HAZARD OF CHEMICAL SUBSTANCES CONTAMINATION OF PROTECTIVE CLOTHING FOR FIREFIGHTERS - A SURVEY ON USE AND MAINTENANCE
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
ORIGINAL PAPER
International Journal of Occupational Medicine and Environmental Health 2022;35(2):235 – 248
https://doi.org/10.13075/ijomeh.1896.01868
HAZARD OF CHEMICAL SUBSTANCES CONTAMINATION
OF PROTECTIVE CLOTHING FOR FIREFIGHTERS –
A SURVEY ON USE AND MAINTENANCE
SYLWIA MARIA KRZEMIŃSKA1 and MAŁGORZATA SZEWCZYŃSKA2
1
Central Institute for Labour Protection – National Research Institute, Łódź, Poland
Department of Personal Equipment
2
Central Institute for Labour Protection – National Research Institute, Warsaw, Poland
Department of Chemical, Biological and Aerosol Hazards
Abstract
Objectives: The objective of the work was to analyze the impact of selected factors concerning the use and maintenance of firefighters’ protective
clothing worn during rescue operations on the hazard of contamination by chemical substances. Material and Methods: The participants were
firefighters (N = 688) from rescue and firefighting units of the State Fire Service in Poland, aged 60 years, with different
seniority: up to >21 years of service. The survey questionnaire developed by the authors was used. The questionnaire was available online. The Sta-
tistica 10.0 statistical package using the χ2 test was applied in the analysis of the significance of the results. Results: As reported by the vast majority
(>60%) of the firefighters, the maintenance was carried out after recording an average or a high level of contamination. It was pointed out that
removal of the contaminants from protective clothing was difficult (83%). The surfaces of the legs and sleeves of protective clothing were the most
contaminated areas. A feeling of discomfort was observed (90%) after returning from firefighting operations due to fire, smoke, or combustion
residues. Conclusions: It is necessary to conduct training and information actions concerning the use and maintenance of protective clothing and
the harmfulness of chemicals contaminating the garments used by firefighters. Int J Occup Med Environ Health. 2022;35(2):235 – 48
Key words:
questionnaire, firefighters, health hazard, protective clothing, maintenance, chemical contamination
INTRODUCTION
The working environment of firefighters is characterized ever, the work of a firefighter is associated not only with
by the presence of many hazardous factors. It has been the aforementioned hazards. During rescue operations,
widely emphasized that firefighters are exposed to flame, firefighters are exposed to chemicals emitted during
radiant heat, or to contact with hot objects during rescue fires of buildings and in open spaces. These substances
operations. The hazardous factors include hot microcli- are characterized by a harmful effect on the human body.
mate, excessive noise, physical load, oxygen-poor work- Their properties can be toxic, corrosive, flammable, ex-
ing environment, as well as occupational stress. How- plosive or sensitizing. Harmful chemicals that can leave
Funding: this work was supported by the 5th stage of the National Programme “Improvement of safety and working conditions” partly supported in 2021–2022 –
within the scope of state services – by the Ministry of Economic Development, Labour and Technology and by The Central Institute for Labour Protection – National
Research Institute, the Programme’s main co-ordinator (project No. 2.SP.11 entitled “A method of removing contaminants from protective clothing to reduce firefight-
ers’ exposure to harmful chemical agents,” project manager: Sylwia Krzemińska, Ph.D. Eng.).
Received: May 5, 2021. Accepted: September 15, 2021.
Corresponding author: Sylwia Maria Krzemińska, Central Institute for Labour Protection – National Research Institute, Department of Personal Equipment,
Wierzbowa 48, 90-133 Łódź, Poland (e-mail: sykrz@ciop.lodz.pl).
Nofer Institute of Occupational Medicine, Łódź, Poland 235ORIGINAL PAPER S.M. KRZEMIŃSKA AND M. SZEWCZYŃSKA
their traces in the organism are the elements accompany- of personal protective equipment with chemicals. Ac-
ing most rescue and firefighting operations [1,2]. cording to the literature reports, the residues of combus-
In Poland, there are approx. 30 500 firefighters em- tion products are deposited on firefighters’ personal pro-
ployed in 501 units of the State Fire Service and approx. tective equipment, including protective clothing covering
490 000 rescuers in almost 16 000 units of the Volunteer the trunk and the limbs. Not only protective clothing, but
Fire Service, who are exposed to harmful chemicals [3]. also the skin of the hands, neck and back is contaminated
In 2013–2017, there were nearly 134 000 fires in Poland. with chemical substances during the activities performed
Fires of residential houses (21% of total fires), agricultur- by firefighters [8].
al facilities, including crops (25%) and forests (4%) were Protective clothing is necessary for protection against
the most common ones [4]. In Europe, almost 240 000 heat and flames, but also plays a part in preventing dermal
persons were employed as firefighters in the 22 EU exposure to chemicals. The development of more heat-
Member States in 2019 [5]. and fire-resistant clothing made from materials such as
Considering the type and intensity of hazardous factors aramid polymers (eg., Nomex, Kevlar) or polybenzimid-
during firefighting activity, we can distinguish: azole (PBI) may enable firefighting activities to be per-
– basic clothing for firefighters compliant with the EN formed closer to the fire, potentially leading to higher
469:2020 standard [6], risk of exposure to combustion products [9]. It should be
– clothing for special fire-fighting operations compliant taken into account that the clothing designed for the fire-
with the EN 1486:2007 standard [7]. fighter consists of several layers: an outer fabric with non-
Basic protective clothing for firefighters is intended for combustible properties, a membrane protecting against
use in rescue and firefighting operations as well as in di- moisture, an insulating material and lining. As the chem-
saster relief operations. It is made of fabrics, or fabrics icals are deposited on the garments, they can penetrate
with membrane coating. Clothing for special firefighting into the structure of the material and then permeate
operations is used when entering the flame. Most often it through the successive layers of materials [10]. As a con-
is made of aluminized film glass fabric. sequence, that may lead to direct contact of chemical
Protective clothing for firefighters should protect in substances with the skin. The literature of the subject em-
the first place against flame, effects of high temperature phasizes that absorption of harmful chemicals through
and heat. Considering the fact that it is used in different the skin is facilitated due to the increased temperature
conditions it should also provide protection against soak- of the firefighters’ skin during rescue operations [11,12].
