NFPA Journal

By virtue of doing its job, the fire service has inadvertently created a devastatingly effective “carcinogen harvesting system,” according to architect Paul Erickson.

It works like this: Firefighters go out to a fire call where they spend hours immersed in toxic chemicals, which seep into their protective gear, trucks, and equipment. Then they bring this contaminated gear back to the station where it off-gases into the air and onto the surfaces where they eat, sleep, live, and work. “This cycle then repeats over the course of days, weeks, months, and years,” Erickson explains, increasing the levels of contamination in their living environment.

Exposure to carcinogens is the main culprit blamed for the alarmingly high rates of cancer in firefighters, which several studies have shown are substantially higher than cancer rates in the public at large. Millions of dollars and countless hours are being spent to address the issue through research, education, and new ways of doing things. That includes a hard look at how fire stations—the epicenter of this carcinogen harvesting system—are designed.

Erickson, who co-founded the Virginia-based firm LeMay Erickson Willcox Architects in 1986, has had a hand in more than 100 public safety building projects over his career, and since 2012 has been at the forefront of the emerging effort to reimagine firehouse design to control the spread of cancer-causing chemicals.

The first firehouse designed using these new concepts is now under construction in New Jersey, and Erickson said more are on the way. NFPA Journal spoke with Erickson to discuss these new fire station design concepts, what departments can do today—short of building a new station—to mitigate risks, and about his own battle with cancer over the last year.

When did the idea of designing firehouses to mitigate cancer risk first get on your radar?

Our interest in the subject grew out of our prior commitment to design stations for the health and well being of the crew, which is something we have focused on for the better part of 10 years. I was presented with some of the facts about firefighter cancer about five years ago and I felt challenged to design a station where incidents of cancer would be reduced. In 2012, Cindy Ell, president of the Firefighter Cancer Support Network, asked me why, with all the contamination present, don’t we apply containment concepts of HAZMAT incidents to fire stations. When I heard the question, it resonated in such a meaningful way that I’ve continued to develop the concepts on my own ever since.

In a nutshell, why are firehouses such hazardous environments?

Any incident that involves smoke also includes exposure to carcinogens and toxic chemicals. Any equipment and clothing taken into service in response to those calls is exposed to those contaminants. Unless a thorough decontamination process occurs on the scene, those contaminants are then conveyed back to the station. Unless you carefully and thoroughly decontaminate all the clothing, all the equipment, all the apparatus, and even your bodies by taking a shower, you are potentially allowing those contaminants to be spread within the station itself.

How can firehouse design help mitigate that exposure?

The premise is to separate spaces within the firehouse based on their exposure to contaminants. Areas associated with items that go out on a call—equipment, tools, personal protective equipment (PPE), apparatus—are categorized as hot-zone spaces. We group these spaces together and call them red areas. The living spaces, regardless of what they’re used for, are grouped together as safe zones, and we categorize those spaces as green areas and keep them totally separate from the red areas. We pay careful attention to the transition and movement back and forth between those red and green areas. They are separated by a yellow area where we set up places to wash hands. In the most current thinking, the yellow area has a route for returning firefighters to take off their contaminated clothes and work uniforms, take showers, and put on clean uniforms to return to service.

Separating contaminated and non-contaminated areas makes intuitive sense, but seems difficult in practice. I imagine the yellow zone is the hardest to design. What design elements and processes exist to ensure contaminants don’t get through to the green zone?

We want to make it as easy and as obvious as possible for the firefighters. One of the things we have are boot wash and hand wash alcoves set right on the pathway from the apparatus bay to the living quarters, so someone doesn’t have to go out of their way to get clean. Those would be things you use on a daily basis walking back and forth between the bay and living quarters, whether on a call or not. After a call, we tried to develop a new protocol that allows returning firefighters to enter a decontamination room and send the gear in one direction, to laundry and storage. Personnel are sent in another direction, to a private bathroom with a sink, toilet, and shower, where they can rinse that off all the contaminants that may have penetrated through the seams of their PPE. Then they get into clean uniforms and get back into service. That is a revolutionary concept. It doesn’t sound complicated, but most stations are not configured that way because people have not historically recognized the link between exposure to contaminants and the risk of cancer.

You’ve presented these ideas across the country, including last year’s NFPA Conference & Expo. What feedback have you received about these ideas?

