2/20/18. Dave Parker Commissioner Harris County ESD 29. The Problem

Transcription

1 Dave Parker Commissioner Harris County ESD 29 The Problem 1

2 Each year:! 1.7 million new cases! 600 thousand deaths (1 in 4 of all deaths).! 15 million individuals are in prevalence! $124 billion in direct costs! Median age for contracting disease is 66! 67% of those diagnosed survive for 5 years! 4-10% of cases are work related Compared to the general public, firefighters have a greater chance of contracting:! Testicular Cancer: (2.02 times)! Multiple Myeloma: (1.53 times)! Non-Hodgkin s Lymphoma: (1.51 times)! Skin Cancer: (1.39 times) LeMasters GK, et al. Cancer risk among firefighters: A review and meta-analysis of 32 studies. JOEM :

3 ! Brain Cancer: (1.31 times)! Malignant Melanoma: (1.31 times)! Prostate Cancer: (1.28 times)! Colon Cancer: (1.21 times)! Leukemia: (1.14 times) LeMasters GK, et al. Cancer risk among firefighters: A review and meta-analysis of 32 studies. JOEM : Cancer is now the leading cause of death for firefighters nationwide. 60 percent of the names on the Fallen Firefighters Memorial Wall are IAFF members who have died from occupational cancer. Research suggests that the prevalence of cancer in firefighters is 9-12 percent higher than the general population. Source: Firefighter Quarterly; Winter

4 Evolution of Research There have been multiple epidemiological studies examining cancer and disease rates among firefighters. In 2006, a meta-analysis of 32 studies of cancer in firefighters ranked elevated risks of testicular and prostate cancer, non-hodgkin s lymphoma, and multiple myeloma in firefighters as probable. LeMaster, G., Genaidy, A., Succop, P., Deddens, J., Sobeih, T., Barriera-Viruet, H., Dunning, K., Lockey, J., (2006). Cancer risk among firefighters: A review and meta-analysis of 32 studies. Retrieved from Cancer%20Risk%20Among%20Firefighters%20-%20UC%20Study.pdf 4

5 In 2007 The International Agency for Research on Cancer (IARC) classified occupational exposure as a firefighter is possibly carcinogenic to humans. World Health Organization International Agency for Research on Cancer (2007). IARC monographs programme finds cancer hazards associated with shiftwork, painting and firefighting. Retrieved from In 2007 (2010) Underwriters Laboratory (UL), in conjunction with the Chicago Fire Department and the University of Cincinnati College of Medicine conducted a study titled FIREFIGHTER EXPOSURE TO SMOKE PARTICULATES. Underwriters Laboratories, Inc. (2010). Firefighter exposure to smoke particulates: final report. Retrieved from EMW-2007-FP cebf37283b5f736fe7dd535dcf26382e5b5b5d5e911d8b28af6fed60ad0b6e6a.pdf 5

6 Using typical modern home furnishing and modern vehicles, data was collected on the smoke and gas effluents (liquid waste) to which firefighters are exposed during routine firefighting operations, as well as contact exposure from contaminated personal protective equipment. Underwriters Laboratories, Inc. (2010). Firefighter exposure to smoke particulates: final report. Retrieved from assets/emw-2007-fp cebf37283b5f736fe7dd535dcf26382e5b5b5d5e911d8b28af6fed60ad0b6e6a.pdf Among the key laboratory findings:! Synthetic materials produced more smoke than natural materials.! The most prolific smoke production was observed for styrene based materials which in 2014 was listed as reasonably anticipated to be a human carcinogen. Underwriters Laboratories, Inc. (2010). Firefighter exposure to smoke particulates: final report. Retrieved from ulfirefightersafety.org/assets/emw-2007-fp-0209-cebf37283b5f736fe7dd535dcf26382e5b5b5d5e911d8b28af6fed60ad0b6e6a.pdf 6