ing, cold and poor visibility. The requirements specified Stec et al. [13] assumed dermal absorption to be the main
in EN 469:2020 [6] refer to fabrics and material systems route of exposure. Firefighters can also be exposed
used in firefighter clothing. The garments for firefighters to chemicals from inadequately cleaned protective cloth-
are multi-layered. The outer layer is a fabric with non- ing and equipment [10,14]. Taking into account that
flammable properties. The middle layer is a membrane semi-volatile organic compounds are highly lipophilic,
that protects against water penetration. The inner layer Alexander and Baxter [11] supposed that phthalate dies-
is the lining, most often with a warming layer, closest to ters would be absorbed through the skin easily, especially
the user’s skin. at elevated temperature present at the sites of firefight-
An important issue, increasingly recognized by the fire- ing operations. It is therefore important to take action
fighters’ community, is the contamination of the surface to reduce the level of hazardous chemicals. Baum [15]
236 IJOMEH 2022;35(2)CHEMICAL CONTAMINATION OF FIREFIGHTERS’ CLOTHING ORIGINAL PAPER
conducted research the purpose of which was to deter- der was 2 times higher compared to the forearm skin (p ≤
mine whether the use of Class A compressed air foam can 0.5). Besides the differences in PAH absorption between
reduce the levels of carcinogenic combustion byproducts anatomical sites, it was found that the residual amount
and reduce the risks to the firefighting personnel to create after washing also differed significantly depending on
the rationale for potentially retrofitting the Amboy Fire the anatomical location [18].
Protection district 2 fire engines with a Compressed Air The most dangerous chemical substances are [2,11,19,20]:
Foam System (CAFS). Based on the results of 11 live fire – isocyanates (absorption routes – the respiratory tract,
tests he found that the use of a Class A CAFS reduced the skin, the gastrointestinal tract);
the levels of benzene and formaldehyde as compared to – volatile organic compounds – styrene, benzene, o-xy
water-only application, and that brand B that contained lene, ethylbenzene, heptane, 1-ethyl-3-methylbenzene,
ethyl alcohol in its chemical makeup caused lower-level 3-methylhexane (absorption routes – the respiratory
readings for benzene and formaldehyde when compared tract, the gastrointestinal tract, the skin);
to brand A that contained lauryl alcohol [15]. – polycyclic aromatic hydrocarbons (PAH) – benzo(a)
The removal of contaminants from firefighters’ protec- pyrene, benzo(a)anthracene, benzo(e)pyrene, benzo(b)
tive clothing requires a cleaning process to be performed. fluoranthene, benzo(j)fluoranthene, benzo(k)fluoran-
Inspections carried out in fire brigade units indicate thene, benzo(g,h,i)perylene, chrysene, dibenzo(a,h)
that the maintenance of clothes for firefighters in terms anthracene, fluoranthene, fluoren, phenanthrene, pyr-
of washing frequency, reimpregnation and correctness of eneand indeno(1,2,3-cd)pyrene (absorption routes –
maintenance processes requires more attention [16]. the respiratory tract, the skin);
On the one hand, it is emphasized that inappropriate – phthalates – butyl benzyl phthalate (BBP), di (2-ethyl-
maintenance of clothes for firefighters can lead to a loss hexyl) phthalate (DEHP) (absorption routes: the res-
of their protective properties. Clothing soiled with hydro- piratory tract, the gastrointestinal tract, the skin);
carbons, lubricants, oils reflects much less thermal ra- – inorganic combustion products – CO, CO2, NO (ab-
diation and has a reduced resistance to ignition, making sorption – through the respiratory tract, by inhala-
the firefighter exposed to higher heat levels [17]. On the tion).
other hand, it has been pointed out that a fire may pro- Some of these chemicals are known carcinogens, such
duce a large number of carcinogenic substances, includ- as benzo(a)pyrene and benzo(a)anthracene [21]. Ther-
ing polycyclic aromatic hydrocarbons (PAHs), volatile mal degradation of polymers found in buildings produce
organic compounds, as well as persistent, bioaccumula- volatile organic compounds such as methane, benzene,
tive, and toxic substances. The substances harmful for toluene, in addition to monomers like ethylene, styrene,
the firefighters’ health may get to their organisms mainly phenol, formaldehyde, 1,3-butadiene, phenol, and iso-
by deposition from air (through the respiratory tract, in- prene) [22]. More and more literature reports mention
halation), by oral route or by contact with contaminated that the work of a firefighter is associated with a distant
surfaces like clothing (through the skin) [18]. The study effect of the development of malignant tumors. The most
conducted by Van Rooij et al. [18] showed differences in common ones include melanoma, leukemia, multiple
PAH absorption between anatomical sites. He noted sig- myeloma, cancers of the esophagus, brain and kid-
nificant, but low, regional variation in dermal absorption neys [23,24]. The presumed carcinogens found in the fire-
rate of PAH. The absorption rate at the skin of the shoul- fighting environment include acrolein, benzene, formal-
IJOMEH 2022;35(2) 237ORIGINAL PAPER S.M. KRZEMIŃSKA AND M. SZEWCZYŃSKA
dehyde, perchloroethylene and some polycyclic aromatic Poznań, Białystok, Lublin, Katowice, Opole, Kraków)
hydrocarbons [15]. Multiple studies have identified were asked to participate in the surveys and provide
a range of contaminants in a post-fire environment [25]. the access data to the questionnaire to the interested sub-
Asphyxiants, irritants and carcinogens have been found jects. The survey was anonymous. The survey question-
to be present in concentration levels up to IDLH (Imme- naire is available from the authors of the publication.
