Fireground Exposure of Firefighters: A Literature Review
Transcript of 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.
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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, Päpke, 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
Environ Health Perspect
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, Løhr M, Kermanizadeh A, Loft S, Ebbehoj N, Hansen ÅM, 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
Int J Hyg Environ Health
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
J Expo Sci Environ Epidemiol
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
J Expo Sci Environ Epidemiol
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
Int J Hyg Environ Health
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
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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
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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).
Samples were collected
pre- exposure (~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
Response/ Mean (range)
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
ne (μg/g creatinine)
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
ne (μg/g creatinine)
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)
Reference Location, Setting, Study design Sample Type
Study Population
Exposure level, No. of exposed
cases
Response/ Mean (range)
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)
Reference Location, Setting, Study design
Sample Type
Study Population Exposure level, No. of exposed
cases
Response/ Mean (range)
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)
Reference Location, Setting, Study design Sample Type
Study Population
Exposure level, No. of
exposed cases
Response/ Mean (range)
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)
Reference Location, Setting, Study design
Sample Type
Study Population
Exposure level, No. of exposed cases
Response/ Mean(range)
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
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
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
in the past 5 years. Samples
were
collected within 24h of
responding to a fire.
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
Study Population Exposure level, No. of exposed
cases
Response/ Mean(range)
Comments/ additional data
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)
Reference Location, Setting, Study design
Sample Type
Study Population
Exposure level, No. of exposed cases
Response/ Mean(range)
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
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 in the past 5 years.
Samples were
collected within 24h of
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
responding to a fire.
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 in the past 5 years.
Samples were
collected within 24h of
responding to a fire.
Blood 12 male FFs
(mean(range)
age: 41.3 (32-
59)y
Concentrations of
DDE were determined
in serum.
Mean(sd); Median; Range
p,p’-
Dichlorodiphenyldichloroethylen
e (p,p’-DDE) 292(168); 249;
128–662
44 | P a g e
Table 13 Biomonitoring: PAHs – Phthalates (Group 2B)
Reference Location, Setting, Study design
Sample Type
Study Population
Exposure level, No. of exposed cases
Response/ Mean(range)
Comments/
additional data
Kolena 2020 Slovakia ND
Two Slovakian Fire and
Rescue Service Stations.
Samples were collected
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)
Mean(sd); Median; Range
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)
Reference Location, Setting, Study design
Sample Type
Study Population
Exposure level, No.
of exposed cases
Response/ Mean(range)
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)
Reference Location, Setting, Study design
Sample Type
Study Population
Exposure level, No. of
exposed cases
Response/ Mean (range)
Comments/ additional data
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
Mean(sd); Median; Range
Perfluorooctanioic acid (PFOA)
47 | P a g e
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 in the past 5
years. Samples were
collected within 24h of
responding to a fire.
59)y serum. 7(3); 6; 2–12
48 | P a g e
Table 16 Biomonitoring: Dioxins & Furans (Group 2B)
Reference Location, Setting, Study design
Sample Type
Study Population Exposure level, No. of exposed
cases
Response/ Mean(range)
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)
1,2,3,4,7,8-HxCDD: 0.2 Group 3 per IARC;
however EPA stated
Group 2B
1,2,3,7,8,9-HxCDD: 0.3 Group 3 per IARC;
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
Reference Location, Setting, Study design
Sample Type
Study Population
Exposure level, No. of exposed cases
Response/ Mean(range)
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).
Urine 28 non-smoking
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
Urine 153 non-smoking
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
Urine 15 non-smoking
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
Reference Location, Setting, Study design
Sample Type
Study Population
Exposure level, No. of exposed cases
Response/ Mean(range)
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)
Reference Location, Setting, Study design
Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional data
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
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
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)
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
Swap sample within and around transformer
NR 0.2 ng NR Maximum Values
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
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
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
Comments/ additional data
Bolstad-Johnson 2000
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
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 Training
Passive Personal Air Monitoring Emergency Events
31
31
18.0 ± 2.14 𝝁g/M3
250 ± 2.66 𝝁g/M3
(5.37-79.0 𝝁g/M3)
(48.9–665 𝝁g/M3)
geometric mean ± geometric standard deviation
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 fire- ground 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
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:
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
Personal Active Event 6
Outside structure
Inside Structure
Personal Active Event 7
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
Personal Passive Event 2
Outside structure
Personal Passive Event 3
Outside structure
Personal Passive Event 4
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
Fire 2: Air Sample 1
Fire 2: Air Sample 2
Fire 3: Air Sample 1
Fire 3: Air Sample 2
Fire 3: Air Sample 3
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)
Reference Location, Setting, Study design
Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional data
Bolstad-Johnson 2000
Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires
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
Deposition concentration
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)
Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, 7 Team Leading firefighters in seven training situations, 8 Team Leading firefighters during eight emergency events
Active Air Sampling FF Train
Passive Personal Air Sampling FF Train
Passive Personal Air Monitoring Emergency Events
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)
geometric mean ± geometric standard deviation
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)
Austin 2001 Canada, 15 experimental fires burned in a basement for 15 minutes
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)
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
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
Mayer 2019 USA, Simulated Structure Fire, crews of 12 firefighters in pairs of 2 completed four scenarios of job assignments
Gear
Exposed unlaundered hoods after 4 residential fire responses
Routinely laundered hoods after 4 residential fire responses
5
0
488 ng/g ± 361
ND
NR Mean Standard ± Deviation
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
Atmospheric concentration
81 | P a g e
students inside structural firefighting ensemble
NR
NA
0.4-13 𝝁g/M3
Range of atmospheric concentrations
Kirk 2015 Australia, Simulated Structure Fire, Training Fire, instructor monitoring for five evolutions
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
Deposition concentration
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
Burn 2: Day 1 ignition
Burn 2: 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
Alexander 2014 USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Glove 1 Inner Glove Layer
Glove 2 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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples Exposure level
Exposure range
Comments/ additional data
Bolstad-Johnson 2000
Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires
Personal Air 96 0.25 ppm ± 0.252
(0.016-1.18 ppm)
Average Sample Concentration
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
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
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 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:
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
