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A special issue of Toxics (ISSN 2305-6304). This special issue belongs to the section "Exposome Analysis and Risk Assessment".

Deadline for manuscript submissions: closed (31 December 2024) | Viewed by 22175

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Special Issue Editors

Dr. Anne Thoustrup Saber

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Guest Editor

The National Research Centre for the Working Environment, department of Chemical Working Environment, Copenhagen, Denmark
Interests: firefighting; particles; occupational toxicity; cancer; cardiovascular diseases; human biomonitoring

Dr. Maria Helena Guerra Andersen

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Guest Editor

The National Research Centre for the Working Environment, department of Chemical Working Environment, Copenhagen, Denmark
Interests: firefighting; DNA damage; cardiovascular; air pollution; particles; PAHs; human biomonitoring; epidemiology

Special Issue Information

Dear Colleagues,

Firefighting activities include a combination of exposures, involving a highly complex mix of hazards such as smoke and combustion products, soot, physical exhaustion, hyperthermia and dehydration, exposure to chemicals, night work, noise and mental stress. Firefighting exposures have been associated with cancer in humans, with sufficient evidence for causality (IARC 2022). Firefighters have also been reported to suffer more from cardiovascular disease than other groups of workers in studies around the globe. Furthermore, some studies have reported affected reproductive and neurotoxic endpoints among firefighters.

The complexity of studying mechanisms of toxicity from firefighting is also challenged by differences in firefighting realities around the globe. These include the different types of fires, the different roles and tasks performed at fire scenes, the different personal protection used, the changes in protection equipment and processes used over time and the historical differences within buildings, electronics and furnishing materials and chemicals. Assessing the occupational exposures and health hazards of firefighting is therefore challenging, but it is critical for the safety of firefighters.

Authors are warmly invited to submit original research papers and state-of-the-art reviews addressing the field of firefighters’ occupational exposures and health risks. The topics of interest include, but are not limited to, the following: assessment of firefighters’ exposure to health-relevant hazards; use of biomarkers to assess occupational exposure and associated effects; mechanisms of toxicity. All submitted manuscripts will go through a rigorous peer review process.

Dr. Anne Thoustrup Saber
Dr. Maria Helena Guerra Andersen
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Toxics is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

firefighting
biomonitoring
exposure assessment
health outcomes

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Published Papers (12 papers)

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Editorial

Jump to: Research, Review

4 pages, 306 KiB

Open AccessEditorial

Special Issue: Firefighters’ Occupational Exposures and Health Risks

by Maria Helena Guerra Andersen and Anne Thoustrup Saber

Toxics 2025, 13(5), 343; https://doi.org/10.3390/toxics13050343 - 26 Apr 2025

Viewed by 87

Abstract

Firefighters are occupationally exposed to a complex mixture of hazardous agents [...] Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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Research

Jump to: Editorial, Review

12 pages, 489 KiB

Open AccessArticle

Evaluation of Passive Silicone Samplers Compared to Active Sampling Methods for Polycyclic Aromatic Hydrocarbons During Fire Training

by Paro Sen, Miriam Calkins, Keith Stakes, Danielle L. Neumann, I-Chen Chen and Gavin P. Horn

Toxics 2025, 13(2), 132; https://doi.org/10.3390/toxics13020132 - 12 Feb 2025

Viewed by 724

Abstract

Firefighters are occupationally exposed to many chemicals, including polycyclic aromatic hydrocarbons (PAHs), which are formed by the incomplete combustion of organic matter during fire response and training activities. However, due to the harsh environments in which firefighters work, as well as consideration for time and physical safety while wearing bulky equipment, traditional active sampling methods may not be feasible to measure PAH exposures. Silicone passive samplers offer an alternative approach to assess exposure during fire responses and live fire training due to their heat resistance and ease of deployment in remote or time-limited environments. In this study, the primary objective was to investigate and determine the statistical strength of the relationship between active air sampling methods and passive silicone samplers for PAHs. In this study, silicone wristbands were paired with active sampling devices in a series of burn experiments to compare PAH measurements. Silicone-based measurements correlated strongly with active air samples for the dominant PAHs found, naphthalene and phenanthrene; however, detection was limited in the wristbands when air concentrations were low in active samples. In situations where PAH levels are expected to be high and the potential for contaminant loss via off-gassing is low, silicone samplers may be a useful tool for industrial hygienists to measure PAHs in fire and other emergency responses in extreme environments. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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15 pages, 1621 KiB

