Contaminants in Fire and Rescue Activities Position Statement
1. Issue identification
There is a growing body of evidence both internationally and in the UK on the risks of occupational exposure to contaminants in fire and rescue activities.
Contaminants are most commonly encountered as the products of combustion and can be ingested, inhaled or absorbed through the skin and can be dangerous to firefighters in a number of ways. Research findings also indicate that some of the contaminants that firefighters are exposed to in their work are carcinogenic (cancer-causing).
Whilst the exact nature and scale of UK firefighter exposure to contaminants and the resultant health effects are yet to be fully established, it is clear that, if not managed effectively, contaminants pose a risk to firefighters. Furthermore, it is accepted that risk mitigation measures and active health monitoring are needed to protect firefighters based on research findings to date.
Although fire and rescue services (FRSs) are working hard to prevent and mitigate the risks from contaminants, not all FRSs are currently able to implement even simple measures around decontamination without capital investment. Additionally, differences in approaches across the four UK nations and variations in FRSs’ ability to invest can hinder mitigation.
For example, FRSs in the devolved administrations all currently receive some form of capital funding which can be invested into infrastructural changes which strengthen contaminant management. In contrast, FRSs in England have varying abilities to address these issues due to a lack of capital funding, different levels of resource to invest in infrastructure and equipment, and different delegated authority arrangements.
2. NFCC position
The risks of firefighter exposure to contaminants are a shared challenge which all partners including FRSs, fire and rescue authorities, the national and devolved governments, unions and representative bodies, and the wider sector must work together to address. Given the nature and scale of the challenge and the urgent need for investment, FRSs cannot fully address this problem without capital investment.
As a national professional membership organisation, NFCC is committed to reviewing research, improving education, developing guidance, and sharing best practice. Nevertheless, Government action is also needed to invest in FRSs to enable improvements to FRS facilities, equipment and procedures; to help enhance the evidence base used to inform further mitigation measures and to explore opportunities such as health monitoring for firefighters, which has the potential to play a valuable role in safeguarding firefighter wellbeing.
Without Government support, NFCC is concerned that the measures taken to prevent and mitigate risks will not be as robust as they could and should be, placing firefighter health at risk. Capital investment in fire service infrastructure is not a nice-to-have—it is a critical requirement to support the health, safety, wellbeing and dignity of our people. As research enhances our understanding, we need to take action to proactively manage the risk and, by extension, Government needs to support this endeavour through financial investment and policy support. Targeted investment will deliver long-term benefits through improved firefighter health outcomes, reduced financial liability, and a stronger safety culture across the sector.
3. Recommendations
- The UK Government must invest in ongoing long-term capital and revenue funding for estates upgrades, decontamination equipment and facilities, and to support rising costs from increasingly complex and bespoke personal protective equipment (PPE) and laundering needs. Funding requirements should be kept under review to enable FRSs to respond to emerging learning and support continuous improvement.
- The UK Government must explore the opportunities of ongoing firefighter health monitoring to enable earlier identification of ill-health effects for firefighters due to exposure to contaminants, and appropriate interventions.
- The UK Government should work with the sector to support the establishment of an expert group with membership that is inclusive of appropriate health, academic and wider sector-based expertise to advise on emerging learning and appropriate interventions, such as decontamination procedures and guidance to FRSs.
4. Supporting evidence
NFCC and FRS action
Occupational exposure as a firefighter is complex. Firefighters respond to various types of fires and other incidents, such as road traffic collisions and flooding, where they may be exposed to a mixture of combustion products, hazardous materials and chemicals. The increasing frequency of various types of fires—such as lithium-ion battery fires and wildfires—combined with changes in building, furniture and furnishing materials; and the evolving firefighter role and responsibilities has changed the nature of firefighter exposure to contaminants over time. FRSs have worked continuously to address these risks through improvements to PPE, decontamination procedures, and training.
FRSs are already familiar with external work on contaminants, including interim guidance produced following research led by the Fire Brigades Union (FBU) and the University of Central Lancashire (UCLan). These materials set out a range of mitigations that many services are already considering. FRSs, supported by NFCC’s Contaminants Working Group are therefore continuing to strengthen their approach to mitigating the risks associated with contaminants, building on the wider evidence base of national and international notable practice.
It is essential, however, that FRSs are provided with adequate investment from Government so that the latest learning and national guidance to support improved approaches to mitigate risks associated with contaminants can be implemented rigorously and consistently.
Research on the effects of contaminants on firefighter health
Over the last decade, a growing body of research into the effects of contaminant exposure on firefighters has developed. In the UK, the most notable studies have been led by the Fire Brigades Union (FBU) and the University of Central Lancashire (UCLan). A 2020 FBU-commissioned report from UCLan highlighted some of the common risks and best practices for minimising exposure, and for decontaminating personnel and equipment.[1] This report, along with additional work led by NFCC, has informed advice to improve protective measures, access to washing facilities, and safe handling of contaminated equipment. Containing a range of recommendations, the report includes advice about risk-assessed decontamination procedures; making sure personnel receive training on how exposure can be reduced, minimised or eliminated; having policies in place for the routine care, maintenance, inspection and professional cleaning of PPE; establishing and maintaining “designated zones” for preventing cross-contamination; and cleaning and decontaminating emergency response vehicles on a regular basis to reduce secondary exposures.
