A History of FireFighters through the Ages 

Cancer in firefighters

This three-part series is a call to action and retrospective on firefighters and cancer through the eyes of an oncologist.

November 15, 2019, 
By Dr. Kenneth Kunz

 

When compared with the public, firefighters are at a significantly higher risk of being diagnosed with, and subsequently dying of cancer because of the service work that they do. Photo: Getty Images

Editor’s Note: Part 1 in our series looks at the modern statistical picture before delving into the history of firefighters and the dangers they faced. In Part 2, we’ll be looking at medicine and disease in ancient firefighters. Part 3 will take us back to the present and look ahead to what needs to be done to change the increased risk of cancer that firefighters face. Dr. Kenneth Kunz is a medical oncologist who has taken action in the fight against cancer in firefighters through visiting fire departments and spreading the message of risk in various ways. Dr. Kunz has written this three-part series with the support of the Fire Chiefs’ Association of British Columbia.

Having trained professionally as a cancer researcher and a medical oncologist, I am developing an increasing interest in the health and welfare of firefighters. You see, cancer and fire are a lot alike. Both seem to strike mysteriously and when least expected. They strike incisively, often with devastating force. Both have the will and the capacity to — either quickly or leisurely — overwhelm and devour their subjects with an insensate and unquenchable thirst. Physicians and firefighters, cast in the role of onlookers or intercessors, can often do nothing, or at best are relegated to harm reduction or palliative strategies. Meanwhile the cancers — or the flames — mete out the corresponding pain, fury, and confusion that are commensurate with their power. And despite the ongoing scientific advances in each respective discipline — fire fighting and medical oncology — the physical, structural, psychological, and spiritual losses from fire and cancer remain as heartbreaking and perplexing as ever.

But there is a deeper, more personal, and tragically ironic issue that concerns cancer and fire; they share in common an even more poignant property: both are inextricably linked by their propensity to consume firefighters. And cancer, as we now know, usually claims the lion’s share of the spoils.

When I ask my friends, medical colleagues, and other members of the public, to speculate about how they think a firefighter most commonly dies as a result of work in the fire service, they often guess that it involves either being crushed, asphyxiated, or incinerated. They are often surprised when I point out what the ever-expanding scientific literature reveals: when compared with the public, firefighters are at significantly higher risk of being diagnosed with, and subsequently dying of cancer that is fundamentally related to, and caused by, the service work they do.

 

This poignant finding was recently highlighted by an eye-opening report published in 2018 by Rachel Ramsden and her coworkers at the Injury Research and Prevention Unit at the University of British Columbia, in collaboration with Len Garis, a retired fire chief, at the University of the Fraser Valley. Ramsden, who is currently a doctoral student at the UBC School of Population and Public Health, examined a series of workers’ compensation claims awarded to fallen Canadian firefighters or their families over a 10-year span between 2006 and 2015. Out of a total of 568 work-related firefighter deaths, 483, or 85 per cent, were attributed to occupational cancers, while only eight per cent were due to chronic illnesses like lung and heart disease, and six per cent from traumatic injury. In other words, the results of this surprising study indicate that the overwhelming majority of work-related deaths among Canadian firefighters involved cancer. This is a sobering revelation when contrasted with the more modest plight of the standard Canadian citizen, who, by comparison, has “only” a 30 per cent lifetime chance of dying of cancer. Firefighters die of this illness at significantly higher rates than the public.

The solemn relationship that exists between fire fighting, cancer, and death is continually renewed, substantiated, and updated as time moves forward and new evidence emerges. For example, in a hallowed Sept. 11, 2018 bell ringing ceremony in Calgary honouring 47 fallen firefighters, 38 of them, or 80 per cent, died of cancers that were presumed to be as a result of their jobs; and at a similar 2018 9/11 ceremony held in Colorado Springs, 249 fallen firefighters were honoured, 164 of which, or 66 per cent, succumbed to occupational cancers.