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
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:
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
Geometric mean sample concentration by task
87 | P a g e
Engine 6 98 ppb NR
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
Personal Active Event 6
Outside structure
Inside Structure
Personal Active Event 7
Outside structure
Inside Structure
Personal Passive Event 1
Outside structure
Personal Passive Event 2
Outside structure
Personal Passive Event 3
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
Personal Passive Event 4
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
USA, Structure Fire, 14 reported calls with 26 usable samples from 51 firefighters
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
Summary range of measurements
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
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 30 0.16 mg/m3 (0.048-0.42 mg/m3)
Mean
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
(23-51 𝝁g/M3)
(14-26 𝝁g/M3)
(8-22 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
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
Easter 2016 USA, Gear samples from donated occupationally soiled firefighter protective gear
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
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
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
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:
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
Geometric mean sample concentration by task
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
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)
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
USA, Structure Fire, 14 reported calls with 5 usable samples from 51 firefighters
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
Navarro 2019 USA, Wildland, Air concentrations measure for first 12 days of the Willow Fire
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
Arithmetic Mean & Standard Deviation
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
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)
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
Burn 2: Day 1 ignition
Burn 2: Day 2 smolder
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)
Reference Location, Setting, Study design
Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
Brandt-Rauf 1988
USA, Structure Fire, 14 reported calls with 5 usable samples from 51 firefighters
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples Exposure level
Exposure range
Comments/ additional data
Bolstad-Johnson 2000
Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires
Personal Air 96 0.123 ppm ± 0.133
(0.013 - 0.3 ppm)
Average Sample Concentration
Lindquist 1997 Finland, Simulated Structure Fire, Training Fire, 5 firefighters Instructors monitored over two training events
Firehouse Fire
Container Fire
5 measures during workday not extinguishing
5 measures during evening evaporation from clothing
5 measures during workday not extinguishing
5 measures during evening evaporation from clothing
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
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 43 -
-
(ND-0.02 ppm)
Mean
Geometric Mean
Reisen 2009 Australia, 2 experimental burns and 10 prescribed Bushfire Burns, 10 area samples taken adjacent adjacent to fires
Area 9 <0.02 ppm
<0.02 ppm
(ND-0.05 ppm)
Mean
Geometric Mean
97 | P a g e
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
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
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:
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
Geometric mean sample concentration by task
98 | P a g e
Hill 1972 USA, Simulated Structure Fire, Training Fire, Airborn Soot Sampling for 2-5 seconds
Area 1 0.14 mg/M3
NR Airborne soot concentration
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
Overhaul
Inside-mask
22
22
22
NR
NR
NR
ND-3.2 ppm
ND-0.2 ppm
ND-0.9 ppm
Summary range of measurements
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 1 NA 0.052 mg/m3
Mean
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 1
ND 0.016 ppm
NR
Mean concentration
99 | P a g e
Table 30 Environmental Monitoring: Cyclopenta[cd]pyrene (Group 2A)
Reference Location, Setting, Study design Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional
data
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
Burn 2: Day 1 ignition
Burn 2: Day 2 smolder
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
Bolstad-Johnson 2000
Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires
Personal Air 88 45.5 𝝁g/M3 ± 31.6
(23.2-67.9 𝝁g/M3)
Average Sample Concentration
Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, 7 Team Leading firefighters in seven training situations, 8 Team Leading firefighters during eight emergency events
Active Air Sampling firefighters Train
Passive Personal Air Sampling firefighters Train
Passive Personal Air Monitoring Emergency Events
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)
geometric mean ± geometric standard deviation
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: 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)
Mean air concentrations and 95% CI (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)
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
4
2650 ng/g ± 1270
620 ng/g ± 182
NR Mean Standard ± Deviation
Mayer 2019 USA, Simulated Structure Fire, crews of 12 firefighters in pairs of 2 completed four scenarios of job assignments
Gear
Exposed unlaundered hoods after 4 residential fire responses
Routinely laundered hoods after 4 residential fire responses
5
1
2360 ng/g ± 1430
105 ng/g ± 75.7
NR Mean Standard ± Deviation
Navarro 2019 USA, Wildland, Air concentrations measure for first 12 days of the Willow Fire
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
Arithmetic Mean & Standard Deviation
102 | P a g e
24 hour
Day
Night
12
12
12
3 ng/m3 ± 2
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
4 ng/m3 ± 2
4 ng/m3 ± 2
(<3-23 ng/m3)
(<3-50 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 0.010 𝝁g/m3
(ND-0.021 𝝁g/m3)
Mean
Keir 2020 Canada, Emergency Firefighting, 28 firefighters from 4 stations,
Personal Air
Geometric Mean
Arithmetic Mean
29
29
0.27 𝝁g/m3
± 1.29
0.70 𝝁g/m3
(0.02-5.58 𝝁g/m3)
Geometric Mean ± standard error
Arithmetic Mean
Alexander 2014 USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Glove 1 Inner Glove Layer
Glove 2 Inner Glove Layer
Glove 1 Middle Glove
Glove 1 Outer Glove
1
1
1
1
ND
ND
ND
ND
NR Concentration
103 | P a g e
Cuff coat inner wristlet
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional
data
Brandt-Rauf 1988
USA, Structure Fire, 14 reported calls with 5 usable samples from 51 firefighters
Personal Air 1 0.278 ppm NR Concentration
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
(<0.4-1.5 𝝁g/M3)
(ND 𝝁g/M3)
(ND-0.8 𝝁g/M3)
Concentrations
105 | P a g e
Table 33 Environmental Monitoring: Styrene (Group 2A)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
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
Personal Active Event 6
Outside structure
Inside Structure
Personal Active Event 7
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
Austin 2001 Canada, 15 experimental fires burned in a basement for 15 minutes
Area sampling
15 0.4 ppm NR Peak concentrations
Hill 1972 USA, Simulated Structure Fire, Training Fire, Airborn Soot Sampling for 2-5 seconds
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
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
(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)
Reference Location, Setting, Study design Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional data
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
Fent 2020 USA, Structural Fire, 12 controlled residential structure fires, 3 crews of 12 firefighters per crew
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
Median Concentrations
Fent 2020 USA, Structural Fire, 12 controlled residential structure fires, 3 crews of 12 firefighters per crew
Gear-Glove Attack, Search, Outside Vent, and Overhaul: No Decon
2
0.05 ng/cm2
(0.05-0.53 ng/cm2)
Median Concentrations
108 | P a g e
Table 35 Environmental Monitoring: Tetrachloroethylene (perchloroethylene; Group 2A)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional
data
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
(ND-1 𝝁g/M3)
(ND 𝝁g/M3)
(ND 𝝁g/M3)
Concentrations
109 | P a g e
Table 36 Environmental Monitoring: Acetaldehyde (Group 2B)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
Bolstad-Johnson 2000
Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires
Personal Air 96 0.34 ppm ± 0.41
(0.041 - 1.75 ppm)
Average Sample Concentration
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 43 <0.05 ppm
<0.04 ppm
(ND-0.26 ppm)
Mean
Geometric Mean
Reisen 2009 Australia, 2 experimental burns and 10 prescribed Bushfire Burns, 10 area samples taken adjacent adjacent to fires
Area 9 0.05 ppm
0.04 ppm
(0.02-0.09 ppm)
Mean
Geometric Mean
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
Personal Active Event 6
Outside structure
Inside Structure
Personal Active Event 7
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
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
Overhaul
Inside-mask
22
22
22
NR
NR
