NANTUCKET — Kevin Ramos has been a full-time firefighter on the island of Nantucket for seven years, but he’s been wearing turnout gear for 21. His father was a call firefighter on the island, and when he was young, he was in a program called the explorers, for young kids interested in the fire service.
He’s now 33 years old and has four lumps on his thyroid gland.
“When we were explorers, 11 years old, 12 years old, we were coming in and doing calls, training in turnout,” he says. “As junior firefighters, we couldn’t go into burning buildings, but we could do overhaul.”
Overhaul is what happens after a fire is knocked down. You search the area for smoldering hot-spots and hidden fires inside walls, find areas that could flare up again and put them out.
“Now we’ve realized the overhaul is the worst part of this,” he says. “All that white smoke, where we thought it was really cool at 13 years old to put out that white smoke, move stuff with a shovel — now we’ve realized that’s the worst time of a fire, when it’s all totally off-gassing.”
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Ramos spent his youth poking through hazardous sites, and to some extent he knew he was taking a risk to serve a calling. But he figured he was protected by his safety gear. Now, there’s evidence to suggest the firefighter safety gear he wore is itself unsafe, made with and shedding carcinogenic chemicals. He, and over a dozen firefighters from Fall River, Hyannis and Nantucket are part of a unique study to begin understanding whether that's true and, if so, to uncover how badly they've been affected.
Ramos says he expects to get cancer.
“To me, it’s finding out when — it's not if, probably,” he says. “It’s going to be when.”
Six Fall River firefighters recently rode the ferry to this island almost 30 miles off the coast of Massachusetts. Each of the men — Jason Burns, Josh Hetzler, C.J. Ponte, Kevin Poirier, Paul Kosinski and Henry Santos — brought a duffel bag with their helmet, boots, gloves, pants and jacket. They weren’t expecting to see any action. They were taking part in a scientific experiment that could change the fire service.
Their gear is made with chemicals called PFAS, or perfluoroalkyl and polyfluoroalkyl substances. PFAS is a class of over 9,000 different chemicals found in almost every consumer product to make them waterproof, stain-resistant or nonstick — like Teflon.
PFAS is what makes firefighting gear protective, durable and waterproof. But there’s evidence to suggest these chemicals can shed and be absorbed through skin contact or be ingested, or break down in the presence of high heat and be breathed in. Once in the body, PFAS builds up and takes years to be eliminated. And certain PFAS compounds are linked to serious and potentially fatal health consequences, including thyroid disease, high cholesterol levels, ulcerative colitis, and several different kinds of cancer — cancers of the liver, breasts, prostate, testicles, and kidneys being most common.
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“Everybody’s exposed to a little bit of PFAS,” says Courtney Carignan, an assistant professor at Michigan State University, an exposure scientist and environmental epidemiologist. She’s performed extensive research into PFAS exposure in firefighter gear and drinking water, fire retardants, and other hazards.
Seventeen firefighters took part in a study she devised, men from Fall River, Hyannis and Nantucket. They would wear their gear and do training exercises for over an hour, simulating basic firefighting duties, drilling some tasks and working up a sweat. Carignan would measure their levels of PFAS both before and afterward, to see how much PFAS came off their gear, if any — and from there, be better able to study how much could get into their bloodstream.
“There’s a data gap there. We don’t know,” Carignan says. “We just don’t know if their exposure could be through the gear since the dermal exposure data just really isn’t good."
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To state the obvious, Nantucket is a far different place than Fall River. Out here, surrounded by nothing but water for at least 20 miles in any direction, the 30 men and women of the fire department are on their own.
“There’s no mutual aid,” Hetzler says.
They also serve a wealthier community with more available resources than Fall River. A breakfast spread has been laid out for the firefighters before they start their training, featuring veggie quiche, sandwiches of avocado, oat milk to lighten up their coffee. Their new $20 million fire station opened in 2019. Some of Fall River’s fire stations are nearly a century old. The Fall River guys look at a new floor buffer in the apparatus bay, and Ponte says, “Ours came over on the Mayflower.” In the living quarters kitchen, waiting to fill out paperwork before their tests, Ponte peeks into cabinets looking for oil so he can season their cast iron pans for them — not Teflon.
But whether they serve rich or poor communities, cancer doesn’t discriminate among those in the fire service. They are all touched by it.