diately Dangerous to Life or Health). Each of these chemi- The survey questionnaire contained 13 questions: 10 closed
cals has the potential to cause long-term harm to the re- single choice questions (in 1 case with the opportunity to
spiratory and cardiovascular systems, as well as the skin, provide an individual descriptive response) and 3 multiple
on inhalatory and dermal exposures. The combined effect choice questions. The first 3 closed single choice ques-
of multiple chemicals, at various concentrations, coupled tions were used to characterize the group of respondents
with current individual health conditions is impossible and concerned their age, number of the years of service and
to identify. Benzene, chromium, formaldehyde, and aro- position held. The further 7 questions of the survey con-
matic hydrocarbons are a few of the chemicals that have cerned the indication of the parts of protective clothing
all been found to be present in post-fire environments at that get most contaminated (soiled) during rescue op-
the levels that exceed limits [25]. erations, the knowledge of the maintenance instructions
The objective of the work was to analyze the impact of (washing) of the protective clothing used, the frequency
selected factors concerning the use of firefighters’ protec- of maintenance (washing) of protective clothing, the de-
tive clothing used during rescue operations on the hazard tergents used for washing, the assessment of the removal
of chemical contamination. The survey was aimed at of contaminants from the outer garments after washing.
obtaining data on the maintenance of firefighters’ pro- The remaining 3 questions concerned the perceived com-
tective clothing, taking into account the clothing items fort of use of the garments after the firefighting action
that become the most contaminated, the conditions and was completed and whether it would be advisable to have
frequency of clothing maintenance, the visual assessment a second set of outer protective clothing.
of the removal of contaminants in the washing process,
the feeling of comfort/discomfort associated with the use Participants
of contaminated protective clothing. This pilot survey of The study received widespread interest from the firefight-
firefighters was used to evaluate the habits and trends ers’ community. Approximately 700 respondents took
among firefighters concerning the usage and mainte- part in the survey. Completed questionnaire forms were
nance of protective clothing. received from 688 firefighters employed in the fire and
rescue units of the State Fire Service in Poland. Of the
MATERIAL AND METHODS total number of subjects surveyed:
Questionnaire – 39% (N = 266) were watch/section/crew commanders,
The questionnaire survey was addressed to firefighters – 31% (N = 216) were firemen acting as drivers or equip-
participating in rescue operations. The questionnaire was ment operators,
designed by the authors and available online. After post- – 30% (N = 206) worked as rescue and firefighting per-
ing the questionnaire on the website, the Regional Com- sonnel.
mands of the State Fire Service in Poland in the selected The majority of respondents (around 80%) had had a long
areas of the country (Łódź, Olsztyn, Gdańsk, Toruń, time of service as firefighters (>5 years). The largest group
238 IJOMEH 2022;35(2)CHEMICAL CONTAMINATION OF FIREFIGHTERS’ CLOTHING ORIGINAL PAPER
were firefighters with very long experience within the Table 1. Demographic characteristics of the male group of firefighters
11–20 years range – 42% (N = 286). The demographic char- (N = 688) from the State Fire Service in Poland, March–April 2020
acteristic of these 688 firefighters are listed in Table 1. Participants
Variable
[%]
Statistics Age
The data was compiled using Spreadsheet software (Mi- ≤30 years 33
crosoft Office Excel 2007). The analysis of significance of 31–40 years 44
the results of the responses to the survey was carried out 41–50 years 21
using Statistica v. 10.0 using the χ2 test to assess the rela- >50 years 2
tionship between the distribution of the response rates for Service
one variable versus the other variable. 20 years 13
nificant.
For the calculation of structure indicators, the questions
to which respondents could have given ≥1 answer used luted (hem of the trousers legs, trousers legs at the level
the number of persons (N = 688) surveyed in the denom- of the thighs, lower part of the jacket, hem of the sleeves,
inator. This applies to the questions concerning: sleeves at the level of the arms, jacket zipflap, collar) did
– indication of the most contaminated (soiled) parts of not show significant associations between the variables
protective clothing during the rescue and firefighting tested (p > 0.05) (Table 2). It can therefore be concluded
operation, that the firefighters identified the most contaminated
– frequency of maintenance of protective clothing. clothing elements regardless of their position.
Contamination of the firefighter protective suit during
RESULTS rescue operations necessitates its maintenance. There-
Elements of protective clothing
undergoing the heaviest contamination
Firefighter’s protective clothing element
hem of the trousers legs
Firefighters were found to have noted contamination hem of the sleeves
on various pieces of protective clothing. Figure 1 shows lower part of the jacket
the firemen’s responses identifying the elements most trousers legs at the level of the thighs
likely to be contaminated. The results of the study indi- sleeves at the level of the arms
cate the potentially heaviest contamination of the surface
zipflap of the jacket
of the legs and knees of special firefighter suit trousers,
collar
protecting the lower limbs. As many as 84% of firefighters
others
(575 people) selected that location.
0 20 40 60 80 100
Further statistical analysis of the relationship between Answers [%]
the type of the firefighter’s work (rescuer, rescuer driver/
Figure 1. Firefighter’s protective clothing elements undergoing
operator of special equipment, watch/section/crew com- the heaviest contamination during rescue operations,
mander) and the protective clothing elements most pol- State Fire Service in Poland, March–April 2020
IJOMEH 2022;35(2) 239ORIGINAL PAPER S.M. KRZEMIŃSKA AND M. SZEWCZYŃSKA
Table 2. Results of an analysis of the relationship between the firefighter’s workstation and the types of protective clothing elements most polluted, State
Fire Service in Poland, March–April 2020
Participants
(N = 688)
[n (%)]
Clothing element χ² p
rescuer driver/ watch/section/
rescuer
equipment operator crew commander
(N = 206)
(N = 216) (N = 266 )
Hem of the trousers legs 176 (85) 178 (82) 214 (80) 2.01 0.366
Trousers legs at the level of the thighs 70 (34) 87 (40) 84 (32) 4.11 0.128
Lower part of the jacket 100 (48) 99 (46) 121 (45) 0.49 0.781
Hem of the sleeves 142 (69) 135 (62) 165 (62) 2.82 0.244
Sleeves at the level of the arms 67 (32) 63 (29) 74 (28) 1.27 0.531
Zipflap of the jacket 35 (17) 33 (15) 52 (19) 1.55 0.460
Collar 32 (15) 30 (14) 48 (18) 1.58 0.454
fore, the survey paid considerable attention to the main- The maintenance of protective clothing used during
tenance-related issues. rescue operations – according to the responses given by
More than a half of the respondents (52%, N = 358) ex- firefighters actively involved in rescue and firefighting
pressed the opinion that they were familiar with the main- actions – was most frequently carried out after an aver
tenance instructions for protective clothing. A selective, age (31% of the respondents) or even a high degree
partial knowledge of the maintenance instructions was (30% of the respondents) of pollution was noted
indicated by 40% (N = 275) of the surveyed firefight- (Figure 2). It is noteworthy that the vast majority, as many
ers, which seems to be a fairly large group. It should be as 61% of the respondents, represented such an approach
considered positive that only a small group of the re- to the maintenance of special protective suits. This indi-
spondents – 3% (N = 24) stated that they did not know cates that the occupational exposure of firefighters result-
the exact instructions. Only 5% (N = 31) admitted that ing from the effects of harmful chemicals deposited on
they had not read the maintenance instructions. the surface of protective clothing as well as other types of
A half of the firefighters (N = 345) indicated that the main- personal protective equipment (such as special gloves or
tenance process was carried out in accordance with the in- footwear during rescue operations) is sometimes under-
structions for use, attached to each piece of special fire- estimated.
