Firefighters' Health: Up in Smoke?

Oct. 24, 2007 — -- Former California firefighter Afrack Vargas will never forget his first experience with a wildfire.

"We got to the fire, we were going code 3 -- lights and sirens. We were going very fast," he recalled. "I looked up and saw the top of the mountain was on fire."

"I said, 'I'm sure glad we're down here and not up there,' and my crew foreman said, 'Well, that's where we're going.'"

Many years and countless fires later, Vargas is now a spokesperson for the California State Firefighters' Association, a trade organization that represents more than 24,000 of the state's firefighters.

And he said that while the immediate hazards to the more than 6,000 firefighters working the wildfires in California are obvious, the possibility of long-term damage to the health of these heroes is also a concern.

The health effects from wildfire smoke inhalation are numerous, according to the Centers for Disease Control and Prevention. They run the gamut from irritation of air passages to permanent damage and worsening of pre-existing heart and lung conditions.

And pulmonary experts agree that in light of these potential hazards, firefighters battling the California blazes should take special precautions to protect their lungs.

But in many cases, Vargas said, these precautions are ignored -- which may mean that these firefighters are putting themselves at risk of both short- and long-term health complications.

An Unreasonable Risk?

Dr. Clifford Bassett, vice chair of the American Academy of Allergy, Asthma and Immunology's Public Education Committee, said past evidence from fire rescue operations suggests a special breathing apparatus should be an essential piece of gear for any firefighter exposed to smoky conditions.

"Obviously, first responders need to use specialized respirators to protect against particulate matter in the air," Bassett said. "We had our fires secondary to 9/11 actively smoldering for over three months, and they caused a great deal of lung, nasal and sinus problems as well as 'acid reflux' type symptoms, as well."

Dr. Alan Leff, a pulmonary and critical care medicine specialist at the University of Chicago, agrees.

"Firefighters close to the fire should wear self-contained respirators that seal them off from inhaling smoke," Leff said. "In general, any and all should carry respirators to cover all circumstances."

But Vargas said the gear is largely impractical for use in situations such as the California wildfires, making it unlikely that firefighters will even use the equipment.

"There are very few respirators being used, you just don't have the oxygen supplies to really use a completely contained breathing apparatus," Vargas said. "Perhaps in a structure fire, or vehicle fire, where you can get in and out very quickly.

"The air bottles only last 30 minutes, they're not really designed for wildfires."

Instead, he said, these firefighters normally opt for simple face masks or bandanas to protect themselves from the clouds of choking smoke.

"If you take your shirt right now and cover your nose with it, you have about the same respiratory protection that firefighters do that are directly on the fire line," he said. "No, it's not a lot of protection, but ... you can't fight a fire with a 30-pound air pack, tools, and another 50 pounds of hose and equipment on your back."

Dr. Peter Wagner, past president of the American Thoracic Society and professor of medicine and bioengineering at the University of California, San Diego, said that firefighters' acute smoke exposure may lead to health effects ranging from mild bronchitis to fatal lung inflammation.

Wagner, who himself was forced to evacuate his home earlier this week, added that battling the blazes can also bring underlying heart and lung problems to the forefront.

Of course, firefighters have been battling wildfires for years now, and not all develop long-term health effects. Past studies have shown that as a group, these rescue workers experience accelerated declines in lung function. Leff notes, however, that few new studies have been performed to assess these effects on modern-day firefighters.

"Many of these data are old, when they also smoked, so there is no question that repeated exposure to both acted additively to reduce lung function," Leff explained.

However, while short-term health effects of smoke exposure of this kind are widely understood, data is currently lacking on the long-term health effects on firefighters' exposure to wildfire smoke.

Still, Vargas said he fears the very nature of wildfires could expose firefighters to much more than just smoke from burning trees and brush.

"You see a wildfire, and you might think it's just vegetation, but there are plastics, paints, metals, leads, chemicals that are burning," Vargas said.

In fact, Vargas added, laws in California and some other states make it easier for firefighters with cancer or heart-related conditions to be covered by workers' compensation under the presumption that exposures sustained during their work led to their illnesses.

Protecting Firefighters' Lungs

Solutions to better safeguard firefighters' lungs could be on the way. A newly released study presented Wednesday by the New York City Fire Department at the annual meeting of the American College of Chest Physicians in Chicago suggests that immediate treatment with steroid inhalers may help reduce lung damage in firefighters exposed to hazardous smoke.

The data come straight from research conducted after a different disaster -- the Sept. 11 World Trade Center attacks.

But whether such advances come soon enough to protect the lungs of today's firefighters is still unclear.

"There is technology out there, there are some masks that can help deflect or reject some of the smoke. But those masks are expensive," Vargas said. "Generally the fire services are -- we say -- 20 years behind the times.

"It takes times like these to realize on a mass scale the dangers that firefighters are receiving."