CALIFORNIA’S PERSONAL EXPOSURE REPORTING SYSTEM
With the passage of cancer-presumption legislation in many states, including California, Rhode Island. Illinois, and Maryland, it is important for firefighters to document exposure to hazardous substances. Under this legislation, workers’ compensation will be paid to firefighters stricken with cancer if they can demonstrate relevant exposure.
The California Firefighter Foundation in 1984 initiated its Personal Exposure Record, a questionnairebased reporting system, to help with the documentation. Firefighters are encouraged to participate via educational seminars and written materials. Most participants are charged a small enrollment fee. which in some cases is paid by their department or local union. The program has approximately 8,000 participants; two-thirds of them are from California (firefighters from San Diego and Los Angeles are not included, since they are not represented by the California Professional Firefighters Association), almost a third are from Hawaii, and the remainder are mostly from Washington. D.C. and Reno, Nevada.
Firefighter participants fill out two questionnaires: The Entry Record. which is completed at the time of enrollment, asks questions about age. smoking habits, and other background information; the Exposure Report is filled out whenever a firefighter feels he has been exposed to hazardous material Participants keep a supply of preaddressed, blank exposure forms in hip-pocket-size booklets; they are filled out and submitted as soon after an incident as possible.
ANALYSIS OF RESPONSES
Following are the data on exposures, symptoms, and acute medical problems collected from the first 11.125 reports submitted by 1,937 firefighters between August 198 i and February 1987.
PERSONAL EXPOSURE
Demographics. Participants are largely paid firefighters (99 percent) as opposed to being volunteers, are members of the International Assoc iation of Fire Fighters (99 percent), and are male (99 percent). Sixty-eight percent are white, 11 percent Polynesian. 10 percent Asian, 5 percent Hispanic, and 6 percent other race/ ethnic groups. The average age of participants is 38.
Only 13 percent of enrollees are smokers; 37 percent say they never have smoked cigarettes.
Incidents. The number of incident reports per participant varies considerably. Of the t.3 i i firefighters enrolled during the study period, 37 percent sent in no incident reports, 20 percent sent in one to four reports, and 22 percent sent in five or morereports. Among those who sent in one or more reports, the average number of reports was 5.7, and the range was 1 to 129. The high number of 129 was unusual, in that all other numbers of reports per firefighter were fewer than 70.
FIREFIGHTER EXPOSURES
Type of incident. Residential fires, the most common type of incident reported, account for 37 percent of all reports, followed by vehicle fires (12 percent), and wildland fires (11 percent ). The single dwelling is the most common occupancy in which the reported incidents occurred (49 percent), followed in frequency by commercial buildings (17 percent), and multiple-family dwellings (12 percent).
Common exposures. A wide variety of exposures are reported; most often they are reported as “unknown”— “unknown,” however, accounts for only 16 percent of all reported exposures. Identified exposures include the following: combustion products of burning plastics, gasoline/oil/diesel, carbon monoxide, unspecified smoke, insulation/fiberglass, paints/solvents, rubber, acids, wood smoke, grass/ brush, tar, pesticides, asbestos, and chlorine gas.
The average number of exposures per incident is 1.04, but the average varies considerably among the incident types. For example, the average number of exposures reported for industrial fires is 1.9, while the average for wildland fires is 0.6 (many reports did not give a specific exposure).
Route of exposure. Where route of exposure is given by the firefighter, it most often is inhalation (42 percent), followed by inhalation in combination with skin contact (22 percent), and inhalation in combination with skin and eye contact (17 percent). Inhalation exposure occurs at 93 percent of incidents, skin exposure at 51 percent of incidents, and eye exposure at 28 percent of incidents. Use of special equipment, including self-contained breathing apparatus, chemical protective clothing, and special protection for overhaul activities, is noted in 32 percent of the reports. Decontamination. including showering, washing hands with germicide, and dry-cleaning turnouts is noted in 8 percent of the reports.
PERSONAL EXPOSURE
/Emergency medical service exposures. Four percent of the reports indicate exposure to infectious agents during emergency medical service. The largest number of reports cite the AIDS virus (25 percent), followed by hepatitis (16 percent), tuberculosis (6 percent), and meningitis (6 percent).
Length of exposure. The stage of the fire and the firelighter’s activity are strong predictors of length of exposure. Regarding fire stage, longer times are spent in contact with smoldering stages (.38 percent more than one hour) than in incipient (20 percent) or free-burning stages (25 percent). The results for activity are more striking: 68 percent report time of more than three hours in overhaul, whereas fewer than 20 percent report time of more than three hours in entry/ventilation, rescue, and emergency medical services operations.
Types of exposures at incidents. Exposures vary considerably among the various incident types. For example, insulation is a common exposure in residential fires, whereas rubber and gasoline are common exposures in vehicle fires. Vehicle fires often are associated with heavy-density smoke, which frequently is described as black (49 percent black vs. about 25 percent in other types of incidents). Special protective equipment is most commonly used in commercial and residential fires (in about 37 percent of the incidents reported) and least commonly used in wildland fires (17 percent).
Rescue operations. These are notable in several ways. Although rescue constitutes only 4 percent of all reported incidents, it has the highest percentage of infectious agent exposures—about 65 percent. Decontamination occurs most often after rescue incidents (38 percent vs. about 10 percent after other incidents).
MEDICAL OUTCOMES
Symptoms. “Eyes burning” is the most commonly reported symptom at an incident (occurring at 43 percent of incidents), followed by cough and nose/lung irritation. After an incident, eyes burning, cough, and nose/lung irritation are less common although most frequently mentioned. Headache, skin irritation, and ringing ears are the most often reported complaints after an incident. Although the pattern of symptoms reported is basically similar for all incident types, eye irritation and cough are more commonly related to wildland fires, while nausea is more prominent at commercial fires. The symptoms most often associated with carbon monoxide and rubber combustion are headache and respiratory irritation, respectively.
Medical treatment. Smoke inhalation and other respirator)’ ailments constitute well over half of the total problems requiring medical treatment. Medical treatment is uncommon in the major incident types such as residential and vehicle fires (under 2 percent each) but is relatively common in rescue incidents (11 percent).
Enrollment in the Personal Exposure Record system is estimated to be about .30 to 35 percent, and only about half of the enrollees are reporting exposures. This participation is low when compared with formal health studies, where participation is usually greater than 70 percent. Obtaining meaningful data for health research requires high percentages of firefighter participation and reporting accuracy.
We recommend the following to departments that would like to implement an exposure-reporting system: Aim for high participation —use strong recruitment procedures and have employees pay enrollment fees; provide participants with written guidelines for reporting exposures; and follow up with interviews on a sample of the exposure reports received from participating firefighters to develop a better understanding of the nature of the exposures.
