Polycyclic aromatic hydrocarbons at fire stations: firefighters' exposure monitoring and biomonitoring, and assessment of the contribution to total internal dose

Biomonitoring of polycyclic aromatic hydrocarbons exposure and short-time health effects in wildland firefighters during real-life fire events

Human biomonitoring data retrieved from real-life wildland firefighting in Europe and, also, worldwide are scarce. Thus, in this study, 176 Portuguese firefighters were biomonitored pre- and post- unsimulated wildfire combating (average:12-13 h; maximum: 55 h) to evaluate the impact on the levels of urinary polycyclic aromatic hydrocarbons hydroxylated metabolites (OHPAH; quantified by high-performance liquid chromatography with fluorescence detection) and the associated short-term health effects (symptoms, and total and differentiated white blood cells). Correlations between these variables and data retrieved from the self-reported questionnaires were also investigated. Firefighters were organized into four groups according to their exposure to wildfire emissions and their smoking habits: non-smoking non-exposed (NSNExp), non-smoking exposed (NSExp), smoking non-exposed (SNExp), and smoking and exposed (SExp). The most abundant metabolites were 1-hydroxynaphthalene and 1-hydroxyacenaphthene (1OHNaph + 1OHAce) (98-99 %), followed by 2-hydroxyfluorene (2OHFlu) (0.2-1.1 %), 1-hydroxyphenanthrene (1OHPhen) (0.2-0.4 %), and 1-hydroxypyrene (1OHPy) (0.1-0.2 %); urinary 3-hydroxybenzo(a)pyrene was not detected. The exposure to wildfire emissions significantly elevated the median concentrations of each individual and total OHPAH compounds in all groups, but this effect was more pronounced in non-smoking (1.7-4.2 times; p ≤ 0.006) than in smoking firefighters (1.3-1.6 times; p ≤ 0.03). The greatest discriminant of exposure to wildfire emissions was 1OHNaph + 1OHAce (increase of 4.2 times), while for tobacco smoke it was 2OHFlu (increase of 10 times). Post-exposure, white blood cells count significantly increased ranging from 1.4 (smokers, p = 0.025) to 3.7-fold (non-smokers, p < 0.001), which was accompanied by stronger significant correlations (0.480 < r < 0.882; p < 0.04) between individual and total OHPAH and total white blood cells (and lymphocytes > monocytes > neutrophils in non-smokers), evidencing the impact of PAH released from wildfire on immune cells. This study identifies Portuguese firefighters with high levels of biomarkers of exposure to PAH and points out the importance of adopting biomonitoring schemes, that include multiple biomarkers of exposure and biomarkers of effect, and implementing mitigations strategies.

Assessment of PAH exposure and health risks among South Korean firefighters based on urinary PAH metabolites

Polycyclic aromatic hydrocarbons (PAHs) comprise a group of compounds resulting from the incomplete combustion of organic matter. Firefighters engaged in fire suppression are highly exposed to PAHs. This study centered on evaluating the exposure levels and health risks of PAHs in South Korean firefighters involved in firefighting activities. The concentrations of 10 PAH metabolites in the urine of firefighters were measured immediately after, and two weeks post their engagement in extinguishing a large tire factory fire. The levels of OH-PAHs in urine samples immediately after fire suppression were elevated by a factor of 1.01-1.84 compared to urine samples from non-exposed period. The median concentration of total PAH metabolites (OH-PAHs) was higher in urine samples immediately after fire suppression (5910 ng/g creatinine) than in urine samples from non-exposed periods (5020 ng/g creatinine). However, the ∑OH-PAH levels in firefighters' urine were related to personal habits such as smoking. The concentrations of all individual OH-PAHs in the urine samples of nonsmokers exhibited a substantial increase, ranging from 1.37 to 2.3 times, clearly demonstrating that firefighting activities were a substantial source of PAH exposure. The calculated values associated with the health risks stemming from exposure to PAHs, including carcinogenic risk, total estimated daily intake (TEDI), and hazard quotients/index (HQs/HI), all fell within acceptable limits, indicating negligible risk. However, the HQ/HI values and TEDI for individual and total PAH exposures, except those for naphthalene, were 1.36-2.00 times higher in firefighters' samples taken after firefighting operations compared to those during regular duty. This underscores the need for more comprehensive investigations to comprehend the singular impact of firefighting activities due to the diverse sources of PAH emissions in the environment.

Baseline data and associations between urinary biomarkers of polycyclic aromatic hydrocarbons, blood pressure, hemogram, and lifestyle among wildland firefighters

Introduction

Available literature has found an association between firefighting and pathologic pathways leading to cardiorespiratory diseases, which have been linked with exposure to polycyclic aromatic hydrocarbons (PAHs). PAHs are highlighted as priority pollutants by the European Human Biomonitoring Initiative in occupational and non-occupational contexts.

Methods

This cross-sectional study is the first to simultaneously characterize six creatinine-adjusted PAHs metabolites (OHPAHs) in urine, blood pressure, cardiac frequency, and hemogram parameters among wildland firefighters without occupational exposure to fire emissions (> 7 days), while exploring several variables retrieved via questionnaires.

Results

Overall, baseline levels for total OHPAHs levels were 2 to 23-times superior to the general population, whereas individual metabolites remained below the general population median range (except for 1-hydroxynaphthalene+1-hydroxyacenaphtene). Exposure to gaseous pollutants and/or particulate matter during work-shift was associated with a 3.5-fold increase in total OHPAHs levels. Firefighters who smoke presented 3-times higher total concentration of OHPAHs than non-smokers (p < 0.001); non-smoker females presented 2-fold lower total OHPAHs (p = 0.049) than males. 1-hydroxypyrene was below the recommended occupational biological exposure value (2.5 μg/L), and the metabolite of carcinogenic PAH (benzo(a)pyrene) was not detected. Blood pressure was above 120/80 mmHg in 71% of subjects. Firefighters from the permanent intervention team presented significantly increased systolic pressure than those who performed other functions (p = 0.034). Tobacco consumption was significantly associated with higher basophils (p = 0.01-0.02) and hematocrit (p = 0.03). No association between OHPAHs and blood pressure was found. OHPAHs concentrations were positively correlated with monocyte, basophils, large immune cells, atypical lymphocytes, and mean corpuscular volume, which were stronger among smokers. Nevertheless, inverse associations were observed between fluorene and pyrene metabolites with neutrophils and eosinophils, respectively, in non-smokers. Hemogram was negatively affected by overworking and lower physical activity.

Conclusion

This study suggests possible associations between urinary PAHs metabolites and health parameters in firefighters, that should be further assessed in larger groups.

Assessment of phthalate exposure at a fire site in Korean firefighters

To determine phthalate exposure in 32 firefighters, the concentrations of urinary phthalate metabolites, immediately (exposure day) and three weeks (control day) after fire suppression, were compared. Mono-(2-ethyl-5-carboxypentyl) phthalate, mono-(2-ethyl-5-hydroxyhexyl) phthalate, mono-(2-ethyl-5-oxohexyl) phthalate, mono-n-butyl phthalate (MBP), mono-n-benzyl phthalate (MBzP), and total phthalates (∑phthalates) levels, and creatinine-adjusted levels of MBP, MBzP, and ∑phthalates were significantly higher on exposure day than on control day. Phthalate concentration was significantly higher in firefighters who performed the fire extinguishing tasks (geometric mean [GM], 149.9 μg/L) than in those who performed other tasks (GM 70.8 μg/L) (p = .012). The GM concentration of firefighters who were active ≤ 50 m from the fire was 119.0 μg/L, and 37.6 μg/L for those who were > 50 m away (p = .012). The GM concentration was significantly different (p = .039) in firefighters with subjective symptoms after fire suppression (151.9 μg/L) compared to those without symptoms (81.6 μg/L). This study showed that firefighters were exposed to phthalate.

