Beyond the Stats: A Decade of Research into the Fire Service’s Biggest Killer

The podcast episode details the generational crisis of occupational cancer among firefighters and the cultural shift required to address it.

The key points include:

• Cultural Shift: The traditional image of the "salty" veteran, identified by soot-stained gear, has been exposed as a marker of exposure and a "death sentence". The culture is shifting toward a "Professional" standard where cleanliness, decontamination, and wellness are prioritized as essential survival skills.
• The Hazard: Modern fires involve "solidified oil" (plastics, synthetic materials) that, when burned, create a toxic chemical soup, unlike the natural materials of the past.
• The Evidence: Landmark NIOSH studies (2013 and 2015) confirmed that firefighters face a 9% higher risk of cancer diagnosis and a 14% higher risk of death compared to the general population. Cancer accounts for approximately 66% to 80% of career firefighter line-of-duty deaths (LODDs) for IAFF members.
• The PFAS Paradox: Firefighters are exposed to carcinogenic "forever chemicals" (PFAS) through Aqueous Film-Forming Foam (AFFF) and, disturbingly, the moisture barriers in their own turnout gear. The research shows that for every 5-degree increase in skin temperature, the skin's absorption rate increases by 400%, allowing toxins to be "cooked" into the body.
• The Roadmap: New protocols focus on prevention and early detection, including on-scene "Gross Decon" (scrubbing down with soap and water), the "Clean Cab" initiative (storing contaminated gear externally), and a push for annual, fire-specific medical physicals. Early detection at Stage 1 offers a high survival rate, underscoring that wellness is a survival skill.

Transcript

SPEAKER_00 0:04

Welcome everybody. You're listening to Episode 21's Weekend Wrap Up Podcast. Here is your host, Kevin Ferrar. Welcome everyone to Episode 21's Weekend Wrap Up Podcast. I'm your host, Kevin Ferrar. Folks, for nearly a century, the image of the American firefighter was forged in smoke and soot. The salty veteran, identifiable by a blackened helmet, charred turnout gear, and the pervasive, acrid scent of a structure fire represented the pinnacle of the profession. This aesthetic was more than just a uniform, it was a visible testament to experience and courage. However, a decade of research has forced a painful reckoning. We now understand that the very markers we once celebrated as badges of honor were, in reality, toxic residuals acting as silent killers. The culture is undergoing a seismic shift, moving away from the glorification of contamination towards a professional standard where cleanliness and decontamination are recognized as the ultimate survival skills. The nature of fire itself has fundamentally changed. In the mid-twentieth century, residential fires primarily involved natural materials like wood, cotton, and wool. Today, the modern home is a repository of solidified oil, synthetic polymers, plastics, and resins found in furniture, electronics, and building materials, which all create a complex chemical soup when ignited. When these materials undergo incomplete combustion, they release a deadly cocktail of polycyclic aromatic hydrocarbons, or PAH, hydrogen cyanide, and per in polyfluoroal alkyl substances, or PFAS. Research over the years has shown that our traditional personal protective equipment, or turnout gear, was designed for thermal protection, not chemical filtration. Consequently, while we are protected from the heat, we are frequently bathed in a gaseous environment of carcinogens that penetrate our gear and settle on our skin. The empirical evidence supporting this crisis is quite overwhelming. Landmark studies by NIOSH, the National Institute for Occupational Safety and Health, in 2013 and 2015 provided the first large-scale confirmation of the occupational cancer risk. By tracking firefighters, researchers established that the fire service itself faces a 9% higher risk of diagnosis and a 14% higher risk of death compared to the general population. These statistics have only worsened as data collection has improved. In 2022, nearly 75% of those honored at the IAFF, International Association of Firefighters, Fallen Firefighter Memorial, died from occupational cancer. In 2025, that number increased to nearly 80%, thereby illustrating that the silent killer is now more dangerous than the fire itself. Folks, the statistics I just read involved just IAFF members. Because there's so many volunteer firefighters serving across the country, estimated more than 635,000 who are not part of the IAFF or other service unions. It's likely the true number of firefighters who died every year as a result of occupational cancer is much greater. Perhaps the most disturbing revelation of the last decade is the PFAS