Firefighters and Cancer Mario H. Trevino


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  • Here is where I’ve gotten my perspectives on the fire service:
    As you can see, most of my actual firefighting time was in Seattle during the 1970’s, 1980’s, and early 1990’s.
    We had hundreds of fires in those days.
    Seems we had a greater alarm every month or so.
    Lots of working fires.
    We had the swagger that experience gives you.
    Germane to this discussion because I took in a lot of smoke in those days.
  • Here is where I ‘ve gotten my experience and perspectives in the fire service.
    This is also where I’ve gotten my exposures
    Most of my actual firefighting time was in the Seattle Fire Department during the 70’s 80’s and 90’s.
    We had lots of working fires during those days, and the city experienced a greater alarm at least once a month
    We had the swagger that experience gives you.
    This is germane to our discussion today because we all took in a lot of smoke during those experiences.Thank you for the opportunity to be here, and many thanks to my old friend Rich Marinucci for making it possible.
    I’m honored and humbled to be among such a venerable gathering of fire service leadership
    Also, thanks to Firehouse Magazine for helping me get my message out to so many firefighters
    This particular fire was the biggest which I ever served as IC. 5-alarm at Fisherman’s Wharf in San Francisco. Hundreds of firefighters, 44 apparatus & dozens of aux equipment (2 fireboats)
  • I’m proud to have been associated with the NFFF for the past decade.
    I am now serving as an Advocate to help spread the word on firefighter safety
    They gather statistics on firefighter deaths and injuries
    We know that there are about 100 line of duty ff die per year
    You all know the categories,
    But we don’t track cancer.
    Why not? I asked that question at our last national training meeting in Chicago this past March.
    The reason I was given is that cancer is not established as presumptive in all 50 states yet.
    That may change.
  • This was the culture in the SFD in my early days
    We prided ourselves in being an aggressive, interior attack department
    Every rig had SCBA’s, but we rarely used them. If you tried, you were called a bunch of names (not approp here) and told those were for inspections only
    Salvage and overhaul, we called Clean ups: scraped char, mopped floors, got place as ready for re-occupation as possible
    Remember that scene from Backdraft where the guy is coughing at a clean-up from the smoke and lights up a cigarrette? Audience laughs? Real life. Smoke ‘em if you got em.
    Over dinner at 17’s, firefighter remembered when we were expendable. Something changed, and then we focused on staying alive to help others
    What changed? We lost 10 firefighters in the line of duty my last 10 years on the job. Remember Mary Pang?
  • Something else changed, but we didn’t know it yet.
    Decades later, we would find our ranks decimated by cancer.
    The very week I got my own cancer diagnosis, this article came out in the Seattle P.I.
    It reported that 1/3 of Seattle Firefighters hired before 1977 had cancer, had been treated for cancer, or had died from cancer.
    My sister called me the day the article came out and told me about it. I had to tell her then that, yes, I had it too.
  • As you can see from this chart, the focus group was 975 of us.
    Of that group, 347 had cancer, had been treated for cancer, or had died from cancer.
    43 of them were younger than 60 at diagnosis.
    I checked with the Seattle Firefighters Pension Board and found that, since the article was written
    47 more of us, including myself, have been diagnosed since July, 2008.
    That is an additional 4.5%, for a rolling total of 38.4%
    I’d like to have a group of ten people here stand up and represent this group of almost a thousand.
    Starting from your left, I’d like four of you to raise your hands. That’s the impact of cancer on the SFD.
    Here’s how it happens: No last names. Bob went to play golf one day and felt “a little off” stopped at the doctor on his way home. Dr ran some tests and found his body was riddled with cancer. He never went home from the hospital and died two weeks later. Jesse went to visit his future retirement residence in Arizona and blacked out at the airport. The doctors told him they’d found a dark spot on his brain. He passed away just recently.
    What does that mean for the future?
    More and more of us are being affected. By the time we live out our lives, will the total be 50, 60, or 70%?
    I say its possible.
  • As I mentioned, each year, while 100 firefighters die in the line of duty, hundreds more die from cancer that may or may not be reported as an on-duty death
    The incidence of cancer among us is much higher than the general population.
    As an example, throat cancer, like mine, 200% more likely if you are a firefighter.
    I spoke with a fellow survivor in the Spokane Fire Department
    He joined the dept with two buddies. All of them were hired together, trained together, and worked in the same house.