7 ! The recommended exposure levels including immediately dangerous to life and health (IDLH), short term exposure limits (STEL), and time weighted average (TWA) were exceeded during fire growth & overhaul stages for various gases including carbon monoxide, benzene, formaldehyde, arsenic, and hydrogen cyanide. Underwriters Laboratories, Inc. (2010). Firefighter exposure to smoke particulates: final report. Retrieved from ulfirefightersafety.org/assets/emw-2007-fp cebf37283b5f736fe7dd535dcf26382e5b5b5d5e911d8b28af6fed60ad0b6e6a.pdf Among the key field exposure findings:! Gas exposures in excess of NIOSH s IDLH and STEL, along with OSHA s TWA were repeatedly observed.! Chemical composition of the smoke deposited and soot accumulated on firefighter gloves & hoods was virtually the same except that concentrations on the gloves were 100 times greater than the hoods. Underwriters Laboratories, Inc. (2010). Firefighter exposure to smoke particulates: final report. Retrieved from ulfirefightersafety.org/assets/emw-2007-fp cebf37283b5f736fe7dd535dcf26382e5b5b5d5e911d8b28af6fed60ad0b6e6a.pdf 7

8 ! Debris deposits contained lead, Bis(2-ethylhexyl) phthalate (DEHP) and Polycyclic Aromatic Hydrocarbons (PAHs).! DEPH is used in the production of polyvinyl chlorides (PVC s). Europe calls DEHP one of the top 6 chemical threats to humans and has fazed out its sale and usage. Not so in the U.S. Underwriters Laboratories, Inc. (2010). Firefighter exposure to smoke particulates: final report. Retrieved from *Agency for Toxic Substances & Disease Registry. (2011). Polycyclic aromatic hydrocarbons (PAHs). Retrieved from PAHs are a group of over 100 different chemicals that are formed during the incomplete burning of coal, oil and gas, garbage, or other organic substances including tobacco. PAHs are usually found as a mixture such as smoke and soot from fire.* Underwriters Laboratories, Inc. (2010). Firefighter exposure to smoke particulates: final report. Retrieved from *Agency for Toxic Substances & Disease Registry. (2011). Polycyclic aromatic hydrocarbons (PAHs). Retrieved from 8

9 A 2010 NIOSH study of 30,000 firefighters in three metro fire department from found firefighters have:! A greater cancer diagnoses and death rate than general population.! Twice as many instances of mesothelioma (asbestos exposure). The National Institute for Occupational Safety and Health (NIOSH) (2010). Study of cancer among U.S. Firefighters. Retrieved from More instances of under 65 bladder and prostate cancer.! An increase in lung cancer and death related to the amount of time spent in a fire.! An increase in leukemia death related to the number of fire runs made. The National Institute for Occupational Safety and Health (NIOSH) (2010). Study of cancer among U.S. Firefighters. Retrieved from 9

10 The NIOSH study likewise revealed:! Firefighters are at increased risk of certain types of cancer as a result of occupational exposures.! Just because you are a firefighter it does not mean you will get cancer.! If you contract cancer it is not necessarily a result of your fire service.! If you are or were a firefighter and concerned about your health, share information about your career with your doctor. The National Institute for Occupational Safety and Health (NIOSH) (2010). Study of cancer among U.S. Firefighters. Retrieved from In 2012 a panel of scientific experts convened by the World Health Organization's (WHO) International Agency for Research on Cancer (IARC) concluded that diesel engine exhaust is carcinogenic to humans. International Agency for Research on Cancer (2012). IARC: Diesel engine exhaust carcinogenic. Retrieved from media-centre/pr/2012/pdfs/pr213_e.pdf 10

