Fourteen years before her cancer diagnosis, Michelle Bletcher dropped to the ground on a hillside in Shasta-Trinity National Forest and began frantically digging a hole.

Blasts of hot smoke had overtaken Bletcher and her crewmates, wildland firefighters with the U.S. Forest Service, as they burned away overgrown brush on Bully Choop Mountain. They had retreated to a nearby ridge, but the smoke found them, stinging their eyes and searing their throats. Bletcher grabbed clumps of dirt and dug into the ground, desperate to find cooler, cleaner air.

“Everyone,” she recalled, “was on their hands and knees throwing up.”

Firefighter Michelle Bletcher, front, battles a blaze near Springerville, Ariz., in June 2011. Kari Greer/U.S. Forest Service 2011

In a 20-year career, Bletcher, who is now 41, said she often encountered smoke so thick she couldn’t see anything, “not even your co-worker who is holding your hand.” But she loved the job — a thrilling and meaningful career that kept her outdoors.

Then, in 2019, doctors diagnosed her with non-Hodgkin’s lymphoma. One, she said, told her she had a 45% chance of living five years. She was 37. Bletcher doesn’t know how she got sick, but suspects a link to her years on the fire lines.

There are many like her. Catastrophic fires have exploded in California and across the continent in recent years, burning down neighborhoods, ruining entire towns and exposing a fundamental problem: Thousands of firefighters are being sent into battle to breathe toxic smoke with little protection, even as residents far away are advised to wear masks or stay indoors as skies turn orange.

Most wildland firefighters use nothing except heat-resistant shrouds or bandanas to cover their noses and mouths. Even amid mounting evidence that breathing the fine particles, chemicals and gases in smoke can cause long-term harm and even deadly diseases, federal, state and local agencies have done little to protect their workers, essentially treating smoke as a necessary evil.

Government agencies don’t routinely measure how much smoke firefighters inhale during major events. They’ve completed no studies on the long-term health of wildland firefighters, leaving the scope of the impacts unknown. And they have not required respiratory protection during wildland firefights, or prioritized the development of equipment that could ease the problem, despite the extreme conditions in which firefighters work.

Firefighters with the U.S.Forest Service’s Redding Interagency Hotshot Crew march on a dusty bulldozer line while battling the Oak Fire in Mariposa in July 2022. Stephen Lam/The Chronicle

In the aftermath of blazes that devastated cities like Santa Rosa and Paradise (Butte County), California passed emergency rules in 2019 requiring employers to provide respiratory protection to farmworkers and others with outdoor jobs on very smoky days. But wildland firefighters were specifically exempted.

“It’s 35 years in the fire service for me, and I’ve heard the same conversation and dialogue: We need to study smoke,” said Joe Novelli, a battalion chief with the San Mateo Consolidated Fire Department, which like other local departments is often pulled into wildland fire coverage. “Yet nothing is done.”

Members of the public are regularly warned that air quality is hazardous during wildfires, said Dr. John Balmes, a pulmonary specialist and expert on wood smoke pollution at UCSF who sits on the California Air Resources Board. “But that’s nothing compared to what wildland firefighters inhale on the fire line.”

During six months spent looking into firefighters’ smoke exposure, the Chronicle spoke to a dozen men and women diagnosed with serious diseases like cancer who believe their exposure to wildfire smoke was a factor, and to families of firefighters who died. They said that fire agencies at all levels had for too long left questions about smoke unanswered and overlooked the long-term risks to workers.

The Chronicle interviewed experts within and outside the Forest Service, which is the country’s largest firefighting agency and has conducted the most extensive studies of smoke, and reviewed government policies going back decades. During that time, California’s fire seasons have grown longer and more intense, driven in part by climate change.

Officials at the Forest Service and the California Department of Forestry and Fire Protection, or Cal Fire, have known for decades that smoke is bad for human health. But leaders at all levels of government have failed to demand equipment to shield firefighters from its effects.

It is only now that fire agencies are taking basic steps to protect those who are protecting us.

Sarah Curran of the Forest Service’s Redding Interagency Hotshot Crew is covered with dust and soot after a day of extinguishing smoldering debris at the Oak Fire in Mariposa in July 2022. Stephen Lam/The Chronicle

State and federal officials have just begun field-testing the first respirators designed specifically for wildland firefighters, though such devices remain years away from potentially being available. The National Institute for Occupational Safety and Health, a division of the Centers for Disease Control and Prevention, is embarking on the first-ever study of whether wildland firefighters, who must be fit and healthy to be hired, develop cancer in disproportionate numbers.

