News and Record
GREENSBORO, N.C. — Larry “Butch” Cummings was retired from the Greensboro Fire Department when his 30 years of service caught up with him in the form of multiple myeloma, a cancer that afflicts firefighters at a rate 1.5 times greater than the general population.
On Oct. 11, his family will receive a Medal of Honor from the International Association of Fire Fighters because that union recognizes his cancer as a line-of-duty death. Cummings died in October 2012. He was 59.
Heart attacks are still the leading cause of death among firefighters, but they are being stalked by cancer — a slower, subtle killer that often strikes long after the firefighter has retired.
The agents of those deadly diseases can be found in the smoke swirling all around them, settling on their gear, soaking into their skin.
“We know that our men and women go into immediately dangerous environments,” Greensboro Fire Chief Greg Grayson said. “That’s drilled into our heads from Day One. We anticipate many of those dangers and train on what to do. We anticipate collapses like the one at the Elm Street fire.
“Cancer is one of the unanticipated hazards.”
Fires are equivalent to a hazmat event
The risks firefighters take don’t end when they hang up their helmets. Exposure to chemicals, carcinogens and other contaminants accumulated over a firefighter’s career can cause cancer years later.
They call it dying with your boots off.
In a hospice. In a hospital bed. In your home.
Firefighters get testicular cancer at more than twice the rate of the general population.
Malignant mesothelioma, twice the rate.
Multiple myeloma, 1.53 times the rate.
Non-Hodgkin lymphoma, 1.51 times the rate.
Skin cancer, 1.39 times the rate.
The most recent study by the National Institute for Occupational Safety and Health found that digestive, oral, respiratory and urinary cancers disproportionately affect firefighters compared to the general population. Male firefighters also tend to get bladder and prostate cancers at an earlier age.
It makes sense because firefighters are exposed to far greater varieties of cancer-causing materials, at much greater amounts and with much greater frequency.
“The fires we fight today are not the fires we used to fight, when most things were made of natural fiber,” said Dave Coker, president of the Professional Fire Fighters of Greensboro, IAFF Local 947.
“Now there are all kinds of plastics and chemicals in consumer products. A lot of them are petroleum-based. They produce fires that burn faster and hotter. And the chemicals in those fires are being off-gassed for hours afterward.”
Today’s house fire is equivalent to a hazmat event because of all the plastics and synthetics present in furniture, appliances and other consumer goods, said Jamie Burgess, N.C. director of the Firefighter Cancer Support Network and a firefighter with Fire District 13 in northeast Guilford County.
There’s benzene, found in oils, paint and furniture wax.
Formaldehyde, used in cleaning products and building materials.
Methyl chloride, used in paint removers, metal cleaning and degreasing.
Hydrogen cyanide, used in manufacturing synthetic fibers and plastics.
Add to that the chemicals in flame retardants, which produce toxic fumes when they burn, Burgess said.
“Used to be, we were scared of carbon monoxide,” said Capt. Tim Gibbs of the Greensboro Fire Department. “Now, it’s things like hydrogen cyanide, which can be absorbed through the skin. We’re not in an encapsulated suit. When you fight a fire, your pores open up, you’re sweating and you can draw in these contaminants that are extremely deadly.”
The most permeable skin on the human body is the face, neck and groin. The rate of absorption increases 400 percent for every 5 degree increase in skin temperature, according to research compiled by the Firefighter Cancer Support Network.
For instance, soot filtering through a firefighter’s hood is carried into the suit by sweat and rubbed into the skin while the firefighter is working.
One of the first studies on the subject done in 2006 by the University of Cincinnati found a significantly increased risk among firefighters for cancers including multiple myeloma, non-Hodgkin lymphoma, prostate and testicular cancer.
In 2007, the World Health Organization’s International Agency for Research on Cancer Working Group classified firefighting as “possibly carcinogenic to humans” and called for more research.
And in 2012, the U.S. government extended free monitoring and treatment for 50 forms of cancer to firefighters and other first responders who worked at the sites of the Sept. 11 terrorist attacks. Within a decade after that extreme and prolonged exposure to a fire site, even young men were dying of cancer.
“That was huge because it was the first time the federal government recognized the correlation between firefighting and cancer,” Burgess said.
The link was further strengthened with a 2013 study of 30,000 firefighters by the National Institute for Occupational Safety and Health. The study found higher rates of several types of cancers, and of all cancers combined, than the U.S. population as a whole.
“The NIOSH study confirmed what we knew in our bones,” Coker said. “It became a lot more personal for us in Greensboro with Butch.”
State has ‘failed first responders,’ critics say
Cummings was someone who was always smiling and upbeat, Coker said.
“He always had a Scripture,” said Gibbs, who was his captain in the final years of his career. “And he would take a word and break it down. Like ‘history’ is ‘his story.’?And he would apply that in some way to a situation in life or to Christ.
“He was active as a pastor in his church. The fire department was his job, but that was his calling.”
When Cummings was diagnosed with cancer, the Professional Fire Fighters of Greensboro and his firefighting brothers in the Greensboro Fire Department raised about $15,000 to help with medical expenses.
Currently, to get disability coverage in North Carolina, a firefighter would have to prove he contracted the cancer on a particular day at a particular fire.
“Of course, cancer doesn’t work that way,” Coker said. “It has a cumulative effect over a career of 30 years.”
