External studies and reports

Externa dok8

Skelleftea Model - Healthy Firefighters

Magnusson and Hultman (2014) started the project Healthy Firefighters – the Skellefteå model. The basic idea was to improve the work environment for firefighters. The publication “Healthy Firefighters” was published by the Swedish Civil Contingencies Agency (MSB).

Some quotes:
“Common substances found in combustion gases, and which have been established as carcinogenic, include: benzene, dioxin, formaldehyde, polyaromatic hydrocarbons (PAH) and vinyl chloride. Some of these substances are easily absorbed through the skin. (p. 17)”
“In this context, there are three primary ways in which airborne harmful substances can make their way into our bodies…via skin absorption” (p. 20)
“There are many situations in which firefighters’ skin comes into contact with harmful substances… “How much of a substance is absorbed by the body via the skin is determined by the quantity and type of substance, the size of the molecules and the skin condition. The substance penetrates warm and sweaty skin quicker than dry or cool skin
“Many medicines are designed to be absorbed by the skin, e.g., analgesic creams, heart disease medication and nicotine patches…harmful molecules can make their way into the firefighter’s body when they come into contact with the skin
Can you possibly know what substances remain on your skin? (p. 23-24)

The publication “Healthy Firefighters” can be downloaded here:

Externa dok5

Report “Minimising firefighters’ exposure to toxic fire effluents”

An independent report from the University of Central Lancashire (UCLan), commissioned by the FBU.
Professor Anna Stec et al. (2020) presented an independent report about firefighters’ health and their exposure to toxic fire effluents.

Some quotes:
The report details how firefighters face danger...these toxic fire effluents can be absorbed by the skin. It demonstrates where current Fire and Rescue health and safety practices are failing…” (foreword)
“Firefighters may be exposed to toxic contaminants...Dermal Absorption occurs when a toxicant comes into contact with an individual’s skin. There are many situations in which firefighters’ skin comes into contact with harmful substances….Absorption of toxicants via the skin will vary depending on exposure time, the quantity and type of substance, location and the surface area of the skin....and the high temperatures in which firefighters operate increases their blood flow, sweating rates and body temperature. Together with the body’s reduced water content, this leads to increased dermal absorption of fire effluents…” (p. 15)
A graph showing that skin cancer is, by far, the highest diagnosed type among British firefighters (p. 23)
“It has been shown that organic contaminants can be transferred from the fabric of PPE to the skin. These contaminants can then penetrate deeper dermal layers, with the potential for systemic toxic effects…” (p. 32)
“The skin’s permeability increases with temperature. For every 5ºC increase in skin temperature, absorption of toxins via skin increases 400%...” (p. 38).

The complete report can be downloaded here

Externa dok6

Article in Canadian Occupational Safety and in EHS Today

Article, referring to a study by Keir et al. (2020), which was published Oct. 18, 2020 in the journal Environmental Science & Technology.

Some quotes:
"Our study shows that the best way to reduce a firefighter's exposure to harmful combustion products is to reduce chemical exposure to the skin," said Jules Blais, professor of environmental toxicology at the University of Ottawa and research team leader" (s. 2)
"The team found a significant link between PAH metabolites found in urine and levels of PAHs on skin, suggesting that firefighters are exposed to these harmful chemicals mainly through contact with their skin, rather than by inhalation." (s. 2-3)
"David Matschke, a firefighter of 32 years. "To have definitive proof of the chemicals that we are exposed to and the routes of our exposures will improve our procedures and our equipment, meaning reduced incidence of job-related disease and longer, healthier lives."" (s. 3)

Download the article: Canadian Occupational Safety alt. EHS Today
The study "Elevated Exposures to Polycyclic Aromatic Hydrocarbons and Other Organic Mutagens in Ottawa Firefighters Participating in Emergency, On-Shift Fire Suppression" by Keir et al. (2020) can’t be downloaded here due to publishing rights but here is a link to the possibility to read the abstract and/or to buy the study.

Externa dok7

Study about the skin’s exposure to PAH for firefighters.

Fent et al. (2013) carried out a study to determine if airborne polycyclic aromatic hydrocarbons (PAHs) and other aromatic hydrocarbons generated during live fire training contaminate and pass through the skin of fire fighters.

Some quotes:
"Conclusion: We found that fire fighters wearing full ensembles absorb PAHs and aromatic hydrocarbons into their bodies. The PAHs and aromatic hydrocarbons most likely entered the fire fighters' bodies through the skin (p. 45)
"Recommendations for Additional Research...Study the effect of turnout hood designs and materials on dermal exposure and absorption of combustion products." (p. 47)
The complete study:
“Evaluation of Dermal Exposure to Polycyclic Aromatic Hydrocarbons in Fire Fighters" by Fent et al. can be downloaded here:

Externa dok1

LeMasters’ Meta-analysis:

LeMaster et al. (2006) at the University of Cincinnati College of Medicine, USA, conducted the largest study to date as they weighed data from 32 other studies. In total, firefighters analysed were over 110,000, and the study identified 10 different types of cancer where firefighters had a clearly increased risk of being diagnosed.

Testicular cancer - 102% higher risk
Multiple myeloma - 53% higher risk
Non-Hodgkin's lymphoma - 51% higher risk
Skin cancer - 39% higher risk
Brain cancer - 32% higher risk
Malignant melanoma - 32% higher risk
Rectal cancer - 29% higher risk
Prostate cancer - 28% higher risk
Stomach cancer - 22% higher risk
Colon cancer - 21% higher risk
(Higher risk = higher risk compared to average population)

The complete analysis:
“Cancer Risk Among Firefighters: A Review and Meta-analysis of 32 Studies” by LeMasters et al. can be downloaded here:

Externa dok2

NIOSH study:

Daniels et al. (2013) at the National Institute for the National Institute for Occupational Safety and Health (NIOSH) in Cincinnati, USA, investigated the link between cancer and firefighters. The study included 30,000 firefighters from San Francisco, Chicago and Philadelphia, and the results showed that firefighters have a 14% higher risk of dying from cancer and a significantly higher risk of developing seven different types of cancer compared to the average population.

Mesothelioma - 100% higher risk
Rectal cancer - 45% higher risk
Oral / pharyngeal cancer 40% higher risk
Esophageal cancer - 39% higher risk
Colon cancer - 31% higher risk
Kidney cancer - 29% higher risk
Lung cancer - 10% higher risk
(Higher risk = higher risk compared to average population)

The complete study:
“Mortality and cancer incidence in a pooled cohort of US firefighters from San Francisco, Chicago and Philadelphia (1950–2009)” by Daniels et al. can be downloaded here:

Externa dok3

The Nordic study

Pukkala et al. (2014) at various universities and institutes in Finland, Sweden, Norway, Denmark and Iceland published a study of 16,000 Nordic firefighters. Among other things, this study divided the risk of cancer per age group and the study shows a statistically significant increased risk for all age groups to develop five different types of cancer.

Mesothelioma - 155% higher risk
Non-melanoma skin cancer - 33% higher risk
Lung cancer (lung adenocarcinoma) - 29% higher risk Malignant melanoma - 25% higher risk
Prostate cancer - 13% higher risk
Prostate cancer (for firefighters aged from 30 to 49 years) - 159% higher risk

The complete study:
"Cancer incidence among firefighters: 45 years
of follow-up in five Nordic countries" by Pukkala et al can be downloaded here: