Sounding the alarm
No one warned Mark Rine that while he was saving others, he was killing himself.
The bad habits that would ensure his death sentence started with his very first fire in 2007.
Rine was supposed to help set up the ladder, but he ignored his orders, grabbed the hose and charged into the burning two-story brick house.
The rookie firefighter trudged through thick black smoke. In seconds, he was covered in soot. His head throbbed, but he moved on.
Once he and the other Columbus firefighters from Station 23 extinguished the flames, they slogged back between fallen lumber and smoking furniture to make sure fire wasn’t hiding behind the walls.
At this point, Rine was wearing only a T-shirt and his heavy-duty pants, exposing his skin to chemicals. Instead of putting his air mask back on, he followed the older guys’ lead and covered his nose with the hood that covered his head and part of his face.
By the time the trucks cleared the scene on the Far East Side of Columbus, black mucus oozed from Rine's nostrils. The drip and headache lasted for days.
For nearly six years, he was told by other firefighters that it was OK to wear nothing but a T-shirt when tearing into the guts of a smoldering house. It didn’t matter whether he wore an air mask. Like the other guys, Rine often put off showering, opting instead for a drink after his shift ended. He carried home his scorched helmet and blackened coat, trophies of a hero firefighter.
Then in September 2012, Rine learned that he had terminal stage 4 melanoma — skin cancer that had spread to other organs. He was given about a 5 percent chance of surviving five years.
Doctors also told Rine that his cancer likely was caused by his job, that the cancerous spots covering his body and a tumor in his lower back were a result of exposure to the carcinogens, flame retardants and toxic chemicals contained in uncounted burning objects inside homes, other buildings and vehicles.
Now, at 36, Rine is using the strength he has left to try and save thousands of other firefighters in the United States from his fate. He has traveled the state and country preaching to his firefighting comrades that they must protect themselves and one another from the cancer threat.
Rine pursues this calling to give them the warning he never got. It's also a warning for those of us they seek to protect. Unsafe practices in firefighting are stealing our community heroes from us and creating a liability for taxpayers.
The fact that he's dying won't stop him.
The real threat
Firefighters are at least 14 percent more likely to develop cancer than the general public. They're twice as likely to get skin and testicular cancer, and mesothelioma — a cancer that grows in the lining of the lungs, abdomen or heart that is caused by asbestos, according to a recent 2015 study by the National Institute for Occupational Safety and Health.
Most of the nation’s estimated 1.1 million firefighters didn’t know that when they entered the academy. Many still don’t.
“Occupational cancer is something we need to look at and we need a paradigm shift,” said Frank Szabo, a battalion chief with the city of Cleveland Division of Fire. “Cancer is a silent killer, and it is giving us a knockout punch.”
No one tracks exactly how many firefighters have been diagnosed with or have died from occupational cancer. But a Dispatch examination found that it’s a grave threat affecting fire stations in Columbus and around the nation.
In Columbus, at least 100 of about 1,500 firefighters currently are battling cancer. There likely are more: Some firefighters are never screened, hide their diagnosis or don’t seek treatment. And in Orange Township in Delaware County, an internal survey found that five of the township’s 41 firefighters have cancer.
Concord, North Carolina, fire officials were stunned when three out of a class of 10 rookie firefighters were diagnosed with cancer within two years on the job.
More than 60 percent of the names added to the International Association of Fire Fighters national memorial in Colorado Springs, Colorado, are firefighters who died of occupational cancer in the past 15 years. That’s a total of 1,155 cancer deaths just within the union’s membership. And that number is low because the deaths are self-reported from the local unions in 36 states that have presumptive cancer laws for firefighters.
The NIOSH study released in 2015 determined that the 30,000 firefighters in Chicago, Philadelphia and San Francisco were more likely to get cancer than the general public. Those firefighters had higher rates of skin, colon and prostate cancer and were twice as likely to be diagnosed with testicular cancer and mesothelioma. Those cities were chosen for the study because they were willing to cooperate and had necessary records to conduct the study.
