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Keeping Volunteer Firefighters Safe from Cancer: A Father/Daughter Conversation 

Written by: Rachel Schramm, Program Manager, Iowa Cancer Consortium & Dan Neenan, Director, National Education Center for Agricultural Safety 

Introduction 

Iowa’s volunteer fire departments are tasked with protecting Iowa’s smaller and rural communities. Of approximately 850 fire departments across the state, about 92% are volunteer fire departments. When I was just about to enter Kindergarten, our family moved to Epworth, Iowa – a small town located in northeast Iowa (population 1,300). Shortly after we arrived, a friendly firefighter in town drove by to welcome us and encouraged my dad to come with him to the weekly fire department meeting the next day. Eager to connect with the community and learn what firefighting was all about, he went. And the rest is history. 

My dad has served as a firefighter/paramedic for the Epworth Fire Department for nearly 35 years, and our family has been along for the ride. Being at a fire station as an adult brings me back to being a little girl and the smell of soot on his clothes after a call, the eight o’clock pager checks each evening, and my heart flutter when I saw his truck leaving our garage with emergency lights flashing – thinking “my dad is a helper, and I want to be just like him.” And now, as a public health professional, I was able to sit down with him and chat about how the fire service has evolved during his tenure related to cancer prevention. 

Volunteer Firefighters & Cancer Risk 

Firefighters are exposed to chemicals that can increase their risk for developing cancer. In the United States, nearly two-thirds of firefighters serve their community as volunteers – and yet, are often overlooked in occupational health studies. In 2021, researchers from institutions across the country came together to establish the Firefighter Cancer Assessment and Prevention Study (CAPS), part of the larger Fire Fighter Cancer Cohort Study (FFCCS) to close the research gap. The study officially ended last year (2025), and found that compared to their career firefighter counterparts, a higher proportion of volunteer firefighters reported health behaviors linked to cancers – including higher rates of tobacco and alcohol use, lower levels of physical activity, etc. In addition to the known carcinogenic exposures (like smoke and chemicals) associated with firefighting, the study findings suggest lifestyle factors are an important set of risk factors to address among volunteer firefighters to reduce overall cancer risk. While volunteers typically respond to fewer calls over the short-term, they typically spend more years in service than a career firefighter – extending their cumulative exposure to carcinogens throughout their lifespan.  

Gear & Equipment 

Personal Protective Equipment (PPE) for firefighters is necessary, and very costly for any fire department! Estimates suggest one PPE ensemble can cost upwards of $14,138 per firefighter! And in an ideal scenario, each firefighter would have two sets of gear to rotate between for emergency calls (example: one in the wash, one clean to wear). A firefighter’s PPE includes a helmet, coat/pants, suspenders, boots, hood (protects the head, face, neck, and upper chest from heat, flames, smoke, and dangerous carcinogenic particles), gloves, personal alert safety system (PASS), and self-contained breathing apparatus (SCBA).  

Thirty years ago, firefighter gear was designed with one goal in mind: to protect against heat and flames – with little to no thought about protection from carcinogens. At the same time, gear was only washed due to visible dirt and stains. 

Ideally, a department would have two sets of gear available for each firefighter, so they would have a clean set of gear while the other was being washed. However, because of the high cost, many volunteer departments can only afford one set of gear per firefighter. The National Fire Protection Association (NFPA) standards require replacement of turnout gear every 10 years. Therefore, many departments must rely on community grants or fundraising efforts to make these safety upgrades possible. Cost can also be a barrier for volunteer departments to purchase more than one industrial washing machine for firefighters to use to clean their gear at the fire station.   

I remember a call where we responded to a car accident on a really cold night. and I pulled up my Nomex hood over my mouth and nose to stay warm. I don’t do that anymore; I was probably breathing carcinogens directly into my lungs.   

What’s Next 

The volunteer fire community is making changes to put the health of firefighters first. Lessons on cancer prevention procedures in firefighting are required as part of firefighter training, both in Iowa and across the nation. This ensures that the newest generation of firefighters will have a cancer prevention mindset starting at the beginning of their career. Gone are the days of believing soot on your face made you a ‘real’ firefighter. Requiring the proper PPE during the “salvage and overhaul” or the post-fire clean-up period and the modeling cancer prevention behaviors by leadership goes a long way to change the culture and attitudes within the department. And finally, advancements to modern firefighter gear design are everchanging. The latest gear offers layered protection and safer materials (including PFAs alternatives) to resist water and shed soot easier, and the materials used are tested to withstand more frequent washing without breaking down. Promising innovations like smart sensors (for measuring toxins) are also on the horizon. 

Advice from Dad: 

  • Don’t keep your fire gear in the cab of your truck or inside your living spaces – it can expose you and your family to the off-gassing chemicals. Instead, store them in the bed of your truck or outside your living spaces.  
  • Keep wet wipes in your vehicle for after a fire call to wash your face, take a shower right away upon return. 
  • If your volunteer department is able, set aside funds on an annual basis to update and replace turnout gear. This allows for the purchases to happen gradually, instead of being replaced all at once for a large expense. 
  • Technology advancements alone are not enough – we need continued education and cultural shifts within the fire service to keep firefighters safe and reduce cancer risk. Protecting firefighters from cancer isn’t just about gear, it’s about mindset. 

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