Perfluoroalkyl substances toxic to humans are present in both suits and fire-fighting foams, but the Ministry of the Interior does not start the investigations necessary for the safety of firefighters
July 19, 2023
Authors ~ Francesca Cicculli and Laura Fazzini
un pair of boots, thick socks, trousers and a gray polo shirt, a jacket. And then over another pair of trousers and a flame retardant jacket. And still the helmet and gloves. The uniform of a firefighter who is preparing to intervene is a composition of different layers designed to protect the skin from fire, toxic substances and fumes. Several layers to insulate and protect, which leave only the face exposed, which is covered by filter masks only if the intervention requires it. Every firefighter knows he is protected only if he wears all these personal protective equipment (PPE).
To be effective and fulfill their protective role, flame-retardant suits must be built with fire-resistant materials, and those supplied to the National Fire Brigade (CNVV.F) contain Polytetrafluoroethylene (Ptfe), better known as Teflon, and other Pfas, the perfluoralkyl substances known above all for being responsible for one of the largest Italian environmental contaminations, which occurred in the province of Vicenza by the Miteni company .
The investigation in brief
- The personal protective equipment (PPE) of the firefighters, such as the flame retardant suits, contain Teflon, a material composed of Pfas, the perfluoroalkyl substances which have been the subject of analysis and bans for several years because they are toxic and carcinogenic to humans
- IrpiMedia interviewed several Italian firefighters, who said they did not know they were potentially exposed to these toxic substances, nor that they had ever been trained to avoid contamination
- While in the United States the correlation between exposure to Pfas through PPE and some diseases affecting firefighters has been demonstrated, in Italy the Ministry of the Interior underestimates the problem, avoiding analyzes on flame retardant suits and an epidemiological investigation
- IrpiMedia had an Italian firefighter’s flame-retardant jacket analyzed and the concentration of Pfas detected instead suggests that more in-depth investigations should be launched into the safety of the PPE data supplied to the firefighters
Until a few years ago, Teflon contained Pfoa , a Pfas considered carcinogenic and banned since 2013 due to its danger to humans. It is best known for being contained in non-stick pans — it does not spread flames, allows the fabrics to withstand high temperatures, is water and oil repellent, therefore ideal for firefighters’ intervention suits. However, the prolonged wearing time of flame retardant suits, together with the heat due to high temperatures during fires, could increase the human body’s ability to absorb Pfas, which can lead to cardiovascular and thyroid diseases, tumors, hypertension and hypercholesterolemia.
Scientific literature has already amply demonstrated that the most common tumors among those who have been continuously exposed to Pfas are: testicular cancer, mesothelioma, non-Hodgkin’s lymphoma and prostate cancer. According to some US studies these are four of the eight major cancers that affect firefighters with a higher percentage than the normal population.
In Veneto, the second largest aquifer in Europe is polluted
Yet several firefighters interviewed by IrpiMedia said they did not know they were potentially exposed to this toxic substance, nor that they had ever been trained to avoid contamination. While trials are beginning in the United States against the manufacturers of PPE for firefighters and the Biden administration allocates millions of dollars for cancer screening of firefighters, in Italy there are no analyzes and epidemiological studies on firefighters and the Ministry of the Interior gives summary and superficial answers on the potential exposure to Pfas by the National Body.
Many sick people, few investigations
“In the first ten years of service I have seen many people close to me who have fallen ill.” Sergio (name invented to protect his identity as he was already the victim of legal attacks), a firefighter with 30 years of experience in the field, has a firm voice when he tells us about his experience and that of his colleagues with the disease. For many, the cancer arrived around the age of fifty, when they were already retired. In the last two years, at least five people in his command have been affected by various oncological problems: one with the prostate, one with the stomach or pancreas and then two others, like him, with non-Hodgink lymphoma. The youngest among them is 46 years old.
During the chemotherapy sessions, three of five hours every 23 days, Sergio began to wonder if he had done something wrong in his job, if he had always followed all the safety rules or if, in some way, he had accidentally exposed himself to some danger.
In July last year, the International Agency for Research on Cancer (IARC) reclassified firefighting by firefighters as a high-risk occupation for cancer. Research from the University of Central Lancashire in 2020 revealed that 4.1% of police officers surveyed, still on duty, had been diagnosed with cancer compared to 1% of the general population. The most common cancers were skin cancer (26%), followed by testicular cancer (10%), head and neck cancer (4%) and non-Hodgkin’s lymphoma (3%). To cause tumours, according to this research and also according to the Iarc, would be the irritating and carcinogenic toxic chemical substances emitted during a fire in the form of dust, smoke, vapors and fibres, first of all asbestos .
