Holy Smokes! The Story of a Firefighter
Gilmer County Fire Department Chief Tony Pritchett has the specific details of a minor smoke inhalation episode nailed down. The condition is first initiated by a deep-set exhaustion: he’s already usually hot, sweaty, and tired out from the firefighting work. Overwhelmed, his respiratory system begins to let down its defenses. Then he starts to get a tightness in his chest, like his upper body is being squeezed by an invisible fist. It becomes hard for him to fully catch his breath, and he can feel a distinct obstruction in his windpipe with every attempt to suck air into his lungs. At the same time, his energy levels plummet dangerously.
Even so, Chief Pritchett, who also serves as Director of the Gilmer County Emergency Management Agency in Ellijay, GA, isn’t fazed. After working in the fire department for 15 years, this kind of event has become a routine problem for him. Of course, with more severe issues, he still admits to getting a bit scared and panicky upon realizing and dealing with the extent of the damage. But at this point, Pritchett has experienced almost everything that a fire can throw at him, although thankfully severe respiratory problems are nowhere near as common as minor breathing issues. When first asked about the regularity of such events, Pritchett couldn’t even begin to count how many times he’d experienced any kind of medical complication from smoke inhalation. Finally, he suggested he’s had somewhere between 30 and 40 separate occasions where he’s suffered an episode severe enough to warrant some kind of medical breathing treatment.
Pritchett isn’t alone among firefighters when it comes to respiratory damage from smoke inhalation. Even so, it’s not the most intuitive health risk that people think of firefighters having to face when they’re in the field. Most people imagine the danger to human health comes from the actual flames, says Pritchett, whether it’s from severe burns, weakened and collapsing structures, or the heat coupled with exertion. And while all these are valid concerns, in reality, firefighters worry a lot more about the smoke than you might think. In fact, the number one cause of death related to fires is smoke inhalation. An estimated 50 to 80 percent of fire deaths are the result of smoke inhalation injuries. Given the nature of their jobs, it comes as no surprise that firefighters are especially at risk.
“We have had individuals go to seek medical treatment because of extended exposure to smoke,” said Pritchett. “Most of the time, those are individuals who have been out there for a duration or have been in more extreme fire conditions directly.” He continued, “Just off the top of my head, I would say maybe five out of every ten fires that we go to, we may experience issues related to smoke inhalation.”
That being said, a firefighter suffering from minor smoke inhalation on the job doesn’t necessarily need to be transported to a hospital or medical facility to be treated for it. Most of the time, if the exposure was brief enough, a couple of puffs from an albuterol inhaler or some albuterol pills will do the trick. Albuterol is a bronchodilator, which means that it’s a medication that relaxes medium and large muscles in the airways, allowing for increased air flow to the lungs. According to Pritchett, a dose of albuterol is the most common and traditional treatment for firefighters with smoke inhalation issues. And it’s not solely for firefighters; the medication is so helpful for a variety of respiratory conditions that it’s common practice to have it on hand in ambulances in case Pritchett’s team has to dispense breathing treatments for civilians.
But unfortunately, smoke inhalation-related medical issues don’t always have an easy, on-scene fix. There’s a popular misconception that only the firefighters who responded to the World Trade Center attacks on 9/11 risk developing cancer, because of their exposure to jet fuel and asbestos. In reality, due to the amount of carcinogens that they are exposed to on a daily basis, cancer threatens firefighters everywhere. Researchers from the National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control (CDC) surveyed 30,000 firefighters in 2013 and found that on average, they had higher rates of several types of cancers as well as all cancers combined. When it comes to lung cancer specifically, which Pritchett identifies as one of the leading causes of job-related injury to firefighters, the study also found that the risk of a firefighter contracting the disease increases with every fire they fight. And because firefighters tend to spend more years on the job on average, compared to other first responders like paramedics and police officers, this health risk especially hits home for them.
“There are a ton of health risks firefighters face,” said Pritchett. “Respiratory conditions are up there, but they all kind of go hand in hand.”
