Use of Aqueous Film-Forming Foams and Knowledge of Perfluorinated Compounds among Florida Firefighters
By Alberto J. Caban-Martinez, Natasha Schaefer Solle, Paola Louzado Feliciano, Kevin Griffin, Katerina M. Santiago, David J. Lee, Sylvia Daunert, Sapna K. Deo, Kenneth Fent, Miriam Calkins, Jefferey L. Burgess, and Erin N. Kobetz
J. Occup. Environ. Med.
April 15, 2019
DOI: 10.1097/JOM.0000000000001566
The US Navy developed aqueous film-forming foam (AFFF) in the 1960s containing per- and polyfluoroalkyl subsances (PFAS) and synthetic foaming surfactants that allowed for improved firefighter safety, particularly for firefighters involved in liquid fuel and crash fire rescue operations and those using nozzles during structural firefighting. PFAS are also commonly used to water and stain-proof specific textiles such as the materials used to construct firefighter turnout gear. AFFFs have evolved to include a number of different formulations (including AFFFs that meet Military Specifications [MILSPEC], alcohol-resistant aqueous film-forming foam [AR-AFFF], etc.) that often, but not always, rely on PFAS compounds for proper foam performance. AFFFs used to fight class B petroleum fires have historically contained longer chain PFAS such as perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS)4–6 that are associated with adverse health outcomes.7,8 PFOS use in new AFFFs and other products were banned in the European Union in 2011 and Canada in 2013, and major US manufacturers of AFFF indicated they would no longer produce PFOA-based fluorosurfactant foams after 2015. However, AFFFs typically have a long shelf life of up to 25 years. In addition, current fluorinated AFFFs contain shorter chain PFAS chemicals with less information on potential toxicity. Little is known about AFFF use and knowledge of legacy and current PFOA and PFOS chemicals among firefighters.
Some PFAS are associated with cancer, such that in 2016 the International Agency for Research on Cancer (IARC) classified PFOA as Group 2B indicating they are possibly carcinogenic to humans, based on limited evidence in humans that it can cause testicular and kidney cancer, and limited evidence in laboratory animals. Since the IARC designation, some additional cancer studies have suggested an increased risk of testicular cancer with increased PFOA exposure, whereas others have suggested possible links to thyroid cancer and kidney cancer. Epidemiologic studies have associated firefighting with an increased risk for a variety of cancers, including testicular and kidney cancer, among others, but the exposures responsible for these increased rates have not been identified. To date there is limited knowledge about the use of PFOA/PFOS containing foams within the US fire service. This is of greater concern in airport facilities where AFFFs that meet the MILSPEC are required for use on Federal Aviation Administration (FAA)-regulated airports and military airports.
Concerns about AFFF use and PFOA/PFOS chemical exposure center around the potential negative impact on firefighter health as well as on the environment from the discharge of foam solutions generated from the combination of water and foam concentrate. When PFOA/PFOS-containing AFFF are repeatedly used in one location over an extended period of time (such as in firefighter training facilities), the PFOA/PFOS can move from the foam substance into soil and then into groundwater. The amount of PFOA/PFOS that enter the groundwater depends on the type and amount of AFFF used, where it was used, and the type of soil and other factors. At firefighter training facilities, where AFFF is often repeated discharged onto concrete training areas, long-term release of PFAS into the surrounding soil and water from the concrete is anticipated to occur on the order of decades. As an initial first step to study the concern about AFFF use and PFOA/PFOS knowledge, we assess the awareness and knowledge of perfluorinated chemicals and AFFF use among Florida fire departments.
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