Running Into PFAS: The Firefighter Health Crisis
Firefighters—who run toward fires that everyone else flees—face a occupational health burden that extends far beyond acute injury risk. Decades of AFFF exposure, dermal absorption from PFAS-treated turnout gear, and ingestion of PFAS from fire scene contamination have created a firefighter population with elevated PFAS body burdens and associated health consequences that are only now being comprehensively documented. The convergence of occupational PFAS science, expanding cancer presumption laws, and major litigation settlements is transforming how firefighter PFAS health is understood, compensated, and prevented.
PFAS Body Burden in Firefighters: What Studies Show
Multiple biomonitoring studies have documented that firefighters—particularly those with longer careers and those working in departments that have used AFFF extensively—have significantly elevated serum PFAS concentrations compared to general population references. Studies of firefighters in Australia, the United States, Denmark, and Sweden have found median PFOS and PFOA concentrations 2 to 5 times higher than matched general population controls, with long-tenured AFFF-using firefighters showing even greater elevations. These body burden elevations are consistent with expected levels based on measured AFFF PFAS concentrations and documented exposure frequency.
PFAS exposure pathways in firefighters include direct skin contact with AFFF during training and emergency response, inhalation of PFAS aerosols during AFFF application, dermal absorption from PFAS-treated turnout gear that becomes PFAS-contaminated during fire response, and hand-to-mouth transfer during post-response activities before showering and decontamination. The importance of decontamination—removing PFAS-contaminated gear, showering immediately after fire response, and washing gear before storage in living quarters—has been demonstrated to meaningfully reduce PFAS exposure and is now a standard occupational health recommendation.
Cancer Evidence and Presumption Laws
The AFFF MDL’s focus on bladder cancer and kidney cancer as AFFF-associated cancers reflects the strongest available epidemiological evidence linking firefighter PFAS exposure to specific cancer outcomes. NIOSH’s occupational cancer studies of U.S. fire departments have documented elevated cancer rates in firefighters across multiple sites, including digestive, oral, respiratory, and urinary tract cancers. The International Association of Fire Fighters (IAFF) has pushed for expansion of presumptive cancer legislation—state laws that presume firefighter cancer diagnoses are occupationally related—to include specific PFAS-associated cancers. As of 2024, most U.S. states have enacted some form of cancer presumption law for firefighters, though the specific cancers covered and the required years of service vary by state.
Beyond cancer, cardiovascular disease has emerged as a significant health concern in firefighter PFAS research. Multiple studies have found elevated PFAS body burden associated with hypertension, dyslipidemia, and markers of cardiovascular risk in firefighter cohorts—findings consistent with PFAS mechanisms of lipid metabolism disruption and endothelial dysfunction. Cardiovascular disease is not typically covered by firefighter cancer presumption laws, representing a policy gap relative to the evidence base. Neurological effects including sleep disturbance, depression, and cognitive concerns in firefighter populations are an emerging area of research with less definitive evidence but growing scientific attention.
Gear Innovation and PFAS Reduction Strategies
The PFAS content of turnout gear—protective clothing required to meet NFPA 1971 performance standards—has received significant attention as a firefighter exposure reduction opportunity. Traditional turnout gear uses PFAS-treated outer shells for flame resistance and moisture barrier layers incorporating fluoropolymer membranes for water and chemical protection. PFAS-free turnout gear alternatives are under development by manufacturers including Globe Manufacturing and Lion Group, with prototype gear undergoing performance testing against NFPA standards. The transition to PFAS-free turnout gear faces the challenge of meeting stringent thermal protection, moisture resistance, and durability requirements without the performance advantages of fluorochemical treatments—a technically demanding goal that the firefighter gear industry is actively pursuing under pressure from firefighter unions and state legislation.