Station 1902

[00:16] Speaker A: I'm your host, Ed Mann, director of training and education at Provident. Our guest today is Alex Mayer from the center for Disease Control, National Institute of Safety and Health, Division of Field Studies and Engineering. I'm sure many of our listeners have heard of NIOSH and instantly think, oh, they're the people who investigate firefighter line of duty deaths through the firefighter investigation and prevention program. I know the mission of NIOSH to support the fire service is much more than that, and I'm sure after listening to this podcast, our listeners will have a much greater appreciation of the work that you do on our behalf. Alex, welcome to the show. Please take a few minutes to tell our listeners about yourself and how you come to work at NIOSh.

[01:06] Speaker B: Yeah, well, I just wanted to start by thanking you for having me here today, Ed. It's a pleasure to be here today to talk about the National Firefighter Registry for Cancer, which I know we'll get into later, and other research at NIOSH that relates to the fire service. As far as how I came to work at NIASH, I went to Ohio State University and obtained a bachelor's degree in health sciences. I then went to the University of Cincinnati for my master's in public health with a primary focus in epidemiology. After that, I worked as an epidemiologist at a local health department here in Cincinnati. And then in 2017, I made the jump to NIOSH. Since I started with NIOSH, I primarily worked in firefighter health and safety research. I've also looked at flame retardant exposure in different occupations, and several of the projects I've worked on have looked at firefighter exposure to carcinogens during fire responses. My main function since 2019 has been the National Firefighter registry for Cancer, or NFR, something I know we'll talk about a little later here.

[02:20] Speaker C: Great.

[02:21] Speaker A: Alex. During my welcome to our listeners, I rattled off a very long name. Please take some time to explain just what the overall mission of NIOSH is as it relates to the fire service, especially the division of field Studies and Engineering.

[02:38] Speaker B: Yeah, it's a great question. So NIOSH's mission is reducing exposures and reducing illness and injury for occupations that includes firefighters. As far as the Division of Field Studies and Engineering, or DFSC, we conduct a lot of research looking at firefighters. One of the most important functions that you touched on earlier that DFSE serves is the firefighter fatality program. The medical side of the firefighter fatality program is housed within, and this is something that, unfortunately, I'm sure many firefighters are aware of, but they do really great work for the fire service. It's a really important function that NIOSH serves. We also have the Health hazard evaluation program, or HHE program, that helps employees, unions, and employers learn whether health hazards are present at their workplace, and they recommend ways to reduce hazards and prevent work related illnesses. We currently have a project in that unit looking at diesel exhaust exposures for firefighters, primarily for this project, we're looking at the diesel exhaust capture systems, a few different systems that are currently available to see which ones work best at reducing diesel exposure. We also have the NFR, which, again, we'll talk about in a few minutes. And lastly, we have several research projects looking at firefighter exposures. So one of the big ones was led by Kenny Fent, and it was a partnership with the Illinois Fire Service Institute, or IFSI, Ul FSRi, and Skidmore College. And these four groups held several studies from 2015 to 2021 looking at firefighter exposures. The first was a modern fire study in 2015, and then the training fire study in 2016, where they looked at different fuel types the next year. In 2017, there was a PPE cleaning project that looked at gross Decon and laundering of gear after the fire. More specifically, we exposed gear to 40 repeated exposures and laundered or gross decons over an entire summer just to see if it impacted the protection factors for the gear. And most recently, in 2021, we had an interface study where we looked at ways of tightening the interfaces and the PPE ensemble to reduce breakthrough. Several of these projects that I've referenced so far have found that chemicals or contaminants readily break through the firefighter PPE ensemble, potentially exposing the firefighter to dermal exposure inside the PPE ensemble. We see this for some of the more volatile chemicals, like benzene. So the thought is that potentially tightening the interfaces or the openings of the PPE ensemble might reduce some of that breakthrough and therefore might reduce some of the firefighter exposures. We've also had a wildland firefighter study where we went out on a wildfire line and captured samples from firefighters. We recently published a manuscript that shares some of those findings. This was led by Dr. Kat Navarro from the Department of Interior. We also have the firefighter Cancer Cohort study, or FFCCS, which is a 30 year project looking at firefighter biomarkers of exposure and biomarkers of effect after fires. This is being led by the University of Arizona and Rutgers. NDRI, NFPA and NIOSH are also heavily involved in this project. Last year, several NIOSH researchers, including myself traveled to Maui to collect biomonitoring samples from firefighters who had responded to the 2023 Maui wildfire. We recently returned notification letters to those participants, of which there were about 300. And we will be writing a final report that we'll be able to share with the fire service and researchers that share some of the high level results and some potential recommendations for the future. And lastly, I'm also leading a project working with FSRI looking at characterizing exposures to electric vehicle fires. We're characterizing several contaminants commonly found on the fireground, similar to what we've done in the past, looking at like polycyclic aromatic hydrocarbons or phs, as well as benzene and other compounds commonly found on the fireground. For those of you that have responded to EV fires, I'm sure you've noticed that there is a different smell present at these fires compared to an internal combustion engine vehicle or ice vehicle. And some of the smells are probably coming from chemicals like hydrogen fluoride or heavy metals. There's been some limited evidence that these chemicals are more abundant during the electric vehicle fires, but we really need to have more data to better understand it. So hopefully this project will be able to answer that question during these fires. We're also collecting some particulate and doing toxicity testing with a partnership through the Environmental Protection Agency or EPA. They've currently done some toxicity testing on particulate collected from wood fire smokes. So we'll have a nice comparison to see the different toxicity present comparing wood fire smoke to ev fires I have.