But examining the firefighter cancer mortality rates in these special, very public, and therefore sensationalized instances can have the untoward effect of magnifying or overamplifying the real numbers. A more accurate approximation of what really happens to firefighters comes from the work of epidemiologist Dr. Robert Daniels and his associates at the National Institute for Occupational Safety and Health (NIOSH), the National Cancer Institute (NCI), and the University of California at Davis. In 2015, this research team published the most thorough, ambitious, and authoritative study to date on the subject of cancer in firefighters. After examining data from nearly 30,000 urban U.S. firefighters over a span of almost 60 years, the group reported that firefighters have a nine per cent higher chance of developing cancer at some point during their lives, and a 14 per cent higher probability of subsequently dying from cancer than the general public. These may seem like modest increases; nine per cent and 14 per cent, respectively, however, they must be considered in context to the baseline cancer risk faced by the standard North American citizen. For example, if, in 2019, the average Canadian has a 44 per cent lifetime risk of developing cancer, that number jumps to 53 per cent if that Canadian happens to be, or has been, a firefighter. If the average Canadian has a 30 per cent lifetime risk of dying of cancer, that mortality rate now increases to 44 per cent if that person had a career in the fire service.

It is high time that steps be taken by society to stem this rising tide; to slow, stop and eventually reverse the number of firefighters consumed in this roiling cancer tsunami. Helping to reduce the burden of cancer, particularly as it concerns those in the fire service, falls within my special area of professional interest. To understand the entire story of cancer and firefighters, it is important and utterly fascinating to learn some of the history behind fire fighting.

On the antiquity of fire, firefighters and cancer
Curiosity has often led me to wonder: how long has the industrial association between fire, fire fighting, and cancer been going on? Probably a long time — epochs, in fact. It is now generally accepted among archeologists and anthropologists that our early ancestors began the controlled use of fire for warmth, protection, tool making, and food preparation approximately 1.5 million-years-ago. That’s about 50,000 hominid generations, perhaps longer. This allowed primitive populations to expand, disperse geographically, and evolve culturally, with the eventual introduction of agriculture some 12,000 years ago. Reliable food sources made possible the gradual expansion of smaller communities into larger cities of several hundred thousand people; cities such as Damascus, Syria, which has seen human inhabitation for 11,000 years.

In the absence of our modern synthetic construction materials, stone, mudbricks, and natural fiber were common building materials for sure, but also, indispensably and predominantly wood — and plenty of it.

Because of the scarcity of timber in the Sahara, it is recorded that in 2,600 BC, Sneferu, a powerful Egyptian pharaoh of the 4th Dynasty, ordered the construction of a fleet of 60 seaworthy cargo ships. Successive convoys of these high-capacity transport vessels sailed an ancient Mediterranean superhighway to harvest the richest source of cedar logs, found at Byblos, Lebanon. One papyrus invoice of the time catalogued the delivery of 40 such shiploads of massive cedar logs. Wood was delivered continuously and in abundance, to source the expansion of the magnificent Egyptian empire. Everywhere in the ancient world, as cities were growing, wood craftwork and construction was booming.

With so much timber used throughout these cities of antiquity, fires were ubiquitous and inevitable. Not only smaller domestic-sized blazes — but outright industrial-scale, citywide conflagrations — posed an ever-present threat to property and life. So far, we have only indirect knowledge of professional fire fighting services in ancient Egypt, but such did exist. If the Egyptians were able to design and construct ships capable of transporting 180-ton granite obelisks at a distance, they probably had a fairly sophisticated fire service as well. Knowledge regarding this comes to us from the well-kept records of imperial Rome.

A brief history of firefighting in ancient Rome
In considering a history of fire fighting in ancient Rome, and how it leads up to the modern-day plague of cancer in firefighters, the first certain knowledge of organized attempts at urban fire control comes to us from the journalists who were there to see it. Ancient historians such as Cassius Dio (AD 155 -235), Pliny the Elder (AD 23 – 79), and Plutarch (AD 46 – 120), among others, left careful accounts of day to day life in these distant times. We learn that roughly 2,000 years ago, the city of Rome was a high-density metropolis of approximately one to two million people, a significant 30 per cent of which were slaves. We are told that the city was frequently and repeatedly ravaged by lethal and devastating fires, to the continual dismay and vexation of the empire. One estimate suggests there were as many as 100 smaller fires per day, any two of which could erupt into terrifying infernos that would threaten the city at large.

