Health Beat--October, 2002--The "Smoldering" and "Flying" Hazards, Part 1

The next time you are tempted to take off your respiratory protection during overhaul operations for reasons of comfort, consider the following.  "The most dangerous time for firefighters is after the fire is out," according to an in-depth study conducted by Robin Rowland, CBC News in Canada. "Smoke, fumes and soot are still present at the site."

 The report "Deadly Duty, Firefighters Cancer Risk," says that at least 15 studies show a statistical link between brain cancer and firefighting. Epidemiologist Kristin Aronson, a specialist in the causes of cancer quoted in the report, fingers toxins created by smoldering plastics as the primary suspect after having analyzed death reports of 6,000 Toronto firefighters. Potentially cancer-causing vapors found in smoke, she adds, come from "glues, wraps, paints, insulation, and other building materials-the synthetics found in almost every article of modern day life." Polyvinyl chloride (PVC) is found in upholstery, wire, pipes, and wall coverings. When burning, PVC gives out hydrogen chloride and phosgene. Actually, polyethylene and PVC can be more dangerous when smoldering than when burning at the height of the fire. They emit carbon monoxide, hydrogen cyanide, hydrochloric acid, and other hazardous chemicals. One fact that may be indicative of the plastics-brain cancer link is that earlier studies of firefighter mortality (those done before the widespread introduction of plastics in the 1950s) did not identify brain cancer as a cause of death. Brain cancer in firefighters with 20 years of experience is so common in Ontario that it is recognized as a workplace injury and victims are automatically compensated. (Ontario is the only Canadian province that does this.) 

A 1994 Ontario Industrial Disease Standards Panel report estimated that "80 percent of firefighters' injuries are caused by smoke inhalation or oxygen deficiency and that more than 50 percent of line-of-duty deaths are caused by smoke exposures." The report noted also that firefighters sometimes found the breathing apparatus too hot, heavy, and cumbersome under strenuous conditions and found it difficult to breathe once the tank had reached 30 percent capacity. They, therefore, often removed their breathing apparatus as soon as they perceived that the fire was no longer a danger to them, exposing themselves to the dangerous chemicals in the smoke-each substance dangerous in itself and most likely even more so (the extent of the danger is unknown) when mixed and heated with other agents in the fire environment.

In relation to carbon monoxide, considered by some as possibly the most hazardous chemical for firefighters, it was found that firefighters who take their breathing apparatus on and off in the fire environment are virtually at the same risk as those who do not wear the apparatus at all. Since carbon monoxide is odorless, colorless, and tasteless, you cannot determine how much is in the air you are breathing without using a detector. Some experts say the amount of smoke present is not necessarily indicative of the quantity of carbon monoxide present.

The 1994 Ontario study has shown that firefighters outside Ontario are just as likely to get brain cancer, which means that--since all the suspected materials and substances are in use throughout the United States and virtually the world--all firefighters should be aware of these risks and protect themselves to the maximum.

Next time, some additional commonly found hazards.

1.       1. Investigative Report: Firefighters Cancer Risk, David Mc Lauchlin and Curt Petrovich, CBC Radio News; Dr. Brian Goldman, CBC Television News; Robin Rowland & Gary Graves, CBC News Online, http://cbc.ca/news/features/firefighter_safety/, Feb. 5-6, 2001

Health Beat--The "Smoldering" and "Flying" Hazards, Part 2

In addition to brain cancer and carbon monoxide poisoning (discussed in Part 1), recent research has shown that failure to wear adequate respiratory protection during overhaul and other non-firefighting operations can lead to respiratory distress and even respiratory failure. Contaminated air is even more threatening to individuals with chronic heart and lung conditions.

A Norwegian study, conducted 11 years ago and published in the American Journal of Respiratory and Critical Care Medicine, found a connection between asbestos exposure and a high risk of severe breathlessness and asthma. The study observed 2,819 subjects. Almost a third of them had been exposed to dust and fumes in the workplace. The study found an association between dust/fume exposure and respiratory problems in between 5.7 percent and 19.3 percent of the study participants and a link between an exposure and asthma in 14.4 percent.¹ 

The 9-11-01 World Trade Center disaster reinforced quite vividly the message that health hazards are inherent in fire and other emergency disaster environments. On analysis, it can be seen that many of these dangers lurk in many of the environments to which you respond routinely.

Let's look at some of the most commonly encountered contaminants, carcinogens, and other harmful substances, a good number of which are derived from building construction materials.

