Title: Is Your On-scene Rehab And PPE Care Sufficient To .

Title: Is Your On-scene Rehab and PPE Care Sufficient to Reduce Cancer Risk?Submitted:September 2018Time Required: 2 – 3 hoursTeaching Materials: ComputerProjector or TelevisionPowerPoint es

Motivation: A growing body of research from around the world is concluding that firefighters are at asubstantially increased risk of developing certain types of cancer. Current research is now focusing onbest practices to reduce or eliminate this risk, with an emphasis on preventative actions by thedepartment and individual firefighter.Student Performance Objective: The student will be able to identify the possible causes of firefightercancer, proper PPE, rehabilitation at the scene and decontamination procedures.Enabling Objectives: The student will be able to identify the causes and symptoms of cancer The student will become familiar with possible cancer risks of burning building materialsand furnishings The student will be aware of increasing risks to responding personnel The student will be able to determine the best option for minimizing personal risk The student will be exposed to current research and differing trains of thought inreference to PPE contamination/decontamination The student will be better prepared to assist their department with implementing ormodifying S.O.P.s concerning proper handling of contaminated PPEOverview:A. WHAT IS CANCER?SLIDE 4Cancer occurs when abnormal cells divide without control and are able to invade othertissues. This is usually caused by damaged DNA, which regulates growth in normal cells.This may result in a mass of cells, or a tumor developing. They can be either benign (nonspreading, non-cancerous) or malignant (cancerous).There are more than 100 different types of cancers. Most are not deadly, but of theestimated 1.6 million cases of cancer discover each year, over 575,000 will be fatal to thepatient.B. RISK TO FIREFIGHTERS

1. Exposure Risks (Inhaled or Absorbed)SLIDE 5a. Vehicle Exhaustb. Sootc. Smokei. Contains minute particles of unburned carbonii. Easily infiltrates fabric layers of PPEiii. Carry toxic gasesd. Chemicalsi. Building materials and furnishingsflashover 50 times faster than materials 50 years agoii. Duke University study (2012) found that 85% offurniture was treated with flame retardants that arepotentially toxica. Polybrominated Biphenyls1. Affinity to attach to fat/lipid cells in thebody2. Every 5 degree rise in body temperatureincreases absorption rates by awhopping 400 percentb. Chlorinated Tris (banned from children’sclothes)c. Penta BDE (now globally banned)iii. Underwriters Labs found burning furniture producedcarcinogens such as:a. Benzeneb. Chromiumc. Polcylic aromatic hydrocarbonsd. Formaldehydeiv. Risk from the increased use of soybean oil in furniture iscurrently uncleare. Some researchers now saying that the chemicals and materialsused in the manufacture of turnout gear may be anothersignificant source of exposure.i. PFOA is utilized in the manufacture of PPEii. European Chemistry Agency has firefighter PPE on theirlist for restrictions due to being a Substance of VeryHigh Concern.

SLIDES 6, 7, 8, 92. Abnormal/Elevated Levels of Cancer Among Firefightersa. Testicular 2.02 times the riskb. Mesothelioma 2 times the riskc. Non-Hodgkin’s Lymphoma 1.51 times the riskd. Multiple Myeloma 1.53 times the riske. Prostate 1.28 times the riskf. Skin Cancer 1.39 times the riskg. Brain Cancer 1.31 times the riskh. Colon Cancer 1.21 times the riski. Leukemia 1.14 times the risk3. Signs and Symptomsa.b.c.d.e.f.g.h.i.SLIDE 10Appetite lossBlood in the stoolBlood in the urineCough that doesn’t go awayExtreme fatigueFever that doesn’t go awayLump in the neck, testicles or breastNight sweatsSkin changesi. Spotsa. Get bigger or thickerb. Change colorc. Has an oddly shaped borderd. Is larger than a pencil erasere. Crusts or scabs over and doesn’t healj. Swollen lymph nodesk. Trouble swallowingl. Shed pounds without tryingC. 2014 ARTICLE IN THE “ANNALS OF OCCUPATIONS HYGIENE” SLIDE 111. Tests Conducted by Illinois Fire Service Institute and NIOSH

2. Polycyclic aromatic hydrocarbons (PAHs) present in firefighters after firesuppression and overhaul activities3. The most likely route of entry was determined to be the neck (hood) orinhaled or absorbed while doffing gear that was off-gassing contaminants.1. Off-gassing (also known as out-gassing) refers to the release ofairborne particulates or chemicals—dubbed volatile organiccompounds (VOCs)—from common household products. Potentialsources of off-gassing range from construction materials to carpeting,cabinetry, furniture, paint, and any number of household goods. Someof the most common chemicals off-gassed from household itemsinclude formaldehyde, benzene, ammonia, and toluene.D. INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS INFILTRATION TESTSLIDES 13, 14, 15, 161. Performed at Research Triangle Institute in January 2018 utilizingDepartment of Defense Fluorescent Aerosol Screening test on fullturnouts including SCBA2. High-level concentration of silica powder laced with a tracer withparticle size approximately 0.1 to 10 microns (smoke particles areabout one hundred thousandth of an inch or .25 microns)3. Particles blown at test subject for 30 minutes at 10 mph4. Large exposure occurred in the face and neck area not covered by theface piece and on the calves above the boot line5. Smaller exposure occurred through the front closures, between thepant and coat, and between the gloves and coatE. TAKING A PROACTIVE APPROACH1. Firefighter Rehaba. Rehab requirements outlined in NFPA 1584: Standardon the Rehabilitation Process for Members DuringEmergency Operations AND (highlight added) TrainingExercisesi.ii.Chapter 5: Rehabilitation AreaResponsibilities and CharacteristicsChapter 6: Incident Scene andTraining Rehabilitation

