Respiratory diseases remain a significant health issue for firefighters and emergency responders as well as civilians. Respiratory disease is the No. 3 killer in North America, exceeded only by heart disease and cancer, and is responsible for one in six deaths. The American Respiratory Association estimates that more than 35 million Americans are living with chronic respiratory diseases such as asthma or chronic obstructive pulmonary diseases, including emphysema and chronic bronchitis.

Firefighters work hard each and every day, proudly protecting and serving our citizens by answering the call for help — a call to save lives. That call may be to suppress fire and save lives jeopardized by smoke and flame. It may be a response to a hazardous materials incident, a structural collapse or other special operations event. The response may be for emergency medical assistance and transport to the hospital, with potential exposures to a host of infectious diseases. Firefighters have little idea about the identity of many of the materials they are exposed to or the health hazards of such exposures — whether they are chemical, biological or particulates. Nevertheless, firefighters and emergency medical responders continue to respond to the scene and work immediately to save lives and reduce property damage without regard to the potential health hazards that may exist. A fire emergency has no engineering controls or occupational safety and health standards to reduce the effect of irritating, asphyxiating or toxic gases, aerosols, chemicals or particulates. It is an uncontrollable environment that is fought by firefighters using heavy, bulky and often times inadequate personal protective equipment and clothing.

An occupational disease takes years to develop. It is the result of a career of responding to fires and hazardous materials incidents; it is caused by breathing toxic smoke, fumes, biological agents and particulate matter on the job; and it is the response to continuous medical runs or extricating victims at accidents. Some health effects are immediate while others may take years and even decades to develop and because some respiratory diseases develop over time, it’s impossible to say, “This specific emergency response caused my disease,” yet fire fighters continue to get sick and die from occupationally caused respiratory diseases.

Variability in exposures among firefighters can be great; however, a number of exposures are commonly found in many fire scenarios. The common combustion products encountered by firefighters that present respiratory disease hazards include but are not limited to: asbestos, arsenic, benzene and other polycyclic hydrocarbons, cadmium, chlorophenols, chromium, diesel fumes, carbon monoxide, dioxins, ethylene oxide, formaldehyde and vinyl chloride. Also, findings from firefighters monitored during the overhaul phase (fire is extinguished, clean-up begins, and respiratory protection is not usually available) of structural fires indicates that short-term exposure levels are exceeded for acrolein, benzene, carbon monoxide, formaldehyde, glutaraldehyde, nitrogen dioxide and sulfur dioxide as well as soot and particulates. They are often exposed in their fire stations to significant levels of diesel particulate from the operation of the diesel-fueled fire apparatus. Firefighters are routinely exposed to respirable particulate matter consisting of liquids, hydrocarbons, soot, diesel fumes, dusts, acids from aerosols and smoke. Health effects are known to be produced not just by the particulates themselves but also by certain chemicals absorbed onto the particulates. Further, the mixture of hazardous chemicals is different at every fire and the synergistic effects of these substances are largely unknown.

Michael Heath is president of the St. John Professional Firefighters Association.