Research, Forms, and Model Language

In this section, you will find separate folders that contain the resources and references to help learn about the scope of the problem and the ways departments are addressing the issue.

The Handouts and Publications folder is the location where you can find printable materials for your organization.

In the Policies & Procedures folder, you will find policies and procedures adopted throughout the fire service to reduce and address exposures to carcinogens linked to the higher incidences of firefighter cancers.

In the Presentations folder, you will see PDF slide decks that enhance the readers' knowledge of the dangers found in the fire service, including the cancer problem, as well the need to document exposures.

In the Studies folder, you will find many studies related to Firefighter Exposures to known contaminants and carcinogens -some of the studies offer recommendations to address the problem.

Order By: [Date] [Name] [Ascending]

Studies

IARC Volume 132 - Occupational Exposures as a Firefighter
05/15/2025 - 17.65MB

In June, 2022, 25 scientists from eight countries met at the International Agency for Research on Cancer (IARC) in Lyon, France, to finalize their evaluation of the carcinogenicity of occupational exposure as a firefighter. This assessment will be published in Volume 132 of the IARC Monographs. This is the complete study report from the IARC

NIOSH Study
03/31/2025 - 0.23MB

Exposure–response relationships for select cancer and non-cancer health outcomes in a cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009). Key words: Lung, Leukemia

Firefighter Cancer Risk Study
03/31/2025 - 0.30MB

Nov 2006 U of Cincinnati LeMasters "Cancer Risk Among Firefighters" Key words: Multiple Myeloma, Non-Hodgkin's Lymphoma, Testicular, Leukemia, Prostate, Skin, Colon, Stomach, Malignant Melanoma, Brain, Rectum

2007 CDC-ATF Uniform contamination study
12/17/2024 - 0.99MB

The National Institute for Occupational Safety and Health (NIOSH) received a management request for a health hazard evaluation (HHE) at the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) in Austin, Texas. The agent submitted the HHE request because of concerns about chemical agents encountered at fire scene investigations contaminating their clothing worn at the scene and possible cross-contamination of personal washing machines and dryers when the garments are taken home for laundering. NIOSH investigators conducted a multi-phased field and laboratory evaluation to investigate any possible contamination of the agents’ uniforms.

Evaluation of CBRN canisters for use by firefighters during overhaul
12/17/2024 - 1.09MB

Air-purifying respirators (APRs) have been proposed to provide an additional respiratory protection option for structural firefighters involved in overhaul operations and wildland firefighters, where particulate and aldehyde exposures have been documented. Previous studies (Anthony et al., 2007) developed test methods to evaluate APR cartridges and canisters for use in overhaul activities, where initial findings indicated that multi-gas cartridges may not be effective. This study evaluated the performance of three chemical, biological, radiological, and nuclear (CBRN) canisters (MSA, 3M, and Scott) and one multi-gas canister similar in appearance to CBRN canisters but without CBRN certification (3M FR-64040).

Firefighters & Thyroid Cancer
12/11/2024 - 3.04MB

Firefighters are exposed to a broad range of chemicals, both in the firehouse and during emergency response. Recent research conducted with live burns has begun to identify and quantify the presence of carcinogens that typically are present on the fire ground. Most alarming are findings that, even when the air appears “clear” there are often ultra-fine respirable particles and gaseous chemicals of several known carcinogens present. Unfortunately, this time period when there is no visible smoke is typically when firefighters remove their personal protective equipment and self-contained breathing apparatus.

Evaluation of a Bladder Cancer Cluster in a Population of Criminal Investigators with the Bureau of Alcohol, Tobacco, Firearms and Explosives
12/11/2024 - 1.30MB

This study evaluated the association of bladder cancer risk and fire scene investigation within a cohort of white male criminal investigators with the United States Bureau of Alcohol, Tobacco, Firearms and Explosives that was found to be at increased risk for bladder cancer.

Evaluation of CBRN Canisters for Use during Overhaul II: In Mask Analyte Sampling with Integrated Dynamic Breathing Machine
12/11/2024 - 2.94MB

According to the National Fire Protection Association there were 487,500 structural fires in the U.S. in 2013. After visible flames are extinguished firefighters begin the overhaul stage where remaining hot spots are identified and further extinguished. During overhaul, significant amount of potentially hazardous chemicals can remain in the ambient environment. Previous research suggests that the use of air purifying respirators fitted with chemical, biological, radiological and nuclear (CBRN) canisters may reduce occupational exposure. This study used large scale burns of representative structural materials to perform side-by-side, filtering and service-life evaluations of commercially available CBRN filters using two head forms fitted with full face respirators and a dynamic breathing machine.