The Fall River guys all remember Paul Chippendale, who died nearly a decade ago at 37 of cancer, and two years later, Adam Franco, who died at 32. Fall River firefighter Michael O’Reagan was diagnosed with lymphoma in 2016, underwent surgery, chemotherapy and radiation before returning to duty two years later. He has signed on to a lawsuit against 25 chemical companies alleging that PFAS in his gear gave him cancer.
Poirier says his father, who was not a firefighter, died of cancer a few years ago, so he’s naturally concerned about getting cancer himself. Part of his father's jaw had to be removed, and was replaced with a segment of his fibula, a shin bone.
“He didn’t last much longer after that, about eight months,” Poirier says, “but nice try.”
Nantucket Fire Capt. Nate Barber is in remission from seminoma, a form of testicular cancer, underwent radiation and an orchiectomy two years ago. He believes this was likely caused by exposure to toxic chemicals as a part of his job. When he speaks about his diagnosis, he becomes very quiet and grows emotional.
“I'm trying to move on from that part of my life," he says. “I want to not have cancer. I want to not have to think about it.”
His wife, Ayesha Khan, co-founded the Nantucket PFAS Action Group, and has dedicated herself to educating people about the potential dangers of PFAS contamination. Not only has her family been affected directly — her community has issues with PFAS-contaminated drinking water, which could be from the use of AFFF, or firefighting foam, at the island’s airport. The gear testing is taking place thanks to a grant she received from the Toxics Use Reduction Institute at UMass Lowell. She works closely with Nantucket Deputy Chief Sean Mitchell, who has spearheaded efforts to educate his crew about PFAS, limit the use of foam, and gotten the community to buy everyone new gear with an outer shell that’s PFAS-free — one of the first communities nationwide to do so. They’ve hooked up with Burns, a 15-year firefighter in Fall River and former union president who has been vocal about the dangers he says PFAS pose to the men and women in his crew.
Together, they’ve united firefighters from two radically different communities under the same cause: to find out whether they're being poisoned by their own safety equipment.
“The reality is, the work they’re doing will probably be more impactful than anything else that anyone’s doing in the industry,” Barber says. “Because it will affect everyone who’s a firefighter. So I think the impact on health and safety is going to be substantial.”
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The idea that safety gear could itself be harmful isn’t new. Fire proximity suits were, for much of the early to mid-20th century, made with asbestos fibers even though the risks of using asbestos had been known within the industry for decades.
The chemical companies that produce PFAS maintain their products are safe. On a statement on its website, 3M says "the weight of scientific evidence does not show that PFOS or PFOA causes harm to people at current or historical levels," while Dupont notes that human studies of their health effects have produced "mixed results." The Chemours Co. says fluoropolymers "do not pose a significant risk to human health or the environment." And the National Fire Protection Association, which sets national standards for fire safety equipment, in September 2021 refused to change its testing standard to allow for a layer inside turnout gear, closer to the skin, to be made without PFAS. That vote drew condemnation from the national firefighters' union, firefighters and their families, who cite scientific studies showing links between PFAS and cancer risk, and unusually high rates of cancer in the fire service.
Both Burns and Mitchell have advised the people in their departments to only wear PFAS-made safety gear when it’s necessary, and avoid using it when it’s not, to minimize any potential exposure to chemicals. That means no posing for photos and no exercising in turnout gear.
Except today — it's a calculated risk.
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After some paperwork and testing, and a blood draw to measure each man’s long-term exposure to PFAS, the men suit up in their gear and divide themselves into stations meant to simulate firefighting tactics or just get them sweating. One group recreates ladder rescues by carrying down a heavy hose then carrying it back up three flights of stairs and handing it off to the next man. Another group drags a full hose of water into the apparatus bay and blasts it into a stairwell. A third creates its own makeshift gym, using 4-inch hoses like battle ropes, hitting a coiled 5-inch hose with sledgehammers, and doing push-ups.
Turnout gear is warm and heavy, weighing anywhere from 15 to 45 pounds or more. It takes only a few minutes of exercise before sweat starts pouring down their faces. Nantucket Fire Capt. Charlie Kymer opens his jacket — the interior lining is hot to the touch.
“I think it’s funny that we’re doing exactly what you’re not supposed to do,” Ponte says. “Working out in the gear, getting sweaty. That’s how it absorbs in your skin.”