Open AccessArticle

Air, Skin, and Biological Monitoring of French Fire Instructors’ Exposure to Particles/PAHs During Controlled Fire and Mitigation Strategies

by Pauline Zangl, Clément Collart and Renaud Persoons

Toxics 2025, 13(2), 106; https://doi.org/10.3390/toxics13020106 - 28 Jan 2025

Viewed by 748

Abstract

Occupational exposure as a firefighter was recently classified as carcinogenic to humans by the IARC. Fire instructors’ exposure to carcinogenic PAHs is a major concern, and studies that have tried to assess the determinants of their exposure are scarce. An air and biomonitoring study was conducted in fire instructors performing simulated training exercises in enclosed containers. Air samples were collected, as well as urine samples from 22 firefighting instructors, and skin wipes were collected from FFs’ skin at the end of the exercises. PAH metabolites (1-hydroxypyrene, 3-hydroxybenzo(a)pyrene, 2/3-hydroxyfluorene, and 2/3-hydroxyphenanthrene) were measured in urine samples at three sampling times (beginning of shift, end of shift, and next morning). Airborne PAHs were dominated by low molecular weight compounds (naphthalene), and levels were as high as 67 µg·m⁻³ close to the containers, decreasing at higher distances. Skin contamination was observed both on the neck/face and hands/wrists of fire instructors and pilots. Ten times lower skin contamination was observed when nitrile undergloves were worn. High internal exposure was measured, with 1-hydroxypyrene and 3-hydroxybenzo(a)pyrene levels frequently exceeding maximum recommended values in occupational settings (up to 2.8 µmol/mol creatinine for 1-OHP, 14 µmol/mol creatinine for ΣOH-PAH, and 1.0 nmol/mol creatinine for 3-OHBaP), whereas benzene exposure was revealed to be very low. These types of exposure were found to derive both from dermal absorption (combustion products deposited on the skin) and inhalation (when removing SCBA outside the containers). Several recommendations are proposed in order to reduce both exposure routes (nitrile undergloves and half-masks in the vicinity of containers), harmonise decontamination (PPEs) and cleaning procedures, and prevent the dermal absorption of PAH from turnout gear. This study emphasises the complex PAH exposure profiles of fire instructors and characterises the main drivers of exposure, highlighting the need for better mitigation strategies. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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15 pages, 903 KiB

Open AccessArticle

Assessment of Polycyclic Aromatic Hydrocarbon Exposure in Trainee Firefighters Using PAH CALUX Bioassay

by Johanna Grünfeld, Peter Møller, Ulla Vogel, Simon Pelle Jensen, Vivi Kofoed-Sørensen and Maria Helena Guerra Andersen

Toxics 2024, 12(11), 825; https://doi.org/10.3390/toxics12110825 - 18 Nov 2024

Viewed by 1335

Abstract

This work investigated the application of a reporter gene bioassay in assessing polycyclic aromatic hydrocarbon (PAH) exposure in trainee firefighters. In the PAH CALUX bioassay, the PAH-induced activation of the aryl hydrocarbon receptor in a reporter cell line is recorded by increased luminescence. A repeated measurement study was performed, collecting urine and skin wipe samples at two baseline sessions (spring and autumn) and after three firefighting sessions: one with wood fuel, one with gas fuel, and one without fire. The bioassay response was expressed as benzo[a]pyrene equivalents, which was compared to levels of 16 EPA criteria PAHs in skin wipe samples and 8 hydroxylated PAHs (OH-PAHs) in urine samples quantified by chromatography–tandem mass spectrometry techniques. Benzo[a]pyrene equivalents and PAH levels in skin wipes indicated larger exposure to PAHs during the wood session compared to the other sessions. The urine bioassay showed non-significant effect sizes after all sessions, whereas the chemical analysis showed increased OH-PAH levels after the gas session. The non-significant changes observed for the session without fire suggest a negligible exposure from contaminated gear. In conclusion, the bioassay response for skin wipes shows that trainee firefighters were exposed to higher levels of potentially toxic PAHs during the wood fire training session. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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14 pages, 634 KiB