[08:31] Speaker A: To tell you, and I've said this to the fire service at least 1000 times, I don't think the fire service really knows just how much research is being done from folks like you and FSRI and UL and all the scientific and research communities across the country on behalf of the fire service. And before we move on, I just want you to know that I, as a firefighter, certainly appreciate all the work that the scientific and research community is doing on our behalf. I can't say enough about so, Alex, cancer in the fire services has had the spotlight shined on the issue now for several years, and work continues by the research and scientific communities to have even a greater understanding of the causes and the steps the fire service can take to reduce the risk. Because of the research, Congress passed the Firefighter Cancer Registry act in 2018. This is where I really want to focus our attention for the remainder of the podcast. Alex, please walk our listeners through what the registry is and more importantly, what it's not.

[09:52] Speaker B: Yeah, thanks for that. So, the National Firefighter Registry for Cancer, or NFR, is the largest effort ever undertaken to understand and reduce the risk of cancer among us firefighters. As you mentioned, firefighters are exposed to chemicals on the fireground that could increase their risk of developing cancer. And in fact, in 2022, the International Agency for Research on Cancer, or IARC, classified firefighting as a group, one known carcinogen engine. However, there are still many unanswered questions about how cancer risk may vary across our nation's diverse fire service. So in 2018, Congress passed the Firefighter Cancer Registry act, which directed NIOSH to develop a registry to study cancer among firefighters. The most important thing to note about the registry, at least from my perspective, is you do not have to have cancer in order to register for the NFR. The NFR is open to all U. S. Firefighters, not just those with the previous diagnosis of cancer. In fact, having many types of firefighters join the NFR is crucial to examining relationships between firefighting activities and cancer. NIOSH encourages all firefighters to participate in the NFR, including active, former and retired firefighters, career paid on call and volunteer firefighters, as well as structural wildland fire instructors, fire investigators, and really any other fire service member who served at least one day as A-U-S. Firefighter.

[11:25] Speaker A: So, Alex, please take a couple of minutes and explain just how easy it is to get registered. And I think you touched on the importance already, but let's drive that point home one more time.

[11:39] Speaker C: Sure thing.

[11:40] Speaker B: So firefighters can go to NFR CDC dot Gov to register for the NFR. Registration takes somewhere between 30 to 60 minutes to complete. You start by creating an account through login Gov, and this will ask you to do multifactor authentication, which will enhance the security of the data that you provide. We'll then ask you for your informed consent to participate. This is a voluntary project so no one can force you to join the NFR. You'll then create a user profile, and then you'll go through and complete the NFR questionnaire, which includes a demographic section, a work history section, a health and lifestyle history sections. The work history section is pretty comprehensive, so for those of you that have a long history with the fire service, or if you've worked at multiple fire departments, this may take you a while to complete. However, for firefighters just starting out, they may be able to finish this relatively quickly. So it's a pretty easy process. We've tried to make it as smooth as possible to walk through from beginning to end, and once you're registered, you're in the system. We will send out voluntary follow up questionnaires in the future, which we hope to keep to under ten minutes. But once you're registered, you're in, and we will have enough information to follow you in the future, if, God forbid, you ever do develop cancer, we'll be able to link that information back to the state cancer.