These historians tell us of a notorious, privately-owned, and commercialized fire service that emerged in Rome in the first century BC; fire fighting that amounted to little more than a swindle in the form of organized extortion. A certain Marcus Licinius Crassus (115 BC – AD 53), whose life was marked by craft, cunning, and an overpowering lust for wealth, assembled a retinue of about 500 men, indentured slaves who, before falling on hard times, were formally trained as builders and architects. The crew would rush to a blaze and then remain on standby while the brazen Crassus entered into an impassioned haggling with the distraught owner to purchase the property — as it was burning — at an insultingly low rate. If the frantic owner, in a moment of vulnerability, accepted the deal, the fire crew would jump into action and attempt to extinguish the flames. If no deal was reached, the erstwhile firefighters would stand down and watch the structure burn to the ground. In the aftermath, Crassus would often successfully acquire the damaged or burned-out ruins, which sometimes amounted to large tracts of the neighbourhood, and his skilled team of ‘contractors’ would repair or rebuild so that he could sell the properties back to their original owners, or others, at much higher rates. In this way, along with operating other nefarious schemes as well as legitimate enterprises, Crassus amassed a fortune that by today’s standards is estimated to be in the range of about $15 billion US. Dishonest intentions, however, combined with profiting from the misfortune of others, inevitably comes with a cost. We learn that Crassus, one of the first, self-stylized fire chiefs, had his head hacked off and molten gold poured down his throat (although I am not sure in what order) in a scornful public mockery of his lust for wealth.

A more commendable and praiseworthy attempt at establishing a fire service took place 30 or 40 years later, somewhere around 22 BC, when a certain ambitious magistrate, Marcus Egnatius Rufus, won great distinction in Rome by establishing the next organized, privately-run, but free-of-charge fire service. Considered to be a dangerous and somewhat less than prestigious occupation, this early fire department was also necessarily staffed by slaves, to the number of about 600 men. Given the immensity of the city and the frequent number of overwhelming infernos, this poorly-resourced agency was stretched far beyond its capacity to render effective response. Historical reports suggest that the fire services were disappointingly haphazard and unreliable. The proud and confident Chief Rufus, after basking on an initial crest of popularity, was subsequently executed by reason of unrelated conspiracies combined with the sinister intricacies of Roman politics.

In exasperation after another particularly dreadful blaze around AD 6, and inspired by the lofty endeavors which won popularity for the hapless Chief Rufus, Augustus Caesar (63 BC – AD 14) resolved once and for all to implement a no-nonsense, imperially-ordained, professional fire service.

After considerable research, the following is my reasoned approximation of how Caesar was able to inaugurate his highly-effective and military-disciplined fire authority. For better administrative management, Caesar divided the expansive city into 14 distinct geographical regions. As a means of generating a fire budget, he levied a new tax of four per cent on the sale of all slaves. Caesar specified that the new fire service be modeled after the agency then operating in Alexandria, Egypt, which was renowned for its efficiency. The emperor appointed a fire commissioner, who oversaw the creation of seven municipal fire authorities, with each authority responsible for providing fire protection to two geographical regions of the city. Each of these seven main authorities were further subdivided into seven distinct fire brigades, with each brigade consisting of 70 to 80 full-time firefighters. Each brigade had its own sophisticated, expansive, and especially designed firehall complete with barracks and water cisterns, and equipped with an impressive array of fire fighting implements. Horse-drawn fire engines — rolling wagons partially filled with a reservoir of water — were fitted with a primitive form of deck-mounted deluge gun: powerful, Greek-designed, twin-suction Ctesibius piston pumps. These forerunners of our modern apparatus were capable, according to some reports, of projecting a fountain of water some 20 or 30 meters high. The deck guns were manned by experienced pump operators who worked in collaboration with firefighters whose primary task was to locate and access a continuous supply of water, which they sourced from the numerous wells, basins, aqueducts, and public fountains distributed throughout the city.