And last year the federal government finally took steps to make it easier for wildland firefighters with long-term diseases to file workers’ compensation claims related to those conditions.

Officials for the Forest Service and Cal Fire say no respirator has been invented that suits such a physically demanding job done deep in the backcountry and simultaneously keeps out the soot, gases and chemicals in wildfire smoke. They say there are more urgent priorities when it comes to firefighter safety and health — like falling trees and heat illness.

Smoke “is just one of the challenges that we deal with in an environment and a job that is frankly inherently hazardous,” Forest Service Deputy Chief Jaelith Hall-Rivera said. “There’s not a silver bullet, unfortunately, around smoke inhalation.”

Jerry Perez, national director of fire and aviation management for the Forest Service, said that “understanding the way smoke travels” is the most effective tool to position firefighters in the field.

Former Cal Fire deputy director Gabrielle Avina, interviewed before retiring last December, said she suspects the hazardous nature of smoke has been underestimated, but that respiratory protection technology “isn’t there.”

The slow pace of action on such a critical issue has exacted a high cost, many career firefighters say.

Isaac Karuzas, 48, spent more than two decades as an elite Forest Service hotshot and smokejumper working on the most perilous part of fires, sometimes by parachuting into remote, burning forests.

Karuzas once ran 20 miles a day but now struggles to catch his breath when climbing stairs. In 2017, he was diagnosed with sarcoidosis, an immune system disease that caused scarring throughout his lungs. There’s no way to know definitively what caused it, but Karuzas asked his doctor if it could have been caused by his job.

“She said, ‘Absolutely,’ ” he said.

Karuzas compared the lack of progress on smoke exposure to the treatment of concussions in the National Football League. Only in recent years has the league confronted a wave of debilitating brain injuries caused by blows to the head and adopted a detailed monitoring system.

“The attitude was, ‘OK, it’s just part of the job,’ ” Karuzas said. “Then finally, wait a second — you get concussion protocol.”

A known risk, an unknown toll

Brontë Wittpenn/The Chronicle

San Francisco firefighter Matt Alba remembers the taste in his mouth: acrid, metallic. “There goes five years off our lives,” one of his engine mates joked.

It was November 2018 and Alba and his crew had been deployed to the scene of the Camp Fire that destroyed Paradise. Carrying pictures of bones in various states of decay as visual aids, they walked methodically through destroyed properties. Stomping out smoldering materials. Shoveling through the debris. Looking for signs of some of the 85 people who died.

They worked in smoke and ash for eight days without masks, Alba said, before fire officials handed out N95 respirators, which are designed to filter out most particles but not gases.

San Francisco firefighter Matt Alba meets with colleagues in August 2022. During the 2018 Camp Fire in Paradise (Butte County), Alba said, he and his crew had no masks for eight days while they sifted through burned debris. Alba was diagnosed with a brain tumor two years later. Stephen Lam/The Chronicle

Jeremy Lawson, a Cal Fire staff chief overseeing the safety and emergency medical service divisions, acknowledged N95s are rarely used against smoke or soot during wildfires. Their primary purpose, he said, is to protect against infectious diseases or valley fever, a serious illness caused by fungus in dirt.

Alba sensed he was breathing dangerous fumes and soot. He and others called the San Francisco Firefighters Cancer Prevention Foundation, and more than 80 firefighters gave blood samples at a Chico hospital. The results were chilling — high levels of mercury, lead, flame retardants and chemicals from plastics.

Even without the added hazards from manmade materials, forest fire smoke is a soup of harmful particles and gases, including carbon monoxide, acrolein, formaldehyde, polycyclic aromatic hydrocarbons, benzene and more.

Novelli, the San Mateo battalion chief, was among hundreds of local firefighters who helped battle the Camp Fire. Black gunk came out of his pores for weeks afterwards, he said, “regardless of how many showers I took.” (Smoke is absorbed through the skin as well as inhaled.) A hacking cough dragged on for much of the next year.

Some pollutants from smoke get coughed out. But tiny, inhalable particulate matter — called PM 2.5, about one-thirtieth the diameter of a human hair — can penetrate deep, inflaming the walls of tiny air sacs at the roots of the lungs.

These particles, which can include contaminants like heavy metals, may enter the bloodstream and diffuse throughout the body. They can trigger inflammation affecting vital organs like the heart, the brain and, in pregnant women, the placenta. Inflammation can increase the risk of some cancers like leukemia.

