Debating Cancer Prevention Techniques

For some time now, cancer in the fire service has been a hot topic leading to passionate pleas and spirited debates. It seems there has recently been an even bigger uptick in the “air time” that cancer is getting in articles, on social media, and in presentations across the country. Everywhere you look, it seems that a new study is being conducted, results are out from a study completed, or a new way of doing things is making the rounds.

We all agree that cancer is a major concern for us. What we can not seem to agree on is the best way to tackle the issue. In recent weeks we’ve been inundated online with fights over what works and what doesn’t. We make a dividing line of sorts, separating firefighters into two basic camps: those who are “ultra prevention conscious” and those who are “carrying a cancer death wish.” But name-calling and questioning of fortitude do nothing in terms of solving the problem, instead, they only further divide us as a fire service.

One of the challenges is that we don’t have all the answers. Science has done some remarkable things in identifying cancer-causing products and exposure sources. However, science has not caught up to everything that is out there; day in and day out more things seem to be rearing their ugly heads as carcinogenic. This is a problem for us as firefighters as we tend to be doers and fixers. We don’t like to wait to see the results from testing on anything, much less on that which could kill us.

Gross decon at fire scenes, fire wipes, storing your gear in plastic totes. All these have some amount of common sense that causes us to embrace their effectiveness. But are they? How many stations have been built in the last couple of years with separate shower areas in order to combat cancer? How many saunas have been installed because a report says that the best thing to do is to sweat out cancer? Is there empirical evidence to show that these things work or are we just relying on what is being touted by fear mongers and vendors peddling their wares all in the name of everyone goes home?

In the past week or so, social media has been buzzing with the “clean cab concept” that is aimed at preventing any dirty gear from being put into the cab. It has even gone so far as to say that all SCBA should be kept in outside compartments so as to avoid contaminating the cab. These postings about a different way of doing things did nothing to further the fight against cancer. Rather, they quickly resorted to the usual internet bashing of our brothers and sisters who have a different outlook than we do. Unfortunately, it occurred on both sides of the issue, and there were few facts, if any, that I saw in support of either line of thinking.

For years, we were told as EMT’s and Medics to give high-flow oxygen to all patients, everyone who fell from a standing position or higher got full spinal immobilization, and patients were A&0 X 3, not 4. I came on with Bretylium as part of the algorithm (the gray box that you never wanted to give because the dosage required math!) Because all those things are now frowned upon, does that mean we were doing things wrong? No. At that time, with the information we had, they were believed to be effective. I wonder if that might be where we are right now with some of the cancer “fixes”. Some of these steps to reduce cancer may be simply a Class IIb treatment of sorts...you know, “may be reasonable/beneficial, usefulness/effectiveness is unknown/unclear/uncertain or not well established.” In other words, we don’t know yet if they are good or not.

It may come as news to some people, but there are no silver bullets in this fight against our deadly opponent. We have a long road ahead of us as we try to determine what preventative measures will, in fact, help us reduce our exposures to carcinogens. Stopping to continually attack our own teammates does nothing to reach our goal of reducing firefighter cancer rates.

Action steps:
1. Be informed. Sticking your head in the sand and denying the problem exists is just as bad as jumping to conclusions based on the preliminary reports of every study. Look for the hard data not just what a vendor or organization tells you.

2. Try things. Some of the current trends may end up proving to be correct. They may also prove to be pointless. Only time can tell. If they seem to be working on a local level, great, run with it. If they seem to be a Class IIb response then keep them in mind but don’t necessarily reconfigure the apparatus floor for a new shower/sauna/whatever room just yet.

3. Avoid living in the past just because it’s comfortable. Take an honest look at the current trends and try them out. Conversely, don’t dismiss things out of hand just because they came from a previous time period or administration in your department. Remember, an experience can be both good and bad.

4. Make the course corrections that we can all actually agree make sense. Wash yourself after all contact with the bad stuff. When, where, how you wash should be determined locally without being ridiculed by other departments. Clean your rig or store your equipment in ways that make sense for your type and frequency of runs. 2 fire a year departments and 2 fire a day departments are going to have different logistical procedures. It’s possible that they can both be right!

5. Check your mindset. I disagree with the groups who state that we are more important than the citizen and that our health and safety trumps everyone while jumping from trend to trend looking for the perfect solution. I also disagree with those who brashly declare “cancer is part of the job quit if you can’t handle it!” To me that’s just a way of trying to cover up their fear that if they can’t go into fires any more they will somehow be less of a man. Get over it. Yes, this job is dangerous. However, that does not excuse us from taking reasonable steps to reduce the dangers where we can without compromising the core value of citizen first.

Understand that while we don’t have all the answers we need, there are some common sense approaches that we can implement. Do what is best for your department not someone else's. Stop the bashing. Our brotherhood is going to be even more important going forward as we fight this ugly cancer monster.