With the fire monitors pumping a continuous stream of water onto the blaze, firefighters on the ground worked knockdown using buckets, ladders, grappling hooks, ropes, pickaxes, and mattocks. They were assisted in their work by heavy military engines designed to create firebreaks by demolishing burning buildings and any nearby structures also at risk of catching fire. With bravery, skill, and resource, these ancient firefighters also muffled flames by throwing large, water-soaked patchwork quilts over fires, in addition to chemically smothering flames by spraying a vinegar-based fire retardant.

Apartment blocks, some higher than five or six stories, were common in the city of Rome, thus the firefighters had a ready supply of bulky rescue mats that were designed to cushion the falls of tenants who chose to escape incineration by jumping for their lives. Motivated by fear and desperation at the thought of a fiery death, the Romans were nothing if not resourceful and daring.

Another major task was to get out and actively patrol the streets on foot, especially at night, when the fire hazards peaked due to the use of candles, oil-lamps, hearth fires, and fixed-lighting torches. Since lethal fires could spread so quickly, homeowners were expected to assist in fire suppression and prevention. Roman fire codes specified that landlords and tenants were to keep fire fighting equipment ready-to-hand, along with an abundant supply of water to assist in battling any flames that might erupt.

Archeological evidence reveals that the firefighters of ancient Rome wielded a more fearful power —even a brutal influence — over the general public than our more temperate and well-mannered firefighters of today. Tasked with serious responsibilities, and held accountable by an unforgiving imperial authority, Roman firefighters, in thought and action, were actually a hardened amalgamation of military soldier, police officer, and firefighter. This can be seen from the gravestones of Roman firefighters, which indicate that some were equipped with a lethal short sword as well as a heavy, knobby-wooded baton called a fustis, which served, essentially, as a bludgeon.

Many firefighters today would be interested to learn that, under the authority of the emperor, if a member of the public was discovered to be negligent in adhering to fire codes, or careless in managing a fire, the fire chief could order them to be summarily beaten, horsewhipped, or, at the very least, for minor infractions, given a good tongue-lashing. Many lives, then, just as now, would depend upon such responsible fire conduct.

Because of the difficulty and danger of ancient fire knockdown and overhaul, there was initially some reluctance for prospective young firefighters to enlist in the new service. Therefore, in AD 24, Tiberius Caesar (42 BC – AD 37) vowed to grant full Roman citizenship — a title with considerable privileges and benefits — in addition to a significant cash bonus, to any firefighter who survived or endured a six-year span of service.

A six-year span of service? When contrasted with the standard 25-year term expected of soldiers fighting with the imperial Roman army, this may convey significant depths of meaning regarding the anticipated survival rates of each of these disciplines. Nevertheless, the enticements offered by the government must have had some success, as a census in AD 55 recorded that the fire service in the city of Rome had grown to 3,920 full-time career firefighters. In AD 205, because of the ongoing and indispensable successes of the fire department, this number was doubled to about 7,000 firefighters. The imperial Roman government recognized that organized, professional fire brigades were an absolute necessity as the empire expanded and progressed. Therefore, similar models quickly sprung up in many, if not all, Roman cities, for example Carthage and Antioch, among others.

Look for Part 2 in our series on firefighters and cancer in the February edition of Fire Fighting in Canada.

Dr. Kenneth Kunz is a classically trained medical internist, oncologist, chemist and cancer researcher and most recently a mental health and addictions consultant. He is a competitive track and field athlete and father of two residing in British Columbia.

Features 
Cancer in firefighters

Part 2 - The ancient discipline of fire fighting medicine

February 4, 2020 
By Dr. Kenneth Kunz

 

Many young chimney sweeps, like the young boy picture here (circa 1877), were victims of a well-documented and savage cancer that was frequently fatal.

Editor’s Note: Part 1 in our cancer in firefighters ran in our December edition. In Part 2, we’ll be looking at medicine and disease in ancient firefighters. Look for Part 3 in March. Dr. Kenneth Kunz is a medical oncologist who has taken action in the fight against cancer in firefighters through visiting fire departments and spreading the message of risk in various ways. Dr. Kunz has written this three-part series with the support of the Fire Chiefs’ Association of British Columbia.