The Environmental Protection Agency has warned that breathing fine particulates increases the risk of respiratory infections and heart disease, and recent studies from academic researchers have linked the particles to higher risks of cancer, in the lungs and elsewhere. The World Health Organization last year described firefighting as “carcinogenic to humans.”

In a study published in 2022, researchers at McGill University in Quebec, drawing from Canada’s cancer registry, found that people living in wildfire-prone areas contracted lung cancer 5% more often than the general population, and brain cancer 10% more often.

This month, a study published in JAMA Internal Medicine concluded that repeated exposure to PM 2.5 through wildfires was “robustly associated with greater rates of dementia.”

During the 2020 Creek Fire that broke out near Shaver Lake in Fresno County, federal air quality experts visited a base camp where firefighters ate, slept and strategized. They found that levels of PM 2.5 rose far above the air quality index level of 300 considered hazardous to breathe, reaching 500 one day and going above 700 the next. Air quality is considered good if the index level is under 50.

Early studies by the Forest Service focused on the short-term effects of smoke inhalation and suggested the body could fight them off. A major 1997 report found that while more medical studies were needed, wildland firefighters typically recovered from respiratory problems when fires died down in winter. “Health effects were moderate and often reversible,” researchers said.

Today, however, scientists know that’s not always the case, especially in the long term.

In 2019, researchers with the Forest Service, universities and other institutions used mathematical projections and data about harm from cigarette smoke to estimate the hazards of wildfire smoke inhalation for firefighters.

After five years on the job, they said in a published report, wildland firefighters have a 16% greater risk of dying from cardiovascular disease compared with the public and an 8% greater risk of dying from lung cancer. After 25 years on the job, the researchers estimated, they have a 30% greater risk for cardiovascular disease and a 43% greater risk for lung cancer.

Scars are seen on firefighter Matt Alba’s head following surgery to remove a brain tumor in January 2021. Alba, who has battled forest fires as well as city fires, does not know what caused his cancer, but he believes wildland firefighters need respiratory protection. Provided by Matthew Alba

Lead researcher Kat Navarro said the data shows that reducing smoke inhalation among wildland firefighters is urgent but all too often overlooked in a job with dangers all around. “You almost become numb to these longer-term risks,” said Navarro, who previously worked as a Forest Service hotshot firefighter.

Yet until this year, no federal studies have tracked the real-world health outcomes of wildland firefighters, even though Forest Service experts in 1997 urged the agency to conduct one. Retired Forest Service smoke researcher Brian Sharkey said the agency never felt it had the budget to launch a proper study. “If we’d begun that in 1990,” Sharkey said, “we’d probably have an answer.”

Alba, the San Francisco firefighter, said he began having severe headaches after the Camp Fire. Then in December 2020, while in his garage getting his bicycle ready for a ride, he had a seizure. He was rushed to a hospital, where doctors discovered a tumor called an oligodendroglioma in his brain.

Alba will never know how he got his cancer. Firefighters are exposed to a wide range of toxicants beyond burning buildings or forests, including diesel exhaust fumes and chemicals in uniforms and firefighting foams. As a city firefighter, he came into contact with burning plastics and other manmade materials many times in his career. But he’s sure that firefighters weren’t sufficiently protected during the Camp Fire and other wildland blazes.

"How many more funerals do we need to go to to consider this a systemic problem of firefighter cancer?" he said.

Missed opportunities, worsening conditions

Brontë Wittpenn/The Chronicle

Fire and health agencies have for decades wrestled with what to do about smoke, even if they did not understand its full effects.

Concerns intensified in 1987, when dozens of wildfires broke out in the Klamath National Forest in Siskiyou County, a mountainous region that’s brutal for fighting fire because of extremely steep terrain. A weather pattern made conditions nearly unbearable, trapping smoke in canyons for weeks. Daytime was so dark, bats took to the sky.

Craig Lechleiter, a retired leader of the Forest Service’s Redding Hotshots, recalled that headaches and hacking coughs were relentless. “You’re poisoned, you’re fatigued, you have snot running out of your nose,” Lechleiter said. “You’re wearing bandanas — that’s the respiratory device.”

The California Department of Forestry and Fire Protection summoned state health officials to study how exposure to carbon monoxide and other pollutants affected firefighters. Of 94 firefighters studied, 76% reported respiratory problems and 70% displayed at least one neurological symptom like lightheadedness, headaches or loss of consciousness.