11 In 2016 the Illinois Fire Service Institute-IFSI Research University of Illinois at Urbana-Champaign conducted a study that was designed to better understand how operating in a modern fire environment is related to the two leading health issues facing firefighterscardiovascular events and chemical exposures related to carcinogenic risk. Fent, K., Alexander, B., Roberts, J., Robertson, S., Toennis, C., Sammons, D., Bertke, S., Smith, D., Horn, G., (2017). Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene volume 14 issue 10. Retrieved from Among the study findings:! Air sampling from within the structure during active fire on one day showed hydrogen cyanide levels that were nearly 7 times the IDLH. Fent, K., Alexander, B., Roberts, J., Robertson, S., Toennis, C., Sammons, D., Bertke, S., Smith, D., Horn, G., (2017). Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene volume 14 issue 10. Retrieved from 11

12 ! Benzene levels within the structure were up to 15 times the permissible exposure limits(pel). These and other volatile compounds were also detected inside the structure during overhaul and on the fireground but at levels below applicable exposure limits. Robertson, S., Toennis, C., Sammons, D., Bertke, S., Smith, D., Horn, G., (2017). Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene volume 14 issue 10. Retrieved from Two important sources of particulate were identified on the fireground; smoke plume from the fire and diesel exhaust from the fire apparatus. The contribution of both sources were found to be dependent on the wind direction. Fent, K., Alexander, B., Roberts, J., Robertson, S., Toennis, C., Sammons, D., Bertke, S., Smith, D., Horn, G., (2017). Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene volume 14 issue 10. Retrieved from 12

13 ! Several flame retardants and PAHs were detected on turnout gear items after use in a fire. Gross on-scene decon with water/detergent and scrubbing was effective in bringing the PAH contamination to pre-fire levels. Fent, K., Alexander, B., Roberts, J., Robertson, S., Toennis, C., Sammons, D., Bertke, S., Smith, D., Horn, G., (2017). Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene volume 14 issue 10. Retrieved from Volatile compounds like hydrogen cyanide and benzene were measured off-gassing from turnout gear after use but at levels below applicable exposure limits. Off-gas levels returned to background within an hour, regardless of whether or not the turnout gear were decontaminated. Fent, K., Alexander, B., Roberts, J., Robertson, S., Toennis, C., Sammons, D., Bertke, S., Smith, D., Horn, G., (2017). Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene volume 14 issue 10. Retrieved from 13

14 ! Personal protective equipment, neck skin, and hand skin became contaminated with PAH during firefighting.! Fire attack and search teams generally had the most contamination on their turnout gear and their hand skin was more contaminated than their neck skin.! Contamination on turnout gear increased with each fire response if not decontaminated. Fent, K., Alexander, B., Roberts, J., Robertson, S., Toennis, C., Sammons, D., Bertke, S., Smith, D., Horn, G., (2017). Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene volume 14 issue 10. Retrieved from Three types of field decontamination methods were evaluated and wet-soap decon was found to be the most effective at removing PAH contamination from turnout gear.! Commercial cleansing wipes also showed some benefit at removing PAH contamination from neck skin. Fent, K., Alexander, B., Roberts, J., Robertson, S., Toennis, C., Sammons, D., Bertke, S., Smith, D., Horn, G., (2017). Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene volume 14 issue 10. Retrieved from 14

15 Overall, this study provided a greater understanding of the exposure pathways associated with firefighting and the measures that can be implemented to reduce these exposures. Fent, K., Alexander, B., Roberts, J., Robertson, S., Toennis, C., Sammons, D., Bertke, S., Smith, D., Horn, G., (2017). Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene volume 14 issue 10. Retrieved from 15

16 Task Location Detected On Median Range Attack Hands 96% Neck 50% < 32 < Search Hands 100% Neck 50% < 27 < Overhaul Hands 67% Outside Ventilation Neck 38% < 24 < Hands 83% Neck 58% 30.5 <

17 Exposure Risks The effects of chronic exposure to diesel exhaust have been linked to an increased risk of Lung cancer. Diesel particulates 16 times above EPA Standards can be commonly found inside the fire station. Options to control exposure include:! Mechanical Evacuation Systems! Air Filtration Systems! Direct Capture Systems! Engine Mounted Diesel Particulate Filters 17

