On a clear morning last May a long row of fire trucks lined the shore of Fort Baker in Sausalito, gleaming before the backdrop of the Golden Gate Bridge. The cry of bagpipes floated over the bay where a fire boat waited for its moment — a traditional water salute. This was a memorial for Ross Valley Fire Captain Rick Addicks, and fire ladders rose toward the sky, supporting an American flag to honor the fallen 22-year veteran of the Marin County fire service. In April 2024, Addicks died of occupational esophageal cancer at age 55, one year after he was diagnosed. His wife Kristen spoke of his abiding commitment to his career and his firefighting “family,” and as the firefighting community paid tribute to Addicks’ life and service, it became clear that as a lawyer as well as a firefighter, he spent his career not only fighting fires, but also advocating for the physical and mental health of his fire service peers.
“We loved Rick,” says Sid Jamotte, one of Addicks’ younger colleagues at the Ross Valley Fire Department. “When Rick got sick, cancer became so much more real.” Jamotte describes Addicks’ efforts to look out for the well-being of his colleagues as non-confrontational, but inquiring and persistent. “I asked him what he would like me to do once he passed, and he said, ‘Keep charging.’ And I will, because that is what he did,” says Jamotte.
According to Jamotte, who is now the Health and Safety Chair of the Marin Professional Firefighters Local 1775, and John Bagala, the president of the same union, the number of cancer diagnoses amongst the ranks of the 465 firefighters in the nine fire agencies across Marin County continues to rise at an alarming rate. “It used to be heart attacks, then vehicle accidents that were line-of-duty deaths for firefighters,” says Bagala. “Then, in 2014, we lost more firefighters by suicide than line-of-duty deaths. On the heels of that, there has been this rise in cancer. Now cancer is the leading cause of death among firefighters. So we have to ask ourselves the question: Why do the number of firefighters diagnosed with cancer keep going up? We cannot slide backwards protecting firefighters’ lives.”
In December of 2020, Matthew Alba, a San Francisco Fire Department battalion chief was at his home in San Anselmo getting ready for a bike ride with his daughter when he had a seizure. His daughter, just 11 years old at the time, called 911, then ran across the street to get help. Alba was stabilized and diagnosed with incurable brain cancer. Despite dealing with chronic cancer, Alba continues to work for the San Francisco Fire Department. He has undergone treatment, including major brain surgery to remove a large tumor, and while he has not experienced physical deficits, Alba has some cognitive deficits and his communication skills have been affected by aphasia, a disorder caused by damage in the area of the brain that controls language expression. After 26 years in the field, Alba is no longer on active duty, but assumed a position as battalion chief in charge of the Division of Health, Safety and Wellness for SFFD. He is also a board member of the San Francisco Firefighters Cancer Prevention Foundation. The Foundation, founded by 30-year veteran Tony Stefani, who was diagnosed with bladder cancer in 2001, supports Northern California firefighters who are facing a cancer diagnosis and commissions science-based studies around cancer and cancer prevention.
“As long as I am working in the Fire Department, I will continue to try to protect firefighters,” says Alba. One of the exercises prescribed to Alba to regain his ability to access language is to read complex material outloud. “I alternate reading poetry with reading peer-reviewed scientific journals that include the studies that tie cancer to fire service,” he says. “In the past, the connection was hypothetical. Now science has confirmed it as a fact. Firefighters are the modern version of the canary in a coal mine because we are exposed to so many known carcinogens.”
According to research by the Centers for Disease Control and the National Institute for Occupational Safety and Health, occupational cancer is now the leading cause of line-of-duty deaths in the fire service. The International Association of Firefighters found that nearly 75% of those honored at the Fallen Firefighter Memorial in September 2022 died of occupational cancer. Fire service representatives and legislators in many states across the U.S. are working to classify all cancers contracted by firefighters as “presumptive,” meaning the disease is related directly to the occupation, something that is critical to supporting firefighters as they seek workers’ compensation and disability benefits.
Firefighters have long known the risks of exposure to carcinogens in the smoke from burning buildings and in firefighting foam, but as researchers investigate possible causes for increasing rates of cancer, the PFAS (per- and polyfluoroalkyl substances) in the firefighting “turnouts” (protective gear) have been implicated. These synthetic “forever chemicals,” named so because they are highly persistent in the environment, are used in industry and consumer products worldwide. Firefighting gear is particularly laden with PFAS, which are used for thermoregulation and heat and water resistance, including in the layers of clothing close to the firefighter’s skin.
“We’ve known firefighting is one of the most dangerous jobs. We’ve always known. Now as science and technology progress, we have to make improvements to make ourselves more safe,” say Bagala. As cancer diagnoses and deaths impact fire agencies, many leaders in the Northern California community have become increasingly vocal about the urgent need to reduce chemical exposure, and are adamant about the long-term industry knowledge of the cancer risk that PFAS pose and the need to hold manufacturers accountable. In June of 2023, 3M Company settled a $10 billion class action lawsuit assuming accountability for the PFAS in Aqueous Film Forming Foam (AFFF), and currently a tidal wave of class action and personal injury lawsuits against manufacturers 3M, DuPont, BASF, Tyco Fire Products and others, points to manufacturers’ knowledge of the grave health risks of PFAS used in foam and turnout gear. Internal documentation from as far back as 1970 confirms that the company DuPont knew that PFAS were “highly toxic when inhaled,” and, in the decades since, multiple internal documents from DuPont, 3M and other manufacturers point to awareness of PFAS as “persistent,” “bioaccumulative” and “toxic.”
“The equipment manufacturers that make the gear we wear have been lying to us for years,” says Union President Bagala. “They knew these chemicals were not safe, and, like Big Tobacco, they had a big campaign to convince us otherwise. The last thing we expected is that these manufacturers intentionally, or unintentionally, have been poisoning our people.” The Local 1775 union has purchased a copy of Burned, a 2023 documentary film that follows the chronology of industry suppression and misrepresentation of information about the health risks of PFAS, and will hold screenings for the Marin County fire community as well as the general public in the coming year.
“A minority of people have been profiting from a majority of people suffering,” says SFFD’s Alba. “Companies have been making money off of these chemicals.” As awareness grows among the fire service, politicians and the general public, the needle has begun to move, and California and the Bay Area are on the forefront of changemaking. In 2020, California joined 13 other states, passing a ban on PFAS compounds from firefighting foams. This law took effect on January 1, 2022. Then, last May, San Francisco became the first city in the nation to ban the chemicals from the city’s firefighting gear. A local ordinance requires the city to invest an estimated $10 million to replace firefighting turnouts by June 30, 2026. Meanwhile, in Sacramento, AB 2408 proposes a ban on the manufacturing, sale and distribution of firefighter gear that contain PFAS. The bill, authored by state Assemblymember Matt Haney of San Francisco’s District 17 and sponsored by California Professional Firefighters, passed unanimously in the Assembly and is on its way to review in the Senate.
In his separate roles in the Fire Department and on the board of the San Francisco Firefighters Cancer Prevention Foundation, Alba is involved in efforts to protect firefighters by establishing health testing protocols, studying supplements such as sulforaphane for efficacy in mitigating cellular damage and finding non-toxic replacement turnouts. SFFD recently concluded a 90-day trial of PFAS-free gear made by a company called Stedfast. Unfortunately, in order to meet “vertical flame test” regulations set by the National Fire Protection Association, the gear uses a fire retardant that is also a known carcinogen, so the search for effective non-toxic turnouts continues. In Marin County, Jamotte is looking into an opportunity to replace the “bunker” gear, which is for training purposes only and does not require the same level of protection, with PFAS-free alternatives. “There is more and more stuff coming out now,” he says. “A firefighter in Florida created a set of bunker gear for training with no chemicals whatsoever. We can wear these turnouts in training and we are not absorbing known carcinogens.”
Jamotte, Bagala and Alba all say that the process of replacing turnouts nationwide will be a matter of public awareness, leading to political and financial will at local, state and national levels. Assemblymember Damon Connolly, who represents Marin in the California Assembly, and the North Bay’s State Senator Mike McGuire, have both been vocal advocates for AB 2408. “If there is change at the state level holding manufacturers accountable, it will lead to change at the local level,” says Bagala. “But this is a long-term fix. Even if we start replacing our turnouts today, there are approximately 400,000 paid professional firefighters — and each has a set of two turnouts. That is an investment, and it will take time.” Bagala estimates it will take five to 10 years before fire departments across the nation see turnouts free of harmful chemicals.
Josh McHugh of San Anselmo and Rick Addicks were best friends for three decades. Both were fire captains — McHugh in the Southern Marin Fire District and Addicks at the Ross Valley Fire Department. They worked together, surfed together, skied together and raised their families together. “I lost the best friend I ever had,” says McHugh of Addicks’ death in April. Something else the two men shared is a cancer diagnosis. McHugh was diagnosed with occupational colorectal cancer on Cinco de Mayo, 2020, at age 51, which forced him to retire after 26 years in the fire service. “I loved firefighting so much, and I miss it terribly,” he says. “When I hear a siren go by I still wonder what is going on. I cherish every moment of my career.” After treatment and surgery, McHugh’s cancer is in remission, but he continues to face post-treatment health challenges.
Because the transition to non-toxic gear will take time, McHugh believes it is critical that fire agencies establish other immediate ways to protect firefighters. “Trying to get manufacturers to change their products is very slow,” says McHugh. “So we need health screenings, preventative care and awareness. And there are also simple changes we can make. For example, we used to just have one set of turnouts. Now we have multiple. We need to bag up our dirty stuff, and we need to have decontamination stations on the scene.”
Bagala and Jamotte echo McHugh, saying that establishing decontamination protocols and, most importantly, regular health screenings to diagnose early, before cancer spreads, are the immediate actions Marin County fire agencies can take. “There are hundreds of things to do, but occupational testing will save lives and careers. Testing for these cancers — colon, esophageal, breast, prostate, brain, thyroid — so we catch them early. It is a lot cheaper to do the tests now than to treat our people later,” says Bagala.
Regular testing will cost an estimated $2500 per firefighter, says Jamotte. He believes that Marin County taxpayers want to know that the people they rely on in residential fires and wildfires, who deliver babies, rescue them from waves and save them from heart attacks, among other emergencies, are taken care of and are healthy. So the key is that fire chiefs allocate the funds for these measures. “A budget is a moral document,” Jamotte adds. “We can spend a fraction of our budget so that every year our firefighters get a clean bill of health. If we catch one case of cancer at stage one, instead of stage four, which was what Rick’s diagnosis was, it is worth every penny because we saved a firefighter, and we saved a human being.”
