Firefighters face elevated exposure to forever chemicals

A new study of frontline employees in Arizona reveals that firefighters carry the greatest load of per- and polyfluoroalkyl substances (PFAS) in their blood, while health care personnel also show moderate but notable elevations. The findings point to unseen hazards in everyday work gear and environments.

The investigation, led by scientists at the University of Arizona Health Sciences, compared blood samples from nearly 2,000 adults in firefighting, health care, and other essential occupations to learn how job duties shape chemical exposure.

PFAS are human-made compounds prized for stain, water, and flame resistance. They coat cookware, clothing, carpets, packaging, and industrial foams. Because their molecular bonds are hard to break, the chemicals linger in air, soil, and water for decades and build up in living tissues.

Firefighters’ exposure to forever chemicals

The researchers measured serum PFAS concentrations in 280 firefighters, 787 health care workers, and 734 employees from other trades. Blood was collected between 2018 and 2021.

For most workers, PFAS totals declined by six to 17 percent each year, yet measurable levels remained in every group by the study’s end. Firefighters topped the charts for several compounds, including PFHxS, Sm-PFOS, n-PFOS, and PFHpS.

Health care workers ranked second overall and showed higher odds of two PFAS – Sb-PFOA and PFDoA – when compared with peers in other fields. They also had modest rises in PFHpS and PFUnA.

Clues from previous research

Study senior author Kate Ellingson is an associate professor at the Mel and Enid Zuckerman College of Public Health.

“Our study reinforces previous research showing elevated PFAS levels among firefighters and suggests that health care workers may have unique sources of PFAS exposure as well,” said Ellingson.

“Our findings underscore the need to understand occupational exposure pathways for PFAS among different types of workers.”

Firefighters have long been flagged for exposure because their protective clothing and the foams used to quench fuel fires contain PFAS.

Less is known about how nurses, surgeons, or technicians come into contact with the chemicals. Single-use gowns, surgical masks, sterile wraps, and even X-ray film may contribute, but few studies have investigated those items.

Health risks linked to forever chemicals

Study co-author Jeff Burgess is the director of the Center for Firefighter Health Collaborative Research.

“Almost all adults in the U.S. have detectable levels of certain PFAS, and people in occupations with more frequent exposure to PFAS-containing materials have been shown to exhibit higher serum concentrations of some PFAS,” said Burgess.

“Research into occupational exposure to PFAS is vital to reduce the health risks associated with PFAS, including but not limited to increases in rates of certain cancers, increases in cholesterol levels, lower antibody response to certain immunizations, and increased rates of certain adverse reproductive outcomes.”

Although scientists are still mapping dose-response relationships, mounting evidence ties long-term PFAS exposure to thyroid dysfunction, immune suppression, and reproductive harm, as well as kidney, prostate, and testicular cancers. That makes the new data especially relevant for workers who already confront other job-related dangers.

PFAS in health care settings

“To date, PFAS exposure in health care settings has not been widely studied, and the potential sources of exposure remain unclear,” Ellingson said. He also noted that single-use surgical masks, surgical gowns, and X-ray film could be potential sources of PFAS exposure.

“Therefore, it’s important to further examine specific exposure routes and health consequences for firefighters and health care workers.”

The researchers suggest that manufacturers, hospitals, and fire departments audit supply chains to identify products treated with PFAS. Substituting safer materials where possible – and improving decontamination practices when replacement is not feasible – could lower cumulative dose.

Avoiding PFAS exposure

Many PFAS formulas have been phased out in the United States, yet older stockpiles and imported goods keep the chemicals in circulation.

The authors call for expanded monitoring of occupational exposures, stronger regulation of PFAS in consumer products and more public funding for exposure-reduction programs.

They also urge longitudinal studies to track how changing equipment or policies alters blood levels over time. Because PFAS can stay in the body for years, measuring declines after interventions will help pinpoint which strategies work best.

Chemical exposure beyond firefighters

The Arizona results echo national surveys showing widespread but uneven PFAS contamination. They also highlight chemical exposure gaps: firefighters remain the most researched group, while other frontline roles – from paramedics to factory workers – receive far less attention.

By bringing health care personnel into the spotlight, the new study widens the search for hidden chemical risks at work. As communities push to remove PFAS from water supplies and household goods, understanding workplace exposures becomes equally urgent.

The current findings provide a starting map – and a reminder that protecting those who protect the rest of us means looking beyond the obvious dangers of heat, smoke, and infection to the quieter threat of “forever chemicals.”

The study is published in the Journal of Exposure Science & Environmental Epidemiology.

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