Cardiovascular & Chemical Exposure Risks in Modern Firefighting
12/11/2024 - 22.14MB

Using modern building materials and room contents; employing real firefighters executing commonly employed tactics, techniques, and procedures of entry, search, extinguishment, ventilation and overhaul, this study will enable researchers to truly assess risk. This study is the logical next step in our refinement of what we know, what we think, and what we suspect. It will inform the next steps in research and more importantly, it will help the firefighting profession better protect its most important resource - the firefighter.

DHS - Respiration Protection for Firefighters During Overhaul Operations
12/11/2024 - 0.09MB

Toxic Particulates Place Firefighters at Risk After a structure fire has been suppressed, firefighters carry out salvage and overhaul operations to check for and extinguish any smoldering hot spots, while at the same time trying to minimize damage to the structure and its contents. Early in the overhaul operations while opening walls, ceilings, etc. to check for fire, firefighters wear their self-contained breathing apparatus (SCBA) to protect them from high carbon monoxide (CO) levels. Later on as the firefighters become fatigued, it is common practice for them to remove the SCBA when the CO concentration drops below the 8-hour Occupational Safety and Health Administration permissible exposure level of 35 parts per million.

Air Monitoring Report
12/11/2024 - 1.25MB

A Study on Chemicals found in the Overhaul Phase of Structure Fires using Advanced Portable Air Monitoring available for Chemical Speciation. This study conducted with TVFR and Oregon FMO of the atmosphere immediately after the fire is declared out - what are we breathing during overhaul and methods to reduce exposures

Firefighter Exposure to Smoke Particulates
12/11/2024 - 10.37MB

The potential for firefighters to experience acute and/or chronic respiratory health effects related to exposures during firefighting activities has long been recognized. An additional cardiovascular risk factor that is receiving increasing attention is exposure to respirable particles in the ultrafine range (particles less than 0.1 micron in diameter), which have been detected in smoke. Exposure to these gaseous and particulate agents has been linked to acute and chronic effects resulting in increased fire fighter mortality and morbidity (higher risk of specific cancers and cardiovascular disease).

IARC Monographs 98 - Firefighting Study.pdf
12/11/2024 - 0.80MB

This volume of the IARC Monographs provides evaluations of the carcinogenicity of shiftwork, painting and firefighting. Shiftwork is estimated to involve about 15-20% of the total working population. It is most prevalent among workers in the health care, transportation, communication, leisure and hospitality sectors. Shiftwork involving work at night is the most disruptive for the circadian clock. Painters are potentially exposed to the chemicals found in paint products during their application and removal, and may also be exposed to other workplace hazards, such as asbestos or crystalline silica dust. Firefighters may be exposed at different intensity levels depending on crew assignment, tasks, and/or the time spent at fires. All fires generate a very large number of toxic combustion products, including known, probable or possible carcinogens. An IARC Monographs Working Group reviewed epidemiological evidence, animal bioassays where appropriate, and mechanistic and other relevant data to reach conclusions as to the carcinogenic hazard of these three exposure circumstances to humans.

DOD and IAFF Dermal Exposure Study
12/11/2024 - 1.79MB

RTI conducted an aerosol test that found aerosol particles can penetrate a firefighter’s hood and deposit on the skin. However, RTI did not conduct any research on whether there is a link between the aerosol exposures and cancers. This report discusses a single test of a single hood; as such, the results may not be representative of other hoods or other test conditions.

WA State L&I Study for Presumptive Cancers
12/11/2024 - 0.30MB

Review of the Epidemiologic Studies for the Association between Firefighters and Selected Cancers; Multiple Myeloma, Stomach, Prostate, Testicular, Intestinal - Colon and Rectal Cancers. Washington State Labor and Industries Technical Report Number 74-1-2007 March 2007

NIST Smoke Toxicity
12/11/2024 - 0.86MB

Fire smoke toxicity has been a recurring theme for fire safety professionals for over four decades. There especially continue to be difficulty and controversy in assessing and addressing the contribution of the sublethal effects of smoke in hazard and risk analyses. The Fire Protection Research Foundation (FPRF), the National Institute of Standards and Technology (NIST), and NFPA have begun a private/public fire research initiative, the “International Study of the Sublethal Effects of Fire Smoke on Survival and Health” (SEFS) to provide scientific information on these effects for public policy makers. This report on the first phase of the project estimates the magnitude and impact of sublethal exposures to fire smoke on the U.S. population, provides the best available lethal and incapacitating toxic potency values for the smoke from commercial products, determines the potential for various sizes of fires to produce smoke yields that could result in sublethal health effects, and provides state-of-the-art information on the production of the condensed components of smoke from fires and their evolutionary changes during transport from the fire.

