Lately I have been thinking about a story by Richard Kalish that I first heard early in my college years at Iowa State. In the tale, a man journeyed to Nepal to consult a famous guru. This man was pursuing the study of medicine and the issues of death and dying. He felt his questions could be answered only by the highest of spiritual leaders of the one religion which seems to be held in the highest regard on the issues of death and dying.
After an arduous and exhausting climb for an audience with the guru — and to the point of exhaustion from the altitude — he was given an opportunity to ask a question. "Your holiness, what is it the dying person feels when no one will speak with him nor permit him to speak about his dying and what it is like to die," he asked.
The guru answered after several minutes: "It is the horse on the dining room table." Shortly after that comment, the man fell asleep. When he awoke, he found that the guru was gone. The man left with the idea he would understand the comment at some point.
Several years later, the man and his wife attended a dinner party. The guests assembled in a part of the house away from the dining room. There was lively conversation with drinks and snacks in the den. When dinner was ready, the guests moved single file into the dining room for buffet service. A silence followed immediately. When the man and his wife entered, they were shocked by the horse that had been placed in the center of the table. The man looked back to see his hosts had a similar look of shock and amazement. The horse dominated the atmosphere.
People sat next to their place cards and barely conversed. No one spoke of the horse. Someone would start a conversation about taxes or politics, but it couldn't be sustained in the overwhelming presence of the horse. No one asked from where this horse had come, why was it there or who brought it. But as uncomfortable as the horse made everyone, no one removed it. It was as if the horse had complete control over everyone and everything. It was a miserable dining experience. After dinner, everyone expressed their gratitude and left immediately.
The man promptly returned to Nepal for another audience with the guru. This time, they engaged in a lengthy conversation.
I share this story because I see parallels in the fire service. I share it because I am outraged by others' ignorance of the fire service's horse.
Like the horse on the dining room table, the fire service often doesn't discuss cancer — though the occurrences of it stare us in the face daily. It seems like you hear of a new case every month, yet we don't acknowledge its presence. It is time to change that.
There seems to be an alarming increase in the cancer rates for firefighters. In February, I saw my previous department struggle with the diagnosis and soon-after death of one of the most humble and dedicated firefighters I have ever known, from an aggressive melanoma that more than one cancer study has correlated with firefighting. The fire service tracks and records line-of-duty deaths, but cancer deaths aren't examined in the detail we need.
Toxic smoke and combustion products, coupled with the stresses of the job and toll the alarm response takes on the body, give cancer a foothold. Some studies show certain cancer rates to be 150% to 300% higher in firefighters than in the general population. Some states have presumptive legislation that addresses cancer-related firefighter illness or death. But these benefits appear to be under attack. The National League of Cities has misinterpreted a recent study by TriData on firefighters and cancer. It is important to read the entire study and not just the press release from the NLC, which distorts the information.
Cancer has been the horse on the station table for years, and the fire service has yet to engage in a serious effort to acknowledge it, combat it and take the risk seriously.
The real and immediate need is threefold. First, we need to begin gathering statistics on cancer occurrences in the fire service. Many fire departments experience a death and it goes unreported as an LODD. Well-documented exposure reports often don't connect a cancer case to a repeated or single event where a firefighter was exposed to a known carcinogen. This prevents science from proving that firefighters are at risk like no other group of public-safety professionals. These numbers make it paramount for the NFPA to adjust fire department physicals and ensure the screening tools are looking for the most prevalent killers. We must back up the presumptive legislation with real numbers.
Second, there needs to be more funding from the National Institutes of Health to look at exposures to products of combustion, effects of stress and lifestyles of firefighters. Most of the cancer studies in the last 10 years have been funded by drug companies that were looking for the effects of a specific treatment. In the 1980s, many of the studies used more epidemiological approaches. In 1988, Michael Bates at the University of California-Berkeley produced a study of 3,659 firefighters taken from a cancer registry database. This should be mandatory reading for anyone engaged in this argument.
Lastly, fire department EMS — or the health and safety divisions — need to take an active role in screening members for cancers. Comprehensive screening and portable ultrasound machines make diagnostics simple enough for even the most basic of clinics. As with all cancers, early diagnosis is crucial to a positive outcome. Fire departments need physicians who are inquisitive and not acting on behalf of workers' compensation boards by minimizing screening or explaining away disease to other causes with weaker scientific links.
There are a lot of good research beginnings. Some research advocates the use of the anti-oxidant therapy. Other research is looking at firefighter protective clothing and the National Institute for Occupational Safety and Health is looking at many of the suspected carcinogens. But there's no one organization to coordinate or promote comprehensive cancer programs and research for firefighters.
The Firefighter Cancer Support Network provides assistance to all fire service members and their families in the event of cancer diagnosis. The FCSN is in collaboration with the American Cancer Society and the Lance Armstrong Foundation, but limited funds to support research. A similar group, the Firefighter Cancer Foundation, provides international outreach, support and resource-assistance programs for firefighters and family members who are stricken by cancer. More a service organization, it lacks resources to lobby and conduct research. Both of these organizations could combine to build a national presence and advance a one-stop comprehensive service to America's fire service.
The International Association of Fire Fighters established the Redmond Foundation as a nonprofit organization to conduct research and education regarding the occupational hazards and diseases associated with firefighting. Cancer long has been on the radar screen for the foundation and its biannual symposium. More efforts to put money into this foundation to spearhead more efforts toward cancer research are needed. The millions the fire service has raised for muscular dystrophy should have an equal effort applied to the Redmond Foundation fund-raising.
A final key piece of wisdom came from that plateau in Nepal. "If you speak about the horse, then you will find that others can also speak about the horse if you are gentle and kind with your words. You can not make magic to have the horse disappear, but you can speak of the horse and thereby render it less powerful." We need to move forward with comprehensive cancer surveillance and preventative measures to lesson the risk.
Bruce Evans is the EMS chief for the North Las Vegas (Nev.) Fire Department. He also is the fire science program coordinator at the Community College of Southern Nevada and an adjunct faculty member for the National Fire Academy's EMS and injury prevention courses. He has an associate's degree in fire management and a master's degree in public administration.
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On the Web
Firefighter Cancer Support Network
This site provides support and mentorship for firefighters with cancer.
This organization supports firefighters with cancer.
This site has the recent controversial publication on firefighter cancer rates and presumptive cancer legislation.
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