What I find thought provoking, as a physician who works with firefighters, is that overseeing the health care of each of the seven municipal fire authorities in imperial Rome was a team of four full-time physicians, in addition to a fire department chaplain, whose responsibility was to address the emotional, psychological, and spiritual needs of the firefighters. In other words, 2000 years ago, the professional fire rescue services of The Eternal City were staffed by a multidisciplinary health care team of 28 medical doctors, in conjunction with counselling and solace provided by a set of spiritual advisors. Aside from the well-known battlefield surgeons of the day, this, to my knowledge, may constitute one of the first subspecialty medical practices — Interdisciplinary Firefighting Medicine.

The necessity of such robust medical, psychological, and spiritual support in the fire service leads me to ponder certain questions as they concern workplace safety and health — including the mental health of Roman firefighters. What kinds of illnesses, injuries, and deaths were these ancient firefighters subjected to? I can find nothing mentioned regarding bunker gear or breathing apparatus in the historical reports —what kind of personal protective equipment was available to the fire service? One can imagine these staunch gladiators of the fire fighting arena battling burning apartment blocks while clad only in hooded leather ponchos, with thick rawhide gloves and aprons, stout boots, and a damp cloth secured over the mouth to fend of the choking heat and toxic fumes.

Just as today though, these imperial firefighters probably suffered frequent slips, trips, and falls. And no doubt many died from asphyxiation, crush injuries, bone fractures, and burns — complicated, of course, in an era without antibiotics, by the deadly infections that subsequently attend these types of insults. But what about job-related cancers?

 

Large, real-time, statistically significant epidemiological studies linking cancer to fires would have to wait for another two thousand years. Or, until 1775, when British surgeon Percival Pott (1714 – 1788), published a startling description of the agonizing and fatal cancers associated with prolonged exposure to smoke and soot — cancers that routinely consumed young chimney sweeps during the industrial revolution in England. We will return to Pott and his findings in due course.

■ Did Ancient Firefighters Live Long Enough to Develop Cancer?
Cancer often, but not always, takes decades to develop, even when people are exposed to carcinogens on a daily basis. In my practice as an oncologist, I recall seeing many patients present with lung, or the myriad other smoking-related cancers, in their early seventies, after fifty years or more of concerted tobacco consumption. Cancer, in the public at least, is usually a disease of advancing maturity. In Canada and the U.S., about 90 per cent of cancer diagnoses occur among individuals who are at least 50-years of age or older.

Therefore, did Roman firefighters, with a lifespan that was probably quite short, even live long enough to develop line-of-duty cancers? We have no direct information, even though tens of thousands of professional firefighters lived and died in a multitude of Roman cities over the five centuries that the imperial fire service flourished. No data was captured — no medical or epidemiological observations were ever chronicled, for the sake of posterity, to enlighten future generations as to the various ways in which these firefighters were injured or died.

Some indirect information, however, comes to us from construction of the 300 km/h Rome to Naples high-speed railway, completed in 2009. These excavations would allow a multidisciplinary team of Italian researchers, including medical historian Valentina Gazzaniga, at the Sapienza University of Rome, to finally make some informed observations about the harsh, even brutal realities of life as it concerned the Roman proletariat. A suburban, working-class graveyard from the first and second centuries was uncovered that contained the skeletal remains of about 1,800 Roman blue-collar workers — their bones were systematically examined by visual inspection, CT scanning, and plain radiographs. The grim news was that the average workers — and this would surely include the firefighters of Rome — were dead by the median age of 30. The skeletons harboured conditions and diseases that physicians of today still commonly see: arthritis, bone infections, nutritional deficiencies, metabolic bone diseases, severe fractures of the nose, hands, limbs, and clavicles, and “a really high incidence of bone cancer.” Cancer of the soft tissues or internal organs will dissolve away with time as the body decomposes, but cancer that starts in or spreads to the bones, well, that can be preserved in the forensic anthropology records forever.

These striking observations regarding injuries, chronic illnesses, and cancer in the Roman working class may explain why imperial Roman firefighters were celebrated and rewarded if they withstood a daunting six-year stint in the fire service. Six years, that is, if they were fortunate enough to last that long. Recognizing this, the barrier was subsequently lowered by the imperial Roman government to a presumably more survivable three-year span of service, after which the firefighters were entitled to a lifetime supply of free grain as supplied by the emperor.

