This article is the second part of a four-part series examining the conclusions of the PCIAW® Improving Firefighter Safety Round Tables held in 2024. The Professional Clothing Industry Association Worldwide (PCIAW®) brought together industry members from across the firefighting and emergency response community to explore the critical challenges facing modern firefighter safety and personal protective equipment (PPE) design. This second article focuses on the carcinogenic risks facing firefighters, particularly examining the alarming cancer rates among female firefighters and the critical role of contamination management in long-term health protection.
In 2022, the World Health Organisation’s declaration of firefighting as a carcinogenic occupation marked a watershed moment for the profession, officially recognising what many in the field had long suspected. The PCIAW® Improving Firefighter Safety Round Table discussions revealed alarming statistics and critical insights into the cancer risks facing firefighters, particularly highlighting previously overlooked vulnerabilities in female firefighter PPE and the complex challenges of contamination management.
The Carcinogenic Reality
Firefighters are exposed to high levels of carcinogens and toxic chemicals carried by particles in fire smoke, which enter the body through airways or skin absorption, significantly increasing cancer risk. These toxic chemicals are particularly concentrated in urban fires where paints, chemically treated products, and electrical equipment contribute to a hazardous cocktail of airborne contaminants.
The scope of exposure is expanding with emerging fire types. Lithium-ion battery fires release hot toxic gases that can both burn and poison firefighters in cases of over-exposure. Wildland fires, increasingly prevalent due to climate change, present their own dangers with seven identified carcinogenic pollutants from wood smoke that are absorbed through the skin. This growing presence of wildfires threatens not only firefighters but entire local communities.
Research presented during the roundtable revealed a particularly concerning factor: a 5°C increase in body temperature can lead to a 400% increase in particulate absorption through the skin. This finding underscores the dangerous intersection between heat stress and carcinogen exposure, making thermal management not just a comfort issue but a critical cancer prevention strategy.
Gender-Specific Cancer Risks
Perhaps the most shocking revelation from the roundtable discussions concerned female firefighters and cancer risks. In San Francisco, where approximately 16% of the department consists of female firefighters, 15% of female firefighters between ages 40-50 have been diagnosed with breast cancer – a rate six times higher than the civilian population. This statistic demands immediate attention and action from the firefighting community and PPE manufacturers.
New research insights reveal a troubling relationship between PPE fit and cancer risks, particularly concerning the lymphatic system. Ill-fitting PPE, especially around the upper body where the lymphatic system is concentrated, may contribute to increased cancer risks by allowing smoke ingress. Critical points include the neck, arm sleeves, and waist, where loose-fitting PPE will let the most contaminants in.
Currently, female firefighters represent approximately 7-8% of the operational workforce in the UK. Despite manufacturers providing male and female fit options, many UK services reported that female firefighters are often forced to wear male kit due to availability constraints, typically the result of cost-cutting or procurement limitations. The lack of provision for form-fitting PPE for female firefighters creates dangerous gaps where carcinogenic particles can enter, explaining one factor in the elevated cancer rates among female firefighters. As PPE is the last line of defence, best practice cleaning and maintenance is essential, removing contaminated gear as soon as possible to avoid permeation into the skin.
The Contamination Cycle
Beyond direct smoke exposure, repeated use of contaminated firefighting PPE increases firefighters’ cumulative exposure over time. Each use of inadequately cleaned gear adds to the total body burden of carcinogens, creating a dangerous cycle of re-exposure that compounds cancer risk throughout a firefighter’s career.
Conventional water washing for decontamination has proven limited in effectiveness. The chemicals used in traditional washing can degrade firefighting PPE over time, and fail to penetrate deeper garment layers, struggling to dislodge particulates embedded in membranes. Water washing alone may leave behind 50% or more of contaminants, according to roundtable participants, creating a false sense of security while leaving firefighters exposed to ongoing risk.
The National Fire Protection Association currently requires a 50% removal rate for semi-volatile organic compounds and heavy metals during cleaning, with discussions ongoing about raising this standard to 70%. These standards are being achieved at washing temperatures of 40°C, though consideration is being given to increasing this to 50°C to increase effectiveness. UK fire services typically wash PPE at 60°C, potentially achieving higher contaminant removal rates, though the Health and Safety Executive is conducting tests to better understand the overall effectiveness of various cleaning methods.
Liquid carbon dioxide (LCO2) decontamination emerged as a superior alternative during roundtable discussions. Unlike water washing, LCO2 penetrates further into garments and can remove contaminants sustainably without degrading the protective properties of the PPE. LCO2 decontamination providers recommend submitting garments for cleaning after just 20 minutes of hot zone exposure, ensuring firefighters don’t use their gear past the point of serious penetrative contamination.
Implementation Barriers
Despite its superior decontamination capabilities, LCO2 cleaning faces significant adoption challenges. Limited availability and higher costs pose obstacles for widespread implementation, with most dedicated LCO2 facilities located in urbanised areas, limiting access for rural communities. The cost of installing an LCO2 decontamination unit remains beyond the budget of most firefighting departments, creating a critical gap between best practice and practical reality.
Norway’s approach offers a potential model if we want to maximise firefighter health, as PPE decontamination is mandated by law, recognising the importance of maintaining protective gear in optimal condition. This harsher regulatory approach acknowledges that decontamination is not an optional extra but a fundamental component of firefighter health protection.
Design Solutions for Protection
Round table participants emphasised that creating and procuring PPE with tight-fitted connections between garments prevents smoke from entering through openings. The full protective suit should be size-compatible at all connection points – where trousers meet boots, where jacket sleeves meet gloves. Gussets and fasteners can aid in preventing smoke ingress and should be made compatible across different manufacturers’ products.
The 2008 global financial crisis created lasting problems when firefighting departments purchased equipment from diverse suppliers due to supply constraints. This fragmented approach reduced compatibility between PPE items, leading to a decade or more of increased contaminant ingress. Participants advocated for standardised sizing at garment connections to ensure smoke prevention even when firefighters wear items from different manufacturers.
Moving Forward
Addressing the cancer crisis in firefighting requires a multifaceted approach combining improved PPE design, enhanced decontamination protocols, and better understanding of exposure pathways. The alarming statistics, particularly regarding female firefighters, demand immediate action from manufacturers, fire services, and policymakers.
Making LCO2 decontamination more accessible is crucial for mitigating risks associated with long-term smoke particulate exposure. Combined with better-fitting PPE designed for all body types and regular contamination monitoring, the firefighting community can begin to address this health crisis. The revelation that firefighting is officially recognised as a carcinogenic profession should serve as a catalyst for comprehensive reform in how we protect those who protect us.