Firefighters' personal exposure to gaseous PAHs during controlled forest fires: A case study with estimation of respiratory health risks and in vitro toxicity

Firefighters are daily exposed to adverse health-hazardous pollutants. Polycyclic aromatic hydrocarbons (PAHs), well known endocrine disruptors with carcinogenic, mutagenic, and teratogenic properties, are among the most relevant pollutants. The characterization of firefighters' occupational exposure to airborne PAHs remains limited; information is scarce for European firefighters. Also, the in vitro assessment of firefighters' respiratory health risks is inexistent. To reply to these scientific gaps, this work characterizes the levels of gaseous PAH in firefighters' personal air during regular working activities at controlled forest fires and at fire stations (control group). Breathable levels were 2.2-26.7 times higher during fire events than in the control group (2.63-32.63 μg/m3versus 1.22 μg/m3, p < 0.001); the available occupational guidelines (100 and 200 μg/m3 defined by the US National Institute for Occupational Safety and Health and the North American Occupational Safety and Health Administration, respectively) were not exceeded. Concentrations of (possible/probable) carcinogenic PAHs were 1.9-15.3 times superior during firefighting (p < 0.001). Increased values of total benzo(a)pyrene equivalents (p = 0.101), dose rates (p < 0.001), and carcinogenic risks (p = 0.063) were estimated in firefighters during controlled fires comparatively with the control group. Firefighters' breathable gaseous phase collected during fire events contributed to induce a significant viability decrease (<70 %; p < 0.05) in A549 and Calu-3 cell lines. The principal component analysis (PCA) allowed the differentiation between firefighters participating in controlled fire events from the control group. PCA analysis demonstrated the potential of PAHs to distinguish different sources of firefighters´ occupational exposure and of combining estimated health risk parameters with in vitro toxicities determined with human-breathable air collected during real-life scenarios. Overall, the participation in controlled fire events contributes to the respiratory health burden of firefighting forces. However, more studies are needed to corroborate these preliminary findings, explore the respiratory toxicological mechanisms, and support the implementation of preventive actions and mitigation strategies to pursue firefighters' health.

Air pollution inside fire stations: State-of-the-art and future challenges

Firefighters are frequently exposed to products of combustion and pyrolysis. Exposure to these substances occurs not only during fires but also at fire stations, particularly where fire equipment and fire uniforms are stored after firefighting operations. The aims of this study were to review the research on the concentrations of various air pollutants in fire stations, identify the limitations and strengths of such research, identify research gaps and related future challenges, and highlight potential solutions for reducing firefighter exposure to air pollution at fire stations. A total of 32 articles published in international journals during 1987-2023 were selected for analysis. The most frequently studied pollutants in fire stations were polycyclic aromatic hydrocarbons, particulate matter, and diesel particulate matter. Research was most often conducted on changing rooms and garages. Firefighting equipment, personal protective equipment, fire trucks, and combustion tools were identified as the main sources of pollution at fire stations. Recommendations aimed at reducing the concentration of pollutants in fire stations were mainly concerned with the systematic decontamination of equipment and the introduction of ventilation solutions that would remove exhaust fumes from garages. This in-depth literature review indicates a lack of comprehensive research on the state and quality of air at fire stations. It also highlights the emerging need for more knowledge on the concentrations of air pollutants in fire stations, health exposure related to these substances, and an analysis of the effectiveness of the proposed solutions.

The effect of polycyclic aromatic hydrocarbon biomarkers on cardiovascular diseases

Polycyclic aromatic hydrocarbon (PAHs) are part of particulate matter (PM), which is produced from incomplete combustion of organic matter. Biomarkers mean biological indicators, molecules that indicate a normal or abnormal process in the body and may be a sign of a condition or disease. Studies show that PAHs increase the risk of cardiovascular diseases through processes such as oxidative stress, inflammation and atherosclerosis. The present study focused on the evaluation of health effects PAHs biomarkers on cardiovascular diseases (CVD). In this narrative study, data were collected from databases such as Scopus, PubMed, Web of science and Google Scholar in the period 1975-2023. After screening, duplicate and irrelevant articles were removed. Finally, 68 articles related to the effect of PAHs on CVD were included in the study. In addition to the articles found through the search in databases, another 18 articles from the references of the selected articles were included. According to the finding in during the biotransformation of PAH, a number of metabolites are made, such as phenols, diols, quinones, and epoxides. Phenolic isomers have the highest percentage and biomarkers used for their detection include 2-OHNAP used to trace naphthalene from heating processed food, 3-OHPHEN used to trace phenanthrene from diesel, 2-OHFLU used to trace fluorene and 1-OHPYR used to trace pyrene from cigarette and hookah smoke. According to the result, increasing blood pressure and heart rate and causing atherosclerosis are the main complications due to exposure to PAH metabolite on cardiovascular system. The most important agents that causes this affects including increased homocysteine, cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), serum biomarkers of C-reactive protein, and triglycerides. Result this study showed that cardiovascular diseases risk is increased by exposure to PAH biomarkers from smoking, car emissions, occupational exposure, and incinerators. Therefore, strict controls should be implemented for sources of PAH production and exposure.

Qualitative Assessment of Off-Gassing of Compounds from Field-Contaminated Firefighter Jackets with Varied Air Exposure Time Intervals Using Headspace GC-MS

Firefighters are exposed to a complex mix of volatile and semi-volatile compounds from burning construction materials, consumer products, and other elements during fire suppression and rescue. These compounds can be absorbed onto the gear worn by firefighters and, depending on their volatility, can be released from the gear under different conditions. Few studies have focused on the off-gassing of toxic compounds from firefighters' gear, particularly in terms of qualitative analysis methods. This study introduces a novel qualitative analysis method using headspace gas chromatography-mass spectrometry (HS-GC-MS) to assess off-gassing from field-contaminated jackets at regular intervals. Our findings show that certain compounds, such as acetic acid and di-ethyl-hexyl-phthalate (DEHP), remained present even after the gear were allowed to air out for 48 h. The persistent off-gassing of chemicals, even under ambient conditions, raises concerns about potential hazards that could pose risks for personnel in the vicinity of contaminated gear, including inside fire stations. The implications of these findings extend beyond fire stations and may have significant public health implications for firefighters who are repeatedly exposed to these compounds over time.

In vitro data for fire pollutants: contribution of studies using human cell models towards firefighters' occupational

Firefighters are the principal line of defense against fires, being at elevated risk of exposure to health-relevant pollutants released during fires and burning processes. Although many biomonitoring studies exist, only a limited number of human in vitro investigations in fire risk assessment are currently available. In vitro studies stand out as valuable tools to assess the toxicity mechanisms involved following exposure to fire pollutants at a cellular level. The aim of the present review was to contextualize existing in vitro studies using human cell models exposed to chemicals emitted from fire emissions and wood smoke and discuss the implications of the observed toxic outcomes on adverse health effects detected in firefighters. Most of the reported in vitro investigations focused on monocultures respiratory models and exposure to particulate matter (PM) extracts collected from fire effluents. Overall, (1) a decrease in cellular viability, (2) enhanced oxidative stress, (3) increased pro-inflammatory cytokines levels and (4) elevated cell death frequencies were noted. However, limited information remains regarding the toxicity mechanisms initiated by firefighting activities. Hence, more studies employing advanced in vitro models and exposure systems using human cell lines are urgently needed taking into consideration different routes of exposure and health-related pollutants released from fires. Data are needed to establish and define firefighters' occupational exposure limits and to propose mitigation strategies to promote beneficial human health.

Research progress in human biological monitoring of aromatic hydrocarbon with emphasis on the analytical technology of biomarkers

Aromatic hydrocarbons are unsaturated compounds containing carbon and hydrogen that form single aromatic ring, or double, triple, or multiple fused rings. This review focuses on the research progress of aromatic hydrocarbons represented by polycyclic aromatic hydrocarbons (including halogenated polycyclic aromatic hydrocarbons), benzene and its derivatives including toluene, ethylbenzene, xylenes (o-, m- and p-), styrene, nitrobenzene, and aniline. Due to the toxicity, widespread coexistence, and persistence of aromatic hydrocarbons in the environment, accurate assessment of exposure to aromatic hydrocarbons is essential to protect human health. The effects of aromatic hydrocarbons on human health are mainly derived from three aspects: different routes of exposure, the duration and relative toxicity of aromatic hydrocarbons, and the concentration of aromatic hydrocarbons which should be below the biological exposure limit. Therefore, this review discusses the primary exposure routes, toxic effects on humans, and key populations, in particular. This review briefly summarizes the different biomarker indicators of main aromatic hydrocarbons in urine, since most aromatic hydrocarbon metabolites are excreted via urine, which is more feasible, convenient, and non-invasive. In this review, the pretreatment and analytical techniques are compiled systematically for the qualitative and quantitative assessments of aromatic hydrocarbons metabolites such as gas chromatography and high-performance liquid chromatography with multiple detectors. This review aims to identify and monitor the co-exposure of aromatic hydrocarbons that provides a basis for the formulation of corresponding health risk control measures and guide the adjustment of the exposure dose of pollutants to the population.

