One day in 2014, Dr. Jeffery Burgess was contacted by a Tucson firefighter about something that would set him on a research course for the next five years.
The firefighter, John Gulotta, works for the Tucson Fire Department and he had a friend whom had been diagnosed with leukemia.
Tom Quesnel was a fire investigator, one of the people who, after everyone else has packed up and left the scene, goes back in and tries to determine the exact cause and origin of the blaze. One of the dogs he trained for fire investigations was even sent to the 1995 Oklahoma City bombings to assist in the investigation.
Quesnel had been a fire investigator for 20 years, and had been exposed to a litany of dangerous chemicals known to be carcinogens. Gulotta sought Burgess’s expert opinion on the matter because there was a bit of a snag: Quesnel’s workers compensation claim to treat his cancer had been denied.
Much like the recent case in Glendale, Quesnel was fighting to have his cancer treatment covered, arguing that his illness was likely a result of his work as a fire investigator.
Quesnel’s claim was approved, but not until after he died due to complications from his cancer, which would later be added to a list of cancers that are presumed to be caused by the dangers of the job.
Even Quesnel’s two dogs who worked with him on the job, sniffing out accelerants used in arson, later died of cancer.
Burgess worked to provide information to physicians working on Quesnel’s case to prove that the chemicals he was exposed to could cause the type of cancer he was diagnosed with.
“He was a genuine country boy,” Gulotta told Arizona Mirror of Quesnel.
One day, Quesnel was cleaning out his office, his already small frame considerably more frail from the treatments. Still, he tried to keep his upbeat attitude, Gulotta said. His office sat across from Gulotta’s and he came over with two coffee cups in hand.
He sat one coffee cup in-front of Gulotta and asked three favors of him.
One, that he work to make sure that the “presumptive” part of presumptive cancer claims become more than just “words on paper that makes politicians feel good.” Two, that he work to help other firefighters with cancer better navigate worker compensation claims. Three, that he make sure another family doesn’t go through what his had been going through.
So Burgess and Gulotta began formulating a plan on how to start researching the issue to see if they could show a definitive connection that could help firefighters in a multitude of ways. They applied for a FEMA grant and got funding, beginning a research project that would take up their next few years and would lead to new discoveries that could eventually help reduce cancer risks in firefighters nationally.
Where is the exposure occurring?
The first main question Burgess wanted to answer in his research was where the main exposure that was putting firefighters at risk was occuring.
Was it happening during the fires? After the fires? In the trucks? There wasn’t enough data or information to formulate a good theory.
It was already known that firefighters are exposed to an array of toxic chemicals, but it was unclear which of those types of exposure or how those exposures could lead to increased risks of cancer. Some studies had already shown increased risks, but Burgess and Gulotta wanted to look deeper.
So Burgess set out to study firefighters before and after fires by looking at some particular data points, chief among them their urine.
“It’s not exactly the glamorous firefighting stuff,” Gulotta joked about collecting over 2,500 urine samples over a three-year period.
Burgess would have supervisors collect urine samples from firefighters prior to them being dispatched to get a baseline sample and then again after they finished up at a fire.
Many of the chemicals that are linked to possible increased risks for certain cancers are absorbed through the skin and later excreted out in the urine. Burgess wanted to see if firefighters are really exposing themselves more to chemicals that are known to cause rare cancers such as leukemia and multiple myeloma due to the hazards of their job.
The field work of collecting the urine was completed in January, and now Burgess is focused on analyzing the mountains of data that comes with it.
So far, Burgess and his colleagues have put out two research papers on the issue from this partnership.
In the most recent, “DNA methylation among firefighters,” which was published earlier this year, Burgess and his team drew blood from 86 non-smoking firefighters to see if their DNA had certain changes that are indicative of having an elevated risk of cancer.
Specifically, they found that the newer recruits had a much lower risk than those who had already been working with the department – supporting their theory that the job inherently puts firefighters at a higher risk of certain cancers.
The blood test performed was even able to give a ballpark estimate of how long a person had been working as a firefighter by how at risk they are for cancer.
The study did have its limitations, however, as it was made up of mostly white males from the Tucson Fire Department.
“Future longitudinal studies of larger number of firefighters across geographic regions are needed,” Burgess and his team wrote.
A similar study Burgess and his team published last year on microRNA that compared new recruits to veteran firefighters also had similar results.
With evidence supporting the hypothesis that firefighters are exposed to substances that increase their risk of cancer, Burgess began trying to determine what would be the best ways to limit exposure to the chemicals that were causing harm.
Firefighters already have the gear they wear when going into most hazardous situations and protocols to protect them from exposure to chemicals, but Burgess began looking to see if it was enough.
Burgess and his team found that just about everyone on a fire has some level of exposure to chemicals that can increase their likelihood of developing cancer.
Based on that finding alone, the Tucson Fire Department is now having its engineers wear protective respiratory gear whenever there is smoke, no matter what.
Typically, engineers stay with the fire engine at the scene of a fire, so their levels of exposure were previously thought to be minimal. Burgess’s research has found otherwise.
The results were promising: This simple change cut down on the levels of certain toxins found in urine samples of engineers by a third.
Another change Tucson has implemented in its effort to cut down on exposure is also simple: washing down.
As soon as they come off a fire, firefighters use water and some dish soap to clean the soot and everything else off all their gear and themselves. This helps clear the chemicals, break them down and remove them from the equation quickly. It also reduces the risk of getting chemicals directly onto the firefighters themselves from their gear if they wash their gear properly.
There are three main ways that chemicals that can cause cancer are transported into the body. By breathing them in, ingesting them or through the skin. Cleaning gear protects firefighters from getting it on their skin, according to Burgess.
Small preventative measures could help reduce exposure and potentially down the line prevent firefighters from developing deadly and costly cancers, he said.
Both Gulotta and Burgess have been working with other departments and organizations to educate them on these new best practices.
“We’ve got a long way to go, but the work we’ve done here in Tucson has paved the way, I believe,” Gulotta said.
Burgess has also been advocating for departments to have their crews wear their self contained breathing apparatuses at all times, even when conducting support after a fire. Both this and washing down after a fire shouldn’t cost any department extra money, Burgess stressed.
Burgess is hoping to have his complete findings on how the intervention methods worked by the end of the year, after which he will turn his attention to spreading the word on those methods to other departments.
He’s also starting a new study soon looking at airport firefighters, who are often exposed to a different host of chemicals as compared to their suburban and urban counterparts.
“We need to help them make their workplace safer,” Burgess said “They need all the support and help they can get since they help and support us.”
Gulotta and Burgess are both now looking at the next big picture. There are still a lot of unknowns in the field of chemical exposures and firefighters nationally.
One area that the two are already looking into is how chemicals female firefighters are exposed to could be passed through their breast milk and how chemicals firefighters are exposed to could become genetic issues that are passed on to their children.
For Gulotta, the issue is still personal. Since he started working with Burgess, Tucson Fire Department has had two engineers die from brain cancer and three firefighters diagnosed with other rare forms of cancer.
“We just took a peek into the box and we are starting to move into the direction of knowledge, and with knowledge, we can create preventative measures,” Gulotta said.