Open AccessEditor’s ChoiceArticle

Impact of Skin Decontamination Wipe Solutions on the Percutaneous Absorption of Polycyclic Aromatic Hydrocarbons

by Chandler Probert, R. Bryan Ormond and Ronald E. Baynes

Toxics 2024, 12(10), 716; https://doi.org/10.3390/toxics12100716 - 30 Sep 2024

Cited by 1 | Viewed by 2523

Abstract

Firefighter occupational exposures were categorized as a class 1 (known) carcinogen by the International Agency for Research on Cancer in 2022. As a result, firefighters have become heavily focused on identifying effective and easy to implement decontamination strategies to reduce their chemical exposures. Skin decontamination using wipes post-exposure is one decontamination strategy that every firefighter has available to them. However, firefighters have expressed concerns over the ingredients in the wipe solution increasing dermal absorption. The goal of this study was to determine if the ingredients in skin decontamination wipe solution had any enhancement effect on the dermal absorption of phenanthrene. To determine any enhancement effects, the additive solution of four skin decontamination wipe products was applied to porcine skin 15 min after chemical dosing. The absorption of phenanthrene was tested in vitro using a flow-through diffusion cell system over eight hours. The wipe solution effects on dermal absorption were determined by measuring multiple absorption characteristics including cumulative absorption (µg/cm²), absorption efficiency (% dose absorbed), lag time (minutes), flux (µg/cm²/h), diffusivity (cm²/h), and permeability (cm/h). No penetration enhancement effects were observed in any of the skin decontamination wipe solutions tested; rather, all wipe solutions decreased the absorption of phenanthrene. Slight differences in cumulative absorption among two pairings of skin decontamination wipe solutions, wipes 1 and 3 vs. wipes 2 and 4, were observed, indicating that some ingredients may impact dermal absorption. These findings show that firefighters should continue using skin decontamination wipes to reduce their dermal exposures to fireground contaminants with little concern of increasing the absorption of phenanthrene. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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17 pages, 2113 KiB

Open AccessEditor’s ChoiceArticle

Occupational Exposure of On-Shift Ottawa Firefighters to Flame Retardants and Polycyclic Aromatic Hydrocarbons

by William Papas, Rocio Aranda-Rodriguez, Xinghua Fan, Cariton Kubwabo, Janet S. L. Lee, Emma Fantin, Elita D. Zheng, Jennifer L. A. Keir, Dave Matschke, Jules M. Blais and Paul A. White

Toxics 2024, 12(9), 677; https://doi.org/10.3390/toxics12090677 - 17 Sep 2024

Cited by 1 | Viewed by 1799

Abstract

Firefighters can be exposed to complex mixtures of airborne substances, including hazardous substances released during structural fires. This study employed silicone wristbands (SWBs) as passive samplers to investigate potential exposure to polycyclic aromatic hydrocarbons (PAHs) and flame retardants (FRs). SWBs were deployed at different areas of four fire stations, in four truck cabins, and at an office control location; they were also donned outside the jackets of 18 firefighters who responded to fire calls. Overall, office areas had significantly lower PAHs than fire station areas. Vehicle bays and truck cabins had significantly higher concentrations of low molecular weight (LMW) PAHs than sleeping and living room areas. For organophosphate ester flame retardants (OPFRs), tri-n-butyl phosphate (TnBP) and tris(1-chloro-2-propyl) phosphate (TCPP) were detected in all the samples; 2-ethylhexyl diphenyl phosphate (EHDPP) was more frequently detected in the fire station areas. Triphenyl phosphate (TPP) concentrations were highest in the truck cabin and office areas, and tris(1,3-dichloro-2-propyl)phosphate (TDCPP) was highest in truck cabins. Thirteen of 16 PAHs and nine of 36 OPFRs were detected in all the SWBs worn by firefighters, and tris (2-butoxyethyl) phosphate (TBEP) was the predominant OPFR. Levels of LMW PAHs were significantly lower when firefighters did not enter the fire. LMW PAHs, HMW (high molecular weight) PAHs, and EHDPP were significantly elevated when heavy smoke was reported. This work highlights the potential for occupational exposure to PAHs and flame retardants in some fire station areas; moreover, factors that may influence exposure during fire suppression. Whilst firefighters’ occupational exposure to PAHs is likely related to fire suppression and exposure to contaminated gear and trucks, exposure to OPFRs may be more related to their presence in truck interiors and electronics. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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17 pages, 730 KiB

