This article is the third in a series, A Fire Hose of ‘Forever Chemicals,’ which can be seen in entirety here.
Small-town fire stations have a striking simplicity, their plain architecture and functional interiors reflect their sole mission: mustering members, largely volunteers, to help neighbors in times of need. In Maine, many of these buildings were constructed in the last century, at a time when communities were smaller, fewer demands were placed on firefighters, and far less was known about the hazards of the job.
Monmouth’s 62-year-old fire station fits this stereotype, with three truck bays flanked by a single meeting room. One wall of the truck bay holds hooks for the protective turnout gear that the department’s volunteer firefighters don to shield them from flames, heat and water.
The station has no shower facility, so when firefighters return from calls coated in the soot and toxic chemicals that emanate from structure fires, “we take our dirty bodies back home,” observed Dan Roy, the town’s fire chief, contaminating personal vehicles and family spaces in the process. “It would be nice to ‘ shower within the hour,’” he said — quoting the preventive health directive firefighters now receive, but that’s not possible. “Knowing now what the exposures are, it’s challenging,” he added.
Firefighters face elevated risk of cancer, compared with the U.S. population. Maine’s presumptive disability law formally recognizes many of the occupational risks that confront firefighters, identifying eleven associated cancers, including ones linked to per- and polyfluoroalkyl substances (PFAS), such as kidney, testicular and breast cancer.
As research confirmed these linkages, the fire service has adapted practices to reduce the chemical exposure firefighters receive. In 2021, the National Volunteer Fire Council released a widely circulated Lavender Ribbon Report that presents “eleven specific actions firefighters need to take to lessen their risk of occupational cancer.” The report calls for each fire department to have — at a minimum — one shower and one heavy-duty clothes washer (called a gear extractor) to facilitate cleaning their personal protective equipment after every fire.
According to respondents in a survey Maine Morning Star distributed to fire departments statewide, 18 percent lack a shower and nearly 15 percent have no gear extractor.
Cleaning heavy, layered jackets and pants in the absence of a machine is labor-intensive and not always effective, according to Jonathan Cote, chief of the Millinocket Fire Department. His members do their best to clean the gear with oversized buckets, a scrub brush and a garden hose, he said, but without a machine’s spin function to extract excess water, the suits take an inordinate amount of time to dry, even with the help of fans.
To ensure that firefighters always have a clean set of gear handy, departments with frequent fire calls are now advised to have two sets of turnout gear and two hoods for each firefighter — a significant expense since each full suit can cost several thousand dollars. Many Maine departments are incrementally moving toward this goal, purchasing the second sets as budgets permit.
Some departments without gear extractors used to wash turnout gear in local laundromats, but that practice changed when the fire service learned in 2020 that PFAS permeate their turnout gear.
That revelation hit hard, following on the news that firefighters had received high PFAS exposure through use of Class B firefighting foam, known as aqueous film-forming foam. “We swam through it,” recalled Shawn Esler, who recently became Maine state fire marshal after serving as Waterville’s fire chief. “None of us knew the issues we were up against.”
‘Encapsulated in PFAS’
Firefighters discovered that they had unwittingly been “encapsulated in PFAS,” in the words of one former fire chief, following years of advocacy by Diane Cotter, the wife of a Worcester, Massachusetts, firefighter forced into early retirement by cancer (a story recounted in the documentary “Burned: Protecting the Protectors”). In response to her requests and with funding she raised, researchers at the University of Notre Dame tested turnout gear for total fluorine, an indicator of the PFAS present. The gear samples contained fluorine in all three layers, including the inner thermal barrier in direct contact with skin.
Health risks from dermal absorption of PFAS have received little study, so impacts from wearing the turnout gear — in conditions of high heat — are not yet confirmed. A federal study released earlier this year demonstrated that turnout gear sheds PFAS the more it is worn, abraded and washed. Most of the turnout gear in Maine departments appears to be in good condition: Four of five survey respondents reported that little to no gear in their departments shows visible degradation, and two-thirds characterized their members’ gear as in either “excellent” or “very good” condition.
In some departments, though, older turnout gear with worn-out knees or frayed cuffs was traditionally passed down to junior crew members. “It would protect our juniors who don’t go into structure fires, but they need reflective gear to operate on the fire ground or at accident scenes,” Roy explained. Only in hindsight did fire chiefs learn that “it was probably not a good idea to be putting that on our youth,” he said.
