Changing the Conversation about the Dangers of Fire Smoke
The dangers of long-term exposure to cyanide & CO is garnering more attention
By Shannon Pieper

Do you wear your SCBA until overhaul is complete? Does your department maintain—and enforce—SOPs for gas detection on the fireground? When locating command posts and rehab areas, do you take into account their exposure to smoke?

Over the past several years, the conversation about the dangers firefighters are exposed to on the fireground has started to shift. Now that most departments are doing an effective job of ensuring proper SCBA and PPE use during a fire attack (protection from short-term effects), we are beginning to see a new focus on the need to protect firefighters from the long-term effects of smoke exposure—hence the questions above.

Seven years ago, Rob Schnepp, assistant chief of the Alameda County (Calif.) Fire Department, started researching smoke. “It arose out of curiosity on my part about smoke,” Schnepp says. I wondered why I sometimes had a headache and felt bad after a fire - sometimes for several days. That drove me to try to understand why that was happening.” Now, Schnepp has become a leader in educating firefighters about exposure to toxins in smoke. He taught “Fire Smoke: Perceptions, Myths and Misunderstandings,” sponsored by Meridian, today at FDIC in Indianapolis.

“If you turn the clock back six or seven years, that was the beginnings of the discussion about the toxicity of fire smoke,” Schnepp says. “It should have been obvious, but it wasn’t. And then the discussion has matured over the years, and it’s become more of a hot topic as firefighters get to know the full complement of things that are in smoke.”

Today, we hear more and more about the role smoke exposure plays in common long-term health problems firefighters have, including cancers, Parkinson’s disease and respiratory diseases—many of which show up after the firefighter has retired. “Now that the awareness level [of the danger] has increased, we start to ask deeper and more probing questions about the dangers we’re being exposed to,” Schnepp says.   

Why Cyanide?
Typically, we hear about CO poisoning and the risk of cancer from carcinogens in smoke. But Schnepp is increasingly involved in educating firefighters about the dangers of cyanide poisoning. “Carbon monoxide is a product of combustion; we’ve heard that for years and we accept it; it’s ingrained in us,” Schnepp says. “People just stopped the discussion there, because they thought they’d found the culprit, but recent studies show that cyanide also plays a part because of all the synthetic materials that are found in structures today. An apartment fire you see today is very different from an apartment fire 20 years ago.”

But cyanide poisoning is elusive. Although CO can be easily tested in the field, cyanide testing involves a more complex process that can only be completed by a few dozen labs across the country. Symptoms of cyanide poisoning and CO poisoning also mirror one another. “It’s not so easy to separate the two,” Schnepp says. “It’s safer to say that you’ve likely been exposed to both at some level.”

That’s why, Schnepp says, more departments are beginning to conduct air monitoring at fire scenes. Some departments are also carrying new cyanide poisoning treatments on engines. Hydroxocobalamin, a relatively new product that premiered at last year’s FDIC under the name CYANOKIT, can be used for cases where cyanide poisoning is merely suspected, not confirmed.  

Beyond Treatment
Schnepp notes that even when antidotes are easily administered with few side effects, fire departments must look for other approaches to reduce exposure. “In the perfect and ideal world, cyanide antidotes would be readily available on whatever apparatus is responding,” he says. “But you have to balance that against reality and budgets. It’s a matter of coming up with an appropriate and reasonable deployment model, based on your own department’s response mechanism.”

Awareness and education is an important part of that balancing act. Departments may need to look at SOPs that govern exposure limits, how long firefighters are required to wear SCBA, location of command posts, , etc. But Schnepp emphasizes that it’s not just about policies and procedures. “Safety boils down to a personal choice; you can’t completely legislate safe behavior,” he says. “So you have to provide a compelling case, substantiate the information for your people to understand why they need to protect themselves. If they’re informed , you can see behavior changes at the back end—someone decides to put their mask on.”

But that’s a long battle, and one that requires leadership and personal responsibility. “There’s a complacency out there about our own operating environment in the fire service,” Schnepp says. “Every member of the fire department, from the lowest ranking or newest member to the fire chief, has to understand that there is a problem that exists and that the issues may not be uncovered for years and years, until someone retires after 30 years of service and gets an unusual form of cancer. There are answers out there and ways to reduce your exposure over time. Leadership and change has to start from the top. We have to stand up in our own agencies and pay attention to this issue.”

So think about the questions at the beginning of this article again. Are you comfortable with your answers?

Shannon Pieper is senior deputy editor for FireRescue magazine.