Sergio — who also played the role of firefighters trainer — thanks to his personal experience he tried to explain the decontamination practices that colleagues should follow to minimize exposure to toxic substances. “With the provincial structure we started looking for a way to be able to return to the office after an operation in the best possible way from the point of view of personal hygiene and PPE,” he says. “We started by doing sanitation in place and trying to block dust and fumes. We disassemble the PPE on site and put them in water-soluble bags and then in turn in garbage bags. From there they are taken to the laundry, which can be outside or inside the headquarters».
Example of fireproof jacket supplied to the Fire Brigade — Photo: IrpiMedia
But in 2021, Sergio began to read studies arriving from the United States, where there was talk of a possible correlation between some firefighters’ diseases and the substances already present in the PPE: “I inquired and discovered that our anti-flame suits are constructed in such a way as to have these Pfas in contact with the skin and over time, due to sweat and the high temperatures to which we are subjected, these substances could permeate inside”.
Sergio affirms with certainty that he has never heard from anyone that the flame retardant suits possess Pfas and therefore that he has never taken any precautions in this regard. Confirmation that also comes from Riccardo Boriassi, deputy general secretary of Conapo, an independent union of firefighters: “We knew about the dangers of Pfas because it is known worldwide, but we certainly could not imagine risking having it in contact with our body”.
Irpi Mediaconsulted various specifications of the Ministry of the Interior, discovering that starting from 2010 it is specified that the external membrane of the jacket and trousers must be composed of “Polytetrafluoroethylene (Ptfe) with an expanded microporous structure” and that a suitable Ptfe tape must be applied to the “internal part of the external seams to ensure perfect adherence”. Parts of the firefighting suit are therefore certainly made of Teflon, which could potentially come into contact with the firefighters’ skin and be released due to the extreme conditions to which they are subjected during an intervention. But in Italy no studies have ever been carried out that ascertained the possible exposure to Pfas by firefighters,
“What we know (about the diseases that affect firefighters the most, ed. ) is because it is told to us by colleagues,” Riccardo Boriassi tells IrpiMedia . Boriassi explains that the National Fire Brigade does not follow the Inail legislation which associates pathologies with the profession but, like the other state bodies, follows the system of service causes “where you have the burden of proof to demonstrate that the pathology derives from the service “ .
In the early 2000s, precisely to give answers to the trade union organizations that asked for attention to the problem of occupational diseases, the bilateral Observatory for occupational safety and health policies of the CNVV.F was born, which Boriassi describes as «a meeting point between the various administration offices and the trade union organizations to focus on what the risks to health and safety in the workplace may be. But in fact it has been transformed into a body which then has the power to discuss but does not have the power to decide», claims the secretary of Conapo, who has its own member within the Observatory and assures that the problem of exposure to Pfas and the diseases connected to them has never been addressed even in that forum.
Some firefighters have discovered their pathologies thanks to the health checks they have to undergo every two years. It starts from blood analysis, spirometry, ophthalmology. Then there’s a psychological consultation and an electrocardiogram. “The results are sent to the doctor present in each command, who in case of doubtful reports, can ask you to carry out further tests at your expense”, says Sergio. If the pathology is diagnosed outside of scheduled checks, many decide to hide it to avoid the salary reduction that is triggered when the problem persists for more than nine months. “So people think carefully before making a health problem known as long as they can go on on their own,” explains Sergio, who was among those who decided to hide his pathology.
Meanwhile, in the United States, the fight to defend the health of the firefighters had already begun in 2014 with a sentence: “Yes, it’s cancer”. A doctor at the Worcester (Massachusetts) hospital pronounced it to Paul Cotter, a 55-year-old firefighter who was ill with prostate cancer. A healthy policeman, with no family pathologies, no symptoms, had received the diagnosis after a routine analysis. His wife Diane decides to better understand the reason for that tragedy: she studies the health documents present in the archives of the trade unions and finds a request from the Iaff (International Association of Firefighters) union in 1999 which asked to collect overalls following the death of a firefighter from burns. The suits are certified as suitable by the National Fire Protection Association, a US organization that issues the standards and is half made up of the manufacturers of the suits. Diane starts asking about the composition of the protective equipment, but she gets vague answers. On her Pfoa she is told that she was only present in traces of her.