Evaluation of Chemical and Particle Exposures During Vehicle Fire Suppression Training
12/11/2024 - 5.08MB

NIOSH evaluated fire fighter exposures to chemicals and particles during vehicle fire suppression training. We found many different chemicals and high particle concentrations during the fires. According to our measurements, the potential exists for overexposure to formaldehyde, isocyanates, and CO. We recommend that fire fighters wear SCBAs until overhaul is completed. We also recommend that fire fighters stand away from diesel exhaust and park fire apparatus upwind of the fires.

Diesel Emissions in the Fire Station
12/11/2024 - 0.17MB

Firefighters are exposed to diesel emissions from idling fire trucks and generators inside fire stations. Diesel exhaust is a mixture of gases and microscopic solids. Gases include carbon monoxide (CO), carbon dioxide (CO2), hydrocarbons (HC), and nitrogen oxides (NOx), sulfide oxides (SOx). Diesel exhaust causes health problems including pulmonary disease and may be carcinogenic

Training Smoke Machine Evaluation
12/11/2024 - 3.05MB

The Health Hazard Evaluation Program received a request from fire department managers. The request concerned exposures and potential health effects to fire fighter trainers from a mineral oil-based smoke simulant used during training exercises. We evaluated fire fighter trainers’ chemical exposures and health effects during training exercises involving smoke simulant. Trainers could be overexposed to mineral oil mist, diethylene glycol, and thermal decomposition products. Wearing appropriate and fit-tested respiratory protection during training exercises should prevent eye and respiratory irritation and more serious acute respiratory effects.

Journal of environmental monitoring - vehicle fires
12/11/2024 - 0.61MB

Despite the frequent occurrence of vehicle fires, very few studies investigating firefighters’ potential inhalation exposures during vehicle fire suppression have been conducted. In this paper, we present an assessment of firefighters’ health risk from vehicle fire suppression that accounts for the mixture of gases and vapors likely to be found in these fires

Systemic Exposure to PAHs and Benzene in Firefighters Suppressing Controlled Structure Fires
12/11/2024 - 1.02MB

Turnout gear provides protection against dermal exposure to contaminants during firefighting; however, the level of protection is unknown. We explored the dermal contribution to the systemic dose of polycyclic aromatic hydrocarbons (PAHs) and other aromatic hydrocarbons in firefighters during suppression and overhaul of controlled structure burns.

Evaluation of Dermal Exposure to Polycyclic Aromatic Hydrocarbons in Fire Fighters
12/11/2024 - 5.40MB

The 330,000 career fire fighters and 770,000 volunteer fire fighters in the United States [NFPA 2011] are potentially exposed to chemicals during fire suppression and overhaul. These chemicals may exist as vapors, gases, and particles. One group of chemicals, polycyclic aromatic hydrocarbons (PAHs), are products of incomplete combustion that can exist in particle and gas phases

Presentations

The Leaders Toolkit
12/11/2024 - 6.27MB

This presentation is designed to help prepare the fire service officers and leaders when a co-worker is diagnosed with cancer. The most important thing to remember though is that we are here to help navigate through a cancer diagnosis

Healthy in, Healthy Out - Original
12/11/2024 - 7.97MB

To encourage safe and healthy practices from Day 1 to Retirement! Healthy In, Healthy Out! Cancer may never be eliminated, but steps must be taken NOW to reduce the number of fire fighters being diagnosed and dying every year. These Best Practices include: equipment, guidelines, and common sense practices to reduce exposures.

Smoke perceptions, myths, and understandings
12/11/2024 - 2.37MB

Educational Supplement sponsored by the Cyanide Poisoning Treatment Coalition explores the other hazards found in the smoke on the fire ground. “Firefighters need to understand and know that today’s fire smoke is more dangerous then ever.”

Smoke inhalation and Acute Cyanide Poisoning
12/11/2024 - 0.76MB

Developed by Maryland institute for Emergency Medical Services System, Toxins and gases found in smoke from fires

No Smoke, No Fire, No Hazards
12/11/2024 - 1.80MB

Firefighters Perspective on the Hazards of Fire Overhaul and How to Protect Against Them. A Phoenix Fire Department study on post fire contaminants and respiratory protection Dawn Bolstad-Johnson, MPH, CIH, CSP.

