Chloe SanClemente Thompson

SPH 381 A
Full Grant Final

More Extensive use of Personal Protective Equipment to Protect from PM2.5 in Woodsmoke

1. Background
1.1 Exposure Characterization
Firefighters are often exposed to wood smoke from burning houses and forest fires in
the line of duty. This smoke contains PM2.5- particulate matter that is 2.5 micrometers (μm) or
less in diameter (Baxter, Hoffman, Knipp, Reponen & Haynes, 2014, p. 1). These particles can be
inhaled immediately upon contact or can contaminate clothes and be absorbed later through
the skin (Fabian, Baxter & Dalton, 2011, p. 994). Exposure to the particulates can result in
cardiovascular disease, exacerbation of pre-existing respiratory problems like asthma and
COPD, and increased mortality overall (Fabian et al., 2011, p. 995). The easiest way to limit
exposure is to wear personal respiratory and skin protection equipment before, during, and
after firefighters extinguish burning materials (Baxter et al., 2014, p. 1). Although gear is
standardly required during fire response, sometimes it is neglected after burning materials have
been extinguished and are being inspected. This neglect can be dangerous for fire fighters. For
the general public, exposure to PM2.5 is regulated by the EPA’s Clean Air Act and required to
stay between 12 and 35 micrometers per cubic meter (EPA, 2013, p. 3086). OSHA regulates the
workplace for firefighters. OSHA only calculates acceptable ranges for PM3.5 and PM4, but
most research monitors PM2.5. One study adjusted OSHA rates and found that even their
highest number for PM2.5 exposure (2068 μg/m3 ) did not surpass the limits set by OSHA
(Adetona, Simpson, Onstad & Naeher, 2013, p. 982). OSHA also protects firefighters by
requiring breathing apparatuses for firefighters working in buildings or confined spaces (OSHA,
2008, 1910.156(f)(1)(ii)).
Additionally, OSHA mandates that employees in emergency situations be physically
able. Employees with known heart disease, epilepsy, or emphysema cannot participate in
emergency response until cleared by a doctor. However, asthmatic individuals are not
dismissed from consideration for firefighter duty and therefore could be a vulnerable
subpopulation (OSHA, 2008, 1910.156(b)(2)). Beyond that, any group that takes off PPE and
breathing apparatuses while in the field is at a greater risk of poor health outcomes.

1.2 Literature Review

Prior research has focused on previously unstudied areas of the U.S., such as the
Southeast. Adetona et al. (2013) measured forest firefighters’ exposure to carbon monoxide
(CO), PM2.5, and levoglucosan (LG) during their shifts in South Carolina. PM2.5 was collected
with small sampling devices called personal sampling cyclones attached to the firefighters’ lapel
or in their vest pockets. These devices pump air through internal filters that collect PM2.5. The
change in weight of the filters before and after sample collection indicated how much PM2.5
there was collected in a cubic meter of air. Additionally, researchers administered a
questionnaire to determine demographic information and an activity diary to assess the
perceived severity of their exposure and the tasks they performed during their shift. Adetona et
al. concluded that although exposure to particulate matter during firefighters’ shifts did not
exceed limits set by occupational standards, wildland firefighting does elevate exposure to
PM2.5 (2013). Certain conditions increased exposure- vegetation with higher pine
concentrations and working on the fire lines closer to active burns.
Other research demonstrates the importance of wearing Personal Protective Equipment
(PPE) outside of active fire extinguishing. Baxter et al. (2014) studied exposure even after
burning materials had been extinguished and within firehouses themselves. Researchers used
Personal Modular Impactor pumps with removable filters to measure PM2.5. Filters were
weighed before and after sampling by a commercial laboratory to determine the amount of
PM2.5 in a cubic meter of air. Researchers only collected air samples during overhaul (checking
for hidden fires or other dangers immediately after a fire has been extinguished) and inside
firehouses themselves. Baxter et al. (2014) concluded that it was possible for a firefighter to
exceed EPA exposure limits (35 μg/m3 ) set for the general public during a 24-hour shift. By far,
the highest PM2.5 concentration occurred during the process of overhaul. However, PM2.5
levels were higher than a control location in many locations inside the firehouses including
kitchens and truck bays. In one of the firehouses researchers sampled from, PM2.5 levels in the
kitchen were comparable to PM2.5 levels during overhaul events. Researchers were hesitant to
compare their results to occupational exposure limits because of the variable nature of
exposure and a lack of limits set for PM2.5 specifically. Adetona et al. addressed this by
adjusting their rates as mentioned above in order to compare their results to PM3.5 standards
set by OSHA (2013).
Implications of this research include policy advocating for lower levels of acceptable
exposure. OSHA only requires breathing apparatuses in enclosed spaces. Research about
wildfire exposure shows that negative health outcomes arise even in completely ventilated
environments. Additionally, health workers should be aware of the negative health impacts of
even small exposures to PM2.5 especially for vulnerable populations such as asthmatics. Other
recommendations based on current literature include the prolonged use of personal breathing
equipment even during overhaul events when it is often removed (Baxter et al., 2014). The
literature supports rethinking layouts and ventilation of firehouses in order to reduce the flow
of PM2.5 into kitchens/sleeping areas where it could be consumed. Finally, better
decontamination of skin and clothes could prevent secondary dermal exposure and subsequent
absorption into the body.

2. Grant Proposal
2.1 Problem Statement
The research idea being proposed is further investigation into the benefits of increased
use of personal protective equipment for firefighters during overhaul events.

2.2 Project Goals and Objectives

This grant will help to answer whether or not requiring more intensive use of air filter
PPE reduces exposure to harmful PM2.5 in smoke for firefighters on the job. Research might
indicate a proportion of exposure that occurs after taking PPE off in the field and the proportion
that occurs in firehouses. It will serve the population of interest by helping firefighters optimize
the use of equipment they already have access to and subsequently improve health outcomes
for them. This grant will advance public health by evaluating the effectiveness of
recommendations made by past researchers to increase air filter use and pave the way for
further research to understand exposure inside of firehouses.

2.3 Project Methods

This research will serve firefighters that work in areas prone to woodland fires now and
in the future. Relevant areas include California, Oregon, and (increasingly) Washington.
Firefighters in these locales will make up the sample populations. These populations and areas
are important to study because of the rapidly increasing number of wildfires due to changing
climate patterns and increasing temperatures.
In order to evaluate appropriateness of a sample population, a preliminary survey will
be administered to determine how long firefighters already wear PPE. If a firehouse is deemed
a good testing site, then the study will proceed. The research will include two groups- one that
wears their PPE from leaving their transportation (helicopter, fire truck, etc.) until re-entering
and another that does not change their normal PPE practice. It is important that the test group
wears their PPE even during overhaul evaluation or charred materials. After coming back from a
fire event, urine samples will be collected and tested for trace amounts of Levoglucosan, a
metabolite that can indicate exposure to PM2.5 in woodsmoke. This procedure will occur
during and after three fire events. In addition, firefighters will receive a survey that records
demographic and health information.
Stakeholders to work with on the research include: graduate students and faculty in the
Department of Environmental and Occupational Health Sciences at the University of
Washington, professionals at OSHA, and the Washington State Council of Fire Fighters (WSCFF).
Faculty and students will be invaluable in approving, sponsoring, and executing the research;
OSHA and the WSCFF will help in implementing recommendations generated through the
research and in creating contacts and avenues of communication with sample populations.

2.4 Project Evaluation

In order to assess whether the project accomplished its goals, the control group will be
compared with other studies that evaluated exposure with reduced use of PPE. This metric will
gage the credibility of the baseline which this project is using to measure difference in
exposure. The study will meet its goals if it discovers either measureable differences or lack
thereof between control and experimental groups. If results indicate that PPE is effective in
protecting from exposure to PM2.5 when worn for longer periods of time, then
recommendations will be given to the firehouses studied and will be published for wider use.
Additionally, research could help firefighters and public health practitioners understand if
directing efforts towards increased use of PPE or restructuring firehouses is more important to
reduce dangerous exposure.
The results of this research are limited in their generalizability. Although results should
be generalizable to firefighters in the Pacific Northwest, samples will likely only be collected
from Washington firefighters. It is also worth noting that vegetation varies across the country
and that results derived from woodland fires in Washington and nearby states may only be
generalizable to the states sampled and not to, for example, states in the southeast United
States. Other limitations are that the study does not address the secondary exposure
firefighters receive in their firehouses. This area requires further research.

2.5 Project Budget

It will take an estimated 3 months during summer (prime wildfire season) to gather data
and a month to analyze data for a total of 4 months to complete the project. To complete this
research, researchers will require personnel, equipment, and other resources. Basic testing and
analysis equipment necessary to the study includes: urine sampling supplies, a computer to
collect data with, a lab for analyzing urine sample results, and paper or tablets in order to
administer the surveys. Researchers will also need cars for transportation of personnel and
equipment to and from firehouses. Time needs to be dedicated to finding willing firehouses and
administering the preliminary sampling eligibility survey. To meet the lab and surveying needs,
it will be necessary to hire research assistants.

2.6 Conclusion
The proposed research will advance public health research by testing the validity of
previous recommendations for firefighters and evaluating whether the use of PPE to greater
extents than it is already used in practice is a protective factor for firefighter health. Discovering
the usefulness of PPE can help future public health practitioners be more intentional with their
educational and policy-related occupational health efforts. Additionally, this research could
encourage future research into other avenues of exposure that firefighters face by helping
contribute to understandings of how much exposure to PM2.5 comes from poor PPE practices
by firefighters.

3. References
Adetona, O., Simpson, C., Onstad, G., & Naeher, L. (2013). Exposure of Wildland Firefighters to
Carbon Monoxide, Fine Particles, and Levoglucosan. Annals of Occupational
Hygiene,57(8), 979-991. doi:10.1093/annhyg/met024
Baxter, C. S., Hoffman, J. D., Knipp, M. J., Reponen, T., & Haynes, E. N. (2014). Exposure of
firefighters to particulates and polycyclic aromatic hydrocarbons. Journal of
Occupational and Environmental Hygiene, 11(7), D85–D91.
http://doi.org/10.1080/15459624.2014.890286
EPA. (2013). National ambient air quality standards for particulate matter. Federal Register,
78(10), p. 3086. Retrieved from: https://www.gpo.gov/fdsys/pkg/FR-2013-01-
15/pdf/2012-30946.pdf
Fabian, T. Z., Baxter, C. S., Dalton, J. M. (2014). Characterization of firefighter smoke exposure.
Fire Technology, 50(4), p. 993-1019. doi:10.1007/s10694-011-0212-2
OSHA. (2008). Fire brigades (Standard No. 1910.156). Retrieved from:
https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=9810&p_table=ST
ANDARDS