He then decides to buy a whole new piece of equipment and have it analyzed. Nuclear physics professor Graham Peaslee of the University of Notre Dame offers to do the job. Peaslee’s work, entirely pro bono and published in 2020, demonstrates that the jackets contain Teflon which is constantly released, both during washing and during their use. The new management of the Iaff with the president Ed Kelly obtains confirmation that the jackets are coated with Teflon and manages to sign agreements with the individual states to look for substitutes for both the clothes and the fire-fighting foams, which are also full of Pfas.
In July 2020, Democratic Senator Dan Kildee presents a request to the 116th Congress for a law that protects firefighters from exposure to Pfas due to equipment. Joe Biden’s administration itself in March 2023 earmarked $370 million to support cancer screening for firefighters.
Now Diane and Paul, who has overcome the disease, have embarked on a second battle. On June 5, a criminal trial began against some manufacturers of flame-retardant suits, aided by attorney Robert Bilott who was the first to discover Pfas in West Carolina drinking water in the early 1990s.
The same dangers
US events and studies, also thanks to IrpiMediawhich began working on the issue, arrived two years ago to some Italian firefighters unions, including Conapo and FNS Cisl. The latter, on 7 June 2021, during a meeting of the bilateral Observatory for occupational safety and health policies, requested “specific technical checks from the Administration to ascertain the presence of Pfas in the PPE and foam used by CNVV.F personnel”, given that “in the United States and other EU countries, recent and well-founded scientific studies have found the presence of Pfas in the PPE and in the equipment of firefighters, even discovering that such substances were found not only on the outside of the protective clothing, but also on the inner lining of the same”.
The following day, Conapo also joined the request, which recorded “concern among Italian firefighters after the publication of a research conducted on 135 New Jersey firefighters which revealed the presence in the blood of perfluoroalkyl substance values much higher than the average of the normal population”. The union therefore asked to make known urgently whether these substances were also present in the clothing and personal protective equipment of the Italian firefighters.
The answer comes on June 14, 2021 from the Central Directorate for Logistics and Instrumental Resources headed by the Ministry of the Interior. It is not signed and contains a series of information that the Fns Cisl defines as «approximate and conflicting». In fact, the Ministry claims to have “carried out a check on an analysis document issued by a certified laboratory, as required for supplies of PPE”. The document refers to a supply of flame retardant suits from 2018 which, according to data delivered by the manufacturing company, has “a concentration of PFOA and PFOS < 0.1 μg/m2 (less than 0.1 microgram per square metre, ed)”. The Central Administration then states that: “As far as reported, there is no element that justifies the doubt about the safety of the PPE used by the Italian firefighters, as regards the presence of Pfas” and adds that it must also be considered that “the flame retardant suit is never used in contact with the skin, but more separation garments are interposed, including the intervention uniform”.
The Ministry therefore confirms that the overalls contain Pfas, but does not deem it necessary to investigate the percentage of Pfas present in flame retardant suits, with independent research with respect to what is declared by the manufacturers and certifiers of the garments, or whether these substances could represent a danger for firefighters.
The Ministry’s response therefore did not satisfy the unions, who asked Rome to proceed with a national biomonitoring to evaluate, in a significant sample of firefighters, the possible presence of Pfas in the blood, the possible correlation with some diseases and to proceed, if necessary, with the purchase of clothing free of these substances.
“We would have expected a group of firefighters to be tested. Because regardless of how many Pfas there are in the uniforms, what we actually need to know is whether these then go into the human body and if we absorb them», says Riccardo Boriassi, who adds: «The answer then came from the Central Directorate for Logistics and Instrumental Resources, i.e. those who deal with the purchase of uniforms, we were not answered by the health area of the National Corps, i.e. the one that should have taken care of verifying whether or not there was contamination by these substances. The impression we had is that this of the Pfas is not a problem for our Administration”.
It is also true that the flame-retardant jacket should not be used directly in contact with the skin, but the interviews collected by IrpiMedia return a more complex picture: “By disposition we should wear our shirt, our jacket and also our trousers underneath these jackets, but in some situations it becomes impossible to be dressed in this way, therefore, sometimes you put on trousers and a short-sleeved shirt and go, because otherwise it would be unthinkable to work with very high temperatures inside and outside”, he told Irpi Media Paolo Zanarella, provincial trade union representative of the Fns Cisl in Vicenza .
