17 July 2018
TO: BRIGADE SECRETARIES
FIREFIGHTING AND CANCER/CONTAMINANTS UPDATE
One of the key issues the FBU is taking forward is the cancer/contaminants work. This circular provides an update, some of the issues we are facing and the proposals for work in the future.
It also contains a link to a short film produced by the University of Miami Sylvester Comprehensive Cancer Center’s Firefighter Initiative. It is titled “Bunker Gear Transfer: The Invisible Danger” and can be accessed via this YouTube link:
This film was designed to raise awareness among Miami firefighters and is a good illustration of how contamination could occur post incident. Although much of the terminology is different it is still a useful tool to demonstrate some of the things we are trying to put over to firefighters in an attempt to avoid unnecessary contamination. Please take a few minutes to look at this film and feel free to share it further.
Head Office has been following up on cancer/contaminated related resolutions from Conference 2017. All the resolutions related to cancer/contaminants at Conference 2018 were remitted or withdrawn to allow us to continue with our ongoing work and planned projects.
The resolutions from 2017 are:
DEVELOP A POLICY TO MINIMISE THE EFFECTS OF TOXINS
Conference instructs the Executive Council to develop a definitive policy using all available UK and international research data which will assist local officials in negotiations aimed at providing adequate procedures to minimise the effects of toxins post-incident. This policy should take the form of a best practice document.
FIREFIGHTER WORK RELATED CANCERS – PRESUMPTIVE LEGISLATION
Conference recognises and applauds the large amount of research that has been carried out in several countries around the world, which has been brought to the attention of our Members, the potential for contaminants that firefighters regularly come into contact with through their daily work, causing cancer.
In some countries, this has led to presumptive legislation being introduced to cover firefighters contracting certain types of cancer which are widely recognised to be caused by exposure to contaminants encountered during their career in the fire service.
Conference therefore instructs the Executive Council to commence work with our employers within the National Joint Council, and the relevant MPs, at the earliest opportunity in each administration with the UK, to introduce similar presumptive legislation.
CANCER AS AN INDUSTRIAL INJURY
Conference continues to note with concern the numbers of firefighters and control Members who suffer cancers with those cancers being more numerous and more aggressive than those suffered in the general population.
Conference further notes the numerous academic studies regarding these issues but remains dismayed that currently in the UK, cancer is not recognised as an industrial injury due to the role of a firefighter.
Conference instructs the Executive Council to continue lobbying Government to recognise cancers in the UK Fire and Rescue Service as an industrial injury.
Two of these resolutions directly call for us to press for presumptive legislation while, the other relates to providing a best practice approach to minimising contamination.
We have been looking at these through the health and safety committee, but the bulk of the work has been undertaken by a much smaller group of officials and the FBU research department.
This work is being approached from two angles:
- Compensation for firefighters who contract cancers. – presumption.
- Prevention through contamination.
Compensation For Firefighters Who Contract Cancers
Executive Council members have received regular updates in relation to the work we have been doing on this.
A number of FBU officials and members think that presumptive legislation, which has been achieved in some form for firefighters in other parts of the world, most notably in some North American states, most of Australia and parts of Canada, is the key area that we should be focusing on. Two of the resolutions we are looking at focus on this aspect.
However, to date this legislation has not been achieved for UK firefighters nor has it been achieved for firefighters in any other part of Europe. A delegation from the FBU attended a recent firefighter cancer conference in Iceland and looked at this in more detail. We also took the opportunity to speak with other unions from around the world and got more information on how they have been dealing with this issue.
Barriers To Presumptive Legislation
Previously as part of our work the FBU met with Hugh Robertson, TUC head of health and safety, to informally discuss the options available in relation to in advancing a campaign for presumptive legislation in current conditions. Hugh was less than optimistic about any successful challenge, and outlined that there are a number of very steep barriers to overcome to get presumption at present. This was detailed in a subsequent Executive Council paper outlining these barriers.
In summary this paper suggested that if we wanted to take this forward, we would have to commission our own study and an up to date literature review showing that the risk of firefighters from cancer is twice that of the general population.
Shortly after this meeting we received a literature review that had just been done by Richard Graveling from the Institute of Occupational Medicine (IOM), which indicated that the situation on cancers and links to firefighting was not going to support our challenge. In fact in some areas (testicular) this review was showing improved figures.
However, other things have subsequently come to light that may impact on this. The FBU also attends a national PPE contaminants group (PPEC). During one of these meetings attendees received a presentation by Professor Anna Stec (University of Central Lancashire) which suggested that the risk to firefighters was greater than ever, and suggested that the evidence in her soon to be released study would reveal some shocking information. Following the PPEC meeting, the FBU have met with Professor Anna Stec several times in addition to exchanging numerous email and telephone conversations with her.
