The science underpinning this legislation is pivotal to its
justification. The committee received as evidence a large amount of the research
that has been conducted into the link between firefighting and cancer. These
studies were used to inform this report and are all publicly available.
Given the quantity and quality of evidence presented, the committee is
confident that a link between firefighting and an increased incidence of
certain cancers has been demonstrated beyond doubt.
The health consequences of firefighting have attracted substantial
academic research due to the occupational risks firefighters are exposed to. Studies
have progressively become more sophisticated. The committee was informed that policymakers
are now able to access several large-scale studies which conclusively show that
a link exists between firefighting and cancer:
It has been stated that firefighting is the most studied
occupation in the world when it comes to cancer. There are literally dozens of
major studies from around the world spanning over twenty years and they have
made a definitive connection between firefighting and elevated cancer risk.
One of these studies, commissioned by the Canadian province of Manitoba
in 2002, looked at evidence gathered from 1994 to 2002. Led by Tee L. Guidotti,
the study analysed research conducted worldwide looking at firefighters and five
specific types of cancer: brain, bladder, kidney, non-Hodgkin's lymphoma and
leukaemia. Processing enormous volumes of information, the researchers
concluded that a firm link exists between firefighting and these primary-site
cancers. In his report to the Workers Compensation Board of Manitoba, Guidotti
The evidence available since 1994 suggests it is reasonable
given the available scientific evidence to adopt a policy of presumption for brain
cancer, bladder cancer, kidney cancer, non-Hodgkin's lymphoma (lymphatic
cancer) and leukaemia (hematopoietic cancer) for claims associated with
occupation as a firefighter.
The conclusions were used to inform Manitoba's presumptive legislation,
the first of its kind in the world, and subsequent presumptive legislation in
Other studies have confirmed a link between more than just the
abovementioned cancers and firefighting. Bates et al conducted a
retrospective cohort study of mortality and cancer in professional New Zealand
firefighters in 2000, following a cluster of testicular cancers detected in
Wellington firefighters in the 1980s. They looked at the incidence of
testicular cancer in a cohort of firefighters and compared it to the incidence
among the general population, using data obtained from the New Zealand Health
Information Service (NZHIS). The committee was told that the results of the
...put the scientific world on its heels. They found that the
level of testicular cancer for New Zealand firefighters—I believe they looked
at 4800 New Zealand firefighters within about three decades—was upwards of five
times that of the general population.
Mr Alex Forrest, President of United Fire Fighters of Winnipeg and
Canadian Trustee of the International Association of Fire Fighters, told the
When this study came out I read it and said: ' Five times the
level—it just cannot be true.' Almost immediately different epidemiologists
around the world took on the challenge of discrediting this study out of New
Zealand. A gentleman by the name of Jockel out of Germany looked at all
firefighters in Germany. What he found surprised him. His study almost exactly
replicated the results—the rate of testicular cancer in New Zealand was the
same as the rate in Germany. That just shows you the global aspect of this.
Another large meta-study confirmed these results in 2006. Researchers
led by Grace LeMasters '...looked at 110 000 firefighters and replicated the
rate of testicular cancer....You have three studies—one from New Zealand, one
from Germany and one from the United States—all showing the same rate of
The LeMasters study was commissioned by the Department of Environmental
Health at the University of Cincinnati college of Medicine and is the largest
study of its kind finalised to date. It looked at 32 other studies which addressed
the cancer risk to firefighters who are routinely exposed to harmful substances
such as lead, cadmium, uranium, chemical substances, harmful minerals and
'various gases that may have acute, toxic effects.'
The LeMasters study found '...an elevated metarelative risk' of certain cancers
Studies conducted in the years since Manitoba first introduced
presumptive legislation in 2002 have led that province to expand the number of
cancers its legislation covers from five to 14.
The committee heard that most overseas jurisdictions with similar
legislation in place have moved substantially beyond the five cancers covered
by Manitoba's initial legislation in 2002 and those listed by the proposed
Bill. Today, with the benefit of a large volume of scientific research, every
province in Canada is moving towards covering 14 cancers.
This increase in the number of cancers covered has been driven by
growing scientific evidence over the past decade, with lung cancer being a
strong example of how legislation has progressed:
...[T]here was a major study done out of British Columbia by
Tee Guidotti which looked at lung cancer. Once you take out the factor of
smoking, firefighters had a risk of lung cancer three or four times as high as
the general population. So, within a few months of that study, we saw the
provinces of first Manitoba and then Alberta, British Columbia and Saskatchewan
add lung cancer in nonsmokers. Again, that shows the specific nature and narrow
scope of the legislation, but it also shows that science really drives this
more than anything.
