Fireground Exposure of Firefighters: A Literature Review

Fireground Exposure of Firefighters: A Literature Review Final Report by: Sara A. Jahnke, Ph.D. Nattinee Jitnarin, Ph.D. Christopher M. Kaipust, Ph.D., M.P.H. Brittany S. Hollerbach, Ph.D. Brittni M. Naylor, Ph.D., M.P.H. Carolyn Crisp, M.P.H. Center for Fire, Rescue and EMS Health Research NDRI Ventures Leawood, Kansas, USA May 2021 © 2021 Fire Protection Research Foundation 1 Batterymarch Park, Quincy, MA 02169 | Web: www.nfpa.org/foundation | Email: [email protected]

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Foreword

There is growing concern in the fire and life safety community that repeated exposures to contamination at the fire scene, combined with the subsequent post fire scene exposures to contaminated clothing, tools, apparatus, and stations are likely causing increased rates of cancer in firefighters. Moreover, contamination has broader negative effects on health than just cancer. A number of other chronic health disorders could be related to broad chemical exposures. While there have been studies on firefighter exposure, there is not yet a complete understanding of what firefighters are exposed to during firefighting and training as each of the existing studies focuses on a limited number of contaminants/toxicants and/or exposure scenarios. A comprehensive compilation and review of global literature is needed to provide a focus on this topic in support of ongoing efforts to address firefighter health and safety. The objective of the project was to assimilate the existing peer reviewed literature into a framework to understand the matrix of carcinogen exposure risks firefighters face in the course of their job tasks on the fireground. This examination focused specifically on carcinogenic exposure on the fire ground. The Fire Protection Research Foundation expresses gratitude to the report authors Sara A. Jahnke, Ph.D., Nattinee Jitnarin, Ph.D., Christopher M. Kaipust, Ph.D., M.P.H., Brittany S. Hollerbach, Ph.D., Brittni M. Naylor, Ph.D., M.P.H., Carolyn Crisp, MPH who are with Center for Fire, Rescue, and EMS Health Research NDRI Ventures located in Leawood, Kansas, USA. The Research Foundation appreciates the guidance provided by the Project Technical Panelists, the funding provided by the National Fire Protection Association, and all others that contributed to this research effort. The content, opinions and conclusions contained in this report are solely those of the authors and do not necessarily represent the views of the Fire Protection Research Foundation, NFPA, Technical Panel or Sponsors. The Foundation makes no guaranty or warranty as to the accuracy or completeness of any information published herein. About the Fire Protection Research Foundation

The Fire Protection Research Foundation plans, manages, and communicates research on a broad range of fire safety issues in collaboration with scientists and laboratories around the world. The Foundation is an affiliate of NFPA.

About the National Fire Protection Association (NFPA)

Founded in 1896, NFPA is a global, nonprofit organization devoted to eliminating death, injury, property and economic loss due to fire, electrical and related hazards. The association delivers information and knowledge through more than 300 consensus codes and standards, research, training, education, outreach and advocacy; and by partnering with others who share an interest in furthering the NFPA mission. All NFPA codes and standards can be viewed online for free. NFPA's membership totals more than 65,000 individuals around the world.

http://www.nfpa.org/foundation

http://www.nfpa.org/codes-and-standards/free-access

http://www.nfpa.org/member-access

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Keywords: firefighter, investigator, instructor, fireground, exposure, carcinogen Report number: FPRF-2021-05 Project Manager: Sreenivasan Ranganathan

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Project Technical Panel

Jeff Burgess, University of Arizona (AZ)

Miriam Calkins, NIOSH (OH)

Robert Fash, NFPA (MA)

Gavin Horn, UL FSRI (MD)

Randy Krause, Port of Seattle Fire Department & NFPA 1500 TC (WA)

Birgitte Messerschmidt, Applied Research, NFPA & Sponsor Representative (MA)

Jeremy Metz, West Metro Fire Rescue (CO)

Tim Tomlinson, Addison Fire Dept., & NFPA 1851 TC Chair (TX)

Project Sponsors

This research is sponsored by the National Fire Protection Association

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Fireground Exposure of Firefighters: A Literature Review

Prepared for the Fire Protection Research Foundation

Sara A. Jahnke, Ph.D. Nattinee Jitnarin, Ph.D.

Christopher M. Kaipust, Ph.D., M.P.H. Brittany S. Hollerbach, Ph.D.

Brittni M. Naylor, Ph.D., M.P.H. Carolyn Crisp, M.P.H.

Center for Fire, Rescue & EMS Health Research

NDRI Ventures

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Table of Contents

List of Tables ............................................................................................................................................. 3

List of Figures ........................................................................................................................................... 5

Executive Summary ................................................................................................................................. 6

Background ............................................................................................................................................... 7

Objective .................................................................................................................................................... 7

Methods ...................................................................................................................................................... 7

Search Criteria ...................................................................................................................................... 7

Inclusion Criteria .................................................................................................................................. 7

Exclusion Criteria ................................................................................................................................. 8

Approach ................................................................................................................................................ 8

Framework Development ................................................................................................................... 8

Results ........................................................................................................................................................ 8

Gap Analysis, Biomonitoring .............................................................................................................. 18

Gap Analysis, Environmental Monitoring ........................................................................................ 19

BIOMONITORING TABLES .................................................................................................................. 25

ENVIRONMENTAL MONITORING ....................................................................................................... 67

WORLD TRADE CENTER – ENVIRONMENTAL MONITORING ................................................. 167

References ............................................................................................................................................. 172

Appendix A. Excluded Studies ......................................................................................................... 185

Appendix B. Excluded (Non-relevant) World Trade Center Studies ....................................... 192

Appendix C. Coding Sheets .............................................................................................................. 198

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List of Tables

Table 1 Included Articles ............................................................................................................................. 11

Table 2 Gap Analysis, Biomonitoring .......................................................................................................... 18

Table 3 Gap Analysis, Environmental Monitoring ...................................................................................... 19

Table 4 Summary of Overall Findings ......................................................................................................... 22

Table 5 Biomonitoring: Benzene (Group 1) ................................................................................................ 25

Table 6 Biomonitoring: Specified PAHs (Group 1) ...................................................................................... 29

Table 7 Biomonitoring: PCBs and Dioxin-like PCBs (Group 1)..................................................................... 33

Table 8 Biomonitoring: Dioxins & Furans (Group 1) ................................................................................... 36

Table 9 Biomonitoring: Guaiacol (Group 2A) .............................................................................................. 38

Table 10 Biomonitoring: Organochlorines (Group 2A) ............................................................................... 39

Table 11 Biomonitoring: 1,4 Dichlorobenzene (Group 2B) ......................................................................... 41

Table 12 Biomonitoring: Organochlorines (Group 2B) ............................................................................... 42

Table 13 Biomonitoring: PAHs – Phthalates (Group 2B) ............................................................................. 44

Table 14 Biomonitoring: Phenolic Compounds (Group 2B) ........................................................................ 45

Table 15 Biomonitoring: Perfluoroalkyl Acids (PFAAs; Group 2B) .............................................................. 46

Table 16 Biomonitoring: Dioxins & Furans (Group 2B) ............................................................................... 48

Table 17 Biomonitoring: Unspecified PAHs ................................................................................................ 50

Table 18 Biomonitoring: Heavy Metals ....................................................................................................... 64

Table 19 Environmental Monitoring: 1,3-Butadiene (Group 1) .................................................................. 67

Table 20 Environmental Monitoring: 2,3,4,7,8-Pentachlorodibenzofuran (Group 1) ................................ 68

Table 21 Environmental Monitoring: 2,3,7,8-Tetrachlorodibenzo-P-dioxin (Group 1) .............................. 68

Table 22 Environmental Monitoring: Asbestos (Group 1) .......................................................................... 69

Table 23 Environmental Monitoring: Benzene (Group 1) ........................................................................... 70

Table 24 Environmental Monitoring: Benzo[a]pyrene (Group 1) ............................................................... 76

Table 25 Environmental Monitoring: Formaldehyde (Group 1) ................................................................. 85

Table 26 Environmental Monitoring: Pentachlorophenol (Group 1).......................................................... 90

Table 27 Environmental Monitoring: Respirable Particulate Matter (Group 1) ......................................... 91

Table 28 Environmental Monitoring: Trichloroethylene (Group 1) ............................................................ 95

Table 29 Environmental Monitoring: Acrolein (Group 2A) ......................................................................... 96

Table 30 Environmental Monitoring: Cyclopenta[cd]pyrene (Group 2A) ................................................... 99

Table 31 Environmental Monitoring: Dibenz[a,h]anthracene (Group 2A) ............................................... 100

Table 32 Environmental Monitoring: Dichloromethane (methylene chloride; Group 2A)....................... 104

Table 33 Environmental Monitoring: Styrene (Group 2A) ........................................................................ 105

Table 34 Environmental Monitoring: Tetrabromobisphenol (Group 2A) ................................................. 107

Table 35 Environmental Monitoring: Tetrachloroethylene (perchloroethylene; Group 2A) ................... 108

Table 36 Environmental Monitoring: Acetaldehyde (Group 2B) .............................................................. 109

Table 37 Environmental Monitoring: Benz[a]anthracene (Group 2B) ...................................................... 111

Table 38 Environmental Monitoring: Benzo[b]fluoranthene (Group 2B) ................................................. 119

Table 39 Environmental Monitoring: Benzo[c]phenanthrene (Group 2B) ............................................... 125

Table 40 Environmental Monitoring: Benzo[j]fluoranthene (Group 2B) .................................................. 126

Table 41 Environmental Monitoring: Benzo[k]fluoranthene (Group 2B) ................................................. 127

Table 42 Environmental Monitoring: Chrysene (Group 2B) ..................................................................... 133

Table 43 Environmental Monitoring: Crotonaldehyde (Group 2B) .......................................................... 141

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Table 44 Environmental Monitoring: Di(2-ethylhexyl)phthalate (Group 2B) ........................................... 143

Table 45 Environmental Monitoring: Dichloromethane (Group 2B) ........................................................ 145

Table 46 Environmental Monitoring: Indeno[1,2,3-cd]pyrene (Group 2B) .............................................. 147

Table 47 Environmental Monitoring: Isoprene (Group 2B) ...................................................................... 154

Table 48 Environmental Monitoring: Methyl Isobutyl Ketone (Group 2B) .............................................. 155

Table 49 Environmental Monitoring: Naphthalene (Group 2B) ............................................................... 157

Table 50 Environmental Monitoring: Perfluorooctanoic Acid (Group 2B) ............................................... 165

Table 51 Environmental Monitoring: Trichlorophenol (Group 2B) .......................................................... 166

Table 52 World Trade Center Environmental Monitoring ........................................................................ 167

Table 53 Excluded “Other” Exposure Articles ........................................................................................... 185

Table 54 Table of Excluded World Trade Center Articles ......................................................................... 192

Table 55 Chemical Name & Variable Name .............................................................................................. 198

Table 56 Codebook ................................................................................................................................... 202

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List of Figures

Figure 1 PRISMA Flow Diagram ................................................................................................................... 10

Figure 2 Publications Over Time ................................................................................................................. 17

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Executive Summary

There has been significant interest in the relationship between occupational exposures of firefighters and the increased risk of cancers they face. Understanding the fireground exposures to carcinogens is an important mechanistic link. Given the significant growth in research on this topic, the Fire Protection Research Foundation undertook the task of developing a systematic review of existing literature to outline the current state of the science, summarize the findings, and identify gaps in the literature. A total of 75 articles were included in the analysis with most (68%) being conducted in the last decade.

Biomonitoring studies have been conducted that identified the presence of known human carcinogens (Group 1: benzene, PAHs, PCBs, dioxins, furans, and dioxin-like PCBs), probable carcinogens (Group 2A: guaiacol, organochlorines), and possible carcinogens (Group 2B: 1,4 dichlorobenzene, organochlorines, phthalates, phenolic compounds, PFAAs, heavy metals) on the fireground. Similarly, environmental monitoring studies have found known carcinogens (Group 1: 1,3 butadiene, 2,3,4,7,8 pentachorodibenzofuran, 2,3,7,8-tetrachlorodibenzo-P-dioxin, asbestos, benzene, benzo[a]pyrene, formaldehyde, pentachlorophenol, trichloroethylene), probable carcinogens (Group 2A: acrolein, cyclopenta[cd]pyrene, dibenz[a,h]anthracene, styrene, perchloroethylene), and possible carcinogens (Group 2B: acetaldehyde, benz[a]anthracene, benzo[b]fluoranthene, benzo[c]phenanthrene, benzo[j]fluoranthene, benzo[k]fluoranthene, chrysene, di(2-ethylhexyl)phthalate, crotonaldehyde, dichloromethane, indeno[1,2,3-cd]pyrene, isoprene, methyl isobutyl ketones, naphthalene, trichlorophenol) on the fireground.

For biomonitoring studies, significant gaps were identified for fire instructors, fire investigators, aircraft rescue and firefighting (ARFF) firefighters, industrial firefighters, and recruits. It was also noted that future research should focus on examining the impact of the changing fire environment as the products of combustion in fires have evolved over the years.

The gap analysis identified several areas of needed research within environmental monitoring including studies of carcinogens through wildland fires, exposures through electrical/transformer fires, ARFF exposures, and training fires. Additional research by type of data collection such as through gear samples and passive sampling devices also were identified. Finally, additional research on major events is needed through real-time environmental monitoring.

Clearly, the fireground – by its very nature – is a high-risk environment with a number of carcinogenic exposures for any responder on the scene. Understanding these risks is an important foundation for understanding health and environmental impacts and for identifying and promoting mitigation and prevention efforts.

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Background Research on the epidemiologic relationship between cancer and firefighting has been a focus of several recent cohort (Daniels et al., 2013), registry (Lee et al., 2020; Pukkala et al., 2014; Tsai et al., 2015) and meta-analytic (Jalilian et al., 2019; LeMasters et al., 2006; Soteriades et al., 2019) studies. While overall cancer risk is estimated to be increased around 9-14% compared to the general population, increased risk for individual cancers is often much higher and has been found to be increased as much as 100% for mesothelioma (Daniels et al., 2013). Alarmingly, firefighters have been found to develop cancer at younger ages than the general population (Lee et al., 2020). Current studies such as the Federal Emergency Management Agency (FEMA)-funded prospective multicenter Fire Fighter Cancer Cohort Study (ffccs.org) and the National Firefighter Registry (NIOSH, 2020) will further elucidate the relationships between exposures and risk with more detail. Beyond cancer, exposures also have implications for firefighter health including cardiovascular (Kales & Smith, 2017), respiratory (Burgess et al., 2001), and reproductive outcomes for both female (Evanoff & Rosenstock, 1986; Jahnke et al., 2018; Kehler et al., 2018; McDiarmid et al., 1991) and male (Petersen et al., 2019) firefighters. Complementing the compelling evidence for the increased risk of cancers among firefighters, a wide variety of exposure studies have been published in the last 10 years which supplement earlier studies. A growing number of studies are examining known and suspected carcinogens present on the fireground (Baxter et al., 2014; K. W. Fent et al., 2014, 2015, 2017; Keir et al., 2017, 2020b; Kirk & Logan, 2015a; Robinson et al., 2008). Studies vary significantly in terms of data collection methods (e.g., biological sampling, active or passive air sampling, personal sampling devices such as a silicone dosimeter), type of incident (e.g., wildland fire, room and contents fire, training, vehicle fire, hazmat incident), and locations. In particular, there are likely regional differences as building materials vary both by locale and time of construction (e.g., legacy vs. modern construction). Understanding the nuances of exposures and risk in the literature has implications for both prevention and intervention efforts for our nation’s firefighters. In addition, understanding exposures has repercussions for cancer presumption on a regional basis and for individual workers’ compensation cases for firefighters.

Objective The objective of the project was to assimilate the existing peer reviewed literature into a framework to understand the matrix of carcinogen exposure risks firefighters face in the course of their job tasks on the fireground. This examination focused specifically on carcinogenic exposure on the fireground.

Methods

Search Criteria

The research team did a keyword search in May 2020 including the terms “fire”, “firefighter”,

“arson investigator”, “arson investigation”, “fire trainer”, “fire instructor”, “airport fire”, and “airport

firefighter” cross-referenced with “exposure” and “carcinogen” using PubMed and Google

Scholar.

Inclusion Criteria

Eligible articles included: any peer-reviewed published journal article that reported specific

chemicals (or groups of chemicals) in body fluids (blood, urine, semen, and breastmilk) or

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monitored in the air attributed to fire smoke exposure. Only chemical exposures specific to the

fireground were included. We also searched the references of key articles, including the 2010

IARC monograph and Stull et al., 2018 and Engelsman et al 2020.

Exclusion Criteria

Articles were excluded if they did not specifically examine carcinogenic exposure on the

fireground (i.e.: sound, noise, hearing loss, etc.). Chemicals such as carbon monoxide, hydrogen

cyanide, etc. that have not been deemed carcinogenic according to IARC were not included. The

larger group of perfluoroalkyl substances (PFAS) was excluded as it is not classified as a

carcinogenic compound by IARC. However, perfluorooctanoic acid (PFOA) and perfluorooctane

sulfonate (PFOS) were included as they are classified by IARC as carcinogenic. Articles that

examined breath, hair, fingernails, and saliva were also excluded due to the confounding effects

of environmental contamination or lack of sensitivity in analysis (Engelsman et al., 2020). Studies

also were excluded if they only examined health impacts of occupational exposure (i.e.: lung

disease). Studies examining major events were excluded as they often covered fire and non-fire

events (i.e.: Oklahoma City bombing, large-scale, non-fire disasters). However, the review panel

requested a review of articles specific to the World Trade Center (9/11) environment. Finally, the

search was limited to those published before the September 2020 date of the search.

Approach

Each study had one set of study level variables that were applied to both biomonitoring and environmental monitoring. Coding forms were developed separately for biomonitoring and environmental monitoring given the differences that made naming and sorting criteria consistent across types difficult. Each study had coding sheets for measurements reported (e.g., biomonitoring only, environmental monitoring only, or both). Framework Development

The framework was developed through an iterative process. The initial framework was based on the categorizations outlined in previous publications (International Agency for Research on Cancer (IARC) 2010; Fire Protection Research Foundation 2019; Stull et al. 2018; Engelsman et al., 2020) with categorizations by type of fire (e.g. wildland, residential, training, vehicle, hazmat, etc.) stratified by type of position (e.g., instructor, structural firefighter). Categories were divided by type of measurement tool used (e.g., active air monitoring, blood, silicone dosimeter) or countries and/or regions where assessments were taken. As the literature review progressed, additional strata were added as they were discovered. Upon review, and in consultation with the Fire Protection Research Foundation (FPRF) team, similar categories/themes were collapsed as deemed appropriate with notes being made on category definitions, inclusion, and exclusion criteria. Categories not chosen as strata were included as variables tracked for each publication.

Results

Our initial search returned 4,093 records and 409 references from the additional key articles. After

these were combined, a total of 590 duplicate titles were excluded, yielding 3,912 articles (title

and abstract). After screening for relevance, 3,369 records were excluded due to irrelevance

(titles or abstracts did not include firefighters and/or did not examine exposures relevant to this

study). A total of 543 full-text articles were further assessed for eligibility, and 72 articles were

included for the systematic review. Of the 471 articles that were removed, 330 were irrelevant

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(did not include firefighters or did not include chemical exposures in line with this examination);

65 were specific to the World Trade Center disaster and did not specifically measure chemical

exposure on the fireground; 28 were review articles; 14 were not available in English; 12 were

conference abstracts; eight were not accessible (i.e., only citation provided, no full-text article

found); six were from theses or dissertations; six were technical reports; and two were relevant

but not meeting inclusion criteria. Upon further examination of the non-English articles, it was

determined by the abstracts that 13 were irrelevant to this examination and one, though potentially

relevant, was not available in English. Three additional articles were added based on panel

recommendation for a total of 75 final included articles.

Tables are divided into biomonitoring and environmental monitoring. Within each category, tables

are groups by IARC chemical classification. Group 1 chemicals are defined by IARC as

“carcinogenic to humans”. Group 2A are “probably carcinogenic to humans”. Group 2B are

“possibly carcinogenic to humans” and Group 3 are “not classifiable as to their carcinogenicity to

humans.”

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram

Figure 1 PRISMA Flow Diagram

Records identified through database

searching

(n = 4,093)

Scre

enin

g In

clu

ded

El

igib

ility

Id

enti

fica

tio

n

Additional records identified through

other sources

(n = 409)

Records after duplicates removed

(n = 3,912)

Records screened

(n = 3,912)

Records excluded

(n = 3,369)

Full-text articles assessed for

eligibility

(n = 543)

Full-text articles excluded, with

reasons

(n = 471)

-Relevance (n = 330)

-WTC (n = 65)

-Review (n = 28)

-Not in English (n = 14)

-Conference abstract (n = 12)

-Not accessible (n = 8)

-Thesis/Dissertation (n = 6)

-Report (n = 6)

-Not mtg incl criteria (n = 2)

-Letter to editor (n = 1)

Studies included in

qualitative synthesis

(n = 72)

Final studies included in

quantitative synthesis (n =

75); 3 studies added by panel

suggestion

From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses:

The PRISMA Statement. PLoS Med 6(7): e1000097. doi:10.1371/journal.pmed1000097

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Table 1 Included Articles

Date Authors Title Journal

1972 Hill TA, Siedle AR, Perry R. Chemical hazards of a fire-fighting training environment

Am Ind Hyg Assoc J

1985 Atlas EL, Donnelly KC, Giam CS, McFarland AR.

Chemical and biological characterization of emissions from a fireperson training facility

Am Ind Hyg Assoc J

1988 Brandt-Rauf PW, Fallon LF Jr, Tarantini T, Idema C, Andrews L.

Health hazards of fire fighters: exposure assessment

Br J Ind Med

1991 J. Jankovic, W. Jones, J. Burkhart, and G. Noonan

Environmental Study of Firefighters Ann. Occup Hyg

1992 Materna BL, Jones JR, Sutton PM, Rothman N, Harrison RJ.

Occupational exposures in California wildland fire fighting

Am Ind Hyg Assoc J

1997 Feunekes FD, Jongeneelen FJ, vd Laan H, Schoonhof FH.

Uptake of polycyclic aromatic hydrocarbons among trainers in a fire-fighting training facility

Am Ind Hyg Assoc J

1997 Lindqvist-Virkamaki, S; Riihimaki, V; Hakala, E; Jarventaus, H;

Evaluation of the risk of exposure to fumes for fire fighter instructors

Työ ja ihminen

1997 Moen BE, Ovrebo¸ S. Assessment of exposure to polycyclic aromatic hydrocarbons during firefighting by measurement of urinary 1-hydroxypyrene

J Occup Environ Med

2000 Bolstad-Johnson DM, Burgess JL, Crutchfield CD, Storment S, Gerkin R, Wilson JR.

Characterization of firefighter exposures during fire overhaul

AIHAJ

2001 Austin CC, Wang D, Ecobichon DJ, Dussault G.

Characterization of volatile organic compounds in smoke at experimental fires

J Toxicol Environ Health A

2001 Burgess JL, Nanson CJ, Bolstad-Johnson DM, Gerkin R, Hysong TA, Lantz RC, Sherrill DL, Crutchfield CD, Quan SF, Bernard AM, Witten ML.

Adverse respiratory effects following overhaul in firefighters

J Occup Environ Med

2002 Caux C, O'Brien C, Viau C. Determination of firefighter exposure to polycyclic aromatic hydrocarbons and benzene during fire fighting using measurement of biological indicators

Appl Occup Environ Hyg

2002 Kelly KJ, Connelly E, Reinhold GA, Byrne M, Prezant DJ.

Assessment of health effects in New York City firefighters after exposure to polychlorinated biphenyls (PCBs) and polychlorinated dibenzofurans (PCDFs): the Staten Island Transformer Fire Health Surveillance Project

Arch Environ Health

2002 Lioy PJ, Weisel CP, Millette JR, Eisenreich S, Vallero D, Offenberg J, Buckley B, Turpin B, Zhong M, Cohen MD, Prophete C

Characterization of the Dust/Smoke Aerosol that Settled East of the World Trade Center (WTC) in Lower Manhattan after the Collapse of the WTC 11 September 2001

Environ Health Perspect

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2002 Schecter A, Pavuk M, Amirova DA, Grosheva EI, PÃ¤pke, Ryan JJ, Adibi J, Piskac AL.

Characterization of dioxin exposure in firefighters, residents, and chemical workers in the Irkutsk Region of Russian Siberia

Chemosphere

2003 Edelman P, Osterloh J, Pirkle J, Caudill SP, Grainger J, Jones R, Blount B, Calafat A, Turner W, Feldman D, Baron S.

Biomonitoring of Chemical Exposure among New York City Firefighters Responding to the World Trade Center Fire and Collapse


2004 Pleil JD, Vette AF, Johnson BA, Rappaport SM

Air levels of carcinogenic polycyclic aromatic hydrocarbons after the World Trade Center disaster

PNAS

2004 Reinhardt TE, Ottmar RD. Baseline measurements of smoke exposure among wildland firefighters

J Occup Environ Hyg

2008 Robinson MS, Anthony TR, Littau SR, Herckes P, Nelson X, Poplin GS, Burgess JL.

Occupational PAH exposures during prescribed pile burns

Ann Occup Hyg

2009 Al-Malki AL. Serum heavy metals and hemoglobin related compounds in Saudi Arabia firefighters

J Occup Med Toxicol

2009 Neitzel R, Naeher LP, Paulsen M, Dunn K, Stock A, Simpson CD.

Biological monitoring of smoke exposure among wildland firefighters: a pilot study comparing urinary methoxyphenols with personal exposures to carbon monoxide, particular matter, and levoglucosan

J Expo Sci Environ Epidemiol

2009 Reisen F, Brown SK. Australian firefighters' exposure to air toxics during bushfire burns of autumn 2005 and 2006

Environ Int

2010 de Perio MA, Durgam S, Caldwell KL, Eisenberg J.

A health hazard evaluation of antimony exposure in fire fighters

J Occup Environ Med

2010 Miranda, AI; Martins, V; Cascão, P; Amorim, JH; Valente, J; Tavares, R; Tchepel, O; Borrego, C; Cordeiro, CR; Ferreira, AJ;

Monitoring fire-fighters’ smoke exposure and related health effects during Gestosa experimental fires

WIT Transactions on Ecology and the Environment

2011 Fent KW, Evans DE. Assessing the risk to firefighters from chemical vapors and gases during vehicle fire suppression

J Environ Monit

2011 Hsu JF, Guo HR, Wang HW, Liao CK, Liao PC.

An occupational exposure assessment of polychlorinated dibenzo-p-dioxin and dibenzofurans in firefighters

Chemosphere

2011 Reisen F, Hansen D, Meyer CP. Exposure to bushfire smoke during prescribed burns and wildfires: firefighters' exposure risks and options

Environ Int

2012 Laitinen J, Makela M, Mikkola J, Huttu I. Firefighters' multiple exposure assessments in practice

Toxicol Lett

2013 Adetona O, Simpson CD, Onstad G, Naeher LP.

Exposure of wildland firefighters to carbon monoxide, fine particles, and levoglucosan

Ann Occup Hyg

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2013 Naeher LP, Barr DB, Adetona O, Simpson CD.

Urinary levoglucosan as a biomarker for woodsmoke exposure in wildland firefighters

Int J Occup Environ Health

2013 Shaw SD, Berger ML, Harris JH, Yun SH, Wu Q, Liao C, Blum A, Stefani A, Kannan K.

Persistent organic pollutants including polychlorinated and polybrominated dibenzo-p-dioxins and dibenzofurans in firefighters from Northern California

Chemosphere

2013 Smith WR, Montopoli G, Byerly A, Montopoli M, Harlow H, Wheeler AR 3rd.

Mercury toxicity in wildland firefighters Wilderness Environ Med

2014 Alexander BM, Baxter CS. Plasticizer contamination of firefighter personal protective clothing--a potential factor in increased health risks in firefighters

J Occup Environ Hyg

2014 Baxter CS, Hoffman JD, Knipp MJ, Reponen T, Haynes EN.

Exposure of firefighters to particulates and polycyclic aromatic hydrocarbons

J Occup Environ Hyg

2014 Fabian, Thomas Z; Borgerson, Jacob L; Gandhi, Pravinray D; Baxter, C Stuart; Ross, Clara Sue; Lockey, James E; Dalton, James M;

Characterization of firefighter smoke exposure

Fire Technology

2014 Fent KW, Eisenberg J, Snawder J, Sammons D, Pleil JD, Stiegel MA, Mueller C, Horn GP, Dalton J.

Systemic exposure to PAHs and benzene in firefighters suppressing controlled structure fires

Ann Occup Hyg

2014 Gaughan DM, Siegel PD, Hughes MD, Chang CY, Law BF, Campbell CR, Richards JC, Kales SF, Chertok M, Kobzik L, Nguyen PS, O'Donnell CR, Kiefer M, Wagner GR, Christiani DC.