paradox. Firefighters we know are exposed to carcinogenic forever chemicals through the very tools meant to protect them. Whether it's aqueous film forming foam, AFF, or our very own turnout gear. PFAS chemicals have been used in the moisture barriers and thermal liners of this turnout gear to provide water and oil resistance. And we know this because research led by Dr. Graham Peasley has demonstrated that these chemicals are in the turnout gear, but can also shed from the gear directly onto the firefighter's skin. This is made worse by the physiological realities of firefighting. For every five-degree increase in skin temperature, the absorption rate of the skin increases by 400%. Folks, we're essentially cooking ourselves in a toxic suit, allowing these toxic substances like PFOS, PFOS, which has a biological half-life of nearly nine years, to bioaccumulate in our organs, leading to increased risks of various cancers like testicular, prostate, and kidney. So stick around, folks. When we come back from a short break, we're going to discuss a new roadmap within the fire service, decontamination and prevention, and how it can positively impact you and your organization. So welcome back everybody. So in response to data involving occupational cancer rates, the fire service overall is implementing rigorous and new protocols, albeit slow in some areas and some departments. But gross decon, it's now a standard operating procedure requiring firefighters to be sprayed down or scrubbed down using soap and water while still on the fire ground to remove particulates before removing their SCBA. So it's almost a hazmat decon, and that's really how it should be treated. The clean cab initiative mandates that contaminated gear be stored in exterior compartments of the apparatus rather than inside, preventing the inhalation of off-gassing chemicals during the return to the station. Furthermore, the focus is shifting toward early detection through fire-specific medical physicals. We've learned that catching cancers before or at stage one offers an incredibly high survival rate, whereas firefighters waiting for symptoms to show up, often dismissed as the price of admission for the job, is frequently too late. Without a doubt, the mission of the fire service has evolved. We know that. We're no longer just fighting fires. We're fighting for the long-term health of our members and the safety of our families. A decade of research has supported this roadmap, but it requires relentless advocacy and a commitment to cultural change for it to be successful. So as we move forward, the definition of a firefighter must be one who is disciplined enough to stay clean, informed enough to demand safe equipment, and professional enough to prioritize wellness as a core survival skill. The watch continues until every aquifer is clean, every carcinogen is phased out, and every one of our sick brother and sisters receives the care and recognition they so deserve. For a long time there was a specific look to a firefighter. You know the one I'm talking about. The salty veteran with that soot-stained helmet, the melted eye shields, the charred turnouts, and that smell, oh god, that lingering acrid scent of wood smoke and chemicals that followed them into the grocery store or the dinner table. You just knew, you knew when you were near these individuals what profession they were in without asking. For decades, that soot or odor was a badge of honor among those individuals. It meant you were there. It meant you did the work. That badge was often portrayed in several popular firefighter movies like Backdraft and Ladder 49. But folks, the reality is, unlike the movies, those on the front lines in our communities. We're not actors. And the exposures we're confronted with, those are movie props. Over the last 10 years, that badge of honor that many of us mistook as a sign of courage has been revealed as a death sentence. We used to think the biggest threat to a firefighter was a structural collapse or a flashover. But today, we know the real killer often waits until years after the fire out. And that killer is cancer. Today we're going beyond the stats. We're looking at 10 years of groundbreaking research from the NIOS studies to the IAFF's latest data to figure out what we've actually learned, what we were wrong about, and how the culture of the fire service is literally fighting for its life. This decade of research has redefined our understanding of occupational hazards. A landmark 2020 or 2013 NIOSH study established that firefighters face a 9% higher risk of cancer diagnosis and a 14% higher risk of cancer-related death compared to the general population. You've heard me say this before, you're going to hear me echo it again. It's that important. These aren't just abstract numbers. For career firefighters, cancer now accounts for approximately 