Change the Habit
After recently sending my better half a picture of my crew, he jokingly sent me a text back saying, “Tell them to take off the cancer pants” (they were half dressed in their bunker gear). I laughed and sent him a picture showing that I was wearing my bunker pants as well. I could feel his eyes rolling from an entire state away.
We had both just returned from the International Association of Fire Fighters (IAFF) Affiliate Leadership Training Summit (ALTS), where the documentary “Burned” had premiered. The short film focuses on Diane Cotter, who is the wife of a Massachusetts firefighter, and the fight she waged to prove that our bunker gear is laden with unsafe levels of PFAS (a known carcinogen). Cotter was labeled as “crazy” by the industry at one point for her efforts and now, in a turn of events, the IAFF is planning on suing manufacturers over their willful disregard for the health of firefighters. It turns out she was right all along.
Here I was, sitting willfully in my cancer pants. PFAS, aka “forever chemicals,” can’t simply be washed off of your skin like soot can. In fact, one study that I read stated the only way people with higher levels of PFAS can lower them successfully is to donate blood or plasma every few weeks. That awkward fact alone should make me wary of touching my gear unnecessarily.
More importantly, when I got that text, why was my reaction a simple shrug and the thought, “I’m going to die of cancer most likely anyway”? Sound familiar? Of course, it does. We all say it anytime a health-related issue comes up. Naturally, I took to the Internet to see if doctor Google had any studies that showed a relation between our calloused attitude toward health and high-risk careers. There were none. It seems our “devil may care” attitude hasn’t been deemed worthy of academia attention yet.
How much of what we do is based on ingrained habit that is only changed by a sudden event? We’ve all heard the saying, “The fire service is 200-plus years of tradition, unimpeded by progress.” Sure, that statement is tongue in cheek, but there is always a hint of truth in every joke. Our gear has represented safety since day one for all of us. When we can’t see an immediate danger right in front of our faces, how can we be expected to just suddenly view gear as a potential hazard?
The answer is that we change the habit of wearing our gear all the time the same way we change everything else—at the kitchen table, by having a discussion with your shift. Do some research. In addition to being a known carcinogen, PFAS is a known endocrine (think hormones) disrupting chemical. Know anyone who’s struggled to start a family? Had multiple miscarriages? The effects on our health go way beyond cancer. Our lives depend on us being one with our gear. We need to move well in it and know the limits of our dexterity. We need to train in it and be heat tolerant. Do we really need to be wearing it on an EMS run after working out or because it’s cold outside?
This week marks the passing of two of my former shift mates to cancer and heart disease at ages far too young. At the IAFF’s ALTS conference, when attendees were asked if they had known anyone on the job who had been diagnosed with cancer, every individual in the room raised his hand. In a career field where change is hard and habits abound, maybe the motivation we need to harness is taking every opportunity to protect ourselves in ways that will allow us to show up for our shift mates every day. If we can change one habit at a time so we can continue to show up and do the job we love, maybe the next generation won’t have to shrug and assume that cancer’s going to take them anyway.
Stephanie White
Technician
Fairfax County (VA) Fire and Rescue
We Have to Do Better
What is leukemia? The official definition is, a malignant progressive disease in which bone marrow or other blood-forming organs produce increased numbers of immature or abnormal leukocytes. That is the simple definition. It’s much more complicated and overwhelming than the sterile definition. There are several types of leukemias, and within each type there are several mutations—some bad and some really bad.
What is leukemia to me? Leukemia is a 54-year-old man who had it three years ago and beat it. Six months from retirement, he found out he had it for the second time. Leukemia to me is a captain in the fire service who selflessly dedicated his life to the dutiful helping of others—a man who followed the rules and did what was right; a husband of 21 years; a father to a beautiful 19-year-old daughter. He is a son, a brother, my best friend and soul mate, a man who is fighting for his own life after so many years of fighting for others.
In five months, we have spent an average of six hours a day in the hospital, sometimes longer, nearly every day of the week. There have been five rounds of chemotherapy, 10 days each time, and dozens of prescription medications as well as bandages and other medical products and procedures to combat the many side effects of chemo, be it a cut or a bloody nose, diarrhea, or constipation. There have been 65 blood and platelet transfusions, six bone marrow biopsies, three trips to Tampa for consults, an unexpected hospital stay for infection, countless labs tests, and too many doctor appointments to count.
He hasn’t even gotten to the bone marrow transplant phase yet. That is a whole other battle for us, which will involve six months of treatments and all the unpredictability that will bring. That said, I am so grateful we were even able to get to this point. So many others were less fortunate.
Sounds terrible, right? I can’t even begin to relay all the side effects and complications from all the above treatments—not only for him but for me, the caretaker, as well. Stress and anxiety plague me 24/7 and have wreaked havoc on every system in my body. What I would do for one night of solid sleep.
