PPE & Duty of Care Forum - condensed

Published:  23 February, 2016

Delegates attending the highly successful PPE & Duty of Care Forum held in Birmingham in February experienced the complexities surrounding the evolving process of ensuring that firefighters remain safe not only today but also throughout their lives. Highlights by Jose Sanchez de Muniain.

Following the recent publication of a number of scientific papers linking firefighters to a higher incidence in cancers it seemed appropriate for the Forum to begin by addressing this issue head on.

The long latency characteristics of cancer means that exposure to cancer-causing substances could take 20, 30, 40 years or longer to result in cancer, explained Chris Barber, Deputy Chief Medical Officer at the Health and Safety Laboratory and Respiratory Consultant, Sheffield Teaching Hospitals. ‘So if we find an association now, is it really relevant to now or is it related to how people used to work 50 years ago? Because if it is, we’re maybe less interested in it and there may be no point in modifying how we’re working now.’

Part of the World Health Organization, the International Agency for Research on Cancer (IARC) coordinates and conducts both epidemiological and laboratory research into the causes of human cancer. It lists over 40 possible carcinogens in firefighting and in 2010 analysed 42 studies looking at firefighting cancer risk. ‘Their meta-analysis came out with only three cancers that they thought had enough evidence to support an excess cancer risk. These were testicular, prostate and non-Hodgkin lymphoma.’

However, in its conclusion, the IARC also said that due to the different study designs the overall evidence was very limited. They concluded that there is limited evidence in humans for the carcinogenicity of occupational exposure from firefighting.

Since 2010 two large studies have been published, including one for over 16,000 firefighters in five Nordic countries (Pukkala, OEM 2014). This study found a small excess of cancer overall, with a significant excess of prostate cancer, but only in younger age groups. ‘The more times you split down your analyses, and the more analyses you look at, the more likely you are to find chance associations’. In contrast to the IARC, this study found no excess of non-Hodgkin lymphoma, and a reduced risk of testicular cancer. The Nordic report did however find significant excess of myeloma, mesothelioma, skin and lung cancer in people over 70 – cancers not identified in the original IARC review. ‘The Nordic study didn’t find any excess of lymphoma but it found, actually, a reduced risk of testicular cancer. So how on earth can we interpret these studies when they’re all showing different things?’

Complicating the picture further, an even bigger study of US firefighters (Daniels, OEM 2014) demonstrated an overall mortality identical to the rest of the US population. It showed [in firefighters] nevertheless an increase in lung, oesophageal cancer, colorectal and kidney cancer – none of which were, again, highlighted in the original IARC meta- analysis: ‘And there was no excess mortality whatsoever in the three cancers identified by the IARC - prostate, testicular and non-Hodgkin lymphoma.’

Summarising, Dr Barber emphasised that although firefighters have the potential for exposures to a range of well-established carcinogens,  it has been difficult to establish a link between particular types of cancer and firefighting, despite numerous research studies. ‘Any cancers now relate to historical exposures, to how people did firefighting many years ago which, I suspect, is quite different to how people are doing it now.

‘There are very well established cancer risk factors which are relevant to all of us and will be just as important for firefighters. This includes things like smoking, too much sunlight from outdoor work, poor diet, obesity and alcohol,’ he concluded.

It is common for the Health and Safety Laboratory to be brought into fatal firefighter investigations to determine whether the PPE used was adequate or used correctly and Nick Baxter of the HSL’s engineering and personal safety unit presented some common factors.

The HSL attempts to recreate the conditions at the time of an incident and Baxter remarked that, generally speaking, the PPE that came across his path was not only adequate and conforming to all the relevant codes and standards, but showed that it was well maintained and professionally repaired.

Reports of gloves shrinking and melting onto hands were relatively common and the HSL had carried out extensive testing on gloves and their components. Any failures were not due to garment defects: ‘People tend to have their own favourite pair of gloves so they probably don’t’ replace them as often as they should do… fire hoods are similar in that regard, people tend to have their own favourite hood they don’t’ want to get rid of.’

Some cases have involved retained firefighters wearing unsuitable undergarments, such as acrylic jumpers: ‘We’ve also had many incidences of denim worn underneath, which isn’t such a huge problem but when denim does start to burn it will keep on burning very slowly. You might not think that it’s actually burning but in reality it is.’

