Dr. Alberto Caban-Martinez

After the 12-story Champlain Towers South building suddenly crumbled in Surfside, Sylvester Comprehensive Cancer Center’s Firefighter Cancer Initiative stepped up to protect rescue workers from health hazards.

About 30 hours after the shocking collapse of the Champlain Towers South condominium in Surfside, Dr. Alberto Caban-Martinez, PhD, DO, MPH, drove his packed SUV to the disaster site. Escorted through the chaos by an ambulance, the deputy director of Sylvester Comprehensive Cancer Center’s Firefighter Cancer Initiative (FCI) was on a mission to deliver thousands of baby wipes and a dozen decontamination kits embossed with the lifesaving motto now found in hundreds of fire stations across Florida.

“Clean is the new badge of honor,” the large, green buckets said. Each contained the dish soap, scrub brushes, wipes, spray bottles, and hoses that Dr. Caban-Martinez hoped the search-and-rescue personnel would use to eliminate microscopic toxins he knew would cling to their skin and gear after their 12-hour shifts sifting through the debris pile that entombed nearly 100 people.

“Prevention is key,” explained Dr. Caban-Martinez, who is also an associate professor of public health sciences at the University of Miami Miller School of Medicine. “You do not want to be marinating in these compounds that are circulating in the air.”

Soon after, FCI founding director Dr. Erin Kobetz, PhD, MPH, who began collaborating with South Florida firefighters in 2014 to investigate why cancer seemed to be stalking their ranks, ordered hundreds of air-filtering P-100 respiratory masks to replenish the supply at the collapse site.

Learning From Tragedy

Turning an unthinkable tragedy into a valuable learning opportunity, she and Dr. Caban-Martinez also expanded FCI’s role in Surfside to help launch an environmental and exposure monitoring program that not only kept first responders safer on the ground but will inform future guidelines for protecting them from another occupational hazard likely to add to their risk profile.

“We were uniquely positioned to take the evidence gleaned from our ongoing effort to address why firefighters are at increased risk of cancer incidence and mortality and rapidly translate it to a disaster that could augment this risk substantially,” said Dr. Kobetz, Sylvester’s associate director for population sciences and cancer disparity and the University of Miami’s vice provost for research and scholarship. “Our hope is that we and our firefighter colleagues learn together how to mitigate the risks that emerge in a different disaster scenario.”

Dr. Caban-Martinez is scheduled to discuss the first exposure study from the June 24 collapse at the recent annual meeting of the American College of Epidemiology. Conducted in partnership with Miami-Dade Fire Rescue and the Department of Science and Research at the International Association of Fire Fighters, the study found that rescue workers who conducted the tireless search of the collapsed 12-story structure were exposed to high concentrations of polyaromatic hydrocarbons, a massive class of known, probable, and possible carcinogens which firefighters are all too often exposed to in their line of work.

SAFE Collecting Data

Dr. Caban-Martinez also just launched SAFE — for the Surfside Assessment of First-Responder Exposures study — which aims to collect two years’ worth of toenail clippings from hundreds of firefighters who worked on the debris pile. Like slow-growing rings of a tree, Dr. Caban-Martinez said, toenail clippings can provide snapshots of a person’s exposure to heavy metals.

But the hope is that those who adhered to the health and safety rules that the MDFR and IAFF developed with guidance from Dr. Caban-Martinez and Dr. David Prezant, the co-director of the World Trade Center Health Program, mitigated the risks posed by PAHs or other toxins released by the building’s collapse and ensuing fires. If so, that outcome would be owed in part to the University’s real-time environmental and exposure monitoring efforts that were used to keep rescue workers informed of the hazards and motivated to follow decontamination and personal protective equipment protocols.

“There are usually two aspects to encouraging PPE use,” said Derek Urwin, the IAFF’s director of science and research, who collaborated with the MDFR; Federal Emergency Management Agency safety officers; and researchers and students from the Miller School, the Rosenstiel School of Marine and Atmospheric Science, and the College of Engineering to get environmental and exposure monitoring up and running at Surfside.

“One is enforcement — when your boss tells you to do it,” Urwin continued. “The other, which is more effective, is motivation — when you understand that you can protect yourself from real hazards. We were able to use real-time environmental data to convey to the firefighters that, ‘You can’t see them. You can’t smell them, but there are respiratory hazards here. So, keep your respirators on.’ It made a big difference and hopefully the outcome will be that we won’t see a lot of long-term health impacts like we did after 9/11.”