A submission from the ACT Chief Minister and Cabinet Directorate argued
that a lack of scientific consensus exists on this issue among researchers and
clinicians, posing challenges to this Bill.
This view does not, however, appear to be supported by evidence received
by the committee, nor was it expressed by representatives of the ACT Government
subsequently. Mr Andrew Kefford, Deputy Director-General of the ACT Chief
Minister and Cabinet Directorate, confirmed that a link between firefighting
and cancer is recognised, explaining that he was not in a position to ascertain
the strength of the scientific link:
I do not think anyone is contesting that there is a link in
the exposure of firefighters to smoke for at least the increased risk of
contracting cancer later.
But whether that is absolute or somewhere in between is not
something in which I am in a position to comment. That is not my area of
In the absence of clear evidence before the committee refuting the
causal link between cancer and firefighting as defined by this Bill, the
committee is satisfied that the science underpinning this legislation is sound.
The committee is confident in the quality of the studies it has seen and
considers them to be compelling evidence in support of this Bill.
The committee emphasises that, as outlined in Chapter 1 of this report,
claims under the proposed legislation would be rebuttable. This reflects the
fact that science tells us that if a firefighter with a certain number of years
of service develops cancer, that cancer is most likely to be caused by
occupational exposure to carcinogens. Not definitely caused by
occupational exposure, but most likely. In that light, any potential lack of absolute
scientific consensus—which is incidentally absent in most fields of study—becomes
Adjudication under workers' compensation requires an
examination of the weight of evidence, not scientific certainty.
The committee also notes that the body of scientific evidence has
expanded since presumptive legislation was first introduced to cover five
cancers in Canada in 2002. Researchers have since demonstrated that
firefighters are at risk of a greater range of occupational cancers.
The committee is concerned that, even if passed, the proposed
legislation would only serve to bring Australian commonwealth law into line
with outdated jurisprudence. Considering that similar legislation has been in
place overseas for nearly a decade, and has in fact been strengthened to cover
more cancers as a result of growing scientific evidence, the committee would
prefer to see Australia enact legislation in step with the most advanced
jurisprudence available. The committee sees no reason to ignore scientific
evidence demonstrating a link between firefighting as an occupation and a
greater number of cancers than the seven listed by this Bill.
2.19 The committee recommends that the types of cancer listed by the proposed
Bill be expanded to include multiple myeloma, primary site lung cancer in
non-smokers, primary site prostate, ureter, colorectal and oesophageal cancers.
The healthy worker effect
Studies looking at firefighters and occupational disease also highlight
the impact of what is known as the 'healthy worker effect'. The phenomenon is
found across scientific literature and describes the protective effect of
above-average health status on morbidity and mortality levels among groups who
are otherwise at elevated risk of illness.
In the case of firefighters, the impact of the healthy worker effect
means that their health and fitness levels, which are markedly higher on
average than those of the general population, may protect them from
diseases—including cancer—to a certain extent. In turn this suggests that were
firefighters' health and fitness levels the same as those of the rest of the
community, given their occupational exposure to carcinogens, they would suffer
from cancers at a far greater rate than is currently the case.
It also means that the relatively high rates of certain types of cancers
among firefighters are still lower than the rates we would see among the
general population were the latter regularly subjected to similar carcinogenic
The healthy worker effect therefore may mask the true level of risk
firefighters are exposed to:
One would expect the morbidity and mortality rates to be
lower among firefighters than in the general population containing people who
are ill, infirm and generally not suited for fire service.
Because of this, a study may show no difference in morbidity
or mortality rates between firefighter and the general population when, in
reality, the firefighters may be sustaining greater illness and death than
would be expected in a similar healthy group. Additionally, only healthy
firefighters stay on the job. Those who become ill may leave the fire service
without documented disability before retirement. Others may leave seemingly
healthy, only to suffer the long-term effects long after their association with
the fire service has ended.
The effect has been observed where specific cancers, such as, for
example, colon cancer, are concerned. Evidence exists suggesting that physical
fitness and activity should protect individuals from certain types of cancer.
This does not appear to be the case for firefighters:
Despite the reports of a consistent inverse relationship
found in other studies between physical activity and risk of colon cancer...we
observed an increased risk of colon cancer among Philadelphia firefighters,
suggesting factors exist that negate the protection that might be expected from
the increased physical activity.
Mr Forrest referred in his evidence to studies which concluded that:
...if firefighters never fought a fire, the mortality and morbidity
rates for their particular health group would probably be anywhere from 60 to
70 per cent of that for the general population.
Mr Forrest concluded that studies looking at cancer risk among
firefighters were in all likelihood conservative in their conclusions due to
the healthy worker effect.