Lithium Ion Fires and the need to document exposures
12/11/2024 - 10.06MB

At the 2024 Fire Department Safety Officers Association conference, this presentation showed an example of new hazards faced by firefighters with Lithium Ion Battery Fires and the ongoing need to document exposures in PIIERS.

Policies & Procedures

IC Hot Wash Template
12/11/2024 - 0.26MB

Following the declaration of "all clear" and "fire extinguished", it is recommended that the IC pause operations to transition into the next operational phase, the overhaul and investigative phase. The Hot Wash Template is designed to give the Incident Commander a checklist to use when transitioning into the overhaul phase identifying hazards and allowing the scene to cool and off-gas thereby reducing exposures to known and proven contaminants and carcinogens. Following the risk benefit model, the overhaul phase does not warrant risking the lives of firefighters unnecessarily.

Gross Decontamination Policy
12/11/2024 - 0.13MB

Creating a safer working environment to known carcinogens, Shoreline Fire Department implemented the Gross Decontamination Policy and Procedures

Fireground Carcinogen Exposure Reduction
12/11/2024 - 0.02MB

This policy created by Kirkland Fire Department to provide proactive and reasonable steps to limit employee exposures to the byproducts of combustion and other carcinogens on the fireground.

Command and Safety SOG
12/11/2024 - 0.09MB

This policy implemented by Kittitas Valley Fire and Rescue defines roles and responsibilities of the IC and Safety Officer including decontamination practices with documentation requirements to ensure compliance to best practices.

Personal Protective Equipment SOG
12/11/2024 - 0.20MB

This SOG implemented by Kittitas Valley Fire & Rescue includes procedures for addressing post incident decontamination following best practices defined in Healthy in - Healthy Out

Hood Exchange Directive
12/11/2024 - 0.11MB

Eastside Fire and Rescue implemented a hood exchange program that emphasizes reducing dermal absorption by changing your flash hood when you change your bottle.

NFPA 1500 2018 edition summary
12/11/2024 - 0.26MB

This file contains a summary of the changes made to the 2018 edition of NFPA 1500 as they relate to firefighter cancer reduction efforts.

Fireground Decontamination
12/10/2024 - 0.08MB

Contents of this folder provide model language for Fire Ground Decontamination Procedures.

Handouts and Publications

Fireground Flow Chart - Minimize Exposures
12/17/2024 - 0.26MB

This flow chart is designed to help understand and develop best practices for reducing and minimizing exposures on the fireground.

Incident Command Hotwash Template
12/17/2024 - 0.17MB

Studies have found allowing time after the fire is out for chemicals to dissipate can reduce unnecessary exposure to known carcinogens. This template will help the Incident Commander in a hotwash to address required safety points and buy time for the chemicals to dissipate 8 1/2" x 11" Poster printed on 65lb premium card stock paper.

Morning Briefing - Diesel Exhaust Hazards
12/11/2024 - 0.38MB

This provides the individual to lead a quick 10-minute conversation on diesel exhaust hazards and reenforces the need to utilize diesel exhaust capture systems.

Wash Your Hands
12/11/2024 - 0.13MB

This Quick reminder can be posted around the fire station to remind crews to wash their hands after handling dirty or contaminated equipment or gear.

FCSN Cancer poster
12/11/2024 - 4.53MB

This colorful CANCER Acronym poster is an effective Safety Board reminder of the cancer problem in the fire service

Morning Briefing - Overhaul Protection
12/11/2024 - 0.35MB

This document is intended to guide a quick 10-minute conversation on the importance of wearing all PPE during overhaul and provides the instructor the prompts to insert the departments policy.

Healthy In Healthy Out v2
12/11/2024 - 20.26MB

Healthy In, Healthy Out provides a comprehensive approach to safeguarding your health and well-being. It gives you the knowledge and tools needed to reduce exposure to carcinogens, prevent musculoskeletal injuries, address behavioral health concerns, and optimize overall wellness and nutrition. Printed copies are available for individuals and groups. Email or call the WSCFF office, 360.943.3030, for more information. Download a PDF copy

PIIERS Tri-fold
12/11/2024 - 7.13MB

The WSCFF Cancer Foundation created the Personal Injury and Illness Exposure Reporting System (PIIERS) for you to document your health history throughout your career including work related injuries, illnesses, and exposures. This printable Tri-fold can be used to promote your department membership signing up for PIIERS.

NFR Factsheet - Stand Together
12/11/2024 - 0.90MB

Answer the call. Join your brothers and sisters in a new effort to understand and reduce cancer. JOIN THE NATIONAL FIREFIGHTER REGISTRY (NFR) FOR CANCER This document answers the question how and why every firefighter should register with the National Firefighter Cancer Registry.