At a recent meeting of the Sonoita-Elgin Fire District Board, acting Capt. Tim Hart, president of the United Firefighters of Sonoita, spoke about the known risks to firefighters, such as burns, smoke inhalation, cardiac arrest and navigating traffic.
He then quietly added, “Our No. 1 killer is a silent one – occupational cancer. Consistent exposure to smoke, byproducts of combustion, vehicle exhaust, firefighting foam and chemicals in our uniforms are all contributors.”
The following article is based on the information Hart shared in his report.
For decades, cardiac arrest and heart disease were the primary causes of line-of-duty deaths for firefighters.
Not anymore.
Firefighters now face elevated risks of cancers such as testicular, prostrate, bladder, kidney, thyroid, breast and many others. SEFD Chief Marc Meredith said the International Association of Fire Fighters recently reported that cancer caused 70% of career firefighter line-of-duty deaths, compared with 18% from heart disease. Exposure to wildfire and structural fire smoke adds to risks, as it can contain toxic chemicals such as carbon monoxide, benzene, formaldehyde and dangerous levels of particulate matter. As research continues, fire stations, unions, medical personnel and government agencies are struggling with how to deal with the problem.
PFAS – a group of synthetic chemicals used in various products for their resistance to heat, grease and water – are emerging as the source of devastating, debilitating and deadly cancers. They are commonly referred to as “forever chemicals” due to their persistence in the environment for decades. PFAS are used in firefighter personal protective equipment including “turnout” gear – multilayered pants, jackets, gloves and hoods – to repel water and contaminants like oil, prevent moisture-related burns, and resist heat. They also are present in air, dust and smoke at fire scenes, often from sealants, roofing materials, paints, metal coatings, carpets, electronics and furniture. Firefighters are exposed to PFAS through inhalation, ingestion and dermal absorption.
Elevated PFAS levels have been detected in firefighters’ blood serum, with higher concentrations compared with the public. Studies show that PFAS chemicals aare absorbed through the skin, especially with wear and tear on the gear. A University of Arizona Health Sciences study found that blood levels of specific PFAS in firefighters changed gene expression tied to cancer development and disorders and immune system issues. These findings have created a wave of concern and movement to remove the dangerous chemicals from gear, but it’s not a simple process.
The development and deployment of PFAS-free gear is relatively new, and safety standards have not been modified to require such. The International Association of Fire Fighters reports five states have already banned PFAS from firefighter protective gear and hope these bans will spur more states to act. At the national level, the PFAS Alternatives Act, designed to accelerate the development of PFAS-free turnout gear, was introduced in May 2025, and referred to subcommittees. Many states including Arizona have already banned the use of foam containing PFAS, but no legislation to ban PFAS from gear is on the docket, at least not yet. Meanwhile, health concerns among firefighters have kindled a host of lawsuits against manufactures of gear and PFAS chemicals.
SEFD is taking measures to reduce exposures and prioritize health and safety. Meredith requires all members to inspect their gear regularly, and the district will replace any that is damaged or worn. Over the last two years, the district has and continues to purchase new structural personal protective equipment for all employees. Following exposure, firefighters are expected to clean their equipment via gross decontamination and wash the gear in a special district-provided PPE extractor washing machine with appropriate detergent. Employees are encouraged to shower after removal of all PPE. The PPE is not stored or worn in living quarters or other open-air environments. The district provides PPE storage in the bay. All hoses, hose appliances and apparatus are washed before being placed back in service. Meredith added that full-time SEFD firefighters undergo extensive annual physicals, and SEFD has been able to offer cancer detection tests to select members in recent years and is working to provide testing to even more members.
“Ideally, I would like to offer all our firefighters advanced cancer screening on an annual basis, but money is an issue,” Meredith said.
Other measures Meredith is working on include providing a second set of turnout gear and contract out for PPE professional cleaning. “There is more that we can and want to do,” he said. He also hopes for a clear and mandatory standard on PFAS in turnout gear, enabling SEFD to transition to safer gear.
Patagonia Volunteer Fire and Rescue Chief Zay Hartigan said that over the past year, he has seen an elevated awareness of firefighter cancer risks.
“PVFR’s isolation in a small town highlights the different challenges faced by volunteer and career fire departments,” Hartigan said. “Volunteer departments do not have funds to cover the costs of medical exams and are limited in their ability to buy new gear (and) pay for medical exams and extractor washing machines.”
Hartigan relies heavily on fundraising and grants, which usually are specific in scope. PVFR does not have advanced equipment to wash gear, but Meredith has offered use of the SEFD extractor washing machine to PVFR. Gross decontamination for all gear occurs before leaving the scene, and upon return to the station, additional cleaning occurs as needed. PVFR has a new hose washer and minimize storage of potentially contaminated gear/equipment. Volunteers do not receive a physical exam prior to or during time with the station. The chief pushes safety and cancer awareness information to volunteers through various channels and encourages discussions during the monthly general member meetings.
Awareness of cancer risks linked to PFAS exposure for firefighters and data on occupational deaths continue to emerge and are affecting change. In 2017, Arizona expanded the list of health conditions that are presumed to arise from employment, adding 12 types of cancers for firefighting duties and several amendments have occurred since then.
On June 22, the Arizona Legislature passed a new law to further protect firefighters by adding more qualified cancer types and expanding benefits. The new list includes 23 cancers related to employment exposure. The law also states that any disease, infirmity or impairment of a firefighter’s health from covered cancers is presumed to be an occupational disease covered by workers’ compensation provided the firefighter (1) passed a physical examination before employment and the exam did not indicate evidence of cancer, (2) he/she was assigned to hazardous duty for at least five years and (3) the physical examination is reasonably aligned with national fire protection association standards for fire departments. The new law is retroactive to July 1, 2021.
Because of an influx with firefighters being diagnosed with multiple various aggressive end-stage cancers at young ages, the Vincere Cancer Center in Scottsdale, Arizona, established a pilot screening program to study the impact of early aggressive cancer screening for firefighters and first responders. The center reported that firefighters have a 50% increased risk of dying from cancer compared with the general population.
“This is an epidemic amongst our nation’s first responders,” said Vincere’s Dr. Vershalee Shukla, who said he sees three firefighters with terminal cancer each week, adding that early diagnosis is critical, but too often firefighters are at Stage 3 or 4 by the time they are tested.
Kat Crockett is a member of the SEFD board of directors.