According to the New York Committee for Occupational Safety and Health (NYCOSH), these hazardous substances include cement and drywall dust; airborne particles of burned plastic, including polyvinyl chloride (PVC); and asbestos.² Because these are substances to which all responders at one time or another are exposed in structure and vehicle fires, structure collapses, and natural disasters--even though the information on contaminants and the recommendations for protecting responders were directed at those in the vicinity of the World Trade Center operations at the time the information was released-- they are also relevant for other emergencies and disasters that present similar dangers for responders.

The NYCOSH document explains that cement and drywall dust generally contain crystalline silica and that inhaling silica dust can cause silicosis or other potentially fatal lung diseases. Cement dust can irritate the respiratory system or aggravate asthma and chronic bronchitis. The same is true for airborne particles of burned plastics used in insulation, conduits, furniture, and other items. All dusts, in fact, may cause asthma or bronchitis and other respiratory problems, irritate eyes, or cause allergic skin reactions.

In addition, working or conducting an investigation in confined or restricted areas without wearing adequate respiratory and body protection may also expose you to flammables or explosives released from ruptured gas lines or storage containers, thereby subjecting you to the ill effects of carbon monoxide, including possible asphyxiation or an oxygen deficiency. Gases also can irritate the eyes, nose, throat, or lungs. (2)

In addition, any emergency scene poses the threat of exposure to communicable diseases. You must make sure that infected blood or other bodily fluids do not enter your body through your eyes, nose, mouth, or an unprotected (uncovered) cut, scratch, or break in your skin. (2)

Keep in mind also that you must protect your food, beverage containers, smoking materials, and other personal items from contaminants that might be on your clothing and in your immediate environment.

Keep in mind also that you must protect your food, beverage containers, smoking materials, and other personal items from contaminants that might be on your clothing and in your immediate environment.

Precautions

The NYCOSH precautions with regard to dust exposure include the following:

• Prevent dust/ash from becoming airborne by wetting it with water before disturbing it. Do not sweep or handle it when dry. Dust is hazardous when it is airborne. It doesn't take much to make it airborne. Simply walking by the dust can do it. Note: If the dust might contain asbestos or some other hazardous substances, it should be tested before cleanup is attempted. Only those adequately trained to clean up the hazardous materials should do the work.
• Do not vacuum dust with equipment that does not have HEPA filters.
• Wear a respirator that provides eye protection (or goggles).
• Have available sufficient supplies of respirator cleaning supplies and replacement cartridges or replacement respirators. Make sure the respirator protects from the specific air contaminants to which you are exposed. Make sure it fits properly and that its seal is not compromised by fire. Note: A dust mask is not a respirator and does not protect from asbestos, silica, or other hazardous particulates.
• For incidents involving high-rises, use rubberized masks with screw-in particulate P-100 or R-100 HEPA cartridges (not N-100). Disposable respirator seats may not be sturdy enough for these conditions. Replace respirator cartridges once a shift at minimum, or when it becomes difficult to breathe through them.
  If several blocks from the disaster site, where dust/ash is the main air contaminant, the respirator should be rated N-, P-, or R-100. Replaceable cartridges are preferred; disposable respirators rated N-, P-, or R-100 are acceptable if they can be protected from conditions that compromise the seals.
• Respirators that protect from dust cannot protect for oxygen deficiency or flammable and toxic gases. Test the air in an unventilated area where toxic or flammable gases may be present before entering. No one who has not been trained and certified in confined-space entry should enter an area where these hazards may be present.
• Wear protective clothing so you can change out of your work clothes before returning home. Bag your work clothes, and wash them separately from your personal laundry to prevent contamination. Entering your vehicle or home while wearing your dusty work clothes will contaminate these areas.
• Use universal precautions to protect yourself against bloodborne diseases.
• Since you may ingest toxic materials that are on your clothing, in your hair, or on your skin when you eat, wash before doing anything that could result in ingestion. If washing water is not available, use moist towelettes.

Note: After preparing this column, the following came to my attention. According to the FEMA/USFA Web site database on line-of-duty deaths, two fatalities were recently attributed to smoke inhalation. In one instance, a 51-year-old Fall River (MA) Fire Department district fire chief was commanding a major structure fire under heavy smoke conditions on September 19. He complained of breathing difficulties after inhaling toxic and noxious gases and fumes. He consulted medical professionals. His condition worsened. He died of acute respiratory distress syndrome in the hospital on October 24.

On November 4, a 39-year-old volunteer firefighter with the Northern Wayne Fire Company in Lakewood, Pennsylvania, died of carbon monoxide poisoning caused by smoke inhalation during interior operations at a structure fire.