Arterial stiffness, oxidative stress, and smoke exposure in wildland firefighters

Am J Ind Med

2014 Laitinen JA, Koponen J, Koikkalainen J, Kiviranta H.

Firefighters' exposure to perfluoroalkyl acids and 2-butoxyethanol present in firefighting foams

Toxicol Lett

2015 Dobraca D, Israel L, McNeel S, Voss R, Wang M, Gajek R, Park JS, Harwani S, Barley F, She J, Das R.

Biomonitoring in California firefighters: metals and perfluorinated chemicals

J Occup Environ Med

2015 Kirk KM, Logan MB. Firefighting instructors' exposures to polycyclic aromatic hydrocarbons during live fire training scenarios

J Occup Environ Hyg

2015 Kirk KM, Logan MB. Structural Fire Fighting Ensembles: Accumulation and Off-gassing of Combustion Products

J Occup Environ Hyg

2015 Park JS, Voss RW, McNeel S, Wu N, Guo T, Wang Y, Israel L, Das R, Petreas M.

High exposure of California firefighters to polybrominated diphenyl ethers

Environ Sci Technol

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2015 Rotander A, Karrman A, Toms LM, Kay M, Mueller JF, Gomez Ramos MJ.

Novel fluorinated surfactants tentatively identified in firefighters using liquid chromatography quadrupole time-of-flight tandem mass spectrometry and a case-control approach

Environ Sci Technol

2016 Alexander BM, Baxter CS. Flame-retardant contamination of firefighter personal protective clothing - A potential health risk for firefighters

J Occup Environ Hyg

2016 Easter E, Lander D, Huston T. Risk assessment of soils identified on firefighter turnout gear

J Occup Environ Hyg

2016 Fernando S, Shaw L, Shaw D, Gallea M, VandenEnden L, House R, Verma DK, Britz-McKibbin P, McCarry BE.

Evaluation of Firefighter Exposure to Wood Smoke during Training Exercises at Burn Houses

Environ Sci Technol

2016 Oliveira M, Slezakova K, Alves MJ, Fernandes A, Teixeira JP, Delerue-Matos C, Pereira MDC, Morais S.

Firefighters' exposure biomonitoring: Impact of firefighting activities on levels of urinary monohydroxyl metabolites

Int J Hyg Environ Health

2016 Waldman JM, Gavin Q, Anderson M, Hoover S, Alvaran J, Ip HSS, Fenster L, Wu NT, Krowech G, Plummer L, Israel L, Das R, She J.

Exposures to environmental phenols in Southern California firefighters and findings of elevated urinary benzophenone-3 levels

Environ Int

2017 Fent KW, Alexander B, Roberts J, Robertson S, Toennis C, Sammons D, Bertke S, Kerber S, Smith D, Horn G.

Contamination of firefighter personal protective equipment and skin and the effectiveness of decontamination procedures

J Occup Environ Hyg

2017 Keir JLA, Akhtar US, Matschke DMJ, Kirkham TL, Chan HM, Ayotte P, White PA, Blais JM.

Elevated Exposures to Polycyclic Aromatic Hydrocarbons and Other Organic Mutagens in Ottawa Firefighters Participating in Emergency, On-Shift Fire Suppression

Environ Sci Technol

2017 Navarro KM, Cisneros R, Noth EM, Balmes JR, Hammond SK.

Occupational Exposure to Polycyclic Aromatic Hydrocarbon of Wildland Firefighters at Prescribed and Wildland Fires

Environ Sci Technol

2017 Oliveira M, Slezakova K, Magalhaes CP, Fernandes A, Teixeira JP, Delerue-Matos C, do Carmo Pereira M, Morais S.

Individual and cumulative impacts of fire emissions and tobacco consumption on wildland firefighters' total exposure to polycyclic aromatic hydrocarbons

J Hazard Mater

2018 Andersen MHG, Saber AT, Clausen PA, Pedersen JE, LÃ¸hr M, Kermanizadeh A, Loft S, Ebbehoj N, Hansen Ã…M, Pedersen PB, Koponen IK, Norskov EC, Moller P, Vogel U.

Association between polycyclic aromatic hydrocarbon exposure and peripheral blood mononuclear cell DNA damage in human volunteers during fire extinction exercises

Mutagenesis

2018 Andersen MHG, Saber AT, Pedersen JE, Pedersen PB, Clausen PA, Lohr M, Kermanizadeh A, Loft S, Ebbehoj NE, Hansen Ã…M, Kalevi Koponen I, Norskov EC, Vogel U, Moller P.

Assessment of polycyclic aromatic hydrocarbon exposure, lung function, systemic inflammation, and genotoxicity in peripheral blood mononuclear cells from firefighters before and after a work shift

Environ Mol Mutagen

15 | P a g e

2018 Caban-Martinez AJ, Kropa B, Niemczyk N, Moore KJ, Baum J, Solle NS, Sterling DA, Kobetz EN.

The "Warm Zone" Cases: Environmental Monitoring Immediately Outside the Fire Incident Response Arena by Firefighters

Saf Health Work

2018 Fent KW, Evans DE, Babik K, Striley C, Bertke S, Kerber S, Smith D, Horn GP.

Airborne contaminants during controlled residential fires

J Occup Environ Hyg

2018 Stec AA, Dickens KE, Salden M, Hewitt FE, Watts DP, Houldsworth PE, Martin FL.

Occupational Exposure to Polycyclic Aromatic Hydrocarbons and Elevated Cancer Incidence in Firefighters

Sci Rep

2019 Abrard S, Bertrand M, De Valence T, Schaupp T.

French firefighters exposure to Benzo[a]pyrene after simulated structure fires


2019 Adetona O, Simpson CD, Li Z, Sjodin A, Calafat AM, Naeher LP

Hydroxylated polycyclic aromatic hydrocarbons as biomarkers of exposure to wood smoke in wildland firefighters


2019 Fent KW, Mayer A, Bertke S, Kerber S, Smith D, Horn GP.

Understanding airborne contaminants produced by different fuel packages during training fires

J Occup Environ Hyg

2019 Fent KW, Toennis C, Sammons D, Robertson S, Bertke S, Calafat AM, Pleil JD, Wallace MAG, Kerber S, Smith D, Horn GP

Firefighters’ absorption of PAHs and VOCs during controlled residential fires by job assignment and fire attack tactic


2019 Fent KW, Toennis C, Sammons D, Robertson S, Bertke S, Calafat AM, Pleil JD, Geer Wallace MA, Kerber S, Smith DL, Horn GP.

Firefighters' and instructors' absorption of PAHs and benzene during training exercises


2019 Kirk KM, Logan MB. Exposures to air contaminants in compartment fire behavior training (CFBT) using particleboard fuel

J Occup Environ Hyg

2019 Mayer AC, Fent KW, Bertke S, Horn GP, Smith DL, Kerber S, La Guardia MJ.

Firefighter hood contamination: Efficiency of laundering to remove PAHs and FRs

J Occup Environ Hyg

2019 Navarro KM, Cisneros R, Schweizer D, Chowdhary P, Noth EM, Balmes JR, Hammond SK.

Incident command post exposure to polycyclic aromatic hydrocarbons and particulate matter during a wildfire

J Occup Environ Hyg

2019 Sjostrom M, Julander A, Strandberg B, Lewne M, Bigert C.

Airborne and Dermal Exposure to Polycyclic Aromatic Hydrocarbons, Volatile Organic Compounds, and Particles among Firefighters and Police Investigators

Ann Work Expo Health

2020 Beitel SC, Flahr LM, Hoppe-Jones C, Burgess JL, Littau SR, Gulotta J, Moore P, Wallentine D, Snyder SA.

Assessment of the toxicity of firefighter exposures using the PAH CALUX bioassay

Environ Int

16 | P a g e

2020 Burgess JL, Hoppe-Jones C, Griffin SC, Zhou JJ, Gulotta JJ, Wallentine DD, Moore PK, Valliere EA, Weller SR, Beitel SC, Flahr LM, Littau SR, Dearmon-Moore D, Zhai J, Jung AM, Garavito F, Snyder SA.

Evaluation of Interventions to Reduce Firefighter Exposures

J Occup Environ Med

2020 Fent, K.W., LaGuardia, M., McCormick. S., Mayer, A., Chen, I-C., Kerber, S., Smith, D., Horn, G.P.

Flame retardants, dioxins, and furans in air and on firefighters’ protective ensembles during controlled residential firefighting

Environ Int

2020 Keir JLA, Akhtar US, Matschke DMJ, White PA, Kirkham TL, Chan HM, Blais JM.

Polycyclic aromatic hydrocarbon (PAH) and metal contamination of air and surfaces exposed to combustion emissions during emergency fire suppression: Implications for firefighters' exposures

Sci Total Environ

2020 Kolena B, Petrovicova I, Sidlovska M, Hlisnikova H, Bystrianova L, Wimmerova S, Trnovec T.

Occupational Hazards and Risks Associated with Phthalates among Slovakian Firefighters

Int J Environ Res Public Health

2020 Oliveira, Marta; Costa, Solange; Vaz, Josiana; Fernandes, Adília; Slezakova, Klara; Delerue-Matos, Cristina; Teixeira, João Paulo; Pereira, Maria Carmo; Morais, Simone

Firefighters exposure to fire emissions: Impact on levels of biomarkers of exposure to polycyclic aromatic hydrocarbons and genotoxic/oxidative-effects

Journal of Hazardous Materials

2020 Peaslee, Graham F; Wilkinson, John T; McGuinness, Sean R; Tighe, Meghanne; Caterisano, Nicholas; Lee, Seryeong; Gonzales, Alec; Roddy, Matthew; Mills, Simon; Mitchell, Krystle;

Another Pathway for Firefighter Exposure to Per-and Polyfluoroalkyl Substances: Firefighter Textiles

Environmental Science & Technology Letters

2020 Rossbach, Bernd; Wollschläger, Daniel; Letzel, Stephan; Gottschalk, Wolfgang; Muttray, Axel

Internal exposure of firefighting instructors to polycyclic aromatic hydrocarbons (PAH) during live fire training

Toxicology letters

2020 Rosting C, Olsen R. Biomonitoring of the benzene metabolite s-phenylmercapturic acid and the toluene metabolite s-benzylmercapturic acid in urine from firefighters

Toxicol Lett

17 | P a g e

Figure 2 Publications Over Time

*Note: 2020 only includes articles through May 2020

0

1

2

3

4

5

6

7

8

9

10

1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020

Nu

mb

er o

f P

ub

licat

ion

s

Publications Over Time

18 | P a g e

Gap Analysis, Biomonitoring

General Observations. Most biomonitoring studies used urine to assess exposures with

the majority being among structural firefighters, wildland firefighters, and fire instructors (See

Table 2. Blood has been analyzed most frequently with structural firefighters with limited work in

the areas of other types of job exposures. Additional research is needed to assess the blood of

wildland firefighters, fire instructors, ARFF, industrial firefighters, and recruits specifically. Further

research examining urine among fire investigators, ARFF, industrial firefighters, and recruits is

also necessary. Emerging areas of research are outlined below.

Table 2 Gap Analysis, Biomonitoring

Method

Blood Urine

Structural Firefighters

Kelly et al., 2002; Al-Malki et al., 2009; Dobraca et al., 2015; Park et al., 2015; Andersen et al., 2018;

Caux et al., 2002; De Perio et al., 2010; Fernando et al., 2016; Waldman et al., 2016; Keir et al., 2017; Andersen et al., 2018; Fent et al., 2019a; Fent et al., 2019b; Beitel et al., 2020; Kolena et al., 2020; Rosting et al., 2020

Wildland Firefighters Smith et al., 2013 Neitzel et al., 2008; Robinson et al., 2008; Naeher et al., 2013; Gaughan et al., 2014; Oliveira et al., 2016; Oliveira et al., 2017; Adetona et al., 2019; Oliveira et al., 2020

Fire Instructors Lindquist et al., 1997 Lindquist et al., 1997; Moen et al., 1997; Feunekes et al., 1997; Laitinen et al., 2012; Fent et al., 2019b; Rossbach et al., 2020

Fire Investigators Hsu et al., 2011

Aviation/Airport Laitinen et al., 2014 Laitinen et al., 2014

Industrial Schecter et al., 2002

Recruits Guerra Andersen et al., 2018

Fire Instructors. Future research needs to focus on exposures of fire instructors and their

exposures through acquired structures, live fires in training facilities, and controlled fuel packages.

While there have been studies on this population, the majority most are more than a decade old.

Given the frequency and intensity of exposures instructors face, it is important to understand both

their acute and cumulative exposures to carcinogens.

Fire Investigators. Limited evidence is available on the exposures of fire investigators

with one study that examined exposures in the blood and none that have studied urine. In the

past, exposures of fire investigators have been thought to be low considering the fire has been

extinguished and the air is typically “clear” during an investigation, similar to the beliefs about

overhaul post fire. However, the growing body of literature on ultrafine particulates present on the

fireground has pushed organizations and scientists to reconsider this assumption. Sjostrom et al.,

2019 did measure airborne contamination levels during post-fire investigations in Sweden and

found that firefighters and investigators are exposed to a number of hazardous compounds in

their work. In 2018, the International Association of Fire Investigators (International Association

19 | P a g e

of Arson Investigators, Inc.; Health & Safety Committee, 2018) issued their first “best practices”

document on decreasing carcinogen exposure as well as a second report on general health and

wellness recommendations for fire investigators in 2020 (The International Association of Arson

Investigators, Inc., 2020) that outline the risk and mitigation strategies fire investigators should

implement. Additional biomonitoring research is needed on this population.

Aircraft Rescue & Fire Fighting (ARFF). Biomonitoring data was limited to one study in

the current review. An emerging area of focus in recent years has been on the unique risks faced

by ARFF firefighters, particularly given the awareness of the deleterious impact of PFAS present

in legacy firefighting foams (US Fire Administration, 2020). Additional biomonitoring studies on

exposures during fire/rescue activities, during training, and long-term should be considered.

Researchers also should be sensitive to the evolution of extinguishing agents over time as new

regulations are enacted and evolving firefighting foams are adopted (Dauchy et al., 2017; Dubocq

et al., 2020). There are also several other unique exposures possible for ARFF firefighters due to

the proximity to airports, exhaust, fuels, etc.

Industrial Firefighting. Only one study was found that specifically focused on industrial

firefighters. Future research should focus on the unique carcinogen exposures of this population

as their tasks and firefighting activities can vary significantly from structural firefighters. Industrial

firefighting includes a broad group of firefighters who respond to fires in their particular industry,

ranging from petroleum products to fertilizers to manufacturing of products ranging from

automotive to medical device to pharmaceuticals and beyond. Thus, a broad range of risks are

likely present in this group.

Recruits. Very limited data were available on carcinogen exposures specific to recruits.

Biomonitoring studies that explore exposures pre and post fire exposure in recruit school would

likely provide significant insights capitalizing on a within-subject design.

Legacy versus Modern Fires. While beyond the scope and detail of this project, there

is increasing understanding of the changing fire environments due to the types of materials that

are being used for building and furnishing modern homes. As an example, legacy furniture was

traditionally made of wood and natural materials. Modern furniture is typically designed to be

lightweight and constructed out of synthetic materials. As a result of changes, it is well

documented that fires burn hotter and faster today than they once did. Research into the changing

exposures due to changes in materials burning also needs attention.

Gap Analysis, Environmental Monitoring

General Observations. The majority of environmental monitoring studies focused on

residential/structure or simulated/training fires (see Table 3). Air monitoring was the most common

method of assessment employed, although residential/simulated residential fires also have been

assessed through skin wipes and testing gear and/or clothes.

Table 3 Gap Analysis, Environmental Monitoring

Assessment Method

Fire Type Air Gear/Cloth Skin Wipe

Residential/Structural Fire

Gold et al., 1978; Brandt-Rauf et al., 1988; Jankovic et al., 1991; Bolstad-Johnson

Gold et al., 1978; Hsu et al., 2011; Fent et al., 2017; Abrard et al.,

Baxter et al., 2014; Fent et al., 2014; Fent et al., 2017; Keir 2020

20 | P a g e

et al., 2000; Burgess et al., 2001; Baxter et al., 2014; Fent et al., 2014; Fent et al., 2018; Caban-Martinez et al., 2018; Fent et al., 2019; Fent et al., 2020; Keir et al., 2020; Rosting et al., 2020

2019; Fent et al., 2020; Keir et al., 2020

Simulated/Training Fire

Atlas et al., 1985; Feunekes et al., 1997; Lindquist et al., 1997; Austin et al., 2001; Laitinen et al., 2012; Fabian et al., 2014; Kirk et al., 2015; Fernando et al., 2016; Kirk et al., 2019; Sjostrom et al., 2019

Lindquist et al., 1997; Kirk et al., 2015; Mayer et al., 2019

Lindquist et al., 1997; Fernando et al., 2016; Guerra Andersen et al., 2018; Sjostrom et al., 2019

Wildland Materna et al., 1992; Reinhardt et al., 2004; Neitzel et al., 2008; Robinson et al., 2008; Reisen et al., 2009; Reisen et al., 2011; Adetona et al., 2013; Navarro et al., 2017; Navarro et al., 2019; Adetona et al., 2019

Gear Samples (not incident specific; see summary)

Alexander et al., 2014; Kirk et al., 2015; Alexander et al., 2016; Easter et al., 2016; Peaslee et al., 2020

Electrical/Transformer Kelly et al., 2002

Aviation/Airport

Other Fires

Wildland. Assessments for wildland fires have been focused on air monitoring to date.

Future research should include studies of skin wipes and clothing contamination to determine

what carcinogens reach firefighters. Studies of run-off or ground water post incident may be telling

as there is growing evidence of persistent contamination of community water near wildland

events. In addition, studies of contamination in different settings (e.g., base camps) are needed

to understand the unique risks faced by all those involved in a fire response.

Electrical/Transformer. Only one study was identified that used air sampling for

electrical/transformer fires. Additional research in this area is warranted across methods.

Aircraft Rescue & Fire Fighting (ARFF). Environmental monitoring at ARFF incidents

was not found in the literature review. Research in this area is needed across methods. Studies

of run-off or ground water post incident may be telling as there is growing evidence of persistent

contamination of community water in areas with high use of firefighting foams. Such studies were

excluded from the current analysis as they did not fall within the inclusion criteria.

21 | P a g e

Other Fires. No studies were found that focused on carcinogen exposure from vehicle,

dumpster, or kitchen fires. Research across methods is warranted in this area, particularly as

these are often seen as low risk exposures where firefighters are less likely to wear appropriate

PPE.

Gear Samples. Studies were found that examined contamination of gear that was not

specific to one type of fire. Theoretically, these exposures were accumulated over the course of

the fire exposure although new research is exploring the presence of chemical compounds of

concern that are introduced as part of the gear manufacturing process (Peaslee et al., 2020).

While outside the scope of this project to examine gear studies in detail, this is an emerging issue

in carcinogen exposure that should be considered.

Passive Sampling Devices. There are numerous types of passive sampling devices that

can be used to measure exposures among firefighters including active air sampling, cloth/gear

samples, and wipes. An emerging tool for data collection on the fireground is the use of silicone

dosimeters. Given the tool is relatively new, published studies are limited but show promise in

other occupational groups (Dixon et al., 2018; O’Connell et al., 2014). Future research should

expand the use of this environmental assessment given its sensitivity and ease of use make it a

possibility for complex and real-world assessment.

Major Events. While the current analysis focused specifically on fireground exposures,

World Trade Center (WTC) studies meeting search criteria were included at the request of the

advisory panel. Publications on major events, particularly, as they are occurring, are limited. This

lack of data is likely due to the complexity of deploying a research protocol on short notice in an

unpredictable environment. Given the advancements in data collection protocols and tools, future

research should focus on preparing for environmental monitoring at large events that can be

deployed as opportunities arise.

22 | P a g e

Overall Findings

Table 4 Summary of Overall Findings

Chemicals Detected

Biomonitoring

IARC Group Author, Year

Group 1

Benzene Lindquist 1997; Caux 2002; Fent 2014; Rosting 2020

PAHs (specified) Oliveira 2016; Keir 2017; Oliveira 2017; Beitel 2020; Burgess 2020; Oliveira 2020

PCBs & Dioxin-like PCBs Schecter 2002; Kelly 2002; Shaw 2013; Park 2015

Dioxins & Furans Kelly 2002; Schecter 2002; Hsu 2011

Group 2A

Guaiacol Neitzel 2008

Organochlorines Shaw 2013; Park 2015

Group 2B

1,4 Dichlorobenzene Edelman 2003

Organochlorines Shaw 2013; Park 2015

Phthalates Kolena 2020

Phenolic Compounds Waldman 2016

Perfluoralkyl Acids (PFAAs) Shaw 2013; Latinen 2014; Dobraca 2015

Dioxins & Furans Kelly 2002; Schecter 2002; Hsu 2011

Unspecified PAHs Feunekes 1997; Lindquist 1997; Moen 1997; Caux 2002; Edelman 2003; Robinson 2008; Laitinen 2012; Fent 2014; Adetona 2015; Fernando 2016; Oliveira 2016; Keir 2017; Oliveira 2017; Andersen 2018; Fent 2019; Oliveira 2020; Rossbach 2020

Heavy Metals Edelman 2003; Al-Malki 2009; de Perio 2010; Dobraca 2015

Environmental Monitoring

Group 1

1,3 Butadiene Austin 2001; Sjostrom 2019

2,3,4,7,8-Pentachlorodibenzofuran

Kelly 2002

2,3,7,8-Tetrachlorodibenzo-P-dioxin

Kelly 2002

Asbestos Bolstad-Johnson 2000

Benzene Hill 1972; Brandt-Rauf 1988; Jankovic 1991; Bolstad-Johnson 2000; Burgess 2001; Reinhardt 2004; Reisen 2009; Kirk 2015; Fent 2017; Fent 2018; Kirk 2019; Sjostrom 2019; Rosting 2020

Benzo[a]pyrene Atlas 1985; Jankovic 1991; Materna 1992; Feunekes 1997; Bolstad-Johnson 2000; Austin 2001; Pleil 2004; Robinson 2008; Alexander 2014; Baxter 2014; Kirk 2015; Alexander 2016; Easter 2016; Fernando 2016; Abrard 2019; Mayer 2019; Navarro 2019; Sjostrom 2019; Keir 2020

Formaldehyde Brandt-Rauf 1988; Jankovic 1991; Materna 1992; Lindquist 1997; Bolstad-Johnson 2000; Burgess 2001; Reinhardt 2004; Reisen 2009; Reisen 2011; Kirk 2015; Kirk 2019

23 | P a g e

Pentachlorophenol Easter 2016

Respirable Particulate Matter Brandt-Rauf 1988; Materna 1992; Reinhardt 2004; Neitzel 2008; Robinson 2008; Adetona 2013; Adetona 2019; Navarro 2019

Trichloroethylene Brandt-Rauf 1988

Group 2A

Acrolein Hill 1972; Materna 1992; Lindquist 1997; Bolstad-Johnson 2000; Burgess 2001; Reinhardt 2004; Reisen 2009;

Cyclopenta[cd]pyrene Robinson 2008

Dibenz[a,h]anthracene Materna 1992; Bolstad-Johnson 2000; Pleil 2004; Alexander 2014; Mayer 2019; Navarro 2019; Sjostrom 2019; Keir 2020

Dichloromethane (methylene chloride)

Brandt-Rauf 1988; Kirk 2015

Styrene Hill 1972; Austin 2001; Kirk 2019; Kirk 2015; Fent 2017

Tetrachloroethylene (perchloroethylene)

Kirk 2015

Group 2B

Acetaldehyde Jankovic 1991; Materna 1992; Bolstad-Johnson 2000; Burgess 2001; Reisen 2009; Kirk 2015; Kirk 2019

Benz[a]anthracene Materna 1992; Bolstad-Johnson 2000; Pleil 2004; Robinson 2008; Alexander 2014; Baxter 2014; Kirk 2015; Alexander 2016; Fernando 2016; Mayer 2019; Navarro 2019; Sjostrom 2019; Keir 2020

Benzo[b]fluoranthene Jankovic 1991; Materna 1992; Bolstad-Johnson 2000; Pleil 2004; Robinson 2008; Alexander 2014; Alexander 2016; Fernando 2016; Mayer 2019; Navarro 2019; Sjostrom 2019; Keir 2020

Benzo[c]phenanthrene Robinson 2008

Benzo[j]fluoranthene Robinson 2008; Fernando 2016

Benzo[k]fluoranthene Jankovic 1991; Materna 1992; Bolstad-Johnson 2000; Pleil 2004; Robinson 2008; Alexander 2014; Alexander 2016; Fernando 2016; Mayer 2019; Navarro 2019; Sjostrom 2019; Keir 2020

Chrysene

Atlas 1985; Jankovic 1991; Materna 1992; Pleil 2004; Alexander 2014; Baxter 2014; Kirk 2015; Alexander 2016; Easter 2016; Fernando 2016; Mayer 2019; Navarro 2019; Sjostrom 2019; Keir 2020

Crotonaldehyde Kirk 2015; Kirk 2019

Di(2-ethylhexyl)phthalate Alexander 2014; Alexander 2016; Easter 2016

Dichloromethane Kirk 2019

Indeno[1,2,3-cd]pyrene Hill 1972; Jankovic 1991; Materna 1992; Bolstad-Johnson 2000; Pleil 2004; Robinson 2008; Alexander 2014; Baxter 2014; Kirk 2015; Alexander 2016; Mayer 2019; Navarro 2019; Sjostrom 2019; Keir 2020

Isoprene Hill 1972

Methyl Isobutyl Ketone Kirk 2015; Kirk 2019

Naphthalene Hill 1972; Austin 2001; Robinson 2008; Alexander 2014; Baxter 2014; Kirk 2015; Alexander 2016; Easter 2016; Fernando 2016; Navarro 2019; Sjostrom 2019; Keir 2020

24 | P a g e

Trichlorophenol Brandt-Rauf 1988

World Trade Center – Environmental Monitoring

Group 1

2,3,4,7,8-Pentachlorodibenzofuran

Lioy 2002

2,3,7,8-Tetrachlorodibenzo-P-dioxin

Benzo[a]pyrene

Group 2A

4,4-Dichlorodiphenyltrichloroethane

Group 2B

3,3'-Dichlorobenzidine

Trichlorophenol

Benzo[c]phenanthrene

Isoprene

Chrysene

Heptachlor

Hexachlorobenzene

Mirex

25 | P a g e

BIOMONITORING TABLES

Table 5 Biomonitoring: Benzene (Group 1)

Reference Location, Setting, Study design

Sample Type

Study Population

Exposure level, No. of

exposed cases

Response/ Mean (range)

Comments/

additional data

Lindquist

1997

Finland 1996

Two routine exercises:

extinguishing training

exercises in firehouse and

shipping container.

Samples were collected at

the end of workday.

Urine 5 non-smoking male

FF instructors (Mean

age 33.2 (range 28-

35) compared to 5

non-smoking male

staff (mean age

33.6; range 28-39)

at the same rescue

college

Tested for its

metabolite, trans,

trans-muconic acid

(Functional limit: 40

μmol/L)

In 3 subjects, the urinary

muconic acid

level remained below the

reference limit of the

unexposed subjects (0.5

μmol/L) on both study days.

The results of two test

subjects were 2.0

μmol/L and 2.1 μmol/L after

the firehouse exercise and,

4.2 μmol/L and 0.8 μmol/L

after the container exercise

day.

Rosting

2020

USA ND

FFs’ exposure to benzene

during a fire drill. FFs were

divided into three groups of

three firefighters. The fire

drill consisted of three

separate fires in the same

house and each firefighter

group extinguished only

one fire (duration of fire-

fighting ∼ 20 min for each

Urine (9

samples

were

collected

prior to the

drill, 9

samples

were

collected

immediate

ly after the

9 non-smoking FFs

(4 using snuff)

Measuring benzene

metabolite s-

phenylmercapturic

acid (SPMA).

The American

Conference of

Governmental

Industrial Hygienists

(ACGIH) has set the

biological exposure

index (BEI) for

The metabolite SPMA was

also detected in all urine

samples donated ≥ three

hours after the fire drill with

a median concentration of

0.6 μg/g creatinine (range

0.1-3.0)

Range SPMA (μg/g

creatinine)

An increasing

level of urinary

SPMA was

observed in the

samples

collected from

3.5 h after

firefighting. The

highest level (3.0

μg/g creatinine)

was found from

26 | P a g e

group). Samples were

collected immediately prior

to the fire drill, directly after

the fire drill and 3-6h after

the drill.

drill, 6

samples

were

collected

approxima

tely 3.5 h

after the

drill and 6

samples

were

collected

approxima

tely 6 hrs

after the

end of the

drill.)

workers exposed to

0.5 ppm benzene

(TWA 8 h) at 25 μg

SPMA/g creatinine.

Pre-drill < Limit of

quantification (LOQ)-0.21

Post drill 0.1-2.6

one of the FFs

working in the

first group

entering the

burning house.

Caux 2002 Canada 1994

(197 volunteered, 43

provided samples).

Samples were collected

during the period extending

for 20h following the end of

fire exposure. A control

sample was also obtained

from each participant after

at least 4 days w/o

involvement in fire

activities.

Urine 43 FFs

(n = 20: 26-35y

n = 20: 36-45y

n = 2; 45+)

Exposure to

benzene was

assessed by means

of urinary

measurements of

t,t-muconic acid

Median (range) μmol/mol

creatinine

Control: Below detection

limit, BDL (BDL)

At 0 h urination: BDL (BDL-

1.15)

0-4 h: BDL (BDL-2.82 )

4-8 h: BDL (BDL-1.12)

8-12 h: BDL (BDL-0.77)

Among 43 FFs,

18 had

measurable

excretion of this

metabolite after

firefighting. Only

6 had t,t-muconic

acid

concentrations

exceeding 1.1,

and reaching up

to 2.8, mmol/mol

creatinine.

None of the

27 | P a g e

12-16 h: BDL (BDL-2.35)

16-20 h: BDL (BDL-0.58)

control samples

had a t,t-muconic

acid

concentration

above the limit of

detection (less

than 0.5 ppm of

benzene for 8

hours.)

Overall, based

on t,t-muconic

acid

determinations,

exposure to

benzene was

rather low in this

study.

Fent 2014 USA 2010-2011

Non-smoking males 45

years of age or younger

who were instructors with

the Chicago Fire

Department. Round 1 of

the study was in August

2010; round 2 was 1 year

later. Each round consisted

of three controlled structure

burns (one burn each day).


preexposure (~1 h before

the controlled burn), post-

exposure (10–40 min after

Urine 15 Non-smoking fire

instructors (15 FFs

participated in each

round (five FFseach

day). 12 FFs from

round 1 repeated the

study during round

2.)

Assessed benzene

exposure by

measuring their

benzene metabolite

(s-

phenylmercapturic

acid or s-PMA)

levels.

All the urine

concentrations of s-PMA

were below the LOD of 5

μg/L.

28 | P a g e

the controlled

burn), 3-, and 6h after the

controlled burn.

29 | P a g e

Table 6 Biomonitoring: Specified PAHs (Group 1)

Reference Location, Setting, Study design Sample Type

Study Population

Exposure level, No. of exposed

cases


Comments/ additional data

Beitel 2020 USA ND

Ten firefighters were in the

building, with 5 in either the maze

room or burn room, and 1

individual outside of the building in

full gear who did not enter the

building. Half way through the fire,

the individuals switched rooms

and activities. Samples were

collected before the controlled fire

and 2, 4, and 6 hr post fire. Two

different hood types were used

within this study: 5 participants

wore prototype particulate blocking

hoods (not commercially

available) meant to provide

improved protection against

particulates while the other 5

participants wore a traditional non-

particulate

hood.

Urine 11 non-

smoking male

FFs Mean(sd)

age 39(9)

years

Concentrations of the

hydroxylated PAHs

were quantified in ex-

tracts of the urine

samples from the

control fire and were

used along with the

relative potencies

(REPs) to predict a

Benzo[a]Pyrene

(B[a]P) equivalent

response.

Range of B[a]P

equivalent in urine

samples (nM) taken

compared hoods with

and without

particulate blocking

material

Pre-fire (0 hr): 150-

350/ 100-150

2hr post fire: 100-

175/

125-175

4hr post fire: 100-

300/ 100-200

6hr post fire: 100-

300/ 100-200

Of the PAH-OHs

that were responsive in

the bioassay and used

to calculate the

predicted

B[a]P equivalence, 2-

hydroxyphenanthrene,

3-hydroxyfluorene, 1-

hyroxypyrene, 6-

hydroxychrysene and 2-

hydroxynaphthalene

were detected in the

urine samples, where 4-

hydroxyphenanthrene

and 3-

hydroxychrysene were

below the detection limit

in all samples. This

comparison between

predicted- and observed

B[a]P equivalence

showed that less than

1% of the response was

able to be accounted for

by the quantified

hydroxylated PAHs, and

therefore greater than

99% is

30 | P a g e

from unknown

compounds.

Keir 2017 Canada 2016

27 FFs were recruited

for study blocks of 5 consecutive

24 h shifts typically spanning

12 days. Samples were collected

at the beginning of each shift

(preexposure) and 18h after fire

(postexposure)

Urine 17 male FFs

participants in

emergency

suppression

(avg. age 34;

range 25-50)

compared

with 17 office

workers (avg.

age 50y;

range 28-62)

Evaluated

Benzo(a)pyrene’s

metabolites: 3-

Hydroxybenzo(a)pyre

ne (μg/g creatinine)

Samples were below

the limit of detection

Oliveira

2016

Portugal 2014

FFs from 6 firefighting

corporations. Compared 2 groups:

non-exposed (were not involved in

fire combat activities within 48 h

prior to urine collection), and

exposed firefighters (were actively

involved in fire combat and

extinction).

Urine 153 non-

smoking

wildland FFs

(n = 57

exposed, 79%

male)

Evaluated

Benzo(a)pyrene’s

metabolites: 3-

Hydroxybenzo(a)pyre


3OHB[a]P was never

detected in

non-exposed and

exposed firefighters.

Oliveira

2020

Portugal ND

FFs from 8 units from the district of

Braganca, were organized into 3

groups according to their active

participation in firefighting activities

(within the 48 h before sample

collection) and their smoking

habits: (i) non-smoking and non-

exposed subjects (Control group -

Urine

Samples

were

collected

at the end

of the 8h

work-shift.

171 male FFs

(median age

30-36y)

Evaluated

Benzo(a)pyrene’s

metabolites: 3-

Hydroxybenzo(a)pyre


3OHB(a)P was not

detected

31 | P a g e

firefighters that stayed at the fire

stations and did not participate in

fire combat), (ii) non-smoking and

exposed subjects (i.e. non-

smoking individuals who were

directly involved in firefighting

activities; Group A), and (iii)

smoking and exposed subjects

(i.e. smoking firefighters exposed

to fire

emissions; Group B).

Oliveira

2017

Portugal 2015

FFs were serving at 3 different fire

stations, namely Vinhais (VNH),

Mirandela (MDL) and Braganca

(BRG). FFs were organized into 3

different groups: non-smoking and

non-exposed to fire emissions

(NSNExp), smoking non-exposed

(SNexp) and smoking exposed

(Sexp).

Urine 108 wildland

FFs (Mean

ages for

NSNExp 34

(22–48 years);

SNExp 34

(21–60 years);

SExp 31

years (21–53)

All firefighters

were asked to

collect a spot

urine sample

at the end of a

regular work

shift.

PAH metabolites,

3OHB[a]P, were

determined.

3OHB[a]P was never

detected

Burgess

2020

USA 2018

Two intervention studies were conducted with FFs from two

Urine FFs were predominantly non-Hispanic

Evaluated 10 PAH-OHs (1-naphthol,

Σ sums (Geometric

Means (SD) ng/L)

32 | P a g e

department. Fireground interventions included use of self-contained breathing apparatus by engineers, entry team wash down, contaminated equipment isolation, and personnel showering and washing of gear upon return to station.

white males. The average ages were 38.5 years. All FFs were asked to collect a urine sample at baseline, pre-intervention postexposure, and post-intervention postexposure

for the

fireground

intervention,

and pre- and

post-

intervention

for the sauna

intervention

2-naphthol, 2-fluorenol, 3-fluorenol, 4-fluorenol, 1-phenanthrol, 2- phenanthrol, 3-

phenanthrol, 4-

phenanthrol, and 1-

hydroxypyrene)

Urinary mean

concentration (Σ

sums) of all naphthol,

fluorenol, and

phenanthrol

metabolites and 1-

hydroxypyrene

combined were

determined.

Fireground

intervention:

Baseline:

7436.6 (2.5) – 8396.8

(2.7)

Pre-intervention

15332.9 (2.3) -

22706.9 (2.7)

Post-intervention

12544.3 (2.7) –

14454.7 (2.7)

Sauna intervention:

Pre-intervention

8495.7 (2.2)

Post-intervention

control

40012.1 (2.6)

Post-intervention

treatment

22604.3 (1.6)

33 | P a g e

Table 7 Biomonitoring: PCBs and Dioxin-like PCBs (Group 1)


Study Population

Exposure level, No. of exposed

cases


Comments/

additional data

Schecter

2002

Russia 1998

Two groups of FFs from Irkutsk

region who were extinguishing the

fire in the Shelekhovo Cable factory

in 1992. Disabled group has been

diagnosed with a variety of medical

conditions that may or may not be

related to the fire. Most of them

have received an ‘‘invalid’’ status

and are no longer working as FFs.

Blood 10 Disabled

male FFs

(mean age

39.3y)

15 Non-

disabled male

FFs (mean age

40.9y)

Measure levels

converted to mean

dioxin toxic

equivalents (TEQ)

Mean TEQ levels

Disabled group

3,3’,4,4’-TCB 77:0

3,3’,4,4’,5’-PCB 126:

3.3

3,3’,4,4’,5,5’-HCB

169: 0.3

Non-disabled group

3,3’,4,4’-TCB

77:(Not analyzed)

NA

3,3’,4,4’,5’-PCB 126:

NA

3,3’,4,4’,5,5’-HCB

169: NA

Total coplanar PCB

for the disabled

firefighters is 7.1

parts per trillion

(ppt); NA for non-

disabled group

Kelly 2002 USA 1998

FDNY personnel

presented at the Staten Island Con

Edison transformer

Fire with PCB contamination.

Samples were collected 2-3 wk

after the transformer fire and 9 mo

follow-up.

Blood 58 male FFs

Mean(sd) and

range age

42.9(9.1); 19-

63y

(39 FFs (65%)

reported for

follow-up)

Average serum PCB

levels for the general

U.S. population

average 1-2 ppb.

Mean(sd); range

(ppb)

Post-exposure

2.92(1.96); 1.9-11.0

Follow-up

2.47(1.39); 1.9- 8.0

20 participants (34%

of those tested) had

a serum PCB level

that exceeded 1.9

ppb and 5 (9%) had

a serum PCB level

greater than or equal

to 6 ppb.

34 | P a g e

11 subjects with

serum

polychlorinated

biphenyl (PCB)

levels > 1.9 ppb on

initial post-exposure

testing, and who

presented for follow-

up testing, 8 (73%)

had a significant

decrease in serum

PCB levels. In 1 FF,

there was no change

in serum PCB

levels, and in 2 FFs

there was an

increase in serum

PCBs.

Park 2015 USA 2011

A convenience sample of FFs

Southern California county (137

met criteria, 101 participated)

Blood 101 FFs

(98% male)

Mean age 43y

Geometric Means

(95% CI) ng/g lipid

PCB-118: 2.66

(2.46-2.87)

PCB-156: 1.84

(1.61-2.09)

Shaw 2013 USA 2009

FFs working at different stations in

San Francisco, CA, were selected

according to the following criteria:

(1) they had not worked in

Blood 12 male FFs

mean(range)

age: 41.3y (32-

59)

Concentrations of

PCBs (118, 156) were

determined in serum.

Mean(sd); Median;

Range

23’44’5-

Pentachlorobiphenyl

35 | P a g e

industries with known

chemical emissions; (2) they were

FFs for at least 5 years; and (3)

they had responded to fire scenes

at least 20 times in the past 5

years. Samples were

collected within 24h of responding

to a fire.

(PCB-118) 4(2); 2;

not detected (nd)–19

233’44’5-

Hexachlorobiphenyl

(PCB-156) 5(4); 4;

1–12

36 | P a g e

Table 8 Biomonitoring: Dioxins & Furans (Group 1)


Sample Type

Study Population Exposure level, No. of exposed

cases


Comments/ Additional data

Schecter

2002

Russia 1998

Two groups of FFs from

Irkutsk region who were

extinguishing the fire in the

Shelekhovo Cable factory in

1992. Disabled group has

been diagnosed with a

variety of medical conditions

that may or may not be

related to the fire. Most of

them have received an

‘‘invalid’’ status and are no

longer working as FFs.

Blood 10 Disabled male

FFs (mean age

39.3y)

15 Non-disabled

male FFs (mean age

40.9y)

Measure levels

converted to mean

dioxin toxic

equivalents (TEQ)

Mean TEQ levels

Disabled group

2,3,7,8-TCDD: 3.5

2,3,4,7,8-PeCDF: 9.6

Non-disabled group

2,3,7,8-TCDD: 4.4

2,3,4,7,8-PeCDF: 9.9

Total PCDD/F

TEQ for the disabled

firefighters is 23.6 parts

per trillion (ppt)

The total PCDD/F

TEQ for the non-

disabled firefighters is

25.0 ppt

Hsu 2011 Taiwan 2010

FFs working at the Fire

Bureau of Tainan Country,

Taiwan (350 Recruited, 291

completed survey, 46

qualified, 20 volunteered).

Blood

(serum)

20 male FFs and fire

scene investigators

Mean(sd) age:

43(5.6)y

Avg. attended fire

scene: 45 (range 20-

300)

The 2005 WHO-

TEFs system (Van

den Berg et al.,

2006) was used to

calculate

the TEQ values.

Mean(sd); Median;

Range

2,3,7,8-TCDD:

1.4(0.45); 4.4; 0.84-

2.6

2,3,4,7,8-PeCDF:

8.0(2.3); 8.0; 4.4-13

Total PCDD/F TEQ

Median 12

Mean(sd) 12(3.1)

Range (6.3-18)

Seven PCDD

concentrations

accounted

for 90.1% of the total

PCDD/F concentrations,

and the other 10 PCDF

congeners accounted

for the remaining 9.9%.

37 | P a g e

Kelly 2002 USA 1998

FDNY personnel

presented at the Staten

Island Con Edison

transformer fire with PCB

contamination. Samples

were collected 3 mo after the

transformer fire.

Blood

58 male FFs

Mean(sd) and range

age 42.9(9.1)y; 19-

63

(48 FFs (80%)

agreed to submit

serum samples for

PCDD and PCDF

analysis)

Post-exposure

Mean(sd); range

(pg/gm)

2,3,4,7,8-PeCDF:

11.70(13.163);

undetected (UD) -69.9

TEF 0.5

2,3,7,8-TCDD:

3.77(4.16); UD-13.4

TEF 1.0

38 | P a g e

Table 9 Biomonitoring: Guaiacol (Group 2A)


Study Population


exposed cases


Comments/

additional data

Neitzel 2008 USA 2004

Full-shift measurements were

made over 20 work shifts in winter

2004 at the US Forest Service

Savannah River site, a National

Environmental Research Park.

Urine samples were collected from

study participants each day before

and after the completion of the

shift.

Urine 13 wildland

FFs

(92.3% male)

Median (range)

age 28 (21-

35)y

Using creatinine urinary methoxyphenol (MP) as biomarkers of woodsmoke exposure, Guaiacol

Mean(sd); range mg/ml

Pre-shift 0.343(0.266) 0.138-

1.295

Post shift 0.862(0.578) 0.071-

1.996

Difference pre-post

0.529(0.564) -0.155-1.450

39 | P a g e

Table 10 Biomonitoring: Organochlorines (Group 2A)


Sample Type

Study Population

Exposure level, No. of exposed cases

Response/ Mean(range)


Park 2015 USA 2011

A convenience sample of FFs

from 35 stations in a Southern

CA county (137 met criteria,

101 participated)

Blood 101 FFs

(98% male)

Mean age

43

Metabolite of chlordane,

Trans-nonachlor

Geometric Means, (95%

CI) ng/g lipid

β-BHC 2.19 (2.00-2.41)

4,4’-DDE: 1.34 (1.20-

1.50)

Hexachlorobenzene

(HCB) 177 (161-169)

Trans-nonachlor 7.2

(6.57-8.15)

Oxychlordane 4.08

(3.64-4.56)

Shaw 2013 USA 2009

FFs working at different

stations in San Francisco, CA,

were selected according to

the following criteria: (1) they

had not worked in industries

with known

chemical emissions; (2) they

were FFs for at least 5 years;

and (3) they had responded to

fire scenes at least 20 times

Blood 12 male FFs

mean(range

) age: 41.3

(32-59)y

Concentrations of HCB

were determined in

serum.

Mean(sd); Median;

Range

Hexachlorobenzene

(HCB) 22(11); 21; 8–46

40 | P a g e

in the past 5 years. Samples

were

collected within 24h of

responding to a fire.

Shaw 2013 USA 2009


stations in San Francisco, CA,

were selected according to

the following criteria: (1) they

had not worked in industries

with known



and (3) they had responded to

fire scenes at least 20 times

in the past 5 years. Samples

were



Blood 12 male FFs

(mean(rang

e) age: 41.3

(32-59)y

Concentrations of DDE

were determined in

serum.

Mean(sd); Median;

Range

p,p’-

Dichlorodiphenyldichloro

ethylene (p,p’-DDE)

292(168); 249; 128–662

41 | P a g e

Table 11 Biomonitoring: 1,4 Dichlorobenzene (Group 2B)

Reference Location, Setting, Study Design

Sample Type


cases



Edelman 2003 USA 2001

A cross-sectional study

using a stratified sample

of FF units based on WTC

arrival time. Arrival time

was categorized as a)

present at the WTC

collapse, b) arrival on day

1 or 2 but post-collapse,

and c) arrival on days 3–

7.

370 FFs (321 exposed, 47

controls, and 2 with

missing data) participated,

368 having chemical

measurements.

Blood Of the participating

FFs (N = 368), 148

were present

during the WTC

towers collapse,

and 142 arrived

Post-collapse on

days 1–2.

Measuring 1,4-Dichlorobenzene

Geometric mean μg/L

Exposed (n = 318):

0.235

Controls (n = 47):

0.165

By arrival time

Present at collapse (n

= 148): 0.274

1-2 days after collapse

(n = 142): 0.289

By unit assignment

Special operations

command (n = 95):

0.343

Other FFs (n = 195):

0.231

Significant differences of

1,4-Dichlorobenzene

levels between special

and other FFs (p-value <

0.01)

42 | P a g e

Table 12 Biomonitoring: Organochlorines (Group 2B)


Sample Type

Study Population



Comments/

additional data

Park 2015 USA 2011

A convenience sample of

FFs from 35 stations in a

Southern CA county (137

met criteria, 101 participated)

Blood 101 FFs

(98% male)

Mean age 43

Metabolite of

chlordane, Trans-

nonachlor

Geometric Means, (95% CI) ng/g

lipid

β-BHC 2.19 (2.00-2.41)

4,4’-DDE: 1.34 (1.20-1.50)

Hexachlorobenzene (HCB) 177

(161-169)

Trans-nonachlor 7.2 (6.57-8.15)

Oxychlordane 4.08 (3.64-4.56)

Shaw 2013 USA 2009


stations in San Francisco,

CA, were selected according

to the following criteria: (1)

they had not worked in




and (3) they had responded

to fire scenes at least 20

times in the past 5 years.

Samples were


Blood 12 male FFs

(mean(range)

age: 41.3 (32-

59)y

Concentrations of

HCB were determined

in serum.

Mean(sd); Median; Range

Hexachlorobenzene (HCB)

22(11); 21; 8–46

43 | P a g e


Shaw 2013 USA 2009


stations in San Francisco,

CA, were selected according

to the following criteria: (1)





and (3) they had responded

to fire scenes at least 20

times in the past 5 years.

Samples were



Blood 12 male FFs

(mean(range)

age: 41.3 (32-

59)y

Concentrations of

DDE were determined

in serum.


p,p’-

Dichlorodiphenyldichloroethylen

e (p,p’-DDE) 292(168); 249;

128–662

44 | P a g e

Table 13 Biomonitoring: PAHs – Phthalates (Group 2B)


Sample Type

Study Population



Comments/

additional data

Kolena 2020 Slovakia ND

Two Slovakian Fire and

Rescue Service Stations.


at the beginning of work,

not

earlier than 6:00 am, at

the end of the workweek

(Friday, work duration of

at least 8 h per shift).

Urine 32 male FFs

(Mean (sd)

age: 38.22

(8.23); range

24-53y)

Quantified urinary

concentration of

compounds: mono-methyl

phthalate (MMP), mono-ethyl

phthalate (MEP), mono-

isobutyl phthalate (MiBP),

mono-n-butyl phthalate

(MnBP), mono-benzyl

phthalate (MBzP), mono-2-

ethylhexyl phthalate (MEHP),

mono(2-ethyl-5-hydroxyhexyl)

phthalate (5OH-MEHP),

mono(2-ethyl-5-oxohexyl)

phthalate (5oxo-MEHP),

mono(2-ethyl-5-

carboxypentyl) phthalate (5cx-

MECPP), mono(2-

carboxymethyl-hexyl)

phthalate (2cx-MMHP), and

mono-isononyl phthalate

(MiNP)


MMP 3.02(5.22); 1.70; 1.70-

30.71

MEP 64.55(222.55); 9.86;

1.26-1251.61

MiBP 29.36(19.69); 23.95;

75.68-75.68

MnBP 56.26(37.87); 45.17;

5.26-170.78

MBzP 0.22(0.27); 0.12;

0.00-1.39

MEHP 5.94(5.47); 3.93;

0.24-21.85

5OH-MEHP 13.33(11.21);

9.82; 0.81-53.99

5oxo-MEHP 7.86(5.75);

6.03; 0.69-25.02

5cx-MECPP 14.63(10.78);

11.58; 0.30-39.22

2cx-MMHP 3.61(2.84); 2.86;

0.15-11.21

MiNP 0.91(1.74); 0.28;

0.28-9.36

Detected the

presence of

phthalate

metabolites MiBP,

MnBP, 5OH-

MEHP,

5oxo-MEHP, and

5cx- MECPP in

each urine

sample, followed

by the presence

of phthalate

metabolites

MEP, MEHP, and

2cx-MMHP in

93.75% of

samples; of MBzP

in 78.14% of

samples; of MiNP

in 21.87%

of samples; and

of MMP in 12.5%

of samples

45 | P a g e

Table 14 Biomonitoring: Phenolic Compounds (Group 2B)


Sample Type

Study Population

Exposure level, No.

of exposed cases


Comments/additional data

Waldman 2016 USA 2011

A convenience sample of

FFs from a Southern CA

county. Samples were

collected at the time of

their routine examinations,

which were scheduled

during work shifts.

Urine 101 full time

male FFs

Range age

25-62y

Geometric Mean

(95% CI); range

Benzophenone-3

(BP-3): 78.5

(58.3-106)

Detected BP-3 100% of subjects.

BP-3 levels were markedly elevated

compared to levels in the NHANES

group. The Cr-adj BP-3 levels were

consistently higher than for NHANES

for the 25th percentile (7.9 times

higher) through the 95th percentile

(73% higher).

46 | P a g e

Table 15 Biomonitoring: Perfluoroalkyl Acids (PFAAs; Group 2B)


Sample Type

Study Population


exposed cases



Dobraca

2015

USA 2011

A convenience sample

of FFs in a southern

CA

County (137 invited,

101 participated)

Blood 101 FFs

(98% male)

Mean(se) age

42.8(0.9)y

Geometric mean (95% CI) μg/L

Perfluorooctane acid (PFOA):

3.75 (3.37-4.17)

Laitinen

2014

Finland 2010

FFs from the Oulu

Airport Fire Brigade in

Finland participated in

3 consecutive training

sessions. Sthamex 3%

AFFF was used for

fire suppression.

Samples were

collected at 4 time

points - 2 weeks

before the first training

session (BL); the next

3 samples were taken

two weeks after each

training session.

Blood 8 male FFs

Mean(sd) age:

44.4 (12.4) y

In the general

Nordic population,

the PFOA

concentration is

expected to be in

the range of 0.76-

5.01 ng/mL

Median (range) of PFOA

concentration (ng/mL): 2.94

(1.61-4.85)

The most abundant PFAAs

in the AFFFs were PFOS

and PFOA.

Total serum PFAA

concentrations in this study

population

ranged from 6.5 to 51

ng/mL.

Shaw 2013 USA 2009

FFs working at

different stations in

Blood 12 male FFs

(mean(range)

age: 41.3 (32-

Concentrations of

PFOA were

determined in


Perfluorooctanioic acid (PFOA)

47 | P a g e

San Francisco, CA,

were selected

according to the

following criteria: (1)



chemical emissions;

(2) they were FFs for

at least 5 years; and

(3) they had

responded to fire

scenes at least 20

times in the past 5

years. Samples were



59)y serum. 7(3); 6; 2–12

48 | P a g e

Table 16 Biomonitoring: Dioxins & Furans (Group 2B)


Sample Type


cases


Comments/

additional data

Schecter

2002

Russia 1998

Blood 10 Disabled male FFs

(mean age 39.3y)

Measure levels

converted to mean

dioxin toxic

equivalents (TEQ)

1,2,3,4,7,8-HxCDD: 0.3

Group 3 per IARC;

however EPA stated

Group 2B

1,2,3,7,8,9-HxCDD: 0.2 Group 3 per IARC;

however EPA stated

Group 2B

Schecter

2002

Russia 1998

Blood 15 Non-disabled

male FFs (mean age

40.9)

Measure levels

converted to mean

dioxin toxic

equivalents (TEQ)


however EPA stated

Group 2B


however EPA stated

Group 2B

Hsu 2011 Taiwan 2010

FFs working at the

Fire

Bureau of Tainan

Country, Taiwan

(350 Recruited,

291completed

survey, 46 qualified,

20 volunteered).

Blood

(serum)

20 male FFs and fire

scene investigators

Mean(sd) age:

43(5.6)y

Avg. attended fire

scene: 45 (ranged

20-300)

The 2005 WHO-TEFs

system (Van den Berg

et al., 2006) was used

to calculate

the TEQ values.

1,2,3,4,7,8-HxCDD: Median

1.6

Mean(sd) 1.7(0.80)

Range 0.41-3.4

Group 3 per IARC;

however EPA stated

Group 2B

49 | P a g e

Kelly 2002 USA 1998

FDNY personnel

presented at the

Staten Island Con

Edison transformer

fire with PCB

contamination.

Samples were

collected 3 mo after

the transformer fire.

Blood 58 male FFs

Mean(sd) and range

age 42.9(9.1); 19-63y

Post-exposure

Mean(sd); range (pg/gm)

1,2,3,4,7,8-HxCDD:

12.29(10.03); undetected

(UD)-38.4)

TEF 0.1

UD = undetected

50 | P a g e

Table 17 Biomonitoring: Unspecified PAHs


Sample Type

Study Population



Comments/

additional data

Andersen

2018

Denmark ND

FFs were from the

Greater Copenhagen

Fire Department: three

24h work shifts.

Sequential study:

measured 2 time points

-start of the work shift

(between 8-9 A.M.) and

at the end of the shift

around 24-h later

(between 7-8am)

Urine

22 male FFs

(3 shifts; n = 7,

8, 7).

Mean (sd) age:

51.7 (sd 6.2y)

Smoker 4/18

(22.2%)

Fire smoke

exposure 14/18

(77.8%)

PAH mixtures exposure

was assessed by urinary

1-hydroxypyrene

(1-OHP)

Limit of detection was 1.1

nmol/L

1-OHP before/ after the 24h work

shift (μmol/mol creatinine; Mean

(sd))

Shift 1: 0.72(0.62)/ 0.47(0.22)

Shift 2: 0.24(0.10)/ 0.28(0.20)

Shift 3: 0.66(0.58)/ 0.98(0.76)

Total:

0.52(0.51)/ 0.56(0.53)

Participated in fire activities

(n=14): 0.66(0.59)/ 0.67(0.57)

Not participated in fire activities

(n=8): 0.29(0.18)/ 0.36(0.42)

Pyrene is

commonly found in

PAH mixtures, and

its urinary

metabolite, 1-

OHP, has been

used widely as an

indicator of

exposure to PAH

chemicals. IARC

determined that

pyrene was not

classifiable as to

its human

carcinogenicity.

Andersen

2018

Denmark 2015

Cross over study in 3

exposure scenarios.

Samples were

collected 14 days

before the smoke-

diving course,

immediately after the 3-

day course exercises

and 14 days

subsequent to the end

of the training session.

Urine 53 non-smoking

FF trainees

(77.4% male)

Mean(sd); range

age: 21.4(1.8)y;

18-26

Used urinary excretion of

1-OHP as PAH markers

Mean (sd); Median (Q1-Q3)

μmol/mol creatinine:

Before exposure

0.41(0.40); 0.27 (0.19–0.43)

After exercises

0.68(0.53); 0.51 (0.28–0.98)

After 14-day exposure

0.48(0.23); 0.41 (0.23–0.60)

Firefighting

increased 1-OHP

concentration in

urine by 70.4%

(95% CI: 33.4,

113.5) compared

with the mean of

the two control

periods

51 | P a g e

Fernado

2016

Canada ND

The exposure of

firefighters to wood

smoke was evaluated

during training

exercises in burn

houses at four

different sites across

Ontario. Samples were

collected immediately

before the training (pre-

exposure/baseline)

followed by collection

of urine specimens for

the next 24h after the

training exercise

(postexposure).


FFs

(85.7% male)

Assessed metabolites of

pyrene (1-

hydroxypyrene) and

fluoranthene (3-

hydroxyfluoranthene)

Not reported Metabolites of

pyrene (1-

hydroxypyrene)

and fluoranthene

(3-

hydroxyfluoranthe

ne) were detected

in <50% of the

samples. Higher-

molecular weight

PAH metabolites

were not detected

because of their

low concentration

levels in urine.

Of the 22 and 16

PAHs originally

measured in the

air and from skin

wipe extracts,

respectively, only

10 OH-PAHs

derived from 5

parent PAHs were

detected in urine

when using

GC−MS/MS

analysis

52 | P a g e

Lindquist

1997

Finland 1996

Two routine exercises:

extinguishing training in

firehouse and shipping

container exercises.

Samples were

collected at the end of

both days.

Urine 5 non-smoking

male FF

instructors

Mean age 33.2y

(range 28-35)

compared to 5

non-smoking

male staffs

(mean age 33.6;

range 28-39y) at

the same rescue

college

Evaluated pyrene’s

metabolite, 1-pyrenol at

the end of the workday

(Detection limit: 0.1

nmol/L) and compared it

with a sample from the

beginning of the

semester (after summer

vacation).

Mean (range) nmol/L

Firehouse: 15.8 (6.0-30.6)

Container: 8.4 (1.8-21.3)

Moen 1997 Norway ND

Participants were from

a firefighter training

school. Samples were

collected before and 6-

7 hrs after

extinguishing burning

diesel fuel.

9 students and 4

teachers from a

FF training

school (only 3

teachers

provided a

second after-fire

urine sample)

Assessed PAH mixtures

exposure using PAH-

metabolite, 1-

hydroxypyrene

Mean(sd) before/after fire training

All 0.06(0.08)/ 0.13(0.14)

Nonsmoker 0.02(0.02)/ 0.07

(0.02)

Smoker 0.11(0.11)/ 0.20(0.20)

A significant

increase in the

concentration of 1-

hydroxypyrene

was demonstrated

after the training.

Caux 2002 Canada 1994

(197 volunteered, 43

provided samples).

Samples were

collected during the

period extending for

20h following the end

of fire exposure. A

control sample was

also obtained from

Urine 43 FFs

(n = 20: 26-35y

n = 20: 36-45y

n = 2; 45+y)

Using PAH- metabolite,

urinary 1-hydroxypyrene

Median (range) μmol/mol

creatinine

Control: Below detection limit,

BDL (BDL-0.49)

At 0 h urination: 0.11 (BDL-1.08)

0-4 h: 0.22 (0.049-1.01)

All but one 1-OHP

baseline value

were below 0.32

μmol/mol

creatinine, the

95th percentile of

urinary 1-

hydroxypyren e

values

encountered in

53 | P a g e

each participant after at

least 4 days w/o

involvement in fire

activities.

4-8 h: 0.15 (0.032-3.63)

8-12 h: 0.10 (BDL-3.05)

12-16 h: 0.14 (BDL-0.52)

16-20 h: 0.22 (BDL-1.15)

non-occupationally

exposed

populations

Keir 2017 Canada 2016

27 FFs were recruited

for study blocks of 5

consecutive 24 h shifts

typically spanning

12 days. Samples were

collected at the

beginning of each shift

(preexposure) and 18h

after fire

(postexposure).

27 male FFs

participants in

emergency

suppression

(avg. age 34;

range 25-50y)

compared with

17 office workers

(avg. age 50;

range 28-62y)

Evaluated pyrene’s

metabolite, 1-

hydroxypyrene;

Pre-/Post-fire

Geometric mean(SE); range μg/g

creatinine

1-hydroxypyrene

0.10(0.01); 0.02-0.03/

0.27(0.02); 0.06-1.81

∑hydroxyphenanthrenes 0.35(0.02); 0.09-0.98/ 0.89(0.06); 0.20-6.56 ∑hydroxyfluorenes 0.48(0.02); 0.12-1.17/ 1.31(0.07); 0.32-7.09

Fent 2019 USA ND

A repeated-measures

design. 12 FFs

assigned to attack,

search, outside vent, or

backup/overhaul who

were sampled for 23 h

after a single interior

fire attack scenario.

Samples were

Urine

41 FFs (90.2%

male)

Evaluated PAH’s

metabolites:

Σhydroxyphenanthrenes

(1-hydroxyphenanthrene,

2-hydroxyphenanthrene,

and 3-

hydroxyphenanthrene)

1-hydroxypyrene,

Median OH-PAH

metabolites μg/g creatinine

(attack/search, outside vent,

backup/overhaul)

ΣHydroxyphenanthrenes

Pre: 0.26, 0.28, 0.36

3h: 3.1*, 1.3*, 1.1*

6h: 2.2*, 0.83*, 0.73*

12h: 1.0*, 0.52*, 0.48*

In all cases,

median

concentrations of

the OH-PAH

metabolites

increased

significantly (p <

0.01) from pre-

exposure to 3-h

post exposure.

54 | P a g e

collected pre- and 3h

post-fire.

Σhydroxyfluorenes (2-

hydroxyfluorene and 3-

hydroxyfluorene)

23h: 0.67*, 0.37*, 0.42*

1-hydroxypyrene,

Pre: 0.11, 0.14, 0.12

3h: 0.56*, 0.45*, 0.47*

6h: 0.81*, 0.33*, 0.29*

12h: 0.73*, 0.26*, 0.23*

23h: 0.49*, 0.23*, 0.22*

Σhydroxyfluorenes

Pre: 0.34, 0.35, 0.32

3h: 1.1*, 0.74*, 0.67*

6h: 0.61*, 0.53*, 0.44*

12h: 0.44*, 0.40*, 0.39*

23h: 0.36, 0.34, 0.33

[* sig different from pre]

.

Fent 2019 USA ND

A repeated-measures

design. Two sets of 5

instructors (designated

alpha and bravo)

worked alternating

days (three study days

in five calendar days

each), each set led 3

training exercises with

a

different crew of 4 FFs

involved in each daily

exercise.

Urine

10 instructors

(90% male)

24 FFs (91.6%

male)

Evaluated PAH’s

metabolites:

Σhydroxyphenanthrenes

(1-hydroxyphenanthrene,

2-hydroxyphenanthrene,

and 3-

hydroxyphenanthrene)

1-hydroxypyrene,

Σhydroxyfluorenes (2-

hydroxyfluorene and 3-

hydroxyfluorene)

Median μg/g creatinine

(scenarios: A, B, C-alpha, C-

bravo)

1-hydroxyphenanthrene

FFs: 0.23, 0.38, 0.49, 1.3

Inst: 0.32, 0.72, 1.4, 1.5

2,- and 3-hydroxyphenanthrene

FFs: 0.33, 0.55 ,0.93, 2.3

Inst: 0.67, 1.2, 2.2, 3.0

1-hydroxypyrene

FFs: 0.15, 0.26, 0.32, 0.78

Firefighters had a

significant

increase in OH-

PAH

concentrations

3-hr after training

for all scenarios.

Instructors’ OH-

PAH

concentrations

increased steadily

throughout each

training day and by

55 | P a g e

The 3 scenarios

differed primarily by

fuel package and type

or orientation of the

structure: a) simulated

smoke, b) pallet and

straw, and c) oriented

strand board (OSB) -

alpha/bravo.

FFs’ samples were

collected pre-, and 3-hr

post-firefighting.

Instructors’ samples

were collected before

the first crew's training

exercise (pre-

firefighting), right after

the second crew's

training exercise (∼3 h

after first scenario), and

3-hr after the last

crew's training exercise

(∼9 h after the first

scenario).

Inst: 0.27, 0.84, 1.5, 3.5

2-hydroxyfluorene

FFs: 0.45, 0.55, 0.96, 1.5

Inst: 0.88, 1.3, 1.5, 2.2

3-hydroxyfluorene

FFs: 0.18, 0.19, 0.29, 0.45

Inst: 0.21, 0.58, 0.68, 0.92

the end of the shift

were significantly

greater than the

pre-training levels

for all scenarios.

hydroxyphenanthr

enes had the

largest pre-to 3-hr

post- training urine

concentration

increase on a

percentage basis

(median +1074%)

Oliveira

2016

Portugal 2014

FFs from 6 firefighting

corporations.

Compared 2 groups:

non-exposed (were not

involved in fire combat

activities within 48 h

prior the urine


wildland FFs (57

exposed, 79%

male)

Determining biomarkers

of PAH exposure using

total urinary

monohydroxyl -PAHs

(ΣOH-PAHs)

Median; range ΣOH-PAHs

μmom/mol creatinine from 6 FCs

Nonexposed FFs: 1.54(0.44-

0.24), 0.25(0.25-1.55), 0.81(0.24-

2.39), 1.57(1.11-2.57), 0.45(0.21,

2.20), 1.14(0.80-2.08)

56 | P a g e

collection), and

exposed FFs (were

actively involved in fires

combat and extinction).

Exposed FFs: 2.40(0.82-4.33),

8.75(5.99-9.06), 7.67(6.82-8.90),

7.86(1.93-121), 0.97(0.40-4.39),

1.97(1.31-2.62)

Oliveira

2020

Portugal ND

FFs from 8 units from

the district of Braganca,

were organized into 3

groups according to

their active participation

in firefighting activities

(within the 48 h before

sample collection) and

their smoking habits: (i)

non-smoking and non-

exposed subjects

(Control group -

FFsthat stayed at the

fire stations and did not

participate in fire

combat), (ii) non-

smoking and exposed

subjects (i.e. non-

smoking individuals

who were directly

involved in firefighting

activities; Group A),

and (iii) smoking and

exposed subjects (i.e.

smoking FFs exposed

to fire

emissions; Group B).

Urine

Samples

were

collected

at the

end of

the 8h

work-

shift.

171 male

wildland FFs

(median age 30-

36y)

Determining biomarkers

of PAH exposure using

urinary 2-

hydroxyfluorene

(2OHFlu), 1-

hydroxyphenanthrene

(1OHPhe), 1-hy

droxypyrene

(1OHPy), and urinary

monohydroxyl -PAHs

(ΣOH-PAHs)

Median (P25-P75); range of

urinary levels (μmol/mol

creatinine)

Control/A/B

2OHFlu:

0.06 (0.04–0.12); 5.67×10−4–

0.48/ 0.09 (0.05–0.21);

5.67×10−4–0.47/ 0.62 (0.41–

1.08); 0.29–1.61

1OHPhe:

0.04 (0.02–0.10); 6.71×10−3–

0.21/ 0.06 (0.04–0.08); 0.02–

0.29/ 0.04 (0.03–0.09); 0.02–

0.19

1OHPy:

0.03 (0.02–0.04); 1.84×10−3–

0.23/ 0.04 (0.02–0.07);

1.84×10−3–0.19/ 0.04 (0.02–

0.10); 3.69×10−3–0.85

ΣOH-PAHs:

1.59 (0.75–2.19); 0.10–4.27/ 1.68

1OHPhe, 2OHFlu

and 1OHPy

were detected in

more than 90% of

the subjects.

The Inter-

comparison of

ΣOHPAH

concentrations

among the three

different groups

was (by

decreasing order):

Group B (6.96

μmol/mol

creatinine) >

Group A (1.68

μmol/mol

creatinine) >

Control group

(1.59 μmol/mol

creatinine).

57 | P a g e

(1.09–3.39); 0.82–121/ 6.96

(4.32–8.82); 1.52–48.6

Laitinen

2012

Finland ND

The exposure tests

were carried out in

conventional (11 test

persons) and modern

(2 test persons)

simulators. The first

urine sample was taken

before exposure, the

second sample was

taken as recommended

by the general

guidelines, and the

third and fourth

samples were taken 6

h after exposure and

the next morning.

Urine 13 male smoke

diving trainers

Evaluating 1-

hydroxypyrene

The FFs’ average 1-

hydroxypyrene concentrations

after training in the

conventional simulator was 5

nmol/L, and

1.2 nmol/L after training in the

modern simulator

(under the limit of 1-

hydroxypyrene for the unexposed

population

in Finland).

Adetona

2015

USA 2009

Wildland FFs who

worked at prescribed

burns at SRS

participated during the

dormant winter

seasons. Samples

were collected pre-shift

immediately before

work at prescribed

burns, and on the same

day immediately after

Urine

19 wildland FFs

(89.5% male) 56

pre- and post-

shift

urine sample

pairs from 14

subjects (12

males and 2

females) working

at 16

of the prescribed

burn work shifts

Measured mono-

hydroxylated PAHs: 2-,

3-hydroxyfluorene (2FLU,

3FLU), 1-,

2-, 3-, 4-

hydroxyphenanthrene

(1PHE, 2PHE, 3PHE,

4PHE) and 1-

hydroxypyrene (1PYR).

Estimate (95% CI) pre-shift/post-

shift (ng/g creatinine)

2FLU 496 (371-663)/ 1491 (1115-

1994)

3FLU 199 (150-264)/ 426 (321-

564)

1PHE 247 (183-334)/ 557 (412-

752)

All the OH-PAHs

were above the

limits of detection

in >96% of the

samples, with

2NAP, 2FLU,

1PHE and 1PYR

being detected in

all the samples.

4PHE had the

lowest

concentrations in

58 | P a g e

prescribed burn was

completed.

with an average

duration of 7.6 h

2PHE 123 (94-163)/ 346 (262-

457)

3PHE 198 (150-263)/ 705 (531-

935)

4PHE 33 (25-43)/ 121 (92-158)

1PYR 313 (212-463)/ 576 (390-

851)

Σ(OH-PAHs) 9202 (6828-12,402)/

27,447 (20,406-37,064)

both pre- and post-

shift urine samples

among the

subjects.

Postshift urinary

concentrations of

all individual OH-

PAHs and the

Σ(OH-PAHs) were

significantly higher

compared with the

pre-shift

concentrations,

with the post-shift

concentrations

being

1.83–4.23 times

higher compared

with the pre-shift

concentrations.

The creatinine-

corrected post-

shift concentration

of Σ(OH-PAHs)

was 2.99 times

higher than the

pre-shift

concentration.

Oliveira

2017

Portugal 2015

FFs were serving at 3

different fire stations,

Urine 108 wildland FFs

(Mean ages for

NSNExp 34 (22–

PAH metabolites, 2-

hydroxyfluorene

(2OHFlu), 1-

NSNExp:

1OHPhen

0.002–0.077 μmol/mol creatinine;

1OHPhen

was quantified in

all samples,

59 | P a g e

namely Vinhais (VNH),

Mirandela (MDL) and

Braganca (BRG), and

organized into 3

different groups: non-

smoking and non-

exposed to fire

emissions (NSNExp),

smoking non-exposed

(SNexp) and smoking

exposed (Sexp).

Samples were

collected at the end of

a regular work shift.

48 y);

SNExp 34 (21–

60 years);

SExp 31 y (21–

53)

hydroxyphenanthrene

1OHPhen), and 1OHPy

were determined.

0.007–0.362 μg/L urine

1OHPy

0.004–0.089 μmol/mol creatinine;

0.022–0.369 μg/L urine)

Median concentrations μmol/mol

creatinine NSNExp/SNExp/SExp:

2OHFlu (BRG: 0.017/ 0.022/

0.257; VNH: 0.118/ 0.340/ 0.718)

1OHPhen (VNH: 0.029/ 0.051/

0.108; MDL: 0.074/ 0.204/ 0.4)

1OHPy (VNH: 0.020/ 0.024/

0.024; BRG: 0.009/ 0.024/ 0.044)

2OHFlu and

1OHPy were

determined in 97%

of the urine

samples.

From 3 fire

stations, the

median

concentrations of

individual and total

∑OH-PAHs

compounds in

SExp > SNExp >

NSNExp subjects.

Rossbach

2020

Germany 2018

FFs completed five 2h-

training sessions each

in a carbonaceous-fired

simulation unit using

self-containing

breathing apparatuses

(SCBA). Complying

with a minimum time

interval of 6 days

between the individual

training sessions.

Samples were

collected in the

morning of exposure

day, before and

Urine 6 male non-

smoking

firefighting

instructors

(median and

range age 35

(25-41y)

270 samples

(6x5x9)

Evaluated hydroxylated

PAH metabolites,

2-hydroxyfluorene (2-OH-

FLU), 3-hydroxyfluorene

(3-OH-FLU), 9-

hydroxyfluorene (9-OH-

FLU), 1-

hydroxyphenanthrene (1-

OH-PHE), 2-

hydroxyphenanthrene (2-

OHPHE),

3-hydroxyphenanthrene

(3-OH-PHE), 4-

hydroxyphenanthrene

(4-OH-PHE) and 1-

hydroxypyrene (1-OH-

Median (range) μg/g creatinine

(morning before training/ end of

training/ 3h post-training/ morning

after training)

2-OH-FLU: 0.33 (<LOD-0.83)/

1.49 (0.64-6.25)/ 1.74 (0.84-

3.83)/ 0.47 (0.08-1.04)

3-OH-FLU: 0.05 (<LOD-0.38)/

0.25 (0.02-1.15)/ 0.31 (0.16-

0.94)/ 0.13 (<LOD-0.42)

9-OH-FLU: 0.14 (0.03-2.80)/ 1.42

(0.46-3.98)/ 1.09 (0.19-2.22)/

0.18 (0.03-0.53)

Comparing before

and after training

(sampling 2 and

3) showed a clear

increase for ΣOH-

NAP (median

concentrations

2.29

vs. 11.88 μg/g

crea., median

increase +277 %,

calculated from the

individual values of

relative change)

and ΣOH-FLU

(0.41 vs. 1.76,

60 | P a g e

immediately after, as

well as 1, 3, 6, 9, 11,

and 18 h after each

training session (9 time

points).

PYR).

1-OH-PHE: 0.15 (0.05-0.33)/ 0.36

(0.14-1.74)/ 0.62 (0.31-3.57)/

0.22 (0.12-0.64)

2-OHPHE: 0.06 (0.02-0.21)/ 0.30

(0.10-1.41)/ 0.44 (0.12-1.72)/

0.07 (<LOD-0.56)

3-OH-PHE: 0.11 (0.05-0.27)/ 0.48

(0.25-1.83)/ 0.70 (0.36-2.23)/

0.17 (0.10-0.43)

4-OH-PHE: 0.02 (<LOD-0.10)/

0.16 (<LOD-0.76)/ 0.18 (<LOD-

1.28)/ 0.03 (<LOD-0.14)

1-OH-PYR: 0.06 (0.03-0.15)/ 0.20

(0.06-1.61)/ 0.40 (0.16-1.88)/

0.17 (0.05-0.63)

+302 %). By

contrast, only a

small increase was

found for ΣOH-

PHE

(0.30 vs. 0.38, +31

%) and 1-OH-PYR

(0.050 vs. 0.060,

+7 %).

The concentration

of ΣOH-FLU

(sampling 2 vs. 4),

ΣOH-PHE

(sampling 2 vs. 5)

and 1-OH-PYR

(sampling 2 vs. 5)

increased in

median by 2.91,

1.60 and 0.31 μg/g

crea. or

+673, +564 and

+693 %,

respectively.

Though clearly

decreasing

afterwards, the

concentrations

remained higher

than in sampling 2

until the end of the

observation

period.

61 | P a g e

Robinson

2008

USA ND

Wood smoke from pile

burning exposure in

Native American

wildland FFs (The

White Mountain

Apache Tribe

(WMAT)). Samples

were collected pre-

exposure (first morning

void), at the end of the

prescribed- burn shift,

and the morning

following prescribed

burning (first morning

void).

Urine 21 Wildland FFs

(20 from WMAT)

86% male

Mean (range)

age 41.2 (26-

89y)

Urinary 1-HP Mean (sd); Median, Range μg/L

Baseline: 0.14 (0.19); 0.03

(<0.01-0.56)

End of shift: 0.09 (0.12); 0.03;

(<0.01-0.50)

Next AM: 0.05 (0.12); 0.02;

(<0.01-0.53)

No significant

changes were

found comparing

baseline to post-

exposure urinary

1-HP.

Fent 2014 USA 2010-2011

Non-smoking males 45

years of age or

younger who were

instructors with the

Chicago Fire

Department. Round 1

of the study was in

August 2010; round 2


fire instructors

(15 FFs

participated in

each

round (five FF

seach day). 12

FFs from round 1

repeated the

Assessed PAH-

metabolite

(phenanthrene

equivalents) levels.

Median PAH metabolites: Not

reported

The 3-h urinary levels of PAH

metabolites

median = 62 μg/g; range = 29–

140 μg/g)

Median urinary

PAH metabolite

levels

appear higher

during round 1

than round 2. The

highest median

urinary PAH

metabolite levels

62 | P a g e

was 1 year later. Each

round consisted of

three controlled

structure burns (one

burn each day).

Samples were

collected pre-exposure

(~1 h before the

controlled burn), post-

exposure (10–40 min

after the controlled

burn), 3-, and 6h after

the controlled burn.

study during

round 2.)

were measured

during the 3-h

collection for both

rounds, but the

temporal pattern

varied between

rounds. The PAH

metabolite levels

in the 3-h samples

did not differ

significantly from

the pre-exposure

levels for either

round.

Feunekes

1997

Netherlands ND

Participants were from

the fire-fighting school

of the Royal

Netherlands Navy.

Samples were

collected after a

summer leave of 3-4

weeks, before

beginning work (pre-

shift), and last day of a

complete exercise

week (16-20h after the

last firefighting exercise

for Group A and 2-4h

after the last firefighting

of an intense exercise

day for Group B)

Urine Male firefighting

trainers

Group A n = 23;

mean(sd) age

35(8.3)

Group B n = 10

mean(sd) age

37(7.7)

Using a metabolite of pyrene, 1-hydroxypyrene

Median 1-Hydroxypyrene smoker

vs. non-smokers (μg/L)

Group A: 0.65 vs. 0.60

Group B: 1.01 vs. 0.51

The

concentrations of

both groups were

similar, and

smoking persons

had increased

concentrations of

1-hydroxypyrene

in urine.

An increase in

urinary

concentration was

observed in Group

A, but not

statistically

significant.

63 | P a g e

Edelman

2003

USA 2001

A cross-sectional study

using a stratified

sample of FF units

based on WTC arrival

time. Arrival time was

categorized as a)

present at the WTC

collapse, b) arrival on

day 1 or 2 but post-

collapse, and c) arrival

on days 3–7.

370 firefighters (321

exposed, 47 controls,

and 2 with missing

data) participated, 368

having chemical

measurements.

Blood Of the

participating FFs

(N = 368), 148

were present

during the WTC

towers collapse,

and 142 arrived

Post-collapse on

days 1–2.

Measuring 1-Hydroxypyrene 1-Hydroxyphenanthrene 2-Hydroxyphenanthrene 3-Hydroxyphenanthrene

Geometric mean μg/L urine

(Exposed/Control; Present/after

collapse; Special Ops vs FFs)

1-Hydroxypyrene: 93.2/62.5; 110/113; 159/77.9 1-Hydroxyphenanthrene: 186/158; 197/206; 248/164 2-Hydroxyphenanthrene: 164/119; 163/191; 211/147 3-Hydroxyphenanthrene: 162/127; 168/185; 214/145

Our analytic

method measured

14 hydroxylated

metabolites in

urine. The most

common PAH

metabolite used

for biomonitoring

exposure is 1-

hydroxypyrene

Special Ops

Command FFs

fighters had more

than twice the

level of urinary 1-

hydroxypyrene

as did other

exposed FFs or

control

FFs. The urinary

concentrations in

the other exposed

FFs were similar to

controls.

64 | P a g e

Table 18 Biomonitoring: Heavy Metals


Sample Type

Study Population



Comments/

additional data

de Perio

2010

USA 2008

FFs from 2

departments - not

wearing (Dept. A) and

wearing (Dept. B)

antimony-containing

pants (154 invited

(112 from A; 42 from

B); 64 participated).

Urine 62 FFs

A: n=20 Mean age

49.3y; 95.8% male

B: n=42 Mean age

39y; 92.9% male

Antimony trioxide (IARC

2B)

The analytical limit of

detection (LOD) for

antimony is

0.032 micrograms per liter

(μg/L), and the national

reference range

for antimony in the urine is

0.130 to 0.340 μg/L or

0.120 to 0.364

micrograms per gram

(μg/g creatinine).

Urine antimony

concentrations

Geometric mean

(range) μg/g

creatinine

A: 0.063 (0.027-

0.285)

B: 0.054 (0.017-

0.366)

None of the participating

Fire Department A

employees had

worn pants made from

FireWear fabric in the

preceding 4 months.

Fire Department B

participants wore FireWear

pants for a mean of 92 hrs,

or close to four 24-hour

shifts, during the previous 2

weeks. Fire Department B

participants reported

wearing the FireWear pants

for a mean of 4 years and

owned a mean of four pairs

of the pants.

Dobraca

2015

USA 2011

A convenience sample

of FFs in a southern

CA

County (137 invited,

101 participated)

Blood 101 FFs

(98% male)

Mean(se) age

42.8(0.9)y

Total mercury (inorganic

IARC 3), manganese (no

record found), cadmium

(IARC 1), and lead

(inorganic IARC 2A) were

analyzed.

Geometric mean

(95% CI)

Cadmium 0.19 (0.18-

0.21) μg/L

Lead 0.96 (0.87-1.05)

μg/dL

All blood lead and cadmium

concentrations were below

the

CDC early reporting

thresholds

Al-Malki Saudi Arabia ND Blood 49 male non- Lead (IARC 2A), Arsenic Urinary geometric

65 | P a g e

2009 Two groups of male

non-smokers FFs

participated (Jeddah &

Yanbu). Samples were

collected within the

first hour of

firefighting.

smoking FFs

Mean (sd) age: 39

(6.5y); 43 (7.5y)

(IARC 1), Cadmium (IARC

1), and Antimony (IARC

2B) were analyzed.

mean (sd) μg/dL

(Jeddah vs. Yanbu)

Lead 3.49 (1.06) vs.

3.83 (1.64

Arsenic 0.34 (0.23)

vs. 0.33 (0.15)

Cadmium 0.07 (0.03)

vs. 0.10 (0.08)

Antimony 0.00

Edelman

2003

USA 2001

A cross-sectional

study using a stratified

sample of FF units

based on WTC arrival

time. Arrival time was

categorized as a)

present at the WTC

collapse, b) arrival on

day 1 or 2 but post-

collapse, and c) arrival

on days 3–7.

370 firefighters (321

exposed, 47 controls,

and 2 with missing

data) participated, 368

having chemical

measurements.

Urine

(all)

Blood

(Lead)

Of the participating

FFs (N = 368), 148

were present during

the WTC towers

collapse, and 142

arrived post-

collapse on days 1–

2.

Exposed group (n =

318) vs. Control (n

= 47)

By arrival time

Present at collapse

(n =148) vs. 1-2

days after collapse

(n=142)

Lead (inorganic IARC 2A), Antimony (IARC 2B), Cadmium (IARC 1) were analyzed.