A year later, nearly 10,000 firefighters made 30,000 visits to medical tents amid colossal fires in Yellowstone National Park. Forty percent sought care for respiratory problems, according to a report from the National Institute for Occupational Safety and Health, which sent investigators to the scene.

The institute urged in a 1992 report that federal firefighting agencies decrease the length of work shifts, reduce the number of days in a row people work and move base camps where firefighters sleep “further away from the fire to reduce the amount of smoke in these camps.”

“Bandanas should be prohibited,” the agency said, noting that the thin fabric gave “no degree of protection from the gaseous contaminants present in smoke.” And federal firefighting agencies, including the Park Service and the Forest Service, should give crews “disposable, single use filter respirators designed to remove dust and mists.”

Some of those recommendations led to improvements that benefit firefighters today, including requirements that they get breaks after 14 consecutive days of work. But wildland firefighters still rarely use masks.

A sense of bravado buoyed generations of firefighters through grueling seasons, and dealing with smoke has been an accepted part of the job. This was a profession of “smoke eaters,” in which young recruits once rolled in the dirt to muss up bright yellow uniforms.

Forest Service firefighter Simon Gonzalez sits at his dining table in Corona (Riverside County) shortly after taking his daily chemotherapy medication in September 2022. He was diagnosed with leukemia four months earlier after collapsing on a hike near his station in the Cleveland National Forest. Stephen Lam/The Chronicle

Simon Gonzales once felt invincible. Assigned to a Forest Service fire engine crew in Southern California’s Cleveland National Forest, Gonzalez held the hose nozzle and took the brunt of the smoke, dust and debris. With everyone behind him “coughing a lung” — tears and mucus streaming down their faces — his eyes barely watered.

“This is what I was meant to do,” Gonzales thought. “I can do this. I can handle it.”

But last year, after eight years as a firefighter, Gonzales started getting fevers and dropped 35 pounds. After collapsing on a training hike in May 2022, he was diagnosed with leukemia, a cancer of the blood that federal studies found is higher among city firefighters than the general population. His macho, self-sacrificing attitude gave way to fear that he would die before his kids finished elementary school. He was 33.

Federal firefighter Simon Gonzales, who is battling leukemia, marshals his energy to play with daughter Izzy at his home in Corona in September 2022. Gonzales, 33, has feared he might not live to see his kids finish elementary school. Stephen Lam/The Chronicle

“They never gave us N95s. Bandanas don’t do much,” said Gonzales, who is undergoing cancer treatment. “There’s nothing we had that could actually help us.”

George Broyles, who led the Forest Service’s smoke research program from 2008 to 2014 and retired in 2021, said the agency failed to make meaningful changes to reduce smoke exposure for its firefighters.

He recalled a moment in 2012 when he raised concerns about crews working in thick smoke during the Waldo Canyon Fire near Colorado Springs, Colo. Broyles said he suggested commanders pull crews further back, out of the smoke, but he received pushback from those making operational decisions that day.

“One of the deputies said, ‘George, it’s just smoke — that’s what we’re paid to do,’ ” Broyles recalled. That, he said, was a typical attitude within the Forest Service.

A study Broyles produced for the Forest Service in 2013 found that, based on measurements of firefighters’ carbon monoxide exposure — a proxy for fine particles and other irritants — the amount of pollution inhaled by firefighters was essentially unchanged from 25 years earlier, when the terrible fires of the 1980s prompted the creation of the agency’s smoke program.

“There has been no appreciable reduction in firefighter exposure and in some instances unsafe exposures are more severe than observed by previous research,” the report stated.

The Forest Service, when asked about these findings, defended its efforts to reduce smoke exposure among employees.

“We rely on training to protect firefighters from over-exposure to carbon monoxide, which threatens safety and good decision making, and emphasize staying out of smoke when avoidable,” Forest Service officials said in an email. The agency, they said, provides clean-air trailers during some incidents and encourages firefighters camping outdoors to choose “less smoke-filled areas.”

Broyles and other researchers, though, question whether current practices are effective enough. In Navarro’s 2019 study, researchers wrote that it was “unclear” whether tactical methods, like rotating firefighters out of smoky conditions, reduce smoke exposure enough to benefit health.

"We absolutely know it’s hazardous, there can be no doubt,” Broyles said in an interview. “I hear people say we need more data. We can get more data, but we have to stop being stupid at some point.”

Federal firefighter Simon Gonzales (plaid shirt) embraces U.S. Forest Service Capt. Anthony Beigel outside a coffee shop in Corona (Riverside County) in September 2022. Stephen Lam/The Chronicle

Hotter and drier climate conditions have changed the nature of fire, said Joseph Domitrovich, a Forest Service physiologist and smoke studies leader. He said wildland firefighters are exposed to smoke more than ever before, both because they stay with the service longer and because wildfire seasons are more severe.

The federal government, though, only occasionally puts pollution monitors around the necks of firefighters to understand how much they are exposed to. Public agencies put in far more effort to understand the risk to the general public.

Avina, who ran Cal Fire’s safety and equipment programs before her retirement, said the agency does not take smoke-related measurements during wildfires. While it is responding to an emergency, she said, immediate perils dictate its moves.

“What are we going to do when the air quality is unhealthy?” Avina said. “Are we not going to go in and fight the fire?”

A solution eyed, but still far off

Brontë Wittpenn/The Chronicle

Deep in a South Carolina forest, Los Angeles County fire Capt. Ryan Souder grabbed a shovel and hacked at grasses to expose bare dirt. A battery-powered air filter was clipped to his belt, pumping clean air through a hose to a hard blue mask covering his nose and mouth.

It was the first respirator for wildfires that the federal government had ever tested in the field.

Souder said that while the device worked in a calm setting — no fire, no emergency — it quickly fell apart when he handled it roughly to simulate the punishing work of fighting fire. The hose came apart from the pack and the belt clips broke.

“Firefighters — they’d eat that device alive,” Souder said.

Even still, it took 16 years to get to that point. In 2006, a nonprofit called the National Fire Protection Association, or NFPA, had decided to tackle the wildland fire respirator issue. The NFPA creates design criteria for virtually every element of firefighters’ uniforms and equipment. It is the gold standard that fire agencies follow.

It’s a hard task: The ideal respirator must filter out everything from particles to toxic gases. It must be light and sturdy and not suffocating, so as to limit heat illness and heart attacks, which are top killers of firefighters.

A U.S. Forest Service firefighter battles the Mosquito Fire near Foresthill in unincorporated Placer County in September 2022. Stephen Lam/The Chronicle

The first NFPA standard, published in 2011, adopted most of those goals. It mandated a battery that would last at least eight hours, to force clean air into the facepiece so the wearer does not have to work harder to breathe.

The standard was supposed to trigger innovation. It didn’t. The problem, said Steven Weinstein, who worked on respiratory protection projects for Honeywell until he retired in 2020, was that companies like his former employer never got a signal that firefighting agencies would buy the equipment.

“The anticipation was the U.S. Forest Service was going to sign onto this and all the other wildland firefighter (agencies) would follow along,” he said. “But the answer was always, ‘Nope. We don’t think we need it.’ ”

Daniel Rossos, a retired Portland, Ore., firefighter who led the committee that developed the NFPA’s standard, called the lack of progress since 2011 “heartbreaking.”

“Manufacturers were like, ‘OK, let’s get going,’ ” he said. “What happened is the (firefighting) industry said we’re not going to get them. So as a result of that, the manufacturers said we’re not going to make them.”

Perez of the Forest Service said his agency looked for a respirator that might work in response to the NFPA protocol but “found none that met our standards.” He said the Forest Service sought devices that partly met the standards as a potential first step, but “found they created additional hazards” for employees, especially overheating.

Sharkey reached a similar conclusion in the 1990s when he worked on the problem for the Forest Service. Testing lung function in firefighters who ran on treadmills or worked on prescribed fires, he found that respirator prototypes might do more harm than good.

“I can remember one young lady, she said, ‘If I have to wear this to fight fire, I quit,’ ” Sharkey said. “You need to try one to know what it really feels like. Try it on a hot day when you’re sweating like a pig.”

Cal Fire aired similar concerns last year, when the state’s Division of Occupational Safety and Health, or Cal/OSHA, held its first-ever hearing on whether to mandate respirators for wildland firefighters. This had been a subject of discussion in the state since 2014, when then-Gov. Jerry Brown signed a law requiring Cal/OSHA to update its rules governing firefighting gear to meet NFPA standards.

Jeff Killip, Cal/OSHA’s chief, told participants this could be “a watershed moment” for “meaningful” respiratory protection for wildland firefighters.

An hour into the discussion, Lawson, the Cal Fire staff chief overseeing Safety and Emergency Medical Services, urged the division not to mandate respirators. Respirator technology is too far behind, he said, and devices are too bulky and restrictive. Firefighters must stay focused on acutely life-threatening problems — like falling trees, heat stroke, exhaustion and vehicle crashes.

“We can all agree there’s some cumulative effect of smoke,” Lawson told the group. “But we’ve got to balance that with what’s an immediate concern to firefighters — not the thing that will get them down the road.”

Some officials and firefighters are convinced that no single respirator can achieve so many goals simultaneously. Domitrovich, the Forest Service physiologist, said that a solution is at least years away. “Right now, I think it’s a puzzle,” he said.

Engineers solved a similar puzzle decades ago for city firefighters, who once ran into burning buildings with little protection from breathing smoke; one ancient tactic involved wetting beards as makeshift filters. A breakthrough came in the 1940s with devices derived from scuba equipment.

Nowadays, urban firefighters breathe through tight-fitting masks with hoses connected to cylinders of compressed air. These packs are designed to last between 30 and 60 minutes and weigh between 20 and 30 pounds.

“It took federal legislation and a lot of education and enlightenment to get people to start wearing them,” said Weinstein, formerly of Honeywell. “Now you’d be crazy not to wear it.”

The absence of respiratory protection for wildland crews prompted some firefighters to raise the issue with the U.S. Department of Homeland Security. The department, whose science and technology division supports innovation for first-responder equipment, put out a call for respirator prototypes in 2016.

Smoke rises from a burning hillside during the Mountain Fire in Siskiyou County in September 2022. Stephen Lam/The Chronicle

“There is no federal mandate for respiratory protection,” said Kimberli Jones-Holt, who heads the program. “That’s something that is really unfortunate.”

Of three companies that submitted device designs, just one, TDA Research Inc. of Colorado, made the cut for initial testing. This was the two-pound device Souder tried during the training exercise in South Carolina.

Souder worried that it was flimsy, but his bigger concern was the lack of options. “I want to see other companies building devices — not just one,” he said. “Where are all these other companies? Where are the other devices?”

Girish Srinivas, the CEO of TDA Research, said his company used feedback from firefighters like Souder to adjust the design. The device was to be tested again in late August by the Los Angeles County Fire Department and Cal/OSHA, alongside five other designs in early development.

Then TDA Research will seek certification from the National Institute for Occupational Safety and Health and the NFPA, the two entities that certify respirators. If all goes well, Srinivas estimated that the respirators could hit the market as soon as late 2024 or early 2025 — at about $600 to $1,000 apiece.

“I am hoping this will be a success story,” Srinivas said.

‘Why don’t we just make changes?’

Stephen Lam/The Chronicle

Short of the holy grail of a practical respirator that will protect firefighters from a range of gases and particles, fire bosses can reduce smoke exposure in many smaller ways that cumulatively can make a difference, experts told the Chronicle.

Since those terrible fire seasons of 1987 and 1988, the federal government has been consistent with its recommendations: Rotate crews in and out of smoky areas. Ensure they are sleeping in clean clothes and in clean air — such as in an air-conditioned hotel room — whenever possible. Minimize the smokiest work, such as “mop up” after the main fire has blown through, when crews extinguish smoldering debris to keep it from reigniting. Battle fires from behind and the sides rather than meeting them head-on.

These remain their most important methods for protecting firefighters, Forest Service officials have said. However, it’s difficult to know how much these methods are being used.

In the Stanislaus National Forest in June, the Chronicle observed teams of federal firefighters as they burned about 4,000 acres of overgrowth to make way for a healthier, less fire-prone forest.

Sunny Kim with the Cedar City Hotshots wets down a tree during a prescribed burn in June in Stanislaus National Forest in Tuolumne County. Stephen Lam/The Chronicle

These intentional burnings, called prescribed fires, can involve some of the smokiest work, many wildland firefighters said. That’s because they must remain close to the flames to ensure things don’t get out of hand.

Capt. Richard Miotti managed a crew burning dozens of acres in a steep canyon not far from cabins and homes. He directed them in a variety of jobs. A line of firefighters dripped flames from torches as they hiked through thick brush. One manned a water tanker and checked weather readings with a handheld device.

Another stood on a gravel road with his back to the fire to watch for stray embers, while a firefighter in a pickup truck led a small caravan of civilian vehicles traveling through the area. The smoke was so thick that drivers couldn’t see the road or the abrupt drop just past its edge.

None of the crew members wore N95 masks, even when standing around.

Miotti said human senses are some of the best tools for avoiding too much smoke. Step away if you can, and if not, hold your breath. “When you feel the heat, close your eyes and don’t breathe,” he said. “Open your eyes when you feel the coolness return.”

Embers swirl around a firefighter during the Mosquito Fire in Placer County in September 2022. Stephen Lam/The Chronicle

Broyles, the former lead smoke researcher for the Forest Service, said the agency needs to more directly communicate with managers running firefighting operations that reducing smoke exposure is a priority. A decade ago, he proposed methods for studying what tactics work to reduce smoke inhalation, he said. But Forest Service officials today said they have no such monitoring data.

“We know we’re exposed to all these carcinogens, respiratory irritants, things that affect our blood,” Broyles said. “So why don’t we just make changes?”

When asked about these concerns, the Forest Service said the agency emphasizes “staying out of smoke when avoidable, including when (firefighters) are on breaks,” particularly because of carbon monoxide, which when inhaled can muddy critical thinking in a dangerous environment. Regular training sessions emphasize this point.

Hall-Rivera, the Forest Service deputy chief, said she’d like the agency to do more to help firefighters get breaks in clean air, such as by putting them in hotel rooms, something Cal Fire already does. The Forest Service sends air resource advisers to major incidents — though not to a fire’s front lines — to monitor air quality for the public and make general recommendations about where firefighters might sleep.

At least one change has occurred recently, driven by the coronavirus pandemic. N95 masks are now on virtually every engine, across all fire services. Cal Fire and local agencies say they encourage crews to wear masks at base camps and during non-intensive tasks when air quality is poor. But no agency requires their use.

Mary Prunicki, director of air pollution and health research at Stanford University, said any workers who must be in smoke “should have a mask on,” but acknowledged that’s not always possible for fire crews. “Wildland firefighters are at a huge disadvantage,” she said.

Union officials and firefighters at the Forest Service, Cal Fire and local agencies said N95 masks are rarely worn today in smoky conditions, even when crews are at rest.

The problem is that disposable masks like N95s get clogged easily with sweat, dust and debris, causing them to loosen around the face. It’s harder to hear someone shouting through a mask. And they are hard to breathe through when they get damp, said Albert Yanagisawa, fire marshal with the Los Angeles County Fire Department — as well as being too stifling during tasks requiring heavy exertion.

Fire agencies look to the NFPA for equipment standards, and N95s miss the mark in part because they don’t filter out gases.

San Francisco fire Lt. Michael Teupel echoed many department leaders in saying that respiratory protection is voluntary during wildland fire deployments. Some firefighters buy their own gear, he said, like heat-resistant neck shrouds to pull over their noses and mouths. (The shrouds do not protect against smoke installation.)

“For wildland, in our department, it’s individually chosen,” Teupel said. “There’s a box (of N95s) on the engine.”

Santa Clara County fire officials earlier this year added a new neck gaiter that can be pulled over the mouth and nose designed to provide some protection against particulate pollution to its wildland equipment. A similar gaiter is being reviewed by the Los Angeles County Fire Department.

Sonoma County Fire Chief Mark Heine said supervisors are given discretion to order crews to wear masks when they are away from the fire line and experiencing unhealthy conditions, like ground-level smoke. But he called masks secondary to the priority: “Move them away from that smoky environment.”

Tim Edwards, president of the union representing Cal Fire firefighters, said that while it was once extremely rare for a firefighter to wear an N95 to guard against smoke, he believes more firefighters are using them during lower-intensity tasks like mopping up smoldering vegetation. Still, he estimated that, at most, perhaps 15% of firefighters make this choice, with younger ones being more inclined to do so.

“The old thought process of: It’s just a wildland fire, smoke’s going up in the air, you’re outside, in the clear — that is gone,” Edwards said.

A new era?

Stephen Lam/The Chronicle

When she was diagnosed with cancer in 2019, Michelle Bletcher, the firefighter stricken with non-Hodgkin’s lymphoma, said she didn’t apply for workers’ compensation benefits.

It seemed pointless: She’d never heard of anyone filing for those benefits because of cancer and didn’t think she could prove that a career battling forest fires had caused her illness. So she used her vacation and sick days while undergoing surgeries, chemotherapy and a stem cell transplant.

But last year, a federal bulletin for the first time acknowledged that federal firefighters are at higher risk of cancers as well as heart and lung diseases. Crucially, it advised workers’ compensation claim evaluators to require less proof from those who have fallen ill with a long-term disease that they acquired it on the job. This year, the policy became law, one of several signs that the government is starting to do more to help firefighters who get sick, though progress has been slow.

In November, Bletcher said, her claim was approved, months after her initial one was denied.