NR
(ND-8.1 ppm)
(ND-1.6 ppm)
(ND-0.9 ppm)
Summary range of measurements
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 24 0.078 mg/m3
(ND-0.15mg/m3)
Mean
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
(10-16 𝝁g/M3)
(4-160 𝝁g/M3)
(20-25 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
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)
Reference Location, Setting, Study design Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional data
Bolstad-Johnson 2000
Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires
Personal Air 88 24.9 𝝁g/M3 ± 4.90
(19.3-27.9 𝝁g/M3)
Average Sample Concentration
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
Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, 7 Team Leading firefighters in seven training situations, 8 Team Leading firefighters during eight emergency events
Active Air Sampling firefighters Train
Passive Personal Air Sampling firefighters Train
Passive Personal Air Monitoring Emergency Events
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)
geometric mean ± geometric standard deviation
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
0.19 ng/cm2 ± 0.22
0.30 ng/cm2 ± 0.35
0.42 ng/cm2
±0.60
NR Average ± Standard Deviation
113 | P a g e
0.31 ng/cm2 ± 0.44
0.26 ng/cm2 ± 0.22
Baxter 2014 Ohio, USA, Overhaul Scenes at 5 Live Events, 20 Skin wipes collected from 10 firefighters
Dermal Face & Neck 3 0.11𝝁g ± 0.023
NR Mean Mass per Wipe ± Standard Deviation
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: 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)
Mean air concentrations and 95% CI (ng/m3)
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
3
418 ng/g ± 254
101 ng/g ± 42.2
NR Mean ± Standard Deviation
114 | 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 unlaundered hoods after 4 residential fire responses
Routinely laundered hoods after 4 residential fire responses
5
0
362 ng/g ± 283
ND
NR Mean ± Standard Deviation
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 students inside structural firefighting ensemble
NR
NR
NR
11 𝝁g/M3
NA
2.1 𝝁g/M3
NR
4.1-46 𝝁g/M3
NR
Atmospheric concentration
Range of atmospheric concentrations
Atmospheric concentration
115 | P a g e
NR
NA
0.56-11 𝝁g/M3
Range of atmospheric concentrations
Kirk 2015 Australia, Simulated Structure Fire, Training Fire, instructor monitoring for five evolutions
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
12 ng/cm2
NA
NR
5-30 ng/cm2
Deposition concentration
Range of deposition concentrations
Alexander 2016 USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Hood
Wristlet
1
1
1.4 𝝁g/g
ND
NR Total contaminants
Navarro 2019 USA, Wildland, Air concentrations measure for first 12 days of the Willow Fire
Area
Arithmetic Mean
24 hour
Day
12
12
3 ng/m3 ± 2
NR
Arithmetic Mean & Standard Deviation
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
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
11
28
8 ng/m3 ± 4
10 ng/m3 ± 4
(<3-84 ng/m3)
(<3-192 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 0.018 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
0.376 𝝁g/m3
NR Concentration
117 | P a g e
Burn 2: Day 1 ignition
Burn 2: Day 2 smolder
1
1
0.120 𝝁g/m3
0.066 𝝁g/m3
0.275 𝝁g/m3
Keir 2020 Canada, Emergency Firefighting, 28 firefighters from 4 stations,
Personal Air
Geometric Mean
Arithmetic Mean
29
29
0.91 𝝁g/m3
± 1.48
12.59 𝝁g/m3
(0.02-236.05 𝝁g/m3)
Geometric Mean ± standard error
Arithmetic Mean
Alexander 2014 USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Glove 1 Inner Glove Layer
Glove 2 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
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
Bolstad-Johnson 2000
Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires
Personal Air 88 22.3 𝝁g/M3 ± 10.6
(9.5-34 𝝁g/M3)
Average Sample Concentration
Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, 7 Team Leading firefighters in seven training situations, 8 Team Leading firefighters during eight emergency events
Active Air Sampling firefighters Train
Passive Personal Air Sampling firefighters Train
Passive Personal Air Monitoring Emergency Events
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)
geometric mean ± geometric standard deviation
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
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
Dermal collarbone firefighters leader enter burning house
Dermal collarbone firefighters fire starter
Dermal collarbone firefighters leader outside house
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
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
0.07 ng/cm2 ± 0.11
0.05 ng/cm2 ± 0.05
0.05 ng/cm2
±0.06
0.03 ng/cm2 ± 0.07
NR Average ± Standard Deviation
121 | P a g e
0.07 ng/cm2 ± 0.07
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: 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)
Mean air concentrations and 95% CI (ng/m3)
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
Overhaul
3
3
6 𝝁g/M3
ND
NR Concentrations of polynuclear aromatic hydrocarbon (PNAs)
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
3
720 ng/g ± 398
101 ng/g ± 45.5
NR Mean Standard ± Deviation
Mayer 2019 USA, Simulated Structure Fire, crews of 12 firefighters in pairs of 2 completed four scenarios of job assignments
Gear
5
626 ng/g ± 450
NR Mean Standard ± Deviation
122 | P a g e
Exposed unlaundered hoods after 4 residential fire responses
Routinely laundered hoods after 4 residential fire responses
0
ND
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
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
Arithmetic Mean & Standard Deviation
Geometric Mean & Standard Deviation
Navarro 2019 USA, Wildland and Prescribed Burn Training Fire, 25 wildland firefighters: 21 wildland
Personal Air
Geometric Mean ± standard deviation
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)
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 18 0.028 𝝁g/m3
(ND-0.120 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
Burn 2: Day 1 ignition
Burn 2: Day 2 smolder
1
1
1
1
0.121 𝝁g/m3
0.015 𝝁g/m3
0.026 𝝁g/m3
0.079 𝝁g/m3
NR Concentration
Keir 2020 Canada, Emergency Firefighting, 28 firefighters from 4 stations,
Personal Air
Geometric Mean
Arithmetic Mean
29
29
1.52 𝝁g/m3
± 1.55
17.00 𝝁g/m3
(0.02-218.59 𝝁g/m3)
Geometric Mean ± standard error
Arithmetic Mean
124 | P a g e
Alexander 2014 USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Glove 1 Inner Glove Layer
Glove 2 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
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)
Reference Location, Setting, Study design Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional
data
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
Burn 2: Day 1 ignition
Burn 2: Day 2 smolder
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)
Reference Location, Setting, Study design
Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional data
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
NR Average ± Standard Deviation
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
Burn 2: Day 1 ignition
Burn 2: Day 2 smolder
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
Bolstad-Johnson 2000
Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires
Personal Air 88 23.8 𝝁g/M3 ± 1.67
(22.6-25 𝝁g/M3)
Average Sample Concentration
Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, 7 Team Leading firefighters in seven training situations, 8 Team Leading firefighters during eight emergency events
Active Air Sampling firefighters Train
Passive Personal Air Sampling firefighters Train
Passive Personal Air Monitoring Emergency Events
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)
geometric mean ± geometric standard deviation
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
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
Dermal collarbone firefighters leader enter burning house
Dermal collarbone firefighters fire starter
Dermal collarbone firefighters leader outside house
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
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 ± 0.09
0.07 ng/cm2 ± 0.08
0.10 ng/cm2
±0.13
0.10 ng/cm2 ± 0.15
NR Average ± Standard Deviation
129 | P a g e
0.05 ng/cm2 ± 0.05
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: 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)
Mean air concentrations and 95% CI (ng/m3)
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
Overhaul
3
3
3 𝝁g/M3
ND
NR Concentrations of polynuclear aromatic hydrocarbon (PNAs)
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
0
250 ng/g ± 129
ND
NR Mean Standard ± Deviation
Mayer 2019 USA, Simulated Structure Fire, crews of 12 firefighters in pairs of 2 completed four scenarios of job assignments
Gear
5
219 ng/g ± 147
NR Mean Standard ± Deviation
130 | P a g e
Exposed unlaundered hoods after 4 residential fire responses
Routinely laundered hoods after 4 residential fire responses
0
ND
Alexander 2016 USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Hood
Wristlet
1
1
ND
0.8 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
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
Arithmetic Mean & Standard Deviation
Geometric Mean & Standard Deviation
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)
Geometric Mean ± standard deviation
131 | P a g e
4 wildland firefighters conducting prescribed burns
Wildland Fire
28