Geometric mean μg/L

urine or μg/dL blood

(Exposed/Control;

Present/after

collapse; Special op

vs FFs)

Lead (blood):

2.76/1.93; 3.08/2.98;

3.77/2.43

Lead (urine):

1.17/1.01; 1.44/1.19;

1.77/0.96

Antimony:

0.203/0.165;

0.271/0.238;

0.381/0.169

66 | P a g e

By unit assignment

Special operations

command (n=95)

vs. Other FFs

(n=195)

Cadmium:

0.324/0.377;

0.355/0.299;

0.351/0.303

67 | P a g e

ENVIRONMENTAL MONITORING

Table 19 Environmental Monitoring: 1,3-Butadiene (Group 1)


Sampling Matrix No. of samples

Exposure level

Exposure range


Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, 7 Team Leading firefighters in seven training situations, 8 Team Leading firefighters during eight emergency events

Passive Personal Air Sampling FF Train

Passive Personal Air Monitoring Emergency Events

29

29

2.69 ng/M3

± 2.32

23.6 ng/M3

± 3.78

(0.454-9.58 ng/M3)

(3.94–226 ng/M3)

geometric mean ± geometric standard deviation

Austin 2001 Canada, 15 experimental fires burned in a basement for 15 minutes

Area sampling 15 0.1 ppm NR Peak concentrations

68 | P a g e

Table 20 Environmental Monitoring: 2,3,4,7,8-Pentachlorodibenzofuran (Group 1)

Reference Location, Setting, Study design Sampling Matrix

No. of samples

Exposure level

Exposure range

Comments/ additional

data

Kelly 2002 New York, USA, Following an electrical transformer fire in Staten Island, New York, a health surveillance program was established for 60 New York City firefighters and emergency medical technicians exposed to PCBs, PCDDs, and PCDFs

Swab sample within and around transformer

NR 179 ng NR Maximum Values


Area air sample within and around transformer

NR 3305 pg/m3

NR Maximum Values

Table 21 Environmental Monitoring: 2,3,7,8-Tetrachlorodibenzo-P-dioxin (Group 1)


No. of samples

Exposure level

Exposure range


data


Swap sample within and around transformer

NR 0.2 ng NR Maximum Values


Area air sample within and around transformer

NR 5 pg/m3 NR Maximum Values

69 | P a g e

Table 22 Environmental Monitoring: Asbestos (Group 1)


No. of samples

Exposure level

Exposure range


Bolstad-Johnson 2000

Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department set up two area samplers for 25 fires: 1 at point of origin and one adjacent where overhaul activities occurred within structure

Area 46 0.073 f/cc ± 0.063

(0-0.2 f/cc) Average Sample Concentration ± standard deviation

70 | P a g e

Table 23 Environmental Monitoring: Benzene (Group 1)

Reference Location, Setting, Study design Sampling Matrix No. of samples

Exposure level

Exposure range



Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires

Personal Air 95 0.383 ppm ± 0.425

(0.07-1.99 ppm)

Average Sample Concentration ± standard deviation


Passive Personal Air Sampling Training


31

31

18.0 ± 2.14 𝝁g/M3

250 ± 2.66 𝝁g/M3

(5.37-79.0 𝝁g/M3)

(48.9–665 𝝁g/M3)


Fent 2018 Illinois, USA, Structure Fire, Fire Training, 6 crews of 12 firefighters, each crew was deployed to 2 fire scenarios using 2 fire attack tactics, completed 6 fireground job assignments

Personal Air Sampling: Attack

Personal Air Sampling: Search

Personal Air Sampling: Overhaul

Personal Air Sampling: Outside Vent

Personal Air Sampling: Command/Pump

Area Sample: VOCs

17

22

47

22

24

40300 ppb

37900 ppb

902 ppb

204 ppb

<10 ppb

(12400-322000 ppb)

(12000-306200 ppb)

(<6-2970 ppb)

(<9-883 ppb)

Median Concentration

71 | P a g e

12

13930 ppb

(<10-297 ppb)

(64.3-20900 ppb)

Reisen 2009 Australia, 2 experimental burns and 10 prescribed Bushfire Burns, 40 firefighters and 10 researchers wore personal samplers across the 12 burns

Personal Air 31 0.06 mg/m3

0.03 mg/m3

(0.002-0.26 mg/m3)

Mean

Geometric Mean

Reisen 2009 Australia, 2 experimental burns and 10 prescribed Bushfire Burns, 10 area samples taken adjacent adjacent to fires

Area 10 0.19 mg/m3

0.10 mg/m3

(0.01-0.69 mg/m3)

Mean

Geometric Mean

Reinhardt 2004 USA, 30 days of wildfire suppression, 84 firefighters monitored for 17 days at 8 project wildfires, 45 firefighters monitored for 13 days of initial attack incidents, 221 firefighters monitored for 29 prescribed burns for smoke exposure

Personal Air:

Initial Attack Overall (Shift) Initial Attack At Fires (Fireline)

Project Fires

Overall (Shift) Project Fires At Fires (Fireline)

Prescribed Burns Overall (Shift) Prescribed Burns At Fires (Fireline)

45

45

84

84

200

200

3 ppb

24 ppb

14 ppb

43 ppb

4 ppb

249 ppb

6 ppb

384 ppb

16 ppb

58 ppb

NR

NR

NR

NR

NR

NR

Geometric Mean

Maximum

72 | P a g e

28 ppb

88 ppb


Personal Air:

Burn boss

Lighting

Holding

Holding boss

Direct attack

Mop up

Sawyer

Engine

16

98

85

19

15

62

3

5

21 ppb

45 ppb

21 ppb

26 ppb

41 ppb

20 ppb

91 ppb

39 ppb

NR

NR

NR

NR

NR

NR

NR

NR

Geometric mean sample concentration by task

Kirk 2019 Australia, Fire Training, Seven training events, Passive sampling for one instructor at each event, active sampling for one instruct at each event of events 5-7

Personal Active Event 5

Outside structure

Inside Structure


Outside structure

Inside Structure


Outside structure

Inside Structure

Personal Passive Event 1

1

1

1

1

1

>7.8 mg/m3

0.16 mg/m3

6.4 mg/m3

2.3 mg/m3

NR

Concentration

73 | P a g e

Outside structure


Outside structure


Outside structure


Outside structure

1

1

1

1

1

4.5 mg/m3

4.9 mg/m3

>1/6 mg/m3

>3.1 mg/m3

>2.0 mg/m3

>1.4 mg/m3

74 | P a g e

Hill 1972 USA, Simulated Structure Fire, Training Fire, Airborn Soot Sampling for 2-5 seconds

Area 1 3.73 mg/M3

NR Airborne soot concentration

Rosting 2020 Norway, Structure Fire, Training Fire, 3 groups of 3 firefighters extinguishing 1 fire each for 3 fires total

Personal Air: Fire 1: Air Sample 1

Fire 1: Air Sample 2






1

1

1

1

1

1

1

32.8 ppm

19.5 ppm

4 ppm

3.8 ppm

11.2 ppm

18.6 ppm

25.5 ppm

NR Average

Fent 2017 USA, Structure Fire, Total of 40 firefighters worked in teams of 12 firefighters to complete fire response across 12 scenarios and 6 job tasks

Gear Off-Gassing

Turnout jackets and trousers

12 230 𝝁g/M3 NR Median post-fire off-gassing from Non-decontaminated gear

Brandt-Rauf 1988

USA, Structure Fire, 14 reported calls with 26 usable samples from 51 firefighters

Personal Air 26 NR 8.3-250 ppm

Range of Concentration from each of the 26 samples

Jankovic 1991 USA, 22 fires: 6 training, 15 structural, and one automobile, two engine and two truck company firefighters for each event as well as two industrial hygienists

Personal Air

Knockdown

22

NR

ND-22 ppm

Summary range of measurements

75 | P a g e

Overhaul

Inside-mask

22

22

NR

NR

ND-0.3 ppm

ND-21 ppm

Kirk 2015 Australia, Structural Fire, Training Fire, teams of two firefighters, four consecutive training activities each day on three separate days

Gear

Pre-exposure

Post-exposure

Post-laundering

3

3

3

NR

(0.6-4.4 𝝁g/M3)

(13->CR 𝝁g/M3)

(ND-0.7 𝝁g/M3)

Concentrations

Burgess 2001 USA, 7 Structural Fires and 2 Training Fires, 51 firefighters monitored during overhaul events, 25 without respiratory protection in Tucson, and 26 wearing cartridge respirators in Phoenix

Personal Air Tucson-no protection Phoenix-protection

0 10

ND 0.557 ppm ± 0.465

NR

Mean concentration

76 | P a g e

Table 24 Environmental Monitoring: Benzo[a]pyrene (Group 1)



Exposure level

Exposure range




Personal Air 88 33.2 𝝁g/M3 ± 13.6

(18.7-50 𝝁g/M3)

Average Sample Concentration

Abrard 2019 France, Simulated Structure Fire, Training, Measurement of concentration of BaP during one session of training, measurement of BaP after one or more sessions and after maintenance/cleaning

Gear/Cloth Sample

Helmet surface during one session/control simulation with gas fire

Hose during one session

Helmet surface during one session

Outer surface of unexposed textile before maintenance/washing

Textile cloth during 1 session before maintenance/washing

Textile cloth during 1 session after maintenance/washing

Helmet flap during ~15 sessions before maintenance

2

1

1

1

4

0.5 𝝁g/M2

0.8 𝝁g/M2

51 𝝁g/M2

12 𝝁g/M2

<8 𝝁g/M2

113.75 𝝁g/M2

(68.72-159.78)

Deposition concentration



Concentration

77 | P a g e

ID badge ~12 sessions before maintenance/washing

Textile sample ~12 sessions before maintenance/washing

4

1

1

1

164 𝝁g/M2

3826 𝝁g/M2

6916 𝝁g/M2

1922 𝝁g/M2

(117.23-210.77)


Active Air Sampling FF Train



21

29

29

8.67 ng/M3

± 3.06

6.55 ng/M3

± 2.97

13.2 ng/M3

± 5.05

(1.46-51.4 ng/M3)

(1.40-41.7 ng/M3)

(0.970–83.1 ng/M3)


Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, seven training fire situations, 3 firefighters as fire starters, 3 firefighters acting as

Dermal wrist FF leader enter burning house

Dermal wrist FF fire starter

3

3

0.18 ng/cm2

0.35 ng/cm2

(0.09-0.27 ng/cm2)

Median, min-max

Median, min-max

78 | P a g e

leaders entering the burning house, 8 team leaders outside the house

Dermal wrist FF leader outside house

Dermal collarbone FF leader enter burning house

Dermal collarbone FF fire starter

Dermal collarbone FF leader outside house

8

3

3

8

0.09 ng/cm2

0.05 ng/cm2

0.08 ng/cm2

0.05 ng/cm2

(0.34-0.38 ng/cm2)

(0.07-0.14 ng/cm2)

(0.05-0.05 ng/cm2)

(0.06-0.10 ng/cm2)

(0.05-0.05 ng/cm2)

Median, min-max

Median, min-max

Median, min-max

Median, min-max

Fernando 2016 Canada, Burn Fire, Training Fire, 5 training exercises, 28 firefighters

Dermal wrist

Dermal Neck

Dermal Forehead

Dermal Back

Dermal Fingers

28

28

28

28

28

0.05 ng/cm2

± 0.08

0.04 ng/cm2

± 0.05

0.08 ng/cm2

±0.11

0.05 ng/cm2

± 0.07

0.03 ng/cm2

± 0.03

NR Average ± Standard Deviation

Baxter 2014 Ohio, USA, Overhaul Scenes at 5 Live Events, 20 Skin wipes collected from 10 firefighters

Dermal Face & Neck 2 0.09𝝁g ± 0.04

NR Mean Mass per Wipe ± Standard Deviation

79 | P a g e

Pleil 2004 New York, USA, Collecting air samples at or near Ground Zero to monitor a variety of pollutants. Four of the sites deployed monitors for fine particulate matter (PM2.5) and PAHs by using Teflon filters. Three of the sites were at the fence line of Ground Zero, whereas the fourth site was on the 16th floor of an office building at 290 Broadway, 0.5 km from Ground Zero. Samples were collected daily at each site (24-h duration) between September 23, 2001, and March 27, 2002.

Air sampling 243

Ground zero (n = 170)

209 Broadway

(n = 73)

Day 3: 2.2 ng/m3

Day 100: 0.44 ng/m3

Day 200: 0.34 ng/m3

Day 3: 1.0 ng/m3

Day 100: 0.17 ng/m3

Day 200: 0.07 ng/m3

(0.07-4.4 ng/m3) (0.36-0.52 ng/m3) (0.25-0.43 ng/m3)

(0.00-2.4 ng/m3) (0.12-0.23 ng/m3) (0.03-0.11 ng/m3)

Mean air concentrations and 95% CI (ng/m3)


Area sampling 15 NR (0.6-65 ppm) Peak concentrations

Atlas 1985 Texas, USA, Simulated Fire, Training Fire, 6 tests conducted to characterize chemical composition of smoke

Area Sampling

Upwind (Control)

Downwind Filter C

Burn 6

6

6

6

Below Detection

12 𝝁g

0.3 mg/g

18 𝝁g

0.9 mg/g

NR Total Amount (𝝁g) Concentration (mg/g)


Personal Air

Knockdown

Overhaul

3

3

10 𝝁g/M3

ND

NR Concentrations of polynuclear aromatic hydrocarbon (PNAs)

80 | P a g e

Mayer 2019 USA, Simulated Structure Fire, crews of 12 firefighters in pairs of 2 completed four scenarios of job assignments

Gear

Exposed hoods before single laundering

Exposed hoods after single laundering

4

2

570 ng/g ± 311

105 ng/g ± 41.6

NR Mean Standard ± Deviation


Gear

Exposed unlaundered hoods after 4 residential fire responses

Routinely laundered hoods after 4 residential fire responses

5

0

488 ng/g ± 361

ND


Kirk 2015 Australia, Simulated Structure Fire, Training Fire, instructor monitoring for five evolutions

Personal Air

Instructor demonstration of behavior of fire outside structural firefighting ensemble

Instructor monitor progress and safety of students outside structural firefighting ensemble

Instructor demonstration of behavior of fire inside structural firefighting ensemble

Instructor monitor progress and safety of

NR

NR

NR

7.3 𝝁g/M3

NA

1.7 𝝁g/M3

NR

1.8-47 𝝁g/M3

NR

Atmospheric concentration

Range of atmospheric concentrations


81 | P a g e

students inside structural firefighting ensemble

NR

NA

0.4-13 𝝁g/M3



Gear

Deposition concentration on structural firefighting ensemble of instructors demonstrating behavior of fire

Deposition concentration on structural firefighting ensemble of instructors monitoring progress and safety of students

NR

NR

8.6 ng/cm2

NA

NR

5.5-24 ng/cm2


Range of deposition concentrations

Alexander 2016 USA, Gear Samples from donated occupationally soiled firefighter protective gear

Used Gear

Hood

Wristlet

1

1

ND

0.4 𝝁g/g

NR Total contaminants

Navarro 2019 USA, Wildland, Air concentrations measure for first 12 days of the Willow Fire

Area

Arithmetic Mean

24 hour

Day

Night

12

12

12

3 ng/m3 ± 2

4 ng/m3 ± 6

3 ng/m3 ± 1

NR

Arithmetic Mean & Standard Deviation

82 | P a g e

Geometric Mean

24 hour

Day

Night

12

12

12

3 ng/m3 ± 1

3 ng/m3 ± 2

3 ng/m3 ± 1

Geometric Mean & Standard Deviation

Navarro 2019 USA, Wildland and Prescribed Burn Training Fire, 25 wildland firefighters: 21 wildland firefighters suppressing 2 fires and 4 wildland firefighters conducting prescribed burns

Personal Air

Prescribed Burn

Wildland Fire

6

28

5 ng/m3 ± 4

7 ng/m3 ± 4

(<3-66 ng/m3)

(<3-140 ng/m3)

Geometric Mean ± standard deviation

Materna 1992 USA, Wildland and prescribed burns, 3 successful wildland seasons, 3 Wildland fires and 1 series of prescribed burns, 10 sampled work shifts

Personal Air 19 0.015 𝝁g/m3

(ND-0.034 𝝁g/m3)

Mean

Robinson 2008 USA, Prescribed Burn, 5 prescribed pile burns, 21 firefighters

Area sampling done for 2 burns

Burn 1: Day 1 ignition

Burn 1: Day 2 smolder



1

1

1

1

0.185 𝝁g/m3

0.003 𝝁g/m3

0.019 𝝁g/m3

NR Concentration

83 | P a g e

0.136 𝝁g/m3

Keir 2020 Canada, Emergency Firefighting, 28 firefighters from 4 stations,

Personal Air

Geometric Mean

Arithmetic Mean

29

29

1.54 𝝁g/m3

± 1.44

10.44 𝝁g/m3

(0.03-133.76 𝝁g/m3)

Geometric Mean ± standard error

Arithmetic Mean


Used Gear

Glove 1 Inner Glove Layer


Glove 1 Middle Glove

Glove 1 Outer Glove

Cuff coat inner wristlet

Hood 1

Hood 2

Hood 3

1

1

1

1

1

1

1

1

ND

ND

0.8 𝝁g/m3

ND

0.4 𝝁g/m3

ND

ND

ND

NR Concentration

Easter 2016 USA, Gear samples from donated occupationally soiled firefighter protective gear

Used Gear

Outer Shell

28

NR Average Concentration ±

84 | P a g e

Thermal Liner

21

2.0 mg/kg ± 2

0.32 mg/kg ± 0.2

standard deviation

Feunekes 1997 Netherlands, Training Fires, 10 trainers including 4 instructors, 3 safety officers, and 3 fire assistants

Personal Air

Instructor

Safety Officer

Fire Assistant

16 total

NR

NR

NR

0.42 mg/m3

0.70 mg/m3

0..30 mg/m3

NR Average Airborne Concentrations

85 | P a g e

Table 25 Environmental Monitoring: Formaldehyde (Group 1)


No. of samples Exposure level

Exposure range





(0.016-1.18 ppm)


Lindquist 1997 Finland, Simulated Structure Fire, Training Fire, 5 firefighter Instructors monitored over two training events

Firehouse Fire

Container Fire

5 measures during workday not extinguishing

5 measures during evening evaporation from clothing



34 𝝁g/M3 ± 8

71 𝝁g/M3 ± 29

24 𝝁g/M3 ± 31

23 𝝁g/M3 ± 23

NR

NR

NR

NR

Average Contents and Mean Spread


Personal Air 43 <0.14 ppm

<0.09 ppm

(ND-0.57 ppm)

Mean

Geometric Mean

Reisen 2009 Australia, 2 experimental burns and 10 prescribed Bushfire Burns, 10 area

Area 9 <0.20 ppm

(ND-0.52 ppm)

Mean

86 | P a g e

samples taken adjacent adjacent to fires

<0.14 ppm Geometric Mean

Reinhardt 2004 USA, 30 days of wildfire suppression, 84 FF monitored for 17 days at 8 project wildfires, 45 firefighters monitored for 13 days of initial attack incidents, 221 firefighters monitored for 29 prescribed burns for smoke exposure

Personal Air:


Project Fires



45

45

84

84

200

200

6 ppb

58 ppb

28 ppb

92 ppb

13 ppb

84 ppb

18 ppb

93 ppb

47 ppb

390 ppb

75 ppb

600 ppb

NR

NR

NR

NR

NR

NR

Geometric Mean

Maximum


Personal Air:

Burn boss

Lighting

Holding

Holding boss

Direct attack

Mop up

Sawyer

17

100

96

21

12

56

3

77 ppb

38 ppb

127 ppb

119 ppb

464 ppb

91 ppb

346 ppb

NR

NR

NR

NR

NR

NR

NR


87 | P a g e

Engine 6 98 ppb NR



Outside structure

Inside Structure


Outside structure

Inside Structure


Outside structure

Inside Structure


Outside structure


Outside structure


1

1

1

1

1

1

1

1

2.2 mg/m3

<detectable limit

2.1 mg/m3

0.20 mg/m3

1.3 mg/m3

<detectable limit

0.96 mg/m3

3.2 mg/m3

NR

Concentration

88 | P a g e

Outside structure


Outside structure

1

1

0.53 mg/m3

5.0 mg/m3

Reisen 2011 Australia, Prescribed Burns, Wildland, 102 firefighters monitored across Australia and 28 monitored at Victorian wildfires. 3-5 firefighters monitored per event

Personal Air

Fuel Reduction Burns

Experimental Burns

Slash or Heap Burns

Prescribed Burns

Victorian Burns

35

10

10

55

10

<0.192 ppm

<0.112 ppm

0.172 ppm

0.144 ppm

<0.042 ppm

<0.037 ppm

<0.161 ppm

<0.096 ppm

0.042 ppm

0.037 ppm

(ND-0.665 ppm)

(0.068-0.405 ppm)

(ND-0.077 ppm)

(ND-0.665 ppm)

(0.024-0.109 ppm)

Average

Geometric Mean

Brandt-Rauf 1988


Personal Air 26 0.1-8.3 ppm NR Range of Concentration from each of the 26 samples

Jankovic 1991 USA, 22 fires: 6 training, 15 structural, and one automobile, two engine and two truck company firefighters for each

Personal Air

Knockdown

22

NR

ND-8 ppm


89 | P a g e

event as well as two industrial hygienists

Overhaul

Inside-mask

22

22

NR

NR

ND-0.4 ppm

ND-0.3 ppm


Personal Air 30 0.16 mg/m3 (0.048-0.42 mg/m3)

Mean


Gear

Pre-exposure

Post-exposure

Post-laundering

3

3

3

NR

(23-51 𝝁g/M3)

(14-26 𝝁g/M3)

(8-22 𝝁g/M3)

Concentrations



21 19

0.109 ppm ± 0.182 0.257 ppm ± 0.249

NR

Mean concentration

90 | P a g e

Table 26 Environmental Monitoring: Pentachlorophenol (Group 1)


No. of samples

Exposure level

Exposure range



Used Gear

Outer Shell

Thermal Liner

28

21

ND mg/kg ± 1

ND mg/kg ± 0.5

NR Average Concentration ± standard deviation

91 | P a g e

Table 27 Environmental Monitoring: Respirable Particulate Matter (Group 1)


No. of samples

Exposure level

Exposure range



Personal Air:


Project Fires



45

45

84

84

200

200

0.022 mg/m3

1.56 mg/m3

1.11 mg/m3

2.46 mg/m3

0.50 mg/m3

2.30 mg/m3

0.72 mg/m3

2.93 mg/m3

0.63 mg/m3

6.9 mg/m3

1 mg/m3

10.5 mg/m3

NR

NR

NR

NR

NR

NR

PM3.5

Geometric Mean

Maximum


Personal Air:

Burn boss

Lighting

Holding

Holding boss

Direct attack

17

105

82

17

10

1.32 mg/m3

0.75 mg/m3

1.56 mg/m3

1.81 mg/m3

4.04 pmg/m3

NR

NR

NR

NR

NR

PM3.5


92 | P a g e

Mop up

Sawyer

Engine

49

6

5

0.75 mg/m3

2.93 mg/m3

1.37 mg/m3

NR

NR

NR


Personal Air:


Project Fires


7

7

15

15

1.39 mg/m3

1.81 mg/m3

5.32 mg/m3

8.64 mg/m3

1.47 mg/m3

4.17 mg/m3

1.72 mg/m3

4.38 mg/m3

NR

NR

NR

NR

Total PM

Geometric Mean

Maximum

Neitzel 2008 USA, Prescribed Burn, 13 wildland firefighters over 20 full shifts

Personal Air

Full Shift Exposure

>60% of shift exposure

All samples

11

16

19

1054 𝝁g/M3

± 415

1154 𝝁g/M3

± 524

1201 𝝁g/M3

± 606

(628-1694 𝝁g/M3)

(628-2341 𝝁g/M3)

(628-2674 𝝁g/M3)

PM2.5 Mean Concentration

Adetona 2013 USA, Prescribed Burn, 18 wildland firefighters over 30 prescribed burns

Personal Air

Overall

2008

130

72

530 𝝁g/M3

509 𝝁g/M3

(476-591 𝝁g/M3)

(446-579 𝝁g/M3)

PM 2.5 unadjusted geometric mean

93 | P a g e

2009

58

559 𝝁g/M3

(465-671 𝝁g/M3)

Brandt-Rauf 1988


Personal Air 5 NR ()10.1-344.4 mg/M3)

Range of Particulate Concentration from each of the 5 samples

Adetona 2019 USA, Wildland, Prescribed Burn, 14 wildland firefighters monitored over 16 prescribed burn shifts

Personal Air 14 577𝝁g/M3 (492, 675 𝝁g/M3)

PM2.5

Geometric mean concentrations


Area

Arithmetic Mean

24 hour

Day

Night

Geometric Mean

24 hour

Day

Night

12

12

12

12

12

12

29 𝝁g/m3 ± 50

58 𝝁g/m3 ± 31

13 𝝁g/m3 ± 5

14 𝝁g/m3 ± 2

49 𝝁g/m3 ± 2

12 𝝁g/m3 ± 1

NR PM2.5




Personal Air

Base camp, waiting in stage area

3

3.27 mg/m3

(1.80-4.40 mg/m3)

Total Particulate Matter Mean

94 | P a g e

Fireline, mop-up

22 9.46 mg/m3 (2.70-37.4 mg/m3)







2

2

2

2

6.98 mg/m3

± 0.08

0.90 mg/m3

± 0.05

1.05 mg/m3

± 0.17

2.89 mg/m3

± 0.07

NR PM2.5

Concentration ± standard deviation

95 | P a g e

Table 28 Environmental Monitoring: Trichloroethylene (Group 1)


Sampling Matrix

No. of samples

Exposure level

Exposure range


Brandt-Rauf 1988


Personal Air 5 0.112-0.181 ppm

NR Range of Concentration from each of the 5 samples

96 | P a g e

Table 29 Environmental Monitoring: Acrolein (Group 2A)


No. of samples Exposure level

Exposure range





(0.013 - 0.3 ppm)


Lindquist 1997 Finland, Simulated Structure Fire, Training Fire, 5 firefighters Instructors monitored over two training events

Firehouse Fire

Container Fire





5.8 𝝁g/M3

± 2.6

8.6 𝝁g/M3

± 3.4

<3 𝝁g/M3

<3 𝝁g/M3

NR

NR

NR

NR

Average Contents and Mean Spread


Personal Air 43 -

-

(ND-0.02 ppm)

Mean

Geometric Mean


Area 9 <0.02 ppm

<0.02 ppm

(ND-0.05 ppm)

Mean

Geometric Mean

97 | P a g e


Personal Air:


Project Fires



45

45

84

84

200

200

1 ppb

11 ppb

5 ppb

37 ppb

1 ppb

15 ppb

2 ppb

16 ppb

9 ppb

60 ppb

15 ppb

98 ppb

NR

NR

NR

NR

NR

NR

Geometric Mean

Maximum


Personal Air:

Burn boss

Lighting

Holding

Holding boss

Direct attack

Mop up

Sawyer

Engine

9

31

33

11

1

29

1

1

31 ppb

5 ppb

18 ppb

30 ppb

62 ppb

12 ppb

10 ppb

<1 ppb

NR

NR

NR

NR

NR

NR

NR

NR


98 | P a g e


Area 1 0.14 mg/M3

NR Airborne soot concentration


Personal Air

Knockdown

Overhaul

Inside-mask

22

22

22

NR

NR

NR

ND-3.2 ppm

ND-0.2 ppm

ND-0.9 ppm



Personal Air 1 NA 0.052 mg/m3

Mean



0 1

ND 0.016 ppm

NR

Mean concentration

99 | P a g e

Table 30 Environmental Monitoring: Cyclopenta[cd]pyrene (Group 2A)


Exposure level

Exposure range


data







1

1

1

1

0.153 𝝁g/m3

0.011 𝝁g/m3

0.002 𝝁g/m3

0.117 𝝁g/m3

NR Concentration

100 | P a g e

Table 31 Environmental Monitoring: Dibenz[a,h]anthracene (Group 2A)


No. of samples

Exposure level

Exposure range





(23.2-67.9 𝝁g/M3)



Active Air Sampling firefighters Train

Passive Personal Air Sampling firefighters Train


21

29

29

2.03 ng/M3

± 2.92

0.756 ng/M3 ± 9.03

0.827 ng/M3 ± 16.1

(0.423-11.6 ng/M3)

(0.0369-13.1 ng/M3)

(0.0369–21.3 ng/M3)



Air sampling 243


209 Broadway

(n = 73)

Day 3: 1.3 ng/m3

Day 100: 0.10 ng/m3

Day 200: 0.03 ng/m3

Day 3: 0.69 ng/m3

(0.00-2.9 ng/m3) (0.08-0.12 ng/m3) (0.01-0.06 ng/m3)

(0.00-1.7 ng/m3) (0.06-0.11 ng/m3)


101 | P a g e

Day 100: 0.08 ng/m3

Day 200: 0.01 ng/m3

(0.00-0.03 ng/m3)


Gear



4

4

2650 ng/g ± 1270

620 ng/g ± 182



Gear



5

1

2360 ng/g ± 1430

105 ng/g ± 75.7



Area

Arithmetic Mean

24 hour

Day

Night

Geometric Mean

12

12

12

4 ng/m3 ± 6

2 ng/m3 ± 3

1 ng/m3 ± 1

NR


102 | P a g e

24 hour

Day

Night

12

12

12

3 ng/m3 ± 2

3 ng/m3 ± 2

3 ng/m3 ± 1



Personal Air

Prescribed Burn

Wildland Fire

6

28

4 ng/m3 ± 2

4 ng/m3 ± 2

(<3-23 ng/m3)

(<3-50 ng/m3)




(ND-0.021 𝝁g/m3)

Mean


Personal Air

Geometric Mean

Arithmetic Mean

29

29

0.27 𝝁g/m3

± 1.29

0.70 𝝁g/m3

(0.02-5.58 𝝁g/m3)


Arithmetic Mean


Used Gear




Glove 1 Outer Glove

1

1

1

1

ND

ND

ND

ND

NR Concentration

103 | P a g e


Hood 1

Hood 2

Hood 3

1

1

1

1

ND

0.8 𝝁g/m3

ND

ND

104 | P a g e

Table 32 Environmental Monitoring: Dichloromethane (methylene chloride; Group 2A)


No. of samples

Exposure level

Exposure range


data

Brandt-Rauf 1988


Personal Air 1 0.278 ppm NR Concentration


Gear

Pre-exposure

Post-exposure

Post-laundering

3

3

3

NR

(<0.4-1.5 𝝁g/M3)