fighter suit while 29% (N = 199) reported some differences The most desirable action, the maintenance of cloth-
in the maintenance process compared to the instructions. ing after each instance of soiling, was noted only
On the other hand, 16% (N = 111), which is a large group of for 17% of respondents (Figure 2). The responses of
people, were not familiar with maintenance instructions and the survey participants indicate that protective cloth-
a further 5 % (N = 33) admitted that they did not pay atten- ing is more often subjected to cleaning in the case of
tion to them. The above indicates that there is still a need for visible heavy soiling than of less visible small impuri-
periodic training of firefighters on the proper use of protec- ties. The results of the study signal that some firefight-
tive clothing, complying with maintenance requirements. ers using protective clothing are partially aware of
240 IJOMEH 2022;35(2)CHEMICAL CONTAMINATION OF FIREFIGHTERS’ CLOTHING ORIGINAL PAPER
Protective clothing maintenance frequency
the danger. This is indicated by maintenance not after after average soiling 31
each, but after 2–3 rescue operations (11%, N = 77). after heavy soiling 30
It can be concluded that firefighters have a premonition after each soiling 17
and know that clothing used in more actions (eg., 5 or after each operation 11
10) is much more contaminated and can pose a risk. after 2–3 operations 11
Contamination with harmful substances may settle on after 5 operations 4
the body in contact with the skin, or be inhaled. There is >10 operations 7
a need to promote appropriate behavior among firefight- at 3-month intervals 6
ers with respect to the maintenance of protective cloth- at 1-month intervals 5
ing and a need to inform firefighters about the harm- at 2-week intervals 1
fulness of the deposited chemicals. This should increase
no washing at all 1
the frequency of protective clothing maintenance proce-
others 2
dures after its use.
0 10 20 30 40
The survey also obtained responses indicating that pro- Answers [%]
tective clothing was not maintained at all (Figure 2). Such
Figure 2. Frequency of maintenance of protective clothing,
answers were given by 1% of the respondents (N = 7). State Fire Service in Poland, March–April 2020
The reasons for the lack of maintenance of protective
clothing, whether this was due to the lack of technical ca- that they used a powder/liquid intended for home use.
pacity to carry out the maintenance process or the light- Some respondents did not pay attention to the cleaning
heartedness of the respondents, were not given. Account agents used for the maintenance of protective clothing,
should also be taken of the cases where clothing gets se- using any available product (23%, N = 157). It can be
verely damaged or soiled already during the first action concluded that the predominant group of subjects using
and is withdrawn from further use. maintenance products other than those recommended by
A statistically significant relationship (p = 0.008) was found the manufacturer were not informed of the importance of
between the number of years of service and the frequency using the appropriate preparation.
of maintenance of protective clothing used by firefighters Firefighters commenting on the degree of removal of
for the selected response “every 3 months”. It was noted contaminants from outer protective clothing during
that such a response was given more often by firefighters the maintenance process found in the vast majority (83%)
with a seniority of 5–10 years than by other groups. For that it was difficult to eliminate the soiling and that it was
other correlations, there was no significant impact of se- still visible. This may indicate that the garments subject-
niority on maintenance frequency (p = 0.117–0.912). ed to maintenance are too dirty. Oils, fats, tar, soot and
One third of the survey participants (254 subjects) lubricants – according to the responses obtained from
used a product recommended by the manufacturer for firefighters – were the types of dirt considered the most
the maintenance of firefighters’ protective clothing. This difficult to remove from protective clothing (Figure 3).
is good news, as the type of detergent can affect the ef- In total, such answers accounted for 72 % of the responses.
fectiveness of removing contaminants, including harmful Firefighters emphasized that their experience indicated
chemicals, from the garment surfaces. A slightly larger difficulties in removing biological contaminants such
group of the respondents – 40% (N = 277) reported as blood (11%, N = 74) as well as paint and varnish
IJOMEH 2022;35(2) 241ORIGINAL PAPER S.M. KRZEMIŃSKA AND M. SZEWCZYŃSKA
fats, petroleum-derived substances
Protective clothing soiling type
(i.a. oils) 31 of the surveyed firefighters felt uncomfortable. Only 10%
tar 17 (N = 69) of them felt that work did not affect their well-
soot 17 being and very rarely or never felt discomfort caused by
lubricants 15 participating in a firefighting operation.
blood 11 Similarly, a large proportion of the respondents also
fire contamination 8 pointed to a perceptible odor from the dirt deposited
paint, varnish 6 on protective clothing (83%, N = 571), 13% (N = 89) of
stains caused by operational liquids 5 the respondents considered that smell to be of moder-
plastic combustion products 4
ate intensity and only 3% of the respondents (22 people)
fire smoke stains 1
stated that the smell was perceptible to a small extent
only. It should be borne in mind that the perception of
mud 0
smell of the firefighter’s protective clothing may have
others 9
been dependent on the nature of the rescue operation,
no answer 18
the type of burning objects and the duration of the action.