    All of them got throat cancer. One died. One was forced to retire, and one was still on the job when I spoke with him.
  • Here’s why I believe cancer is so preponderant among us.
  • Last December, I wrote an article that was published in Firehouse Magazine and on Firehouse On-line.
    I entitled it “We Danced With The Devil”
    I wanted to share my own experience with other firefighters, to hopefully prevent them from the same fate as me.
    It was important to document what I had gone through while it was still fresh in my mind. Your mind plays tricks on you and you begin to forget things that are too painful to remember.
    Normally, when you hear about someone getting cancer, you visit, call, email,
    Then, six months later, you hear whether they lived or died.
    You don’t hear much about those six months.
    I wanted to write about what happens in between diagnosis and outcome.
  • I got hundreds of emails from all over the US, Canada, even the UK and Africa. The magazine told me that almost 18000 people read the online story in only the first week
    Here is what they said, in their own words:
    Robert: The structure fire is out, there is steam in the air, and our people take off their PPE’s
    Chris: Since instituting SCBA during overhaul & filter cannisters for our Fire Marshals, we’ve met with risistence
    Chandra: Once our CO meters read below hazardous limits, re remove our regulators
    Kyle: We just get so overwhelmed, excited, or just want to be cool & we just don’t take every precaution
    Aileen: We don’t wear tanks during overhaul
    Ted: I never wore a mask in my formative years of firefighting and know I was subjected to carcinogens. I pray I don’t become the next victim; thoughts of cancer weigh on my mind every day.
    Larry: Don’t kid yourself by thinking that we are there in terms of firefighter safety.
    Ryan, we have a cowboy mentality here
    Brandt: Elected chief of my volunteer fire department. Instituted full PPE’s and SCBA’s in IDLH environments and overhauls. After 11 months, I was voted OUT and a new chief voted in. Now, things are back to the Good Old Days
    Do we still have a problem? I say, yes we do. Our problem is our culture.
  • JSo, I ask myself, “has my article helped?
    Here are some messages I received.
    Rick: Thank you for sharing your article; we’re making it required reading for all ff’s and stressing SCBA use during overhaul
    Jerry: Your article will make a difference in the way I tackle our next fire.
    Ty: I can honestly say your article changed the way I fight fire.
    Shawn: Thank you for the article. Now I don’t care if everyone thinks I’m the biggest ass in the department. SCBA’s WILL be worn during fires and overhaul.
    Mark: Thank you for your story. I will now ALWAYS wear my SCBA
    Roy: Your article has really brought home to me the importance of wearing breathing protection
    Chad: Thank you for telling the cold, hard truth
    John: Your article has saved lives
    Larry: Your article has given me the reason I needed: I just threw away my last cigar!
  • Remember when it was okay to smoke at the firehouse? Around kids? At hospitals? On airplanes?
    Remember when you could get away with drunk driving? Flying a plane drunk? Fighting fires drunk?
    Legal mandates: seat belt laws, smoking bans, PPE requirements
    Contractual mandates: wellness programs, tobacco prohibitions, etc.
    New blood: computer and technological skills, languages,
    Customs and social mores: peer pressure for using safety equipment, fitness trends, smoking and drinking guidelines,
    Science: greater knowledge about disease, illness, exposures. We KNOW what is in smoke now.
    Enlightened leadership is an outstanding example of change agency
  • The reason I’m here today is that I stand before you as a glowing example of how NOT to do something.
    One of my favorite novelists, William Gibson, has a character named Wilson, who did something really stupid on the playground.
    One of those things usually preceded by the words, “Hey everybody, watch this!”
    He killed himself on the very first try.
    Thereafter, the kids said anyone who did something like this “pulled a Wilson.”
    One of the nice things about being fire chief in places like Las Vegas and San Francisco is that you get to meet a lot of famous people.
    I met Robin Williams, Mohammed Ali, Elton John, Sharon Stone. Lots of folks.
    One day I met boxer Mike Tyson at the Forum Shops at Ceaser’s Palace.
    He was heavyweight champion at the time, and he was surrounded by about a half dozen of his entourage. They were buying up everything in sight on his tab. He didn’t buy anything for himself. My impression was that, while he wasn’t as tall as I’d imagined him to be, he is almost unbelievably WIDE. His back seemed to be as wide as a VW and his arms were like tree trunks. You have this impression of immense, barely contained latent power.
