b'I N T R O D U C T I O NHEALTHY IN, HEALTHY OUTBest practices for fire fighter wellness including reduced risk of carcinogen exposure, musculoskeletal injury prevention and behavioral health awarenessI t has been several years since the game-changing Healthyvariety of hazardous substances, including polycyclic aromatic In, Healthy Out was published to establish a manual on thehydrocarbons (PAHs), benzene, formaldehyde and asbestos, Best Practices for Reducing Fire fighter Risk of Exposures toamong others. It has become more important than ever for the fire Carcinogens. Since that time, research funded by FEMA grantsservice to implement best practices to prevent and eliminate the has increased significantly, and so much more is known about therisks associated with cancer.risks fire fighters face at emergency scenes, inside fire stations andThe Washington State Council of Fire Fighters (WSCFF) while using apparatusas well as how sleep, fitness and nutritionprovided the technical review panel with members from the are linked to cancer. For fire fighters, its important to acknowledgeInternational Association of Fire Fighters (IAFF) locally across the that work-related factors can greatly influence their overall healthstate of Washington. We also have worked with the Washington and well-being. Therefore, any approach to Total Worker HealthState Department of Labor & Industries (L&I), the IAFF and (TWH), a holistic approach to worker safety and health, must takenational experts who dedicate themselves to researching the into account both the physical and psychosocial aspects of the job. prevalence of cancer in the fire service.In 2020, FEMA awarded a Fire Prevention and Safety GrantThis technical panel searched fire service agencies across to Puget Sound Regional Fire Authority, formerly Kent Firethe state, the country and the world to identify the current Department, to update this manual with new research identifyingpractices that will, to the greatest extent possible, reduce the risk the increased risk of cancer to fire fighters. We have updatedof exposures to carcinogens for firefighting activities.cancer-prevention tactics and included best practices forA best practice is a method or technique that identifies a behavioral health, wellness, fitness and nutrition, along with sleepstandard way of doing something that multiple organizations can hygiene and exposure documentation. Lastly, information aboutuse and adopt. A best practice can, and will, evolve to become musculoskeletal injury prevention has been added to help avoidbetter as improvements are discovered. those often-debilitating injuries that have lifelong impacts. This document is organized in the format of the Incident In June 2022, the International Agency for Research on Management System (IMS) with Finance, Command, Planning, Cancer (IARC) reclassified the occupation of firefighting to Operations and Logistics sections. While not every fire Group 1, the highest hazard category, due to their risk of exposuredepartment will have the capability or the budget capacity to to certain carcinogens. Occupational exposure as a fire fighterimplement all of these practices, this document refers to the has been shown to be carcinogenic based on sufficient evidencebest practices that have been identified to reduce exposures to of cancer in humans. Fire fighters are at risk of exposure to acarcinogens with the goal of propagating potential change.2'