0 10 20 30 40
Answers [%] Nevertheless, almost all firefighters emphasized that they
sensed a smell that could affect the feeling of discomfort
Figure 3. Types of soiling on protective clothing identified by firefighters as
the most difficult to remove, State Fire Service in Poland, March–April 2020 after returning from the operation.
There was no significant correlation between the type of
stains (6%, N = 41). Analysis of the statements shows that cleaning agent (“recommended by the manufacturer of
the vast majority of respondents were aware of the types clothing,” “powder/liquid for household use,” “any agent
of hazardous chemicals involved in rescue operations, in- available,” “I do not care which one”) used for the main-
cluding firefighting. However, it is difficult to determine tenance of special firefighter suits by the surveyed group
whether the respondents were aware of the very harm- of firefighters and their discomfort (“never,” “very rarely,”
ful effects of chemicals deposited on protective clothing. “from time to time,” “often,” “almost always”) after return-
It was not reflected in the frequency of clothing mainte-
nance. Table 3. Impact of participation in the firefighting operation
There was no significant relationship between the length of (effects of fire smoke, combustion residues) on well-being in firefighters
service of firefighters and the visual assessment of the ef- from the State Fire Service in Poland, March–April 2020
fectiveness of maintenance of protective clothing declared Participants
by the respondents (p > 0.05). It was found that seniority Variable (N = 688)
is not a factor that influences the assessment of the degree n %
of removal of impurities from protective clothing. A feeling of discomfort after returning 688 100
from a firefighting operation
Information on the health impact never 17 2.5
very rarely 66 10
of participation in rescue operations
from time to time 179 26
The majority of respondents observed discomfort after
often 230 33.5
returning from firefighting operations due to fire smoke
almost always 196 28
or combustion residues (Table 3). About 90% (N = 619)
242 IJOMEH 2022;35(2)CHEMICAL CONTAMINATION OF FIREFIGHTERS’ CLOTHING ORIGINAL PAPER
ing from rescue operations (p = 0.751). Also, studies of departments. A historical overview of how the exposure-
the correlation between the type of the cleaning agent and modifying factors have changed could add nuanced in-
the sensation of smell from dirt deposited on the outer- formation to exposure metrics for future epidemiological
wear after the firefighting operation (“yes,” “moderate,” studies.
“slight,” “none”) did not confirm significant dependencies According to Jakobsen et al., a significant change con-
(p = 0.390). cerning handling and cleaning of contaminated personal
protective equipment and gear took place around 2010.
DISCUSSION For all except 1 department, there were no set standards
As demonstrated by the survey results, the maintenance for cleaning of turnout gear until 2000. Now, dirty cloth-
of protective clothing for firefighters used in rescue op- ing and gear is washed after each use. So, some changes in
erations was not carried out frequently enough. A vast working conditions with implication for carcinogen ex-
majority of the firefighters (>60%) declared that main- posure were identified there over the years. The routines
tenance was carried out after an average or high degree implemented around 2010 with respect to the handling
of contamination was noted. Only a small group (approx. and cleaning of used gear and protective clothing should
15%) undertook maintenance of the garments after each mark a reduction in exposure to potential carcinogens.
use. Research indicates that only a proportion of firefight- Now, in every department dirty gear is washed after each
ers using protective clothing were aware of the danger use in a contaminated environment. Similar results were
posed by debris deposited on the surface of the garments. found for the transport of used gear. Jakobsen et al. found
They tried to clean the clothes as often as possible, with- it interesting that although there were variations between
out causing the chemicals contained in the stains to pen- different Norwegian fire departments, the overarching
etrate into the deeper layers. This may indicate insuffi- trends in working conditions were similar throughout
cient information among firefighters on the harmfulness the country. He stated, focusing on department-specific
of chemicals contaminating the clothing materials, their work conditions, that a peak risk of carcinogen exposure
carcinogenic and mutagenic properties, often demon- occurred during the 1970s and 1980s.
strated even at low doses. It should be mentioned that Comparing their research results with the results of Ped-
the statements of firefighters indicate that having a spare ersen’s et al. study [26] concerning the working conditions
set of protective clothing would facilitate its mainte- of firefighters in Denmark, Jakobsen observed that there
nance. were differences between fire departments in Norway and
The results of surveys conducted among professional fire- in Denmark. Assignment to chemical clean-ups seems
fighters by Jakobsen et al. [9] indicated positive changes to have occurred earlier in Denmark (early 1970s) than
regarding the working conditions with implication for in Norway (1980s and 1990s). These differences showed
exposure to potential occupational carcinogens in Nor- that working conditions may vary geographically, even
wegian fire departments from 1950 until today. Jakobsen between countries as similar as Denmark and Norway.
et al. described working conditions in Norwegian fire de- In Poland, surveys have shown that there is a gradual
partments from 1950 until today, with special attention improvement in the cleaning of protective clothing. It is
toward work conditions and practices that could influ- visible that the clothing is assigned for cleaning after
ence the exposure to occupational carcinogens. His study a shorter period of use than a few or a dozen years ago.
was based on a survey carried out among Norwegian fire As noted by Kahn et al. [27], the perception of the culture
IJOMEH 2022;35(2) 243ORIGINAL PAPER S.M. KRZEMIŃSKA AND M. SZEWCZYŃSKA
of “toughness” among firefighters is changing. The soiled was not sufficient to remove some substances contami-
firefighter’s protective suit is not always perceived as nating protective clothing. Washing procedure used by
a sign of pride. Kahn et al. conducted a pilot survey Abrard et al. included a hot water washing cycle with
of firefighters in the southeastern region of the United the use of a non-ionic surfactant; a washing phase with
States in order to identify the safety practices, use of pro- a detergent containing surfactants, sequestering agents,
tective gear and injuries. The results of his research indi- additives, and enzymes and finally, a rinsing phase; and
cated that almost 40% of firefighters did not clean their a fluorinated waterproofing treatment.
gear regularly. This presented a considerable long-term He observed a significant deposit of benzo[a]pyrene (BaP)
risk to firefighters due to the carcinogenic nature of many on the outer surface after a single fire training session.
chemicals entrapped in the soiled gear. He noted that BaP concentration of the textile clothing
One of the most important questions was why firefighters sample increased by 44% after the washing procedure
did not use their personal protective clothing properly. Ac- and concluded that some PAHs, in particular the BaP, are
cording to the authors, this was partly due to a culture of probably more difficult to remove than others. BaP is not
“toughness” in which using clean gear was seen as weak- soluble in water. It is possible that the washing procedure
ness. Many firefighters reported a culture in which dirty was not adapted to the physicochemical characteristics of
gear was seen as a sign of pride and clean gear was seen as this contaminant. Also Kirk et al. [10] noted in their stud-
the mark of a new and inexperienced firefighter. The survey ies that the levels of some compounds remained above
showed that older, more experienced firefighters were more pre-exposure levels after washing.
likely to have been burned. So, the rates of gear cleaning Most firefighters observed discomfort (90%) after re-
may be influenced by cultural factors. Kahn et al. conclud- turning from firefighting operations due to fire smoke
ed that the guidelines of maintenance should be developed or combustion residues. It indicates that the firefighters
and promoted for ensuring firefighters’ safety. are aware of the impact of harmful factors present during
Banks et al. [14] observed that the levels of PAHs de- rescue operations on their health. Engelsman et al. [29]
position on Australian firefighters’ skin and protective conducted an interesting analysis of studies of firefight-
equipment were comparable to the data reported in other ers exposed to occupational pollutants. As it follows from
studies on firefighters in Canada, Sweden and the United that analysis, firefighters are exposed to a wide range of
States. toxic chemicals due to fire smoke, potentially exceeding
Recent studies highlight the importance of proper clean- the range of exposure of other occupations. The synergis-
ing of turnout gear since carcinogens can persist and ac- tic and/or antagonistic effects of chemical exposure have
cumulate in clothing, leading to continuous exposure out- not been considered to date. However, the presence of
side of firefighting situations [8,28]. In the survey, the fire- many chemicals that affect firefighters at the same time
fighters stated that it was difficult to remove contaminants can cause more discomfort after the rescue operations
from protective clothing (83%). Very often the contami- have been completed. This is a new issue in the context
nants remained visible, even when using the maintenance of the occupational exposure of firefighters. This is par-
products recommended by the garment manufacturer. ticularly of interest when considering urban firefighters,
This is in line with previous research by Abrard et al. [22]. as they were found to be occupationally exposed to PAHs,
He showed that the use of water wash procedure for per- benzene, per- and polyfluoroalkyl substances (PFASs),
sonal protective equipment (jacket, overtrousers, gloves) metals, flame retardants and pesticides [29].
244 IJOMEH 2022;35(2)CHEMICAL CONTAMINATION OF FIREFIGHTERS’ CLOTHING ORIGINAL PAPER
An important issue is to adjust the size of the protec- PFOA, PFOS, and PFNA) were detected in 100% of par-
tive clothing to the user, which is important in the case ticipants. Women firefighters are exposed to higher levels
of personal protective equipment for women firefight- of some PFAS compared to office workers, suggesting that
ers. The use of PPE dedicated to women firefighters may some of these exposures may be occupationally related.
reduce their contamination and thus reduce exposure to Multivariate models showed that congeners exposure was
chemicals contained in them. higher in firefighters compared to office workers after
As reported by Watkins et al. [30] based on an internation- controlling for age, race and ethnicity, and education.
al survey (840 women firefighters from 14 different coun- The authors of the survey expected that, for family rea-
tries: United Kingdom, Ireland, United States, Canada, sons, longer-term firefighters would pay more attention
Australia, New Zealand, Europe, aged M±SD 40±9 years; to health-promoting behaviors than their younger col-
time as a firefighter M±SD 13±8 years), only 42% of leagues. However, there was no clear correlation be-
women firefighters had the access to female-specific PPE. tween seniority and the frequency of maintenance of
There is a need for education into heat exposure, chemi- protective clothing. The majority of firefighters (61%)
cal substance exposure, gynecological issues and their regardless of their time of service, declared the main-
effects on women firefighters’ fertility and cancer risk. tenance of protective clothing, including the removal
Watkins et al. noted that the number of women firefight- of chemical contaminants, after recording a medium or
ers is increasing worldwide, as a result of many bodies high degree of soiling. Heavy soiling is likely to have oc-
introducing recruitment quotas and targets for women. curred after a period of 3 months of the garment use
Women firefighters are estimated to represent roughly by firefighters with a seniority of 5–10 years, as they
6.3% of firefighters. The authors concluded that there was gave such an answer more often than other age groups.
a lack of research into the association between contami- The obtained results indicate a further need for infor-
nant exposures and breast and ovarian cancers, likely as mation on the importance of maintenance in the re-
a consequence of the reduced population size in compari- moval of residues of harmful chemicals, both among
son to male firefighters, with women previously having young people with short experience and among middle-
been excluded from many cancer risk assessments. aged people with much longer experience in firefight-
One of the scarce biomonitoring studies to measure en- ing. It is noteworthy to link the seniority of firefighters
vironmental chemical exposures to perfluoroalkyl sub- to health-promoting behaviors regarding the frequency
stances (PFAS) among firefighters, including women as of clothing maintenance.
compared to the general population (office workers) was
conducted by Trowbridge et al. [31]. These chemicals have Limitations
been associated with adverse health outcomes including One of the limitations of the presented study is the fact
breast cancer and breast tumor development. Perfluoro- that it was attended by firefighters from several Provincial
alkyl substances are ubiquitous in the environment and Commands of the State Fire Service in Poland in the se-
have been found in dust, food, and humans worldwide. lected areas of the country. Surveying higher numbers
Firefighting foams may be an important source of PFAS of firefighters from other country regions will shed ad-
exposure. The studies by Trowbridge et al. demonstrated ditional light on these issues.