North Carolina is one of a handful of states that don’t provide presumptive disability coverage for cancers linked to fighting fires.
Presumptive disability automatically qualifies the illness for coverage, but it has a rebuttal clause that allows employers to contest the decision. Without presumptive disability, the burden of proof is on the firefighter to prove that an illness is job-related.
Thirty-three states have presumptive disability laws that recognize certain types of cancers as job related for firefighters.
Thirty-seven states recognize heart disease as a presumptive job disability for firefighters, 32 states recognize lung disease as a presumptive job disability, and 25 recognize certain infectious diseases as presumptive job disability.
North Carolina doesn’t recognize any of these as presumptive job disabilities for firefighters.
A 2013 bill was introduced in the N.C. House that would have recognized hypertension, heart disease, respiratory illness, cancer, hepatitis and HIV as occupational diseases that would be covered by Worker’s Compensation. The bill is still in committee.
Opposition on the national level often comes from groups representing cities and municipalities, such as the National League of Cities. That Washington-based advocacy group said the cost is too high and that there isn’t enough medical evidence to support the link.
“We’re in an occupation where you go to work every morning, and there’s a chance you’re not going to come home the way you left or come home at all,” Coker said.
“We assume we’ll be taken care of, that our employers will do the right thing. But both sides of the aisle in the General Assembly have failed first responders in this state.”
Working toward a change in the firehouse
The Firefighter Cancer Network and the IAFF, which represents two-thirds of Greensboro Fire Department employees, also are working to educate firefighters about cancer risks.
“We need to have a culture change in the firehouse,” Coker said. “There’s still a dirty gear mentality.”
The charred helmet and sooty face was a badge of honor, Burgess said.
That mentality started in fire training, Gibbs said. Thirty years ago, he learned filter breathing in fire school by lying on the floor of the burn house and breathing through his sleeve while tires and upholstery burned inside.
“When I came along, you were considered a wimp if you wore your air pack on every little call,” Gibbs said. “Now, we’ve learned that you need to wear that on every single fire, even a Dumpster fire.”
Groups including the Firefighter Cancer Support Network and the International Myeloma Foundation have issued a slate of safety recommendations to help reduce cancer risks for firefighters.
Personal Protective Equipment, also known as turnout gear, should be cleaned after every working fire.
Firefighters should shower immediately when they return from a fire.
Firehouses should have exhaust removal systems to keep diesel fumes out of the station.
Dirty turnout gear should never be taken home or even transported in a personal vehicle.
Firefighters should get annual medical exams, including cancer screenings.
The Greensboro Fire Department follows all these procedures. Every firehouse has diesel exhaust systems for the trucks. Most firefighters have two sets of turnout gear, so they never have to reuse a dirty one. The department pays for annual medical exams for all personnel by a doctor specializing in occupational health.
A bond approved by Greensboro voters in February funded a $2 million replacement of all SCBAs — the air tanks used by firefighters.
“That’s the No. 1 protection that our people have — using SCBAs and having really reliable ones,” Chief Grayson said. “The No. 2 line of defense is physicals. We provide annual physicals, and that includes blood work.”
Grayson gets a report every year showing the top health needs and problems department-wide. In the Greensboro Fire Department, cardiac problems are still the top health concern, and he used that data to get a grant for exercise equipment.
A harder sell with firefighters is the recommendation by the Firefighter Cancer Support Network that SCBAs should be worn until firefighters roll up the hoses and get back on the truck.
“I know how it is,” Coker said. “You have all your safety equipment on during the fire, but as soon as it’s under control, you’re hot. You’re tired. You just want to get as much equipment off as possible.”
But many synthetic materials continue to emit toxic gasses for hours after a fire. Fire investigators, Grayson noted, have an even higher incidence of cancer than firefighters.
“We’ve got to address that culture shift because it’s our responsibility to advocate with and for our members,” Coker said. “It’s incumbent upon the leadership to work for legislation that is going to protect us and to advocate for culture change in the firehouse that will protect us.”
Federal rules only mandate wearing SCBAs when going inside a burning structure, not during overhaul and salvage, when crews are pulling out furniture and putting out hotspots.
“We’re not at 100 percent on that,” Grayson said. “The awareness is there, but we could always do better.”
Burgess believes fire departments need to develop zero-tolerance policies on all cancer safety procedures, including the removal of SCBAs anytime during a fire operation.
“If there is any leeway, firefighters will take it,” Burgess said.
He knows it will take time, but firefighters have adapted to zero-tolerance policies on other safety issues, such as wearing seat belts in the firetruck.
It starts with education, Burgess said, beginning at the fire academy.
“The State Fire Marshal’s office develops the curriculum, and they are starting to add cancer education,” Burgess said.
Members of the Cancer Support Network like Burgess also visit stations and present cancer prevention programs and literature.
Burgess, 26, has only been on the job for seven years, but he is keenly aware that what he does now can have an impact on his life expectancy when he retires. Or even sooner. He recently met a 27-year-old firefighter with testicular cancer.
And for all of them, there’s the memory of Butch. Coker teared up when he started to talk about him.
“We have the science and we have a human story to tell,” Coker said. “We want to make it part of Butch’s legacy to ... raise awareness of how cancer affects firefighters.”
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