Leukemia patients have platelet issues, which can quickly lead to stroke or aneurysms. It’s difficult to sleep with the anxiety level that accompanies touching my spouse multiple times a night, without waking him, just to make sure he is still warm and breathing. Sometimes, I wonder if cancer is harder on the patient or the caretaker. I am a wife, mom, patient advocate, watchman, chauffeur, wound-care specialist, housekeeper, culinary specialist, accountant, college tuition payer, and all-around doer of everything. If that didn’t make for a full plate, did I mention that the few hours of the day that might be left over are consumed with insurance fights over bills that were denied that clearly shouldn’t have been? I will never understand insurance. When fighting for your life, the last thing you should have to do is deal with insurance to get bills paid. It is cruel and completely unnecessary.
I’m not complaining. I swear. I would endure this hell forever if it means I get to keep him here with me. An outsider might think a caretaker would be pissed, spiteful, and jealous. Don’t get me wrong, I have my moments, but overall, I am grateful—grateful for God! God has most definitely placed His hand upon Ritchie and me and blessed us with several miracles. I have no doubt that God will continue to bless and protect us.
I am grateful for Ritchie. The fight this man has in him is unlike anything I have ever seen. Ask him who he fights for. It’s not for himself; it’s for me. He isn’t ready to leave me! Twenty-five years together is not nearly enough time.
I am grateful for our daughter, Holly. She will be giving Ritchie the best gift of all—the gift of life! Holly will be Ritchie’s bone marrow donor. She will go through a procedure that is not for the faint of heart. She is as tough as her dad.
We are also grateful for the family and friends who have been there for us. As firefighters, we have a hard time accepting help. It isn’t in our nature. However, those of you who have been there for us, through all of this, know that you are loved and appreciated more than you will ever know. All of your love for Ritchie also keeps him going. He doesn’t want to let any of you down.
I have given you the condensed version. I spared you the small details. I spared you how many times I have cried, how many times I have screamed at the top of my lungs, how many times I have lashed out at others for asking me how we were. I share this story because we need to do better! I, myself, am a retired firefighter. I retired the first time Ritchie had leukemia because I didn’t know how much time I had left with him and I wanted to spend every minute possible with my husband.
I tell you this story, too, because I am terrified of cancer. I think about it morning, noon, and night. I think about how many times I did overhaul off air, how many times I did not wear a mask when using the “kitty litter” on motor vehicle collision scenes, how many times I stood next to the truck’s exhaust while the engines were running, how many times I didn’t hook up the ventilation fan, how many times I didn’t wash my hair or even take a shower after a car fire because “I didn’t get too sweaty” or because it was 3 a.m. and I was just too tired. It’s admittedly insane how I never washed my gear because it was “cool” to have dirty gear. It proved that I was in there, fighting the beast, and dirt was my badge of honor.
These days, I am terrified every time I have an odd cough or a random pain. In my head, everything is cancer until proven otherwise. Every time I go to a wellness check, I literally convince myself that this is the appointment where I will find out I have cancer too—for me, it’s when, not if, I get cancer. I wish I knew then what I know now. I would have done better.
We need to do better. We need to use the tools and resources given to us to minimize our risks and exposures. Cancer is the #1 cause of line-of-duty deaths as well as countless deaths to retirees.
I hate that Ritchie has become the cliché—cancer, right in time for retirement, not to mention the brand-new RV that we bought the week before the diagnosis. We have so many plans for our retirement, and now I don’t even know if we will be able to do any of it. We fight hard because we must. When this is done, God willing, we will continue to fight, fight so that all firefighters and all cancers are covered by the state, not just a select few. It’s hard to stand back and see firefighters not treated the same in this righteous state. I’m happy that there are firefighters who don’t have to stress about bills and having their time covered, but it hurts to watch others force themselves to go to work right after chemo or radiation because they feel they need to so that they don’t burn through all their time banks.
As I write this, Ritchie is at work after completing his ninth day in a row of chemo this morning, as well as needing a platelet transfusion after the chemo. Since leukemia is not a cancer covered by our state presumptive bill, Ritchie has to choose whether to pad his DROP and continue to work or retire to save his sick and vacation time banks to help pay for his insurance once he does retire.
No firefighter should have to make that choice. We need to lobby to get more added to the cancer presumptive bill. Twenty-one cancers was a good start, but we can’t stop until all cancers are covered. We can do better. We have to do better!
Gina Hudson
Firefighter/Paramedic (Ret.)