(ND 𝝁g/M3)

(ND-0.8 𝝁g/M3)

Concentrations

105 | P a g e

Table 33 Environmental Monitoring: Styrene (Group 2A)


No. of samples

Exposure level

Exposure range




Outside structure

Inside Structure


Outside structure

Inside Structure


Outside structure

Inside Structure

1

1

1

1

1

1

0.94 mg/m3

<detectable limit

0.98 mg/m3

0.33 mg/m3

1.5 mg/m3

0.19 mg/m3

NR

Concentration


Area sampling

15 0.4 ppm NR Peak concentrations


Area 1 2.28 mg/M3 NR Airborne soot concentration

106 | P a g e

Fent 2017

USA, Structure Fire, Total of 40 firefighters worked in teams of 12 firefighters to complete fire response across 12 scenarios and 6 job tasks

Gear Off-Gassing

Turnout jackets and trousers

12 340 𝝁g/M3 NR Median post-fire off-gassing from Non-decontaminated gear


Gear

Pre-exposure

Post-exposure

Post-laundering

3

3

3

NR

(2.1-3.5 𝝁g/M3)

(41->CR 𝝁g/M3)

(1.3-3.9 𝝁g/M3)

Concentrations

107 | P a g e

Table 34 Environmental Monitoring: Tetrabromobisphenol (Group 2A)


Exposure level

Exposure range


Fent 2020 USA, Structural Fire, 12 controlled residential structure fires, 3 crews of 12 firefighters per crew

Area Air Active Fire Overhaul

5

0

0.24 𝝁g/M2

ND

(0.03-18.5 𝝁g/M2) ND

Median Concentrations


Gear Attack, Search, Outside Vent, and Overhaul: No Decon Decon IC/Engineer: No Decon Decon

2 1

ND

ND

0.05 ng/cm2

0.05 ng/cm2

ND ND

(0.05-7.60 ng/cm2) (0.05-0.75 ng/cm2) ND ND



Gear-Glove Attack, Search, Outside Vent, and Overhaul: No Decon

2

0.05 ng/cm2

(0.05-0.53 ng/cm2)


108 | P a g e

Table 35 Environmental Monitoring: Tetrachloroethylene (perchloroethylene; Group 2A)


No. of samples

Exposure level

Exposure range


data


Gear

Pre-exposure

Post-exposure

Post-laundering

3

3

3

NR

(ND-1 𝝁g/M3)

(ND 𝝁g/M3)

(ND 𝝁g/M3)

Concentrations

109 | P a g e

Table 36 Environmental Monitoring: Acetaldehyde (Group 2B)


No. of samples

Exposure level

Exposure range





(0.041 - 1.75 ppm)



Personal Air 43 <0.05 ppm

<0.04 ppm

(ND-0.26 ppm)

Mean

Geometric Mean


Area 9 0.05 ppm

0.04 ppm

(0.02-0.09 ppm)

Mean

Geometric Mean



Outside structure

Inside Structure


Outside structure

Inside Structure


1

1

1

1

1

1

3.0 mg/m3

0.5 mg/m3

3.5 mg/m3

1.2 mg/m3

5.1 mg/m3

1.0 mg/m3

NR

Concentration

110 | P a g e

Outside structure

Inside Structure


Personal Air

Knockdown

Overhaul

Inside-mask

22

22

22

NR

NR

NR

(ND-8.1 ppm)

(ND-1.6 ppm)

(ND-0.9 ppm)



Personal Air 24 0.078 mg/m3

(ND-0.15mg/m3)

Mean


Gear

Pre-exposure

Post-exposure

Post-laundering

3

3

3

NR

(10-16 𝝁g/M3)

(4-160 𝝁g/M3)

(20-25 𝝁g/M3)

Concentrations



5 18

0.158 ppm ± 0.037 0.383 ppm ± 0.494

NR

Mean concentration

111 | P a g e

Table 37 Environmental Monitoring: Benz[a]anthracene (Group 2B)


Exposure level

Exposure range





(19.3-27.9 𝝁g/M3)


Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, seven training fire situations, 3 firefighters as fire starters, 3 firefighters acting as leaders entering the burning house, 8 team leaders outside the house

Dermal wrist firefighters leader enter burning house

Dermal wrist firefighters fire starter

Dermal wrist firefighters leader outside house

Dermal collarbone firefighters leader enter burning house

Dermal collarbone firefighters fire starter

Dermal collarbone firefighters leader outside house

3

3

8

3

3

8

0.13 ng/cm2

0.37 ng/cm2

0.09 ng/cm2

0.06 ng/cm2

0.09 ng/cm2

(0.05-0.25 ng/cm2)

(0.24-0.48 ng/cm2)

(0.01-0.19 ng/cm2)

(0.05-0.06 ng/cm2)

(0.08-0.09 ng/cm2)

(0.01-0.06 ng/cm2)

Median, min-max

Median, min-max

Median, min-max

Median, min-max

Median, min-max

Median, min-max

112 | P a g e

0.04 ng/cm2





21

29

29

2.56 ng/M3± 2.23

5.70 ng/M3

± 3.86

14.7 ng/M3

± 4.95

(1.03-10.1 ng/M3)

(0.340-46.1 ng/M3)

(0.961–159 ng/M3)



Dermal wrist

Dermal Neck

Dermal Forehead

Dermal Back

Dermal Fingers

28

28

28

28

28

0.19 ng/cm2 ± 0.22

0.30 ng/cm2 ± 0.35

0.42 ng/cm2

±0.60


113 | P a g e

0.31 ng/cm2 ± 0.44

0.26 ng/cm2 ± 0.22





Air sampling 243


209 Broadway

(n = 73)

Day 3: 1.3 ng/m3

Day 100: 0.17 ng/m3 Day 200: 0.40 ng/m3

Day 3: 0.40 ng/m3

Day 100: 0.03 ng/m3

Day 200: 0.02 ng/m3

(0.18-2.8 ng/m3) (0.14-0.20 ng/m3) (0.00-0.92 ng/m3)

(0.00-0.92 ng/m3) (0.02-0.04 ng/m3)

(0.01-0.03 ng/m3)



Gear



4

3

418 ng/g ± 254

101 ng/g ± 42.2

NR Mean ± Standard Deviation

114 | P a g e


Gear



5

0

362 ng/g ± 283

ND

NR Mean ± Standard Deviation


Personal Air




Instructor monitor progress and safety of students inside structural firefighting ensemble

NR

NR

NR

11 𝝁g/M3

NA

2.1 𝝁g/M3

NR

4.1-46 𝝁g/M3

NR




115 | P a g e

NR

NA

0.56-11 𝝁g/M3



Gear



NR

NR

12 ng/cm2

NA

NR

5-30 ng/cm2




Used Gear

Hood

Wristlet

1

1

1.4 𝝁g/g

ND



Area

Arithmetic Mean

24 hour

Day

12

12

3 ng/m3 ± 2

NR


116 | P a g e

Night

Geometric Mean

24 hour

Day

Night

12

12

12

12

1 ng/m3 ± 1

1 ng/m3 ± 1

3 ng/m3 ± 1

3 ng/m3 ± 2

3 ng/m3 ± 2



Personal Air

Prescribed Burn

Wildland Fire

11

28

8 ng/m3 ± 4

10 ng/m3 ± 4

(<3-84 ng/m3)

(<3-192 ng/m3)




(ND-0.034 𝝁g/m3)

Mean





1

1

0.376 𝝁g/m3

NR Concentration

117 | P a g e



1

1

0.120 𝝁g/m3

0.066 𝝁g/m3

0.275 𝝁g/m3


Personal Air

Geometric Mean

Arithmetic Mean

29

29

0.91 𝝁g/m3

± 1.48

12.59 𝝁g/m3

(0.02-236.05 𝝁g/m3)


Arithmetic Mean


Used Gear




Glove 1 Outer Glove


Hood 1

Hood 2

Hood 3

1

1

1

1

1

1

1

ND

ND

2.3 𝝁g/m3

1.4 𝝁g/m3

ND

1.4 𝝁g/m3

ND

NR Concentration

118 | P a g e

1

0.5𝝁g/m3

119 | P a g e

Table 38 Environmental Monitoring: Benzo[b]fluoranthene (Group 2B)


No. of samples

Exposure level

Exposure range





(9.5-34 𝝁g/M3)






21

29

29

10.8 ng/M3

± 2.05

4.44 ng/M3

± 3.29

14.0 ng/M3

± 5.53

(4.48-38.9 ng/M3)

(0.423-27.4 ng/M3)

(0.554–13 ng/M3)






3

3

8

0.14 ng/cm2

0.41 ng/cm2

0.11 ng/cm2

(0.10-0.19 ng/cm2)

(0.40-0.57 ng/cm2)

(0.05-0.15 ng/cm2)

Median, min-max

Median, min-max

Median, min-max

Median, min-max

120 | P a g e




3

3

8

0.06 ng/cm2

0.06 ng/cm2

0.06 ng/cm2

(0.05-0.07 ng/cm2)

(0.05-0.09 ng/cm2)

(0.05-0.07 ng/cm2)

Median, min-max

Median, min-max


Dermal wrist

Dermal Neck

Dermal Forehead

Dermal Back

Dermal Fingers

28

28

28

28

28

0.07 ng/cm2 ± 0.11

0.05 ng/cm2 ± 0.05

0.05 ng/cm2

±0.06

0.03 ng/cm2 ± 0.07


121 | P a g e

0.07 ng/cm2 ± 0.07


Air sampling 243


209 Broadway

(n = 73)

Day 3: 15 ng/m3

Day 100: 0.53 ng/m3

Day 200: 0.25 ng/m3

Day 3: 5.6 ng/m3

Day 100: 0.36 ng/m3

Day 200: 0.07 ng/m3

(0.82-29 ng/m3) (0.43-0.63 ng/m3) (0.14-0.35 ng/m3)

(0.00-13 ng/m3) (0.25-0.46 ng/m3) (0.02-0.12 ng/m3)



Personal Air

Knockdown

Overhaul

3

3

6 𝝁g/M3

ND



Gear



4

3

720 ng/g ± 398

101 ng/g ± 45.5



Gear

5

626 ng/g ± 450


122 | P a g e



0

ND


Used Gear

Hood

Wristlet

1

1

ND

0.4 𝝁g/g



Area

Arithmetic Mean

24 hour

Day

Night

Geometric Mean

24 hour

Day

Night

12

12

12

12

12

12

3 ng/m3 ± 2

4 ng/m3 ± 0

4 ng/m3 ± 1

3 ng/m3 ± 1

3 ng/m3 ± 2

3 ng/m3 ± 1

NR



Navarro 2019 USA, Wildland and Prescribed Burn Training Fire, 25 wildland firefighters: 21 wildland

Personal Air


123 | P a g e

firefighters suppressing 2 fires and 4 wildland firefighters conducting prescribed burns

Prescribed Burn

Wildland Fire

6

28

5 ng/m3 ± 3

7 ng/m3 ± 3

(<3-45 ng/m3)

(<3-87 ng/m3)



(ND-0.120 𝝁g/m3)

Mean







1

1

1

1

0.121 𝝁g/m3

0.015 𝝁g/m3

0.026 𝝁g/m3

0.079 𝝁g/m3

NR Concentration


Personal Air

Geometric Mean

Arithmetic Mean

29

29

1.52 𝝁g/m3

± 1.55

17.00 𝝁g/m3

(0.02-218.59 𝝁g/m3)


Arithmetic Mean

124 | P a g e


Used Gear




Glove 1 Outer Glove


Hood 1

Hood 2

Hood 3

1

1

1

1

1

1

1

1

ND

ND

2.0 𝝁g/m3

ND

0.4 𝝁g/m3

ND

0.5 𝝁g/m3

ND

NR Concentration

125 | P a g e

Table 39 Environmental Monitoring: Benzo[c]phenanthrene (Group 2B)


Exposure level

Exposure range


data







1

1

1

1

0.016 𝝁g/m3

0.002 𝝁g/m3

0.001 𝝁g/m3

0.017 𝝁g/m3

NR Concentration

126 | P a g e

Table 40 Environmental Monitoring: Benzo[j]fluoranthene (Group 2B)



Exposure level

Exposure range


Fernando 2016 Canada, Burn Fire, Training Fire, 5 training exercises, 28 FFs

Dermal wrist

Dermal Neck

Dermal Forehead

Dermal Back

Dermal Fingers

28

28

28

28

28

0.04 ng/cm2 ± 0.06

0.03 ng/cm2 ± 0.02

0.03 ng/cm2

±0.04

0.03 ng/cm2 ± 0.05

0.03 ng/cm2 ± 0.02








1

1

1

1

0.056 𝝁g/m3

0.006 𝝁g/m3

0.006 𝝁g/m3

0.039 𝝁g/m3

NR Concentration

127 | P a g e

Table 41 Environmental Monitoring: Benzo[k]fluoranthene (Group 2B)


No. of samples

Exposure level

Exposure range





(22.6-25 𝝁g/M3)






21

29

29

5.31 ng/M3

± 2.34

4.39 ng/M3

± 2.94

14.6 ng/M3

± 5.47

(1.51-16.3 ng/M3)

(1.07-24.3 ng/M3)

(0.613–169 ng/M3)






3

3

8

0.13 ng/cm2

0.29 ng/cm2

0.08 ng/cm2

(0.10-0.16 ng/cm2)

(0.24-0.31 ng/cm2)

(0.06-0.11 ng/cm2)

Median, min-max

Median, min-max

Median, min-max

Median, min-max

128 | P a g e




3

3

8

0.05 ng/cm2

0.05 ng/cm2

0.05 ng/cm2

(0.05-0.05 ng/cm2)

(0.04-0.05 ng/cm2)

(0.04-0.06 ng/cm2)

Median, min-max

Median, min-max


Dermal wrist

Dermal Neck

Dermal Forehead

Dermal Back

Dermal Fingers

28

28

28

28

28

0.05 ng/cm2 ± 0.09

0.07 ng/cm2 ± 0.08

0.10 ng/cm2

±0.13

0.10 ng/cm2 ± 0.15


129 | P a g e

0.05 ng/cm2 ± 0.05


Air sampling 243


209 Broadway

(n = 73)

Day 3: 4.8 ng/m3

Day 100: 0.31 ng/m3

Day 200: 0.23 ng/m3

Day 3: 1.7 ng/m3

Day 100: 0.12 ng/m3

Day 200: 0.05 ng/m3

(0.72-9.0 ng/m3) (0.26-0.36 ng/m3) (0.17-0.29 ng/m3)

(0.00-3.6 ng/m3) (0.09-0.16 ng/m3) (0.02-0.07 ng/m3)



Personal Air

Knockdown

Overhaul

3

3

3 𝝁g/M3

ND



Gear



4

0

250 ng/g ± 129

ND



Gear

5

219 ng/g ± 147


130 | P a g e



0

ND


Used Gear

Hood

Wristlet

1

1

ND

0.8 𝝁g/g



Area

Arithmetic Mean

24 hour

Day

Night

Geometric Mean

24 hour

Day

Night

12

12

12

12

12

12

4 ng/m3 ± 4

3 ng/m3 ± 2

3 ng/m3 ± 1

3 ng/m3 ± 2

3 ng/m3 ± 2

3 ng/m3 ± 1

NR



Navarro 2019 USA, Wildland and Prescribed Burn Training Fire, 25 wildland firefighters: 21 wildland firefighters suppressing 2 fires and

Personal Air

Prescribed Burn

6

5 ng/m3 ± 3

(<3-59 ng/m3)


131 | P a g e

4 wildland firefighters conducting prescribed burns

Wildland Fire

28

7 ng/m3 ± 3

(<3-79 ng/m3)



(ND-0.014 𝝁g/m3)

Mean







1

1

1

1

0.116 𝝁g/m3

0.015 𝝁g/m3

0.020 𝝁g/m3

0.52 𝝁g/m3

NR Concentration


Personal Air

Geometric Mean

Arithmetic Mean

29

29

0.69 𝝁g/m3

± 1.46

6.66 𝝁g/m3

(0.03-79.12 𝝁g/m3)


Arithmetic Mean


Used Gear


1

ND

NR Concentration

132 | P a g e



Glove 1 Outer Glove


Hood 1

Hood 2

Hood 3

1

1

1

1

1

1

1

ND

0.8 𝝁g/m3

ND

0.8 𝝁g/m3

ND

ND

ND

133 | P a g e

Table 42 Environmental Monitoring: Chrysene (Group 2B)


Exposure level

Exposure range






1

29

29

4.57 ng/M3

± 1.90

7.92 ng/M3

± 4.31

15.2 ng/M3

± 8.76

(2.32-14.4 ng/M3)

(1.49-92.8 ng/M3)

(1.49–270 ng/M3)








3

3

8

3

0.13 ng/cm2

0.37 ng/cm2

0.09 ng/cm2

0.07 ng/cm2

(0.05-0.25 ng/cm2)

(0.24-0.49 ng/cm2)

(0.01-0.19 ng/cm2)

(0.06-0.07 ng/cm2)

Median, min-max

Median, min-max

Median, min-max

Median, min-max

Median, min-max

134 | P a g e


3

8

0.11 ng/cm2

0.04 ng/cm2

(0.10-0.11 ng/cm2)

(0.02-0.07 ng/cm2)

Median, min-max


Dermal wrist

Dermal Neck

Dermal Forehead

Dermal Back

Dermal Fingers

28

28

28

28

28

0.08 ng/cm2 ± 0.11

0.09 ng/cm2 ± 0.08

0.10 ng/cm2

±0.10

0.08 ng/cm2 ± 0.13

0.12 ng/cm2 ± 0.09


135 | P a g e





Air sampling 243


209 Broadway

(n = 73)

Day 3: 1.5 ng/m3

Day 100: 0.16 ng/m3

Day 200: 0.15 ng/m3

Day 3: 0.37 ng/m3

Day 100: 0.04 ng/m3

Day 200: 0.03 ng/m3

(0.24-2.4 ng/m3) (0.14-0.19 ng/m3) (0.12-0.18 ng/m3)

(0.00-0.79 ng/m3) (0.03-0.05 ng/m3) (0.01-0.04 ng/m3)


Atlas 1985 Texas, USA, Simulated Fire, Training Fire, 6 tests conducted to characterize chemical composition of smoke

Area Sampling

Upwind (Control)

Downwind Filter C

Burn 6

6

6

6

Below Detection

33 𝝁g

0.9 mg/g

38 𝝁g

1.9 mg/g

NR Total Amount (𝝁g) Concentration (mg/g)


Personal Air

Knockdown

Overhaul

3

3

10 𝝁g/M3

1 𝝁g/M3


136 | P a g e


Gear



4

1

540 ng/g ± 441

76.7 ng/g ± 31.3



Gear



5

0

466 ng/g ± 471

ND



Personal Air



Instructor demonstration of

NR

NR

9.9 𝝁g/M3

NA

NR

3.4-42 𝝁g/M3



137 | P a g e

behavior of fire inside structural firefighting ensemble


NR

NR

2.3 𝝁g/M3

NA

NR

0.74-10 𝝁g/M3




Gear



NR

NR

9.6 ng/cm2

NA

NR

5.4-16 ng/cm2



Alexander 2016

USA, Gear Samples from donated occupationally soiled firefighter protective gear

Used Gear

Hood

Wristlet

1

1

1.3 𝝁g/g

ND


138 | P a g e


Area

Arithmetic Mean

24 hour

Day

Night

Geometric Mean

24 hour

Day

Night

12

12

12

12

12

12

4 ng/m3 ± 1

3 ng/m3 ± 2

3 ng/m3 ± 0

4 ng/m3 ± 1

4 ng/m3 ± 1

4 ng/m3 ± 1

NR




Personal Air

Prescribed Burn

Wildland Fire

6

28

11 ng/m3 ± 4

16 ng/m3 ± 3

(<4-97 ng/m3)

(<4-250 ng/m3)




(ND-0.080 𝝁g/m3)

Mean

139 | P a g e


Personal Air

Geometric Mean

Arithmetic Mean

29

29

1.31 𝝁g/m3

± 1.63

58.06 𝝁g/m3

(0.03-1062.72 𝝁g/m3)


Arithmetic Mean

Alexander 2014


Used Gear




Glove 1 Outer Glove


Hood 1

Hood 2

Hood 3

1

1

1

1

1

1

1

1

ND

ND

3.5 𝝁g/m3

1.6 𝝁g/m3

ND

1.3 𝝁g/m3

0.4 𝝁g/m3

ND

NR Concentration


Used Gear

Outer Shell

Thermal Liner

28

21

3.8 mg/kg ± 4


140 | P a g e

0.55 mg/kg ± 0.4

141 | P a g e

Table 43 Environmental Monitoring: Crotonaldehyde (Group 2B)


No. of samples

Exposure level

Exposure range


data



Outside structure

Inside Structure


Outside structure

Inside Structure


Outside structure

Inside Structure

1

1

1

1

1

1

0.06

<detectable limit

.13

<detectable limit

0.16

<detectable limit

NR

Concentration


Gear

Pre-exposure

Post-exposure

3

3

3

NR

(ND 𝝁g/M3)

(1-11 𝝁g/M3)

Concentrations

142 | P a g e

Post-laundering

(ND 𝝁g/M3)

143 | P a g e

Table 44 Environmental Monitoring: Di(2-ethylhexyl)phthalate (Group 2B)


No. of samples

Exposure level

Exposure range


Alexander 2016


Used Gear

Hood

Wristlet

1

1

ND

ND


Alexander 2014


Used Gear




Glove 1 Outer Glove


Hood 1

Hood 2

Hood 3

1

1

1

1

1

1

1

1

320.0 𝝁g/m3

30.0 𝝁g/m3

830.0 𝝁g/m3

1400.0 𝝁g/m3

220.0 𝝁g/m3

340.0 𝝁g/m3

170.0 𝝁g/m3

57.0 𝝁g/m3

NR Concentration


Used Gear

Outer Shell

28


144 | P a g e

Thermal Liner

21

146 mg/kg ± 254

30 mg/kg ± 2

145 | P a g e

Table 45 Environmental Monitoring: Dichloromethane (Group 2B)


No. of samples

Exposure level

Exposure range


data



Outside structure

Inside Structure


Outside structure

Inside Structure


Outside structure

Inside Structure


Outside structure

1

1

1

1

1

1

1

1

<detectable limit <detectable limit

<detectable limit

<detectable limit

<detectable limit

<detectable limit

<detectable limit

<detectable limit

NR

Concentration

146 | P a g e


Outside structure


Outside structure


Outside structure

1

1

<detectable limit

<detectable limit

147 | P a g e

Table 46 Environmental Monitoring: Indeno[1,2,3-cd]pyrene (Group 2B)


Exposure level

Exposure range





(14.3-29.1 𝝁g/M3)






21

29

29

15.8 ng/M3

± 2.66

8.33 ng/M3

± 2.80

16.4 ng/M3

± 5.58

(3.06-74.4 ng/M3)

(1.49-40.9 ng/M3)

(0.670–126 ng/M3)


Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, seven training fire situations, 3 firefighters as fire starters, firefighters acting as leaders entering the burning house, 8 team leaders outside the house





3

3

8

3

0.12 ng/cm2

0.46 ng/cm2

0.12 ng/cm2

(0.03-0.41 ng/cm2)

(0.36-0.48 ng/cm2)

(0.08-0.33 ng/cm2)

Median, min-max

Median, min-max

Median, min-max

Median, min-max

148 | P a g e



3

8

0.04 ng/cm2

0.05 ng/cm2

0.06 ng/cm2

(0.03-0.06 ng/cm2)

(0.03-0.06 ng/cm2)

(0.02-0.10 ng/cm2)

Median, min-max

Median, min-max


Dermal Face & Neck 1 0.06 𝝁g ± NR



Air sampling 243


209 Broadway

(n = 73)

Day 3: 4.0 ng/m3

Day 100: 0.57 ng/m3

Day 200: 0.31 ng/m3

Day 3: 1.5 ng/m3

Day 100: 0.39 ng/m3

Day 200: 0.13 ng/m3

(0.06-7.9 ng/m3) (0.47-0.68 ng/m3) (0.19-0.43 ng/m3)

(0.00-3.2 ng/m3) (0.28-0.50 ng/m3) (0.06-0.21 ng/m3)


149 | P a g e

Hill 1972 USA, Simulated Structure Fire, Training Fire, particle sizes of soot collected from walls of the training chambers in 3 cities

Walls form City A

Walls from City B

Walls from City C

1

1

1

0.43 mg/gm

3.34 mg/gm

ND

NR

NR

NR

Quantity of Soot


Personal Air

Knockdown

Overhaul

3

NA

10 𝝁g/M3

NA



Gear



4

2

560 ng/g ± 226

95.8 ng/g ± 40.9



Gear



5

0

482 ng/g ± 318

ND


150 | P a g e


Personal Air





NR

NR

NR

NR

2.4 𝝁g/M3

NA

1 𝝁g/M3

NA

NR

0.9-18 𝝁g/M3

NR

0.28-2.6 𝝁g/M3






Gear

Deposition concentration on structural firefighting ensemble of instructors

NR

ND

NR


151 | P a g e

demonstrating behavior of fire


NR

NA

ND-11 ng/cm2



Used Gear

Hood

Wristlet

1

1

ND

0.2 𝝁g/g



Area

Arithmetic Mean

24 hour

Day

Night

Geometric Mean

24 hour

Day

Night

12

12

12

12

12

12

2 ng/m3 ± 2

3 ng/m3 ± 3

3 ng/m3 ± 0

1 ng/m3 ± 2

1 ng/m3 ± 2

NR



152 | P a g e

1 ng/m3 ± 1


Personal Air

Prescribed Burn

Wildland Fire

6

28

3 ng/m3 ± 5

6 ng/m3 ± 5

(<1-75 ng/m3)

(<1-103 ng/m3)




(ND-0.042 𝝁g/m3)

Mean







1

1

1

1

0.081 𝝁g/m3

0.012 𝝁g/m3

0.011 𝝁g/m3

0.062 𝝁g/m3

NR Concentration


Personal Air

(0.04-146.36 𝝁g/m3)

153 | P a g e

Geometric Mean

Arithmetic Mean

29

29

1.07 𝝁g/m3

± 1.47

9.34 𝝁g/m3


Arithmetic Mean


Used Gear




Glove 1 Outer Glove


Hood 1

Hood 2

Hood 3

1

1

1

1

1

1

1

1

ND

ND

2.0 𝝁g/m3

0.5 𝝁g/m3

0.2 𝝁g/m3

ND

ND

ND

NR Concentration

154 | P a g e

Table 47 Environmental Monitoring: Isoprene (Group 2B)


No. of samples

Exposure level

Exposure range




155 | P a g e

Table 48 Environmental Monitoring: Methyl Isobutyl Ketone (Group 2B)


No. of samples

Exposure level

Exposure range


data



Outside structure

Inside Structure


Outside structure

Inside Structure


Outside structure

Inside Structure


Outside structure

1

1

1

1

1

1

1

1




<detectable limit

<detectable limit

NR

Concentration

156 | P a g e


Outside structure


Outside structure


Outside structure

1

1

<detectable limit

<detectable limit


Gear

Pre-exposure

Post-exposure

Post-laundering

3

3

3

NR

(1.2-1.5 𝝁g/M3)

(2.4-15 𝝁g/M3)

(ND-0.8 𝝁g/M3)

Concentrations

157 | P a g e

Table 49 Environmental Monitoring: Naphthalene (Group 2B)



Exposure level

Exposure range


Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, 7 Team Leading FFs in seven training situations, 8 Team Leading FFs during eight emergency events

Active Air Sampling FF Train



21

29

29

1810 ng/M3

± 1.58

1500 ng/M3

± 22.5

4360 ng/M3

± 4.66

(1010-3680 ng/M3)

(407-6900 ng/M3)

(863–43000 ng/M3)


Fernando 2016 Canada, Burn Fire, Training Fire, 5 training exercises, 28 FFs

Dermal wrist

Dermal Neck

Dermal Forehead

Dermal Back

Dermal Fingers

28

28

28

28

28

1.33 ng/cm2

± 2.11

1.11 ng/cm2

± 1.82

1.26 ng/cm2

± 1.68

1.39 ng/cm2

± 2.24

1.19 ng/cm2

± 1.17


158 | P a g e

Baxter 2014 Ohio, USA, Area sampling on a single day for 8 hours at two metro fire stations and a University Radiation Safety Office as control

