Firefighter Health Study Focuses on Synthetic Materials

Nick Sheridan never thought much about “the health thing” during his first eight years fighting fires. Then three fellow San Diego firemen died of cancer a few years back. Sheridan started thinking.

One death, of abdominal cancer, occurred in Sheridan’s own station. The other two deaths, of lung and stomach cancer, were in his district. Sheridan raised the issue at the labor council. Then his union turned to the medical community for help.

Now the San Diego Fire Department is the subject of a long-term study, led by two UC San Diego medical researchers, of the health effects of fighting fires. Specialists say the investigation is likely to be the most comprehensive ever on what is an increasingly complex and troubling question.

The study comes at a time when plastics, synthetics and toxics have created extraordinary new risks in the most ordinary fires. But the health effects of exposure to toxic fumes at fires have been inadequately studied, and the findings remain inconclusive.

As a result, firefighters have been left wondering about what many believe are elevated rates of heart and lung disease and cancer in their profession. In addition, the lack of definitive findings has slowed efforts to improve protection.

“We have some indications of pulmonary problems, cardiac disease and increased risk for cancer, but we really don’t have that much information defining health problems for firefighters,” said James M. Melius of the National Institute for Occupational Safety and Health, “particularly in the context of the types of exposures they may be experiencing now. The environment may be very different from what they experienced in the past.”

So far, more than 500 of some 725 San Diego firefighters have received complete physicals and tests of heart, lung, liver and kidney function. They have answered questions about coughing, wheezing, phlegm and stress; dug through records on job assignments and hospitalizations and tried to recall exposures to toxics.

Now the researchers, led by two occupational health specialists from UC San Diego Medical Center, hope to expand the study. They want to track down some 850 firefighters who were given lung tests in San Diego between 1960 and 1972 and re-screen them.

They have not begun to analyze the data, which would overwhelm even the medical center’s computer. They decline to talk about informal observations, except to say they have already found considerable loss of hearing--a phenomenon that had not been studied much.

But over the next year the researchers hope to come up with a diagnosis of the department’s physical health in the early 1980s. That “base-line data” will serve as a standard of measurement for tracking changes over decades to come.

The investigation is unusual in other ways, too.

It was initiated by the local firefighters’ union, Local 145 of the International Assn. of Firefighters; and it is being done for a small fraction of its real cost because doctors, nurses and other medical professionals have volunteered their time.

It is also taking place in a city where houses and industries are relatively new and often built with synthetic materials--in contrast to studies done in older cities, like Boston and London.

Researchers have long been curious about firefighters’ health--in particular, the effects of stress on the heart and smoke on the lungs. But concern has widened recently to the “products of combustion”--the smoke from the plastics, pesticides and other chemicals that burn in everyday fires.

Among those products are carbon monoxide, a toxic gas that quickly displaces oxygen in the blood. Hydrogen cyanide, from burning synthetics and urethane foam, inhibits the body’s ability to use oxygen. Benzene, a known carcinogen, appears to come from burning plastics.

Other hazards include hydrogen chloride, a respiratory irritant emitted by the polyvinyl chloride (PVC) used widely in wire insulation and plumbing. Cyanide is released from burning plastic polymers. Asbestos disperses into the air around burning buildings.

“Look at this room: We have a door made of plastic, a desk made of plastic, a rug made out of synthetic material,” said Dr. Gary R. Fujimoto, the author of the San Diego firefighters study, eyeing his office in Hillcrest.

“Every year, more and more of these materials exist,” Fujimoto said. “So the whole nature of firefighting is undergoing a dramatic change because of the changes in the composition of people’s homes.”

Firefighters’ protective equipment has only partially kept pace.

Their “turnout gear” has improved over time--ironically, along with the development of the kinds of synthetics that have created new problems. The self-contained breathing apparatus has improved, though it remains cumbersome.

But some firefighters admit it can be a matter of pride not to clean turnout gear (as a badge of experience), though it can become badly contaminated during a fire. And for convenience, they often remove their tanks during the slow-burning, later phase of a fire when the toxic danger may be most severe.

Furthermore, firefighters have rarely kept records of what they were exposed to during fires. Often, there is no way of knowing what burned--much less what it turned into when it caught fire.

“It’s the long-term effects that I think we don’t fully understand and may not be looking at adequately,” said Fujimoto. “We don’t have the tools right now to be able to have that instant type of analysis.”

A 32-year-old assistant clinical professor of medicine, Fujimoto was one of the doctors Nick Sheridan turned to in 1982. An occupational-health specialist who had worked with a doctor who studied Boston firefighters, Fujimoto has put hundreds of hours into the study.

The study begins with an 11-page questionnaire which each firefighter fills out, using only a number for identification to ensure confidentiality. It covers a wide range of past and present conditions including medical history, work history and family history.

It asks what types of fires the firefighter has fought, such as industrial fires, motor vehicle fires and residential fires. It asks about instances of smoke inhalation, use of air tanks and hospitalization.

Next, each firefighter undergoes physical testing at a clinic in Pacific Beach. There are blood tests, hearing tests, an electrocardiogram, and lung tests measuring ability to empty one’s lungs.

The results are returned to each firefighter, along with comments from Fujimoto. Because it is a screening program, the project offers no long-term treatment. But Fujimoto said some firefighters call back for more information.

The union pays $60 a firefighter toward the costs of lab tests and administering the program. Fujimoto estimates that the real cost would range from $200 a firefighter at a very economical clinic to $1,000 if the work were done at the medical center.

Some firefighters have declined to participate, including one who Sheridan said has since discovered he is dying of cancer. Some may hope simply to avoid learning that anything is wrong, Sheridan said. Others may already feel ill and not want to find out the cause.

Whether the remaining firefighters will participate remains in question; Sheridan said he believes it’s unlikely. Fujimoto and others said the results may be jeopardized if many are missing, depending on whether they are relatively young or older veterans of the force.

“In any study, you lose people,” said Melius, who has worked on several firefighter studies. “I would say if they have 500 out of 700, that’s a very reasonable percentage of the people you expect to get. Unless it’s a lot of older, more experienced firefighters missing, one would feel fairly comfortable with those results. But the more participation the better.”

Meanwhile, Fujimoto is applying for a grant to track down the firefighters and former firefighters screened in the 1960-72 study, which lost its funding before completion. If he succeeds, the final study would cover a longer period than any ever done.

Fujimoto and others trace the lack of comprehensive, long-term studies of firefighters’ health in part to the complexity of the environment in which they work.

Instead of a single toxic, they are exposed to dozens, said Melius, chief of hazard evaluations and field studies for the National Institute for Occupational Safety and Health. Not only is it difficult to define the ingredients when they mix and burn, but little is understood about their synergistic effects on the body.

Furthermore, municipal workers have not been well covered by federal occupational safety and health regulations, Melius said. Finally, he said, “People have sort of assumed that firefighting is a dangerous occupation, so what?”

Even firefighters shared that view, Sheridan said: “The mind-set had been there in the past: ‘I’m a fireman. I can do anything’.”