7 ng/m3 ± 3
(<3-79 ng/m3)
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 18 0.006 𝝁g/m3
(ND-0.014 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
Burn 2: Day 1 ignition
Burn 2: Day 2 smolder
1
1
1
1
0.116 𝝁g/m3
0.015 𝝁g/m3
0.020 𝝁g/m3
0.52 𝝁g/m3
NR Concentration
Keir 2020 Canada, Emergency Firefighting, 28 firefighters from 4 stations,
Personal Air
Geometric Mean
Arithmetic Mean
29
29
0.69 𝝁g/m3
± 1.46
6.66 𝝁g/m3
(0.03-79.12 𝝁g/m3)
Geometric Mean ± standard error
Arithmetic Mean
Alexander 2014 USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Glove 1 Inner Glove Layer
1
ND
NR Concentration
132 | P a g e
Glove 2 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
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)
Reference Location, Setting, Study design Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional data
Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, 7 Team Leading firefighters in seven training situations, 8 Team Leading firefighters during eight emergency events
Active Air Sampling firefighters Train
Passive Personal Air Sampling firefighters Train
Passive Personal Air Monitoring Emergency Events
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)
geometric mean ± geometric standard deviation
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
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
Dermal collarbone firefighters leader outside house
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
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
0.08 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
NR Average ± Standard Deviation
135 | P a g e
Baxter 2014 Ohio, USA, Overhaul Scenes at 5 Live Events, 20 Skin wipes collected from 10 firefighters
Dermal Face & Neck 1 0.10𝝁g ± 0.023
NR Mean Mass per Wipe ± Standard Deviation
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: 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)
Mean air concentrations and 95% CI (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)
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
Overhaul
3
3
10 𝝁g/M3
1 𝝁g/M3
NR Concentrations of polynuclear aromatic hydrocarbon (PNAs)
136 | 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
1
540 ng/g ± 441
76.7 ng/g ± 31.3
NR Mean Standard ± Deviation
Mayer 2019 USA, Simulated Structure Fire, crews of 12 firefighters in pairs of 2 completed four scenarios of job assignments
Gear
Exposed unlaundered hoods after 4 residential fire responses
Routinely laundered hoods after 4 residential fire responses
5
0
466 ng/g ± 471
ND
NR Mean Standard ± Deviation
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
NR
NR
9.9 𝝁g/M3
NA
NR
3.4-42 𝝁g/M3
Atmospheric concentration
Range of atmospheric concentrations
137 | P a g e
behavior of fire inside structural firefighting ensemble
Instructor monitor progress and safety of students inside structural firefighting ensemble
NR
NR
2.3 𝝁g/M3
NA
NR
0.74-10 𝝁g/M3
Atmospheric concentration
Range of atmospheric concentrations
Kirk 2015 Australia, Simulated Structure Fire, Training Fire, instructor monitoring for five evolutions
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
9.6 ng/cm2
NA
NR
5.4-16 ng/cm2
Deposition concentration
Range of deposition concentrations
Alexander 2016
USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Hood
Wristlet
1
1
1.3 𝝁g/g
ND
NR Total contaminants
138 | P a g e
Navarro 2019 USA, Wildland, Air concentrations measure for first 12 days of the Willow Fire
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
Arithmetic Mean & Standard Deviation
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
11 ng/m3 ± 4
16 ng/m3 ± 3
(<4-97 ng/m3)
(<4-250 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 14 0.031 𝝁g/m3
(ND-0.080 𝝁g/m3)
Mean
139 | P a g e
Keir 2020 Canada, Emergency Firefighting, 28 firefighters from 4 stations,
Personal Air
Geometric Mean
Arithmetic Mean
29
29
1.31 𝝁g/m3
± 1.63
58.06 𝝁g/m3
(0.03-1062.72 𝝁g/m3)
Geometric Mean ± standard error
Arithmetic Mean
Alexander 2014
USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Glove 1 Inner Glove Layer
Glove 2 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
3.5 𝝁g/m3
1.6 𝝁g/m3
ND
1.3 𝝁g/m3
0.4 𝝁g/m3
ND
NR Concentration
Easter 2016 USA, Gear samples from donated occupationally soiled firefighter protective gear
Used Gear
Outer Shell
Thermal Liner
28
21
3.8 mg/kg ± 4
NR Average Concentration ± standard deviation
140 | P a g e
0.55 mg/kg ± 0.4
141 | P a g e
Table 43 Environmental Monitoring: Crotonaldehyde (Group 2B)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional
data
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
Personal Active Event 6
Outside structure
Inside Structure
Personal Active Event 7
Outside structure
Inside Structure
1
1
1
1
1
1
0.06
<detectable limit
.13
<detectable limit
0.16
<detectable limit
NR
Concentration
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
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
Alexander 2016
USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Hood
Wristlet
1
1
ND
ND
NR Total contaminants
Alexander 2014
USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Glove 1 Inner Glove Layer
Glove 2 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
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
Easter 2016 USA, Gear samples from donated occupationally soiled firefighter protective gear
Used Gear
Outer Shell
28
NR Average Concentration ± standard deviation
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional
data
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
Personal Active Event 6
Outside structure
Inside Structure
Personal Active Event 7
Outside structure
Inside Structure
Personal Passive Event 1
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
Personal Passive Event 2
Outside structure
Personal Passive Event 3
Outside structure
Personal Passive Event 4
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)
Reference Location, Setting, Study design Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional data
Bolstad-Johnson 2000
Arizona, USA, Structure Fire, 12 firefighters in Phoenix fire department wore personal samplers for 25 fires
Personal Air 88 19.5 𝝁g/M3 ± 8.35
(14.3-29.1 𝝁g/M3)
Average Sample Concentration
Sjöström 2019 Sweden, Simulated Structure Fire, Training Fire, 7 Team Leading firefighters in seven training situations, 8 Team Leading firefighters during eight emergency events
Active Air Sampling firefighters Train
Passive Personal Air Sampling firefighters Train
Passive Personal Air Monitoring Emergency Events
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)
geometric mean ± geometric standard deviation
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
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
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
Dermal collarbone firefighters fire starter
Dermal collarbone firefighters leader outside house
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
Baxter 2014 Ohio, USA, Overhaul Scenes at 5 Live Events, 20 Skin wipes collected from 10 firefighters
Dermal Face & Neck 1 0.06 𝝁g ± NR
NR Mean Mass per Wipe ± Standard Deviation
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: 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)
Mean air concentrations and 95% CI (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
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
Overhaul
3
NA
10 𝝁g/M3
NA
NR Concentrations of polynuclear aromatic hydrocarbon (PNAs)
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
560 ng/g ± 226
95.8 ng/g ± 40.9
NR Mean Standard ± Deviation
Mayer 2019 USA, Simulated Structure Fire, crews of 12 firefighters in pairs of 2 completed four scenarios of job assignments
Gear
Exposed unlaundered hoods after 4 residential fire responses
Routinely laundered hoods after 4 residential fire responses
5
0
482 ng/g ± 318
ND
NR Mean Standard ± Deviation
150 | P a g e
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 students inside structural firefighting ensemble
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
Atmospheric concentration
Range of atmospheric concentrations
Atmospheric concentration
Range of atmospheric concentrations
Kirk 2015 Australia, Simulated Structure Fire, Training Fire, instructor monitoring for five evolutions
Gear
Deposition concentration on structural firefighting ensemble of instructors
NR
ND
NR
Deposition concentration
151 | P a g e
demonstrating behavior of fire
Deposition concentration on structural firefighting ensemble of instructors monitoring progress and safety of students
NR
NA
ND-11 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
0.2 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
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
Arithmetic Mean & Standard Deviation
Geometric Mean & Standard Deviation
152 | P a g e
1 ng/m3 ± 1
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
3 ng/m3 ± 5
6 ng/m3 ± 5
(<1-75 ng/m3)
(<1-103 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 11 0.021 𝝁g/m3
(ND-0.042 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
Burn 2: Day 1 ignition
Burn 2: Day 2 smolder
1
1
1
1
0.081 𝝁g/m3
0.012 𝝁g/m3
0.011 𝝁g/m3
0.062 𝝁g/m3
NR Concentration
Keir 2020 Canada, Emergency Firefighting, 28 firefighters from 4 stations,
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
Geometric Mean ± standard error
