In November, the National Institute of Public Safety Health hosted the Public Safety Health Symposium. This year’s focus was on cancer and firefighting.
The presentations were centered on the latest findings related to exposures, health behaviors and prevention, and the findings of the large cancer cohort study recently completed by NIOSH.
Many of the questions to the presenters revolved around what the science says about how to best prevent exposures to carcinogens on the fireground and at the station. Most commonly, the response was that research is ongoing and that we don’t yet know how effective mitigation strategies are or what specific risks firefighters face.
We don’t know how successful individual interventions are — such as keeping gear out of the cab of a truck, using the exhaust extraction to avoid exposure to diesel exhaust, showering after a fire and cleaning gear. Yet, they remain important for reasons beyond preventing cancer.
At one point, I held the naïve assumption that if a firefighter was diagnosed with cancer and worked in a state where the type of cancer they developed was covered by cancer presumption laws, they automatically received the benefits.
According to those who work to get benefits for firefighters, it is rarely that easy.
First, there are states that still do not have cancer presumption in their laws. Second, claims are often difficult to get covered and often involve a lengthy process of submissions and appeals. At a time when firefighters are focused on treatment and healing, the benefit claims often fall by the wayside.
EXPERT ADVICE
Capt. Jennifer Chadwick, the safety division executive officer with the San Antonio (Texas) Fire Department, is responsible for helping firefighters seek coverage for their cancers.
Her work includes compiling the scientific evidence about the relationship between firefighting and the specific type of cancer the firefighter has been diagnosed with to share with their physicians. She also provides resources on exposures that literature has documented are common on the fireground.
In her work, she finds that physicians often are willing to write letters citing the literature on the link between firefighting and cancer — but even with that, initial claims are often denied.
I recently sat down with John and J.R. Boyd, a father and son team of attorneys from Boyd, Kenter, Thomas & Parrish in Independence, Missouri who work to get firefighters coverage for their work-related cancers. They explained what firefighters face even when they live in a state where their cancer is covered.
Often the initial claim is denied and can lead to an appeals process and sometimes litigation where the courts consider the overall past health of the firefighter (including their health behaviors like tobacco use), mitigation, policies and procedures of the department, and exposures the firefighters experienced.
This is why cancer prevention strategies are so important. While it is too late for firefighters who are seeking benefits to avoid getting cancer, whether their cancer will be covered as work-related often depends on whether prevention efforts were followed.
For instance, if the department provided diesel exhaust mitigation, did the firefighters use it consistently? If the department provided the policy and opportunity to clean gear after each fire, is it regular practice of the firefighters to actually follow the policy?
There are stories of firefighters nearly being denied coverage because of a failure of the crews to follow the department’s mitigation procedures. Beyond the importance of preventing cancer, following prevention practices and recommendations is important for those seeking coverage.
Departments also are considered in the equation. Questions focus on whether the department provided adequate resources and protection for their fire fighters given the risks.
Like most things in the fire service, being proactive about cancer prevention is not just about you. It’s about the good of the crew.
It’s about protecting the chances your brothers and sisters will be able to receive benefits if or when they get cancer by doing everything you can to prevent it.
The simple answer to the “does it matter?” question is a resounding, “yes.”
Sara A. Jahnke, Ph.D. is the director of the Center for Fire, Rescue and EMS Health Research at the National Development and Research Institutes. She was the principal investigator on two large-scale, DHS-funded studies of the health and readiness of the U.S. fire service and on a study on the health of women firefighters. She is a co-investigator of several studies focused on fitness, nutrition and health behaviors in firefighters. She completed her doctorate in psychology with a health emphasis at the University of Missouri – Kansas City and the American Heart Associations’ Fellowship on the Epidemiology and Prevention of Cardiovascular Disease. You can reach her at Sara.Jahnke@firerescue1.com