With a request for access to the documents, IrpiMediaasked the Ministry to be able to view the 2018 flame retardant suit analysis document including the name of the laboratory that had carried out the analysis and the manufacturing company. Two names have emerged from Foia: Alfredo Grassi Spa and the Cotton Textile Center and Clothing Spa (Centrocot). Both companies opposed our first request for access: the first, for reasons of economic and commercial interests — the disclosure of the composition of the complete, according to Grassi, would have represented “an unjustified aid and competitive advantage in the technical development of other operators who would be able to achieve the results obtained over the years by our research activities without any effort” — the second because it was unable to disclose copies of the test reports as it was owned by the customer. Thanks to a review, we were still able to obtain the table with data relating to the percentage of Pfas present in the flame retardant suit — certified by the Centro Cotoniero — which coincide with what was communicated by the Ministry.
The test report on a 2018 flame retardant suit belonging to Grassi Spa. The analyzes were carried out by the Centro Tessile Cotoniero ed Abbigliamento Spa and sent to us by the Ministry in response to a request for access to the documents
In the table provided by the Centro Tessile Cotoniero it is noted that Pfos and Pfoa, the two most toxic compounds, are expressed in a different unit of measurement from that used for the analysis of the other Pfas. According to expert chemists interviewed by IrpiMedia these two units of measurement in a single table would be unusual, since accredited chemical laboratories normally issue results on substances analyzed with the same unit of measurement. We asked the certification center for explanations, but no responses were received.
Alfredo Grassi Spa and Cotton Textile Center and Spa clothing
While the central administration did not carry out independent and in-depth checks and let the Pfas alarm fall on deaf ears, IrpiMedia had a 2014 flame-retardant jacket produced by the Grassi company, which it came into possession, analyzed. We sent the jacket to the United States, to Professor Graham Peaslee, who offered to carry out the analysis for us and measured the total amount of fluoropolymers present in the Italian jacket. His answer is extremely worrying:
«(In general, ed ) fabrics constructed with fluoropolymers have a total fluoride value of approximately 50,000 ppm (parts per million) or higher, this is equivalent to approximately 5% fluorine on the surface. The internal anti-humidity barrier of protective devices is generally made of Ptfe which, when we measure it, returns total fluorine concentrations greater than 20–30%. Your Italian spares appeared to have these total fluoride values identical to those of the spares we measured in the United States and Australia».
According to these statements, the Italian overalls could therefore contain different types of Pfas, such as the US and Australian overalls which, according to Peaslee, have a quantity of Pfoa equal to 2.18 ng/g.
The documents sent by the professor specify that the anti-moisture barrier “was sealed between the outer layer and the thermal one, except at the end of the wrist, where it protruded so as to probably be in contact with the skin of the wrist”. In that area, Peaslee detected an extremely high value of fluoride, off the scale, therefore not measurable by his laboratory.
Graham Peaslee analyzes a flame retardant suit delivered by IrpiMedia to detect the presence of Pfas on the outer and inner surface of the suit
Graham Peaslee analyzes the cuff of the flameproof suit delivered by IrpiMedia, where the moisture barrier protrudes and would be in contact with the firefighter’s skin. In this area, Peaslee detected an extremely high value of fluoride
The Ministry’s data and Peaslee’s show some divergence. One of the two experts consulted explained to us that «the American gives precise numbers, while the Ministry (through the tests of the Centro Tessile Cotoniero, ed. ) did not indicate a specific value».
Not having available a specific concentration like the one sent to us by the American professor, we had the expert convert Peaslee’s data with those received from the Ministry, reducing them to the same unit of measurement. To do this we used the size of the surface of the suit indicated in one of the technical data sheets of the Grassi flame retardant suits (210 g/m2). The results obtained show that the suit analyzed by IrpiMedia has a quantity of Pfoa four times greater than the threshold communicated by the Ministry, and sixteen times greaterfor Pfos. It should be specified that the suit we analyzed had already been used by a firefighter — and therefore a certain amount of Pfas could have collected during an operation — while the table provided to us by Rome probably refers to analyzes carried out on a virgin suit, never contaminated.
Furthermore, the size of the suit could be different and therefore ours is only an estimate, but the data that emerges should at least ask for more in-depth analyzes from the manufacturers of flame-retardant suits and from those who certify them as safe. It is possible that the firefighters are in contact with a high quantity of Pfas, but the Ministry has not been able to provide the analyzes that IrpiMedia has tried to carry out, nor to explain the results obtained by Centrocot. We can hope that from 2014 — the year of the suit analyzed by IrpiMedia– to 2018 — the year of production of the suit viewed by the Ministry — in the meantime the fabrics have been updated and the percentage of Pfas has dropped, but we are not certain: neither the Ministry nor Grassi Spa have answered our questions.