18 The Mechanical Evacuation System is the oldest approach to exhaust extraction. Advantages:! Uses mechanical exhaust fans and or louvers in exterior walls and or roof.! Activates when the bay doors are opened Disadvantages:! Evacuates heat from bays along with exhaust! Need to override the system to leave bay doors open for natural ventilation. The Air Filtration System Advantage:! Provides a single source to remove particulates, carbon and molecular gases from diesel smoke. Disadvantages:! Consistent reliability and thoroughness of the system.! Filter replacement! Spread of particulates within the building 18

19 The Direct Capture System: Advantages:! Prevents gases and particulates from entering bays by venting directly to the exterior from connection directly to the apparatus exhaust. Disadvantages:! Coupling and decoupling by personnel! Requires personnel to work directly in exhaust! Fixes apparatus in one location The Apparatus Mounted Diesel Particulate Filter (DPF) is mounted on the engine and traps particulates before they entering the atmosphere. Advantage:! Excellent for protecting emergency personnel when engine is Idling at a scene or around buildings. Disadvantages:! Fails to capture noxious gases such as CO2 19

20 Absorptions most permeable areas:! Face! Neck! Throat! Groin Additionally, there is a 400% increase of carcinogens for each 5 degrees of skin temperature elevation. Information provided by the Firefighter Cancer Support Network A year prior to the IFSI study, another particle infiltration study was conducted by the IAFF using turnout gear and SCBA s. The results concluded that smoke easily penetrates clothing and serves as pathways for contaminants primarily at the interface areas of the face and neck, glove to sleeve, and the overlap of the boot and pants. 20

21 Ingestion routes:! Particulates can be carried by mucous and saliva to digestive system.! Food consumed at/adjacent to fireground! Cross contamination at the station from ice and vending machines in apparatus bays. How To Enact Change 21

22 Change must start from the leadership to change a culture. If the leadership does not think cancer is a problem then neither will the troops. A simple fix is to simply CHANGE OUR CULTURE. 22

23 Risk Reduction Methods! Gross, wet decontamination will remove 85% of contaminants.! Wash hands and other soiled skin at the scene using appropriate wipes.! SCBA s should be worn throughout firefighting, overhaul, and or investigation.! Release the most contaminated crews first (first in - first out). 23

24 ! Apparatus operators should wear (N95/N99) masks while at an active fire scene.! Limit hot and warm zone personnel! Close apparatus windows with the HVAC system off.! Turn off non-essential apparatus! Stage ready crew s outside the smoke envelope! Transport contaminated gear back to fire station inside plastic bags.! Don clean and launder soiled clothing ASAP (even before showering).! Shower as soon as possible 24

25 ! Don station shoes in place of duty boots! No bunker gear should be allowed in the station! At the least, exchange contaminated hoods and gloves immediately.! Wear EMS gloves while decontaminating apparatus and equipment.! Secondary cleaning of apparatus and equipment occurs at the fire station using cleaning products and abrasive actions.! Apparatus seats should be cleaned and decontaminated after incidents.! No contaminated individuals or gear in POV s 25

26 ! Do not use personal vehicles to relieve companies on scene, use fire department vehicles.! Consider moving SCBA s out of the cabin (Clean Cab Concept).! For routine checks, run all apparatus and tools outside the apparatus bay.! Keep bunker gear room doors closed to prevent contamination by diesel exhaust.! Store turnouts in enclosed, ventilated room without ultraviolet light exposure.! Adopt a gear exchange or share program! Limit carpeting in stations. Use polished concrete flooring or tile. 26

27 Exposure Risks and Fire Station Design Fire Station Design The Hot Zone design manages 3 levels of exposure:! Hot Zone (RED): Those spaces exposed to carcinogens.! Cold Zone (GREEN): Living and working spaces intended for extended occupancy.! Transition Zone (YELLOW): Allows for the movement between the hot and cold zones. 27