that 7 of 12 PFAS congeners were detected in the least Additionally, this survey is subject to limitation due
70% of the study population, and 4 congeners (PFHxS, to the arbitrary division of firefighters into subgroups
IJOMEH 2022;35(2) 245ORIGINAL PAPER S.M. KRZEMIŃSKA AND M. SZEWCZYŃSKA
with a short duration of service (21 years), which was introduced at the characteristics This may affect the accumulation of harmful substances
of participants. The statistical analyses carried out often in protective clothing.
looked at the relationship between the “length of service” Due to the excessive discomfort felt by the respondents
variable and other variables. A different division into after the use of protective clothing during rescue opera-
subgroups would allow additional statistical analysis that tions, partly as a result of a perceptible unpleasant odor
might obtain new conclusions. from dirt on the outer protective clothing, the need for
Another limitation is that the survey contained 2 questions maintenance immediately after the end of the operation
to which the respondents could have given ≥1 answer. becomes important.
The number of responses was not limited, the respon- The results of the survey indicate that training on the use
dents mostly gave several, averaged 3, responses. In future and maintenance of personal protective equipment, in-
studies, attention should be paid to limiting the answers to cluding the protective outerwear, should be provided
multiple choice questions to a specific number. for firefighters. The training should cover the issues re-
lated to the harmfulness of chemicals that contaminate
CONCLUSIONS the protective clothing used by firefighters.
The majority of the group of firefighters surveyed indi- Further studies are needed in order to achieve a better
cated that the surfaces of the legs and sleeves of the spe- knowledge of individual firefighters’ exposure. It will also
cial firefighter suit are soiled most heavily in the condi- be necessary to find a maintenance procedure that sig-
tions of rescue operations. Therefore, the aforementioned nificantly reduces the chemical substance load.
clothing items should be used as samples in the testing of There is an evident need to promote appropriate behav-
harmful chemicals content. iors among firefighters with respect to the maintenance
Contamination of a firefighter’s protective clothing during of protective clothing and a need to inform firefighters
rescue operations necessitates cleaning during the main- about the harmfulness of the chemicals deposited on
tenance process. Most firefighters indicated the knowl- the PPE.
edge of the maintenance process instructions. However,
it is difficult to determine its frequency. The study has ACKNOWLEDGMENTS
shown that a small proportion of firefighters try to clean The authors would like to thank firefighters from the Rescue
their clothing as often as possible to prevent accumula- and Firefighting Units of the State Fire Service in Poland for
tion of a lot of dirt resulting in harmful chemicals con- the work they have done completing the questionnaire. Thanks
tacting the user’s skin and penetrating into the deeper to the Municipal Command of the State Fire Service in Łódź,
layers of the garment. This may indicate that only a part Poland for assistance in developing the questionnaire.
of the firefighters’ community is fully aware of the dan-
gers posed by contamination of clothing surfaces with REFERENCES
harmful substances, including carcinogenic chemicals. 1. Antoniak P. Zagrożenie chorobami nowotworowymi strażaków
The survey confirmed that very often firefighters’ protec- w akcjach ratowniczych. Zesz Nauk WSZOP. 2019;1(15):19–42,
tive clothing is assigned for maintenance when it is too https://doi.org/10.32039/WSZOP/1895-3794-2019-02. Polish.
246 IJOMEH 2022;35(2)CHEMICAL CONTAMINATION OF FIREFIGHTERS’ CLOTHING ORIGINAL PAPER
2. Krzemińska S, Szewczyńska M. Analysis and assessment of increased health risks in firefighters. J Occup Environ Hyg.
hazards caused by chemicals contaminating selected items 2014;11(5):D43-8, https://doi.org/10.1080/15459624.2013.
of firefighter personal protective equipment: Literature re- 877142.
view. Saf Fire Technol. 2020;56(2):92–109, https://doi.org/ 12. Stec A, Wolffe T, Clinton A. Minimising firefighters’ expo-
10.12845/sft.56.2.2020.6. sure to toxic fire effluents. Interim Best Practice Report.
3. National Headquarters of the State Fire Service [Internet]. University of Central Lancashire; Fire Brigades Union
Warsaw: The Organization; 2020 [cited 2020 April 24]. Sta- (FBU); 2020.
tistic data. Available from: https://www.gov.pl/web/kgpsp. 13. Stec AA, Dickens KE, Salden M, Hewitt FE, Watts DP,
4. Janik P. How many fires, what losses (Part 1). Fire Rev. 2018; Houldsworth PE, et al. Occupational exposure to polycyclic
4:36–9. Polish. aromatic hydrocarbons and elevated cancer incidence in
5. European Commission [Internet]. 2020 [cited 2020 April 24]. firefighters. Sci Rep. 2018;8:2476, https://doi.org/10.1038/
Firefighters and fire-protection in the EU. Available from: s41598-018-20616-6.
https://ec.europa.eu/eurostat/web/products-eurostat-news/ 14. Banks APW, Thai P, Engelsman M, Wang X, Osorio AF,
product/-/asset_publisher/VWJkHuaYvLIN/content/EDN- Mueller JF. Characterizing the exposure of Australian
20200504-1/pop_up. firefighters to polycyclic aromatic hydrocarbons gener-
6. EN 469:2020 Protective clothing for firefighters – Perfor- ated in simulated compartment fires. Int J Hyg Environ
mance requirements for protective clothing for firefighting Health. 2021;231:113637, https://doi.org/10.1016/j.ijheh.
activities. 2020.113637.
7. EN 1486:2007 Protective clothing for fire-fighters – Test 15. Baum G. Potential reduction of firefighter exposure to car-
methods and requirements for reflective clothing for spe- bon-based carcinogens in structure fires through the use of
cialised fire-fighting. class a compressed air foam systems [Internet]. Available
8. Fent KW, Alexander B, Roberts J, Robertson S, Toennis C, from: https://www.hsdl.org/?view&did=804449 [cited 2021
Sammons D, et al. Contamination of firefighter personal pro- July 18].
tective equipment and skin and the effectiveness of decontam- 16. Węsierski T, Gałązkowski R, Zboina J. Rescue operations
ination procedures. J Occup Environ Hyg. 2017;14(10):801- in the case of chemical hazards. Saf Fire Tech. 2013;29(1):
14, https://doi.org/10.1080/15459624.2017.1334904. 19–27. Polish.
