SAN JOSE CAPITAL OF SILICON VALLEY

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1 CITY OF SAN JOSE CAPITAL OF SILICON VALLEY TO: PUBLIC SAFETY, FINANCE, AND STRATEGIC SUPPORT COMMITTEE PSFSS COMMITTEE: 5/18/2017 ITEM: (d) 2 Memorandum FROM: Curtis P. Jacobson SUBJECT: FIRE DEPARTMENT - DATE: May 8, 2017 FIREFIGHTER CANCER PREVENTION STATUS REPORT Accept the status report of the current efforts of the Fire Department in the area of firefighter cancer prevention, including personal protective equipment, change to department policies, as well as consideration of the addition of a safety officer position. BACKGROUND On April 12, 2017, the Rules and Open Government Committee approved a memorandum from Councilmember Chappie Jones 1 requesting to add a status report to the Public Safety, Finance, and Strategic Support Committee (PSFSS) workplan regarding the current efforts of the Fire Department in the area of firefighter cancer prevention, including the provision of personal protective equipment, potential changes to department policies, as well as consideration of the addition of a Safety Officer position. The following provides a brief background regarding cancer among firefighters as well as an update on steps the Department has taken, future actions to be taken, and the resources that will be necessary to successfully accomplish the goal of the firefighter cancer prevention. Firefighters Increased and Risk of Cancer In the course of their duties, firefighters may be exposed to many known carcinogens. This may happen during structure fires, vehicle fires, vegetation fires, debris/garbage fires, hazardous materials incidents, vehicle accidents, or any of a wide variety of emergencies mitigated by firefighters. These exposures are becoming increasingly dangerous. Whereas a residential fire in 1960 would generally be a slowly evolving fire of wood and fabric materials, today's residential fire is a rapidly expanding combustion of plastic, laminates, glues, electronics, synthetics, and a wide variety of other toxicants. These potential exposures have raised concerns about the prevalence of cancer among firefighters. In the past decade, a variety of research studies have assessed cancer mortality (death) and morbidity (incidence) within the fire service as compared to the general population. Studies' have found that 1 id=627960

2 May 8, 2017 Page 2 firefighters have a higher rate of cancers of the brain, digestive tract, genitourinary tract and lymphohematopoietic organs. In a recent meta-analysis of 32 studies, significant excess risk was reported for brain, stomach, colon, rectum, prostate, testes, multiple myeloma and non-hodgkin lymphoma. A review of 42 studies by The International Agency for Research on Cancer found significant risks for prostatic cancer, testicular cancer, and non-hodgkin lymphoma. A 2013 study by the National Institute for Occupational Safety and Health (NIOSH) tracked 29,993 firefighters and found increased mortality from lung, esophagus, intestine, rectum, and kidney cancer. The San Jose Fire Department is committed to ensuring the safety of our workforce. At the start of 2016, the San Jose Fire Department joined with San Jose Fire Fighters, IAFF Local 230, to launch a cancer prevention initiative, forming a Cancer Prevention Committee. The goals of the initiative were to ensure safety measures by increasing awareness and to study ways of reducing risk and improving methods for early detection. The Cancer Prevention Committee reviewed best practices and developed a list of recommendations. ANALYSIS Mitigating Exposure to Carcinogens in the Fire Service Carcinogens take the form of a solid, liquid, or gas. In emergency incidents, both solids and liquids are often aerosolized as, for example, dust, smoke, soot, particulates, mists, or sprays. Firefighters have four possible routes of exposure to these carcinogens: inhalation, absorption, ingestion, and injection. The two that are believed to be related to the increased risk of cancer in the fire service are inhalation and absorption. Inhalation exposure occurs when the process of respiration exposes the firefighter's mouth, nasal cavity, throat, lungs, and other related organs to these substances. Absorption occurs when any exposed body part (skin, mucosal membranes, eyes) comes into direct contact with these substances. The eyes are especially sensitive, and while the skin provides some protection, the skin's ability to absorb increases 400 percent for every 5 increase in temperature. Efforts to mitigate exposure to carcinogens in the fire service are focused upon reducing inhalation and absorption exposures to carcinogens. (Basic lifestyle changes are also encouraged, including diet, alcohol moderation, tobacco cessation, and exercise.) There is no single, definitive, accepted list of steps to be taken to reduce cancer risk. However, there are many widely accepted steps, some of which the San Jose Fire Department has implemented and others, which have yet to be implemented. Actions Implemented by the Department Prior to the forming the Cancer Prevention Committee the Fire Department implemented several "best practices" including: Equipping every firefighter with their own Self Contained Breathing Apparatus (SCBA) mask, and fit testing them for that mask annually; Providing a SCBA for every firefighter, and flow testing it annually; Adopting a "mandatory mask" rule, whereby firefighters are required to use their SCBA; Providing every firefighter with two sets of structural firefighting jackets and pants, testing them annually, and contracting with a professional service to have them cleaned after each exposure;

3 Page 3 Placing diesel exhaust removal systems in every fire station; Ensuring new stations provide the ability to store off-gassing personal protective equipment in a separate area or room; Providing annual physical medical exams that may help catch early symptoms of diseases; Establishing a database so firefighters can track their exposures to possible carcinogens; Adopting a "Clean Living Area" policy that states firefighting clothing is to be kept out of the station living areas; Implementing a 20-minute cool-down period immediately after a fire has been knocked down, allowing a large amount of gasses to be released before re-engaging firefighters for further overhaul; Making firefighter exposure an important consideration when selecting emergency incident strategies and tactics; Adoption of a no-tobacco policy; Addition of a wide-brimmed hat to the approved uniform policy for protection from ultraviolet (or UV) rays; Implementing training on cancer prevalence, risk and avoidance; and Adopting policies regarding handling of hazardous materials and establishing a trained Hazardous Incident Team. Next Steps In addition to the above actions already implemented, the Cancer Prevention Committee reviewed best practices and developed the following list of recommendations, some of which are policy driven and have no costs associated, and some of which will require additional equipment, resources, and funding. These recommendations are also incorporated into the Fire Department's Work Plan. The Fire Department will assign an officer to oversee implementation and monitor progress of the items enumerated below. 1) Ensure Department members understand the significance of carcinogen exposures and how they can minimize exposure risks. a. Training on steps to minimize exposure to carcinogens and cancer awareness. b. Department-specific training, featuring department members who voluntarily offered to share their health issues with staff. c. Training on need for SCBA use rather than dust mask use during overhaul to reduce exposure. d. Training on appropriate transportation and storage of personal protective equipment. e. Training on the need to use sunscreen and hats, and overall reduction of sun exposure. f. Training to support other policy changes. 2) Minimize Department member exposure to known carcinogens during fires. a. Mandate use of SCBAs from initial attack through the finish of all overhaul. b. Accelerate crew rotation to minimize exposures, especially rotating out initial attack personnel. c. Discontinue use of dust masks for overhaul. 3) Minimize Department member exposure to known carcinogens after fires. a. Mandate "gross decontamination" of all personal protective equipment on scene immediately following each fire.

4 Page 4 b. Mandate removal and bagging of personal protective equipment for cleaning on scene immediately following each fire. c. Provide each department member with a second set of structural gloves, a second structural hood, and a second structure helmet shroud so contaminated ones may be cleaned. d. Issue cleaning wipes (e.g. "wet wipes") to allow personnel to thoroughly clean soot and contaminated particles from around their airway to reduce inhalation and from their skin to reduce absorption. e. Provide arson investigators with personal protective equipment appropriate for conducting arson investigations in structures that are still off-gassing carcinogens. f. Issue a second set of wildland personal protective clothing (jacket, pants, gloves, and shroud) to all department members so one set may be used for emergency response while the other is being decontaminated. 4) Implement services to improve early cancer detection and provide support for fire fighters with cancer. a. Coordinate with Human Resources to evaluate opportunities to enhance annual physical assessments with additional blood tests, skin checks, screenings, or body scans as per recommended best practices. b. Explore options for tracking cancer diagnoses of active and retired fire fighters, in order to focus mitigation efforts. c. Develop a program similar to the San Francisco Firefighter Cancer Prevention Foundation, partner with the Firefighter Cancer Support Network, or identify other avenues to assist with early detection and department member support. Additional items that can also directly support several of the Cancer Prevention efforts listed above include: Cancer Screening Program: Additional Personal Protective Equipment To directly address the Cancer Prevention Committee's recommendations for minimizing personnel's exposure to known carcinogens after fires, providing additional personal protective equipment to reduce contamination of equipment, will reduce personnel exposure to carcinogenic products of combustion. For example, caches of different size gloves and hoods stored on Med 30, Squads, and Air Units to exchange one-for-one while crews are still on the scene would be an important investment for firefighter cancer prevention. This additional equipment would cost $110,000, and has been included in the Proposed Capital Budget for the Fire Department/Public Safety Capital Program for City Council consideration. Department Safety Officer In December 2011, the Fire Department's Safety Officer (DSO) duties were reassigned among staff in the Bureau of Field Operations and the Bureau of Administrative Services due to budget actions. The primary duties of the DSO position included Injury and Illness Prevention Program (IIPP) administration, oversight of the firefighter wellness and fitness programs, response to greater alarm emergencies as the Incident Safety Officer (ISO), accident and injury investigation, response to OSHA inquiries, and improving the Department's safety culture through safety communications.

5 Page 5 Although many of the programs previously assigned to the DSO have been maintained, the Department has not found capacity to maintain all critical safety functions. Amongst the most critical unsupported DSO functions is the maintenance of the Department's safety culture through focused attention and communication through safety messages, identification of adverse safety trends, and continuous safety improvement. Advancing the recommendations of the Cancer Prevention Committee will require focused attention in order to change behaviors toward reducing exposure to carcinogens. The restoration of 1.0 Battalion Chief to manage the Safety and Wellness programs of the Department would cost a total of $312,000 ongoing for salary, benefits and retirement. However, due to the budgetary position of the General Fund, the restoration of this position is not included in the Proposed Operating Budget. The Department will explore adding a Senior Analyst position in the following year to strengthen existing safety programs and support cancer prevention efforts, but any position addition will need to be evaluated as part of the City's budget outlook at that time and other city-wide and departmental funding priorities. In the meantime, using available staffing resources, the Department will continue to work on the implementation of the recommendations made by the Cancer Prevention Committee as well as other important safety-related issues. CONCLUSION The Fire Department is committed to minimizing the impact of exposure to potentially hazardous materials on our personnel and as outlined above, has taken important steps towards improving education, prevention, and implementing best practices related to cancer prevention amongst firefighters. The Department recognizes that there is much more work to be done surrounding this issue and will continue to work with IAFF, Local 230, and the Cancer Prevention Committee on this important effort. This memorandum has been coordinated with the City Attorney's Office, the City Manager's Budget Office, the Office of Employee Relations, and the Human Resources Department. /s/ CURTIS P. JACOBSON Fire Chief For questions, please contact Curtis P. Jacobson, Fire Chief, at Sources for information cited in Background and Analysis sections: Cancer Risk Among Firefighters: A Review and Meta-analysis of 32 studies Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco. Chicago and Taking Action Against Cancer in the Fire Service Findings from a Study of Cancer among U.S. Fire Fighters