80% of line of duty deaths for IAFF members. And as I mentioned before, unfortunately, we don't know exactly how many volunteer firefighters die every year from occupational cancer, mostly because volunteer firefighters work other jobs, and it's really difficult for physicians to separate exposures. In other words, without some type of monitoring. How does one know whether a volunteer firefighter developed cancer because of exposures during their regular job or from their firefighting duties? The shift in the modern fireground is central to this crisis. Unlike the wood and cotton of the past, today's fires involve solidified oil. There's plastics, resins, and PFAS that create a toxic chemical soup. Let's be honest with ourselves, folks. You roll up curbside to a structure fire, you look at the house, we have no idea what's inside. But I guarantee you this it's a toxic soup of products in there that when consumed by fire are going to off-gas and create an even more hazardous atmosphere for us. And that's compounded by what we mentioned earlier called the PFAS paradox, where the equipment designed to protect us, our turnout gear, from the moisture barriers and turnouts to aqueous film forming foam, ACF. Those products contain carcinogenic forever chemicals that just on the alone they absorb into our skin, but when they are heated, penetrate our skin even more. As we look forward, the mission is shifting toward prevention through lifestyle initiatives and early detection. Experts like my good friend Dr. Krista Arkhan from Penn State University. They're partnering with the fire service to develop programs focused on nutrition and wellness to mitigate these risks. The salty look among firefighters. That's being replaced by the professional standard, one where decontamination, clean cabs, regular medical evaluations, and healthy eating and living lifestyles are seen as the ultimate survival skills. Folks, that's a cultural shift. And I hate to say it, we're still encountering pushback from a lot of individuals, a lot of organizations because they are so reluctant to change. But we have to do it. We have to do it, folks. So let's set the stage. If we go back to the early 1990s, us older folks in the fire service, we can re we can remember cancer in the fire service was talked about in whispers. It was it was taboo to talk about it. So how many of us knew a firefighter Tommy who got sick after they retired? But we, his co-workers, his friends, his family, we all chalked it up to his his age or his lifestyle. This historical lack of acknowledgement meant that many exposures among firefighters went undocumented and untreated for years. That's why we didn't see cancer diagnosis in firefighters until their later years, their 50s, 60s, 70s, because that's when they started going to the doctors and said, hey, something's wrong here. It's not just, you know, I'm tired or anything like that. That mindset changed in 2013 and 2015 when NIOSH, again, the National Institute for Occupational Safety and Health, released their results of a massive multi-year study. Researchers tracked nearly 30,000 firefighters across several major departments. The findings were staggering. You've heard me say this before. Research indicates significantly elevated risk for specific types. Testicular cancer is 2.02 times greater, multiple melanoma is 1.53 times greater, and non-Hodgkins lymphoma is 1.51 times greater than the general population. Firefighters also face a 1.28 times higher risk of developing prostate cancer, and risks are notably higher for skin cancer, 1.39 times, malignant melanoma, 1.31 times, and brain cancer 1.31 times. In June of 2022, the International Agency for Research on Cancer, or IARC, reclassified occupational exposure as a firefighter to group one. First time it's ever been done. Stating carcinogenic to humans, citing specific evidence for mesothelioma and bladder cancer. Why did they do that? Well, because the modern fire has changed. Fifty years ago, you could walk into your living room and it was made up of wood, cotton, and hay. Today, as I said before, it's a giant box of solidified oil, plastics, PFAS, flame retardants, and synthetic resins. When these materials burn, they create a chemical soup that our turnout gear wasn't originally designed to stop. Even the gear itself prevents a PFAS paradox, as moisture barriers and thermal liners often contain these forever chemicals that are absorbed into the skin. This exposure is further validated by the 2015 IAFF fluorescent aerosol screening test, or FAST, which visually demonstrated penetration of smoke particles through PPE into the skin. The research throughout the years has taught us something vital. Our skin is a sponge. For every five degree increase in skin temperature, absorption rates increase by 400%. Folks, we're cooking ourselves in a