Arithmetic Mean
Alexander 2014 USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Glove 1 Inner Glove Layer
Glove 2 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
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional data
Hill 1972 USA, Simulated Structure Fire, Training Fire, Airborn Soot Sampling for 2-5 seconds
Area 1 0.46 mg/M3 NR Airborne soot concentration
155 | P a g e
Table 48 Environmental Monitoring: Methyl Isobutyl Ketone (Group 2B)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional
data
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
Personal Active Event 6
Outside structure
Inside Structure
Personal Active Event 7
Outside structure
Inside Structure
Personal Passive Event 1
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
156 | P a g e
Personal Passive Event 2
Outside structure
Personal Passive Event 3
Outside structure
Personal Passive Event 4
Outside structure
1
1
<detectable limit
<detectable limit
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
(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)
Reference Location, Setting, Study design
Sampling Matrix No. of samples
Exposure level
Exposure range
Comments/ additional data
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
Passive Personal Air Sampling FF Train
Passive Personal Air Monitoring Emergency Events
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)
geometric mean ± geometric standard deviation
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
NR Average ± Standard Deviation
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
Area: Event 1 Sample 2
Area: Event 2 Sample 1
Area: Event 2 Sample 2
Area: Event 3 Sample 1
Area: Event 3 Sample 2
Area: Event 4 Sample 1
Area: Event 4 Sample 2
Area: Event 5 Sample 1
Area: Event 5 Sample 2
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
Austin 2001 Canada, 15 experimental fires burned in a basement for 15 minutes
Area sampling 15 3.0 ppm NR Peak concentrations
160 | P a g e
Hill 1972 USA, Simulated Structure Fire, Training Fire, Airborn Soot Sampling for 2-5 seconds
Area 1 2.19 mg/M3 NR Airborne soot concentration
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
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 students inside structural firefighting ensemble
NR
NR
NR
490 𝝁g/M3
NA
13 𝝁g/M3
NR
73-1300 𝝁g/M3
NR
Atmospheric concentration
Range of atmospheric concentrations
Atmospheric concentration
161 | P a g e
NR
NA
20-210 𝝁g/M3
Range of atmospheric concentrations
Kirk 2015 Australia, Simulated Structure Fire, Training Fire, instructor monitoring for five evolutions
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
ND
ND
ND
ND
Deposition concentration
Range of deposition concentrations
Alexander 2016
USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Hood
Wristlet
1
1
3.1 𝝁g/g
0.2 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
Geometric Mean
24 hour
12
12
12
467 ng/m3 ± 579
589 ng/m3 ± 755
344 ng/m3 ± 302
NR
Arithmetic Mean & Standard Deviation
Geometric Mean & Standard Deviation
162 | P a g e
Day
Night
12
12
12
284 ng/m3 ± 3
327 ng/m3 ± 3
253 ng/m3 ± 2
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
11
21
669 ng/m3 ± 7
3189 ng/m3
± 3
(<4-5073 ng/m3)
(319-21439 ng/m3)
Geometric Mean ± standard deviation
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
Burn 2: Day 1 ignition
Burn 2: Day 2 smolder
1
1
1
1
nd
nd
nd
nd
NR Concentration
Robinson 2008 USA, Prescribed Burn, 5 prescribed pile burns, 21 firefighters
Personal Air 12 6.17 𝝁g/m3 (3.2-81 𝝁g/m3)
Concentration
163 | P a g e
Keir 2020 Canada, Emergency Firefighting, 28 firefighters from 4 stations,
Personal Air
Geometric Mean
Arithmetic Mean
29
29
182.59 𝝁g/m3 ± 1.48
1675.80 𝝁g/m3
(3.95-15916.00 𝝁g/m3)
Geometric Mean ± standard error
Arithmetic Mean
Alexander 2014
USA, Gear Samples from donated occupationally soiled firefighter protective gear
Used Gear
Glove 1 Inner Glove Layer
Glove 2 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
ND
ND
0.2 𝝁g/m3
3.1 𝝁g/m3
ND
ND
NR Concentration
Easter 2016 USA, Gear samples from donated occupationally soiled firefighter protective gear
Used Gear
Outer Shell
Thermal Liner
28
21
0.45 mg/kg ± 0.1
0.14 mg/kg ± 0.05
NR Average Concentration ± standard deviation
164 | P a g e
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
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional
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)
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional
data
Brandt-Rauf 1988
USA, Structure Fire, 14 reported calls with 5 usable samples from 51 firefighters
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
Reference Location, Setting, Study design Sampling Matrix
No. of samples
Exposure level
Exposure range
Comments/ additional
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)
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
7.00 ng/kg
5.81 ng/kg
6.53 ng/kg
NR
Concentration
Benzo[a]pyrene (Group 1)
168 | P a g e
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
23000 ng/g
12100 ng/g
19300 ng/g
NR
Concentration
Group 2A
4,4-Dichlorodiphenyltrichloroethane (Group 2A)
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
ND
ND
ND
NR
Concentration
Group 2B
3,3'-Dichlorobenzidine (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
1
10 𝝁g/g
ND
ND
NR
Concentration
169 | P a g e
Market Street
Trichlorophenol (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
Market Street
1
1
1
21.4 𝝁g/g
ND
11.5 𝝁g/g
NR
Concentration
Benzo[c]phenanthrene (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
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)
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
ND
18.2 𝝁g/g
ND
NR
Concentration
Heptachlor (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
Market Street
1
1
1
ND
ND
ND
NR
Concentration
Hexachlorobenzene (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
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)
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
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
Al-Malki, A. L. (2009). Serum heavy metals and hemoglobin related compounds in Saudi Arabia firefighters.
Journal of Occupational Medicine and Toxicology, 4(1), 18. https://doi.org/10.1186/1745-6673-4-18
Andersen, M. H. G., Saber, A. T., Clausen, P. A., Pedersen, J. E., Løhr, M., Kermanizadeh, A., Loft, S.,
Ebbehøj, N., Hansen, Å. M., Pedersen, P. B., Koponen, I. K., Nørskov, E.-C., Møller, P., & Vogel, U.
(2018). Association between polycyclic aromatic hydrocarbon exposure and peripheral blood
mononuclear cell DNA damage in human volunteers during fire extinction exercises. Mutagenesis,
33(1), 105–115. https://doi.org/10.1093/mutage/gex021
Andersen, M. H. G., Saber, A. T., Pedersen, J. E., Pedersen, P. B., Clausen, P. A., Løhr, M., Kermanizadeh,
A., Loft, S., Ebbehøj, N. E., Hansen, Å. M., Kalevi Koponen, I., Nørskov, E.-C., Vogel, U., & Møller, P.
(2018). 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:
173 | P a g e
Biomarkers of Exposure and Effect after Firefighter’s Work Shift. Environmental and Molecular
Mutagenesis, 59(6), 539–548. https://doi.org/10.1002/em.22193
Atlas, E. L., Donnelly, K. C., Giam, C. S., & McFarland, A. R. (1985). Chemical and Biological Characterization
of Emissions from a Fireperson Training Facility. American Industrial Hygiene Association Journal,
46(9), 532–540. https://doi.org/10.1080/15298668591395300
Austin, C. C., Wang, D., Ecobichon, D. J., & Dussault, G. (2001). Characterization of volatile organic
compounds in smoke at experiemental fires. Journal of Toxicology and Environmental Health, Part A,
63(3), 191–206. https://doi.org/10.1080/15287390151101547
Baxter, C. S., Hoffman, J. D., Knipp, M. J., Reponen, T., & Haynes, E. N. (2014). Exposure of firefighters to
particulates and polycyclic aromatic hydrocarbons. Journal of Occupational and Environmental
Hygiene, 11(7), D85-91. https://doi.org/10.1080/15459624.2014.890286
Beitel, S. C., Flahr, L. M., Hoppe-Jones, C., Burgess, J. L., Littau, S. R., Gulotta, J., Moore, P., Wallentine, D.,
& Snyder, S. A. (2020). Assessment of the toxicity of firefighter exposures using the PAH CALUX
bioassay. Environment International, 135, 105207. https://doi.org/10.1016/j.envint.2019.105207
Bolstad-Johnson, D., Burgess, J., Crutchfield, C., Storment, S., Gerkin, R., & Wilson, J. (2000).
Characterization of firefighter exposures during fire overhaul. AIHAJ-American Industrial Hygiene
Association 61, 636–641.
Brandt-Rauf, P. W., Jr, L. F. F., Tarantini, T., Idema, C., & Andrews’, L. (1988). Health hazards of fire fighters:
Exposure assessment. British Journal of Internal Medicine, 7.
Burgess, J. L., Hoppe-Jones, C., Griffin, S. C., Zhou, J. J., Gulotta, J. J., Wallentine, D. D., Moore, P. K.,
Valliere, E. A., Weller, S. R., Beitel, S. C., Flahr, L. M., Littau, S. R., Dearmon-Moore, D., Zhai, J., Jung,
A. M., Garavito, F., & Snyder, S. A. (2020). Evaluation of Interventions to Reduce Firefighter
Exposures. Journal of Occupational & Environmental Medicine, 62(4), 279–288.
https://doi.org/10.1097/JOM.0000000000001815
Burgess, J., Nanson, C., Bolstad-Johnson, D., Gerkin, R., Hysong, T., Lantz, R., Sherrill, D., Crutchfield, C.,
Quan, S., Bernard, A., & Witten, M. (2001). Adverse Respiratory Effects Following Overhaul in
Firefighters. Journal of Occupational and Environmental Medicine, 43(5), 467–473.