Money to Burn
It’s some consolation that these health threats are common and severe enough that the world is finally beginning to take notice of them. Specifically, policymakers are starting to make it a higher priority to provide financial resources to firefighters who may have contracted cancer on the job, in addition to the benefit they receive from their standard worker’s compensation. Just last week, in Georgia, state lawmakers overwhelmingly voted to pass a bill that gives firefighters a special insurance plan with a payout of $25,000 and three years of salary to help with healthcare costs. To put that into comparison, currently, firefighters who get sick risk losing their jobs and existing health insurance. If House Bill 146 is written into law with Governor Nathan Deal’s approval, Georgia will join 39 other states in financially supporting the medical risks and burdens that their firefighters take on willingly to protect local communities.
Despite the importance of this kind of monetary assistance, policies like House Bill 146 focus on addressing the aftereffects, once firefighters have already contracted these medical conditions. According to Pritchett, one area that fire departments could really use some financial help in to tackle this issue at its root is in purchasing forms of respiratory protection specific to when firefighters are battling wildfires. When firefighters face a house fire, they come armed with self-contained breathing apparatuses (SCBA). These distinctive, bulky devices provide rescue workers, firefighters, and other emergency first responders with breathable air isolated from outdoor contaminants. (If that acronym looks somewhat familiar to you, it might be because SCUBA machines are a type of SCBA—the extra “U” stands for “underwater.”) The full set, which includes a high-pressure air tank, a pressure regulator, and an inhalation connection mounted to a carrying frame, is a nearly 25 pound burden that firefighters often literally can’t afford to carry in wildfire conditions, especially considering that the total weight of a firefighter’s gear can add up to 75 pounds. Unsurprisingly, researchers from Kyushu University in Fukuoka, Japan found that heavier equipment temporarily prevents firefighters from reaching their full physical potential and has a negative affect on their effectiveness in fighting fires.
“With wildfire, typically there’s a lot of walking that has to happen and a lot of strenuous activity getting to remote areas,” Pritchett said. “It’s just not possible or feasible to carry those air packs or those self-contained breathing apparatus into the wilderness or remote areas and sustain that air supply.”
Without the SCBA at their disposal in wildfire settings, however, firefighters are essentially left without respiratory protection of any kind at the forest front. There do exist lightweight respirators and face masks on the market that are designed for firefighters to use when combatting forest fires, and work by filtering out dangerous contaminants and wildfire emissions. For example, Forestry Supplies sells a basic “anti-pollution mask” with a dynamic activated charcoal filter that absorbs atmospheric irritants before they can reach your lungs, while Hot Shield offers a more comprehensive “wildland face protector mask” made from non-flammable fabric and includes a replaceable particulate matter filter. But while these kinds of options are less of a burden on the firefighter’s body, they hit a pinched fire department’s budget where it hurts. The Forestry Supplies mask is about $40, with $20 filter replacements; the Hot Shield mask is $100, with $45 filter replacements.
“Masks are an option, but more so than anything it’s a funding hurdle, because that kind of equipment is expensive, and to replace the cartridges and keep everybody properly sized and keep that stuff issued.” Pritchett explained. “It’s not feasible for a lot of departments.”
The silver lining for firefighters having to fight wildfires with little respiratory protection is that inhaling wildfire smoke is widely considered to be less dangerous than smoke from a house fire or other domestic structural fire, which basically refers to any kind of manmade settlement. The difference is in the materials that are getting burnt: between natural vegetation and the synthetic products found in every home. Researchers believe that this distinct contrast is responsible for not only the existing heightened cancer risk in firefighters, but the reason why these health risks have been rising steadily since 1980. A century ago, houses were furnished with materials with materials whose origins people actually recognized: wood, cloth, metal, and glass. But today, they’ve been replaced by plastics, foams, and coatings, which emit a toxic mixture of carcinogens that lace inside the smoke and soot inside burning buildings, making fires more poisonous and a firefighter’s job even more dangerous than it already is. Look around. Your couch, your printer, your son’s soccer ball, your measuring cups: all of them can be toxic when they’re lit on fire and inhaled.
