A recent BBC News report highlighted research results by the University of Central Lancashire (which complemented research in the US) and established that the UK faces the same problem of an excess of cancers in older and retired firefighters. The likelihood of a fire-fighter in either country contracting cancer is over 30% greater than for the general population. This month we look at what has been done so far about this and the contribution which the professional laundering and textile rental sectors can make.

Which cancers are we talking about?

  • Testicular cancer (2.02 times greater risk)
  • Multiple myeloma (1.53 times greater risk)
  • Non-Hodgkin’s lymphoma (1.51 times greater risk)
  • Skin cancer (1.39 times greater risk)
  • Prostate cancer (1.28 times greater risk)
  • Malignant melanoma (1.31 times great risk)
  • Brain cancer (1.31 times greater risk)
  • Colon cancer (1.21 times great risk)
  • Leukaemia (1.14 times greater risk)
  • Breast cancer in women (preliminary study results from the San Francisco Fire Department)

These are not rare cancers – they affect large numbers of the population, both in North America and in Western Europe. The numbers of fire-fighters suffering is therefore likely to be significant and it calls for swift and expert action.

Which chemicals pose the greatest risk?

Neither the research in the US nor in the UK has attempted to pinpoint which carcinogens are likely to be responsible for these results and this is not really relevant. Modern firefighters are faced with a bewildering array of potential carcinogens in every fire they deal with, resulting from the thermal breakdown and high temperature oxidation of whichever construction materials happen to be involved in any particular blaze.

This leads to the considerable risk of inhalation if not using self-contained breathing apparatus (SCBA) and the constant risk of absorption through the skin. This could be directly from liquid contact or from the effect of noxious vapours, especially at sweaty joints, the neck and the wrist. The latest studies serve to confirm the results of earlier ones and the attribution of the risk to carcinogens released in a blazing building appears entirely reasonable. Indeed, in some US regions it is understood that litigation claims against the fire authorities relating to cancers in firefighters are now based on a presumption of liability on the part of the authority. Research work in this area has been spearheaded by the Fire-fighters Cancer Foundation (FFCF).

Steps taken so far to address this issue

There has been some excellent work by firefighting associations in the US, which is freely available on-line. For example, the National Fire Protection Association (NFPA) has produced a Standard on Selection, Care and Maintenance of Protective Ensembles for Structural Firefighting and for Proximity Firefighting (NFPA-1851). This presents a common-sense approach that includes hosing down of gross contamination before removing protective wear, safe removal techniques, bagging and transportation to the cleansing facility (which is often a washing machine in the fire station) and so on. The approach to cleansing protective wear is to assume that it is contaminated with a wide variety of polar and non-polar (that is both oily and water-soluble) contaminants, along with particles and fibres. Even the most benign solid particles become hazardous if they are very tiny (as work in the UK on PM2.5 particles has shown). A single asbestos fibre can cause serious lung disease. It is therefore deemed vital to decontaminate protective fire-wear after every wearing.

In speaking to a UK front-line firefighter approaching retirement it became apparent that at grass roots level there is widespread awareness of the increased cancer risk and the probable link to occupational exposure. This was reported by LCN in June 2018 and has featured on BBC News in September 2019 and it is still being informed by some excellent independent research at the University of Central Lancashire. However, none of this appears yet to have been reflected in revised risk assessments and codes of practice and there has been little input from the commercial laundry sector.

Why can modern fire-wear be difficult to decontaminate?

Fire fighters are expected to enter areas where there is intense heat and smoke and this requirement is assisted considerably by the scientific design of the multilayer structures used, which give much enhanced protection and greater wearer comfort. However, it is difficult to achieve this with fabrics which are typically used for rugged workwear, such as heavy-duty cotton twill, polycotton or 100% polyester. The fabrics now used demand care in laundering and the use of low to medium temperatures. Aggressive chemistry at high temperature with vigorous mechanical action often produces very short service lives and early loss of protection.

This is where the skills of the professional launderer come in. To be successful the decontamination process must address the following:

Particles from the finest soot to highly reactive powders must be taken off the at the first attempt in the wash and not allowed to redeposit onto the fabrics. This calls for adequate detergency, in both pre-wash and main wash, to lift them off the material in the first place, combined with powerful suspending agents to wrap around each individual particle and keep them in the wash liquor until they can be discharged to drain at the end of each stage. The suspending agents must neutralise any electro-chemical charge on the particle, so as to overcome the natural attraction of the fabric for the particle, as well as providing a physical barrier around each particle to prevent re-deposition.

Fibres lodged in the fabrics must be removed in the same way as particles – the same suspending agents as used for particulate suspension should work also for fibres.

Oily carcinogens can usually be removed with plenty of detergent and alkali, with vigorous mechanical action at high temperature, but this is generally not feasible with firewear, because of the sensitivity of the layered structure. A chemical solution is needed. The best approach is to use a wide range emulsifier, built to solubilise everything from eucalyptus oil with an HLB (hydrophilic-lipophilic balance) ratio of around 7 right up to mineral oil blends with an HLB of 15 or 16. An emulsifier blend that will work at a temperature of 40 – 50C is needed, probably at a pH of 7 to 9. This must be partnered with a detergent, effective at relatively low concentration (to avoid the risk of foaming).