174 | P a g e
Caban-Martinez, A. J., Kropa, B., Niemczyk, N., Moore, K. J., Baum, J., Solle, N. S., Sterling, D. A., & Kobetz,
E. N. (2018). The “Warm Zone” Cases: Environmental Monitoring Immediately Outside the Fire Incident
Response Arena by Firefighters. Safety and Health at Work, 9(3), 352–355.
https://doi.org/10.1016/j.shaw.2017.12.003
Caux, C., O’Brien, C., & Viau, C. (2002). Determination of Firefighter Exposure to Polycyclic Aromatic
Hydrocarbons and Benzene During Fire Fighting Using Measurement of Biological Indicators. Applied
Occupational and Environmental Hygiene, 17(5), 379–386.
https://doi.org/10.1080/10473220252864987
Daniels, R. D., Kubale, T. L., Yiin, J. H., Dahm, M. M., Hales, T. R., Baris, D., Zahm, S. H., Beaumont, J. J.,
Waters, K. M., & Pinkerton, L. E. (2013). Mortality and cancer incidence in a pooled cohort of US
firefighters from San Francisco, Chicago and Philadelphia (1950–2009). Occupational and
Environmental Medicine, oemed-2013-101662. https://doi.org/10.1136/oemed-2013-101662
Dauchy, X., Boiteux, V., Bach, C., Rosin, C., & Munoz, J.-F. (2017). Per- and polyfluoroalkyl substances in
firefighting foam concentrates and water samples collected near sites impacted by the use of these
foams. Chemosphere, 183, 53–61. https://doi.org/10.1016/j.chemosphere.2017.05.056
de Perio, M. A., Durgam, S., Caldwell, K. L., & Eisenberg, J. (2010). A Health Hazard Evaluation of Antimony
Exposure in Fire Fighters. Journal of Occupational & Environmental Medicine, 52(1), 81–84.
https://doi.org/10.1097/JOM.0b013e3181c7514a
Dixon, H. M., Scott, R. P., Holmes, D., Calero, L., Kincl, L. D., Waters, K. M., Camann, D. E., Calafat, A. M.,
Herbstman, J. B., & Anderson, K. A. (2018). Silicone wristbands compared with traditional polycyclic
aromatic hydrocarbon exposure assessment methods. Analytical and Bioanalytical Chemistry, 410(13),
3059–3071. https://doi.org/10.1007/s00216-018-0992-z
Dobraca, D., Israel, L., McNeel, S., Voss, R., Wang, M., Gajek, R., Park, J.-S., Harwani, S., Barley, F., She, J.,
& Das, R. (2015). Biomonitoring in California Firefighters: Metals and Perfluorinated Chemicals. Journal
of Occupational & Environmental Medicine, 57(1), 88–97.
https://doi.org/10.1097/JOM.0000000000000307
175 | P a g e
Dubocq, F., Wang, T., Yeung, L. W. Y., Sjöberg, V., & Kärrman, A. (2020). Characterization of the Chemical
Contents of Fluorinated and Fluorine-Free Firefighting Foams Using a Novel Workflow Combining
Nontarget Screening and Total Fluorine Analysis. Environmental Science & Technology, 54(1), 245–
254. https://doi.org/10.1021/acs.est.9b05440
Easter, E., Lander, D., & Huston, T. (2016). Risk assessment of soils identified on firefighter turnout gear.
Journal of Occupational and Environmental Hygiene, 13(9), 647–657.
https://doi.org/10.1080/15459624.2016.1165823
Edelman, P., Osterloh, J., Pirkle, J., Caudill, S. P., Grainger, J., Jones, R., Blount, B., Calafat, A., Turner, W.,
Feldman, D., Baron, S., Bernard, B., Lushniak, B. D., Kelly, K., & Prezant, D. (2003). Biomonitoring of
chemical exposure among New York City firefighters responding to the World Trade Center fire and
collapse. Environmental Health Perspectives, 111(16), 1906–1911. https://doi.org/10.1289/ehp.6315
Evanoff, B. A., & Rosenstock, L. (1986). Reproductive hazards in the workplace: A case study of women
firefighters. American Journal of Industrial Medicine, 9(6), 503–515.
Fabian, T. Z., Borgerson, J. L., Gandhi, P. D., Baxter, C. S., Ross, C. S., Lockey, J. E., & Dalton, J. M. (2014).
Characterization of Firefighter Smoke Exposure. Fire Technology, 50(4), 993–1019.
https://doi.org/10.1007/s10694-011-0212-2
Fent, K. W., Alexander, B., Roberts, J., Robertson, S., Toennis, C., Sammons, D., Bertke, S., Kerber, S.,
Smith, D., & Horn, G. (2017). Contamination of firefighter personal protective equipment and skin and
the effectiveness of decontamination procedures. Journal of Occupational and Environmental Hygiene,
14(10), 801–814. https://doi.org/10.1080/15459624.2017.1334904
Fent, K. W., Eisenberg, J., Snawder, J., Sammons, D., Pleil, J. D., Stiegel, M. A., Mueller, C., Horn, G. P., &
Dalton, J. (2014). Systemic exposure to PAHs and benzene in firefighters suppressing controlled
structure fires. The Annals of Occupational Hygiene, 58(7), 830–845.
https://doi.org/10.1093/annhyg/meu036
Fent, K. W., & Evans, D. E. (2011). Assessing the risk to firefighters from chemical vapors and gases during
vehicle fire suppression. Journal of Environmental Monitoring, 13(3), 536.
https://doi.org/10.1039/c0em00591f
176 | P a g e
Fent, K. W., Evans, D. E., Babik, K., Striley, C., Bertke, S., Kerber, S., Smith, D., & Horn, G. P. (2018).
Airborne contaminants during controlled residential fires. Journal of Occupational and Environmental
Hygiene, 15(5), 399–412. https://doi.org/10.1080/15459624.2018.1445260
Fent, K. W., Evans, D. E., Booher, D., Pleil, J. D., Stiegel, M. A., Horn, G. P., & Dalton, J. (2015). Volatile
Organic Compounds Off-gassing from Firefighters’ Personal Protective Equipment Ensembles after
Use. Journal of Occupational and Environmental Hygiene, 12(6), 404–414.
https://doi.org/10.1080/15459624.2015.1025135
Fent, K. W., LaGuardia, M., Luellen, D., McCormick, S., Mayer, A., Chen, I.-C., Kerber, S., Smith, D., & Horn,
G. P. (2020). Flame retardants, dioxins, and furans in air and on firefighters’ protective ensembles
during controlled residential firefighting. Environment International, 140, 105756.
https://doi.org/10.1016/j.envint.2020.105756
Fent, K. W., Mayer, A., Bertke, S., Kerber, S., Smith, D., & Horn, G. P. (2019). Understanding airborne
contaminants produced by different fuel packages during training fires. Journal of Occupational and
Environmental Hygiene, 16(8), 532–543. https://doi.org/10.1080/15459624.2019.1617870
Fent, K. W., Toennis, C., Sammons, D., Robertson, S., Bertke, S., Calafat, A. M., Pleil, J. D., Geer Wallace, M.
A., Kerber, S., Smith, D. L., & Horn, G. P. (2019). Firefighters’ and instructors’ absorption of PAHs and
benzene during training exercises. International Journal of Hygiene and Environmental Health, 222(7),
991–1000. https://doi.org/10.1016/j.ijheh.2019.06.006
Fent, K. W., Toennis, C., Sammons, D., Robertson, S., Bertke, S., Calafat, A. M., Pleil, J. D., Wallace, M. A.
G., Kerber, S., Smith, D., & Horn, G. P. (2020). Firefighters’ absorption of PAHs and VOCs during
controlled residential fires by job assignment and fire attack tactic. Journal of Exposure Science &
Environmental Epidemiology, 30(2), 338–349. https://doi.org/10.1038/s41370-019-0145-2
Fernando, S., Shaw, L., Shaw, D., Gallea, M., VandenEnden, L., House, R., Verma, D. K., Britz-McKibbin, P.,
& McCarry, B. E. (2016). Evaluation of Firefighter Exposure to Wood Smoke during Training Exercises
at Burn Houses. Environmental Science & Technology, 50(3), 1536–1543.
https://doi.org/10.1021/acs.est.5b04752
177 | P a g e
Fire Protection Research Foundation. (2019). PPE and Fire Service Gear Cleaning Validation. Fire Protection
Research Foundation. https://www.nfpa.org/PPECleaning
Fuenekes, F., Jongeneelen, F., Laan, H., & Schoonof, F. (1997). Uptake of polycyclic aromatic hydrocarbons
among trainers in a fire-fighting training facility. American Industrial Hygiene Association Journal, 58,
23–28.