Baxter remarked that modern PPE was so protective that wearers were remaining in hotter environments for longer periods than they should, which lead to a higher thermal burden. ‘Simply put, if the heat gained by the wearer exceeds the heat that is lost naturally by the body, then the consequences will be heat stress and, ultimately, death. This question becomes more pertinent for firefighting clothing, which is designed to provide thermal insulation, and which reduces the ability of the wearer to lose heat. This effect is greater in hot and humid environments, where in a worst-case scenario the heat and moisture can actually penetrate the clothing and make the wearer hotter.’

Research in the breathing rates of firefighters wearing full BA has shown that they can peak at around 140 litres a minute. ‘Unfortunately all this research was carried out in ambient conditions but, if you’re increasing the ambient conditions to extreme temperatures, then this is only going to increase. We have seen data from telemetry from breathing apparatus, from actual incidents, indicating that breathing rates can go above 140 litres a minute. Obviously these types of breathing rates cannot be sustained for any period of time, and only for a few minutes before exhaustion kicks in.’

Dr Roger Klein of Cambridge (UK) and Christian Regenhard Center for Emergency Response Studies, John Jay College of Criminal Justice, CUNY, New York provided an insightful presentation on the history and latest developments regarding PPE and fluorochemicals in the fire service.

Around three quarters of all global fluorotelomer production is used for treating textiles and paper in order to give water and oil repellent coatings. However, concern over the potential environmental impact of fluorochemicals has grown since the announcement in May 2000 that 3M would be phasing out PFOS-based production involving Lightwater and ATC foams as well as Scotchgard protective coatings.

Modern emergency services’ PPE makes extensive use of fluorotelomer-treated fabrics for protection against both polar, i.e., water and alcohols, and non-polar, i.e., hydrocarbons, oils and greases, contaminants. The commonly used fluorotelomer acrylate and methacrylate polymers have been characterised traditionally by predominantly C8, C10, and C12 chain lengths, in order to get the required performance and durability of finish.

However, increasing concern by regulatory authorities over the environmental and human health impact of releasing PFOA – and longer chain perfluorocarboxylic acids (PFCAs) –to the environment based on unacceptable PBT (persistent, bio-accumulative, toxic) profiling has led first to the voluntary PFOA Stewardship Program 2010/2015 by the US Environment Protection Agency and, more recently, to the European Chemical Agency (ECHA) PFOA Restriction Proposal initiated by the German and Norwegian governments.

The ECHA PFOA Restriction Proposal sets out to limit free PFOA to 25 parts per billion and PFOA precursors to 1,000ppb (or 1ppm) in all manufactured articles. This is a modification to the original overly strict limit of 2ppb for both free PFOA and PFOA precursors which followed an industry-wide consultation.

In order to give industry time to develop alternative technologies, however, there are specific time-limited derogations for firefighting foam of 1ppm for both PFOA and PFOA precursors, and for protective clothing used by the emergency services, police and military.

The situation is particularly acute for all-weather clothing and hazardous materials PPE since these applications have relied on using fluorotelomer polymers especially rich in C8, C10 and C12 fluorotelomer chains. All C8 fluorotelomer derivatives are known to breakdown to PFOA in the environment. By analogy, C10 and C12 fluorotelomers will yield perfluoro-n-decanoic acid and perfluorododecanoic acid, both of which are more toxic and bioaccumulative than PFOA. All PFCAs are highly environmentally persistent.

Since the introduction of the PFOA Stewardship Program industry has switched to fluorotelomer derivatives using so-called pure C6 compounds. Unfortunately even the very best of these are still contaminated with significant levels of C8 derivatives (and possibly C10, C12…) in terms of achieving the very low levels of PFOA precursors required by the ECHA Restriction Proposal, although free PFOA levels have been drastically reduced. Moreover, switching to pure C6 fluorotelomer derivatives has highlighted problems of achieving functional efficiency, especially in terms of the required levels of oil and water repellency, durability, and maintenance costs.

The PPE industry is thus left with the pressing problem of developing an alternative to fluorochemical treatment that retains functionality and durability.

Product development engineer Pavla Krizman Lavric at Tencate Protective Fabrics concentrated on the importance of the outer shell as the first line of defence as well as the impact that the transition in chemistry from C8 chemicals to C6 chemicals will have on the protection level given by the gear when it comes to protection against splashes of oil, water and chemicals.