The firefighters interviewed, however, guarantee that an overall replacement of the flame retardant suits has never been requested on a national basis: «Everything that has actually been supplied after 2018 is in addition to the garments, with no indication not to use the previous ones», claims Riccardo Boriassi.
The replacement of clothing takes place at the request of the individual firefighter, when he believes that these are worn out. Currently therefore, some firefighters may still have flame retardant suits from 2014, but also earlier. Paolo Zanarella of the Fns Cisl explains: «The central warehouses make the contracts and buy them (the flame-retardant suits, ed ), to then be assigned to the commands. As far as the command is concerned, we have to say how many we have worn out, after which we have to make a request and we receive only a strictly necessary number to make the replacements. But there has never been a full replacement, for components that hurt, so they told us we will remove them and send you these new ones. Also because if we go back to the Administration’s answer, that’s fine for them”.
The care of one’s PPE, almost all the interviewees add, is the responsibility of the individual, both for cleaning, for conservation and possible replacement. Furthermore, according to the technical data sheets, the individual PPE can only withstand a certain number of washes, preserving their qualities, but the testimonies collected tell us that the washing count is not always done and therefore the flame retardant suits could also be used when they are no longer safe. Many say they don’t know how many washes their suit has done.
Furthermore, it is difficult for a firefighter to have more than one spare of his intervention outfits: “It is very frequent that newly hired firefighters do not even have a spare, that is, if they have to send that item to be decontaminated or thoroughly washed, they can no longer carry out interventions because they do not even have a replacement item”, explains Boriassi. Many may therefore have to use the same garment in several operations during the day, without having carried out the required decontamination. Added to this is another problem: some firefighters, precisely because of the lack of spare parts, decide to wash their suits at home, so as to reduce the time. In this way, however, the PPE could be cleaned without implementing the correct procedures for decontamination and maintenance of its properties,
Lack of alternatives and more stringent rules
Grazia Cerini, Managing Director and Director General of Centrocot, believes that at the moment there are no alternatives as valid as the Pfas for flame retardant suits which, although harmful, guarantee firefighters protection from fire. This is also confirmed by Marco Colli, head of Dpi tests, inspections and certifications of the same certification center, who tells IrpiMedia how already the mere replacement of the most harmful Pfas with those not yet banned has already signaled a deterioration in the quality of the suits. The new Pfas make Teflon less resistant, a victim of high temperatures and washing: «The treatment (on firemen’s clothing, ed.) remains less on the surface, therefore with washing it tends to disappear and the protection is no longer given as it was originally. Pfas are the only way to give this type of protection to firefighters’ clothing, because they are garments that protect against many risks: heat, fire, contact with water, chemical agents», explains Marco Colli, according to whom most of the suits he analyzes — regardless of the manufacturing company — lose their protective qualities after only 25 washes.
Centrocot issues both mandatory and voluntary European certifications, such as OEKO-TEX® Standard 100 — also possessed by Grassi overalls — which sets more stringent criteria than European standards and establishes a maximum limit of Pfas equal to 250 µg/kg. Limit which, according to the data received by the American professor, could have been exceeded by the overalls used by the Italian firefighters at least until 2014. From the first quarter of 2023, OEKO-TEX has however established a general ban on the use of Pfas in fabrics that possess the Standard 100 certification. The flame retardant suits of the Grassi company should therefore be re-analysed before granting this voluntary certification again, which also guarantees additional points for the award of tenders high.
The European certification for PPE instead provides for verifying only if the device protects or does not protect — in the case of firefighters from flames and toxic substances — if it has the right pH and if it releases carcinogenic aromatic amines, prohibited by law, but does not say anything about the Pfas. There is therefore no mandatory European directive that controls the use of Pfas in firefighters’ PPE.
Exposure to Pfas for firefighters is a topic that has been addressed since 2020, in response to a European regulation that banned the use of Pfoa in fire-fighting foams. The firefighters interviewed claim that in Italy the foams have been replaced with Pfas-free foams, but it is impossible to verify whether the replacement has affected the whole national territory as the competence belonged to the individual regional commands and the Ministry did not answer our questions. In some commands, however, the old foams may still be used for internal exercises and the vehicles may not have been thoroughly cleaned to prevent the new foams from becoming contaminated. Firefighters could therefore still be exposed to PFAS also through old foam or traces of these, as well as by means of overalls. A more in-depth investigation into the exposure of firefighters to PFAS and the possible consequences that these may have caused on firefighters is becoming increasingly urgent.
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