Florida Firefighters Safety & Health Collaborative
Complacency the Enemy of Progression
When a firefighter dies in the line of duty, that firefighter has earned a traditional firefighter funeral, and if there is one tradition in the fire service that we want to eliminate, it is a funeral. Few firefighters would argue that line-of-duty deaths (LODDs) are preventable. What makes reducing LODDs and injuries so difficult are the behavior, attitudes, and practices in the traditional fire department. To change any of this, we must be willing to change the culture within the service—change the culture of management, personal responsibility, personal accountability, and training.
The mission of the fire service is to save lives and property, and saving lives is a tradition to be proud of. Dying in the fire service, although honorable, is not a tradition we want but comes with the cost of doing business much like injuries. “People often behave unsafely because they have never been hurt before while doing their job in an unsafe way: ‘I’ve always done the job this way’ being a familiar comment.” (Cooper, 2014) However, can we change the culture without presenting a threat to tradition? To do this, we need to change and accept that change. The change must start from the beginning, where it all starts: the education and training of current firefighters and future firefighters. We must change our training and education philosophies and ideologies. Training and education must become progressive and no longer a check in the box. Training someone to the required standard is not enough. Educating individuals to pass a test and expecting them to learn the rest on the job is not a sufficient standard.
Training is great for teaching muscle memory, tactics, techniques, and what works and doesn’t work. Some firefighters argue that hands-on training is the only way they learn. However, some training is best done with the use of digital programs and lectures.
One thing that is not covered enough in firefighter basics is communications. I have reviewed the fifth edition of Essentials of Firefighting (IFSTA, 2008). Chapter 19, page 923 is titled “Fire Department Communications.” Of this 35-page chapter, there is only one page dedicated to talking on the radio during an incident and how to communicate to other companies and dispatch. There is one paragraph that covers and explains evacuation process and signaling. At no point in this manual is there any coverage of a Mayday or what constitutes a Mayday situation. Furthermore, there is no coverage of what to do in the event you have to initiate a Mayday.
A Mayday is something that every person on the fireground should know. It should be reviewed and practiced as often as we pull hose, perform bunker drills, or conduct primary searches. We in the fire service have gotten complacent and pushed one of the most important tools in the service to the back. Is it because we think it will never happen to us? Do we feel comfortable enough to know what to do in that unfortunate scenario? Could we declare a Mayday and perform a LUNAR (Location, Unit, Name, Assignment and Air supply, Resources needed) that explains what needs to be done in the event you become lost, disoriented, injured, or trapped? Once a Mayday has been declared, all communications on that channel stop except the person declaring the Mayday and the incident commander. All efforts will then be turned to locating the persons in trouble. Communication must be clear, concise, and audible; if you are unsure of what is being transmitted or what is expected, then you need to reconfirm your assignment with whoever is assigning it.
In March 2009, the National Institute for Occupational Safety and Health released an LODD report concerning two career firefighters who lost their lives while performing search in a residential structure fire in California. (Tarley, 2009) The deaths of these two firefighters, like in many LODDs, were preventable and easily avoidable. The contributing factor to their death was lack of communication. During the call, Victim 1, the captain of Engine (E) 70, passed command to E74 prior to entering the structure. E74 was transmitting over E73, and no one heard the transmission. The captain failed to ensure that his traffic was understood. This is where the failed communication began to take a turn to fatal. Victim 2 from E70 requested vertical ventilation, which was not understood by dispatch and had to be confirmed by a responding engine, who was not on scene yet. E70 tasked an individual to get a thermal imaging camera from E70. That individual was reassigned by the E73 captain to get a positive pressure ventilation fan. The fan should have never been turned on with a crew inside with no water source. They should have never been in without a water source. This is the complacency and lack of fireground communications that I have been explaining.
The way to correct this issue is to require a more extensive and explanatory course on radio communications and fireground communications. This can be done by adding a one-day course or class during rookie school on how to handle the pressures of communications and making sure they understand their assigned tasks. I understand that a rookie out of school will not be talking on the radio much, but communication does not always mean radio traffic. They need to clearly understand their assignment and the reason for the assignment. We can reduce LODDs if we stop breeding complacency. Good enough is not good enough. Remember, at the end of the day, everyone needs to go home.
Works Cited
Cooper, D. (2014). Be safe managment systems. Retrieved from behavioural-safety.com: http://behavioural-safety.com/component/content/article/3-psychology/2-the-psychology-of-behavioral-safety.
IFSTA. (2008). Essentials of Firefighting 5th Edition. In C. Goodson, Essentials of Firefighting 5Th Edition (pp. 85-122). Stillwater: Fire Protection Publications Oklahoma State University.
Tarley, J. (2009). Death in the line of duty… NIOSH.
Michael Dimas
Firefighter
Navy Region Mid-Atlantic Fire & EMS
Chesapeake, Virginia