The above process should also be adequate to remove polar carcinogens, because these should dissolve in water with the help of the detergent.

Each batch of fire-wear should be disinfected to avoid spreading of infections and this must work at the low temperatures mentioned to optimise service life of the expensive assemblies involved. This usually rules out implied thermal disinfection and calls for chemical disinfection. In order to prevent damage to any of the fabric layers in modern fire-wear, it makes sense to use one of the processes which have been tested and certified by an organisation such as the Robert Koch Institute in Europe or the equivalent body in the US.

Where should the decontamination be situated?

Many fire stations possess small washing machines and there is a strong temptation to adapt these to the task of adequately decontaminating protective wear. However, there are good reasons to dissuade individual stations from doing this. The laundry chemicals need appropriate handling and it is far better to do this in a professional machine equipped with automatic dosing, using processes designed by a professional laundry chemicals supplier and monitored on a regular basis by them for adequacy and performance.

The number of processes through which each piece of protective kit has been passed should be monitored. This is best done with one of the RFID systems now coming into use across the laundry and textile rental sector. The most comparable systems are probably those used in Germany, The Netherlands and the UK for monitoring the decontamination history of specialist surgical gowns made from barrier fabrics. It is now possible to allocate an allowable maximum number of washes to each fire-wear garment and to monitor the number it has experienced to date entirely automatically. The latest RFID readers can correctly list every item in a bag without the need for the bag to be opened in the workroom. By making the bag so that it either opens or dissolves in the wash process itself, the risk to the washroom operative is further reduced.

How effective are the wash processes currently in use?

Research in this area is very limited, but an NFPA research meeting in August 2019 did receive an early indication. Early scoping work suggested that current removal techniques based on standard commercial wash chemistry would only remove around 40% of many potential carcinogens from used protective wear. This is only an indicative result – the research workers are still working how to measure removal accurately when most of the numerous chemical species involved are effectively unknown – but it nevertheless rings alarm bells. Parallel work in the UK on the effectiveness of washing for removing very fine particulates was more encouraging, suggesting over 90% removal, but this does depend strongly on the use of the correct process first time. If a weak process allows re-deposition of particles from the wash liquor back onto the clean fabric, then subsequent recovery becomes much more difficult. It is also becoming apparent that for total success the protective garment must be decontaminated after every use.


The firefighting teams in the US appear to have led the way with this ground-breaking research, revealing both a serious problem and ways of tackling this, to reduce the considerable increase in cancer risk which firefighters are facing. The university research teams in the UK have established that there is a similar risk to firefighters in this country, which means that the problem is almost certainly relevant worldwide. Building materials, chemicals used in industry and everyday manufacturing components are similar in every developing economy. This is not just a US and UK problem.

The one glaring omission from the research described so far has been the absence of a strong input from the professional laundering and textile rental sectors. This is a problem area that should not be dismissed as a small niche market. It needs addressing at national level and the launderer is well-placed to make a significant difference.


Who takes the risk?

Owner’s risk disclaimers are used by the majority of cleaners/wetcleaners to avoid the risk of litigation if an ‘at risk’ item fails during cleaning. While this can be a perfectly legitimate means of avoiding a potential payout, in the event of a dispute, ‘Owner’s Risk’ scribbled on the back of the customer’s collection ticket will be no defence; if a customer decides to take you to court you will almost certainly need to produce evidence that you brought to the customers attention, the precise nature of the risk(s) anticipated.

In the case of items of limited value the cleaner will often accept any low risk items perhaps following a brief discussion with the customer or, in cases of increased risk, decline to accept the item. Where high value and designer items are involved and where the risk/value relationship is unacceptable, the cleaner needs to explain to the customer clearly and precisely what risks are anticipated and create a record. When problems arise between the cleaner and the customer, they are frequently due to a complete failure to adequately explain the risks and in the absence of documentation recording what was discussed, both cleaner and the customer can be prone to selective memory. This leads to acrimonious situations which inevitably reflect badly on the cleaner

Cleaners have a duty of care and must at all times handle their customers’ clothes professionally and competently. Signing an owner’s risk form does not relieve them of this responsibility. In effect this means that, for example, if the care label states ‘Dry Clean Only’, wetcleaning would only be acceptable provided drycleaning has already proved ineffective or extensive water based staining makes a water based process the only option.

When assessing risk my advice would be if you do not believe you have at least a 70% chance of a successful outcome, do not accept the item. Even if the customer has accepted the risk they will not be happy if things turn out badly. Finally, with high value items it is a good idea to confirm that the customer is actually the owner of the garment and not a friend or relative.

While the owner’s risk document below may not necessarily be legally binding, it does confirm the risks foreseen by the cleaner, acknowledged and signed by the customer. Members of The Guild of Cleaners & Launderers can download the form from the Guild website, https://gcl.org.uk/ and disclaimer form will be an option on the opening browser. Just delete risks that do not apply.

Roger Cawood FGCL