Area: Firehouse A Kitchen

Area: Firehouse A Truck Bay

Area: Firehouse A Sleeping Quarters

Area: Firehouse B Kitchen

Area: Firehouse B Truck Bay

Area: Firehouse B Sleeping Quarters

Area: Radiation Safety Office Break Room

Area: Radiation Safety Office Office

1

1

1

1

1

1

1

1

9.22 𝝁g/M3

9.24 𝝁g/M3

BLQ

BLQ

BLQ

BLQ

BLQ

BLQ

NR

NR

Mean Concentration

159 | P a g e

Baxter 2014 Ohio, USA, Area sampling at Overhaul Scenes at 5 Live Events

Area: Event 1 Sample 1










1

NA

1

1

1

1

1

NA

NA

NA

59.33 𝝁g/M3

NA

89.91 𝝁g/M3

BLQ

80.64 𝝁g/M3

2.44 𝝁g/M3

18.02 𝝁g/M3

NA

Equipment Failure

Equipment Failure

NR

NA

NR

NA

NR

NR

NR

NA

NA

NA

Mean Concentration

Baxter 2014 Ohio, USA, Overhaul Scenes at 5 Live Events

Personal: Event 1

Personal: Event 4

56.72 𝝁g/M3

26.23 𝝁g/M3

NR

NR

Mean Concentration


Area sampling 15 3.0 ppm NR Peak concentrations

160 | P a g e



Hill 1972 USA, Simulated Structure Fire, Training Fire, particle sizes of soot collected from walls of the training chambers in 3 cities

Walls form City A

Walls from City B

Walls from City C

1

1

1

0.15 mg/gm

0.59 mg/gm

0.18 mg/gm

NR

NR

NR

Quantity of Soot


Personal Air





NR

NR

NR

490 𝝁g/M3

NA

13 𝝁g/M3

NR

73-1300 𝝁g/M3

NR




161 | P a g e

NR

NA

20-210 𝝁g/M3



Gear



NR

NR

ND

ND

ND

ND



Alexander 2016


Used Gear

Hood

Wristlet

1

1

3.1 𝝁g/g

0.2 𝝁g/g



Area

Arithmetic Mean

24 hour

Day

Night

Geometric Mean

24 hour

12

12

12

467 ng/m3 ± 579

589 ng/m3 ± 755

344 ng/m3 ± 302

NR



162 | P a g e

Day

Night

12

12

12

284 ng/m3 ± 3

327 ng/m3 ± 3

253 ng/m3 ± 2


Personal Air

Prescribed Burn

Wildland Fire

11

21

669 ng/m3 ± 7

3189 ng/m3

± 3

(<4-5073 ng/m3)

(319-21439 ng/m3)








1

1

1

1

nd

nd

nd

nd

NR Concentration


Personal Air 12 6.17 𝝁g/m3 (3.2-81 𝝁g/m3)

Concentration

163 | P a g e


Personal Air

Geometric Mean

Arithmetic Mean

29

29

182.59 𝝁g/m3 ± 1.48

1675.80 𝝁g/m3

(3.95-15916.00 𝝁g/m3)


Arithmetic Mean

Alexander 2014


Used Gear




Glove 1 Outer Glove


Hood 1

Hood 2

Hood 3

1

1

1

1

1

1

1

1

ND

ND

ND

ND

0.2 𝝁g/m3

3.1 𝝁g/m3

ND

ND

NR Concentration


Used Gear

Outer Shell

Thermal Liner

28

21

0.45 mg/kg ± 0.1

0.14 mg/kg ± 0.05


164 | P a g e


Gear

Pre-exposure

Post-exposure

Post-laundering

2

3

3

NR

(0.10-0.11 𝝁g/M3) (1.12-2.38 𝝁g/M3) (0.04-0.21 𝝁g/M3)

Concentrations

165 | P a g e

Table 50 Environmental Monitoring: Perfluorooctanoic Acid (Group 2B)


No. of samples

Exposure level

Exposure range


data

Peaslee 2020 USA, Donated turnout gear, over 30 sets of unused and used turnout gear

Gear Unused Jacket 2008: Thermal liner Moisture barrier Outer shell Used Jacket 2008: Moisture barrier Unused Jacket 2017: Moisture barrier Used Pants 2014: Thermal liner Moisture barrier Outer shell

1 1 1 1 1 1 1 1

78 ppb 46 ppb 182 ppb 37 ppb ND 850 ppb 71 ppb 97 ppb

NR Concentration

166 | P a g e

Table 51 Environmental Monitoring: Trichlorophenol (Group 2B)


No. of samples

Exposure level

Exposure range


data

Brandt-Rauf 1988


Personal Air 1 0.129 NR Concentration

167 | P a g e

WORLD TRADE CENTER – ENVIRONMENTAL MONITORING

Table 52 World Trade Center Environmental Monitoring

Group 1


No. of samples

Exposure level

Exposure range


data

2,3,4,7,8-Pentachlorodibenzofuran (Group 1)

Lioy 2002 USA, WTC, Samples of total settled dust and smoke collected at 3 different locations (Cortlandt, Cherry, and Market Streets)

Settled Dust

Cortland Street

Cherry Street

Market Street

1

1

1

54.5 ng/kg

77.3 ng/kg

85.0 ng/kg

NR Concentration

2,3,7,8-Tetrachlorodibenzo-P-dioxin (Group 1)


Settled Dust

Cortland Street

Cherry Street

Market Street

1

1

1

7.00 ng/kg

5.81 ng/kg

6.53 ng/kg

NR

Concentration

Benzo[a]pyrene (Group 1)

168 | P a g e


Settled Dust

Cortland Street

Cherry Street

Market Street

1

1

1

23000 ng/g

12100 ng/g

19300 ng/g

NR

Concentration

Group 2A

4,4-Dichlorodiphenyltrichloroethane (Group 2A)


Settled Dust

Cortland Street

Cherry Street

Market Street

1

1

1

ND

ND

ND

NR

Concentration

Group 2B

3,3'-Dichlorobenzidine (Group 2B)


Settled Dust

Cortland Street

Cherry Street

1

1

1

10 𝝁g/g

ND

ND

NR

Concentration

169 | P a g e

Market Street

Trichlorophenol (Group 2B)


Settled Dust

Cortland Street

Cherry Street

Market Street

1

1

1

21.4 𝝁g/g

ND

11.5 𝝁g/g

NR

Concentration

Benzo[c]phenanthrene (Group 2B)


Settled Dust

Cortland Street

Cherry Street

Market Street

1

1

1

ND

ND

43.7 𝝁g/g

NR

Concentration

Isoprene (Group 2B)

Lioy 2002

USA, WTC, Samples of total settled dust and smoke collected at 3 different locations (Cortlandt, Cherry, and Market Streets)

Settled Dust

Cortland Street

Cherry Street

1

1

28.6 𝝁g/g

8.1 𝝁g/g

NR

Concentration

170 | P a g e

Market Street

1 22.1 𝝁g/g

Chrysene (Group 2B)


Settled Dust

Cortland Street

Cherry Street

Market Street

1

1

1

ND

18.2 𝝁g/g

ND

NR

Concentration

Heptachlor (Group 2B)


Settled Dust

Cortland Street

Cherry Street

Market Street

1

1

1

ND

ND

ND

NR

Concentration

Hexachlorobenzene (Group 2B)


Settled Dust

Cortland Street

1

1

1.9 ng/g

0.9 ng/g

NR

Concentration

171 | P a g e

Cherry Street

Market Street

1

1.2 ng/g

Mirex (Group 2B)


Settled Dust

Cortland Street

Cherry Street

Market Street

1

1

1

ND

0.8 ng/g

ND

NR

Concentration

172 | P a g e

References

Abrard, S., Bertrand, M., De Valence, T., & Schaupp, T. (2019). French firefighters exposure to

Benzo[a]pyrene after simulated structure fires. International Journal of Hygiene and Environmental

Health, 222(1), 84–88. https://doi.org/10.1016/j.ijheh.2018.08.010

Adetona, O, Simpson, C., Onstad, G., & Naeher, L. (2013). Exposure of wildland firefighters to carbon

monoxide, fine particles, and levoglucosan. The Annals of Occupational Hygiene, 57(8), 979–991.

Adetona, Olorunfemi, Simpson, C. D., Li, Z., Sjodin, A., Calafat, A. M., & Naeher, L. P. (2017). Hydroxylated

polycyclic aromatic hydrocarbons as biomarkers of exposure to wood smoke in wildland firefighters.

Journal of Exposure Science & Environmental Epidemiology, 27(1), 78–83.

https://doi.org/10.1038/jes.2015.75

Alexander, B. M., & Baxter, C. S. (2014). Plasticizer Contamination of Firefighter Personal Protective Clothing

– A Potential Factor in Increased Health Risks in Firefighters. Journal of Occupational and

Environmental Hygiene, 11(5), D43–D48. https://doi.org/10.1080/15459624.2013.877142

Alexander, B. M., & Baxter, C. S. (2016). Flame-retardant contamination of firefighter personal protective

clothing – A potential health risk for firefighters. Journal of Occupational and Environmental Hygiene,

13(9), D148–D155. https://doi.org/10.1080/15459624.2016.1183016

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wildfires: Firefighters’ exposure risks and options. Environment International, 37(2), 314–321.

https://doi.org/10.1016/j.envint.2010.09.005

Robinson, M. S., Anthony, T. R., Littau, S. R., Herckes, P., Nelson, X., Poplin, G. S., & Burgess, J. L. (2008).

Occupational PAH exposures during prescribed pile burns. The Annals of Occupational Hygiene, 52(6),

497–508. https://doi.org/10.1093/annhyg/men027

Rossbach, B., Wollschläger, D., Letzel, S., Gottschalk, W., & Muttray, A. (2020). Internal exposure of

firefighting instructors to polycyclic aromatic hydrocarbons (PAH) during live fire training. Toxicology

Letters, 331, 102–111. https://doi.org/10.1016/j.toxlet.2020.05.024

183 | P a g e

Rosting, C., & Olsen, R. (2020). Biomonitoring of the benzene metabolite s-phenylmercapturic acid and the

toluene metabolite s-benzylmercapturic acid in urine from firefighters. Toxicology Letters, 329, 20–25.

https://doi.org/10.1016/j.toxlet.2020.04.018

Rotander, A., Kärrman, A., Toms, L.-M. L., Kay, M., Mueller, J. F., & Gómez Ramos, M. J. (2015). Novel

Fluorinated Surfactants Tentatively Identified in Firefighters Using Liquid Chromatography Quadrupole

Time-of-Flight Tandem Mass Spectrometry and a Case-Control Approach. Environmental Science &

Technology, 49(4), 2434–2442. https://doi.org/10.1021/es503653n

Schecter, A., Pavuk, M., Amirova, D. A., Grosheva, E. I., Päpke, O., Ryan, J. J., Adibi, J., & Piskac, A. L.

(2002). Characterization of dioxin exposure in firefighters, residents, and chemical workers in the

Irkutsk Region of Russian Siberia. Chemosphere, 47(2), 147–156. https://doi.org/10.1016/S0045-

6535(01)00197-7

Shaw, S. D., Berger, M. L., Harris, J. H., Yun, S. H., Wu, Q., Liao, C., Blum, A., Stefani, A., & Kannan, K.

(2013). Persistent organic pollutants including polychlorinated and polybrominated dibenzo-p-dioxins

and dibenzofurans in firefighters from Northern California. Chemosphere, 91(10), 1386–1394.

https://doi.org/10.1016/j.chemosphere.2012.12.070

Sjöström, M., Julander, A., Strandberg, B., Lewné, M., & Bigert, C. (2019). Airborne and Dermal Exposure to

Polycyclic Aromatic Hydrocarbons, Volatile Organic Compounds, and Particles among Firefighters and

Police Investigators. Annals of Work Exposures and Health, 63(5), 533–545.

https://doi.org/10.1093/annweh/wxz030

Smith, W. R., Montopoli, G., Byerly, A., Montopoli, M., Harlow, H., & Wheeler, A. R. (2013). Mercury Toxicity in

Wildland Firefighters. Wilderness & Environmental Medicine, 24(2), 141–145.

https://doi.org/10.1016/j.wem.2013.01.004

Soteriades, E. S., Kim, J., Christophi, C. A., & Kales, S. N. (2019). Cancer Incidence and Mortality in

Firefighters: A State-of-the-Art Review and Meta-َAnalysis. Asian Pacific Journal of Cancer Prevention:

APJCP, 20(11), 3221–3231. https://doi.org/10.31557/APJCP.2019.20.11.3221

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Stec, A. A., Dickens, K. E., Salden, M., Hewitt, F. E., Watts, D. P., Houldsworth, P. E., & Martin, F. L. (2018).

Occupational Exposure to Polycyclic Aromatic Hydrocarbons and Elevated Cancer Incidence in

Firefighters. Scientific Reports, 8(1), 2476. https://doi.org/10.1038/s41598-018-20616-6

Stull, J., Paul, P., Reynolds, J., Schmid, M., & Tutterow, R. (2018). Recommendations for Developing and

Implementing a Fire Service Contamination Control Campaign. Fire Protection Research Foundation.

https://www.nfpa.org//-/media/Files/News-and-Research/Fire-statistics-and-reports/Emergency-

responders/RFContamControl.pdf

The International Association of Arson Investigators, Inc. (2020). Fire Investigator Health and Safety Best

Practices. 2nd Edition. The International Association of Arson Investigators, Inc.

https://www.firearson.com/uploads/FireInvestigatorHealthSafetyBestPracticesSecond.pdf

Tsai, R. J., Luckhaupt, S. E., Schumacher, P., Cress, R. D., Deapen, D. M., & Calvert, G. M. (2015). Risk of

cancer among firefighters in California, 1988-2007. American Journal of Industrial Medicine, 58(7),

715–729. https://doi.org/10.1002/ajim.22466

US Fire Administration. (2020). The hidden dangers in firefighting foam. U.S. Fire Administration.

https://www.usfa.fema.gov/training/coffee_break/021120.html

Waldman, J. M., Gavin, Q., Anderson, M., Hoover, S., Alvaran, J., Ip, H. S. S., Fenster, L., Wu, N. T., Krowech,

G., Plummer, L., Israel, L., Das, R., & She, J. (2016). Exposures to environmental phenols in Southern

California firefighters and findings of elevated urinary benzophenone-3 levels. Environment

International, 88, 281–287. https://doi.org/10.1016/j.envint.2015.11.014

185 | P a g e

Appendix A. Excluded Studies

Table 53 Excluded “Other” Exposure Articles

Date Title Authors Journal

Mental/Behavioral Health

1989 Long-term psychological distress among chemically exposed firefighters

Markowitz JS. Behav Med

1998 Exposure to duty-related incident stressors in urban firefighters and paramedics

Beaton R, Murphy S, Johnson C, Pike K, Corneil W.

J Trauma Stress

2007 Firefighter risk for trauma exposure & DSM-IV PTSD.

Reed, PL; Breslau, N; AMERICAN JOURNAL OF EPIDEMIOLOGY

2012 Predictors of posttraumatic stress disorder and other psychological symptoms in trauma-exposed firefighters

Meyer EC, Zimering R, Daly E, Knight J, Kamholz BW, Gulliver SB.

Psychol Serv

2013 The effect of sleep restriction and exposure to physical activity on the cognitive ability of volunteer firefighters across a 3-day simulated fire-ground tour

Christoforou, T; Cvirn, M; Ferguson, S; Armstrong, T; Smith, B;

Sleep. Performance and Wellbeing in Adults and Adolescents. Australasian Chronobiology Society, Adelaide

2016 Chronic occupational exposures can influence the rate of PTSD and depressive disorders in first responders and military personnel

Walker A, McKune A, Ferguson S, Pyne DB, Rattray B.

Extrem Physiol Med

2016 Firefighting and mental health: Experiences of repeated exposure to trauma

Jahnke SA, Poston WS, Haddock CK, Murphy B.

Work

2016 Is Cumulative Exposure to Suicide Attempts and Deaths a Risk Factor for Suicidal Behavior Among Firefighters? A Preliminary Study

Kimbrel NA, Pennington ML, Cammarata CM, Leto F, Ostiguy WJ, Gulliver SB.

Suicide Life Threat Behav

2016 The mental health of fire-fighters: An examination of the impact of repeated trauma exposure

Harvey SB, Milligan-Saville JS, Paterson HM, Harkness EL, Marsh AM, Dobson M, Kemp R, Bryant RA.

Aust N Z J Psychiatry

2017 Duty-Related Trauma Exposure and Posttraumatic Stress Symptoms in Professional Firefighters

Lee JH, Lee D, Kim J, Jeon K, Sim M.

J Trauma Stress

2017 Evaluation of fire fighters’ mental health symptoms and exposure to traumatic events, job stress, and bloodborne pathogens

Wiegand, Douglas M; Chiu, Sophia;

HHE Report

2017 Trauma exposure and post‐traumatic stress disorder within fire and emergency services in Western Australia

Skeffington, Petra M; Rees, Clare S; Mazzucchelli, Trevor;

Australian Journal of Psychology

186 | P a g e

2017 Trauma exposure and post‐traumatic stress disorder within fire and emergency services in Western Australia

Skeffington, Petra M; Rees, Clare S; Mazzucchelli, Trevor;

Australian Journal of Psychology

2018 Exposure to suicide and suicide bereavement among women firefighters: Associated suicidality and psychiatric symptoms

Hom MA, Stanley IH, Spencer-Thomas S, Joiner TE.

J Clin Psychol

2018 The Influence of Exposure to Natural Disasters on Depression and PTSD Symptoms among Firefighters

Pennington ML, Carpenter TP, Synett SJ, Torres VA, Teague J, Morissette SB, Knight J, Kamholz BW, Keane TM, Zimering RT, Gulliver SB.

Prehosp Disaster Med

2018 The impact of trauma exposure on the development of PTSD and psychological distress in a volunteer fire service

Milligan-Saville J, Choi I, Deady M, Scott P, Tan L, Calvo RA, Bryant RA, Glozier N, Harvey SB.

Psychiatry Res

2019 Two-month point prevalence of exposure to critical incidents in firefighters in a single fire service

MacDermid, Joy C; Nazari, Goris; Rashid, Coomal; Sinden, Kathryn; Carleton, Nicholas; Cramm, Heidi;

Work

2020 Does Emotional Labor Increase the Risk of Suicidal Ideation among Firefighters?

Hyun DS, Jeung DY, Kim C, Ryu HY, Chang SJ.

Yonsei Med J

Hearing/Noise/Auditory Disturbances

1978 Effect of firetruck noise on firefighters' hearing

Rackl J, Decker TN. J Aud Res

1979 Fire fighter noise exposure Reischl U, Bair HS Jr, Reischl P.

Am Ind Hyg Assoc J

1981 Occupation related fire fighter hearing loss Reischl U, Hanks TG, Reischl P.

Am Ind Hyg Assoc J

1985 Accelerated hearing loss in urban emergency medical services firefighters

Pepe PE, Jerger J, Miller RH, Jerger S.

Ann Emerg Med

1985 Forest fire fighters noise exposure. Gharabegian, Areg; Cosgrove, Kevin M; Pehrson, John R; Trinh, Trung D;

Noise Control Engineering Journal

1991 Occupational noise exposure and hearing loss in fire fighters assigned to airport fire stations

Tubbs RL. Am Ind Hyg Assoc J

2001 Noise exposure in the fire department Diel, Cynthia WUSM

2005 Hearing levels of firefighters: risk of occupational noise-induced hearing loss assessed by cross-sectional and longitudinal data

Clark WW, Bohl CD. Ear Hear

2007 Hazardous decibels: hearing health of firefighters

Hong O, Samo DG. AAOHN J

2009 Hearing damage as a consequence of firefighters' professional exposure to noise]

LaliÄ‡ H, FerhatoviÄ‡ M, Dinko J, CulinoviÄ‡ M.

Acta Med Croatica

2010 High-frequency audiometry in normal hearing military firemen exposed to noise

Rocha RL, Atherino CC, Frota SM.

Braz J Otorhinolaryngol

187 | P a g e

2011 Noise exposure assessment in the Poudre Fire Authority

Schwennker, Catherine;

2012 Hearing effects from intermittent and continuous noise exposure in a study of Korean factory workers and firefighters

Chung IS, Chu IM, Cullen MR.

BMC Public Health

2013 Comparison of sensory-Neural Hearing between Firefighters and Office Workers

Assadi SN, Esmaily H, Mostaan L.

Int J Prev Med

2013 Firefighter noise exposure during training activities and general equipment use

Root KS, Schwennker C, Autenrieth D, Sandfort DR, Lipsey T, Brazile WJ.

J Occup Environ Hyg

2016 Double Jeopardy: Hearing Loss and Tinnitus Among Noise-Exposed Workers

Hong O, Chin DL, Phelps S, Joo Y.

Workplace Health Saf

2016 Injury Risk and Noise Exposure in Firefighter Training Operations

Neitzel RL, Long RN, Sun K, Sayler S, von Thaden TL.

Ann Occup Hyg

2017 Noise exposure among federal wildland fire fighters

Broyles G, Butler CR, Kardous CA.

J Acoust Soc Am

2018 Noise Exposure State of Fire Fighter Choi, JH; Kim, SY; Choi, SW; Lee, JH;

Journal of Korean Institute of Fire Science & Engineering

2018 Simulation of noise exposure level of fire-fighters in emergency response services in Malaysia

Abidin, Ainul Naqueah Zainal; Jusoh, Mazura; Zakaria, Zaki Yamani;

Safety science

2019 Noise exposures and perceptions of hearing conservation programs among wildland firefighters

Broyles G, Kardous CA, Shaw PB, Krieg EF.

J Occup Environ Hyg

2019 Tinnitus and Self-Perceived Hearing Handicap in Firefighters: A Cross-Sectional Study

Jamesdaniel S, Elhage KG, Rosati R, Ghosh S, Arnetz B, Blessman J.


Pulmonary Function

1980 Acute and chronic effects of fire fighting on pulmonary function

Loke J, Farmer W, Matthay RA, Putman CE, Smith GJ.

Chest

1988 Acquired progressive asthma in a fire-fighter

BergstrÃ¶m CE, Tornling G, Unge G.

Eur Respir J

1989 Acute health effects among firefighters exposed to a polyvinyl chloride (PVC) fire

Markowitz JS, Gutterman EM, Schwartz S, Link B, Gorman SM.

Am J Epidemiol

1990 Airway responsiveness of firefighters after smoke exposure

Chia KS, Jeyaratnam J, Chan TB, Lim TK.

Br J Ind Med

1991 Asbestos exposure and fire fighting Markowitz SB, Garibaldi K, Lilis R, Landrigan PJ.

Ann N Y Acad Sci

1996 Acute health hazards of firefighters after fighting a department store fire

Gu TL, Liou SH, Hsu CH, Hsu JC, Wu TN.

Ind Health

2006 Case-Control study of Firefighters with documented positive tuberculin skin test results using Quantiferon-TB testing in comparison with Firefighters with negative tuberculin skin test results

Fleming JL, England TL, Wernick HB, Reinhart S, Dominguez JA, Kelley PL, Gorter FD, Papst V, LaDuke A.

J Occup Med Toxicol

188 | P a g e

2010 Accelerated spirometric decline in New York City firefighters with Î±â‚•-antitrypsin deficiency

Banauch GI, Brantly M, Izbicki G, Hall C, Shanske A, Chavko R, Santhyadka G, Christodoulou V, Weiden MD, Prezant DJ.

Chest

2012 Acute respiratory effects in firefighters Greven FE, Krop EJ, Spithoven JJ, Burger N, Rooyackers JM, Kerstjens HA, van der Heide S, Heederik DJ.

Am J Ind Med

2017 Analysis of the impact of harmful factors in the workplace on functioning of the respiratory system of firefighters

Witt M, Goniewicz M, PawÅ‚owski W, Goniewicz K, Biczysko W.

Ann Agric Environ Med

2018 Acute effects of smoke exposure on airway and systemic inflammation in forest firefighters

Gianniou N, Giannakopoulou C, Dima E, Kardara M, Katsaounou P, Tsakatikas A, Roussos C, Koulouris N, Rovina N.

J Asthma Allergy

2018 Acute Pulmonary Responses among Wildland Firefighters following Exposure to Wildland Fire Smoke

Wu, Chieh-Ming; Adetona, Anna; Naeher, Luke; Adetona, Olorunfemi;

ISEE Conference Abstracts

2018 Risk of asthma and chronic obstructive pulmonary disease in a large historical cohort of Danish firefighters

Pedersen JE, Ugelvig Petersen K, EbbehÃ¸j NE, Bonde JP, Hansen J.

Occup Environ Med

Blood/Bodily Fluids

1994 Hepatitis B markers in Gloucestershire firemen

Springbett RJ, Cartwright KA, Watson BE, Morris R, Cantle A.

Occup Med (Lond)

1995 Communicable disease and firefighters Weaver VM, Arndt SD. Occup Med

2000 Hepatitis C virus infection among firefighters, emergency medical technicians, and paramedics--selected locations, United States, 1991-2000

Roome AJ, Hadler JL, Thomas AL, Migicovsky B, Roth R, Boraz M, Kuszajewksi B, Berkowitz D; Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep

2001 Hepatitis C screening and prevalence among urban public safety workers

Upfal MJ, Naylor P, Mutchnick MM.

J Occup Environ Med

2002 Hepatitis C in urban and rural public safety workers

Rischitelli G, McCauley L, Lambert WE, Lasarev M, Mahoney E.

J Occup Environ Med

2002 Occupational exposures and risk of hepatitis B virus infection among public safety workers

Averhoff FM, Moyer LA, Woodruff BA, Deladisma AM, Nunnery J, Alter MJ, Margolis HS.

J Occup Environ Med

2005 Career risk of hepatitis C virus infection among U.S. emergency medical and public safety workers

Rischitelli G, Lasarev M, McCauley L.

J Occup Environ Med

189 | P a g e

2012 Analysis of working conditions focusing on biological risk: firefighters in Campo Grande, MS, Brazil

Contrera-Moreno L, de Andrade SM, Motta-Castro AR, Pinto AM, Salas FR, Stief AC.

Work

Fire Station

2020 Career fire hall exposures to diesel engine exhaust in Ontario, Canada

Chung J, Demers PA, Kalenge S, Kirkham TL.

J Occup Environ Hyg

Heat

1998 Heat Exposure Increases Energy Expenditure During Rest and Work in Men Dressed in Firefighter Ensemble and Using a Self-contained Breathing Apparatus

Hagan, R Donald; Vurbeff, Gretchen K; Heaney, Jay H;

Naval Health Research Center

2004 Heat stress while wearing long pants or shorts under firefighting protective clothing

McLellan TM, Selkirk GA. Ergonomics

2015 Multiple Days of Heat Exposure on Firefighters' Work Performance and Physiology

Larsen B, Snow R, Vincent G, Tran J, Wolkow A, Aisbett B.

PLoS One

2015 Immune and inflammatory responses of Australian firefighters after repeated exposures to the heat

Walker A, Keene T, Argus C, Driller M, Guy JH, Rattray B.

Ergonomics

2016 Physiological and psychological responses in Fire Instructors to heat exposures

Watt PW, Willmott AG, Maxwell NS, Smeeton NJ, Watt E, Richardson AJ.

J Therm Biol

2017 Effect of Heat Exposure and Simulated Physical Firefighting Work on Acute Inflammatory and Cortisol Responses

Wolkow A, Aisbett B, Jefferies S, Main LC.

Ann Work Expo Health

2017 Heat exposure increases risk of heart attack in firefighters

Nurs Stand

2018 Physiological, cognitive and neuromuscular effects of heat exposure on firefighters after a live training scenario

Abrard S MD, Bertrand M, De Valence T MD, Schaupp T MD.

Int J Occup Saf Ergon

2019 Heat tolerance of Fire Service Instructors Watkins ER, Hayes M, Watt P, Richardson AJ.

J Therm Biol

2020 Extreme occupational heat exposure is associated with elevated haematological and inflammatory markers in Fire Service Instructors

Watkins, Emily R; Hayes, Mark; Watt, Peter; Renshaw, Derek; Richardson, Alan J;

Experimental physiology

Electrical

2002 Fire fighters exposed to electrical hazards during wildland fire operations

KL Cortez, TP Mezzanotte

Appl Occup Environ Hyg

2013 The Studies of the State Fire Service officers Exposure to Electromagnetic Fields of Professional Wireless Communication Devices

Leszko, Wiesław; Zradziński, Patryk;

Bezpieczenstwo i Technika Pozarnicza

Cancer

190 | P a g e

2009 Most cancer in firefighters is due to radio-frequency radiation exposure not inhaled carcinogens

Milham S. Med Hypotheses

Specific Incident

2009 Polychlorinated dibenzo-p-dioxins, dibenzofurans, and biphenyls in the serum of firefighters who participated in extinguishing the 1992 fire at a cable manufacturing plant in Irkutsk oblast

Chernyak YI, Shelepchikov AA, Feshin DB, Brodsky ES, Grassman JA.

Dokl Biol Sci

Gear

2019 Survival of Staphylococcus aureus on the outer shell of fire fighter turnout gear after sanitation in a commercial washer/extractor

Farcas D, Blachere FM, Kashon ML, Sbarra D, Schwegler-Berry D, Stull JO, Noti JD.