A shortened life expectancy in the professional Roman fire service may have been inadvertently captured by the assistant fire chief Quintius Julius Galatus, who probably had his gravestone and most of his epitaph carved before he died (see photo): Quintius Julius Galatus, from Thysdrus in Africa, served in the 6th fire brigade of the City of Rome under the authority of fire chief Lucanius Augurinus. He served a total of 14 years, and during that time he was an attendant of the fire chief for 2 years, then one of his special agents for 2 years, and then rose to the important rank of fire attack director for 3 years. He lived only 37 years.

As an experienced, 14-year veteran firefighter, Galatus was painfully aware that death could come unexpectedly and at any time.

■ How Long Does It Take to Develop an Occupational Cancer?
Returning to the British surgeon Pott, it may have been fortunate for science that he was thrown from his horse in 1756 and suffered a severe fracture of his ankle. Pott was thereby confined to a significant period of bedrest, during which, to while away the hours, he began to write medical publications regarding the various clinical conditions he had encountered during his surgical practice. Were it not for that broken ankle, and the satisfaction he subsequently derived from medical writing, the recognition of an occupational link between environmental carcinogens and cancer — “I mean the chimney-sweepers’ cancer” — he emphasized, may have had to wait for some future generation to document. Percival Pott’s 1775 medical publication, “Chirurgical Observations relative to…cancer of the scrotum”, marked the beginnings of an epidemiological link between environmental carcinogens and job-related cancers. His account describing the plight of these young chimney sweeps was heart-wrenching and compelling.

“The fate of these people seems singularly hard; in their early infancy, they are most frequently treated with great brutality, and almost starved with cold and hunger; they are thrust up narrow, and sometimes hot chimnies, where they are bruised, burned, and almost suffocated; and when they get to puberty, become peculiarly liable to a most [unpleasant], painful, and fatal disease… cancer of the scrotum and testicles.”

Pott describes in fascinating detail how cancer is caused by soot that accumulates in the skin folds and begins somewhat after puberty as a raw and ragged ulcer involving the scrotum. This lesion then spreads quickly over the surrounding skin, penetrating deep into the muscles and membranes of the scrotum. Next, the cancer infiltrates, enlarges, and hardens the adjacent testicle, thereafter ascending up the spermatic cord to involve the lymph nodes of the groin, and from there disseminating into the viscera of the abdominal cavity. Even with early, aggressive surgical removal of all visible disease, followed by excellent healing of the incision and subsequent discharge from the hospital in good health, Pott relates that the disease returns with an inevitable fatality:

“In the space of a few months, it has generally happened, that they have returned [to hospital] either with the same disease in the other testicle, or in the glands of the groin, or with such wan complexions, such pale, leaden countenances, such total loss of strength, and such frequent and acute internal pains, as have sufficiently proved a disease state of some of the viscera, and which have soon been followed by a painful death.”

Although the youngest patient documented by Pott and his colleagues was an apprentice chimney sweep of only eight, most of these young men developed job-related cancers after the age of 20, and usually before the age of 40. As a medical oncologist, I have observed that many occupational cancers, such as those involving firefighters, can sometimes present earlier in life and are often more aggressive and more treatment resistant than the ‘sporadic variety’ of cancers that arise in the general public.

The importance of Pott having established such a relationship was that it eventually led to public acknowledgement of the problem, followed by changes to, and improvements in working conditions. In fact, a concerned British Parliament, motivated to the point of uproar, passed The Chimney Sweepers Act of 1788. This was a new labour law that prohibited the exploitation of orphaned or impoverished children, some as young as four years old, who, without proper food, clothing, or personal protective equipment, were forced to work long and dangerous hours cleaning hot, toxic, soot-encrusted chimneys.

Fortunately, “the chimney-sweepers’ cancer” died out as a frequently encountered clinical entity in the early twentieth century, probably because of alternative methods of heating, improved hygiene and working conditions in the chimney sweep trade, and better methods of cleaning chimneys. However, the scourging legacy of “the chimney sweepers’ cancer” lives on today in spirit, as reflected in the higher incidence of cancer in modern firefighters — and the startling mortality rates that are so often solemnized in bell ringing ceremonies all over Canada and the U.S.