Gaughan, D. M., Siegel, P. D., Hughes, M. D., Chang, C.-Y., Law, B. F., Campbell, C. R., Richards, J. C.,
Kales, S. F., Chertok, M., Kobzik, L., Nguyen, P., O’Donnell, C. R., Kiefer, M., Wagner, G. R., &
Christiani, D. C. (2014). Arterial stiffness, oxidative stress, and smoke exposure in wildland firefighters:
Cardiorespiratory Effects of Wildland Firefighting. American Journal of Industrial Medicine, 57(7), 748–
756. https://doi.org/10.1002/ajim.22331
Gold, A., Burgess, Wm. A., & Clougherty, E. V. (1978). Exposure of firefighters to toxic air contaminants.
American Industrial Hygiene Association Journal, 39(7), 534–539.
https://doi.org/10.1080/0002889778507805
Hill, T. A., Siedle, A. R., & Perry, R. (1972). Chemical Hazards of a Fire-Fighting Training Environment.
American Industrial Hygiene Association Journal, 33(6), 423–430.
https://doi.org/10.1080/0002889728506675
Hsu, J.-F., Guo, H.-R., Wang, H. W., Liao, C.-K., & Liao, P.-C. (2011). An occupational exposure assessment
of polychlorinated dibenzo-p-dioxin and dibenzofurans in firefighters. Chemosphere, 83(10), 1353–
1359. https://doi.org/10.1016/j.chemosphere.2011.02.079
International Agency for Research on Cancer (IARC). (2010). Painting, Firefighting, & Shiftwork, volume 98
(IARC Monograph on the Evaluation of Carcinogenic Risks to Humans).
http://monographs.iarc.fr/ENG/Monographs/vol98/index.php
International Association of Arson Investigators, Inc.; Health & Safety Committee. (2018). Fire Investigator
Health and Safety Best Practices.
Jahnke, S. A., Poston, W. S. C., Jitnarin, N., & Haddock, C. K. (2018). Maternal and Child Health Among
Female Firefighters in the U.S. Maternal and Child Health Journal. https://doi.org/10.1007/s10995-018-
2468-3
178 | P a g e
Jalilian, H., Ziaei, M., Weiderpass, E., Rueegg, C. S., Khosravi, Y., & Kjaerheim, K. (2019). Cancer incidence
and mortality among firefighters. International Journal of Cancer, 145(10), 2639–2646.
https://doi.org/10.1002/ijc.32199
Jankovic, J., Jones, W., Burkhart, J., & NooNANf, G. (1991). Environmental study of firefighters. The Annals of
Occupational Hygiene, 22.
Kales, S. N., & Smith, D. L. (2017). Firefighting and the Heart: Implications for prevention. Circulation, 135,
1296–1299.
Kehler, A. K., Jahnke, S. A., Haddock, C. K., Poston, W. S. C., Jitnarin, N., & Heinrich, K. M. (2018).
Reproductive health concerns among female firefighters. International Journal of Fire Service
Leadership and Management, 12, 15–30.
Keir, J. L. A., Akhtar, U. S., Matschke, D. M. J., Kirkham, T. L., Chan, H. M., Ayotte, P., White, P. A., & Blais, J.
M. (2017). Elevated Exposures to Polycyclic Aromatic Hydrocarbons and Other Organic Mutagens in
Ottawa Firefighters Participating in Emergency, On-Shift Fire Suppression. Environmental Science &
Technology, 51(21), 12745–12755. https://doi.org/10.1021/acs.est.7b02850
Keir, J. L. A., Akhtar, U. S., Matschke, D. M. J., White, P. A., Kirkham, T. L., Chan, H. M., & Blais, J. M.
(2020a). Polycyclic aromatic hydrocarbon (PAH) and metal contamination of air and surfaces exposed
to combustion emissions during emergency fire suppression: Implications for firefighters’ exposures.
Science of The Total Environment, 698, 134211. https://doi.org/10.1016/j.scitotenv.2019.134211
Kelly, K., Connelly, E., Reinhold, G., Byrne, M., & Prezant, D. (2002). 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. Archives of
Environmental Health: An International Journal, 57(4).
Kirk, K. M., & Logan, M. B. (2015a). Structural Fire Fighting Ensembles: Accumulation and Off-gassing of
Combustion Products. Journal of Occupational and Environmental Hygiene, 12(6), 376–383.
https://doi.org/10.1080/15459624.2015.1006638
179 | P a g e
Kirk, K. M., & Logan, M. B. (2015b). Firefighting Instructors’ Exposures to Polycyclic Aromatic Hydrocarbons
During Live Fire Training Scenarios. Journal of Occupational and Environmental Hygiene, 12(4), 227–
234. https://doi.org/10.1080/15459624.2014.955184
Kirk, K. M., & Logan, M. B. (2019). Exposures to air contaminants in compartment fire behavior training (CFBT)
using particleboard fuel. Journal of Occupational and Environmental Hygiene, 16(7), 432–439.
https://doi.org/10.1080/15459624.2019.1603388
Kolena, B., Petrovičová, I., Šidlovská, M., Hlisníková, H., Bystričanová, L., Wimmerová, S., & Trnovec, T.
(2020). Occupational Hazards and Risks Associated with Phthalates among Slovakian Firefighters.
International Journal of Environmental Research and Public Health, 17(7), 2483.
https://doi.org/10.3390/ijerph17072483
Laitinen, J. A., Koponen, J., Koikkalainen, J., & Kiviranta, H. (2014). Firefighters’ exposure to perfluoroalkyl
acids and 2-butoxyethanol present in firefighting foams. Toxicology Letters, 231(2), 227–232.
https://doi.org/10.1016/j.toxlet.2014.09.007
Laitinen, J., Mäkelä, M., Mikkola, J., & Huttu, I. (2012). Firefighters’ multiple exposure assessments in practice.
Toxicology Letters, 213(1), 129–133. https://doi.org/10.1016/j.toxlet.2012.06.005
Lee, D. J., Koru-Sengul, T., Hernandez, M. N., Caban-Martinez, A. J., McClure, L. A., Mackinnon, J. A., &
Kobetz, E. N. (2020). Cancer risk among career male and female Florida firefighters: Evidence from the
Florida Firefighter Cancer Registry (1981-2014). American Journal of Industrial Medicine, 63(4), 285–
299. https://doi.org/10.1002/ajim.23086
LeMasters, G. K., Genaidy, A. M., Succop, P., Deddens, J., Sobeih, T., Barriera-Viruet, H., Dunning, K., &
Lockey, J. (2006). Cancer risk among firefighters: A review and meta-analysis of 32 studies. Journal of
Occupational and Environmental Medicine / American College of Occupational and Environmental
Medicine, 48(11), 1189–1202. https://doi.org/10.1097/01.jom.0000246229.68697.90
Lindqvist-Virkamaki, S., Riihimaki, V., Hakala, E., & Jarventaus, H. (1997). Evaluation of the risk of exposure to
fumes for fire fighter instructors. Työ ja ihminen, 11(4), 229–247.
Lioy, P. J., Weisel, C. P., Millette, J. R., Eisenreich, S., Vallero, D., Offenberg, J., Buckley, B., Turpin, B.,
Zhong, M., Cohen, M. D., Prophete, C., Yang, I., Stiles, R., Chee, G., Johnson, W., Porcja, R.,
180 | P a g e
Alimokhtari, S., Hale, R. C., Weschler, C., & Chen, L. C. (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. Environmental Health Perspectives, 110(7), 703–714.
https://doi.org/10.1289/ehp.02110703
Materna, B. L., Jones, J. R., Sutton, P. M., Rothman, N., & Harrison, R. J. (1992). Occupational exposures in
California wildland fire fighting. American Industrial Hygiene Association Journal, 53(1), 69–76.
https://doi.org/10.1080/15298669291359311
Mayer, A. C., Fent, K. W., Bertke, S., Horn, G. P., Smith, D. L., Kerber, S., & La Guardia, M. J. (2019).