J Occup Med Toxicol

Chemical Exposures not relevant to this study

1978 Gold A, Burgess WA, Clougherty EV. Exposure of firefighters to toxic air contaminants

Am Ind Hyg Assoc J

2001 Fine particle exposure of prescribed fire workers in the Southeastern United States and a comparison of several particulate matter sampling methods.

Yanosky, Jeffrey OSTI

2007 Relative congener scaling of Polychlorinated dibenzo-p-dioxins and dibenzofurans to estimate building fire contributions in air, surface wipes, and dust samples

Pleil JD, Lorber MN. Environ Sci Technol

2011 Perfluoroalkyl acids including perfluorooctane sulfonate and perfluorohexane sulfonate in firefighters

Jin C, Sun Y, Islam A, Qian Y, Ducatman A.

J Occup Environ Med

2012 PCDD, PCDF, and PCB exposure in current and former firefighters from Eastern Siberia

Chernyak YI, Shelepchikov AA, Brodsky ES, Grassman JA.

Toxicol Lett

2015 Elevated levels of PFOS and PFHxS in firefighters exposed to aqueous film forming foam (AFFF)

Rotander A, Toms LM, Aylward L, Kay M, Mueller JF.

Environ Int

2016 Serum concentrations of chlorinated dibenzo-p-dioxins, furans and PCBs, among former phenoxy herbicide production workers and firefighters in New Zealand

't Mannetje A, Eng A, Walls C, Dryson E, McLean D, Kogevinas M, Fowles J, Borman B, O'Connor P, Cheng S, Brooks C, H Smith A, Pearce N.

Int Arch Occup Environ Health

2017 Occupational exposure of firefighters to polycyclic aromatic hydrocarbons in non-fire work environments

Oliveira M, Slezakova K, Fernandes A, Teixeira JP, Delerue-Matos C, Pereira MDC, Morais S.

Sci Total Environ

191 | P a g e

2019 Factors affecting smoke and crystalline silica exposure among wildland firefighters

Reinhardt TE, Broyles G. J Occup Environ Hyg

2019 Leaching and bioavailability of selected perfluoroalkyl acids (PFAAs) from soil contaminated by firefighting activities

BrÃ¤unig J, Baduel C, Barnes CM, Mueller JF.

Sci Total Environ

2020 Exposure to Perfluoroalkyl Substances in a Cohort of Women Firefighters and Office Workers in San Francisco

Trowbridge J, Gerona RR, Lin T, Rudel RA, Bessonneau V, Buren H, Morello-Frosch R.

Environ Sci Technol

2020 Integrating Exposure Knowledge and Serum Suspect Screening as a New Approach to Biomonitoring: An Application in Firefighters and Office Workers

Grashow R, Bessonneau V, Gerona RR, Wang A, Trowbridge J, Lin T, Buren H, Rudel RA, Morello-Frosch R.

Environ Sci Technol

192 | P a g e

Appendix B. Excluded (Non-relevant) World Trade Center Studies

Table 54 Table of Excluded World Trade Center Articles

Date Title Authors Journal

1999 The incidence, prevalence, and severity of sarcoidosis in New York City firefighters

Prezant DJ, Dhala A, Goldstein A, Janus D, Ortiz F, Aldrich TK, Kelly KJ.

Chest

2001 Health consequences of the 11 September 2001 attacks

Landrigan PJ. Environ Health Perspect

2002 Cough and bronchial responsiveness in firefighters at the World Trade Center site

Prezant DJ, Weiden M, Banauch GI, McGuinness G, Rom WN, Aldrich TK, Kelly KJ.

N Engl J Med

2002 Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001

Lioy PJ, Weisel CP, Millette JR, Eisenreich S, Vallero D, Offenberg J, Buckley B, Turpin B, Zhong M, Cohen MD, Prophete C, Yang I, Stiles R, Chee G, Johnson W, Porcja R, Alimokhtari S, Hale RC, Weschler C, Chen LC.


2002 Occupational exposures to air contaminants at the World Trade Center disaster site--New York, September-October, 2001

Centers for Disease Control and Prevention (CDC).

MMWR Morb Mortal Wkly Rep

2003 World Trade Center. Chemical studies of 9/11 disaster tell complex tale of 'bad stuff'

Service RF. Science

2003 Cough and bronchial responsiveness in firefighters at the World Trade Center site

Lange JH. N Engl J Med

2003 Biomonitoring of chemical exposure among New York City firefighters responding to the World Trade Center fire and collapse

Edelman P, Osterloh J, Pirkle J, Caudill SP, Grainger J, Jones R, Blount B, Calafat A, Turner W, Feldman D, Baron S, Bernard B, Lushniak BD, Kelly K, Prezant D.


2004 Symptoms, respirator use, and pulmonary function changes among New York City firefighters responding to the World Trade Center disaster

Feldman DM, Baron SL, Bernard BP, Lushniak BD, Banauch G, Arcentales N, Kelly KJ, Prezant DJ.

Chest

2004 Chemical characterization of ambient particulate matter near the World Trade Center: elemental carbon, organic carbon, and mass reconstruction

Olson DA, Norris GA, Landis MS, Vette AF. Environ Sci Technol

2004 Health and environmental consequences of the world trade center disaster

Landrigan PJ, Lioy PJ, Thurston G, Berkowitz G, Chen LC, Chillrud SN, Gavett SH, Georgopoulos PG, Geyh AS, Levin S, Perera F, Rappaport SM, Small C; NIEHS World Trade Center Working Group.


2004 Induced sputum assessment in New York City firefighters exposed to World Trade Center dust

Fireman EM, Lerman Y, Ganor E, Greif J, Fireman-Shoresh S, Lioy PJ, Banauch GI, Weiden M, Kelly KJ, Prezant DJ.


193 | P a g e

2004 Air levels of carcinogenic polycyclic aromatic hydrocarbons after the World Trade Center disaster

Pleil JD, Vette AF, Johnson BA, Rappaport SM.

Proc Natl Acad Sci U S A

2005 Bronchial hyperreactivity and other inhalation lung injuries in rescue/recovery workers after the World Trade Center collapse

Banauch GI, Dhala A, Alleyne D, Alva R, Santhyadka G, Krasko A, Weiden M, Kelly KJ, Prezant DJ.

Crit Care Med

2005 Accelerated pulmonary function decline after World Trade Center particulate exposure in the New York City Fire Department workforce

Banauch, Gisela; Weiden, Michael; Hall, Charles; Cohen, Hillel W; Aldrich, Thomas K; Arcentales, Nicole; Kelly, Kerry J; Prezant, David J;

Chest

2006 The anatomy of the exposures that occurred around the World Trade Center site: 9/11 and beyond

Lioy PJ, Georgopoulos P. Ann N Y Acad Sci

2006 Pulmonary function after exposure to the World Trade Center collapse in the New York City Fire Department

Banauch GI, Hall C, Weiden M, Cohen HW, Aldrich TK, Christodoulou V, Arcentales N, Kelly KJ, Prezant DJ.

Am J Respir Crit Care Med

2006 Pulmonary function after exposure to the world trade center in the new york city fire department

Aldrich, Thomas K; Christodoulou, Vasillios; Arcentales, Nicole; Prezant, David J;

2007 World Trade Center "sarcoid-like" granulomatous pulmonary disease in New York City Fire Department rescue workers

Izbicki G, Chavko R, Banauch GI, Weiden MD, Berger KI, Aldrich TK, Hall C, Kelly KJ, Prezant DJ.

Chest

2007 The legacy of World Trade Center dust

Samet JM, Geyh AS, Utell MJ. N Engl J Med

2007 Persistent organic pollutants in 9/11 world trade center rescue workers: reduction following detoxification

Dahlgren J, Cecchini M, Takhar H, Paepke O. Chemosphere

2007 Relative congener scaling of Polychlorinated dibenzo-p-dioxins and dibenzofurans to estimate building fire contributions in air, surface wipes, and dust samples

Pleil JD, Lorber MN. Environ Sci Technol

2008 World Trade Center Cough Syndrome and its treatment

Prezant DJ. Lung

2008 Potential for diffuse parenchymal lung disease after exposures at World Trade Center Disaster site

Szeinuk J, Padilla M, de la Hoz RE. Mt Sinai J Med

2009 Respiratory tract symptoms and illnesses in rescue and clearance workers after the World Trade Center catastrophe]

Aro L, Sauni R, Lusa S, Lindholm H, Uitti J. Duodecim

2010 Emerging exposures and respiratory health: World Trade Center dust

Rom WN, Reibman J, Rogers L, Weiden MD, Oppenheimer B, Berger K, Goldring R, Harrison D, Prezant D.

Proc Am Thorac Soc

2010 Longitudinal study of probable post-traumatic stress disorder in firefighters exposed to the World Trade Center disaster

Berninger A, Webber MP, Niles JK, Gustave J, Lee R, Cohen HW, Kelly K, Corrigan M, Prezant DJ.

Am J Ind Med

194 | P a g e

2010 Lung function in rescue workers at the World Trade Center after 7 years

Aldrich TK, Gustave J, Hall CB, Cohen HW, Webber MP, Zeig-Owens R, Cosenza K, Christodoulou V, Glass L, Al-Othman F, Weiden MD, Kelly KJ, Prezant DJ.

N Engl J Med

2010 Obstructive airways disease with air trapping among firefighters exposed to World Trade Center dust

Weiden MD, Ferrier N, Nolan A, Rom WN, Comfort A, Gustave J, Zeig-Owens R, Zheng S, Goldring RM, Berger KI, Cosenza K, Lee R, Webber MP, Kelly KJ, Aldrich TK, Prezant DJ.

Chest

2011 The evolving spectrum of pulmonary disease in responders to the World Trade Center tragedy

Guidotti TL, Prezant D, de la Hoz RE, Miller A.

Am J Ind Med

2011 Epidemiology of respiratory health outcomes among World Trade Center disaster workers: review of the literature 10 years after the September 11, 2001 terrorist attacks

Ekenga CC, Friedman-JimÃ©nez G. Disaster Med Public Health Prep

2011 Comorbid trends in World Trade Center cough syndrome and probable posttraumatic stress disorder in firefighters

Niles JK, Webber MP, Gustave J, Cohen HW, Zeig-Owens R, Kelly KJ, Glass L, Prezant DJ.

Chest

2012 Inflammatory biomarkers predict airflow obstruction after exposure to World Trade Center dust

Nolan A, Naveed B, Comfort AL, Ferrier N, Hall CB, Kwon S, Kasturiarachchi KJ, Cohen HW, Zeig-Owens R, Glaser MS, Webber MP, Aldrich TK, Rom WN, Kelly K, Prezant DJ, Weiden MD.

Chest

2013 Cardiovascular biomarkers predict susceptibility to lung injury in World Trade Center dust-exposed firefighters

Weiden MD, Naveed B, Kwon S, Cho SJ, Comfort AL, Prezant DJ, Rom WN, Nolan A.

Eur Respir J

2013 Longitudinal pulmonary function in newly hired, non-World Trade Center-exposed fire department City of New York firefighters: the first 5 years

Aldrich TK, Ye F, Hall CB, Webber MP, Cohen HW, Dinkels M, Cosenza K, Weiden MD, Nolan A, Christodoulou V, Kelly KJ, Prezant DJ.

Chest

2014 World Trade Center disaster exposure-related probable posttraumatic stress disorder among responders and civilians: a meta-analysis

Liu B, Tarigan LH, Bromet EJ, Kim H. PLoS One

2014 YKL-40 is a Protective Biomarker for Fatty Liver in World Trade Center Particulate Matter-Exposed Firefighters

Cho SJ, Echevarria GC, Lee YI, Kwon S, Park KY, Tsukiji J, Rom WN, Prezant DJ, Nolan A, Weiden MD.

J Mol Biomark Diagn

2014 Enlarged pulmonary artery is predicted by vascular injury biomarkers and is associated with WTC-Lung Injury in exposed fire fighters: a case-control study

Schenck EJ, Echevarria GC, Girvin FG, Kwon S, Comfort AL, Rom WN, Prezant DJ, Weiden MD, Nolan A.

BMJ Open

2014 Estimating the time interval between exposure to the World Trade Center disaster and incident diagnoses of obstructive airway disease

Glaser MS, Webber MP, Zeig-Owens R, Weakley J, Liu X, Ye F, Cohen HW, Aldrich TK, Kelly KJ, Nolan A, Weiden MD, Prezant DJ, Hall CB.

Am J Epidemiol

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2014 Lysophosphatidic acid and apolipoprotein A1 predict increased risk of developing World Trade Center-lung injury: a nested case-control study

Tsukiji J, Cho SJ, Echevarria GC, Kwon S, Joseph P, Schenck EJ, Naveed B, Prezant DJ, Rom WN, Schmidt AM, Weiden MD, Nolan A.

Biomarkers

2014 Obstructive sleep apnea and World Trade Center exposure

Glaser MS, Shah N, Webber MP, Zeig-Owens R, Jaber N, Appel DW, Hall CB, Weakley J, Cohen HW, Shulman L, Kelly K, Prezant D.

J Occup Environ Med

2015 The Duration of an Exposure Response Gradient between Incident Obstructive Airways Disease and Work at the World Trade Center Site: 2001-2011

Hall CB, Liu X, Zeig-Owens R, Webber MP, Aldrich TK, Weakley J, Schwartz T, Cohen HW, Glaser MS, Olivieri BL, Weiden MD, Nolan A, Kelly KJ, Prezant DJ.

PLoS Curr

2015 Biomarkers of World Trade Center Particulate Matter Exposure: Physiology of Distal Airway and Blood Biomarkers that Predict FEVâ‚• Decline

Weiden MD, Kwon S, Caraher E, Berger KI, Reibman J, Rom WN, Prezant DJ, Nolan A.

Semin Respir Crit Care Med

2016 The effect of World Trade Center exposure on the latency of chronic rhinosinusitis diagnoses in New York City firefighters: 2001-2011

Weakley J, Hall CB, Liu X, Zeig-Owens R, Webber MP, Schwartz T, Prezant D.

Occup Environ Med

2016 Post-9/11 cancer incidence in World Trade Center-exposed New York City firefighters as compared to a pooled cohort of firefighters from San Francisco, Chicago and Philadelphia (9/11/2001-2009)

Moir W, Zeig-Owens R, Daniels RD, Hall CB, Webber MP, Jaber N, Yiin JH, Schwartz T, Liu X, Vossbrinck M, Kelly K, Prezant DJ.

Am J Ind Med

2016 Post-September 11, 2001, Incidence of Systemic Autoimmune Diseases in World Trade Center-Exposed Firefighters and Emergency Medical Service Workers

Webber MP, Moir W, Crowson CS, Cohen HW, Zeig-Owens R, Hall CB, Berman J, Qayyum B, Jaber N, Matteson EL, Liu Y, Kelly K, Prezant DJ.

Mayo Clin Proc

2016 Longitudinal Lung Function Decrements in Firefighters Who Responded to the World Trade Center Disaster: Important Insights for the Preservation of Lung Function in Future Disasters

Mohr LC. Chest

2016 Bronchial Reactivity and Lung Function After World Trade Center Exposure

Aldrich TK, Weakley J, Dhar S, Hall CB, Crosse T, Banauch GI, Weiden MD, Izbicki G, Cohen HW, Gupta A, King C, Christodoulou V, Webber MP, Zeig-Owens R, Moir W, Nolan A, Kelly KJ, Prezant DJ.

Chest

2016 Health Conditions as Mediators of the Association Between World Trade Center Exposure and Health-Related Quality of Life in Firefighters and EMS Workers

Yip J, Zeig-Owens R, Hall CB, Webber MP, Olivieri B, Schwartz T, Kelly KJ, Prezant DJ.

J Occup Environ Med

2016 Lung Function Trajectories in World Trade Center-Exposed New York

Aldrich TK, Vossbrinck M, Zeig-Owens R, Hall CB, Schwartz TM, Moir W, Webber MP,

Chest

196 | P a g e

City Firefighters Over 13 Years: The Roles of Smoking and Smoking Cessation

Cohen HW, Nolan A, Weiden MD, Christodoulou V, Kelly KJ, Prezant DJ.

2016 Radiologic Features of World Trade Center-related Sarcoidosis in Exposed NYC Fire Department Rescue Workers

Girvin F, Zeig-Owens R, Gupta D, Schwartz T, Liu Y, Weiden MD, Prezant DJ, Naidich DP.

J Thorac Imaging

2017 The Effect of World Trade Center Exposure on the Timing of Diagnoses of Obstructive Airway Disease, Chronic Rhinosinusitis, and Gastroesophageal Reflux Disease

Liu X, Yip J, Zeig-Owens R, Weakley J, Webber MP, Schwartz TM, Prezant DJ, Weiden MD, Hall CB.

Front Public Health

2017 Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers

Webber MP, Yip J, Zeig-Owens R, Moir W, Ungprasert P, Crowson CS, Hall CB, Jaber N, Weiden MD, Matteson EL, Prezant DJ.

Respir Med

2017 Post-9/11/2001 lung function trajectories by sex and race in World Trade Center-exposed New York City emergency medical service workers

Vossbrinck M, Zeig-Owens R, Hall CB, Schwartz T, Moir W, Webber MP, Cohen HW, Nolan A, Weiden MD, Christodoulou V, Kelly KJ, Aldrich TK, Prezant DJ.

Occup Environ Med

2017 Airway Disease in Rescue/Recovery Workers: Recent Findings from the World Trade Center Collapse

Cleven KL, Webber MP, Zeig-Owens R, Hena KM, Prezant DJ.

Curr Allergy Asthma Rep

2018 Multiple Myeloma and Its Precursor Disease Among Firefighters Exposed to the World Trade Center Disaster

Landgren O, Zeig-Owens R, Giricz O, Goldfarb D, Murata K, Thoren K, Ramanathan L, Hultcrantz M, Dogan A, Nwankwo G, Steidl U, Pradhan K, Hall CB, Cohen HW, Jaber N, Schwartz T, Crowley L, Crane M, Irby S, Webber MP, Verma A, Prezant DJ.

JAMA Oncol

2018 Risk factors for post-9/11 chronic rhinosinusitis in Fire Department of the City of New York workers

Putman B, Zeig-Owens R, Singh A, Hall CB, Schwartz T, Webber MP, Cohen HW, Prezant DJ, Bachert C, Weiden MD.

Occup Environ Med

2018

Clinical Course of Sarcoidosis in World Trade Center-Exposed Firefighters

Hena KM, Yip J, Jaber N, Goldfarb D, Fullam K, Cleven K, Moir W, Zeig-Owens R, Webber MP, Spevack DM, Judson MA, Maier L, Krumerman A, Aizer A, Spivack SD, Berman J, Aldrich TK, Prezant DJ; FDNY Sarcoidosis Clinical Research Group*.

Chest

2019 Post-9/11 Peripheral Neuropathy Symptoms among World Trade Center-Exposed Firefighters and Emergency Medical Service Workers

Colbeth HL, Zeig-Owens R, Webber MP, Goldfarb DG, Schwartz TM, Hall CB, Prezant DJ.


2019 Hearing Loss Among World Trade Center Firefighters and Emergency Medical Service Workers

Flamme GA, Goldfarb DG, Zeig-Owens R, Hall CB, Vaeth BM, Schwartz T, Yip J, Vossbrinck M, Stein CR, Friedman L, Cone JE, Prezant DJ.

J Occup Environ Med

2019 Low serum IgA and airway injury in World Trade Center-exposed firefighters: a 17-year longitudinal study

Putman B, Lahousse L, Zeig-Owens R, Singh A, Hall CB, Liu Y, Schwartz T, Goldfarb D, Webber MP, Prezant DJ, Weiden MD.

Thorax

197 | P a g e

2020 World Trade Center exposure, post-traumatic stress disorder, and subjective cognitive concerns in a cohort of rescue/recovery workers

Singh A, Zeig-Owens R, Hall CB, Liu Y, Rabin L, Schwartz T, Webber MP, Appel D, Prezant DJ.

Acta Psychiatr Scand

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Appendix C. Coding Sheets

Table 55 Chemical Name & Variable Name

Chemical Names Chemical Variable Names

1,2-Dimethylnaphthalene DMN_12

1,3-Dinitropyrene DNPyr_13






1234678-heptachlorodibenzofuran (1234678-HpCDF)

HpCDF_1234678

1234678-heptachlorodibenzo-p-dioxin (1234678-HpCDD) and 12346789-octachlorodibenzo-p-dioxin (OCDD)

OCDD

1234789- heptachlorodibenzofuran (1234789-HpCDF)

HpCDF_1234789

123478-hexachlorodibenzofuran (123478-HxCDF) HxCDF_123478

123478-hexachlorodibenzo-p-dioxin (123478-HxCDD)

HxCDD_123478



HxCDD_123678



HxCDD_123789

12378-pentabromodibenzofuran (12378-PeBDF) PeBDF_12378

12378-pentachlorodibenzofuran (12378-PeCDF) PeCDF_12378

12378-pentachlorodibenzo-p-dioxin (12378-PeCDD)

PeCDD_12378

1-Methylfluoranthene MFRT

1-Methylfluorene MFR

1-Methylnaphthalene MN_1

1-Methylphenanthrene MP_1

1-Methylpyrene Mpyr

1-Nitropyrene NPyr

2,3 Dimethylphenanthrene DMPA

2,3,5-Trimethylnaphthalene TMN_235



22′33′44′566′-nonabromodiphenyl ether (PBDE-207) PBDE_207

22′33′44′66′-octabromodiphenyl ether (PBDE-197) PBDE_197

22′44′55′-hexabromodiphenl ether (PBDE-153) PBDE_153

22′44′5-pentabromodiphenyl ether (PBDE-99) PBDE_99

22′44′6-pentabromodiphenyl ether (PBDE-100) PBDE_100

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22′44′-tetrabromodiphenyl ether (PBDE-47) PBDE_47


23478-pentabromodibenzofuran (23478-PeBDF) PeBDF_23478

23478-pentachlorodibenzofuran (23478-PeCDF) PeCDF_23478

2378-petrabromodibenzo-p-dioxin (2378-TBDD) TBDD_2378

2378-tetrabromodibenzofuran (2378-TBDF) TBDF_2378

2378-tetrachlorodibenzodioxin (2378-TCDD) TCDD_2378

2378-tetrachlorodibenzofuran (2378-TCDF) TCDF

244′-tribromodiphenyl ether (PBDE-28) PBDE_28

2-Ethylnaphthalene EN_2

2-methylanthracene MATC

2-Methylchrysene MCHRY_2

2-Methylnaphthalene MN_2

2-Methylphenanthrene MP_2

2-Nitroanisole NA_2

2-Nitrofluorene NF_2

2-Phenylnaphthalene PN_2

3,7-Dinitrofluoranthene DNFR_37

3,9-Dinitrofluoranthene DNFR_39

3-Methylcholanthrene MC_3

3-Methylphenanthrene MPA

3-Nitrobenzanthrone NB_3

6-Methylchrysene MCHRY_6

6-Nitrochrysene NCHRY

7,12-Dimethyl-benz[a]anthracene DMBA

Acenaphthene ACE

Acenaphthylene ACY

Acetaldehyde ACT

Acrolein ACRO

Antimony Compounds ANTM

Arsenic As

Asbestos ASB

Benz[a]anthracene BaAnt

Benzene BZ

Benzo(a)pyrene BaP

Benzo(b)fluoranthene BbF

Benzo(c)fluorene BcFR

Benzo(ghi)perylene BghiP

Benzo(k)fluoranthene BkF

Benzo[a]fluorene BaFR

Benzo[b]fluorene BbFR

Benzo[e]pyrene BePyr

Benzo[j]fluoranthene BjF

Benzofuran BZF

benzophenone-3 (BP-3) BP-3

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Beryllium and beryllium compounds Be

Bis(ethylhexyl)phthalate Bis

Bisphenol-A (BPA) BPA

butyl paraben (BP) BP

Cadmium Cd

Carbon black Carbon

Chromium (VI) CRM

Coal Tar Pitch Coal

Cobalt and cobalt compounds CBlt

Cyclopenta[cd]pyrene CcdPyr

decabromodiphenyl ether (PBDE-209) PBDE_209

Dibenz[a,h]anthracene DiBAnt

Dibenzo[a,e]pyrene DBaeP

Dibenzo[a,l]pyrene DBaiP

Dibenzo[e,l]pyrene DBeiP

Dichloromethane (methylene chloride) DCM

Diesel Exhaust Diesel

Ethyl benzene EBZ

ethyl paraben (EP) EP

ethylsyringol ES

Fluoranthene FL

Formaldehyde Formald

Furan Furan

Furfural Ffural

hexachlorobenzene (HCB) HCB

Hydrochloric Acid HCl

hydroxyacenaphthene (OH-ACE) OH_ACE

hydroxybenzo[a]anthracene (OH-BaA) OH_BaA

hydroxybenzo[a]pyrene (OH–BaP) OH_BaP

hydroxychrysene OH_CHR

hydroxyfluoranthene (OH-FLU) OH_FLU

hydroxyfluorene (OH-FLO) OH_FLO

Hydroxynaphthalene (OH-NAP) OH_NAP

hydroxyphenanthrene (OH-PHE) OH_PHE

hydroxypyrene (OH-PYR) OH_PYR

Indeno(1,2,3-cd)pyrene IP_123

Indeno[1,2,3-cd]pyrene IdPyr

Isoprene ISP

lead (Pb) Pb

Lead compounds, inorganic Lead_Inorg

Lead compounds, organic Lead_Org

manganese (Mn) Mn

Mercury Hg

metabolites t-t- muconic acid (a metabolite of benzene)

VOC

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methyl paraben (MP) MP

methylsyringol MS

Nickel (metallic/compounds) Nickel

N-Nitrodimethylamine NDMA

n-propyl paraben (PP) PP

octabromodibenzofuran (OBDF) OBDF

octachlorodibenzofuran (OCDF) OCDF

p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) DDE

PCB-16 through to −209 PCB

perfluorobutanesulfonic acid (PFBS) PFBS

perfluorodecane sulfonate (PFDS) PFDS

perfluorodecanoic acid (PFDA) PFDA

Perfluorododecanoic acid (PFDoA) PFDoA

perfluoroheptanesulfonate (PFHpS) PFHpS

perfluoroheptonic acid (PFHpA) PFHpA

Perfluorohexane sulfonate (PFHxS) PFHxS

perfluorohexanoic acid (PFHxA) PFHxA

perfluorononanesulfonic acid (PENS) PENS

perfluorooctane sulfonate (PFOS) PFOS

perfluorooctanioic acid (PFOA) PFOA

perfluoroonanioc acid (PFNA) PFNA

perfluoropentanesulfonic acid (PFPeS) PFPeS

perfluorotetradecanoic acid (PFTeA) PFTeA

perfluorotridecanoic acid (PFTrDA) PFTrDA

perfluoroundecanoic acid (PFUnDA) PFUnDA

Perylene Per

Phenanthrene Phe

Polychlorinated biphenyls PCB

Polychlorophenols PCP

Propylene oxide PPO

propylsyringol PS

Radioactivity (γ activity) Gamma

Radionuclides (α-particle-emitting) Alpha

Radionuclides (β-particle-emitting) Beta

Retene Retene

Silica (amorphous) SiO_amrph

Silica (crystalline) SiO_crys

Styrene Styrene

Tetrachloroethylene (perchloroethylene) PERC

Toluene Toluene

Toluene diisocyanates Toluene_dii

Trichloroethylene TCE

Trichloromethane (chloroform) CHLF

triclosan TRIC

Triphenylene TRP

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unknown sulfonic acids (Cl-PFOS, ketone-PFOS, ether-PFHxS and Cl-PFHxS)

UNK_PFOS

Vinyl Chloride VCM

β-Hexachlorocyclohexane (β-BHC) BHC

Table 56 Codebook

Variables Description Values

ID Study ID

Pub_Yr Publication Year

Auth First Author Name (Last, First Initial)

Title Article Title

Journal Journal name (Abbr.)

Vol Volume

Issue Issue

Pages Page numbers

Loc_St Location of Data Collection: State/Province

Loc_Cnty Location of Data Collection: Country

USA Was data collected in the US: 0 = No 1 = Yes

Data_Yr Year of Data Collection 0 = No 1 = Yes

Fire_Wildland Type of fire: Wildland 0 = No 1 = Yes

Fire_Burn Type of fire: Burn 0 = No 1 = Yes

Fire_Vehicle Type of fire: Vehicle 0 = No 1 = Yes

Fire_Hazmat Type of fire: Hazmat 0 = No 1 = Yes

Fire_Res Type of fire: Residential fire 0 = No 1 = Yes

Fire_SimRes Type of fire: Simulated Residential fire 0 = No 1 = Yes

Fire_Other Type of fire: Other 0 = No 1 = Yes

Fire_OthDescrp Describe other fire

Train_fire Was Fire a Training Fire? 0 = No 1 = Yes

Bio_monitor Biomonitoring 0 = No 1 = Yes

Envi_monitor Environmental Monitoring 0 = No 1 = Yes

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Fireground Exposure of Firefighters: A Literature Review

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