Exposure and protection
As outlined, studies and meta-studies conducted around the world,
including in Australia in the 1980s, demonstrate that certain types of cancer
are caused by the release of carcinogens from combusting materials in structure
fires. These known carcinogens can include benzene, styrene, chloroform and
formaldehyde, and are absorbed by firefighters through the skin or by way of
Submissions to this inquiry discussed the protection available to
firefighters through the world-class safety gear and clothing Australian
The committee heard that this protective gear, although consistent with all
national and international safety regulations, cannot and does not form an
impenetrable barrier between firefighters and the toxins they work amidst.
Mr Brian Whittaker, Commander of the Hazardous Materials (HAZMAT)
Scientific Unit of the Metropolitan Fire Brigade, Melbourne, provided the
committee with extensive evidence based on his expertise in HAZMAT response and
public safety. Mr Whittaker concluded the following concerning the risk to
Their workplace is an uncontrolled environment where safety
controls cannot eliminate all hazardous products encountered. Risk exposure to
various toxic gases, vapours and particulate matter found in fire smoke does
exist. These products can be carcinogenic and cause irritation, incapacitation,
systemic toxicity and asphyxiation. The effects from exposure to the above
products can be both acute and chronic.
Many studies have concluded that the combustion or pyrolysis
(heating) of general household materials can generate many carcinogenic
products. The prediction of combustion products is a complex area and there is potential
for generation of a huge range of products depending on the nature of the fire
and the conditions of burning.
Most operational activities undertaken by urban firefighters are
structural and non-structural fire incidents. Car fires, although technically
considered non-structural, produce toxic chemicals rivalling those found in
structure fires. This, the committee heard, is due to the prevalence of plastic
components found in cars.
Unsurprisingly, even ordinary houses and household products release
toxic chemicals when they burn.
It is estimated there are tens of thousands of toxins and
chemicals in the average household fire. Fabrics, furniture and construction
materials give off a range of toxic gasses when burning. These toxins include
acetic acid, phenol, formaldehyde, benzene, styrene, ammonia, carbon monoxide
and cyanide. In a fire, the combination of these chemicals increases the
The committee heard that although all fires have individual
characteristics, there are a number of common toxic chemicals which may be
present in most fire effluent:
Polycyclic Aromatic Hydrocarbons (PAHs): naphthalene,
- Irritant gasses: formaldehyde, acrolein, oxides of nitrogen; and
- Asphyxiant gasses: carbon monoxide, hydrogen cyanide.
Many of these are either known or suspected carcinogens. PAHs, for
instance, are substances found in particles of soot and linked to certain types
As far back as the year 1775, an increased rate of cancer among chimneysweeps
routinely exposed to soot had already been reported.
Smoke is an aerosol consisting of liquid or solid particles dispersed in
a gaseous medium. This gaseous medium consists largely of toxic gases.
The toxicity of these gases has been rising with modernisation of
industry practices, meaning that the modern environment presents greater
hazards to firefighters than their colleagues in past years. This is partly due
to changes made by the construction industry, namely the shift away from
natural materials such as wood to lighter construction materials that feature
synthetics and petroleum-based materials:
These materials ignite and burn 2–3 times hotter and faster
than conventional materials and when heated, emit a gas or smoke that will also
ignite 2–3 times faster and burn 2–3 times hotter.
Synthetic materials used extensively in commercial and residential
properties include plastics, polymers such as styrofoam and polyutherine foam
and nylons. Combustion has a marked effect on these synthetics and the smoke
they produce when burning. They are commonly carbon based and bonded with
nitrogen, sulphur, hydrogen and chlorine atoms. The increased speed at which
they ignite and burn helps in the speedy creation of a toxic environment.
It is this growing prevalence of synthetic materials that is an enormous
cause for concern:
Chemicals are highly pervasive in the modern world. Since
World War II, astronomic increases in the variety and production volumes of
synthetic chemicals have occurred. Today more than 70 000 distinct chemicals
are used commercially in the United States and are registered with the U.S.
Environmental Protection Agency. Approximately 1000 new chemicals are
registered each year. These chemicals are combined into more than 7 million
mixtures, formulations and blends that are found in homes, public buildings and
workplaces across the United States.
Testing of chemicals for their carcinogenic and other toxic
effects has not kept pace with chemical production. Despite decades of concern
about the toxic effects of chemical substances, the toxic effects of most of
the chemicals currently in commercial use have never been evaluated...The
absence of toxicity data on the majority of chemicals in commercial use means
that firefighters are exposed on a daily basis to chemicals with unknown
effects. It is quite likely, therefore that in addition to their exposures to
known carcinogens, firefighters experience exposures to carcinogenic chemicals
whose cancer-causing potential has not yet been identified.