Open AccessEditor’s ChoiceArticle

Percutaneous Absorption of Fireground Contaminants: Naphthalene, Phenanthrene, and Benzo[a]pyrene in Porcine Skin in an Artificial Sweat Vehicle

by Chandler Probert, Emma Nixon, R. Bryan Ormond and Ronald Baynes

Toxics 2024, 12(8), 588; https://doi.org/10.3390/toxics12080588 - 13 Aug 2024

Cited by 1 | Viewed by 2748

Abstract

Firefighters face significant risks of exposure to toxic chemicals, such as polycyclic aromatic hydrocarbons (PAHs), during fire suppression activities. PAHs have been found in the air, on the gear and equipment, and in biological samples such as the skin, breath, urine, and blood of firefighters after fire response. However, the extent to which exposure occurs via inhalation, dermal absorption, or ingestion is unclear. In this study, three PAHs, naphthalene, phenanthrene, and benzo[a]pyrene, were applied to porcine skin in vitro in an artificial sweat solution to better gauge firefighters’ dermal exposures while mimicking their sweaty skin conditions using an artificial sweat dosing vehicle. Multiple absorption characteristics were calculated, including cumulative absorption, percent dose absorbed, diffusivity, flux, lag time, and permeability. The absorption of the PAHs was greatly influenced by their molecular weight and solubility in the artificial sweat solution. Naphthalene had the greatest dose absorption efficiency (35.0 ± 4.6% dose), followed by phenanthrene (6.8 ± 3.2% dose), and lastly, benzo[a]pyrene, which had the lowest absorption (0.03 ± 0.04% dose). The lag times followed a similar trend. All chemicals had a lag time of approximately 60 min or longer, suggesting that chemical concentrations on the skin may be reduced by immediate skin cleansing practices after fire exposure. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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11 pages, 250 KiB

Open AccessArticle

Perceptions of Exposure and Mask Use in Wildland Firefighters

by Tanis Zadunayski, Natasha Broznitsky, Drew Lichty and Nicola Cherry

Toxics 2024, 12(8), 576; https://doi.org/10.3390/toxics12080576 - 7 Aug 2024

Cited by 2 | Viewed by 1654

Abstract

Wildland firefighters are exposed to airborne particulates, polycyclic aromatic hydrocarbons (PAHs), and other hazardous substances. Respiratory protection is indicated, but information is lacking on the tasks and conditions for which mask wearing should be advised. Studies to assess respiratory protection in wildland firefighters were carried out in western Canada in 2021 and 2023. Sampling pumps measured airborne exposures and urinary 1-hydroxypyrene (1-HP) was assayed to indicate PAH absorption. Participants in 2021 reported the time for which they wore the mask during each task. In 2023, the use of masks was reported, and firefighters rated the smoke intensity. In 2021, 72 firefighters were monitored over 164 shifts and, in 2023, 89 firefighters were monitored for 263 shifts. In 2021, mask wearing was highest for those engaged in initial attack and hot spotting. Urinary 1-HP at the end of rotation was highest for those reporting initial attack, working on a prescribed fire and mop-up. In 2023, firefighter ratings of smoke intensity were strongly associated with measured particulate mass and with urinary 1-HP, but masks were not worn more often when there was higher smoke intensity. The data from the literature did not provide a clear indication of high-exposure tasks. Better task/exposure information is needed for firefighters to make informed decisions about mask wearing. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