toxic sauna and our bodies are soaking it all in. This exposure is made worse during work cycles where our core body temperatures increase significantly, averaging 35.42 degrees Fahrenheit increase, further raising the risk for external heat stress and chemical absorption. This physiological response effectively turns a firefighter's largest organ, that being the skin, into a direct gateway for toxins into the bloodstream. About five years into this decade of research, we hit a wall. We realized the threat wasn't just at the fire, it was in the gear. For decades, firefighters like myself dismissed symptoms of overwhelming fatigue and elevated cholesterol or triglycerides as the unavoidable price of admission for the job. We didn't realize that ACF, which we used to wash our station floors, even our hands, was toxic. It was a great effective degreaser. This is the PFAS paradox. For years, we in the military used ACF to fight fuel fires. It was a miracle product. ACF was invented by the U.S. Navy in the 1960s, derived its incredible efficiency from high concentrations of PFAS, which created an unbreakable chemical bond resistant to heat, water, and oil. You could spray this stuff on any type of fuel fire, and like magic, it would go out somewhat immediately. However, this same durability makes those foams forever chemicals that do not naturally degrade, leading to permanent bioaccumulation in the environment in the human body. Put this into perspective: just one drop of PFAS can pollute 21 million gallons of water. Folks, that's enough water to fill 32 Olympic-sized swimming pools. Again, just one drop of PFAS has that effect. Research led by Dr. Graham Peasley at Notre Dame showed that these forever chemicals were included in the manufacturing of our turnout gear and then shed off into our skin. He found that we were wearing the very carcinogens we were trying to protect ourselves from. But not only did Peasley and his team find PFAS on the outer shell of our turnout gear, but they also found it in the moisture barrier, in the thermal liners as well. This exposure is compounded by the fact that for again, I repeat some of these stats in these figures. The exposure is compounded by the fact that for every five-degree increase in skin temperature, absorption rates increase by 400%. As we fought fires, our skin effectively becomes a sponge, soaking in toxic molecules like PFOS or whatever chemicals are out there. PFOS has that biological half-life of about 8.67 years in humans. This stuff does not go away naturally. These molecules then take up permanent residence in our organs and tissues, linked to disorders ranging from kidney disease to type 2 diabetes and neurodegenerative conditions like ALS. So, this evidence sparked one of the biggest legislative shifts in fire service history. We've learned that clean doesn't just mean no soot, it means looking at the molecular makeup of our equipment. The research has forced manufacturers to rethink everything from the ground up. It's moved the mission from a simple soap and water mindset to a documented struggle for accountability, clean blood, and clean water. Today, the goal is to shift from the salty veteran model to a professional standard where decontamination, clean cabs, and annual medical surveillance are viewed as a Essential survival skills. We're now advocating for mandatory phaseouts of PFAS and presumptive service connection status for cancers like prostate, kidney, and testicular, to ensure that our service doesn't end in a chemical lie. Most importantly, this is where the rubber meets the road. Folks, you can have all the data in the world, but if the culture itself does not change, the death toll won't either. For years, the fire service was defined by its traditions, held on by those salty veterans reluctant to change. You know who I'm talking about. Fortunately, those very traditions are being re-evaluated through the lens of modern science. Historical practices reinforced carelessness. For example, if a firefighter became woozy, it was often attributed to smoke inhalation or fatigue rather than the extinguishing agent or the substances we were exposed to. Ten years ago, gross decon wasn't a thing mentioned on the fire ground. Most of us, after we finished the fire, we packed up. And as a crew, before heading back to the fire station, we may have stopped by the local burrito shop to grab a quick bite. Something, you know, to fill our stomachs before the next call crackled over the radio. The soot on our faces and the smell of smoke on her skin were badges of honor. But now we know those were markers of exposure. I remember in the past using a trip wef to scrub my silver bunkers in the Air Force or the apparatus stall floors because it was a great degreaser, and we often did so barehanded. Now, you walk onto a modern fireground, you