Toxicokinetic analyses of naphthalene, fluorene, phenanthrene, and pyrene in humans after single oral administration

Polycyclic aromatic hydrocarbons (PAHs) are generated by incomplete combustion of organic matter. They have health effects in multiple organs and can cause lung, skin, and bladder cancers in humans. Although data regarding their toxicity is available, information on the absorption, distribution, metabolism, and excretion of PAHs in humans is very limited. In the present study, deuterium-labeled naphthalene (Nap), fluorene (Flu), phenanthrene (Phe), and pyrene (Pyr) were orally administered as a single dose (0.02-0.04 mg/kg) to eight healthy adults. Both serum and urine samples were monitored for 72 h after the exposure. Parent compounds and PAH metabolites (monohydroxy-PAHs; OH-PAHs) were measured by headspace-solid phase microextraction coupled with gas chromatography-mass spectrometry and high-performance liquid chromatography-tandem mass spectrometry, respectively. Based on the time-concentration profiles in serum and urine, non-compartmental analysis was performed, and two-compartment models were constructed and validated for each PAH. Subsequently, all of the parent compounds were rapidly absorbed (T_max: 0.25 to 1.50 h) after oral administration and excreted in urine with a biological half-life (T_1/2) of 1.01 to 2.99 h. The fractional urinary excretion (F_ue) of OH-PAHs ranged from 0.07 % to 11.3 %; their T_1/2 values ranged from 3.4 to 11.0 h. The two-compartment models successfully described the toxicokinetic characteristics of each PAH and its metabolites. F_ue and the two-compartment models could be useful tools for exposure simulation or dose-reconstruction of PAHs. The results of this study will provide useful information for interpreting biomonitoring data of PAHs.

Biomonitoring of firefighting forces: a review on biomarkers of exposure to health-relevant pollutants released from fires

Occupational exposure as a firefighter has recently been classified as a carcinogen to humans by International Agency for Research on Cancer (IARC). Biomonitoring has been increasingly used to characterize exposure of firefighting forces to contaminants. However, available data are dispersed and information on the most relevant and promising biomarkers in this context of firefighting is missing. This review presents a comprehensive summary and critical appraisal of existing biomarkers of exposure including volatile organic compounds such as polycyclic aromatic hydrocarbons, several other persistent other organic pollutants as well as heavy metals and metalloids detected in biological fluids of firefighters attending different fire scenarios. Urine was the most characterized matrix, followed by blood. Firefighters exhaled breath and saliva were poorly evaluated. Overall, biological levels of compounds were predominantly increased in firefighters after participation in firefighting activities. Biomonitoring studies combining different biomarkers of exposure and of effect are currently limited but exploratory findings are of high interest. However, biomonitoring still has some unresolved major limitations since reference or recommended values are not yet established for most biomarkers. In addition, half-lives values for most of the biomarkers have thus far not been defined, which significantly hampers the design of studies. These limitations need to be tackled urgently to improve risk assessment and support implementation of better more effective preventive strategies.

The Use of Human Biomonitoring to Assess Occupational Exposure to PAHs in Europe: A Comprehensive Review

Polycyclic aromatic hydrocarbons (PAHs) are among the chemicals with proven impact on workers' health. The use of human biomonitoring (HBM) to assess occupational exposure to PAHs has become more common in recent years, but the data generated need an overall view to make them more usable by regulators and policymakers. This comprehensive review, developed under the Human Biomonitoring for Europe (HBM4EU) Initiative, was based on the literature available from 2008-2022, aiming to present and discuss the information on occupational exposure to PAHs, in order to identify the strengths and limitations of exposure and effect biomarkers and the knowledge needs for regulation in the workplace. The most frequently used exposure biomarker is urinary 1-hydroxypyrene (1-OH-PYR), a metabolite of pyrene. As effect biomarkers, those based on the measurement of oxidative stress (urinary 8-oxo-dG adducts) and genotoxicity (blood DNA strand-breaks) are the most common. Overall, a need to advance new harmonized approaches both in data and sample collection and in the use of appropriate biomarkers in occupational studies to obtain reliable and comparable data on PAH exposure in different industrial sectors, was noted. Moreover, the use of effect biomarkers can assist to identify work environments or activities of high risk, thus enabling preventive risk mitigation and management measures.

Urinary Metabolites of Polycyclic Aromatic Hydrocarbons in Firefighters: A Systematic Review and Meta-Analysis

Firefighters are intermittently exposed to complex, mixed pollutants in random settings. Of those pollutants, PAHs (polycyclic aromatic hydrocarbons) are the most commonly studied and best understood. PAH exposure can occur via multiple routes; therefore, the levels of hydroxylated metabolites of PAHs in urine have been used as a biomonitoring tool for risk assessment. We performed a systematic review and meta-analysis of the literature to estimate the levels of urinary hydroxylated PAH (OHPAH) among firefighters, determine risk attributions, and, finally, evaluate the scope of preventive efforts and their utility as diagnostic tools. The meta-regression confirmed increases in OHPAH concentrations after fire activities by up to 1.71-times (p-values: <0.0001). Samples collected at a time point of 2−4 h after a fire suppression showed a consistent, statistically significant pattern as compared with baseline samples. The National Fire Protection Association (NFPA) standard 1582 Standard on Comprehensive Occupational Medical Program for Fire Departments lists various health examinations, including a urinalysis for occupational chemical exposure if indicated and medical screening for cancers and cardiovascular diseases. Biomonitoring is a valuable screening tool for assessing occupational exposure and the results of this meta-analysis support their inclusion in regular health screenings for firefighters.

Preschool children health impacts from indoor exposure to PM2.5 and metals

To better understand the relation between children health and indoor air quality, we measured the concentrations of fine particulate matter (PM_2.5) and 11 metals (arsenic, cadmium, chromium, copper, iron, manganese, nickel, lead, antimony, selenium, and zinc) from air samples taken during both winter and spring, and focused on urban and rural area kindergartens of the Upper Silesia Region, Poland, typified by the use of fossil fuels for power and heat purposes. We combined related inhalation intake estimates for children and health effects using separate dose-response approaches for PM_2.5 and metals. Results show that impacts on children from exposure to PM_2.5 was 7.5 min/yr, corresponding to 14 μDALY/yr (DALY: disability-adjusted life years) with 95% confidence interval (CI): 0.3-164 min/yr, which is approximately 10 times lower than cumulative impacts from exposure to the metal components in the PM_2.5 fraction of indoor air (median 76 min/yr; CI: 0.2-4.5 × 10³ min/yr). Highest metal-related health impacts were caused by exposure to hexavalent chromium. The average combined cancer and non-cancer effects for hexavalent chromium were 55 min/yr, corresponding to 104 μDALY/yr, with CI: 0.5 to 8.0 × 10⁴ min/yr. Health impacts on children varied by season and across urban and rural sites, both as functions of varying PM_2.5 metal compositions influenced by indoor and outdoor emission sources. Our study demonstrates the need to consider indoor environments for evaluating health impacts of children, and can assist decision makers to focus on relevant impact reduction and indoor air quality improvement.

Firefighter exposures to potential endocrine disrupting chemicals measured by military-style silicone dog tags

Studies suggest that exposure to potential endocrine disrupting chemicals (pEDCs) may contribute to adverse health outcomes, but pEDC exposures among firefighters have not been fully characterized. Previously, we demonstrated the military-style silicone dog tag as a personal passive sampling device for assessing polycyclic aromatic hydrocarbon exposures among structural firefighters. This follow-up analysis examined the pEDC exposures based on department call volume, duty shift, and questionnaire variables. Structural firefighters (n = 56) were from one high and one low fire call volume department (Kansas City, MO metropolitan area) and wore separate dog tags while on- and off-duty (n_dogtags = 110). The targeted 1530 analyte semi-quantitative screening method was conducted using gas chromatography mass spectrometry (n_pEDCs = 433). A total of 47 pEDCs were detected, and several less-frequently-detected pEDCs (<75%) were more commonly detected in off- compared to on-duty dog tags (conditional logistic regression). Of the 11 phthalates and fragrances detected most frequently (>75%), off-duty pEDC concentrations were strongly correlated (r = 0.31-0.82, p < 0.05), suggesting co-applications of phthalates and fragrances in consumer products. Questionnaire variables of "regular use of conventional cleaning products" and "fireplace in the home" were associated with select elevated pEDC concentrations by duty shift (paired t-test). This suggested researchers should include detailed questions about consumer product use and home environment when examining personal pEDC exposures.