19 pages, 3604 KiB

Open AccessArticle

Assessing the Impact of Pre-Soaking to Enhance Laundering Efficacy of Firefighter Turnout Gear

by Md Tanjim Hossain and R. Bryan Ormond

Toxics 2024, 12(8), 544; https://doi.org/10.3390/toxics12080544 - 27 Jul 2024

Viewed by 1106

Abstract

Firefighters are exposed to hazardous chemicals at fire scenes, including polycyclic aromatic hydrocarbons (PAHs) among many others, which pose significant health risks. Current laundering practices are ineffective at removing persistent contaminants from turnout gear, necessitating further research to optimize cleaning methods. This study explores the impact of presoaking prior to the laundering process and the factors that can affect its effectiveness, including the presoaking duration and detergent concentration, in PAH removal when laundering. For this, contaminated fabric swatches were subjected to various presoaking durations (1, 3, and 12 h) and detergent concentrations (99:1 and 90:10 water-to-detergent ratios) before undergoing bench-scale washing. The cleaning efficacy was assessed for 16 PAH compounds, including both low-molecular-weight (LMW) PAHs and high-molecular-weight (HMW) PAHs. Moreover, the removal mechanisms of PAHs from turnout gear were fundamentally explained using partition coefficients and standard affinities with different parameters during washing. The results demonstrate that 3 h and 12 h of presoaking lead to 2.8 and 4.3 times greater HMW PAH removal, respectively. After 12 h of presoaking in a 90:10 water-to-detergent ratio, 97% of the LMW PAHs and 78% of the HMW PAHs were removed, compared to only an 11% removal of the HMW PAHs with a 99:1 ratio. Additionally, direct washing with a 90:10 ratio achieved comparable efficacy to that of presoaking with the same water-to-detergent ratio, indicating the crucial role of detergent concentration during laundering. These findings offer valuable insights for optimizing firefighter safety practices, emphasizing the role of presoaking and the appropriate methods to perform presoaking to mitigate firefighters’ occupational exposure risks to toxic substances and ensure gear reliability. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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22 pages, 2910 KiB

Open AccessArticle

Characterization of Wildland Firefighters’ Exposure to Coarse, Fine, and Ultrafine Particles; Polycyclic Aromatic Hydrocarbons; and Metal(loid)s, and Estimation of Associated Health Risks

by Joana Teixeira, Gabriel Sousa, Rui Azevedo, Agostinho Almeida, Cristina Delerue-Matos, Xianyu Wang, Alice Santos-Silva, Francisca Rodrigues and Marta Oliveira

Toxics 2024, 12(6), 422; https://doi.org/10.3390/toxics12060422 - 10 Jun 2024

Cited by 3 | Viewed by 2071

Abstract

Firefighters’ occupational activity causes cancer, and the characterization of exposure during firefighting activities remains limited. This work characterizes, for the first time, firefighters’ exposure to (coarse/fine/ultrafine) particulate matter (PM) bound polycyclic aromatic hydrocarbons (PAHs) and metal(loid)s during prescribed fires, Fire 1 and Fire 2 (210 min). An impactor collected 14 PM fractions, the PM levels were determined by gravimetry, and the PM-bound PAHs and metal(loid)s were determined by chromatographic and spectroscopic methodologies, respectively. Firefighters were exposed to a total PM level of 1408.3 and 342.5 µg/m³ in Fire 1 and Fire 2, respectively; fine/ultrafine PM represented more than 90% of total PM. Total PM-bound PAHs (3260.2 ng/m³ in Fire 1; 412.1 ng/m³ in Fire 2) and metal(loid)s (660.8 ng/m³ versus 262.2 ng/m³), distributed between fine/ultrafine PM, contained 4.57–24.5% and 11.7–12.6% of (possible/probable) carcinogenic PAHs and metal(loid)s, respectively. Firefighters’ exposure to PM, PAHs, and metal(loid)s were below available occupational limits. The estimated carcinogenic risks associated with the inhalation of PM-bound PAHs (3.78 × 10⁻⁹ − 1.74 × 10⁻⁶) and metal(loid)s (1.50 × 10⁻² − 2.37 × 10⁻²) were, respectively, below and 150–237 times higher than the acceptable risk level defined by the USEPA during 210 min of firefighting activity and assuming a 40-year career as a firefighter. Additional studies need to (1) explore exposure to (coarse/fine/ultrafine) PM, (2) assess health risks, (3) identify intervention needs, and (4) support regulatory agencies recommending mitigation procedures to reduce the impact of fire effluents on firefighters. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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15 pages, 1524 KiB