These substances are found in AFFF surfactants in firefighting foams, wetting agents as well as textile finishes on the outer shell of firefighters’ protective clothing.

This shell not only provides resistance to mechanical effects such as abrasion, rips, cuts and tears but also provides water, oil and chemical protection via a chemical film on the fibres’ surface. This film prevents droplets from penetrating the fabric whilst allowing moisture vapour and air to transfer through.

Fluorocarbon finishes are currently used because the alternatives do not provide the water and oil repellence required by EN469, the European standard for firefighting protective clothing. These finishes are durable but do not last the lifetime of the garment. In fact, their performance reduces with every wash. The only way to reactivate their properties is to treat the garment with heat and eventually the finish needs to be reapplied.

Krizman outlined the complexity and the many challenges presented by current spray and liquid chemical resistance testing required to meet EN469. A whole load of factors influences the results, ranging from the pre-test wash treatment, the tightness of the weave of the fabric, the smoothness of the fabric and the type of fibres being tested.

Industry is currently working to meet these stringent tests using C6 chemicals rather than C8 chemicals, but research so far has shown that the only way of reaching similar levels of performance without C8 is to use more concentrated chemicals or in larger volumes, which in the future could create a new environmental issue. ‘The performance goes down as the chain size of fluorocarbon goes down from C8 to C6.’

While the expectations are that these challenges will be met, many misconceptions remain. First is that the life of the fluorocarbon finish determines the life of PPE clothing. This is not the case. Proper care and maintenance and timely reapplication will result in optimal finish performance during the lifetime of a garment. The only way to ensure the performance of a garment is to have a good track-and-trace system in place, by working with laundries with the experience of treating these kinds of garments. ‘Don’t rely only on what you think you know, and be aware that fabric testing in a laboratory does not reflect real life,’ concluded Krizman.

Bernhard Kiehl of WL Gore drilled down on the role of durable water-repellent (DWR) finishes and their role in firefighting as well as the challenges being faced with the phasing out of C8 chemicals.

Kiehl demonstrated what happens when the DWR fails on the outer textile layer – it gets wet leading to thermal insulation loss and to discomfort for the wearer. If the garment is a pair of gloves, for example, hands get cold and lose tactility, making it difficult for the firefighter to perform simple tasks.

Commenting on the phasing out of PFOA, Kiehl highlighted that even though traces of PFOA had been found in apparel it had never been considered an immediate risk for end users: ‘There are several agencies around the world looking into that and because the trace amount was so small and dermal intake isn’t really a major route, studies have concluded that wearing the apparel or footwear is not a risk to the consumer.’

Nevertheless in 2003 WL Gore began looking at alternatives to long-chain fluorocarbons in the form of non-fluorinated chemicals as well as short-chain fluorocarbons (which are not bio accumulative or toxic but are persistent in the environment).

The ten-year research programme revealed that although non-fluorinated chemicals initially could perform ‘pretty well’ in terms of water repellence, they did not repel oil. Acknowledging that lab testing only told half the story, the company also carried out field trials with hiking guides in Scotland.

After wear and washing, it was found that the degradation of water repellence was around 50% faster for non-fluorinated fabrics: ‘We believe this is due to the lack of oil repellence in non-fluorocarbon technology.’ In addition, taking a broader environmental view, including carbon footprint and toxicity potential, the company concluded that the non-fluorinated material had a higher toxicity potential than the short chain fluorinate due to the requirement for more frequent washing and re-activation treatment of the garment.

Concluding, Kiehl commented: ‘It seems a simple choice if you just look at the hazard profile, but that only gives you half of the story. We feel the currently available non-fluorinated materials are not fit for use for many end uses right now, but we are continuing to put our efforts behind them.’

Next was active firefighter Stefan Magnusson from Skellefteå Fire Department in northeast Sweden, who made a brave attempt to condense a four-hour presentation about a firefighter safety movement taking the firefighting world by storm into just 25 minutes.

After seeing three fellow firefighters lose their lives to diseases connected to occupational diseases Magnusson and his colleagues launched the Healthy Firefighters Project (aka the Swedish Way or the Skellefeå Project) in 2006. Uniquely, two unions and an employer organisation, which together cover the entire firefighting population in Sweden, supported the project.

The model works by firstly encouraging firefighters to focus on their individual behaviour and to become aware of the hidden risks that surround them – particularly risks whose consequences may not be felt for many years’ time.