Initially Professor Stec provided us with a copy of her report which showed that firefighters in training scenarios in Hampshire were being contaminated well beyond our understanding with carcinogens in soot, smoke etc., and that they were probably not cleaning themselves or their PPE adequately therefore raising the risk of cancers and other diseases.
This report was picked up by the Guardian newspaper and we managed to get a prime spot to make our points in the media including on Sky TV.
Following discussions with Professor Stec, we have revisited many of the studies in the literature review and are looking at other work associated with them. Although these studies, which mainly relate to mortality, do not provide enough evidence to support a challenge to the twice the population barrier that we would need to press for presumption they do reveal that there may be some gaps and other factors that we need to look at in more detail.
For example a study based solely on mortality, which only records firefighters who die from cancer not those who contract cancer and survive only to die from something else, would not show the scale of the problem. It would only show those who unfortunately die from cancers not those who recover. To get this information we would also need to look at incidence as well. However it appears that currently records are not accurate enough to show this without a great deal of work. Also if the death certificate does not record the occupation, then this is another way the information may be missed.
The Route For Presumptive Legislation
To get presumption we would have to convince the Industrial Injuries Advisory Council (IIAC) a non-departmental public body established under the National Insurance (Industrial Injuries) Act 1946.
IIAC provides independent advice to the Secretary of State for Work and Pensions in Great Britain, and the Department for Social Development in Northern Ireland, on matters relating to Industrial Injuries Disablement Benefit and its administration. IIAC is the government body that would have to prescribe certain cancers as a specific risk for firefighters in order for presumptive legislation to be enacted across the UK.
IIAC consists of around seventeen members. It is formed of independent experts with relevant specialist skills, as well as representatives of employees and of employers. At present, there are three union representatives on the Council: Hugh Robertson (TUC), Karen Mitchell (RMT) and Doug Russell (Usdaw). It also has a research sub-committee, which Hugh Robertson sits on. However, government and employers have a built-in majority to block presumption unless unions can show very strong evidence of elevated risk.
The legal avenue of presumption for individual claimants is afforded by Regulation 4 of the Social Security (Industrial Injuries) (Prescribed Diseases) Regulations 1985. At present, 49 of these 71 diseases are accorded presumption, representing over 90% of claims, assessments, and awards in payment during recent times. IIAC has reviewed presumptive legislation in general, but not for firefighters (IIAC, Industrial diseases: presumption that a disease is due to the nature of employment: IIAC report, 12 June 2014).
Research on Firefighters
We have challenged for presumptive legislation previously. Over a decade ago, following FBU conference resolutions on these issues, Head Office officials asked the trade union representatives on IIAC to raise the issue of firefighters’ cancer risks. The result was that IIAC published two reports:
- IIAC, Testicular cancer in fire fighters: IIAC position paper 21, (20 June 2008).
- Richard Graveling and Joanna Crawford, Occupational health risks in firefighters, (1 November 2010).
Graveling and Crawford carried out a comprehensive review of the international literature. They found that firefighters face some elevated risks for colon, rectal, skin, cervical, prostate, testicular, bladder, brain cancers and multiple myeloma, though none met the burden of proof “more likely than not” (risk of 2.0 or greater) required by IIAC. The main cancer excluded from this study, mesothelioma, is already covered by legislation. The report concluded that “from the perspective of the Industrial Injuries Scheme and the evidence before the Council at the present time, the case for prescription is not supported”.
One problem we now recognise with this is that, if the review only focused on cases which recorded cancer in firefighters where it was the cause of death plus where the occupation was recorded, then compared this with the whole population of cancer deaths, it was always going to show an lower figure than the actual case where firefighting had been linked with cancers.
So in effect we were never going to get the comparison we needed while we continued to record in these circumstances. Rather like in the pension campaign – if we had accepted the costs of the scheme were rising and the fact that people were living longer, without looking at in in more detail, we were never going to prove our case. We won our pension arguments by taking their assumptions apart and challenging using our own expert evidence. If we are to make any headway in relation to cancers, we are going to have to adopt the same attitude and accept that it is also going to be time consuming, resource intensive and potentially expensive.
Following the Hugh Robertson meeting, we looked at the problem facing us.
To restart the process with IIAC we would require new evidence, not only of elevated risks faced by firefighters, but evidence of a doubling of risk, “more likely than not” to meet the threshold.
To have any chance of success in relation to presumptive legislation in the UK, we would have to:
- Produce sufficient evidence of a doubling of risk of particular cancers for firefighters, significant enough to outweigh and counter the arguments presented by other studies.