The response has been positive across the board—people seem stimulated by the ideas. I’ve heard people say things like, ‘This is crazy, why haven’t we been doing this for years?” The fact that we are using a familiar concept like HAZMAT control and applying it to station design is something people readily understand. Occasionally, I have seen some elements of doubt that stem, I think, from a sense of the limitation of what is possible. We are pushing against well-established departmental protocols, and sometimes people feel like they just can’t make a change. That’s probably the biggest challenge. But I don’t want to emphasize that too much, because I think the vast majority of people who get exposed to this say, “Hey, there are some really interesting ideas in here and we can do something.” I would propose that we can make a change, that we are obligated to make a change, and even a small change is worth the effort it requires.

What has the interest level been from fire department leaders? Do you get the sense that these ideas are being put into practice?

My sense is this is becoming more mainstream, just like how the cancer issue has moved from the fringes to center stage. I’ve talked to a number of colleagues across the country and they are aware of these concepts and are adopting them in their discussions with clients. A number of our clients are telling us they want to include these strategies in their facilities. There is nothing more important to them than saving the lives of comrades, and this is something we can all unite behind. There was a fire chief who heard my talk in May and called me a month later to say he wanted to talk more about this concept and asked us to come visit. In the interim he told me about what his department had done to change already, and it was clear that the chief had paid careful attention to the presentation and that it had resonated with him. He went back and made numerous changes within just a couple weeks of the presentation.

Most firehouses today were built when contamination control wasn’t at the forefront of firefighter safety. What design elements in a typical firehouse concern you most?

It’s still common to see PPE stored in the apparatus bay, sometimes hanging on hooks on the wall, sometimes in lockers on the wall. That is probably the number-one issue that gets my attention, because any kind of PPE that has been exposed to carcinogens will off-gas unless it has been thoroughly cleaned, and most of the time that doesn’t happen. That off-gassing creates a hostile environment for anybody working there.

The PPE itself is also potentially being exposed to additional contaminants if there isn’t a diesel exhaust control system in the apparatus bay. There is a chance for contaminants to become embedded in the interior of the PPE. According to the Firefighter Cancer Support Network, for every five degrees your body temperature rises, the absorption rate of these chemicals through your skin increases 400 percent. This means that when you start to sweat on the fireground, the contaminants on the inside of your PPE become more readily absorbed through your skin and into your body. So PPE should be stored in a separate room with a door, ideally with a dedicated mechanical unit that would dry out the gear and exhaust any carcinogens to the exterior of the building.

Since it’s not financially feasible for most departments to build new fire stations, what are some steps departments can take to mitigate the risks in their current buildings?

Perhaps the single best way to control the spread of contaminants is to make sure people wash and sanitize their hands. We advocate for putting a hand sink next to the entry into the living quarters. If that’s not possible, you could install a hand sanitizer. That is the single best way to control the spread of contaminants.

Secondly, think about the storage of materials. If something is intended for use in a hot zone like the apparatus bay, it should be stored in the hot zone. The last thing you want to do is store all of your products out in the apparatus bay and pick up your supplies, together with contaminants, into the clean living zones for use.

What else can departments do right now for little or no cost?

I see a lot of firehouses with vending and ice machines and exercise equipment in the apparatus bay. Again, these bays are contaminated, and those contaminants are deposited on various surfaces and released into the air. That puts contaminants in direct contact with the ice, or potentially on surfaces of vending machine food which is then ingested. Strenuous physical workouts like lifting weights and using cardio machines in a contaminated environment is also dangerous. You can have surface contact with contaminated equipment that can be absorbed through skin, and you are probably sweating, so the rate of absorption is increased. You are breathing at an accelerated rate, so any type of airborne contaminants are going deep into your lungs. If you are drinking water to stay hydrated during the workout, you are potentially ingesting contaminants. Getting exercise equipment out of apparatus bays should be a top priority.

You were diagnosed with cancer last year. How are you, and how has the diagnosis impacted your work?

I was talking about cancer control in firehouses for three years before I was diagnosed with head and neck cancer about a year ago. When someone says you have cancer, it is a very sobering experience as statistics suddenly become very personal. I am blessed to have amazing doctors, and the radiation and chemotherapy treatment has been highly effective. Right now, I am cancer free and very grateful. I know many people don’t have the same story to share. It made me appreciate even more the challenges cancer creates for spouses, children, business partners, and of course, individuals. It changes your life, and fortunately for me my story is a good one. I have more compassion, more understanding, and more zeal to make a difference. To me, life is all about leaving the world a better place, and this topic allows me to try to do that.

JESSE ROMAN is associate editor for NFPA Journal. Top Photograph: Lemay Erickson Willcox Architects