see that clean cab concept in action. This initiative aims to keep carcinogens out of the apparatus cab by storing contaminated gear in exterior compartments. You'll see firefighters washing down or scrubbing each other with soap and water while still on air, a process known as decontamination. I said this before. We're starting to see more wipes being used on the necks and wrists of firefighters immediately to remove particulates before they can be absorbed through the skin. And once back at the station, we're seeing more and more career firefighters are showering within the hour to remove whatever is left on their body. As for volunteer firefighters, unfortunately, many act in a different manner. While they may practice the clean cab concept when returning from a fire, many volunteer fire departments lack the necessary equipment to properly wash their contaminated gear. Many firehouses lack the showers for crews to shower within the hour. So many of those volunteer firefighters, they simply pack up their gear, toss it in their the trunk of their vehicle, the bed of their truck, or the back seat next to the baby seat. Then they go home. They may grab a bite to eat before they jump in the shower, and then toss their contaminated clothes in the laundry hamper or in a wash with the rest of their clothes. Cross-contamination is quite common within the volunteer fire service. And that practice, folks, needs to be addressed and it needs to stop. When I was active duty in the Air Force, I remember my first assignment. We'd store our contaminated gear in a wooden locker next to our beds, and we'd inhale those vapors as we slept. In today's career firehouses, most gear is stored in lockers in a well-ventilated room, separated from any dining or living areas. In the volunteer firehouses, most gear is still stored in lockers or on a peg rack, but it's alongside an outer wall in the apparatus bay, so the gear is easily accessible. So the problem with that is that with gear being stored in the apparatus bay, not only is it being exposed to contaminants on the fire ground, but then when it comes back, some of that gear is being exposed to diesel exhaust from that from the apparatus. So again, this is why it's very important, no matter what firehouse you're in, to have a separate gear storage room. Um, so it's away from these carcinogens. And we've also over the years research has proved that the golden hour for decontamination is immediately after exiting the structure. Again, I'm repeating this. For every five-degree increase in skin temperature, absorption rates increase by 400%. So by the time you get back to the station, the toxins have already hitched a ride into your bloodstream through your largest organ, your skin. Studies like the 2015 IAFF fluorescent aerosol screening test, that FAST test, have visually demonstrated how smoke particles penetrate personal protective equipment to reach the skin. Doesn't matter what type of turnout gear that you're wearing, there's always going to be gaps to where these particulates can find a way and get through that turnout gear and onto your skin. Uh, we've also learned about the diesel problem. It's not just the fires, it's the fumes in the apparatus base. You just heard me talk about that with how we store our gear in volunteer in a lot of volunteer fire departments. The push for better exhaust capture systems isn't just about the smell, it's about the fact that the IARC has classified diesel exhaust as a group one carcinogen, just like the fires themselves. This classification is as critical as the IARC's June 2022 reclassification of occupational exposure as a firefighter to Group 1, citing sufficient evidence for mesothelioma and bladder cancer. The biggest lesson of the last decade, well, it's the most dangerous part of the job, isn't the fire, it's the stuff left on you after the fire. This shift from the salty veteran to the professional standard is a direct response to data showing that cancer now accounts for approximately 80% of firefighter line of duty deaths in career service. So what's next? The research is now moving into genetics and early detection. We're learning that certain firefighters might be more susceptible based on their DNA, a field that could eventually redefine how we monitor those at the highest risk. For instance, mutations in the C9ORF72 gene, which supports nerve cell health, may make some individuals inherently more susceptible to neuron damage from environmental toxins. This shift toward personalized medicine is driving a massive push for annual fire-specific physicals and comprehensive medical surveillance, such as the Department of Defense efforts to align PFAS blood testing with CDC panels to better characterize potential exposure. This is a direct response to the 2021 Department of Defense Inspector General reports, which