■ Today’s Carcinogens are More Toxic, and the Fires are Raging Hotter
In terms of professions, 1st century Roman firefighters are not eighteenth-century chimney sweeps, and young chimney sweeps of the 18th century are not our modern 21st century firefighters, but one heartbreaking fact units them all. Each of these groups of hardworking and earnest individuals share something common in the dimensionless bonds of eternity — they have all had to withstand unavoidable work-related risks and hazards that render them dramatically more vulnerable to certain illness and injuries, including job-related cancers. And although the professional firefighters of today are probably better trained, more highly educated, outfitted with state-of-the art equipment and bunker gear, and schooled in the lore of situational awareness, the fires of today are burning hotter, higher, more dangerously, and superbly more toxic than ever before in history.

Cancer in firefighters: Part 3

Doctors, firefighters and why the power is in prevention

March 4, 2020 
By Dr. Kenneth Kunz

 

During my training as a physician, which began in 1982 at the Winnipeg Health Sciences Centre, and concluded in 1996 at the Arizona Cancer Center, I must have assessed and treated thousands of patients. Looking back though, I never really paid much attention to the firefighters, or any other special group, for that matter. As a physician, I was never fully aware of the work-related risks of what it meant to be a firefighter.

Why was this? Why do the impending long-range health dangers that face a firefighter escape a doctor’s attention? The answer is simple: just like firefighters working on the fireground, a doctor must frequently operate under the urgent pressure of workload levered against time. The concept of ‘situational awareness’ applies just as much to the work of a doctor as it does to the work of a firefighter.

Firefighters must note that, for doctors, the medical training itself is so mentally and physically demanding, the patients so numerous, the illnesses so serious, the responsibilities so dire, the hours so merciless, and the patient turnover rates so high, that the goal of just surviving the interminable grind of medical education — without messing up too badly, or else going down altogether — is often the haggard medical resident’s prime objective. Under the burden of circumstance, it is difficult for a doctor to maintain focus on the personalized details of any special group of patients.

On the flip side however, a doctor will be delighted to cooperate with a motivated firefighter for better health and wellness outcomes — once that physician is made aware of the risks that confront the fire service. Firefighters should know this, and be empowered to address it by acting as their own best health advocates. Therefore, a firefighter must take personal responsibility over matters they can control directly. This includes maintaining an optimal body weight through eating a healthy diet with a reasonable calorie count, attaining peak fitness through physical activity, eliminating tobacco consumption, curtailing alcohol along with refined sugar, ensuring a regular, good night’s sleep, and drinking plenty of water. Then, there is something extremely important – our mental health – which determines the way we think and is the basis of all motivation and action. A relatively new science called epigenetics has shown that the cells of our bodies take their signals from our beliefs. The mind is therefore a powerful force, and optimal mental health is critically essential for a firefighter’s overall health. This makes down-time, stress reduction, relaxation, strong social connections, and talking – whether that be with a trusted mentor or a mental health counselor – all critical ingredients for healthy and fit firefighters. It goes without saying that workplace safety and health are also an important part of firefighter health, including proper use of clean, personal protective equipment, and careful decontamination after a fire call.

There is one further important point to make: firefighters must also take the responsibility of informing their primary care providers of the long-term, line-of-duty risks they face. This premise gave rise to the “Firefighter’s Cancer Screening and Surveillance Letter”, which was commissioned under the vision of retired Surrey, B.C., fire chief Len Garis. Freely available to all firefighters working in any geographic location, this letter can be found on the Fire Chiefs’ Association of British Columbia website. Firefighters are encouraged to print this letter out, and regard it as a personalized medical document that has clinical currency in any fire jurisdiction worldwide. I wrote the letter expressly for the purpose of informing primary care providers of the long-term health risks that firefighters face, primarily as it concerns cancer.

In summary, for a firefighter, personal accountability in thought and action constitutes an important act of public service, because healthy and fit firefighters are functional firefighters — they are out in the world working in a spirit of generosity.