Next time: A relatively new respiratory disease.

1.       "Dust on the Job Can Be Tough on the Lungs," HealthScoutNews, HealthCentral.com, Oct. 23, 2002.

2.       "World Trade Center Catastrophe Worker Health Fact Sheet," New York Committee for Occupational Safety and Health, September 11, 2001.

Health Beat--The "Smoldering" and "Flying" Hazards, Part 3

Within the past 15 years, a rare type of lung disease-acute eosinophilic pneumonia-has been identified. Only a few cases of this non-bacterial pneumonia have been identified. According to Dr. William N. Rom, a lung specialist at the New York University School of Medicine, this disease may be caused through inhalation and may be more common than it is believed to be. In fact, two cases of firefighters with eosinophilic pneumonia have recently come to light.¹

According to the Gale Encyclopedia of Medicine, eosinophilic pneumonia is a group of diseases in which there is an above-normal number of eosinophils (a type of white blood cells) in the lungs and blood. These cells are part of the non-specific immune system and participate in inflammatory reactions.

There are two types of eosinophilic pneumonia: Leveler's pneumonia, which clears spontaneously, but slowly, in about a month, and pulmonary infiltrates (cells or body fluids that have passed into a tissue or body cavity) with eosinophilia (PIE), a more serious and potentially fatal disease.

Pneumonia with eosinophils occurs as part of a hypersensitivity reaction--an over-reaction of the immune system to a particular stimulus and generally is not, as already noted, a reaction to an infection. A correlation between asthma and eosinophilic pneumonia has been established.

Eosinophilic pneumonia can also be caused by drugs and by polluted air. Symptoms range from mild (coughing, wheezing, and shortness of breath) to severe and life-threatening (severe shortness of breath and difficulty getting enough oxygen). In a few cases, the disease may rapidly produce life-threatening pneumonia.

The Patients A 38-year-old firefighter, who had responded to the World Trade Center, was hospitalized with respiratory failure and ultimately was diagnosed with acute eosinophilic pneumonia. Dr. Rom treated the firefighter. In a report published in the American Journal of Respiratory and Critical Care Medicine (September 2002), it was stated that after extensive testing, fly ash, which came from the gypsum wallboard used in building construction, was the most likely cause of the eosinophilic pneumonia. Fiberglass particles, asbestos fibers, and eosinophils were also present in the firefighter's lungs.

Dr. Rom made the diagnosis based on the results of testing the contents of the firefighter's lungs through a procedure called a bronchoalveolar lavage (the washing out of the lungs with saline or mucolytic agents).

In another case, a 41-year-old firefighter was reported to have suffered respiratory failure after he was admitted to the hospital for an allergic type of reaction. About a week before his admission, he had responded to a vehicle fire in which the engine and the body of a small sports car were well-involved. The firefighter wore his mask during the fire but removed it after the fire was knocked down, even though the car was still smoldering.

The day after the vehicle fire, the firefighter had responded to an indoor fire during which a television burned. Again, the firefighter took off his mask after the flames had been extinguished, even though, by his own description, the fire was "sooty" and thick smoke was still in the room.

The firefighter reported having a cough that produced black sputum for about four to five days. The cough prompted the firefighter's superior to remove the firefighter from the dive team. On the day he was admitted to the hospital, the firefighter had developed chest pains and shortness of breath. Diagnostic tests showed patchy infiltrates in his lungs, predominantly in the upper lobe. He did not respond to treatment with broad-spectrum antibiotics, experienced respiratory failure over the following three days, and had to be placed on a respirator for a time. He ultimately responded to treatment with steroids.

As a result of having taking off his protection mask while toxic fumes were present, this firefighter experienced an allergic type of reaction that ultimately progressed into acute respiratory distress.

Another important consideration is that even though you might not consider your present situation to be hazardous, whatever contaminant(s) to which you might be subjected may be the proverbial "straw(s) that broke the camel's back": Added to whatever infiltrates that already might be present in your lungs, even a relatively mild exposure can precipitate a major respiratory problem. Also, we really don't know every substance that is present in our environment or whether some material considered safe or "neutral" today might prove to be hazardous tomorrow.

For additional information pertaining to specific health threats to which you may be exposed in your work environment, consult your heath office or local office of occupational safety and health.

You can't be too cautious when it comes to your health. Protect yourself against all exposures. Don't gamble with your health.

1.       "9/11 Firefighter Contracted Rare Pneumonia," Janice Billingsley, Health Scout News Reporter, Health on the Net Foundation, Sept. 18, 2002.