Distribution of polycyclic aromatic hydrocarbons and heavy metals in soil following a large tire fire incident: A case study

In October 2019, a fire occurred in a tire-recycling facility in Alytus (Lithuania), where around 5000 t of tires had been stored. Only after 10 days was the fire completely extinguished, and the potential contamination of the surrounding environment has raised a large public concern. With an aim to assess the pollution level and pollutants distribution in the surrounding area, we conducted a study on polycyclic aromatic hydrocarbons (PAHs) and heavy metals. High concentrations of total PAHs were found inside the fire zone (315-5872 ng g^-1 dw), whereas those detected in the surrounding soils were significantly lower (1.9-72 ng g^-1 dw). Some areas with higher anthropogenic impact were found to contain PAH concentrations as high as 70198 ng g^-1 dw. Concentrations of Cr, Zn, Ni, Cu, Pb were in the range of 1.1-93.9; 20.7-227.5; 0.2-35.7; 0.9-21.3; 0.9-102.9 μg g^-1, respectively. Zn was the prevailing metal in the fire zone, elevated concentrations of Cr, Ni and Cu were also detected in this area. Principal component analysis (PCA) revealed several locations affected by the fire. The one located the closest to the fire zone was found to be highly contaminated with the heavy metals, just like the whole fire zone. Increase of the carcinogenic risk was observed in the fire zone, but no significant risk was detected in the fire-affected stations. The highest carcinogenic risk was detected in the zones with high anthropogenic loading (traffic and urban activities).

Human Biomonitoring of Selected Hazardous Compounds in Portugal: Part I-Lessons Learned on Polycyclic Aromatic Hydrocarbons, Metals, Metalloids, and Pesticides

Human biomonitoring (HBM) data provide information on total exposure regardless of the route and sources of exposure. HBM studies have been applied to quantify human exposure to contaminants and environmental/occupational pollutants by determining the parent compounds, their metabolites or even their reaction products in biological matrices. HBM studies performed among the Portuguese population are disperse and limited. To overcome this knowledge gap, this review gathers, for the first time, the published Portuguese HBM information concerning polycyclic aromatic hydrocarbons (PAHs), metals, metalloids, and pesticides concentrations detected in the urine, serum, milk, hair, and nails of different groups of the Portuguese population. This integrative insight of available HBM data allows the analysis of the main determinants and patterns of exposure of the Portuguese population to these selected hazardous compounds, as well as assessment of the potential health risks. Identification of the main difficulties and challenges of HBM through analysis of the enrolled studies was also an aim. Ultimately, this study aimed to support national and European policies promoting human health and summarizes the most important outcomes and lessons learned through the HBM studies carried out in Portugal.

Human Biomonitoring of Selected Hazardous Compounds in Portugal: Part II—Lessons Learned on Mycotoxins

Human biomonitoring (HBM) data provide information on total exposure regardless of the route and sources of exposure. HBM studies have been applied to quantify human exposure to contaminants and environmental/occupational pollutants by means of determining the parent compounds, their metabolites, or even their reaction products in biological matrices. HBM studies performed among the Portuguese population are dispersed and limited. Thus, to overcome this knowledge gap, this work reviews the published Portuguese HBM information concerning mycotoxins detected in the urine, serum, milk, hair, and nails of different groups of the Portuguese population. This integrative approach to the available HBM data allows us to analyze the main determinants and patterns of exposure of the Portuguese population to the selected hazardous compounds, as well as to assess the potential health risks. We also aimed to identify the main difficulties and challenges of HBM through the analysis of the enrolled studies. Ultimately, this study aims to support national and European policies in promoting human health by summarizing the most important outcomes and lessons learned through the HBM studies carried out in Portugal.

Human health risks estimations from polycyclic aromatic hydrocarbons in serum and their hydroxylated metabolites in paired urine samples

Polycyclic aromatic hydrocarbons (PAHs) are compounds with two or more benzene rings whose hydroxylated metabolites (OH-PAHs) are excreted in urine. Human PAH exposure is therefore commonly estimated based on urinary OH-PAH concentrations. However, no study has compared PAH exposure estimates based on urinary OH-PAHs to measurements of PAH levels in blood samples. Estimates of PAH exposure based solely on urinary OH-PAHs may thus be subject to substantial error. To test this hypothesis, paired measurements of parent PAHs in serum and OH-PAHs in urine samples from 480 participants in Guangzhou, a typical developed city in southern China, were used to investigate differences in the estimates of human PAH exposure obtained by sampling different biological matrices. The median PAH concentration in serum was 4.05 ng mL^-1, which was lower than that of OH-PAHs in urine (8.33 ng mL^-1). However, serum pyrene levels were significantly higher than urinary levels of its metabolite 1-hydroxypyrene. Concentrations of parent PAHs in serum were not significantly correlated with those of their metabolites in urine with the exception of phenanthrene, which exhibited a significant negative correlation. Over 28% of the participants had carcinogenic risk values above the acceptable cancer risk level of 10^-6. Overall, estimated human exposure and health risks based on urinary 1-hydroxypyrene levels were only 13.6% of those based on serum pyrene measurements, indicating that estimates based solely on urine sampling may substantially understate health risks due to PAH exposure.

Urinary biohazard markers in firefighters

Firefighters are the professional force at high risk of suffering potential health consequences due to their chronic exposure to numerous hazardous pollutants during firefighting activities. Unfortunately, determination of fire emission exposure is very challenging. As such, the identification and development of appropriate biomarkers is critical in meeting this need. This chapter presents a critical review of current information related with the use of different urinary biomarkers of effect and exposure in occupationally exposed firefighters over the last 25 years. Evidence suggests that urinary isoprostanes and mutagenicity testing are promising biomarkers of early oxidative stress. Data indicate that firefighters participating in firefighting activities present with increased urinary biomarkers of exposure. These include polycyclic aromatic hydrocarbons, heavy metals and metalloids, organo-chlorine and -phosphorus compounds, environmental phenols, phthalates, benzene and toluene. More studies are urgently needed to better evaluate firefighter occupational safety and health and to support the implementation of preventive measures and mitigation strategies to promote the protection of this chronically exposed group of workers.

Variability in urinary biomarkers of human exposure to polycyclic aromatic hydrocarbons and its association with oxidative stress

Polycyclic aromatic hydrocarbons (PAHs) are ubiquitous environmental pollutants. Urinary concentrations of mono-hydroxylated metabolites of PAHs (OH-PAHs) have been used as biomarkers of these chemicals' exposure in humans. Little is known, however, with regard to intra- and inter-individual variability in OH-PAH concentrations and their association with oxidative stress. We conducted a longitudinal study of measurement of urinary concentrations of 15 OH-PAHs and 7 oxidative stress biomarkers (OSBs) of DNA damage [8-hydroxy-2'-deoxyguanosine (8-OHdG)], lipid [malondialdehyde (MDA) and F₂-isoprostanes (PGF_2α)] and protein [o,o'-dityrosine (diY)] peroxidation in 19 individuals for 44 consecutive days. Metabolites of naphthalene (OHNap), fluorene (OHFlu), phenanthrene (OHPhe), and pyrene (OHPyr) were found in >70% of 515 urine samples analyzed, at sum concentrations (∑OH-PAH) measured in the range of 0.46-60 ng/mL. After adjusting for creatinine, OHNap and ∑OH-PAH concentrations exhibited moderate predictability, with intra-class correlation coefficients (ICCs) ranging from 0.359 to 0.760. However, ICC values were low (0.001-0.494) for OHFlu, OHPhe, and OHPyr, which suggested poor predictability for these PAH metabolites. Linear mixed-effects analysis revealed that an unit increase in ∑OH-PAH concentration corresponded to 4.5%, 5.3%, 20%, and 21% increase in respective urinary 8-OHdG, MDA, PGF_2α, and diY concentrations, suggesting an association with oxidative damage to DNA, lipids, and proteins. The daily intakes of PAHs, calculated from urinary concentrations of OH-PAHs, were 10- to 100-fold below the current reference doses. This study provides valuable information to design sampling strategies in biomonitoring studies and in assigning exposure classifications of PAHs in epidemiologic studies.

Assessment of Exposure of Korean Firefighters to Polybrominated Diphenyl Ethers and Polycyclic Aromatic Hydrocarbons via Their Measurement in Serum and Polycyclic Aromatic Hydrocarbon Metabolites in Urine

This study investigated the occupational exposure of Korean firefighters to a suite of combustion-related pollutants. Exposure to polybrominated diphenyl ethers (PBDEs) and polycyclic aromatic hydrocarbons (PAHs) was assessed by measurement of their levels in serum and metabolites in urine (i.e., monohydroxylated PAHs, OH-PAHs). The mean level of ∑PBDEs in the serum of firefighters (17.1 ng/g lipid weight (lw)) was significantly higher than that of the general population (1.39 ng/g lw) (Mann-Whitney U Test, p < 0.05), which is similar to the ∑PAH levels (1286 ng/g lw for firefighters and 1016 ng/g lw for the general population). Individual OH-PAH levels showed 2.1- to 4.2-fold increases in postfire urine samples compared to the control urine samples, with the mean ∑OH-PAHs being significantly higher in postfire urine samples (22,658 ng/g creatinine) than in the control urine samples (10,253 ng/g creatinine) (Mann-Whitney U test, p < 0.05). It was found that ∑PBDEs correlated with firefighters' length of service and years dedicated to on-site dispatch, while ∑OH-PAHs was strongly associated with firefighters' exposure duration, age, length of service, and years dedicated to on-site dispatch. Indeed, the results of the present study indicate that Korean firefighters are prone to elevated risk of exposure to toxic combustion-related pollutants compared with the general population.

Occupational Exposure and Multiple Myeloma Risk: An Updated Review of Meta-Analyses

The precise etiology of multiple myeloma remains elusive, but both genetic and environmental factors have been suggested to contribute to disease risk. Several occupational categories and toxic agents have been implicated as potentially causative, yet findings from the literature are inconsistent. The aim of this review was to summarize and critically comment on the accumulated epidemiological evidence, across published meta-analyses, about the association between occupational exposure and risk of multiple myeloma. Overall, results from eleven meta-epidemiological studies underscore a significantly increased risk for firefighters, hairdressers, and employees exposed to engine exhaust, whereas farming and methylene chloride exposure have been non-significantly correlated with the disease. Further epidemiological studies are of utmost importance whilst emphasis should be placed on occupational hazard surveillance, as such studies will obtain a more accurate picture of disease occurrence in working populations, and will enable both the implementation of preventive actions and the evaluation of their effectiveness.

Benchmark dose analysis for PAHs hydroxyl metabolites in urine based on mitochondrial damage of peripheral blood leucocytes in coke oven workers in China

OBJECTIVES

The aim was to explore the dose-response relationship between occupational polycyclic aromatic hydrocarbons (PAHs) exposure and mitochondrial damage in coke oven plants workers.

METHODS

544 workers and 238 healthy people were recruited. The ultra-high performance liquid chromatography was used to determine the level of 1-hydroxypyrene, 1-hydroxynaphthalene, 2-hydroxynaphthalene and 3-hydroxyphenanthrene. The real-time fluorescence quantitative polymerase chain reaction was used to determine the mitochondrial DNA copy number (mtDNAcn). The benchmark dose software was used to analyze the benchmark dose.

RESULTS

The mtDNAcn in the exposure group was lower than that in the control group. The concentrations of 1-hydroxypyrene, 1-hydroxynaphthalene, 2-hydroxynaphthalene and 3-hydroxyphenanthrene in the exposure group were higher than those in the control group. There is a dose-response relationship between 1-hydroxypyrene, 3-hydroxyphenanthrene and mitochondrial DNA damage. The benchmark dose lower confidence limit (BMDL) of 1-hydroxypyrene were 0.045, 0.004, and 0.058 pg/μg creatinine in the total, male, and female population, respectively. The BMDL of 3-hydroxyphenanthrene were 5.142, 6.099, and 2.807 pg/μg creatinine in the total, male, and female population, respectively.

CONCLUSIONS

The BMDL of 1-hydroxypyrene and 3-hydroxyphenanthrene initially explored can provide a reference to establish occupational exposure biological limits.

Exposure and Absorption of PAHs in Wildland Firefighters: A Field Study with Pilot Interventions

Objectives

There is limited knowledge of exposure to polycyclic aromatic hydrocarbons (PAHs) in wildland firefighters, or of the effectiveness of interventions to reduce this. This study of wildland firefighters assessed whether PAHs were present and considered respiratory protection and enhanced skin hygiene as possible interventions.

Methods

1-Hydroxypyrene (1-HP) was measured in urine samples collected pre-shift, post-shift, and next morning from wildland firefighters in Alberta and British Columbia. Skin wipes, collected pre- and post-shift, were analysed for eight PAHs. Breathing zone air samples were analysed for 11 PAHs. As pilot interventions, participants were randomized to either normal or enhanced skin hygiene. A sample of volunteers was assigned to a disposable N95 mask or a half facepiece mask with P100 organic vapour cartridge. Participants completed a brief questionnaire on activities post-shift and respiratory symptoms.

Results

Non-smoking firefighters (66 male and 20 female) were recruited from 11 fire crews. Air sampling pumps were carried for the full shift by 28 firefighters, 25 firefighters wore masks (14 N95 and 11 P100); 42 were assigned to the enhanced skin hygiene intervention. Sixty had hot spotting as their main task. Air monitoring identified PAHs (benzo(b,j,k)fluoranthene in particulates, phenanthrene in the gaseous phase) for 6 of the 11 crews. PAHs (largely naphthalene) were found post-shift on 40/84 skin wipes from the hand and 38/84 from jaw/throat. The mean increase in 1-HP in urine samples collected after the shift (compared with samples collected before the shift) was 66 ng g⁻¹ creatinine (P < 0.001) with an increase over the shift found for 76% of participants. 1-HP in next morning urine samples was significantly lower than at the end of shift (a reduction of 39.3 ng g⁻¹: P < 0.001). The amount of naphthalene on skin wipes was greater at the end of the shift (post) than at the start (pre). The mean post–pre weight difference of naphthalene on skin wipes taken from the hand was 0.96 ng wipe⁻¹ (P = 0.01) and from the jaw/throat 1.28 ng wipe⁻¹ (P = 0.002). The enhanced skin hygiene intervention lead to a larger reduction in 1-HP between end of shift and next morning urine samples but only for those with naphthalene on skin wipes at the end of shift. The difference in 1-HP concentration in urine samples collected before and after the shift was reduced for those wearing a mask (linear tend P = 0.063, one-sided). In multivariable models, 1-HP at end of shift was related to gaseous phase phenanthrene, estimated from air sampling [β = 318.2, 95% confidence interval (CI) 67.1–569.2]. Naphthalene on hand skin wipes reflected work in hot spotting during the shift (β = 0.53, 95% CI 0.22–0.86).

Conclusions

This study provided evidence of PAHs in the air and on the skin of many, but not all, fire crew. Absorbed PAHs, reflected in 1-HP in urine, increased over the shift. Results from the pilot interventions suggest that enhanced skin hygiene would reduce absorption post fire where PAHs had been accumulated on the skin, and that masks could be effective in reducing PAH inhalation exposure. Interventions to reduce PAH absorption are supported by the pilot work reported here and warrant further evaluation across a full fire season.

Off-Gassing of Semi-Volatile Organic Compounds from Fire-Fighters' Uniforms in Private Vehicles-A Pilot Study

Firefighters' uniforms become contaminated with a wide range of chemicals, including polycyclic aromatic hydrocarbons (PAHs), organophosphate flame retardants (OPFRs), and polybrominated diphenyl ethers (PBDEs). Laundering practices do not completely remove PAHs, OPFRs, and PBDEs from firefighting uniforms. This residual contamination of firefighting ensembles may be an ongoing source of exposure to firefighters. Firefighters are known to occasionally store firefighting ensembles in private vehicles. This study aimed to assess whether a firefighting uniform in a vehicle could act as a source for PAHs, OPFRs, and PBDEs to vehicle users. The shell layers of four laundered firefighting uniforms were sampled non-destructively. Three of these uniforms were heated in a laboratory oven (40, 60, and 80 °C) while the fourth was placed in a private vehicle on a summer day and off-gassing samples were collected from the uniforms. The off-gassing results for PAHs and OPFRs were relatively consistent between laboratory oven and the in-vehicle sample with ∑₁₃ PAHs in off-gas ranging from 7800-23,000 ng uniform^-1 day^-1, while the ∑₆ OPFRs off-gassed was an order of magnitude lower at 620-1600 ng uniform^-1 day^-1. The off-gassing results for PBDEs were much lower and less consistent between the experiments, which may reflect differences in uniform history. Currently, there is limited understanding of how PAHs, OPFRs, and PBDEs off-gassed from firefighting uniforms influence firefighter exposure to these chemicals. These findings suggest that firefighting ensembles off-gassing in private vehicles could be a relevant source of PAHs, OPFRs, and PBDEs that contributes to firefighters' exposure and that this warrants further investigation.

Assessing decontamination and laundering processes for the removal of polycyclic aromatic hydrocarbons and flame retardants from firefighting uniforms

Firefighter uniforms protect firefighters from exposure to potentially harmful chemicals including a range of semi-volatile organic compounds (SVOCs). Contaminated uniforms can become a secondary source of firefighters' exposure to these chemicals. There is inconsistency on the removal efficiency of SVOCs during the cleaning, laundering and field decontamination of firefighting uniforms. Therefore, this study aims to assess how effective decontamination and laundering processes are in reducing firefighter uniforms as a vector for transport and exposure to SVOCs. Firefighters who had attended a controlled house fire and simulated container burns had their uniforms sampled pre- and post-laundering. Clean station wear was laundered with contaminated uniforms and after a load of contaminated uniforms to assess inter and intra load contamination. Surface wipes were collected from uniforms across 12 fire stations, after they had returned from a laundering provider. Concentrations of 13 polycyclic aromatic hydrocarbons (PAHs), six organophosphate flame retardants (OPFRs) and seven polybrominated diphenyl ethers (PBDEs) were measured in the collected samples. The concentrations of ∑₁₃ PAHs in firefighters uniforms ranged between 0.063 and 43 μg g^-1, while concentration of ∑₆ OPFRs were between 0.061 and 90 μg g^-1 with ∑₇ PBDEs concentrations being measured between 0.00054 and 0.97 μg g^-1.The highest concentrations of ∑₁₃ PAHs were measured on the outer layers of gloves at an average of 19 μg g^-1, with the highest ∑₆ OPFRs concentrations being measured in the middle layers of gloves at an average of 31 μg g^-1. The highest ∑₇ PBDEs concentrations were measured on the shell layers of turnout jackets at 0.42 μg g^-1. The significant reduction in ∑₁₃ PAHs after laundering or decontamination was only found in 3 of the 16 sampled areas from firefighting uniforms. No significant differences were found in the between pre- and post-laundering concentrations of ∑₆ OPFRs or ∑₇ PBDEs in firefighting uniforms. The current laundering techniques do not appear to effectively remove PAHs, OPFRs and PBDEs at the measured concentrations from firefighters' uniforms. Further research is required to assess if chemical exposure though firefighting uniforms poses a health risk to firefighters and to develop methods for the removal of SVOCs from firefighting uniforms.

Backward modeling of urinary test reliability for assessing PAH health risks: An approximation solution for naphthalene

Urine sample tests are one of the most common methods of estimating human exposure to polycyclic aromatic hydrocarbons (PAHs) and assessing population health risks. To evaluate the reliability of the urine test and the impact of other PAH elimination routes on the health risk estimated by this test, we proposed a backward modeling framework integrating other common elimination routes of PAH metabolites to calculate the overall intake rate of the parent PAH based on the levels of corresponding main metabolites in urine. Due to limited biotransformation data, we selected naphthalene as an example to evaluate model performance and collected urine samples from 234 random adults in Shenzhen. The overall intake rates of naphthalene were then simulated and compared to current literature data. The simulated intake rates of naphthalene ranged from 3.70 × 10-3 mg d-1 to 1.95 mg d-1 and followed a lognormal distribution with a median value of 6.51 × 10-2 mg d-1. The results indicated that, if naphthalene exposure occurred only via food for the population of Shenzhen, the literature data fell within the most frequent interval [3.70 × 10-3, 4.45 × 10-2] but were lower than the simulated median value. However, if other exposure routes were considered, the allocation factor-adjusted literature data were close to the simulated median values. In addition, under normal physiological conditions, the simulated results were more sensitive to 1-hydroxynaphthalene (1-OHN) and 2-hydroxynaphthalene (2-OHN) levels in urine than other biometric variables, which is due to the limited load of 1-OHN and 2-OHN in human elimination routes. Furthermore, the suggested safety levels of 1-OHN and 2-OHN in urine to protect 99% of the general population of Shenzhen were 6.40 × 10-6 and 3.75 × 10-5 mg L-1, which could be used as regulatory indicators based on the high reliability of the model.

Characterising the exposure of Australian firefighters to polycyclic aromatic hydrocarbons generated in simulated compartment fires

Firefighters are exposed to a wide variety of chemicals including polycyclic aromatic hydrocarbons (PAHs) while attending fire scenes. The objective of this study was to understand the exposure of firefighters to PAHs when attending simulated compartment fires that consisted of either a diesel pan or particleboard fire. Firefighters remained in the compartment fires for 15 min while using standard gear including self contained breathing apparatus (SCBA). Firefighters were able to remove firefighting clothing and shower within 10 min of leaving the burn. Air samples were collected from inside the compartment during the fire. Twenty-six (26) firefighters participated in the study providing urine and skin wipe samples collected from the wrist and neck before and after either one of the burn types. The concentrations of PAHs were measured in skin wipes and air samples, while concentrations of monohydroxy metabolites of PAHs (OH-PAHs) were measured in urine. The concentrations of all PAHs were significantly higher (p < 0.05) in the smoke layer of particleboard fires than in diesel pan fires. Correspondingly, the level of PAHs deposited on the wrists and necks of participants attending the particleboard fires was higher than those attending diesel pan fires. Urine samples from participants who attended diesel pan fires showed no significant difference (p > 0.05) in the concentration of all OH-PAHs between pre-burn and post-burn. Samples from participants who attended particleboard fires, showed no significant difference (p > 0.05) between 1-hydroxypyrene (1-OH-PYR) concentrations in urine pre- and post-burn. However, median concentrations of hydroxynaphthalenes (OH-NAPs), hydroxyfluorenes (OH-FLUs) and hydroxyphenanthrenes (OH-PHEs) increased significantly from 5.2, 0.44 and 0.88 μg g^-1 creatinine pre-burn to 12, 1.4 and 1.2 μg g^-1 creatinine post-burn, respectively. This suggests that in compartment burns with high concentrations of PAHs in the smoke layer, such as those created by the particleboard fires, exposure to PAHs can be observed though urinary OH-PAH metabolites. Overall, concentrations of urinary OH-PAHs were relatively low considering the potential exposure in these burns. This suggests protective equipment in combination with rapid removal of firefighting ensembles and showering are relatively effective in controlling exposure.

Discovery of firefighter chemical exposures using military-style silicone dog tags

Occupational chemical hazards in the fire service are hypothesized to play a role in increased cancer risk, and reliable sampling technologies are necessary for conducting firefighter chemical exposure assessments. This study presents the military-style dog tag as a new configuration of silicone passive sampling device to sample individual firefighters' exposures at one high and one low fire call volume department in the Kansas City, Missouri metropolitan area. The recruited firefighters (n = 56) wore separate dog tags to assess on- and off-duty exposures (n_dogtags = 110), for a total of 30 24 h shifts. Using a 63 PAH method (GC-MS/MS), the tags detected 45 unique PAHs, of which 18 have not been previously reported as firefighting exposures. PAH concentrations were higher for on- compared to off-duty tags (0.25 < Cohen's d ≤ 0.80) and for the high compared to the low fire call volume department (0.25 ≤ d < 0.70). Using a 1530 analyte screening method (GC-MS), di-n-butyl phthalate, diisobutyl phthalate, guaiacol, and DEET were commonly detected analytes. The number of fire attacks a firefighter participated in was more strongly correlated with PAH concentrations than firefighter rank or years in the fire service. This suggested that quantitative data should be employed for firefighter exposure assessments, rather than surrogate measures. Because several detected analytes are listed as possible carcinogens, future firefighter exposure studies should consider evaluating complex mixtures to assess individual health risks.

Core Competencies of Truck Drivers Responding to Emergencies during Transportation of Hazardous Materials

BACKGROUND

Hazardous material (HAZMAT) transportation drivers are responsible for safe delivery of consignments and face multiple challenges carrying out their duties. Drivers are also the first to respond to emergencies and accidents.

OBJECTIVES

The purpose of the present study was to identify the essential competencies needed by HAZMAT transportation drivers to deal with emergencies.

METHODS

Three rounds of focus groups were conducted using expert panels comprised of HAZMAT specialists, health, safety and emergency representatives, security experts and transportation advisors from June to July 2019. The panel discussed competencies, gathered from a literature review, for emergency responders.

RESULTS

The panel identified six (6) core and 23 sub-competencies of HAZMAT drivers. This is the first study in low- and middle-income countries (LMIC) to identify core competencies of HAZMAT truck drivers.

CONCLUSIONS

The integration of these competencies into a development and training program for drivers will better enable drivers to handle emergencies in an efficient and effective manner.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

The Graduate Advisory Committee of Comsats University approved study protocols.

PARTICIPANT CONSENT

Obtained.

COMPETING INTERESTS

The authors declare no competing financial interests.

Biomonitoring in firefighters for volatile organic compounds, semivolatile organic compounds, persistent organic pollutants, and metals: A systematic review

Firefighters are exposed to a wide range of toxic chemicals due to combustion, with numerous biomonitoring studies completed that have assessed exposure. Many of these studies focus on individual classes of chemicals, with a few considering a broad range of systemic exposures. As yet, no review process has been undertaken to comprehensively examine these studies. The aims of this review are to: (1) ascertain whether biomonitoring studies pertaining to firefighters demonstrate occupational exposure to volatile organic compounds, semivolatile organic compounds, and metals; (2) determine and present results of biomonitoring studies; (3) provide any recommendations presented from the literature that may support exposure mitigation; and (4) suggest future study parameters that may assist in providing a greater understanding surrounding the occupational exposure of firefighters. A systematic review was undertaken with regards to firefighters and biomonitoring studies utilising the matrices of blood, urine, semen and breast milk. This yielded 5690 results. Following duplicate removal, inclusion and exclusion criteria screening and full text screening, 34 studies remained for review. Results of over 80% of studies analysed determined firefighters to experience occupational exposure. Results also show firefighters to be exposed to a wide range of toxic chemicals due to fire smoke; potentially exceeding the range of exposure of other occupations. As firefighters may face increased risk of health effects due to the additive, synergistic, and/or antagonistic effects of chemical exposure, all care must be taken to reduce exposure. This may be achieved by considering tactical decisions, increased personal hygiene, and thorough decontamination procedures. Future biomonitoring studies recognising and assessing the range of chemical exposure firefighters face would be beneficial.

Concentrations of Particulate Matter and PM-Bound Polycyclic Aromatic Hydrocarbons Released during Combustion of Various Types of Materials and Possible Toxicological Potential of the Emissions: The Results of Preliminary Studies

The aim of this study was to compare the concentrations of particulate matter (PM) and PM-bound polycyclic aromatic hydrocarbons (PAHs) during the combustion of various types of materials (i.e., oak, beech, and pine wood, polypropylene, polyurethane, paper, cotton, and oriented strand board (OSB)), and to compare the carcinogenic, mutagenic, and toxic potential of the emissions during the burning of these materials. Personal portable sampling devices were used to collect samples and to determine concentrations of PM4, total suspended particles (TSPs), PM-bound PAHs. The samples were collected during controlled fires under laboratory conditions. The highest PM concentration was recorded during the burning of polyurethane (PM4-1818 mg/m3, TSP-2800 mg/m3), while the highest concentration of PAH mixture was recorded when burning OSB (628.5 µg/m3 PM4-bound; 791.2 µg/m3 TSP-bound PAHs). Thus, the highest carcinogenic (85.5 µg/m3), mutagenic (68.2 µg/m3) and toxic equivalents (26.4 ng/m3) of the PAH mixture were noted during OSB combustion. Carcinogenic potential (CP) of PAH group was determined mainly by phenanthrene (CP on average 21.6%) and pyrene concentrations (13.3%). The results of the study express possible adverse effects from PM-bound PAHs released during combustion for firefighters and other people staying near a fire site.

Firefighters exposure to fire emissions: Impact on levels of biomarkers of exposure to polycyclic aromatic hydrocarbons and genotoxic/oxidative-effects

Firefighters represent one of the riskiest occupations, yet due to the logistic reasons, the respective exposure assessment is one of the most challenging. Thus, this work assessed the impact of firefighting activities on levels of urinary monohydroxyl-polycyclic aromatic hydrocarbons (OHPAHs; 1-hydroxynaphthalene, 1-hydroxyacenaphthene, 2-hydroxyfluorene, 1-hydroxyphenanthrene, 1-hydroxypyrene, 3-hydroxybenzo(a)pyrene) and genotoxic/oxidative-effect biomarkers (basal DNA and oxidative DNA damage) of firefighters from eight firehouses. Cardiac frequency, blood pressure and arterial oxygen saturation were also monitored. OHPAHs were determined by liquid-chromatography with fluorescence detection, while genotoxic/oxidative-effect biomarkers were assessed by the comet assay. Concentrations of total OHPAHs were up to 340% higher (p ≤ 0.05) in (non-smoking and smoking) exposed workers than in control subjects (non-smoking and non-exposed to combat activities); the highest increments were observed for 1-hydroxynaphthalene and 1-hydroxyacenaphthene (82-88% of ∑OHPAHs), and for 2-hydroxyfluorene (5-15%). Levels of biomarker for oxidative stress were increased in non-smoking exposed workers than in control group (316%; p ≤ 0.001); inconclusive results were found for DNA damage. Positive correlations were found between the cardiac frequency, ∑OHPAHs and the oxidative DNA damage of non-smoking (non-exposed and exposed) firefighters. Evidences were raised regarding the simultaneous use of these biomarkers for the surveillance of firefighters' health and to better estimate the potential short-term health risks.

The occurrence of PAHs and flame-retardants in air and dust from Australian fire stations

Firefighters are exposed to a wide range of chemicals whilst on duty, including polycyclic aromatic hydrocarbons (PAHs), organophosphate flame-retardants (OPFRs), and polybrominated diphenyl ethers (PBDEs). These groups of chemicals are related to combustion emissions. PAHs are formed during combustion. OPFRs and PBDEs are flame-retardants and are inadvertently released during combustion. Exposure to these chemicals occurs when attending fire scenes, and firefighters can track these chemicals back into fire stations leading to further exposure. The objective of this study was to understand the concentrations of PAHs, OPFRs, and PBDEs in fire stations, to evaluate factors that affect chemical concentration, and to assess how air and dust could contribute to firefighters' relevant exposure risk. Concentrations of 13 PAHs, 9 OPFRs, and 8 PBDEs were quantified in fire station dust (n = 49) and air (n = 15) samples collected between November 2017 and February 2018. The median ∑₁₃PAH concentration was 15 ng m^-3 and 3.1 µg g^-1 in air and dust, respectively, while the median ∑₉ OPFR concentration was 56 ng m^-3 in air and 84 µg g^-1 in dust, and ∑₈ PBDE had a median concentration of 0.78 ng m^-3 in air and 26 µg g^-1 in dust. The estimated daily intakes through dust and air for ∑₁₃ PAHs, ∑₉ OPFRs, and ∑₈ PBDEs in firefighters were 3.6, 17, and 1.6 ng (kg body weight)^-1day^-1, respectively. The worst-case estimated daily intakes were only 2% of the reference dose for individual chemicals. Pearson's correlations with chemical concentration for several PAHs, OPFRs, and PBDEs were found between the number of years since fire stations were last renovated, as well as the storage locations of firefighting ensembles. These results suggest chemicals are brought back to fire stations from fire scenes and that they are accumulating in fire stations. They also suggest soiled firefighting ensembles are a source of these chemicals in fire stations and that their proximity to the rest of the station determines the extent to which they contribute to chemical concentrations in fire stations.

Assessment of the toxicity of firefighter exposures using the PAH CALUX bioassay

Firefighters can be exposed to a complex set of contaminants while at a fire scene. Identifying new ways to monitor and assess exposure, particularly relating to toxicity is essential to determine the effectiveness of intervention techniques to reduce exposure. This study investigated the use of the polycyclic aromatic hydrocarbon (PAH) CALUX® bioassay for the assessment of exposure and associated toxicity firefighters might encounter. This was done through analysis of extracts of dermal wipes and urine samples collected from firefighters before and after a controlled fire. An increased bioassay response was observed from post-fire neck and calf samples, indicating a greater concentration of PAH-like compounds on the skin. The use of a baby wipe to clean the face and neck during rehab resulted in the attenuation of the observed bioassay response from the neck post-fire. Though a correlation was observed between the bioassay response and hydroxylated PAH concentrations found in the urine, the increased bioassay response from the post-fire urine samples was likely due to unknown compounds other than the hydroxylated PAHs tested. Our results suggest that this bioassay provides a useful measure of firefighter exposure, particularly relating to the potential toxicity of contaminants.

Exposure to metals and semivolatile organic compounds in Australian fire stations

Firefighting is an occupation with exposure to a wide range of chemicals by means of inhalation, ingestion or dermal contact. Although advancements in personal protective clothing and equipment have reduced the risks for acute exposure during fire suppression operations, chronic exposure may still be present at elevated levels in fire stations. The aim of this study was to assess chemicals in air and on surfaces in fire stations, compare this with other indoor environments, and use this data to estimate firefighter exposure within the fire station. Fifteen Australian fire stations were selected for chemical exposure assessment by means of 135 active air monitors, 60 passive air monitors, and 918 wipe samples. These samples were collected from the interior and exterior of fire stations, from personal protective clothing and equipment, and from within the cabins of vehicles. Chemicals analysed included polycyclic aromatic hydrocarbons, volatile organic compounds, metals, and diesel particulate matter. Specific chemicals were detected from within each class of chemicals, with metals being most frequently detected. Statistical analysis by means of Pearson's Correlations and threshold tests were used to consider the source of exposure, and a collective addition risk quotient calculation was used to determine firefighter exposure. The presence of metals in fire stations was compared with findings from global indoor dust measurements. Concentrations across firefighter ensemble, inside vehicle cabins, and within fire stations for chromium (39.5-493 μg/m²), lead (46.7-619 μg/m²), copper (594-3440 μg/m²), zinc (11100-20900 μg/m²), nickel (28.6-2469 μg/m²) and manganese (73.0-997 μg/m²) were in most instances orders of magnitude higher when compared with concentrations measured in homes and offices. Our study suggests that the elevated concentrations are associated with the transfer of chemicals from fire suppression operations. Due to this elevated concentration of chemicals, firefighters may face increased exposure, and in turn increased risk of adverse health effects. Data suggest that exposure may be mitigated by means of increased laundering frequency and increased decontamination at the scene of the fire.

Targeted GC-MS analysis of firefighters' exhaled breath: Exploring biomarker response at the individual level

Biomarker measurements can provide unambiguous evidence of environmental exposures as well as the resultant biological responses. Firefighters have a high rate of occupational cancer incidence, which has been proposed to be linked in part to their increased environmental exposure to byproducts of combustion and contaminants produced during fire responses. In this article, the uptake and elimination of targeted volatile organic compounds were investigated by collecting the exhaled breath of firefighters on sorbent tubes before and after controlled structure burns and analyzing samples using automated thermal desorption-gas chromatography (ATD-GC/MS). Volatile organic compounds exposure was assessed by grouping the data according to firefighting job positions as well as visualizing the data at the level of the individual firefighter to determine which individuals had expected exposure responses. When data were assessed at the group level, benzene concentrations were found to be elevated post-exposure in both fire attack, victim search, and outside ventilation firefighting positions. However, the results of the data analysis at the individual level indicate that certain firefighters may be more susceptible to post-exposure volatile organic compounds increases than others, and this should be considered when assessing the effectiveness of firefighting protective gear. Although this work focuses on firefighting activity, the results can be translated to potential human health and ecological effects from building and forest fires.

Urinary 1-hydroxypyrene and Skin Contamination in Firefighters Deployed to the Fort McMurray Fire

BACKGROUND

In May 2016, firefighters from the province of Alberta, Canada deployed to a fire that engulfed the urban area of Fort McMurray. During the first days of the fire, firefighters experienced heavy smoke exposures during greatly extended work shifts. Urinary samples were collected post-deployment from three fire services for estimation of 1-hydroxypyrene (1-HP) concentration, reflecting exposure to polycyclic aromatic hydrocarbons (PAHs), to determine the effects of respiratory protective equipment (RPE) and skin hygiene in reducing internal dose.

METHODS

Urine samples from one fire service (n = 62) were analyzed for 1-HP by two laboratories, using different assays (LC-MS/MS: GC-MS): remaining samples were analyzed just by LC-MS/MS. A Skin Exposure Mitigation Index (SEMI) was computed from questions on opportunities for changing clothing, showering, and washing during breaks. Regression analyses, using 1-HP ng/g creatinine as the dependent variable, assessed the effect of RPE and skin factors on PAH absorption, allowing for environmental exposure and potential confounders. Stratification identified key groups with equal delay in sample collection.

RESULTS

1-HP was detected in 71.0% of 62 samples by LC-MS/MS and 98.4% by GC-MS, with good mutual agreement between the methods. In 171 post-fire samples, 1-HP corrected for creatinine was related to current cigarette smoking and recent barbeque. Among those with samples collected within 48 h, urinary 1-HP was correlated with estimated exposure(r = 0.53, P < 0.001). In those with only one rotation before urine sample collection, no effect was seen of RPE use but I-HP was significantly lower (P = 0.003) in those with those with a high score on the SEMI scale, indicating better access to factors mitigating skin absorption.

CONCLUSION

Skin exposure to PAHs is an important route of absorption in firefighters, which can be mitigated by good skin hygiene.

Cancer incidence and mortality among firefighters

Firefighters are exposed to both known and suspected carcinogens. This study aims to systematically review the literature on the association of firefighting occupation and cancer incidence and mortality, overall and for specific cancer sites. A systematic review using PubMed, Embase, and Web of Science was performed up to January 1, 2018. We extracted risk estimates of cancers and calculated summary incidence risk estimates (SIRE), summary mortality risk estimates (SMRE), and their 95% confidence intervals (CI). Publication bias and risk of bias in individual studies were assessed using Begg's and Egger's tests and the Newcastle-Ottawa scale (NOS), respectively. We included 50 papers in the review and 48 in the meta-analysis. We found significantly elevated SIREs for cancer of the colon (1.14; CI 1.06 to 1.21), rectum (1.09; CI 1.00 to 1.20), prostate (1.15; CI 1.05 to 1.27), testis (1.34; CI 1.08 to 1.68), bladder (1.12; CI 1.04 to 1.21), thyroid (1.22; CI 1.01 to 1.48), pleura (1.60; CI 1.09 to 2.34), and for malignant melanoma (1.21; CI 1.02 to 1.45). We found significant SMREs of 1.36 (1.18 to 1.57) and 1.42 (1.05 to 1.90) for rectal cancer and Non-Hodgkin's lymphoma, respectively. Considering the significantly elevated risk of some cancers in this occupational group, we suggest improving preventive measures and securing adequate and relevant medical attention for this group. Further studies with more accurate and in-depth exposure assessments are indicated.

The "Warm Zone" Cases: Environmental Monitoring Immediately Outside the Fire Incident Response Arena by Firefighters

Hazardous work zones (i.e., hot, warm, and cold) are typically established by emergency response teams during hazardous materials (HAZMAT) calls but less consistently for fire responses to segment personnel and response activities in the immediate geographic area around the fire. Despite national guidelines, studies have documented the inconsistent use of respiratory protective equipment by firefighters at the fire scene. In this case-series report, we describe warm zone gas levels using multigas detectors across five independent fire incident responses all occurring in a large South Florida fire department. Multigas detector data collected at each fire response indicate the presence of sustained levels of volatile organic compounds in the “warm zone” of each fire event. These cases suggest that firefighters should not only implement strategies for multigas detector use within the warm zone but also include respiratory protection to provide adequate safety from toxic exposures in the warm zone.

Association between cancer risk and polycyclic aromatic hydrocarbons' exposure in the ambient air of Ahvaz, southwest of Iran

Nowadays, a large number of health endpoints such as disease rates, treatment costs, and death, by air pollutants, have been a serious health problem for humans. One of the most hazardous air pollutants, which is highly dangerous for human health, is polycyclic aromatic hydrocarbons (PAHs). The existence of the emission of industries' pollutants and seasonal variations are the primary agents affecting PAHs' concentration. The purposes of this study were to calculate the cancer risk and measure PAHs' exposure in the ambient air of Ahvaz, southwest of Iran, during 2017. Three distinct areas ((S1) industrial, (S2) high traffic, and (S3) residential) of Ahvaz metropolitan were selected. Omni sampler equipped with polytetrafluoroethylene (PTFE) filters were used for active sampling of PAHs. To detect the level of PAHs, gas chromatography with mass spectrometry (GC/MS) was used. Incremental lifetime cancer risk (ILCR) and lifetime average daily dose (LADD) were used to estimate the health risk caused by PAHs. The results showed that the residential and industrial areas had the lowest and highest level of PAHs. Moreover, the average levels of PAHs in industrial, high traffic, and residential areas were 8.44 ± 3.37, 7.11 ± 2.64, and 5.52 ± 1.63 ng m^-3, respectively. Furthermore, ILCR in autumn and winter was higher than EPA standard, 0.06307 and 0.04718, respectively. In addition, ILCR in different areas was significantly higher than standard. Research findings imply that the levels of exposure to PAHs can increase ILCR and risk of health endpoint. The cancer risk attributed to PAHs should be further investigated from the perspective of the public health in metropolitans.

Assessment of Ambient Exposures Firefighters Encounter While at the Fire Station: An Exploratory Study

OBJECTIVE

Firefighters are at an increased risk for many types of cancer. Although most studies on this topic focus on exposures encountered while fighting fires, exposures at the fire station are also cause for concern. This pilot study aimed to describe air quality within a few fire stations in and around Boston, Massachusetts, and to investigate physical and organizational factors that may influence levels of contaminants in stations.

METHODS

Air sampling of particulate matter less than 2.5 μm in diameter (PM2.5) and particle-bound polycyclic aromatic hydrocarbons (PAHs) was completed at four fire stations in Spring, 2016. Sampling occurred in the kitchen, truck bay, and just outside the station. Data were analyzed to assess differences between and within stations. Interviews (n =7) were conducted with officers at each station to explore health and safety-related organizational policies and practices. Interviews were transcribed and analyzed for thematic content.

RESULTS

At each station, levels of contaminants were higher in the truck bays than either the outdoors or kitchen, and varied the most throughout the day. The station with the highest exposures in the truck bay had the lowest levels in the kitchen, which was possibly explained by new building materials and effective separation between building zones. The age and layout of the stations appeared to determine the extent to which policies favoring exhaust capture were implemented.

CONCLUSION

Levels of PM2.5 and PAH inside fire stations may contribute to firefighter cancer risk. Through understanding contaminant variability, we can begin to design and test interventions that improve cancer prevention.