28 Advantages:! Contain the contaminants! Self-sufficient! Separates occupants from contaminants! Controls and or limits crossover! Enhances decontamination 28

29 If you are looking at renovations focus on high hazards such as:! PPE enclosed storage room! Dedicated mechanical room! Diesel exhaust exposure system! Decon room! Hose drying & storage! On-site training capabilities! Hands, Hands, Hands! Signage! Ice and vending machines! Exercise equipment Ask your self these questions?:! How does your station compare! Do you have safe practices in place to contain the contaminants.! Are you adequately separating occupants from contaminants.! Are you controlling crossover! Do you pay attention to transitions! Have you enhanced decontamination! What are you going to do next 29

30 Public use of fire stations can lead to unintentionally transmitting carcinogens to unsuspecting participants:! Weddings! Bingo! Open houses and station tours! Polling place! Equipment storage! Exercise! Bay gathering Controlling Risk Factors 30

31 According to the American Cancer Society:! In 2017, 190,500 or 28 percent of the 690,200 estimated cancer deaths in the U.S. will be caused by tobacco use.! Additionally, cigarette smoking will increase an individual s risk of cancer by 25 times. American Cancer Society (2017). Cancer facts & figures, Retrieved from research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2017/cancer-facts-and-figures-2017.pdf! There are over 7,000 chemicals are found in tobacco, 69 of which are known carcinogens.! Smoking is the leading cause of preventable death.! Tobacco use is associated 87 percent of lung cancers. A Report of the Surgeon General; N. Jitnarin et al. (2015). Nicotine Tob Res 17, (2015). 31

32 The National Cancer Institute states that tobacco is the leading cause of cancer and death from cancer. Smoking prevalence comparisons:! U.S. adult males: 22%! U.S. firefighters: 13% The use of smoking tobacco is linked to the following types of cancer:! Lung, larynx and throat! Mouth, and esophagus! Kidney and bladder! Liver! Stomach and pancreas! Colon and rectum! Cervix! Leukemias A Report of the Surgeon General; N. Jitnarin et al. (2015). Nicotine Tob Res 17, (2015). 32

33 Smokeless tobacco prevalence comparisons:! U.S. adult males: 6%! U.S. firefighters: 11% The use of smokeless tobacco is linked to the following types of cancer:! Mouth! Esophagus! Pancreas A Report of the Surgeon General; N. Jitnarin et al. (2015). Nicotine Tob Res 17, (2015). Type of Cancer Approximate Increased Risk Esophageal 200% Stomach 200% Liver 200% Kidney 200% Pancreatic 150% Gallbladder 60% Brain 50% Colorectal 30% Multiple Myeloma 20% Thyroid 10% 33

34 Overweight prevalence:! U.S. overweight prevalence: 68%*! Career fire & emergency services: 79.5% Obesity prevalence:! U.S. obesity prevalence: 33.8%*! Career fire & emergency services: 33.5%! * *Prevalence and Trends in Obesity Among US Adults, Katherine M. Flegal; Margaret D. Carroll; Cynthia L. Ogden; et al. JAMA. 2010;303(3): (doi: /jama ) Firefighter Data from Poston et al., 2011: FIRE Study. Range in the published literature, BMI > 25: 73-88% According to the World Cancer Research Fund, 20% of all cancers diagnosed in the U.S. are caused by a combination of excess body weight, physical inactivity, excess alcohol consumption, and poor nutrition and thus could be prevented. 34

35 Serious consideration should be given to building your department into a physically fit and tobacco free environment. Be prepared to assist those in need and expect substantial and continual resistance. Early Detection is Key 35

36 ! Colon cancer has a 91 percent 5 year survival if caught early; 11 percent if it has already spread.! Prostate cancer has a 100 percent 5 year survival if caught early. Surveillance, Epidemiology, and End Results Program (SEER), Division of Cancer Control and Population Sciences, NCI. Bethesda, MD ! Breast cancer has a 98 percent 5 year survival rate if caught early; 15 percent survival rate in later stages.! Bowel cancer has a 90 percent 5 year survival rate if caught early. Surveillance, Epidemiology, and End Results Program (SEER), Division of Cancer Control and Population Sciences, NCI. Bethesda, MD

