It’s been a busy year in wildland firefighter health. It started with the tragic Los Angeles fires, a spectacular illustration of how toxic exposures can be.
Then the New York Times investigated what it called a “growing occupational health crisis” among wildland firefighters – focusing on the lack of respiratory protection amid growing knowledge about risks like cancer.
“It would be unthinkable for urban firefighters — those American icons who loom large in the public imagination — to enter a burning building without wearing a mask,” the first story in the series reads. “But across the country, tens of thousands of people who fight wildfires spend weeks working in toxic smoke and ash wearing only a cloth bandanna, or nothing at all.”
That reporting came up at a September Congressional hearing where Forest Service Chief Tom Schultz testified.
“Chief, do you feel like the Forest Service is doing everything that it can and should do…,” Rep. Jared Huffman (D-Calif.) asked Schultz.
“I think there's always more work to do,” he said in response, adding: “Safety is something that we take seriously, and we definitely need to continue to focus on safety as we move forward, including this issue.”
Federal officials also recently announced that some N95 face masks would be made available for limited, voluntary use by firefighters. And then, as a part of a larger reorganization of the federal wildland fire system, department heads also asked for gear recommendations to “ensure the long-term health and safety of wildland firefighters.”
‘This feels like that moment’
“It's been a whirlwind, and I think in a good way,” said Luke Montrose, a Colorado State University professor who studies wildfire smoke’s health impacts. “I think all of those things move the needle towards better protections for wildland firefighters.”
Earlier this month, he was in a third-floor conference room filled with fellow researchers, officials and firefighters themselves in Loveland, Colo., for the sixth edition of the Rocky Mountain Wildfire Smoke Symposium, which Montrose started in 2020. This year’s theme was “Protecting Those Who Work in Smoke,” and the flurry of recent developments, he said, presented an opportunity.
“You need the knowledge, you need the policymakers to be on board, and you need the firefighters to be receptive,” he said. “This feels like that moment.”
The two-day conference was filled with talks on the latest research, some of it important but too technical for laypeople to follow. Other findings had more immediately obvious implications.
“If you washed your clothes before you went to a fire as compared to people that didn't, you had only 39% of the levels of [polycyclic aromatic hydrocarbons] in your urine,” said Dr. Jeff Burgess, a University of Arizona professor who heads the massive Fire Fighter Cancer Cohort Study, about a common fireline toxin.
“The firefighters are interested,” he said after his talk. “They're asking for information about the effects of their exposures and what they can do about it.”
Data presented at the conference shows that the vast majority of firefighters worry about their risk of cancer and other serious health impacts. Burgess thinks that within the next couple of years, wildland respirators could be available to firefighters, as they already are in Canada and elsewhere.
Reducing risk
For now, however, Kat DuBose, a top official at the joint federal Wildland Firefighter Health and Well-Being Program, said “there is no respirator that is NIOSH-compliant and is NFPA-approved to protect against all inhalation hazards identified in the wildfire environment.”
She was referring to the National Institute of Occupational Safety and Health and the nonprofit National Fire Protection Association. The new federal guidance on N95 facemasks also says that no respiratory protection is currently “approved for use during the arduous work performed by wildland firefighters on the fireline.”
When used properly, such masks can filter out 95% of airborne particles, but they do not “protect against gases, vapors, or very small solid particles from fumes or smoke that may also be present.”
“The Interior and Agriculture departments are working on respirator options in the wildland fire environment that meet both regulatory and workplace requirements,” the document continues.
While noting that guidance, DuBose said that personal protective equipment (PPE) is considered the least effective measure by workplace safety officials. The five-level hierarchy of controls identifies the elimination or substitution of hazards as the most effective, but DuBose argued that those “are not feasible” on the fireline.
“We can't really remove smoke from our environment,” she said. “We cannot replace it with anything less hazardous.”
But DuBose, who worked a wildfire season on the Redmond Hotshots in 2019, does see promise in changing the way people work on the fireline – administrative controls in the language of the hierarchy. Rotating personnel out of smoke and choosing strategies that minimize heavy exposure are potential measures, according to her presentation.
“Risk is a function of concentration and duration, and any time you can change one of those factors, you're going to be reducing exposure,” DuBose said. “Right now exposure cannot be zero. But how do we continue to reduce it to reduce cumulative risk?”
She also asked for help from fellow attendees to identify where more research is needed and how to get results out to firefighters in the field.
A roadmap for research
Enter Arielle Milkman, a postdoctoral researcher in Montrose’s lab.
“Our objectives today are to lead our field in defining the current research needs that are most pressing for wildland firefighters' health and well-being,” she told the sizable in-person and online audience.
They then broke up into teams – each with names of firefighting gear like drip torches, used to intentionally light backburns or prescribed fires. The chatter of brainstorming filled the room.
“They're expected to perform as an elite athlete,” one participant noted. “We would never feed elite athletes the way that we feed wildland firefighters.”
“Some of the conversations around limiting exposures, like what other research can be done to determine what are feasible, potential best practices that could be implemented?” another asked. “There's got to be more we can do to protect firefighters that we're just not doing.”
The ideas generated were formally logged as a part of Milkman’s research needs assessment, for which she is also doing an extensive review of firefighter health scholarship.
“Researchers are starting to disentangle the effects of smoke and firefighting on the body, and how that might affect inflammation and oxidative stress,” she said. “ And so they're being really focused on the mechanisms of disease.”
But there’s less work published on long-term disease risk, and potential interventions.
“So that's kind of where I'm seeing the field going,” she said.
‘A united front’
But wherever the field goes, she says earning the buy-in of firefighters is indispensable. Firefighters like Justin DeMoss, who attended the conference and just finished up his second season on a federal Interagency Hotshot Crew.
“You're pushing your mental and physical limits every single day,” he said of the work.
He also works with Hotshot Wellness, a group founded by the elite firefighters to improve health on the fireline. Wildfire has a longstanding reputation for hyper-masculinity, but DeMoss said the culture is going through a major shift.
“I think a lot of individuals are finally coming around to that concept that our vulnerability is not a weakness, our ability to reach out and get help is not a weakness,” he said. “It just makes individuals stronger with community and relationships.”
And at the conference, he sees the real possibility of a ‘united front’ between firefighters and researchers to address serious health concerns.
“It would be really tough to do it without them,” he said of investigators. “And simultaneously, it'd be hard for them to do it without us.”
“I feel like I'm leaving this conference extremely supported,” he added.
This story was produced by the Mountain West News Bureau, a collaboration between Boise State Public Radio, Wyoming Public Media, Nevada Public Radio, KUNR in Nevada, KUNC in Northern Colorado, KANW in New Mexico, Colorado Public Radio and KJZZ in Arizona as well as NPR, with support from affiliate newsrooms across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting and Eric and Wendy Schmidt.