- Demonstrate the mechanism through which firefighters have been exposed to particular contaminants that have then led to the development of a particular cancer in firefighters.
- Convince IIAC to support a presumptive approach to that cancer for firefighters, which would then lead to amended legislation.
Do We Need A New Literature Review?
This is a consideration, and in the meantime we are still gathering information.
At the Iceland seminar, other key union officials with experience of pressing for presumptive legislation such as Peter Marshall (UFU) and Alex Forrest (IAFF), suggested that these types of reviews would be used against us for many of the reasons we outlined earlier, and suggested a different approach. These different approaches are being considered as part of the ongoing work.
Could We Do Our Own Literature Review?
We have also been discussing this and have been exploring the possibility of commissioning our own study, based on current and retired firefighters in the UK, to provide a better evidence base for this campaign.
When this has been done previously, it did not reveal the association between firefighting and cancer that would be required to take to IACC.
Some of the difficulties in doing this work at present include:
- Obtaining firefighter records from brigades that go back far enough.
- Limitations with pension records which usually focus on mortality.
- Hospital records/death certificates often do not mention occupations. (Scotland might be different and might be something to explore further.)
- Mortality rates will not pick up where a firefighter suffers from cancer and survive only to die from another cause.
- Issues of data protection and confidentiality.
- Showing the mechanism linking firefighting to a specific cancer.
Because many of the current reviews;
- *Focus on mortality.
- *Do not record data when a firefighter suffers from cancer and survive, only to die from another cause.
- *Only record firefighters when the occupation is named on the death certificate.
They may be significantly underestimating the scale of the problem.
All this historical evidence would be considered and we would have to prove our case, and also disprove any other research as was explained to us in our meeting with the TUC health and safety lead.
Hugh Robertson added that even if the study yielded some results showing a doubling of the risk, this would not in itself be sufficient to convince IIAC, given the background of other studies showing a lower risk. The IIAC would probably look at the research in other studies to provide a counter argument against presumption. For this reason, any new evidence would need to prove the risk and disprove the findings of previous studies. The FBU could invest resources in this research, but still not get the result on presumption with IIAC.
The reality of this is that we could be investing a great deal of time dealing with a matter of compensation, when it might be better now putting resources into prevention activities among existing members. Seeking to implement world class prevention strategies in every brigade might be the best way to protect existing members from exposure, and hopefully limit the incidence of cancer now and in the future.
For that reason we are also looking at:
Prevention Through Contamination
The Executive Council has already supported our suggestion that we continue with contaminants work, seeking to prevent exposure of current working members and to minimise risks through control measures and PPE. We have already put out an initial 10 point advice sheet on how firefighters can minimise unnecessary contamination, which seems to have gone down well. However, there is a huge task ahead of us and we will need to approach this methodically.
We need to be able to illustrate the dangers of contamination and then offer some advice on how to minimise the dangers, because we will not totally prevent it.
Working with Professor Stec we hope to gather information on how FRAs and firefighters are currently dealing with contamination issues pre, during and post incident.
We are currently looking a significant project in two parts;
- Survey current practices and procedures and provide a best practice guidance for officials on how to minimise firefighter contamination.
- Research into toxic exposures through contamination.
The first part of the project is self-explanatory. We will hope to gather information on current practices and procedures, and provide a best practice guidance for officials on how to minimise firefighter contamination.
As the title suggests this will be a survey(s) of all FRS’s and firefighters to gather information on current practices procedures. The survey will ask for information about clothing, cleaning methods, storage and repairs etc. The majority of this will be done through the normal working arrangements in Head Office, although there is also ongoing discussion about using an online external survey.
We will need the support of officials to ensure that we get a detailed return to the request for information.
The final part of this section of this project is to produce a best practice guidance.
The second project is to look into toxic exposures through contamination.
This will be completed over 3 years and will involve;
- Taking sample collections from firefighters, during and after the fire (including formation of toxicants and various extinguishing methods). This will include collection of the samples directly from the fire (gas sampling), firefighters clothing and work environment. Toxins will cover acute and chronic fire effluents such as hydrogen cyanide, acrolein and formaldehyde, Poly Aromatic Hydrocarbons (PAHs), isocyanates, dioxins, heavy metals etc.
- Analysing the toxins and exposure routes by studyinginhalation, digestion versus dermal absorption. Biological samples will be taken from saliva, blood, and/or urine. Exposure time versus toxins clearance from the body will be identified together with decontamination methods such as use of the wipe samples, shower, etc.
This part of the project will utilise the expertise of Professor Stec and her team.
Our immediate next steps relate to the survey which is currently being prepared.
Further details relating to our ongoing work will be provided.
Yours in Unity,