[13:16] Speaker A: And that leads me right into the next question. Alex, explain how the national registry works with the state cancer registries. I get that question all the time. Well, how's the national registry going to.

[13:28] Speaker C: Know that I have cancer?

[13:31] Speaker A: I've been diagnosed with cancer.

[13:33] Speaker B: Yeah, it's a great question, and it seems pretty complicated, but it's actually pretty easy. So anytime someone is diagnosed with cancer in the United States, their healthcare provider submits information about the diagnosis to a state or population based cancer registry. However, these state cancer registries often capture very little, if any, information about occupation. So a firefighter's cancer diagnosis would be captured by the state cancer registry where they live, but they will not be providing detailed information about their occupation. Additionally, if they're a volunteer firefighter, that information will not be available through the cancer registry as that will not be their primary occupation. The NFR will help researchers and the fire service address this knowledge gap. When you sign up for the NFR, you will be asked in the demographics section to provide your name and other identifying information, including the last four of your Social Security number and date of birth. This will allow NIOSH researchers to match the information you provided in the NFR to cancer diagnosis information from state cancer registries. This will make it possible to study the relationship between firefighting and cancer outcomes over time. We also have a bunch of great materials online that talk about this more, including a video that's called about how the NFR works, that I really recommend your listeners watching if they have other questions.

[15:08] Speaker A: So, Alex, a follow up to that. So let's say I haven't registered with the national registry, and I was diagnosed with cancer a year ago, but now I go get registered. Will that linkage take place between the state registry and the national registry at that point?

[15:30] Speaker B: Yes, that's a great question. So we will go back retrospectively and we'll be able to look back in time for any cancer diagnosis that's happened up until the point when we send the request to the state cancer registries. And we also, in the questionnaire, we do capture some information about self reported cancer diagnosis. So the individual, the firefighter, you could provide your cancer diagnosis there as well. But the primary way that we're going to get cancer diagnoses are through this linkage with the state cancer registries.

[16:08] Speaker C: Great Alex.

[16:09] Speaker A: So as we near the end of the podcast, do you have any words of wisdom for our listeners?

[16:17] Speaker B: Yeah, I don't know if it's words of wisdom, but I would just really like to reiterate or encourage all your listeners to enroll in the NFR and tell your friends to do the same. I think this is a really great opportunity to learn more about how firefighting and cancer are related and because of the comprehensive work history section, which I know takes a long time to complete. But we also ask questions about exposure reduction interventions in that work history section. Because of that, we may be able to deliver some good news to the fire service where we'll be able to track and measure whether some of these exposure reduction interventions are actually working and potentially reducing cancer long term. I know, at least from my perspective, I feel like we as researchers focus a lot on the bad news about firefighting, but I think firefighting is a great occupation and I would love if we could actually find some data and some results to share some positive news with the firefighters, letting them know that some of this work that you're doing is having a measurable effect on reducing risk.

[17:27] Speaker C: Great.

[17:28] Speaker A: So Alex, I want to thank you for a very informative podcast. I'm hopeful those listeners who are not registered will get registered with the National Registry. More importantly, I hope the leadership in every fire department in the country will ensure their current and past members get registered to our listeners. You can go to the National Fire registry at NIOsHCDC to get registered. These links will be in the episode notes, so don't get excited about trying to write them down. To get more information about other resources that NIOSH offers to the fire service, you can visit their website at firefighter Resources NIOSH CDC if you have any questions or need additional resources from today or you have an idea for a future webinar or podcast, please email us at info@providentins.com and we'll get back to you as soon as we can. We will be hosting a live webinar on March the 26th at 07:00 p.m. Eastern Standard Time with Alex to show you just how easy it is to get registered to the National Registry. To sign up for that webinar and view our previously recorded webinars, please visit the link in our notes. Lastly, share this podcast with your colleagues. You can send them our description link also found in the episode notes. This is station 19 two signing out for today. Until then, stay safe for your family safe.