Firefighters’ exposure to per-and polyfluoroalkyl substances (PFAS) as an occupational hazard: A review

Abstract

The term “firefighter” and “cancer” have become so intertwined in the past decade that they are now nearly inseparable. Occupational exposure of firefighters to carcinogenic chemicals may increase their risk of developing different types of cancer. PFAS are one of the major classes of carcinogenic chemicals that firefighters are exposed to as occupational hazard. Elevated levels of PFAS have been observed in firefighters’ blood serum in recent studies. Possible sources of occupational exposure to PFAS include turnout gear, aqueous film-forming foam, and air and dust at both the fire scene and fire station. Preliminary discussion on PFAS includes definition, classification, and chemical structure. The review is then followed by identifying the sources of PFAS that firefighters may encounter as an occupational hazard. The structural properties of the PFAS used in identified sources, their degradation, and exposure pathways are reviewed. The elevated level of PFAS in the blood serum and how this might associate with an increased risk of cancer is discussed. Our review shows a significant amount of PFAS on turnout gear and their migration to untreated layers, and how turnout gear itself might be a potential source of PFAS exposure. PFAS from aqueous film-forming foams (AFFF), air, and dust of fire stations have been already established as potential exposure sources. Studies on firefighters’ cancer suggest that firefighters have a higher cancer risk compared to the general population. This review suggests that increased exposure to PFAS as an occupational hazard could be a potential cancer risk for firefighters.

Evaluating the performance of surfactant and charcoal-based cleaning products to effectively remove PAHs from firefighter gear

“…The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fmats. 2023…”

Per- and polyfluoroalkyl substances in firefighter turnout gear textiles exposed to abrasion, elevated temperature, laundering, or weathering

“…Firefighters have higher PFAS serum concentrations than the public [9][10][11][12][13][14][15][16][17]. There are numerous potential PFAS exposure sources suggested for firefighters, such as the use of aqueous filmforming foams (AFFF) and firefighter gear that has been treated with fluorinated polymers or has accumulated PFAS during firefighting activities [18,19]. Among firefighters, the use of AFFF [11,12,16] and direct engagement in firefighting activities (i.e., as opposed to employment as a driver) [9] are associated with higher serum PFAS concentrations.…”

Toward the future of firefighter gear: Assessing fluorinated and non-fluorinated outer shells following simulated on-the-job exposures

“…4,5 Firefighters can be exposed to combustion products from fires (e.g., polycyclic aromatic hydrocarbons and particulates), building materials (e.g., asbestos), firefighting foams (e.g., per-and polyfluoroalkyl substances (PFAS)), flame retardants, diesel exhaust, and other hazards. [6][7][8][9][10][11] The structural turnout ensemble worn by firefighters principally consists of three layers; outer shell, moisture barrier, and thermal liner, all of which are standardized by the National Fire Protection Association (NFPA) 1971: Standard on Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting. 12 The outer shell protects the wearer from thermal and physical hazards and is typically made of inherently flame-resistant fibers i.e., polybenzimidazole (PBI), meta-aramid, para-aramid, or poly-benzoxazole (PBO), with a ripstop, plain-weave, or twill fabric structures.…”

“…PFAS are a significant concern for the environment and human health due to their toxicity, persistence, and bioaccumulation. 9,16,[27][28][29] The general population is exposed to PFAS through contaminated food, drinking water, cookware, indoor dust, and ambient air. [30][31][32][33] Added exposures to PFAS are relevant to firefighters since these chemicals are used in turnout gear as DWRs and in aqueous film-forming foams (AFFF) that are used to extinguish fires based on fuel and oils.…”

“…[37][38][39][40] Several studies reported an elevated risk of cancer in firefighters compared to the general population. 9,[40][41][42] The International Agency for Research on Cancer (IARC) also re-classified the firefighting occupation as a "Group 1" carcinogen in 2022, defining firefighting as a known carcinogen to humans. 6 Therefore, firefighters' exposure to PFAS and associated health risks are relevant when discussing occupational cancer.…”