Reducing firefighter cancer risk, the Swedish way

As the late-Chief Alan Brunacini once said – and as I too observed in the early stage of my career – “Firefighters hate two things: change and the way things are.”

Now I know that’s a generalization, as there are many fire departments that have a long history of being on the cutting edge of change. However, I still see a reluctance by too many departments here in the U.S. to seek out more progressive ways to be safe, effective and efficient. It’s time that the American fire service look beyond our borders to see how fire departments in other countries approach problems like our own.

In this article, let’s review how firefighters in Sweden are addressing the firefighter cancer risk from exposure to the chemicals, chemical compounds and carcinogens found in modern structural firefighting.

THE SKELLEFTEÅ MODEL: WHERE IT ALL BEGAN

Stefan Magnusson is the principal Health and Safety Representative for the Skellefteå Fire and Rescue Service in Sweden. He also co-founded Healthy Firefighters, a collaborative project among fire service agencies, employers and unions. Now adopted as the standard in 17 European countries, the Healthy Firefighters project provides decontamination protocols that can improve firefighters’ health and well-being.

Magnusson and his collaborators use a unique approach to mitigate firefighter health risks from exposures during structural firefighting. A critical part of this work was the launch of the Skellefteå Model to improve firefighters’ work environment.

In the book “Healthy firefighters – the Skellefteå Model improves the work environment,” authors Magnusson and David Hultman, write: “It should be a given that firefighters themselves are able to act on the extent of their exposure. Firefighters should be able to start their shift in full, clean protective clothing and be able to protect their airways and skin in all situations. There should also be the facility of the cleaning of protective clothing and other equipment by machine every time they have been contaminated. Routines that separate contaminated from clean when transporting and when handling at the fire station are also essential.”

The Skellefteå Model builds upon that powerful with three important factors that together reduce a firefighter’s level of exposure to seen and unseen harmful substances:

1. All personnel in the organization receive the knowledge and insight required to reduce the incidence of contamination;
2. Simple, clear routines and flows are used to minimize the number of instances in which firefighters are subjected to foreign substances; and
3. The organization provides the necessary tools for personnel to carry out those operational routines.

Image/Courtesy of Healthy Firefighters Project

The bottom of the pyramid serves as the foundation, highlighting the importance of providing firefighters with the knowledge about the risks and what can be done to reduce those risks. The middle tier emphasizes the need for the organization to provide the policy, procedures and processes necessary for a firefighter’s work behaviors to be congruent with the knowledge they’ve attained. And finally, the tip is the need for the organization to provide the necessary tools and equipment for a firefighter’s behaviors to be consistent with the two lower layers.

DRY INITIAL CONTAMINANT REDUCTION

A unique part of the Skellefteå Model is its focus on dry initial contaminant reduction at the fire scene as opposed to the more commonly used wet initial contamination reduction favored by most fire departments in the US.

The focus of wet contaminant reduction is to minimize the spread of contaminants beyond the firefighters’ PPE (e.g., other firefighters, contaminated water used for decon). The Skellefteå Model instead focuses on getting the contaminated gear off the firefighter and into a secure, airtight storage bag as quickly as possible after the firefighter exits the hazard area. By doing so, they keep the absorbed contaminants isolated within the PPE, and they don’t create any secondary hazard (e.g., contaminated water) that must be managed.

Here’s how it works: The firefighter removes their PPE and places it in the airtight storage bag in reverse order to which a firefighter typically dons their PPE: gloves, helmet, SCBA facepiece, jacket, pants and boots.

Firefighters are required to have a replacement set of uniform clothing on the fire apparatus so that immediately after doffing their contaminated PPE, they can change into clean clothing. Their contaminated clothing is then placed in the same airtight storage bag that already contains their PPE.

The air-tight storage bag travels with the firefighter on the fire apparatus in the crew compartment back to the station. In this way, should the fire company receive another call before they arrive at the fire station, the firefighter can dismount the fire apparatus and don their PPE again in the proper order.

Should this occur, the firefighter is not donning gear that’s been soaked as it would be following wet initial contamination reduction. This makes donning their PPE easier and reduces the potential for steam burns should the firefighter subsequently engage in interior structural fire suppression operations.

Back at the fire station, firefighters first get their second set of PPE out of storage and place it with their fire apparatus in preparation for the next alarm.

Next, all firefighters shower and don another clean uniform or change of clothing. Only after this has been completed do firefighters begin the next phase of operations: cleaning PPE and equipment and getting the fire apparatus and all its equipment ready for response. Figure 2 provides an overview of the workflow and processes:

Image/Courtesy of Healthy Firefighters Project

Following fire suppression operations, the apparatus, equipment and personnel are considered contaminated, and defined processes are used to isolate and contain individual items for transport back to the station.

Once back at the station, defined processes must be used to keep contaminated equipment and PPE isolated in a designated “hot zone” within the station until they can be cleaned and decontaminated.

But as previously described, this part of the workflow is suspended until all personnel have showered and changed into clean clothes, and have donned the appropriate PPE for the cleaning and decontamination phase of the workflow.

The workflow cycle is complete when all fire apparatus, equipment and PPE has been cleaned and decontaminated and properly stowed for the next emergency response.

TIP OF THE SWEDISH ICEBERG

This is just the tip of the iceberg when it comes to the great work of the Healthy Firefighters project and the Skellefteå Model. The Model addresses several steps in the process toward a healthier and smarter use of PPE. I encourage you to download the book “Healthy firefighters – the Skellefteå Model improves the work environment” to review so you can determine how your department can implement similar health-focuses processes.