Taking himself as an example, Magnusson highlighted that, as a very rough estimate, at least once a week unknown substances would be in contact with his body – eg in smoke. Over his working lifetime the number of these contacts added up to thousands of encounters.

Following the Swedish Way has resulted in new procedures that have been created by the firefighters to protect themselves and their colleagues, which include not only preventing exposure to contaminants by skin and lungs, but also the careful maintenance of PPE equipment after every call-out.

The Healthy Firefighters Project has even won an environmental good practice award from the EU commission, beating competition from companies such as Electrolux and Texaco. In fact, it has been so widely acclaimed and has resulted in so much attention from firefighters globally that Magnusson and his colleagues have written the principles in a free, downloadable book, in English (visit http://www.healthyfirefighters.com/).

Robert Howard, managing director of Rocliff Industrial Laundry provided a rare insight into the journey taken by firefighters’ clothing upon arrival at a specialist laundry for washing and repair.

Firstly all items of clothing are scanned in via barcode and then inspected for severe damage or staining and extraneous objects that can include whistles and wax pencils. The washing process is carried out under stringent control where, for example, washing is at 60 ºC; outlet drying temperature should not exceed 150 ºC; PH in the range 6-10; no natural soaps, phosphates or enzymes to be used; no overloading; and a specific number of litres of water to be used per kg of clothing to limit abrasive damage to the garment. With 84 different wash processes to choose from and a single load potentially representing over £5,000 (US$7,500) worth of garments, it may not be so surprising to hear that two people must be present at the control panel before the washing machine is activated.

Garments then undergo a ten-point inspection with records stored and any necessary repairs then carried out. The barcode allocated to each wearer’s garment enables a complete history from scanning in and out. Popular reports include number of washes, exception reporting, repairs by wearer and repair type. In fact, garments are depreciated weekly on the system so that decisions on repair viability can be made quickly.

Looking to the future of cleaning techniques, Howard pointed out that carbon dioxide cleaning was a possible option as a result of the improvement of machinery and detergents. It involves pumping liquid CO2 into a wash drum - in a similar manner to dry cleaning - and the addition of detergent. This method is less harsh on fabrics because cleaning taking place in cold temperatures and the process is quicker: ‘It’s also non-toxic unlike some dry cleaning solvents and there are indications of it being a good remover of smoke and oil.’ To date, however, it’s a very expensive machine that is much more costly than a standard dry-cleaning machine. Consequently, its usage is growing mainly in specialist applications, particularly in the restoration of fabrics that have been fire damaged.

Ian Callaghan of PBI Performance Products concluded the day’s presentations by highlighting how far the entire PPE market, ranging from brigades, manufacturers and suppliers to weavers and test houses had progressed in a relatively short time.

After all, still within living memory were painted cork helmets, woollen tunics, leggings, rubber boots, not to mention the time when care and maintenance could mainly involve a simple bucket and brush.

‘But we’ve learned lessons over the years and we’ve moved on. We have improved, starting with inherent flame-retardant fabrics, lightweight thermal liners, and fibreglass helmets. Then we introduced membranes into the fire code, which gave us extra protection. So these are big steps forward as a market, as an industry.’

The market was now becoming more aware of the interconnectedness of all the different aspects of PPE. PPE has to protect the people carrying out the dangerous tasks, but it is not enough to have the right gear if it doesn’t match up to the rest of the ensemble. Similarly, care and maintenance serves another vital aspect of the puzzle. ‘But [here in Europe] there is no standard telling us how to care and maintain PPE and I think this question is important. We have one in the US, NFPA 1851, so why don’t we have one?’

New concepts are also being launched, showing a market in a state of evolution and adaptation to new needs. Gothenburg Fire Brigade in Sweden last year introduced a fire fighting protective suit that includes a detachable outer shell that, after an incident, is removed by the firefighter and bagged for cleaning. In 2014 Greater Manchester Fire & Rescue adopted a single garment that met the different levels of protection for structural, USAR and wildland operations through different combinations of outer and undergarments.

Acknowledging that research still remained to be carried out in long-term occupational health protection, Callaghan nevertheless concluded on an upbeat note,: ‘We’ve come a long way and we will tackle these issues and find a solution, like we always have. We’ve grown as a unit, as an industry, so let’s take some credit and move on to the next challenges.’

A pdf of most of the presentations is available to download below.

The full conference programme is still available online here.

  • Operation Florian

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