A firefighter’s smoke-stained gear and burn-marked helmet are almost badges of honor, says Olympia Fire Department Capt. Jim Brown, but they’re examples of subtle dangers contributing to higher rates of cancer among people in the industry.
At age 49, Brown flashes another image these days. “Hold Fast” is tattooed with the letters on his fingers just below the knuckles. A nautical term for persevering, etched a few years ago in tribute to his Coast Guard father, the quote has added meaning today as Brown fights stage 4 lung cancer.
In fire service more than 20 years, he also now teaches emergency workers how to avoid what’s happened to him. Diagnosed May 2015, he calls himself a “scared straight” example of someone who kept fit and never smoked cigarettes but was exposed to workplace carcinogens thought to have led to his disease.
The Emergency Medical Services captain spoke late last month in Spokane at a seminar for the Washington State Council of Fire Fighters.
“Visualize yourself in my position, because it could be you,” said Brown, a day before heading to his 31st chemotherapy treatment. His condition has stabilized, and while he works and stays active, doctors say he’ll never go into remission.
“I want to give you the tools so you don’t end up with cancer. I have cancer.”
Brown advocates for new fire department best practices under Healthy In, Healthy Out, a Washington state manual to reduce firefighters’ risks of exposure to carcinogens. It involves limiting firefighters’ exposure to smoke and toxins even after a fire.
At Brown’s department, every firefighter has two sets of gear so at least one stays clean. Fire stations use industrial washing machines for cleaning gear, he said. Other steps include having firefighters cleanse off at fire sites and sealing smoke-exposed turnouts in a bag kept separate from the truck’s passenger cab.
The fire departments in Spokane and Spokane Valley have adopted Healthy In, Healthy Out policies as well. Additionally, fire departments for District 9 north of Spokane and Coeur d’Alene have set up similar preventive steps the past two years to reduce firefighters’ carcinogen exposure.
For example, Spokane Valley’s department has added procedures after fires for immediate cleanup on site, including skin wipes to wash face, neck and hands; six engines were retrofitted to supply warm water for washing. An industrial washing machine is now at Station 10, with more to be added as funds become available.
The International Association of Fire Fighters cites studies finding an association between firefighting and significantly increased risk for certain cancers. A study conducted by the National Institute for Occupational Safety and Health (NIOSH) in fall 2013 found that firefighters have a 14 percent increased risk of dying from cancer as compared with the general population, the IAFF says.
The study evaluated cancer rates and deaths from cancer among nearly 30,000 firefighters. Despite protective gear and breathing apparatus, the emergency responders can be exposed to cancer-causing contaminants absorbed through the skin or from particulates that linger on gear and equipment.
The IAFF has introduced new cancer awareness and prevention educational resources, developed with the Firefighter Cancer Support Network, designed to help decrease individual risk factors.
Smoke particles have a diameter less than a fraction of a micron, or about 100,000th of an inch, according to industry information. Firefighters also go into burning structures where toxins burn off of woods, plastics, and textiles.
“Anytime you go into a fire zone, even if you go in after a fire, if your gear stinks, then there are carcinogens,” Brown said. “Those carcinogens live in that gear. If you can smell that stuff, you’re being exposed. We’re changing the way we prepare, clean and decontaminate ourselves.”
“We seal stuff up in a bag and it goes into a separate compartment, so it’s not in the cab. We just implemented Healthy In, Healthy Out in January for our department’s program. It was launched 2016 in some departments.”
He oversees it in Olympia, and Brown said he’s the obvious choice. “Because I’m cancer boy. When you have a guy who has cancer tell you how not to get cancer, that’s a pretty powerful tool.”
Fitness has long been part of Brown’s life. Brown once cycled about 80 miles to a location near Mount Rainier, which he climbed on the same trip. He and his wife have three daughters, and the family kept active. Before his diagnosis, Brown had prepped for another Rainier climb, rode his bicycle in races, and got a chance to train for cycling in France.
“That was the winter of 2015, and I’m living the life,” he told the group. “I was pretty fit at the time. In February 2015, I started to develop stridor; that’s the noise an airway that becomes constricted makes. Then coughing came on.”
He dismissed the problems as allergies, so he kept cycling, until he felt worse and couldn’t stop coughing. He then saw a specialist who found an abnormality in the lung requiring a biopsy. While traveling to an EMS meeting in Coeur d’Alene, he got the doctor’s call.
“We were going down the grade into Vantage,” he said. “I could tell by his tone of voice that something was up, that it’s not what we thought it was.”
Brown paused before the crowd, clearly emotional when talking about how he had to tell his family. “I’ve got my best friend with me. I’m saying, ‘How am I going to do this? I’m not going to tell my wife over the phone.’ ”
Covertly arriving back home, he asked his wife with a call to check on something in their motorhome. “She goes outside, and I’m standing in the driveway; that’s when I told her.”
“I go from who I was, to you’ve got cancer and not just cancer, stage 4 lung cancer. The other name for that is terminal cancer. It spread to my lymph nodes and my bones, so it was pretty advanced. Next day, I told my employer. Friday, I told my kids. It’s the hardest thing I’ve ever done.”
With community and fire department colleagues’ support, the family has made trips to Disneyland and Mexico. Brown keeps working a desk job as a chief.
He sought treatment at Seattle Cancer Care Alliance and enrolled in a clinical trial. The chemotherapy started to work. As of now, Brown doesn’t have active cancer in his lungs. Brain MRIs are clear. During his treatment, doctors found a pulmonary embolism, so he started on blood thinners.
“I’m as close to being in remission as you can be without the doctor saying you’re in remission. It’s stabilized and minimized.”
Growing up mostly in Yakima, Brown started rescue work with the Coast Guard and later joined Olympia Fire Department in 1994 as a paramedic.
Statistics of higher rates of different cancers among firefighters aren’t acceptable, Brown said. Plus, it’s considered under-reported in the population.
“We can change that,” he said. “I’m a never-smoker; a large percentage of people with lung cancer are nonsmokers. If we can do things to help us reduce our risk in fire service, that’s what we should do.”
Brown said lung cancer isn’t named under state legislation as a presumed occupational disease regarding firefighters.
“We had to prove the cancer was potentially caused by my job,” he said. “My claim got approved in record time,” with support from the fire chief, city officials and others. The ruling meant provided benefits to his family, and coverage of health care costs related to cancer. He admitted to the group he has occasional bouts of depression, but despite a low survival rate for his type of cancer, he stays mostly upbeat.
“I’m coming up on my two-year anniversary,” he said. “I know people with what I have who are eight-year and 10-year survivors.”
Around chemo treatments, he strives for quality of life by working, riding his bike, and spending time with family. Brown also sees his mission as an advocate for cancer patients and raising awareness of cancer risks for firefighters.
He writes in a blog entry about his cancer challenges and life pursuits. He’s also written about the “Hold Fast” tattoo on his hands, and “it took on a life of its own. My friends made stickers. There are thousands of stickers out there in crazy places.”
Looking back on career exposures to carcinogens, Brown said he followed procedures for use of gear and equipment. “I kept a pretty good discipline,” he said. “I wore my air mask.”
“One of the weaknesses in our gear is around your neck,” Brown added. For every 5 degrees heat goes up, “you have 400 percent greater absorption rate. One of the things we wear is a hood, and when you go in and out of fires, we’re changing hoods. There is some new technology coming out.”
But common sense prevails. “Clean your gear. It takes more effort, but whatever takes more effort is the right thing to do.”