37 NFPA 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments The purpose of this standard is to outline an occupational medical program that when implemented in a fire department will reduce the risk and burden of fire service occupational morbidity and mortality while improving the health, and thus the safety and effectiveness, of firefighters operating to protect civilian life and property. A NFPA 1582 medical program covers areas that include:! Comprehensive medical exams! Vision and hearing tests! Ultrasound imaging (cancer screening)! Cardiopulmonary evaluajons (stress test & ECG)! Laboratory analysis (heavy metals)! Firefighter fitness analysis (diet and exercise)! Medical clearances 37

38 Wellness-Fitness Initiatives Work!! A study examining the relationship among the cause, nature, and cost of firefighter injuries found that overexertion accounted for a significant portion of injuries (35 percent of all firefighter injuries) at a cost of $9,715 per claim. The Economic Consequences of Firefighter Injuries and Their Prevention. Final Report (2004). U.S. Department of Commerce Building and Fire Research Laboratory, National Institute of Standards and Technology, Gaithersburg, MD Retrieved from Wellness-Fitness Initiatives Work!! Substantial long-term cost savings can be expected from preventing cardiovascular disease, certain cancers, and by reducing early disabilities from musculoskeletal and back injuries. The Economic Consequences of Firefighter Injuries and Their Prevention. Final Report (2004). U.S. Department of Commerce Building and Fire Research Laboratory, National Institute of Standards and Technology, Gaithersburg, MD Retrieved from ww.burnandfireprevention.org/nist_gcr_05_874-1.pdf 38

39 Wellness-Fitness Initiatives Work!! For every one dollar spent on uniformed personnel wellness results in an almost immediate return of over two dollars in occupational injury and illness costs.! Additionally, these numbers underestimate the true cost savings, since this does not take into account non-occupational injuries and the long-term medical costs of premature morbidity and mortality. The Economic Consequences of Firefighter Injuries and Their Prevention. Final Report (2004). U.S. Department of Commerce Building and Fire Research Laboratory, National Institute of Standards and Technology, Gaithersburg, MD Retrieved from ww.burnandfireprevention.org/nist_gcr_05_874-1.pdf Wellness-Fitness Initiatives Work!! Overexertion injuries occur when a physical task exceeds the capabilities of firefighters and thus can cause injury. Some of the contributing factors to overexertion included poor posture or ergonomically unsafe positions, and fatigue. In one instance, the elimination of injuries caused by overexertion saved a large fire department $545,000 per year. The Economic Consequences of Firefighter Injuries and Their Prevention. Final Report (2004). U.S. Department of Commerce Building and Fire Research Laboratory, National Institute of Standards and Technology, Gaithersburg, MD Retrieved from 39

40 Aggregate Data TWFD 2017 Wellness Program 752 abnormal findings were found among 140 firefighters and 15 dispatchers to include:! Leaking bicuspid aortic valve (2)! Enlarged aortic root (8)! Left Ventricular Hypertrophy (12)! Liver mass (1)! Kidney stones (26)! Gall stones (27) Data reproduced with authorization from Life Scan Wellness Centers Aggregate Data TWFD 2017 Wellness Program! Enlarged prostate (6)! Prostate mass (1)! Thyroid nodules monitor size (25)! Thyroid nodules follow-up size (6)! Elevated glucose (30)! Stage 1 (vascular damage) hypertension (26)! Those unable to complete stress test due to abnormal responses (4). Data reproduced with authorization from Life Scan Wellness Centers 40

41 Aggregate Data TWFD 2017 Wellness Program Per Body Fat Percentage:! Overweight: (37)! Obese: (14) Per Body Mass Index (BMI):! Overweight: (50)! Obese: (31)! Severely obese: (5)! Morbidly obese: (2) Data reproduced with authorization from Life Scan Wellness Centers Laws to Protect Firefighters 41

