Health risks and health effects of firefighter work: Exposures, diseases and preventive measures

Firefighters are exposed to significant thermal stress and several carcinogens, both by direct exposure via the skin and respiratory tract, clothing, and other personal protective equipment. There is a need for increased knowledge and a better understanding of the factors that lead to health problems and diseases and how this is related to the work performed in this profession. The projects main goal was to study health risks among firefighters, the challenge of exposure to heat and carcinogenic compounds, related outcomes, and how this knowledge can be used to establish preventive measures. The results could form the basis for changes in practice that can lead to a reduction in the incidence of cancer and the development of measures that manufacturers can use to improve protective clothing for firefighters, public agencies, and fire safety actors. Health research groups at SINTEF, the National Institute of Occupational Health in Norway (STAMI), and the Norwegian Cancer Registry have collaborated with RISE Fire Research to increase knowledge about these topics. The project has also collaborated with the Fire Research and Innovation Centre (FRIC), an international advisory expert group, and a reference group with representatives from the fire service, authorities, and manufacturers of protective clothing. It is known that firefighters have a higher risk of some cancers. In 2020, a PhD candidate was recruited at the Cancer Registry of Norway to study the risk of possible exposure-related cancers. A cohort was established with nearly 5,000 firefighters employed from 1950 until 2018. An increased incidence of urinary tract cancer, mesothelioma, and throat cancer was found in firefighters compared to the general Norwegian population. Three articles on these topics have been published. RISE has developed new methods to characterize fire smoke in the laboratory and the field, and several test fires have been performed. The new methods will enable mapping and quantification of how well firefighter clothing protects against carcinogens in the smoke and provide answers on how firefighter clothing can be evaluated and compared regarding protection against particle penetration. SINTEF has completed a laboratory study that examined physiological responses and heat tolerance in women and men dressed in firefighting protective clothing in hot environments. An article was published in Applied Ergonomics. The main finding from this study was that no differences in heat tolerance between women and men were found. However, large individual differences in heat tolerance were noted, suggesting the need for a separate heat tolerance test in the physical employment standards for smoke divers.STAMI has, together with RISE Fire Research and SINTEF, conducted fires in four houses from October 2021 to March 2023. Samples of polycyclic aromatic hydrocarbons (PAH) deposited on skin, occupational hygiene measurements inside and outside the fire clothing, heat exposure measurements and urine samples from the firefighters were collected. STAMI has investigated firefighters' exposure to chemical compounds such as benzene, 1,3-butadiene, and PAH when using current and next-generation firefighting clothing concerning smoke diving at practice fires. For the industry, knowledge about cancer is essential for preventive work in the future, and Niki Marjerrison's PhD has brought forth new knowledge about the occurrence of cancer in firefighters. The development of exposure indicators implies a significant development in the professional field. Efforts to reduce firefighters' occupational exposure should be maintained at the fire scene and station. Further analyses in an extended cohort of cancer incidence will contribute to further knowledge in the future. Knowledge of heat tolerance in women and men is essential, given the Norwegian Labor Inspection Authority's role in creating guidelines for a safe and good working life. The results from particle penetration in clothing and heat tolerance are important knowledge for clothing and protective equipment suppliers. The organization, Firefighters Against Cancer, has actively used the results from the HERO project, and it has been presented in various arenas, including meetings with the Norwegian Research Council and the Gjensidigestiftelsen. SINTEF and STAMI organized the NIVA course "Firefighter Work and Health", where results from the project were presented. Research partners and other stakeholders, such as firefighters and protective clothing manufacturers, attended a webinar in 2023 organized by the European Society of Protective Clothing. In this way, the entire project was presented to more than 150 European participants.

The project has produced knowledge that allows for better evidence-based decisions that will improve the health and safety of firefighters. End-user partners from five fire and rescue services from different parts of Norway, the Norwegian Labour Inspection Authority, the Norwegian Directorate for Civil Protection and manufacturers of personal protective clothing have been involved in workshops as well as national and international seminars, and through this they have gained insight on the scientific results and how they can be used for future innovations with high societal impact. Findings are also important for other key actors in the field not directly involved in the project. For the fire services, the project has increased our knowledge about hazardous particle penetration that could contribute to the development of better routines related to occupational hygiene and to the purchase, use and maintenance of firefighter clothing. Suppliers of firefighters’ clothing have gained knowledge for the development of equipment optimal for protection. Authorities have gained knowledge of how to improve guidelines and regulations for firefighters’ PPE to protect them from carcinogenic exposures and potential cancer risk.

An increased demand for new knowledge and a better understanding of the underlying factors leading to health problems/illnesses among firefighters, and how this relates to firefighting work and the firefighting environment is needed in order to establish functional preventive measures. The primary objectives of the project is to explore health risks among firefighters, and to study the dual challenge of exposure to heat and carcinogenic compounds exposure and related outcomes, and how this knowledge can be used to establish preventive measures. The project will be divided into 5 work packages: WP1. Exposure-related cancer risk among Norwegian firefighters (using register data) WP2. Particle penetration in protective clothing in a medium scale perspective (laboratory study) WP3. Heat strain and thermoregulatory responses in female and male firefighters (laboratory study) WP4. Firefighters exposure to carcinogenic substances in large scale scenarios (field study) WP5. Health-promoting measures (multi-disciplinary, integrated analyses from WP1-WP4) An interdisciplinary approach will be applied to achieve the goals of the project. Health and occupational research groups at SINTEF and National Institute of Occupational Health (STAMI) together with the Cancer Registry of Norway (CRN) and RISE Fire Research will work on this thematic area and seek to generate more knowledge about the risk of cancer in firefighters, exposure to heat and carcinogenic compounds and the benefits of preventive measures. The project will aim at a close collaboration with the Fire Research and Innovation Centre – FRIC and will ensure that health risks are covered in this project as well as in FRIC-projects. The project will also work in close cooperation with an international advisory expert group and a reference group of representatives from firefighter departments, authorities, scientists, and producers of firefighter clothing.