It was, ironically, the growing awareness of those health impacts that inspired the FCI, which the Florida Legislature has continuously funded since its 2015 inception. During the 20 years since terrorists crashed planes into the Word Trade Center’s Twin Towers, at least 200 New York City firefighters have died from illnesses tied to the toxic mist that enveloped Manhattan in the ensuing months. Hundreds more have been diagnosed with a variety of cancers, including multiple myeloma—the same blood cancer that killed the Palm Beach County Fire Rescue captain who first asked Dr. Kobetz to connect the dots between firefighting and cancer.

Butch Smith, who died eight years after his 2008 diagnosis at age 54, and his comrades knew too many other front-line firefighters in Florida who had been diagnosed with a variety of cancers at a young age. But since none of them had taken part in New York’s post 9/11 recovery, they reached out to Sylvester, the state’s only academic cancer center, to provide the evidence-based data that would legitimize — and hopefully one day prevent — what they knew to be true: Their jobs put them at a high risk for cancer.

Learning from 9/11

Erin Kobetz, PhD, MPH

Urwin, a former Miami-Dade firefighter who has been with the Los Angeles County Fire Department for 15 years, also knew who to enlist when he realized it would fall to MDFR and the IAFF to initiate exposure monitoring in Surfside.

“Given the aftermath of 9/11, we all assumed that when this type of major incident takes place, some sort of government environmental monitoring program would automatically go into play,” he said. “But, after a couple of days, it became clear that was not the case, so knowing this was Miami, Alberto and Erin were my first two phone calls.”

In short order, Urwin flew from L.A. to Miami, where researchers from across the University eagerly stepped up to help. They offered their expertise, equipment, and a handful of “remarkable” students, who Urwin said provided essential assistance at the site or in the lab.

Nuresh Kumar, professor of environmental health in the Department of Public Health Sciences who specializes in the health effects of air pollution, facilitated the air-monitoring effort and employed multiple instruments and real-time pollutant sensors to monitor particles and gases circulating on and adjacent to the debris pile—and as far as six blocks away.

“Within a block of the site, I removed my respirator and had a burning sensation in my throat and eyes,” recalled Kumar, who was assisted by graduate students Johnathan Penso and Samantha Abelson. “Using readings from our real-time sensor and my own symptoms, I told Derek: ‘Tell all these folks not to remove their respirators unless they are in the tent or a protected area.’”

Lending Support

Cassandra Gaston, an assistant professor in the Department of Atmospheric Sciences—who studies the composition and size of aerosols—lent handheld, battery-operated air samplers, and her detail-oriented research assistant, Michael Sheridan.

He provided Urwin and Kumar vital in-the-field support. And Helena Solo-Gabriele, professor in the Department of Chemical, Environmental and Materials Engineering, supplied an X-ray Fluorescence Analyzer that, resembling a big gun, almost instantly detects high levels of metals in any material. Her graduate student, Afeefa Abdool-Ghany, is now analyzing dust samples and metal readings collected at the site.

The only researcher with early access to the disaster site, Urwin was also instrumental in organizing the PAH study that Dr. Caban-Martinez is discussing today. For that study, graduate student Umer Bakali processed and analyzed the data collected from 29 silicon wristbands that Urwin placed around the collapse site before the controlled demolition of the remaining tower structure and another 48 wristbands worn by rescue workers who worked on the debris pile afterward.

It was the same kind of simple wristbands that originally helped Dr. Kobetz, Dr. Caban-Martinez, and other FCI investigators begin linking firefighting to cancer. Firefighters who wore the wristbands in earlier studies eventually learned that the soot-covered fire gear they stowed in their cabs, their sleeping quarters, or their homes weren’t badges of honor. They were perfect conduits for spreading the cancer-causing contaminants that could have been wiped away with dish soap and water.

“I’m always thinking about firefighters — like what they were doing after Hurricane Ida hit the Gulf coast; what we could do to protect them from things like water contamination and infection,” Dr. Caban-Martinez said. “Because we know they will do whatever it takes to do their job, which is saving lives without considering the repercussions. But it’s our job to make sure they know how to protect themselves from hazards and reduce their risks.”