The growing amount of academic research led the UK’s Industrial Injuries Advisory Council (IIAC) to commission the 2021 ‘Firefighters and Cancer: Position Paper 47’ report, in which the IIAC stated that various studies have found higher incidence rates for different types of cancer in firefighters. However, the report concluded that the IIAC ‘did not find consistent evidence that the risk of any type of cancer is more likely than not to be due to firefighting i.e. the risk was more than doubled’ except for mesothelioma.[2] The incidence and causes of mesothelioma are already widely researched and it is covered by the Industrial Injuries Disablement Benefit Scheme due to its links with exposure to asbestos.[3] Cancer Research UK estimated in 2015 that 94% of all mesothelioma cases were caused by occupational exposure to asbestos, particularly among painter decorators.[4]
Since the IIAC’s 2021 Position Paper, several new UK-based studies have been published. These include the 2023 ‘Cancer incidence amongst UK firefighters’ study, which used data collected from the UK Firefighter Contamination Survey, and found that cancer incidence rates were between 2.93 and 4.23 times higher in male firefighters aged 30 to 49 surveyed than the same male age groups in the general population.[5] Incidence rates varied between ages and between men and women who, along with minority groups, are often underrepresented in those surveyed as part of studies. The study also reported links between cancer diagnoses and certain behaviours such as eating whilst wearing dirty PPE, and from clean and dirty PPE not being stored appropriately.
International Agency for Research on Cancer Monograph 132
In July 2023, the World Health Organisation International Agency for Research on Cancer (IARC) published ‘Monograph 132 – Occupational Exposure as a Firefighter.’[6] This document examines existing international studies and outlines a comprehensive academic assessment of the relative cancer risk for firefighters compared with the general population. Monograph 132 states that there was ‘sufficient evidence’ that occupational exposure as a firefighter is carcinogenic for mesothelioma and bladder cancer. This builds on a previous monograph from 2010 which only found ‘limited evidence’ that occupational exposure is carcinogenic, demonstrating the evolving research base around firefighter exposure.[7]
IARC estimates in Monograph 132 that incidence rates for mesothelioma and bladder cancer are 1.7 and 1.16 times higher respectively in firefighters than in the general population. Whilst mesothelioma in the UK is already cited as a prescribed disease, the fact that IARC has assessed firefighting exposure as carcinogenic for bladder cancer is a concern.
FRSs are continually learning about what the best prevention and mitigation measures are. Whilst FRSs are already taking action based on the current knowledge base, the establishment of an expert group to interpret the growing research base and advise on the most effective action would greatly enhance approaches to risk prevention and mitigation.
UK FRS decontamination equipment and procedures
FRSs have various procedures and protections in place to reduce firefighter exposure to contaminants, including protective materials used in PPE, decontamination protocols, and the use of breathing apparatus. FRSs are already acting, adapting practices based on the current evidence base, however, this change requires investment.
NFCC Operational Guidance states that firefighters should shower or wash thoroughly and to change into clean clothing at the earliest available opportunity if their PPE has been contaminated with products of combustion.[8] Many FRSs now need to invest in new or refurbished vehicles, upgrades to station layouts to enable zoning and separated storage for clean and dirty PPE, or infrastructure such as air monitoring, showering facilities and cleaning equipment. Additionally, many appliances also lack safe storage for contaminated PPE or breathing apparatus outside of the cab, requiring costly modifications or early replacements in some instances.
FRSs in England previously received capital funding from Government to maintain the integrity and quality of the buildings through which our firefighters protect the public, which included ensuring that buildings are equipped to keep firefighters clean and safe. However, this funding was removed in 2014/15. This loss of investment equates to c.£90 million per annum in today’s money and represents almost £1 billion in lost funding over the last decade. FRSs across England have, therefore, been limited in their ability to ensure that their buildings remain fit for purpose.
In contrast, FRSs in Northern Ireland, Scotland and Wales all currently receive some form of capital funding which can be invested in work to address contaminants. Long-term funding has enabled Northern Ireland FRS to undertake an ongoing fire station modernisation programme to equip their stations to address the risks from contaminants based on the latest learning. Scottish Government has supported Scottish FRS’s participation in the CivTech innovation accelerator programme, which brings together public and private sector organisations to identify and work on innovation projects, and is currently working to identify ways to track firefighter exposure to contaminants and improve health monitoring.
Efforts to invest in capital upgrades can also be complicated by the different governance models that FRSs operate under, and pressure to fund other local demands such as social care where FRSs are part of broader local models. Some Chief Fire Officers have greater autonomy to determine where to allocate their budgets, particularly around capital investment. Consistent and effective investment requires ringfenced funding and local discretion to address specific needs.