The federal government has only just begun to recognize the career is linked to serious diseases, said Steve Lenkart, executive director of the National Federation of Federal Employees, whose members include wildland firefighters. Union surveys have revealed wildland firefighters are worried about the number of colleagues with cancer, including rare forms. “The only common denominator is their job,” Lenkart said.

Honor guards holding folded flags pay tribute to fallen firefighters during the annual California Firefighters Memorial Ceremony in July 2022 in Sacramento. Stephen Lam/The Chronicle

The family of one longtime firefighter who died of cancer said the broader medical field has been too slow to acknowledge the health risks inherent in their work.

Kelci Craig said her father, Stanley Craig, a Southern California firefighter who rose through the Cal Fire ranks, was turned away by a lung cancer clinic around 2018 despite experiencing extreme exhaustion. He told his family he learned he didn’t qualify for screening because he hadn’t smoked for more than 30 years, and because his firefighting career didn’t put him at risk.

“He felt comforted — ‘Oh good, I’m glad it’s not cancer,’ ” she recalled.

The next year, he had a seizure. Doctors found that tumors originating in his lungs had spread to his brain, according to his daughter. He died two months later at age 67.

After his death, Kelci Craig found notes that her father typed on his phone about the symptoms that had dogged him for about a year without a diagnosis. “Fallen to the floor 3x, twice onto tile … can’t remember very recent events,” he wrote.

“It makes me so mad,” she said. “Maybe we could have caught it earlier.”

Cory Craig, left, and Kelci Craig prepare to trace the name of their father, Stanley Craig, a Southern California firefighter who died of lung cancer in 2019, from a memorial wall in Sacramento that honors fallen firefighters. Stephen Lam/The Chronicle

This year, the Centers for Disease Control and Prevention created the nation’s first-ever registry to track long-term diseases in wildland as well as urban firefighters, in accordance with a 2018 federal law. The agency is also working with the Forest Service and UC Berkeley to assess a range of health issues in the profession.

The San Francisco Firefighters Cancer Prevention Foundation has been offering cancer screening to city firefighters since 2006, and this year tested more than 1,700 current and retired employees.

To help reduce smoke absorption through the skin, Cal Fire is taking steps to make it easier for firefighters to wear clean uniforms during major wildfires by issuing extra sets and adding specialized washing machines, with the goal of “reducing your overall exposure for your career,” said Lawson, the staff chief.

Another federally funded study is examining genetic changes among working firefighters in California and Colorado to look for early warning signs of cancer. These same researchers discovered that city firefighters can significantly reduce their exposure to carcinogens by cleaning equipment and clothing, among other measures, and they hope to find early warning signs and similar prevention strategies for wildland crews.

Workers’ compensation claim numbers show that firefighters have not filed claims for cancer and other diseases in great numbers: Only 22 claims for cancer, respiratory or cardiovascular diseases have been filed by federal firefighters between 2018 and July 2023, according to the Department of Labor. The government’s increased receptiveness, though, could bring about change, firefighters said.

Michelle Bletcher, a Forest Service firefighter who was diagnosed with non-Hodgkin’s lymphoma four years ago at age 37, goes on a bicycle ride with niece Ayla in August 2022 in Mount Shasta. Her cancer is under control, but not in remission. Stephen Lam/The Chronicle.

Bletcher said that until her diagnosis four years ago, she had no idea that she risked developing cancer from firefighting and a career of inhaling smoke. “There’s a huge lack of awareness,” she said.

Although her cancer is under control, she’s not in remission — and she can’t keep up with the demanding job of an engine crew anymore. During surgery, she said, a doctor damaged a nerve, paralyzing some of the muscles in her right shoulder.

She applied for a new job within the Forest Service, and got it. Bletcher today patrols the Cleveland National Forest in Southern California in a pickup with 50 gallons of water, looking for newly sparked fires that she can extinguish while they are still small.

She worries what will happen if the cancer worsens, but her doctors urged her to accept things as they are.

“My doctors said, ‘Relax. This is the new normal.’ ”


Reporting by Julie Johnson. Editing by Kate Galbraith and Demian Bulwa. Data and visualizations by Yoohyun Jung. Visuals by Stephen Lam. Additional visuals by Brontë Wittpenn. Visuals editing by Nicole Frugé. Illustrations by John Blanchard. Graphics editing by Hilary Fung. Graphics, design and development by Erin Caughey. Design by Danielle Mollette-Parks. Design and development by Yuri Avila and Alex K. Fong. Production by Chris Crescibene.

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