The study will capture data from a range of different kinds of gear to note any difference between shedding of PFAS chemicals. Some of the firefighters are wearing brand-new gear with a PFAS-free outer shell. Several of the Fall River guys are wearing stuff that was issued in 2017, used but not too old. Some have gear that’s over 20 years old, well broken-in from service on countless fires, faded and soot-stained.
Likewise, there’s a range of firefighter experience. Nantucket's Mac Davis, in his mid-40s, has been a full-time firefighter for six months. Lt. Paul Medeiros of Hyannis Fire Department has been fighting fires for over three decades. They themselves will have a wide range of long-term PFAS exposure.
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“I have the newest gear, so I feel like if anybody’s got a chance to figure out if it’s working or not, it’s me," Davis says. “I also feel like if you’re on a team, you've got to help figure it out with them.”
They exercise for over an hour, but they clearly enjoy it. Hetzler climbs down a ladder carrying a hose he says may weigh 60 to 80 pounds, “the weight of a child,” and says this is an opportunity to practice techniques they don’t always drill. The men from the three departments are curious how their counterparts work — there are certain standards they all know, but still tricks and tips to be shared.
“It’s good to get together and train amongst peers, too," Kymer says. “A lot of information gets very subtly transmitted.”
During breaks, the men chat with each other about their jobs and their lives. Santos sits on the bumper of a truck, and he and a Nantucket firefighter discuss second jobs. A lot of firefighters in both communities have them. They don't earn as much as people might think.
“When we started with three different stations, Fall River guys were together and Nantucket were together,” Mitchell says. “And just like that, they had mixed together and working together, just like we had met before.”
Kymer, at 62, understands he’s being a guinea pig for environmental science. He knows firefighting is an inherently dangerous job, and this is one more risk he’s taking that will hopefully benefit future generations.
“It won’t serve me because I’ll be done in three years,” he says, since he has to retire at 65. “I like the scientific aspect of this, and if we can help somebody else with this — it's easy for us to do, and we can benchmark it against what they’ve now given us as the new generation stuff.
"We’re the only group in the country that has this gear. So if we can’t do it, no one can.”
The results of this day’s experiment won’t be known for months — samples are being taken to university laboratories at Michigan State and Duke for analysis. It’s unknown how long that will take. Given that this analysis is being funded by a grant, and not private funding, it’s of a somewhat lower priority than other studies.
The blood draws from the firefighters aren’t necessarily part of the study. Carignan says those results are "a measure of really long-term exposure over a decade or so.” With those results, individual firefighters can get a read on how much PFAS is in their body already and use that to make better-informed decisions about their own health, or look for markers that could indicate cancer.
Ramos isn’t sure what else he’d do if he finds out his PFAS levels are high. He already knows he’s got thyroid problems, and is waiting to see a specialist about it — a prospect made more difficult because he lives on an island.
“I don’t know what the answers are,” he says.
Poirier isn’t sure, either. If in the future he is told he has a high buildup of carginogenic chemicals in his blood, that would open up many more questions impossible to answer fully now.
“I’d go see a specialist,” he says, chuckling ruefully.
In the kitchen at Nantucket fire headquarters after their exercise, someone jokes having over a dozen sweaty firemen packed into one place has given the air a locker-roomish tang. Capt. Frank Hanlon, who’s been full-time for 25 years, smiles and cracks open a window marked “DO NOT OPEN.” Regardless of what the results show, the departments have made connections.
While the results are being analyzed, all they can do is try to understand what risks may be out there, minimize exposure, and keep studying the issue.
Roberto Santamaria is Nantucket’s director of Health and Human Services. He says public education and awareness are key tools in the fight against possible PFAS toxicity, even more so than regulatory efforts.
“In America, regulations are the last resort. Your best bet is having the public do the work for you," Santamaria says. “The more people you educate, the more people will want to talk to you. Once that good information starts spreading, that’s how change is made, how change is done.”
Education on the subject is why Khan co-founded Nantucket PFAS Action Group — so other people curious and alarmed about potential PFAS contamination can have a starting point.
“It’s our burden, and it sucks, but we have to do something," she says. “We have to use what we have, and we have an affluent community, and people will listen to you. We just have to do the right thing.”
Dan Medeiros can be reached at dmedeiros@heraldnews.com. Support local journalism by purchasing a digital or print subscription to The Herald News today.