Monmouth ended that practice, but it can’t afford to make a wholesale transition to fluorine-free gear. None of the state’s fire departments can. In the meantime, Roy said, “It’s a little unnerving to think that we’re putting on turnout gear that could cause cancer 30 years down the road.” And in an era when most fire departments are struggling to attract and retain sufficient numbers of firefighters, he added, “it’s not a good selling factor for recruitment.”
Minimizing contact with PFAS-laden gear
The International Association of Fire Fighters and Metropolitan Fire Chiefs Association issued a joint statement in 2022 advising firefighters to only wear turnout gear when essential, to keep it out of station living areas, and to transport it in sealed bags (not thrown on the seats of personal vehicles). That warning underscored another risk the gear pose: PFAS shedding off pants and jackets can go airborne and be inhaled.
Far more is understood about the toxicological effects of PFAS from ingestion than from routes of workplace exposure firefighters typically face, such as inhalation, dust ingestion and skin absorption. According to Leena Nylander-French, a PFAS researcher and occupational health specialist at the University North Carolina at Chapel Hill, “we really don’t understand the distinct roles and contributions of these pathways in the realm of total exposure.”
One study testing dust for PFAS at 15 Massachusetts fire stations found locker rooms storing turnout gear had higher levels than living areas, suggesting that the suits “may be an important PFAS source in stations due to intentional additives and/or contamination from firefighting activities.” Keeping PFAS-laden gear in a discrete room could minimize firefighters’ exposure, but relatively few departments in Maine have that option. Among those responding to Maine Morning Star’s survey, fewer than a quarter reported that turnout gear was kept in a separate equipment or locker room. The vast majority have turnout gear, by necessity, hanging in the truck bay.
Keeping gear separated during transport is not constrained by building infrastructure, though, and requires only a minimal investment. About half of survey respondents report that their departments now use sealed bags to carry turnout gear and that they stow the gear in truck beds or the trunks of vehicles. Nearly 30 percent of respondents, however, report that at least some of their members still place turnout gear “directly on seats.” And almost a quarter of respondents indicated that their members wear turnout gear at community events, such as fundraisers or school visits.
A profession slow to change
“Change is tough for the fire service,” Roy said, observing that its members have been hit in the past five years with a flood of new guidance on practices to minimize chemical exposure. He sees many younger firefighters eager to adapt and hopes that “over time, it will trickle up” to reach others.
In his final year of high school, Noah Rousseau, a volunteer firefighter in Hope and Appleton, completed 350 hours of Firefighter I and II training with an instructor and curriculum that emphasized personal safety. “As I enter my years in the fire service, I have a great awareness of the hazards we face both immediate and long term,” he reflected, while knowing that protecting health “takes time to become part of the culture.”
Dirty turnout gear, for example, was once considered a badge of distinction among firefighters, many of whom resisted washing theirs. Rousseau, in contrast, learned that his gear contains PFAS and was not designed to shield firefighters from noxious gases so could have carcinogens permeating it following fires.
In Rousseau’s view, as departments transition off fluorinated chemicals, the goal should be “not exposing yourself unnecessarily,” like working out in gear — a practice once promoted by some firefighters as a means of maximal preparedness. Adaptations are necessary, he added, until the fire service can achieve “the end goal [of] having safe, effective gear that doesn’t kill us.”
Monitoring firefighter health
“Changing the culture is one of the biggest challenges,” according to Judith Graber, a Rutgers University epidemiologist who lives in Hallowell and has collaborated with four Maine volunteer departments as part of a nine-state cancer awareness and prevention study.
Graber, who helped Maine Morning Star design and analyze its survey of Maine fire departments, said reducing exposure to toxic chemicals like PFAS is a matter of “understanding risk and [recognizing] that it can be reduced; it’s an accumulation of small steps.”
“Overall in the fire service, volunteers have been largely left out of research and education efforts,” she added, and there are basic misconceptions to overcome. For one, researchers and firefighters often believe that volunteers have less risk than career firefighters, when in fact they “do the same job, [may] have less protection on the scene and stay on the job longer,” she said.
Participating in the cancer prevention study made Roy more conscious of the cumulative build-up of PFAS within people, and the risks from overlapping or successive occupational exposures. Many firefighters have received added PFAS exposure through their primary job or prior military service. His profession as a fire investigator adds layers to his risk.
