The work firefighters do is among the most essential, needed, but hazardous jobs worldwide. Firefighters not only save lives when a fire breaks out but are often the first responders in other emergencies, too. The job comes with many risks to their life and health, such as heat stress and associated cardiovascular disease, accidents, exposure to various toxic chemicals, and consequently, an increased risk of developing certain job-related cancers.

Many may not know that most firefighters in the U.S. are volunteers. According to statistical data collected by the U.S. Fire Administration (USFA), almost 70% of the firefighters nationwide are volunteers. USFA’s data also shows that in January 2024 in Illinois, 79.3% of the registered fire departments were volunteers, while only 20.7% were career fire departments.

As there is enough evidence by now that firefighters are more at risk of developing certain job-related cancers than the population in general due to their exposure to toxic substances, some states adopted the Cancer Presumption Law that attributes the firefighter's cancerous condition to their job. However, most states did not include volunteer firefighters in their Cancer Presumption Laws. The National Volunteer Fire Council (NVFC) identified that more than half of the states in the U.S. are not legally bound to support volunteer firefighters who have cancer with any form of compensation or disability benefit. One such state is Illinois.   

There is enough evidence to contradict the exclusion

The Cancer Presumption Laws have been voted across the U.S. as there is plenty of evidence that cancer, in the case of firefighters, is a job-related illness. One of the reasons for developing cancer is that firefighters have been working for decades with aqueous film-forming foam (AFFF). This firefighting foam has a large concentration of per- and polyfluoroalkyl substances (PFAS). PFAS are a group of toxic chemicals, often called "forever chemicals," because they are persistent and bioaccumulative once they enter the environment, especially groundwater. Studies show that long-term exposure to PFAS causes numerous health issues, including various types of cancers. On top of that, firefighters often use or wear protective gear that contains PFAS, as these “forever chemicals” have been widely used by manufacturers since the 1950s.    

The results of a recent medical study published in 2023 demonstrate that the risk of skin, prostate, testicular, brain, nervous system, rectal cancers, and non-Hodgkin lymphoma is significantly higher among firefighters than among the general population. Another study published in 2020 by the National Institute for Occupational Safety and Health, Cincinnati, showed an elevated mortality rate from all cancers among firefighters compared to the general population. Finally, a study published in 2021 by the International Journal of Environmental Research & Public Health focused exclusively on volunteer firefighters' PFAS exposure and concluded that they have higher PFAS levels in their organisms compared to the general population. The researchers emphasized that even though volunteer firefighters represent a majority vis-à-vis carrier firefighters, they are underrepresented in health and exposure studies.       

Illinois volunteer firefighters should receive cancer coverage

The Workers’ Occupational Diseases Act of Illinois states that a firefighter disabled by cancer should receive an occupational disease disability benefit, which should be 65% of the previously received salary. Thus, only career firefighters can receive the most needed financial assistance.  

All firefighters, whether career or volunteer, are at a high risk of toxic chemical contamination due to their regular exposure to PFAS and other adverse synthetic chemicals. Some localities have only volunteer fire departments, where volunteers do the same job as career firefighters. Volunteer firefighters regularly attend emergency calls and participate in training and events like their career firefighter peers. However, they do not get financial remuneration and often do not receive the same quality gear, attention, care, and protection as their career counterparts.

Cancer does not differentiate between firefighters, though. On what basis can state officials then decide who may receive occupational disease disability benefits when there is evidence that all firefighters are more prone to developing and dying of cancer than the average citizen due to their public safety duties and the dangerous conditions of their job? Cancer treatment costs are an immense financial burden on most individuals and their families. The initial care for one patient is around $43,516 and can go up to $109,727 in the last year of life on average, according to the National Cancer Institute. These are astonishing numbers. Illinois volunteer firefighters put their lives in danger for the public good and should receive the same treatment and financial benefits as employed firefighters.          

Jonathan Sharp is a chief financial officer at the Environmental Litigation Group, P.C., based in Birmingham, Alabama. The firm is dedicated to assisting civilian and military firefighters exposed to toxic chemicals, especially PFAS. Jonathan is mainly responsible for case evaluation, financial analysis, and asset management.