Protective clothing and equipment
The committee heard that occupational environments involving fire
inherently preclude the design of personal protective clothing (PPC) that would
provide an impermeable physical barrier between firefighters and the toxic
smoke to which they are exposed.
Nevertheless, firefighters work hard to mitigate and eliminate workplace
hazards in an emergency situation. Hazards are mitigated through a process
known as the Hierarchy of Controls, which includes a range of options:
- Elimination of hazard;
- Substitution of hazard;
- Isolation of hazard;
- Administrative controls; and
- Personal protective clothing.
The key principle of the hierarchy is to try and eliminate hazards at
In regards to the 'Hierarchy of Controls' the core activity
of firefighters is to eliminate, substitute and isolate hazards. This is
routinely achieved by the use of engineering controls (equipment),
administrative controls (skills and operational protocols) and PPC/E [personal
protective clothing and equipment]. However with the inherent nature of fire
fighting it is impossible to eliminate all hazards.
As all hazards cannot be eliminated or isolated, engineering and
administrative controls, as well as PPC, remain the principal hazard control
mechanisms available. These are far less reliable methods of hazard mitigation,
are '...more costly and require more work to ensure they are maintained.'
Respiratory equipment available to firefighters can also help eliminate
inhalation as a source of exposure or contamination. Protective clothing,
however, is limited in its capacity to mitigate contamination, so hazards are
managed rather than eliminated through its use.
Managing hazards is achieved through standards for protective equipment
set by the National Fire Protection Association (NFPA):
Level A: Fully encapsulating gas tight suit with breathing
- Level B: Chemical splash suit (protection from liquids and
solids) with BA;
- Level C: Chemical splash suit (protection from liquids and
solids) with respirator; and
- Level D: Structural firefighting ensemble with breathing
Levels of protection are chosen to be fit for purpose. Levels A, B and C
offer protection for incidents which involve hazardous materials but not fire
or risk of fire. Therefore, Level A protection is suitable, for example, when
firefighters attend an incident involving a chemical spill. The kind of
protection required could change if the chemical spill involved fire or if
detection equipment indicated a flammable environment.
In incidents involving fire or risk of fire, Level D protection is
designed to offer the best possible protection. However, although it protects
firefighters in environments involving fire, it does not offer fully
encapsulated protection as provided by Level A:
Structural fire fighting ensemble has limited protection from
gases, vapours and particulate matter due to the requirement and necessity to
have a compromise between protection from radiated heat exposure and the
release of metabolic heat build up. In short the breathability is in effect a
hazard to firefighters that cannot be eliminated.
An average structure fire can expose firefighters to temperatures approaching
1000 degrees Celsius.
This means that the protective clothing firefighters wear in fire incidents
must be able to breathe in order for them to be able to operate in these
extreme temperatures. If the clothing did not breathe, firefighters would suffer
heat stress and could quickly perish from metabolic heat buildup damaging their
This requirement for breathability in protective clothing prevents firefighters
from wearing fully encapsulated suits designed to seal all routes of chemical
entry. The protective clothing they wear when fighting fires protects them from
flames, but leaves them exposed to toxins through inhalation or absorption
through eyes, skin, or wounds.
Therefore, the very nature of the environment firefighters operate in
prevents the design of protective clothing and equipment which could offer
complete protection and isolation from toxic smoke.
'Flash-over' and response time
To minimise loss of life, property damage and interruption to business,
'...fire services mandate a quick response by applying standards for their
firefighters to respond to emergencies.'
This response time standard is considered crucial:
Underpinning fire services response time standards is
scientific research that dictates that a fire must be suppressed within five to
10 minutes of ignition. The physical characteristics of fire cause the
temperature in a building to rise extremely rapidly, and a sudden and dramatic
simultaneous ignition of most combustible materials and gases is called flash-over.
The time required for flash-over to occur varies according to building
construction and furnishing materials and usage. The fire spreads quickly once
flash-over has occurred. In order to maximise the potential of saving life and
minimize damage to property, firefighters must enter the building to commence
suppression activities to avoid flash-over. In short, firefighters must enter
the toxic environment...It is not an option for a firefighter to delay entering
a structure to commence rescue operations and suppression activities.
The committee understands that firefighters work in uncontrolled
environments which make it necessary for their protective gear to breathe,
therefore leaving them vulnerable to toxins and carcinogens.
On the weight of considerable evidence supplied to the
committee supporting a likely causal link between firefighting and certain
cancers, as well as the understanding that claims for compensation would be
legally contestable, the committee is confident that rebuttable presumption is
a solid—and fair—foundation for workers' compensation policy for career
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