In addition to upgrades to estates and vehicles, emerging learning around contaminants impacts on PPE design, procurement and laundering. PPE must now meet higher standards than historically required and must be lightweight, fire and chemical resistant, and durable even after repeated washing, thereby resulting in higher costs for FRSs. These increasingly complex requirements have come about at a time when FRS budgets are increasingly stretched. There was a 30% real-terms reduction in FRSs’ core spending power between 2010/11 and 2017/18, and recent increases have been insufficient to make up for previous cuts. This makes it very difficult for FRSs to absorb higher laundering and PPE costs.
Dedicated capital investment now would unlock FRSs’ ability to invest in their estates in a way that reflects our ambition to diversify the workforce, helping to ensure dignified facilities for all staff and the public, including women and those with a disability, and enabling FRSs to make sure they manage contaminants effectively to keep firefighters safe. Simultaneously, revenue spending must be maintained and enhanced to make sure PPE, other equipment and laundering arrangements are appropriate to support firefighter protection and workplace inclusivity.
Ongoing firefighter health monitoring
One of the challenges facing UK FRSs in making informed decisions about the risk of contaminants to firefighters is the lack of long-term longitudinal studies. We would also be keen to recognise the benefits of ongoing health monitoring to ensure that any adverse health conditions are identified and treated at the earliest possible stage. These two issues could be addressed simultaneously by UK Government investment into ongoing firefighter health monitoring.
The Health and Safety Executive defines health monitoring as “monitoring the health of workers where the effects from an activity or exposure at work are suspected of causing ill health effects, but the association has yet to be fully established.” The extant UK-based and international research shows there is a clear indication of a link between firefighting and ill health effects. However, as shown by the variance in diseases linked to occupational risk as a firefighter and incidence rates, clear association between specific activities or risk behaviours is yet to be fully identified. Health monitoring could fill this gap by providing ongoing learning in a UK context. Analysis of monitoring data against individuals’ protected characteristics would also enable better understanding of any conditions or health inequities that may affect different firefighters in different ways.
The priority for both FRSs as employers, and national and devolved governments should be the health and wellbeing of firefighters. Health monitoring would lead to improved health outcomes by ensuring earlier identification of any ill health effects, and that treatment can be started earlier than may have otherwise been the case. This would have the added benefit of saving money in the long-term. The NHS spends around 5% of its annual budget on cancer care and early intervention, prevention and treatment has been identified as a key unrealised saving for the NHS.[9]
Scottish Government is already examining the prospect of funding health monitoring for Scottish firefighters, and capital investment has allowed Scottish FRS to procure physiological monitors to support ongoing research. Research is also being used to inform the specific markers that could be included in future health monitoring. If this work were to be supported at a UK-wide scale, firefighters could see improved health outcomes and new learning could inform FRS approaches, helping to reduce future ill health effects.
International context
In the UK, we have robust health and safety standards to keep employees safe during the performance of their duties, and UK FRSs have a strong culture and rules around the use of PPE, particularly breathing apparatus.
Several countries, including Australia, Canada and the United States, have longstanding presumptive legislation in place for firefighters who may develop cancer later in life. However, the diseases that qualify and qualifying periods of service vary substantially. In Canada, there has been a legislative focus on prevention and treatment with the National Framework on Cancers Linked to Firefighting Act 2023 establishing commitments to raise awareness, promote research, and improve prevention and treatments of cancers that may be linked to firefighting.[10] However, regulations, procedures and PPE practices for FRSs vary significantly in some of these states and jurisdictions when compared to the UK.
Whilst international comparators do not necessarily help us to understand the risks to UK firefighters specifically, they do demonstrate that the UK needs to be more proactive in taking preventative measures based on what existing research tells us about risks to firefighters. Collective and coordinated action is needed across UK FRSs, governments, employers, representative bodies and health experts to ensure evidence-based and well-informed decisions can be made to safeguard the health and wellbeing of UK firefighters.
References
[1] Minimising firefighters’ exposure to toxic fire effluents | Fire Brigades Union.
[2] Firefighters and cancer: position paper 47 (publishing.service.gov.uk), p.4.
[3] Diffuse mesothelioma payments: Overview – GOV.UK (www.gov.uk).
[4] Mesothelioma statistics | Cancer Research UK.
[5] Cancer incidence amongst UK firefighters | Scientific Reports.
[6] IARC Publications Website – Occupational Exposure as a Firefighter.
[7] IARC Publications Website – Painting, Firefighting, and Shiftwork
[8] NFCC Operational Guidance, Firefighting, Hazard – Failing to manage health, safety and welfare: Fire and products of combustion, Control Measure – Health and safety products: Products of combustion.
[9] Affordability of cancer care in the United Kingdom – Is it time to introduce user charges? – ScienceDirect
[10] National Framework on Cancers Linked to Firefighting Act.
Equalities Impact Assessment