42 ! Many states including Texas have laws establishing a presumption that certain types of cancer contracted by firefighters are the result of duty-related exposure. These laws are informally known as presumptive cancer laws. GOVERNMENT CODE TITLE 6. PUBLIC OFFICERS AND EMPLOYEES SUBTITLE A. PROVISIONS GENERALLY APPLICABLE TO PUBLIC OFFICERS AND EMPLOYEES CHAPTER 607. BENEFITS RELATING TO CERTAIN DISEASES AND ILLNESSES Benefits Relating to Certain Diseases and Illnesses, (2015). Chapter 607, Government Code. Retrieved from 42

43 Sec CANCER. (a) A firefighter or emergency medical technician who suffers from cancer resulting in death or total or partial disability is presumed to have developed the cancer during the course and scope of employment as a firefighter or emergency medical technician if: Benefits Relating to Certain Diseases and Illnesses, (2015). Chapter 607, Government Code. Retrieved from (1) the firefighter or emergency medical technician: (A) regularly responded on the scene to calls involving fires or fire fighting; or (B) regularly responded to an event involving the documented release of radiation or a known or suspected carcinogen while the person was employed as a firefighter or emergency medical technician; and Benefits Relating to Certain Diseases and Illnesses, (2015). Chapter 607, Government Code. Retrieved from

44 (2) the cancer is known to be associated with fire fighting or exposure to heat, smoke, radiation, or a known or suspected carcinogen, as described by Subsection (b). (b) This section applies only to a type of cancer that may be caused by exposure to heat, smoke, radiation, or a known or suspected carcinogen as determined by the International Agency for Research on Cancer. Benefits Relating to Certain Diseases and Illnesses, (2015). Chapter 607, Government Code. Retrieved from My Story 44

45 ! June 2009, started experiencing abdominal pain.! October 2009, diagnosed with non-seminomas embryonal carcinoma (testicular cancer).! Cancer metastasized to my abdomen! Between October 2009, and January 2010, experienced five surgical procedures and two rounds of chemotherapy.! Took two years to realize my new normal v=qkek_2k_k3k&feature=em-upload_owner 45

46 ! In January 2018, a Honolulu newspaper reported that in the last five years, children of three firefighters at the same fire station have been diagnosed with bone cancer. The last diagnosis coming this same month. Yamane, M., Boneza, J. (2018, January 29). Concerns raised after firefighters children diagnosed with cancer. Khon2. Retrieved from It is not known if the station is what's causing this problem or if there are other links that these children have however, the fire station is located within an industrial area. Through a request by the Department of Health, the University of Hawaii Cancer Center is looking at any links between firefighter duties and family members who contract cancer. Yamane, M., Boneza, J. (2018, January 29). Concerns raised after firefighters children diagnosed with cancer. Khon2. Retrieved from 46

47 Additional Completed Applicable Reports:! Firefighter Equipment OperaJonal Environment: EvaluaJon of Thermal CondiJons (2017).! Research Roadmap for Smart Fire FighJng (2015)! Data CollecJon Summary for PPE Care and Maintenance (2013).! Study of Cancer Among U.S. Fire Fighters (2010)! Thermal Capacity of Fire Fighter ProtecJve Clothing (2008)! Respiratory Exposure Study for Fire Fighters and Other Emergency Responders (2007). Important Resources:! The Illinois Fire Safety Institute! The International Association of Firefighters! The National Institute of Occupational Safety and Health (NIOSH).! The National Fallen Firefighters Foundation! Firefighter Cancer Support Network (P & P s).! Simply Google Cancer in the Fire Service 47

48 There is nothing more honorable than a person who gives their time, energy, and resources to ensure the safety and quality of life for others. Warmest Regards Dave Parker HCESD 29 DParker@championsfire.org