Assessing PFAS blood levels, as Monmouth firefighters in Graber’s study did, can help individuals focus on ways to reduce ongoing exposures — allowing their bodies to gradually detoxify. Graber tells firefighters that while PFAS are dubbed “forever chemicals,” they are “not forever in our bodies” if new exposures are markedly reduced. According to a Swedish study, levels of the legacy chemicals PFOS and PFOA can drop by half in less than five years.
While only about 80 Maine firefighters were able to test their blood for PFAS in the first phase of Graber’s study, far more could gain access to PFAS blood testing through a bill being resubmitted for consideration in the upcoming legislative session. Currently, Mainers who want to know their PFAS blood levels may be deterred by high costs (typically $450 to $600 when done at a lab) that not all insurance companies cover. Two years ago, more affordable and scientifically vetted home-test kits became available as well ( see resources page).
Maine Sen. Stacy Brenner, D-Cumberland, introduced in the last session LD 132, modeled after a law in New Hampshire that requires health insurance providers to cover the cost of PFAS blood testing. Clinicians should offer this assessment to individuals with high PFAS exposure, according to guidance developed by the National Academies of Sciences, Engineering and Medicine.
Blood testing helps establish a baseline against which to measure efforts at reduced exposure, and it can guide clinicians in selecting tests to monitor for conditions associated with PFAS. Not all Mainers would be helped by the proposed bill, though, due to high deductibles and co-pays. That leaves fire chiefs like Jason Beckler of Mount Vernon wondering, “Is it the town’s responsibility to pay for that — covering the co-pay?” He’s concerned in that case that firefighters might not get access because “sadly we put money before health.”
The question of who pays for additional health testing for first responders derailed another proposal last session that would have improved insurance coverage for early risk screening. The bill’s sponsor, former state Rep. Anne Perry, D-Calais, said it “will probably come back vetted a little differently,” possibly as a requirement that municipalities cover routine health screening for their first responders. In the recent survey, only 42 percent of the fire departments reported that they provide routine physical exams for their career and volunteer members.
A baseline assessment at the start of fire service work is critical for first responders to make any subsequent worker’s comp claims under Maine’s presumptive disability law — as Andre Poulin, a 37-year veteran of the fire service (primarily serving in Maine), learned this year. Diagnosed just months apart with two forms of cancer, lymphoma and renal cell carcinoma, he got coverage for both conditions because “I always did the annual physicals to meet the presumptive disability requirement,” he said, and he’d gotten an initial exam when starting service.
That coverage has made all the difference, Poulin observed, given that “since January, my treatment has cost almost $430,000 and a kidney.” He tells fire service colleagues to “get your presumptive testing done,” and “if it doesn’t feel right, get it checked.” In his view, the communities and the state that firefighters serve need to ensure that routine screening happens by covering the cost or co-pay: “They should give you that physical [at the outset] and they should pay for that every year.”
The costly road to gear and foam replacement
To lower their ongoing PFAS exposure, firefighters need to address the two primary occupational sources in fire stations: aqueous film-forming foam and turnout gear. That transition is underway in Maine, but more state support will be needed to hasten the pace.
Among the fire departments that responded to the recent survey, just 10 percent have acquired fluorine-free foams. Fluorine-free turnout gear has only come to market recently and the number of companies offering it is expected to increase markedly in the next year or two.
Washington state, known for its strong safer products regulations, has made firefighter personal protective equipment “a priority product” for a PFAS ban once it has identified safer alternatives, said Laurie Valeriano, executive director of the nonprofit Toxic-Free Future. The state has not gotten good information from manufacturers about the chemical ingredients being used in gear, she added, saying the state has issued orders to obtain information but the manufacturers “don’t provide the right set of information or they don’t respond.” Given the past experience with aqueous film-forming foam replacement foams that were still toxic, “we’re concerned about regrettable substitutions,” she said.
South Portland is among the first fire departments in Maine to acquire some PFAS-free gear, but it will do so incrementally — given the high cost. The fluorine-free suits (pants and jackets) the department recently acquired cost $4,200 per set, roughly 20 percent more than the previous suits that contained PFAS.
For the 93 percent of Maine fire departments staffed mostly or entirely by volunteers, replacing PFAS-laden gear is a daunting proposition. Monmouth, for example, is one of the departments with a high enough call volume to warrant a second set of turnout gear for each firefighter. With 42 volunteer members needing 84 sets of fluorine-free gear, the cost would be more than $350,000, 80 percent more than the department’s annual budget.