Open AccessEditor’s ChoiceArticle

Firefighters’ Occupational Exposure in Preparation for Wildfire Season: Addressing Biological Impact

by Filipa Esteves, Klara Slezakova, Joana Madureira, Josiana Vaz, Adília Fernandes, Simone Morais, Maria do Carmo Pereira, João Paulo Teixeira and Solange Costa

Toxics 2024, 12(3), 201; https://doi.org/10.3390/toxics12030201 - 5 Mar 2024

Cited by 2 | Viewed by 2257

Abstract

The characterization of wildland firefighters’ occupational exposure must consider different exposures, including those at the fire station. The present study aimed to characterize the occupational exposure of 172 Northern Portuguese wildland firefighters in fire stations during the pre-wildfire season of 2021. The biological impact of estimated inhaled doses of PM₁₀ and PM_2.5 (indoor/outdoor) was accessed through a buccal micronucleus cytome (BMCyt) assay in exfoliated buccal cells of a subgroup of 80 firefighters. No significant association was found between estimated inhaled doses of PM₁₀ and PM_2.5 (mean 1.73 ± 0.43 µg kg⁻¹ and 0.53 ± 0.21 µg kg⁻¹, respectively) and biological endpoints. However, increased frequencies of cell death parameters were found among subjects of the Permanent Intervention Teams (full-time firefighters). The intake of nutritional supplements was associated with a significant decrease in micronucleus frequencies (i.e., DNA damage or chromosome breakage). In addition, our findings showed a significantly increased frequency of cell death endpoints (i.e., nuclear fragmentation) with coffee consumption, while daily consumption of vegetables significantly decreased it (i.e., nuclear shrinkage). Our results provide data on the occupational exposure of wildland firefighters while working in fire stations during the pre-wildfire season, providing the essential baseline for further studies throughout the wildfire season. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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Review

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24 pages, 799 KiB

Open AccessEditor’s ChoiceReview

Breast Cancer-Related Chemical Exposures in Firefighters

by Bethsaida Cardona, Kathryn M. Rodgers, Jessica Trowbridge, Heather Buren and Ruthann A. Rudel

Toxics 2024, 12(10), 707; https://doi.org/10.3390/toxics12100707 - 28 Sep 2024

Cited by 2 | Viewed by 3578

Abstract

To fill a research gap on firefighter exposures and breast cancer risk, and guide exposure reduction, we aimed to identify firefighter occupational exposures linked to breast cancer. We conducted a systematic search and review to identify firefighter chemical exposures and then identified the subset that was associated with breast cancer. To do this, we compared the firefighter exposures with chemicals that have been shown to increase breast cancer risk in epidemiological studies or increase mammary gland tumors in experimental toxicology studies. For each exposure, we assigned a strength of evidence for the association with firefighter occupation and for the association with breast cancer risk. We identified twelve chemicals or chemical groups that were both linked to breast cancer and were firefighter occupational exposures, including polycyclic aromatic hydrocarbons, volatile aromatics, per- and polyfluoroalkyl substances, persistent organohalogens, and halogenated organophosphate flame retardants. Many of these were found at elevated levels in firefighting environments and were statistically significantly higher in firefighters after firefighting or when compared to the general population. Common exposure sources included combustion byproducts, diesel fuel and exhaust, firefighting foams, and flame retardants. Our findings highlight breast-cancer-related chemical exposures in the firefighting profession to guide equitable worker’s compensation policies and exposure reduction. Full article

(This article belongs to the Special Issue Firefighters’ Occupational Exposures and Health Risks)

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