iii.Initial Medical Monitoring must includea.Body Temperatureb.Heart Ratec.Respiratory Rated.Blood Pressuree.Pulse Oximetryf.CO Monitoring if no SCBA was utilized or exhibitingflu-like symptomsb. Some propose instituting a “Decon Alley” in the warmzone between the hazard area and actual rehabSLIDES 19-23(Avsec, R. 2018. Decon alley-5 steps todoffing firefighter PPE, Fire Rescue 1)i.ii.iii.iv.v.vi.vii.Gross wash (level 1 decon)a.Low velocity waterb.Flush contaminants without drivingthem into fabric or harnessDrop equipment (tools and radios)Doff PPEa.Helmet and Hoodi. The hood acts like a gigantic sponge full oftoxins around the firefighter’s neck and headii. Notice these are removed before gloves! Thisprevents further contamination of handsb.Turnout Coat and Glovesc.Turnout Pantsd.BootsRemoval of SCBA facepiece (left on to reduce inhalation ofoff-gassing contamination)Shut off cylinder and disarm PASSPersonal hygiene (soap/water or wipes)a. Headb. Facec. NeckFirefighter then proceeds to regular decon entry pointNote: this procedure may necessitate personnel have a change of clothing available at theRehab site

Note: Firefighters performing the hose down and tool collection need to be at a level of PPE orbeyond the structural firefighting ensemble to protect them from contaminated water andthe inhalation of aerosolized contaminants as the PPE off-gases (potential concern when PPEis still hot after exiting the fire zone)c.d.e.f.2.Medical monitoringFirefighter enters either: Rest and Recovery Area Cooling and/or Warming Area Rehydration/Caloric Intake/ElectrolyteReplacementFinal Medical EvaluationReleased to: Operations Quarters Transport to HospitalPost-eventa. Showering should become common practice.i. Do not return to bed or lounge on furniture withoutremoving as much of combustion byproducts as possibleii. Canadian firefighters have been using saunas and bicycles to detoxifyafter a fire.iii. The University of Alberta has identified that sweating is the best wayto remove toxins from the bodyF. APPARATUS MODIFICATIONS TO MINIMIZE CONTAMINANTSSLIDES 24, 251.Internal Coatings and Coverings that are easily decontaminatedand non-absorbant2.HVAC with filtration3.Electronic Monitoring for certain carcinogens and/orcontaminants

4.5.6.PPE and SCBA storage outside the passenger compartmentDecontamination and hot water rinse outlets on engineDirty gear storage outside the passenger compartmenta. A Standard Operating Procedure developed in Sweden (The SkellefteåModel for Healthy Firefighters) has personnel strip out of usedturnout gear and throw it into black garbage bags.b. Garbage bags are then stored in the gear compartment of the firetruckc. Several Canadian and U.S. jurisdictions have adopted various versionsthis modelG. FLORIDA FIREFIGHTERS ASSOCIATION MODELSLIDE 271. Gear donned at the scene, not at the stationTests show little loss in response time2. No gear worn inside the passenger compartment of the apparatus3. No PPE inside the inhabited areas of the station4. Personnel handling dirty gear wear Nitrile/Latex glovesH. ADDITIONAL PRECAUTIONS1. Ensure that all gear is cleaned after a firea. Requires gear washer/extractor availabilityb. May necessitate each firefighter be issued two sets of turnoutgear2. Do not transport or store contaminated clothing or gear in your personalvehicle3. Keep gear out of living and sleeping areas4. Get a professional cancer screening5. Utilize a decontamination kit at the scene. Each kit includes a 5-gallonbucket, detergents, scrub brushes, hoses and spray /6. Keep abreast of new equipment such as particulate filtering hoods andturnout gear with better sealing properties.SLIDE 28a. Smoke Resistant Turnout Project by DHS and North Carolina StateUniversity and Lion Apparel/Fire Dex

b. Gore, Fire-Dex and PGI manufacturing hoods that block from 95 to 100%of particulatesc. Utilize double layer of materials with Nomex Nano Flex or Stedair Preventas an inner layerd. Elastic seals at wrist and waist of turnoutsI. ReviewFirefighting increases the risk of certain cancers. Take steps personally and withyour department to reduce your risk. Stay abreast of current research andequipment advances.J. RemotivationFirefighting is one of the most dangerous professions in this country and aroundthe world. Don’t let the “silent killer” take a back seat when it comes to yoursafety and well-being.EVERYONE GOES HOME!

1. Firefighter Rehab a. Rehab requirements outlined in NFPA 1584: Standard on the Rehabilitation Process for Members During Emergency Operations AND (highlight added) Training Exercises i. Chapter 5: Rehabilitation Area Responsibilities and Characteristics ii. Chapter 6: