Everyone considers firefighters to be heroes in our society. They have a very risky and dangerous job. They are exposed to lots of hazards during doing their jobs and rescuing people, these hazards can have a massive effect on their health.

Introduction

Background on firefighting as a profession

As we all know firefighters step into very dangerous situations to rescue people. However, their profession is not just about extinguishing fires in buildings or car accidents. Firefighters are also considered paramedics, they can provide the victims with some emergency management before they are taken to the hospital. They also educate society on how to act in fire emergencies to maintain safety and evacuate the place as fast as possible to help firefighters do their jobs properly.¹

Overview of asbestosis

Asbestosis is a respiratory disease caused due to exposure to a material called asbestos. It affects the lungs, specifically the parenchyma ( the parenchyma is like a wall in the lung made of thousands of alveoli that are responsible for the gaseous exchange).

Asbestosis causes fibrosis ( thickening of tissues) of the parenchyma leading to difficulty in breathing and other respiratory symptoms.³ 

The link between firefighting and asbestos exposure

What does asbestos mean and what is it used for?

Asbestos is a group of minerals with fantastic properties allowing it to be used all over the world in different products. These properties include high strength and durability, heat resistance, low conduction of heat and electrical energy. That's why it was used in big amounts in old buildings, it was also used in the gear firefighters used. This makes firefighters liable to being exposed to large amounts of asbestos when an old building is on fire leading to asbestosis or mesothelioma ( a cancer that affects certain types of cells lining internal organs including the lungs).⁴ 

Understanding asbestosis

Definition 

As mentioned earlier, asbestosis is a type of chronic lung disease affecting the parenchyma due to exposure to the material asbestos. It usually affects both lungs.

Asbestosis does not have certain signs or symptoms that are characteristic of this disease but has the same common signs and symptoms of other chronic lung diseases. Asbestosis takes longer than other lung diseases to progress to a severe situation and its symptoms are not as severe as other pulmonary diseases.⁴

Asbestosis has a very long latent period( time taken by a foreign body to cause a disease and the symptoms start to appear).

Symptoms of asbestosis

Most signs and symptoms accompanied by asbestosis are considered common for most chronic pulmonary (lung) diseases which are:

1. Dyspnea ( difficulty breathing and being hungry for air)
2. Dry cough 
3. Digital clubbing ( swelling or enlargement of the ends of the fingers or toes)
4. Basilar rales ( unusual sounds heard during breathing)
5. Lung volumes decrease 
6. Bronchi and bronchioles (small airways in the lungs) in the lung get obstructed
7. Arterial hypoxemia ( decrease of the amount of oxygen in the blood)⁵

In some cases, asbestosis can affect other organs like the liver, thyroid gland, heart and kidneys due to the migration of fibrosis to other parts of the body. In rare cases, some patients encounter sarcoidosis, which is an inflammatory disease that causes granulomas( a cluster of cells and tissues) in different organs in the body as, a complication of asbestosis.⁵

Diagnosis and treatment options

The asbestosis diagnosis depends mostly on chest radiographs and CT (computed tomography) imaging.The radiographs show that the lower part of both lungs has small and non-defined (irregular) opacities.

 These opacities (opacity in X-rays means the presence of particles or subjects in an organ that shouldn't be found there) in lung radiographs indicate the presence of a disease and according to the site of the opacities and their shapes and size the disease can be identified. Asbestosis can be identified through chest X-rays by 80% and can be identified using CT imaging by 100%.⁵ This makes CT imaging able to detect asbestosis before the appearance of significant signs and symptoms.

Fibrosis(thickening) in the walls of both lungs can also be an indication of asbestosis.

Also, the shape of the diaphragm can show some changes.

The severity of the disease depends on the amount of exposure to asbestos and the time the patient was exposed to it.

Asbestosis can lead to death in some cases.

Unfortunately, asbestosis is an irreversible disease ( meaning it cannot be treated) it will also continue to progress even after there is no longer exposure to asbestos.

The treatment of asbestosis is just supportive treatment meaning it can relieve some of the symptoms of the disease not cure the disease itself.⁶

This is why in most developed countries asbestos is no longer used in either buildings or protective gear as the prevention of exposure is the only way for the disease to not happen.

Occupational hazards in firefighting

General hazards faced by firefighters

Firefighters are exposed to lots of hazards such as:

• The inhalation of steam 

This can cause burns in the bronchi ( small airways in the lung) because the amount of heat stored in vapour is more than that stored in dry air.

• Exposure to harmful gases

Like carbon monoxide, sulfur dioxide, nitrogen dioxide, hydrogen chloride, and hydrogen cyanide.

• Inhalation of smoke and fumes

The intense and increased inhalation of fumes and smoke can massively affect the respiratory system and can lead to death in some cases.

• Psychological effects

Firefighters' jobs are about entering very stressful situations rescuing people and entering burning buildings. It can affect their mental health and psychological well-being.

• Prone to Asthma 
• Susceptible to hearing loss 
• Exposure to carcinogenic materials like asbestos⁷

Specific risks related to asbestos exposure

Inhalation and exposure to asbestos dust released either due to the burning of old buildings or due to the use of it in some protective gears can lead to the entrance of these dust particles in the lungs and the small airways and settling in the lower part of the lungs causing an immune reaction to it leading to fibrosis accompanied by several respiratory signs and symptoms. causing asbestosis, mesothelioma and in some rare cases scleroderma. In some cases, the effect of asbestos can cause harm to other body organs too.

As it's a carcinogenic material it also can cause lung cancer or laryngeal cancer.

Preventative measures and safety protocols

Firefighters follow some protocols for their safety. They also use lots of protective equipment. The use of these protective gears prevents and reduces several hazards exposure to firefighters.

Current safety standards and regulations

Some of the safety standards and regulations follow the acronym “BEST” 

(B) stands for Behavior; this includes the behaviour of firefighters on duty to maintain their well-being, and mental, psychological and physical health during fire emergencies.

(E) stands for Equipment; this includes the use of personal protective equipment, the maintenance of the equipment they use during their job, and knowing how to use each and every equipment.

(S) stands for Standards and codes; the firefighters have to follow all the safety protocols to protect themselves and their colleagues and put themselves at more risk, how to rescue and protect victims found during a fire.

(T) stands for Training; firefighters should continually and constantly train to maintain a certain level of efficiency and proficiency as their careers stand no chance of mistake because this will either put their life at risk or the victim’s life at risk.¹⁰

Use of personal protective equipment 

Firefighters use lots of personal protective equipment (PPE)starting from the clothes they wear while on duty. These clothes protect their bodies from the fire and chemicals they are exposed to.

Self Contained Breathing Apparatus (SCBA) is one of the most important personal protective equipment used by firefighters, it works as follows, it allows a mall amount of air contaminated with all the dangerous gasses and chemicals produced as a result of the fire and maintains a good level of oxygen/non-contaminated air to the firefighters.¹¹

This equipment doesn't just protect the firefighter wearing it but also allows him or her to carry on with their work efficiently so as a result save a lot of lives.

Summary

Firefighters have a very risky job and are full of dangerous situations. Their jobs are not just about extinguishing buildings on fire or cars and trucks on fire due to an accident, they also save lots of lives and in some cases provide medical care to the victims before going to the hospital, but such an honourable job comes with a great price which is the hazards that affect both their mental and physical health. One of these hazards is asbestosis which affects the lungs and the breathing quality of the firefighters and can lead to their death. Asbestosis is caused by the inhalation of the material asbestos that was used in old buildings and some of the protective gear but is no longer used now in lots of countries.