“That’s a huge thing for departments to undertake unless they have funding available,” Roy observed. If the state offered a grant program to help departments cover acquisition of new foam and gear, he observed, “The fire service would embrace it [given] all we have learned in the past few years.” Connecticut, for example, established a $3 million fund offering grants to help fire departments there transition off aqueous film-forming foam.
With initial funding of $250,000 provided by the Legislature, the Maine Fire Protection Services Commission recently launched a “Safety Equipment Grants Program to Reduce Cancer Among Firefighters,” offering fire departments up to $5,000 for gear extractors and up to $10,000 for diesel exhaust systems.
“That is just a drop in the bucket,” according to David LaFountain, a retired fire chief and retired state senator from Winslow: “To remedy the situation, it’s going to cost a lot of money.” Acquiring even a single set of fluorine-free gear for all of the state’s roughly 7,200 firefighters (as estimated by the Maine State Federation of Fire Fighters) could cost more than $30 million, not counting disposal costs for the old gear.
The expense of an aqueous film-forming foam takeback and replacement program is harder to estimate, given uncertainty about disposal options and the amount of inventory left in Maine ( see article 1). But if Maine collected and sent 40,000 gallons to be destroyed using supercritical water oxidation, the route New Hampshire chose, it could cost at least $2 million. Funding for replacement foam might cost another $1 million or more.
Investigating aqueous film-forming foam water and soil contamination, and providing filtration and remediation where needed ( see article 2), could add tens of millions of dollars, based on the state’s experience with sludge-affected farm sites. How much of that expenditure might be recouped through the state’s lawsuit against foam manufacturers remains uncertain.
‘I don’t think people know what’s going on’
The challenge of funding a transition off PFAS in the fire service is layered atop a more fundamental need for greater education about these chemical hazards and ways to reduce exposure.
There’s been a lot of discussion of PFAS at the State House in recent years, recalled Maine Sen. Pinny Beebe-Center, D-Rockland, chair of the Joint Standing Committee on Criminal Justice and Public Safety, but “I don’t recollect any discussion of [PFAS] challenges for firefighters … I don’t think people know what’s going on.”
Addressing PFAS in the fire service will take legislative engagement from multiple committees, Beebe-Center said, and might benefit from a caucus or joint committee hearings, given the cross-disciplinary nature of any solutions. She is confident that will move forward in the coming session, when it’s clear “what’s happening to the number-one people in our communities. They are being poisoned and we need to do something.”
When PFAS surfaced in agricultural settings, farm groups mobilized and farmers testified and held a press conference in Augusta. It’s harder for firefighters to do that, LaFountain said, because they’re on call and often working multiple jobs — not uncommonly serving full time at one department and part time at several others.
More than half of the departments responding to the recent survey reported having five to 10 members who also worked at other fire departments; just over a quarter had more than 10.
Fire departments are struggling to attract and retain members, and the ability to muster sufficient numbers of firefighters to respond to calls is a growing concern. Firefighters juggling jobs, families and volunteer roles have limited time to educate themselves about health guidance. And with new information, “sometimes things sit at the administrative level,” observed Cote, Millinocket’s fire chief, not making it to the firefighters themselves.
At the administrative level, the state has fallen short in educating fire professionals about PFAS, a fact exemplified on the Maine Emergency Management Agency’s PFAS webpage. Nearly all the resources listed for firefighters are five or more years old in a field where the science, policy and technology are evolving rapidly. A “best practices” factsheet offered for aqueous film-forming foam, or AFFF, use comes from the trade association of foam manufacturers, which the state’s lawsuit against those corporations described this way: “Despite its extensive knowledge of the dangers of PFAS, DuPont was a founding member of the Fire Fighting Foam Coalition, which was formed to advocate for AFFF’s continued viability.”
“Education is going to be the big thing behind this for everyone,” Cote observed, such as the need for clearer communication on which foams are safe to use. Fire chiefs seeking fluorine-free replacement foam spoke of wanting an informational clearinghouse at the state level, where departments can learn more about which foams are likely to perform well in particular situations.
“We’re trying to educate ourselves in the fire service, but we need to get to the public as well,” Cote added. “We have a lot of work to do.”
Maine Morning Star is part of States Newsroom, a national nonprofit news organization.
This story was originally published on Stateline.org.