 

■ Training and Survival: Doctors and their Firefighters
When I think back on the matter of a doctor’s training, and the innumerable nights spent ‘on call’ in the hospital, I remember some isolated but dreadful clinical vignettes involving sick or injured firefighters. Cases like the stoically resigned but forlorn 44-year-old firefighter with leukemia who, sitting alone in his isolation room, was breathing through a yellow paper face mask while clad only in a blue hospital gown. He was grasping an I.V. chemotherapy pole to support his weight, after having spent many weeks on the bone marrow transplant unit. Shivering uncontrollably with fevers and chills, his very life was in peril from the leukemia as well as the difficult and prolonged treatment.

And then there was that otherwise fit and robust 55-year-old non-smoking firefighter, accompanied by his visibly shaken and apprehensive wife. He rolled around in agony on a hospital gurney in the clinic, having been diagnosed with a sudden-onset and aggressive form of lung cancer. The disease was already metastatic to his ribs and vertebrae, and his illness was so rapid that I never really got the chance to know him. He didn’t suffer long though, but in dying, left another widow to attend yet another solemn bagpipe ceremony.

All of these, and many other heartbreaking firefighter cases to the side, my life and medical training went necessarily onward. In February 2011, I was living in Nelson, B.C., where I was giving a series of public lectures on cancer awareness and prevention. At one of these, a volunteer firefighter by the name of Harry Hadikin, from Beasley Search and Rescue, asked me if I would consider giving a similar talk on how firefighters, specifically, could avoid getting cancer. This simple request triggered a flood of recollections concerning all the firefighters I had seen over my years of practice who had succumbed to cancer. Later, on researching the issue, I was surprised to discover that several large, statistically significant studies had been published in peer-reviewed medical journals confirming that firefighters, when compared to the general public, had higher incidence and mortality rates from cancer. I have since prepared the lecture Hadikin requested, called: “Job-Related Cancers in Firefighters”, and have given it to appreciative audiences at firehalls and hospital conference rooms all across the province. This talk can be found online on the Comox Search and Rescue website.

These speaking engagements have brought me face to face with many in the fire service who have been diagnosed with a cancer they feel resulted from the toxicity of fighting fires. Some of these firefighters have told me they were unsuccessful in obtaining recognition and support from Workers’ Compensation because the type of cancer they were diagnosed with was not on the presumption list. Just as heartbreaking, I have seen cases where firefighters diagnosed with a Workers’ Compensation-recognized cancer were denied benefits because the clinical timeline of their illness did not meet the required minimum cumulative period. To the best of my knowledge, wisdom, and experience as a cancer consultant, I have never known any type of cancer to obey a minimum cumulative period. Similarly, there are over 200 different types of cells in the human body, any one of which can give rise to cancer in response to a carcinogenic mutation, depending on individual genetic vulnerabilities. Therefore, it is possible for a firefighter to be diagnosed with any type of cancer, and this includes rare cancers that are not typically covered by workers’ compensation. Rare cancers may be infrequent; however, they are not infrequent to the person they are affecting, and this includes firefighters.

A quick review of the firefighter cancer presumption laws, along with the minimum employment periods, shows considerable variation in coverage from province to province. This reflects the complex personal, medicolegal, scientific, and economic controversies that surround this type of legislation. Furthermore, the non-uniformity in cancer presumption highlights the point that cancer is a complex, multifactorial, and poorly understood phenomenon that involves many variables including advancing age, personal lifestyle choices, natural cancer causing exposures like sunlight and certain infections, and environmental and job-related carcinogens, all of which are balanced against an individual’s genetic susceptibility.

In light of this knowledge, I hope progress in cancer presumption legislation will continue to move forward with expanding coverage for firefighters, as firefighters themselves continue assuming personal responsibility for their health.

Dr. Kenneth Kunz trained as an oncologist, cancer researcher and a mental health & addictions counsellor and consultant. He is a competitive track and field athlete and father of two residing in British Columbia. Contact him at Kenn@netidea.com

 

 

Dr. Kenneth Kunz is a classically-trained medical internist, oncologist, chemist and cancer researcher and most recently a mental health and addictions consultant. He is a competitive track and field athlete and father of two residing in British Columbia

This article was published in FireFighting in Canada 2020