    OK, so why am I telling you this?
    You know, I meet people all the time who are fellow cancer survivors. We share immediate affinity, even intimacy.
    I met a guy at a conference recently who was introduced as “the latest guy to beat cancer.” I’ve seen others with lapel pins or T-shirts that say, “I kicked cancer’s ass!”
    But that’s not the way I remember it.
    While I admire their tanacity and celebrate their vitality, to me, being diagnosed with cancer was like waking up and finding myself in the ring with Iron Mike Tyson for the fight of your life. Suddenly, the bell rings and he’s coming for you. He’s HUGE. He seems invincible. You can tell by looking at him that he’s a stone killer. If he lands one good punch, you’re done. So, for 13 rounds, if you can go the distance, you run, you hide, you duck. You do the best you can to avoid him. Throw a punch? Are you kidding me? IF you manage to make it to the last bell, you crawl out of the ring, you leave a trail of blood. Body parts. You see, I don’t think you beat cancer, I think you escape with your life. If my cancer experience was a movie, it wouldn’t be Rocky. It would be something more like Jaws.
    (Story of Death)
    My point is that, if you survive cancer, you don’t walk away unscathed.
    You have physical scars, emotional scars. Yes, and spiritual scars.
    You come out a different person.
    For me, that means I do everything I can to spread the word, to warn other firefighters.
    That’s why I wrote the article and that’s why I’m here.
  • My advice is simple, and its nothing you haven’t heard before.
  • If you are unlucky enough to get cancer, but lucky enough to survive, you might be faced with having to prove that your cancer was duty-related.
    Here is an exerpt from the International Firefighter.
    Here in Washington, the cancers that are deemed presumptive include: brain cancer, malignant melanoma, leukemia, non Hodgkin’s lymphoma, bladder cancer, ureter cancer, and kidney cancer.
    As a nation, we have a long way to go in recognizing the ravages of cancer on firefighters.
    I know there are many of you who are fighting that good fight every day, and I commend and congratulate you.
    I know I’m lucky to be a survivor, and I thank God every single morning for another day with my wife and son.
    I continue to live the dream, but I know the threat is still out there.
    80% of the time, when you get a recurrence, it will be in the first two years.
    90% of the time, the recurrence happens within the first three years.
    When cancer comes back, it comes back with a vengance. It has come back for many of my friends.
    I have a Pavlovian response to hospital smells like hand disinfectant and cleaning supplies. I get a wave of nausea and feel lightheaded.
    The next time Death comes for me, she just might cross that threshold.
    I know that.
    I wanted all of you to know that too.
    So, change your lifestyle, if you have to.
    Protect yourselves and your fellow firefighters with every tool available to you.
    And I wish all of you long, happy lives.
    Thank you.
  • Firefighters and Cancer Mario H. Trevino

    1. 1. Firefighters and Cancer Mario H. Trevino Fire Chief, (retired)
    2. 2. Experience/Exposures • Seattle Fire Department: 1973-1996 •Las Vegas Fire Department: 1997-2001 •San Francisco Fire Department: 2001-2004 •Bellevue Fire Department: 2004-2008
    3. 3. National Fallen Firefighters Foundation Firefighter Mortality & Morbidity Statistics • 100 Line of Duty Firefighter Deaths Per Year • Thousands of Injuries • Tracking for causes: – Cardiac Arrest – Vehicle Accidents – Building Collapse – Smoke Inhalation • We don’t track CANCER • Why?
    4. 4. The Culture of the 1970’s Seattle Fire Department • Aggressive “interior attack” • SCBA’s available, but rarely used • Our heroes were macho “smoke-eaters” • Turnouts: one-layer treated canvas, wool liners (full turnouts only used at night) • One-layer leather gloves from hardware stores • Fibreglass helmets with nylon-webbing for impact • “Clean-ups” lasted for hours, no protection • Widespread Tobacco usage.
    5. 5. My Cancer Diagnosis: August, 2008 •Seattle PI Article; 1/3 of Seattle Firefighters Hired Before 1977 Have Developed Cancer
    6. 6. 975 Seattle Firefighters Hired Before 1977 •347 Had Cancer, Had Been Treated for Cancer, or Died from Cancer (33.8%). •47 Have Been Diagnosed Since July, 2008 (4.5%). • 38.4% Of Total Affected. •FUTURE DIAGNOSES? 50%, 60%, or even 70% Possible.