To better understand the depth of the issue and whether firefighters try to prevent cancer, The Dispatch conducted two statewide surveys among nearly 1,300 active Ohio firefighters and 360 fire chiefs and found that:
• Roughly one in seven has been diagnosed with cancer.
• About 85 percent know at least one firefighter who has been diagnosed with cancer; nearly 60 percent know at least one firefighter who has died from it.
• About half of firefighters believe cancer is their greatest occupational risk. Ten years ago, only about 5 percent believed that.
• Though 95 percent of chiefs surveyed said they know cancer is the greatest occupational risk to firefighters, only about half of their departments provide cancer-prevention training or implemented procedures to reduce the threat. Almost 30 percent of the firehouses don't even have showers.
Chiefs and fire-protection organizations that set policy have been resistant to new cancer-prevention policies because they have an outdated macho culture and some chiefs don't have enough firefighters to give them an hour or more to decontaminate.
“We have an epidemic," said Peter Berger, a fire captain in Hallandale Beach, Florida, who, like Mark Rine, has cancer and is trying to warn firefighters everywhere about cancer. “It’s time to be honest with one another and ourselves, because we all want to go home to our families and retire instead of dying like this."
Changing a 'macho' culture
It’s difficult for many people to acknowledge vulnerability. For firefighters, it's nearly impossible.
But there are also the twin problems of awareness and enforcement. The Dispatch survey found that 90 percent of fire chiefs believed that their firefighters knew of the threats of chemical exposure, but a third of firefighters said they didn't.
Fewer than half of rural departments in Ohio offer training or have implemented policies to prevent cancer, according to the survey of fire chiefs. Those numbers were better in suburban and urban departments, although a third of them also have not implemented cancer-prevention policies.
None of the departments punish firefighters who don’t follow cancer-prevention policies, such as wearing their masks while on a fire scene.
Fire officials, chiefs and union leaders say they have made progress in the past decade in alerting firefighters about the cancer threat and implement measures to protect them. All admit that it’s an arduous process.
“We’re all macho bastards, and I mean that lovingly,” said Brian McCafferty, a Cleveland firefighter and cancer survivor. “We just don’t think of our safety first. That’s how we’re wired.”
The National Fire Protection Association is a nationwide group established in 1896 that sets policies and best practices for fire departments. Nearly all departments, including Columbus and Cleveland, say that meeting the agency's policies is a priority in their mission statements.
Cancer previously never was mentioned in the group's policies and best practices. The group this summer released an update to its safety practices that firefighters must follow.
For the first time, the NFPA officially acknowledged the cancer threat at its annual conference in Boston this year, holding its first-ever seminar on firefighter cancer.
'I hate this'
Privately, Mark Rine battles anxiety and daily thoughts of dying. The idea of leaving his wife without a husband and his five children — two his, two hers, one theirs without a father is more haunting than death itself.
“I hate this,” Rine says.
But there is no time for self-pity. He kneels alongside 6-year-old Halle’s pink bed and reads their nightly Bible story in their Granville home.
Rine could have quit in 2014, when his body no longer could handle 24-hour shifts of medic and fire runs. The money from a disability retirement might have been enough to keep him comfortable.
Or his bosses could have cut him loose.
Instead, his supervisors kept him on the city's payroll as a firefighter and gave him a special assignment. His mission was to save as many firefighters as possible before he dies. He's a traveling anti-cancer evangelist.
He developed a 90-minute presentation to educate firefighters about the dangers of cancer and ways they can better protect themselves. His union president put Rine in a position to help his fellow firefighters not just in Columbus but across Ohio and beyond.
He has given hundreds of presentations in the past three years. He warns. He scolds. He preaches. He pleads. And sometimes, he yells.
The cancer risk, he vividly and desperately shows them, is real.
— Reach Mike Wagner at email@example.com; reach Lucas Sullivan at firstname.lastname@example.org.