Recent years have provided much more information about the increasing health risks to firefighters during the normal course of doing their job. One aspect is the toxicity of the environment in which the firefighters work. The content of the smoke is very hazardous to one’s health and would be classified as a hazardous material if it were not affiliated with a burning building. Those operating in this environment are subject to immediate danger as it would be classified as an IDLH and also to long-term effects on the body. More specifically, the toxins increase the risk of cancer significantly and can also trigger other health issues. Frankly, in these modern times, based upon the contents that can be burning, there is no telling all the dangers present.

If this is the case, then the fire service should be doing all that it can to protect firefighters. There are numerous threats including – thermal insult, toxic vapors, and over exertion – among them. Advances in personal protective equipment (PPE) have helped provide better protection against some of these but there are other advances that could be advantageous. The PPE increases the thermal barrier and covers more of the body. If used in conjunction with a proper training program, better firefighter safety will result. The self-contained breathing apparatus (SCBA) continues to improve, again providing more protection for firefighters. But there are still areas that can improve but they will require action by fire service personnel to come to fruition.

One such development is FARS – firefighter air replenishment systems. This technology has been around for over 20 years and is in over 500 buildings across the country, with more being installed every month. FARS is intended to provide immediate, sustained source of air to distant locations in high-rise, big box and underground structures such as tunnels and parking garages. The concept is to deliver air to working firefighters where it can do the most good and minimize the need to deliver extra equipment (spare bottles) to staging areas. These fires will be challenging for any fire department, are extremely labor intensive and require resources generally not needed for most day-to-day operations. Few organizations can assemble the staffing needed to ensure the best possible outcome. As these events are infrequent for most firefighters and departments, the need for practice to attain mastery is essential. If certain aspects can be simplified with technology such as the use of FARS, more time can be spent on the other aspects of the operations.

There are a couple of considerations that are affected by the challenge of critical air delivery. First, extra personnel are needed to transport spare cylinders to a staging location near the fire. The likely length of the operation will certainly require multiple bottles to be used by firefighters (based upon reviews of many significant high-rise fires, it is not uncommon for firefighters to use 4 or more bottles at these types of fires). At the recent high-rise fire in Honolulu, members were reported to have used as many as 5 bottles and endured the decreased work time that comes with fatigue and exhaustion. In cases where staffing is minimal, especially early in the incident, fire fighters who could be used in the direct operation of attacking the fire will be needed to deliver the extra bottles. Minimal staffing will mean that those working may not get the necessary rehab and will be asked to continue working longer than on a typical incident. They will likely go through multiple bottle changes. This is not just speculation as is indicated by a review of historically significant high-rise incidents where firefighters report numerous bottle changes to continue fire attack with minimal interruption.

These challenges presented to firefighters obviously create health and safety issues that need to be addressed. Most important is the fact that large-scale events will tax the cardiac systems of even the best conditioned firefighters. Annual line of duty death (LODD) statistics consistently list stress and cardiac issues as the leading cause. Large events with less than ideal staffing will strain the workforce. Firefighters don’t quit until the fire is controlled and extinguished, even if it could potentially harm their health. The ability to provide air refills without the added labor needed for transport of bottles can only contribute to the safety of the firefighters. The firefighters who would have been assigned to ferry bottles to staging areas can be better utilized to assist in the extinguishing operation. They can be utilized to either assist in the operation initially, which hopefully would lead to earlier control of the fire, or could be a relief crew. Either way, there is a significant advantage to the operation.

Another health issue that has attracted more attention is the effect of firefighting on cancer rates in firefighters. Being exposed to the products of combustion have shown to be contributing factors in likelihood that firefighters will contract certain cancers. Breathing toxic gases is obviously not desired. In cases where bottles are utilized, the changes are probably taking place relatively close to the fire for convenience. Some studies have shown that even close proximity to the fire will expose firefighters to the toxins present. Areas of refuge, stairwells or firefighter access elevator lobbies that include FARS can add extra protection and minimize the exposure. With a quick-fill connection, exposure to toxic smoke and chemicals is minimized. Swapping out bottles will take more time and potentially add to exposure, depending upon where the exchange takes place.

Added responsibilities on infrequent events can tax even the best trained, equipped, and staffed fire departments. Firefighters know they are going in harm’s way. They should only be asked to go there if they are offered the best and latest protections so they can go about their business with minimal worry about the short and long-term effects on their health. No fire department would consider sending firefighters into the hazard zone without proper PPE and SCBA. They also should be very cognizant of the need for rehab. There is another element that needs to be included to offer the most appropriate protection for firefighters operating in high-rise buildings and other large structures. When the technology exists to offer additional protection, the fire service should embrace it and make sure that their most valuable resource, the firefighters, are given the resources they need.

Getting air to firefighters should be a priority. For over 100 years, large structures have included standpipe systems so that water could be more easily delivered. If this action had not been taken, firefighters would need to stretch hose lines great distances and up into very tall buildings. That seems ridiculous to think about today. But to protect firefighters the best possible way, there needs to be more than water. Air must become part of the equation. FARS are now included in the appendix of the International Fire code, NFPA 1 and the Uniform Plumbing codes. While it can be easily argued, it should be part of the main body, this is a start. The fire service should put forth the effort to help protect the safety and health of firefighters operating during extremely challenging situations. Air is essential for protecting the long and short-term health of firefighters. If the industry is serious about minimizing unnecessary risks to those willing to put themselves in harm’s way, this should be done with the appropriate safety measures in place.