    7. 7. Cancer Incidence Among Firefighters • While 100 Firefighters Die Line-of-Duty Deaths Per Year, HUNDREDS More Die From Cancer that we may not know about. • Firefighters are 200% More Likely To Get Cancer Than General Population: – 300% Above Normal Rate for Lung Cancer – 200% Above Normal Rate for Throat Cancer – 150% Above Normal Rate for Pancreatic Cancer
    8. 8. Carcinogens in smoke • Common construction since the 1940’s; still widely used today • Widely used (75%) to treat lumber, discontinued in 2004 • Product of combustion: drywall products, spray-paint cans, etc. • Commonly found in diesel exhaust • Many, many more. Smoke is a ‘toxic soup” of carcinogens Asbestos Arsenic Formaldehyde Benzene Cyanide, Etc.
    9. 9. “Danced With The Devil” article •What do you do when you hear about someone who gets cancer? •You call •You visit •You send a card •Maybe flowers, fruit basket, books (depending on closeness) •Then, you wait. •Within six months: did they live or die? •We have an aversion to hearing too much about cancer •Almost a superstition •I wanted to write about the “in between” details that we normally don’t hear about. •I didn’t hold back on the brutal details: I wanted to have an impact on firefighters. •The mission: provide the warning that we never got in the 70’s
    10. 10. Do We Still Have A Problem? •Robert- California… •Chris- Prince William County… •Chandra- Ohio… •Kyle- Texas… •Aileen- Michigan… •Ted- San Francisco… •Larry- California… •Ryan- Washington… •Brandt, Texas… •AND Brian in New York, Paul in Anchorage, David in Indiana, Chris in Arizona, Frank in Los Angeles, Calvin in Utah, Tella in Virginia, Travis in Colorado, etc. etc. etc….. Yes. Our problem is still our culture.
    11. 11. Has The Article Helped? •In Their Own Words… •Rick •Jerry •Ty •Shawn •Mark •Roy •Chad •John •Larry
    12. 12. Cultural Change • Our culture is already changing all around us: – Smoking – Alcohol • Sources of the change in the fire service: – Legal mandates – Contractual requirements – “New blood” – Changing customs and social mores – Science and knowledge – LEADERSHIP!
    13. 13. Fire Service Culture: present day •Training is better •Apparatus is better •PPE’s are better •We are more informed about the hazards BUT •We still don’t wear our seat belts at all times while moving •We STILL don’t wear SCBA’s in all IDLH environments •While PPE’s (turnouts, gloves, hoods, helmets) are far better, we STILL don’t wear them (full turnouts, gloves, hoods) •We still don’t eat right, exercise enough, control stress, continue to use tobacco, and we don’t get medical evaluations.
    14. 14. Why Am I Here Today? I “pulled a Wilson” William Gibson Could You Go The Distance With “Iron Mike?”
    15. 15. PROTECTING YOURSELF FROM CANCER • Wear Your PPE’s! • Eat Healthy Foods • Reduce Stress • Exercise • Don’t Use Tobacco • Get Tested • Take Minor Infections Seriously • Find Peace and Faith
    16. 16. The International Firefighter • Oregon brain cancer, colon cancer, stomach cancer, testicular cancer, prostate cancer, multiple myeloma, non-Hodgkin's lymphoma, cancer of the throat or mouth, rectal cancer, breast cancer or leukemia Rhode Island disabling occupational cancer which develops as a result of the inhalation of noxious fumes or poisonous gases South Dakota impairment of health caused by cancer Tennessee any impairment of health of such fire fighter caused by disease or cancer resulting in hospitalization, medical treatment or any disability Texas cancer that may be caused by exposure to heat, smoke, radiation, or a known or suspected carcinogen as determined by the IARC Vermont cancer limited to leukemia, lymphoma, or multiple myeloma, and cancers originating in the bladder, brain, colon, gastrointestinal tract, kidney, liver, pancreas, skin, or testicles. Virginia Leukemia or pancreatic, prostate, rectal, throat, ovarian or breast Washington brain cancer, malignant melanoma, leukemia, non-Hodgkin's lymphoma, bladder cancer, ureter cancer, and kidney cancer Wisconsin skin, breasts, central nervous system or lymphatic, digestive, hematological, urinary, skeletal, oral or reproductive systems