“Although the smoke still is an irritant in wildland fire, it’s burning natural materials, so you’re not really getting so much of those noxious fumes off of manmade materials is the difference,” said Pritchett. “And, with wildland fires, for the most part, there’s a lot more oxygenated air in and around the smoke that you can get to a lot of times to be able to breathe more safely. You’re in the open air.”
Just because wildfire smoke happens to be the lesser of two evils in this case, however, doesn’t mean it’s entirely safe. In fact, emissions from wildfires come with their own set of dangers. We go into this in further depth later, but to make a long story short, the devil is in the details: the microscopic particulate matter (PM), a catch-all term for a mixture of solid particles and liquid droplets found in the air. The smaller the PM, the easier it is to infiltrate deep into the respiratory system without detection. Once there, the metals on PM’s surface will initiate the production of free radicals, whose unpaired electrons (and consequent electron-stealing habit) wreaks havoc through cells, protein, and even DNA. Through a separate strategy, PM also finds a way to get itself ingested by white blood cells, which then initiate cell death in mass numbers to protect the body. Ultimately, these double whammy effects of PM from wildfire emissions lead to a host of respiratory health problems, without the added toxins from synthetic products: from chronic obstructive pulmonary disease, to cardiopulmonary issues, asthma, pneumonia, influenza, acute respiratory tract infection, cardiovascular disease, low birth weight, lung cancer, and early death.
Future of Fire
Even if the Gilmer County Fire Department’s budget swelled significantly overnight, Pritchett isn’t convinced that money alone could help minimize health risks to firefighters as well as local citizens. While he certainly wouldn’t complain, the fire chief believes that there are larger social patterns that need to be addressed to limit prevent wildfires from getting more frequent and severe than they already are. First, he cites the expansion of the wildland-urban interface (WUI), or areas where homes are built near or among lands prone to wildland fire thanks to urban development and sprawl. According to Pritchett, this tendency basically “makes the homes fuel during a wildland fire” and also provides more opportunities for wildfires to start up in the first place due to human activities like cleaning fireplaces or having an electrical malfunction. He also believes that interface could also have larger economic effects.
“I think [wildfires] will become more frequent because of the wildland-urban interface. And even more so than frequency is the amount of damage and the extent of the fires,” Pritchett said. “Because of the interface, it’s not just going to be the woods burning or the mountain burning, it’s going to be the woods and the mountain and the 15 houses that are on that mountain being consumed by that fire. So, your dollar loss is going to go up significantly because you’re going to lose structures and personal property on top of the wildland aspect as well.”
Not to mention, contemporary policymaking and mentality on wildfires isn’t helping either.
“A lot of people look at fire as a totally bad thing, but fire is part of the overall ecology. Nature and the forests need fire,” Pritchett said. “For example, my grandparents that lived there—even my great-great grandparents that lived here back in the early 1900s and 1800s—it wasn’t uncommon then for those folks to go around and set the woods on fire. It’s the same mentality of what controlled burning is today. What it does is it eliminates the fuel of the leaf litter on the ground and dead vegetation; it consumes all that stuff and gets it down to the mineral soil and it provides and promotes a more healthy growth atmosphere.”
That being said, there’s certainly a time and a place for controlled burning. Chief Pritchett has certainly had his fill of fire from the last several months. It’s Friday, and he’s enjoying every minute of it. The fires in northern Georgia were finally put down to rest thanks to the delayed rainstorms, and Pritchett is taking the whole weekend off to relax. On my way out, though, I notice the large sign outside the Gilmer County Fire Department displaying today’s fire danger. The arrow is pointed to the bright red, rightmost slice of the chart that reads the highest warning it’s capable of: “Extreme.” As fire season begins to pick up in Atlanta’s dry heat next month, I hope Pritchett is taking it easy while he still can.