9. Jakobsen J, Babigumira R, Danielsen M, Grimsrud TK, Ol- 17. Stull JO. Evaluation of the cleaning effectiveness and impact
sen R, Rosting C, et al. Work conditions and practices in of esporta and industrial cleaning techniques on firefighter
Norwegian fire departments from 1950 until today. A sur- protective clothing. Tech Rep, Int Personnel Prot, Inc.; 2006.
vey on factors potentially influencing carcinogen exposure. 18. Van Rooij JGM, De Roos JHC, Bodelier‐Bade MM, Jonge-
Saf Health Work. 2020;11:509-16, https://doi.org/10.1016/j. neelen FJ. Absorption of polycyclic aromatic hydrocarbons
shaw.2020.07.004. through human skin: Differences between anatomical sites
10. Kirk KM, Logan MB. Firefighting instructors’ exposures and individuals. J Toxicol Environ Health. 1993;38(4):
to polycyclic aromatic hydrocarbons during live fire train- 355–68, https://doi.org/10.1080/15287399309531724.
ing scenarios. J Occup Environ Hyg. 2015;12(4):227–34, 19. Sawicki T. [Factors threatening the safety of firefighters un-
https://doi.org/10.1080/15459624.2014.955184. der fire conditions]. Bezp Pracy. 2004;7-8:35-8. Polish.
11. Alexander BM, Baxter CS. Plasticizer contamination of fire- 20. Łukawski AS. [Volatile organic compounds in ambient
fighter personal protective clothing – a potential factor in air of firefighting and rescue unit, evaluation of the vocs
IJOMEH 2022;35(2) 247ORIGINAL PAPER S.M. KRZEMIŃSKA AND M. SZEWCZYŃSKA
emission sources and potential negative health effects for community.fireengineering.com/profiles/blog/show?id=12
firefighters]. Zesz Nauk SGSP. 2019;70(2):21–44. Polish. 19672%3ABlogPost%3A64464.
21. Word Health Organization International Agency for Re- 26. Pedersen JE, Petersen KU, Hansen J. Historical changes in
search on Cancer [Internet]. Lyon: IARC Press: 2010 [cited chemical exposures encountered by Danish firefighters.
2021 April 15]. IARC monographs on the evaluation of car- Scand J Work Environ Health. 2019;45(3):248–55.
cinogenic risks to humans. Vol. 92. Some non-heterocyclic 27. Kahn SA, Leonard C, Lee YG, Boatwright R, Flamm T,
polycyclic aromatic hydrocarbons and some related expo- Woods J. A pilot survey of Southeastern firefighters: Safety
sures. Available from: https://publications.iarc.fr/Book- practices, use of protective gear, and injury. Burns. 2020;
And-Report-Series/Iarc-Monographs-On-The-Identifica- 46(2):298–302, https://doi.org/10.1016/j.burns.2019.03.012.
tion-Of-Carcinogenic-Hazards-To-Humans/Some-Non- 28. Fent KW, Toennis Ch, Sammons D, Robertson S, Bertke S,
heterocyclic-Polycyclic-Aromatic-Hydrocarbons-And- Calafat AM, et al. Firefighters’ and instructors’ absorption
Some-Related-Exposures-2010. of PAHs and benzene during training exercises. Int J Hyg
22. Abrard S, Bertrand M, De Valence T, Schaupp T. French Environ Health. 2019;222(7):991–1000, https://doi.org/10.
firefighters exposure to Benzo[a]pyrene after simulated 1016/j.ijheh.2019.06.006.
structure fires. Int J Hyg Environ Health. 2019;222(1):84–8, 29. Engelsman M, Toms LML, Banks APW, Wang X, Muel-
https://doi.org/10.1016/j.ijheh.2018.08.010. ler JF. Biomonitoring in firefighters for volatile organic
23. Tsai RJ, Luckhaupt SE, Schumacher P, Cress RD, Deap- compounds, semivolatile organic compounds, persistent
en DM, Calvert GM. Risk of cancer among firefighters in organic pollutants, and metals: A systematic review. Envi-
California, 1988–2007. Am J Ind Med. 2015;58(7):715–29, ron Res. 2020;188:109562, https://doi.org/10.1016/j.envres.
https://doi.org/10.1002/ajim.22466. 2020.109562.
24. Przegląd Pożarniczy [Internet]. Warszawa: Komendant 30. Watkins ER, Walker A, Mol E, Jahnke S, Richardson AJ.
Główny Państwowej Straży Pożarnej; 2014 [cited 2021 July Women Firefighters’ Health and Well-Being: An Interna-
14]. Kokot-Góra Sz, Porowski R, Słupik D. [Cancer preven- tional Survey. Women’s Health Issues. 2019;29(5):424–31,
tion (part 1)]. Available from: https://www.ppoz.pl/index. https://doi.org/10.1016/j.whi.2019.02.003.
php/zajrzyj-do-srodka/rozmaitosci/1956-zapobieganie- 31. Trowbridge J, Gerona RR, Lin T, Rudel RA, Bessonneau V,
nowotworom-cz-1. Polish. Buren H, et al. Exposure to perfluoroalkyl substances in
25. Fire Engineering [Internet]. Tulsa: Clarion Events; 2019 a cohort of women firefighters and office workers in San
[cited 2021 July 18]. Benson G, De Carlo CM. Use of Francisco. Environ. Sci. Technol. 2020;54:3363–74, https://
SCBA in Post Fire Environments. Available from: https:// doi.org/10.1021/acs.est.9b05490.
This work is available in Open Access model and licensed under a Creative Commons Attribution-NonCommercial 3.0 Poland License – http://creativecommons.org/
licenses/by-nc/3.0/pl/deed.en.
248 IJOMEH 2022;35(2)You can also read