Firefighter hood contamination: Efficiency of laundering to remove PAHs and FRs. Journal of
Occupational and Environmental Hygiene, 16(2), 129–140.
https://doi.org/10.1080/15459624.2018.1540877
McDiarmid, M. A., Lees, P. S., Agnew, J., Midzenski, M., & Duffy, R. (1991). Reproductive hazards of fire
fighting II. Chemical hazards. American Journal of Industrial Medicine, 19(4), 447–472.
Miranda, A. I., Martins, V., Cascão, P., Amorim, J. H., Valente, J., Tavares, R., Tchepel, O., Borrego, C.,
Cordeiro, C. R., Ferreira, A. J., Viegas, D. X., Ribeiro, L. M., & Pita, L. P. (2010). Monitoring fire-
fighters’ smoke exposure and related health effects during Gestosa experimental fires. WIT
Transactions on Ecology and the Environment, 83–94. https://doi.org/10.2495/FIVA100081
Moen, B. E., & Ovrebo S. (1997). Assessment of Exposure to Polycyclic Aromatic Hydrocarbons During
Firefighting by Measurement of Urinary 1-Hydroxypyrene: Journal of Occupational & Environmental
Medicine, 39(6), 515–519. https://doi.org/10.1097/00043764-199706000-00005
Naeher, L. P., Barr, D. B., Adetona, O., & Simpson, C. D. (2013). Urinary levoglucosan as a biomarker for
woodsmoke exposure in wildland firefighters. International Journal of Occupational and Environmental
Health, 19(4), 304–310. https://doi.org/10.1179/2049396713Y.0000000037
Navarro, K. M., Cisneros, R., Noth, E. M., Balmes, J. R., & Hammond, S. K. (2017). Occupational Exposure to
Polycyclic Aromatic Hydrocarbon of Wildland Firefighters at Prescribed and Wildland Fires.
Environmental Science & Technology, 51(11), 6461–6469. https://doi.org/10.1021/acs.est.7b00950
181 | P a g e
Navarro, K. M., Cisneros, R., Schweizer, D., Chowdhary, P., Noth, E. M., Balmes, J. R., & Hammond, S. K.
(2019). Incident command post exposure to polycyclic aromatic hydrocarbons and particulate matter
during a wildfire. Journal of Occupational and Environmental Hygiene, 16(11), 735–744.
https://doi.org/10.1080/15459624.2019.1657579
Neitzel, R., Naeher, L. P., Paulsen, M., Dunn, K., Stock, A., & Simpson, C. D. (2009). Biological monitoring of
smoke exposure among wildland firefighters: A pilot study comparing urinary methoxyphenols with
personal exposures to carbon monoxide, particular matter, and levoglucosan. Journal of Exposure
Science & Environmental Epidemiology, 19(4), 349–358. https://doi.org/10.1038/jes.2008.21
NIOSH. (2020, January 10). National Firefighter Registry. https://www.cdc.gov/niosh/firefighters/registry.html
O’Connell, S. G., Kincl, L. D., & Anderson, K. A. (2014). Silicone wristbands as personal passive samplers.
Environmental Science & Technology, 48(6), 3327–3335. https://doi.org/10.1021/es405022f
Oliveira, M., Costa, S., Vaz, J., Fernandes, A., Slezakova, K., Delerue-Matos, C., Teixeira, J. P., Carmo
Pereira, M., & Morais, S. (2020). Firefighters exposure to fire emissions: Impact on levels of biomarkers
of exposure to polycyclic aromatic hydrocarbons and genotoxic/oxidative-effects. Journal of Hazardous
Materials, 383, 121179. https://doi.org/10.1016/j.jhazmat.2019.121179
Oliveira, M., Slezakova, K., Alves, M. J., Fernandes, A., Teixeira, J. P., Delerue-Matos, C., Pereira, M. do C., &
Morais, S. (2016). Firefighters’ exposure biomonitoring: Impact of firefighting activities on levels of
urinary monohydroxyl metabolites. International Journal of Hygiene and Environmental Health, 219(8),
857–866. https://doi.org/10.1016/j.ijheh.2016.07.011
Oliveira, M., Slezakova, K., Magalhães, C. P., Fernandes, A., Teixeira, J. P., Delerue-Matos, C., do Carmo
Pereira, M., & Morais, S. (2017). Individual and cumulative impacts of fire emissions and tobacco
consumption on wildland firefighters’ total exposure to polycyclic aromatic hydrocarbons. Journal of
Hazardous Materials, 334, 10–20. https://doi.org/10.1016/j.jhazmat.2017.03.057
Park, J.-S., Voss, R. W., McNeel, S., Wu, N., Guo, T., Wang, Y., Israel, L., Das, R., & Petreas, M. (2015). High
Exposure of California Firefighters to Polybrominated Diphenyl Ethers. Environmental Science &
Technology, 49(5), 2948–2958. https://doi.org/10.1021/es5055918
182 | P a g e
Peaslee, G. F., Wilkinson, J., McGuinness, S., Tighe, M., Caterisano, N., Lee, S., Gonzales, A., Roddy, M.,
Mills, S., & Mitchell, K. (2020). Another Pathway for Firefighter Exposure to Per- and Polyfluoroalkyl
Substances: Firefighter Textiles. Environmental Science & Technology, 7(8), 594–599.
Petersen, K. U., Hansen, J., Ebbehoej, N. E., & Bonde, J. P. (2019). Infertility in a Cohort of Male Danish
Firefighters: A Register-Based Study. American Journal of Epidemiology, 188(2), 339–346.
https://doi.org/10.1093/aje/kwy235
Pleil, J. D., Vette, A. F., Johnson, B. A., & Rappaport, S. M. (2004). Air levels of carcinogenic polycyclic
aromatic hydrocarbons after the World Trade Center disaster. Proceedings of the National Academy of
Sciences, 101(32), 11685–11688. https://doi.org/10.1073/pnas.0404499101
Pukkala, E., Martinsen, J. I., Weiderpass, E., Kjaerheim, K., Lynge, E., Tryggvadottir, L., Sparén, P., &
Demers, P. A. (2014). Cancer incidence among firefighters: 45 years of follow-up in five Nordic
countries. Occupational and Environmental Medicine, 71(6), 398–404. https://doi.org/10.1136/oemed-
2013-101803
Reinhardt, T. E., & Ottmar, R. D. (2004). Baseline Measurements of Smoke Exposure Among Wildland
Firefighters. Journal of Occupational and Environmental Hygiene, 1(9), 593–606.
https://doi.org/10.1080/15459620490490101
Reisen, F., & Brown, S. K. (2009). Australian firefighters’ exposure to air toxics during bushfire burns of autumn
2005 and 2006. Environment International, 35(2), 342–352. https://doi.org/10.1016/j.envint.2008.08.011
Reisen, F., Hansen, D., & Meyer, C. P. (2011). Exposure to bushfire smoke during prescribed burns and
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
184 | P a g e
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
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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]
Lalić H, Ferhatović M, Dinko J, Culinović 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
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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.
Int J Environ Res Public Health
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
Bergström 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 αₕ-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, Pawłowski 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, Ebbehøj 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
Bräunig 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
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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.
Environ Health Perspect
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.
Environ Health Perspect
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.
Environ Health Perspect
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.
Environ Health Perspect
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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
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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-Jiménez 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.
Int J Environ Res Public Health
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
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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
1,4-Dimethylnaphthalene DMN_14
1,5-Dimethylnaphthalene DMN_15
1,6-Dinitropyrene DNPyr_16
1,8-Dimethylnaphthalene DMN_18
1,8-Dinitropyrene DNPyr_18
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
123678-hexachlorodibenzofuran (123678-HxCDF) HxCDF_123678
123678-hexachlorodibenzo-p-dioxin (123678-HxCDD)
HxCDD_123678
123789-hexachlorodibenzofuran (123789-HxCDF) HxCDF_123789
123789-hexachlorodibenzo-p-dioxin (123789-HxCDD)
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
2,3-Dimethylnaphthalene DMN_23
2,6-Dimethylnaphthalene DMN_26
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
234678-hexachlorodibenzofuran (234678-HxCDF) HxCDF_234678
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