scolded the DOD for failing to have a plan to track, trend, and analyze blood tests from firefighters. Because here's the hard truth, folks. The research gave us this information. If you catch these cancers before or at stage one, the survival rate is incredibly high. But if you wait for symptoms like persistent fatigue or unexplained weight loss, things often dismissed as the price of admission for the job, it's too late. We're also looking at mental health through a biological lens. The chronic stress of the job causes uh systemic inflation inflammation, which is known as uh a breeding ground for cancer and other metabolic diseases like type 2 diabetes. This biological connection is why the IARC has classified occupational exposure as a firefighter as group one, carcinogenic to humans. The research is showing us that wellness isn't a soft skill, it's a survival skill. So experts like Associate Professor Krista Arkhan, doctor professor from Penn State University, um, are leading the charge, developing nutritional programs focused on the Mediterranean diet to specifically mitigate these risks of inflammation and chronic illness. Her latest project, which I'm proud to say I'm a part of or I'm involved in, aims to establish firefighter advisory groups and statewide registries to collect data on lifestyle behaviors and cancer-related perceptions. Other efforts within the fire service include investigating the efficacy of whole blood and plasma draws to reduce the total body burden of PFAS in the bloodstream. Some of you may be familiar with the 52-week clinical trial in Australia that showed regular blood and plasma donations resulted in a slight reduction of mean PFAS, PFOS, and PFH excess levels. This is critical because PFAS we know are bioaccumulative forever chemicals that the human body does not naturally remove, with PFOS having a biological half-life of around 8.67 years in humans. PFOS exposure is widespread within the fire service. Um my last assignment in the military, Langley Air Force Base, the on-based groundwater contamination reached 2.225 million parts per trillion. Folks, that's over 556,250 times the EPA's current lifetime health advisory of four parts per trillion in drinking water. As we expand the roll call of the sick to include families and children exposed to contaminated drinking water or groundwater, our duty has shifted from simply extinguishing fires to ensuring the long-term endurance of our bloodlines. If we look back at the last 10 years, the statistics they're quite grim. We've lost too many brothers and sisters in the fire service to a silent enemy. The data we've uncovered from the landmark 2013 NIOSH study to the staggering reports of the 2022 IAFF Fallen Firefighter Memorial confirms that cancer now accounts for approximately 66 to let's just say 80% of career firefighter line of duty deaths. Folks, this isn't just a professional hazard. It's a generational crisis that's reached into our firehouses, our homes, and even our blood lines. But the research has also given us this roadmap. We know the enemy now. We know it's the solidified oil of modern plastics and the forever chemicals in our own foam and gear that we use. We know it gets in through our skin, especially as our core temperatures rise during the fight. We know how to wash it off through gross decontamination and the clean cab initiative. And most importantly, we know how to find it early through annual fire-specific physicals and medical surveillance. The salty look among firefighters, whether career or volunteer, is fortunately fading away, replaced by a new standard, the professional. The new standard represents a firefighter who understands that wellness is not a soft skill, but a survival skill. It's the firefighter who proactively cleans their gear, uses those wipes, and demands the truth about the water they drink and the foam they spray. We've moved from a service culture of soap and water lies to a culture of documented evidence and relentless advocacy. Folks, at the end of the day, the coal the goal isn't just to save lives. It's to make sure we live long enough to enjoy the life we've worked so hard for. Our duty has shifted from exposure to endurance, and the watch continues until every contaminated aquifer is clean and every sick brother and sister in the fire service is cared for. So with that, folks, that's going to do it for this episode. Don't tune out just yet. We've got a brief message about how to become a supporter of the show, which will give you access to premium and or bonus episodes like those with the Fire Department Coffee Guys or Chief Billy Goldfeder. In the meantime, I want to personally thank each and every one of you for listening to the AFSO 21's weekend wrap up podcast. I've been your host, Kevin Ferrara, and until next time, stay safe, stay clean, and stay healthy.