respiratory protective equipment (RPE) and skin hygiene in reducing internal dose.

METHODS

Urine samples from one fire service (n = 62) were analyzed for 1-HP by two laboratories, using different assays (LC-MS/MS: GC-MS): remaining samples were analyzed just by LC-MS/MS. A Skin Exposure Mitigation Index (SEMI) was computed from questions on opportunities for changing clothing, showering, and washing during breaks. Regression analyses, using 1-HP ng/g creatinine as the dependent variable, assessed the effect of RPE and skin factors on PAH absorption, allowing for environmental exposure and potential confounders. Stratification identified key groups with equal delay in sample collection.

RESULTS

1-HP was detected in 71.0% of 62 samples by LC-MS/MS and 98.4% by GC-MS, with good mutual agreement between the methods. In 171 post-fire samples, 1-HP corrected for creatinine was related to current cigarette smoking and recent barbeque. Among those with samples collected within 48 h, urinary 1-HP was correlated with estimated exposure(r = 0.53, P < 0.001). In those with only one rotation before urine sample collection, no effect was seen of RPE use but I-HP was significantly lower (P = 0.003) in those with those with a high score on the SEMI scale, indicating better access to factors mitigating skin absorption.

CONCLUSION

Skin exposure to PAHs is an important route of absorption in firefighters, which can be mitigated by good skin hygiene.

DNA methylation among firefighters

Firefighters are exposed to carcinogens and have elevated cancer rates. We hypothesized that occupational exposures in firefighters would lead to DNA methylation changes associated with activation of cancer pathways and increased cancer risk. To address this hypothesis, we collected peripheral blood samples from 45 incumbent and 41 new recruit non-smoking male firefighters and analyzed the samples for DNA methylation using an Illumina Methylation EPIC 850k chip. Adjusting for age and ethnicity, we performed: 1) genome-wide differential methylation analysis; 2) genome-wide prediction for firefighter status (incumbent or new recruit) and years of service; and 3) Ingenuity Pathway Analysis (IPA). Four CpGs, including three in the YIPF6, MPST, and PCED1B genes, demonstrated above 1.5-fold statistically significant differential methylation after Bonferroni correction. Genome-wide methylation predicted with high accuracy incumbent and new recruit status as well as years of service among incumbent firefighters. Using IPA, the top pathways with more than 5 gene members annotated from differentially methylated probes included Sirtuin signaling pathway, p53 signaling, and 5' AMP-activated protein kinase (AMPK) signaling. These DNA methylation findings suggest potential cellular mechanisms associated with increased cancer risk in firefighters.

Non-targeted GC/MS analysis of exhaled breath samples: Exploring human biomarkers of exogenous exposure and endogenous response from professional firefighting activity

A non-targeted analysis workflow was applied to analyze exhaled breath samples collected from firefighters pre- and post-structural fire suppression. Breath samples from firefighters functioning in attack and search positions were examined for target and non-target compounds in automated thermal desorption-GC/MS (ATD-GC/MS) selected ion monitoring (SIM)/scan mode and reviewed for prominent chemicals. Targeted chemicals included products of combustion such as benzene, toluene, xylenes, and polycyclic aromatic hydrocarbons (PAH) that serve as a standard assessment of exposure. Sixty unique chemical features representative of exogenous chemicals and endogenous compounds, including single-ring aromatics, polynuclear aromatic hydrocarbons, volatile sulfur-containing compounds, aldehydes, alkanes, and alkenes were identified using the non-targeted analysis workflow. Fifty-seven out of 60 non-targeted features changed by at least 50% from pre- to post-fire suppression activity in at least one subject, and 7 non-targeted features were found to exhibit significantly increased or decreased concentrations for all subjects as a group. This study is important for (1) alerting the firefighter community to potential new exposures, (2) expanding the current targeted list of toxicants, and (3) finding biomarkers of response to firefighting activity as reflected by changes in endogenous compounds. Data demonstrate that there are non-targeted compounds in firefighters' breath that are indicative of environmental exposure despite the use of protective gear, and this information may be further utilized to improve the effectiveness of personal protective equipment.