Understanding and Mitigating Contaminant Exposure in Firefighting: Comprehensive Review of Firefighter PPE on Contamination, Health Risks, and Decontamination Methods

Firefighters are exposed to complex combustion products and to contaminants carried on personal protective equipment (PPE). Occupational exposure as a firefighter is classified as carcinogenic. This review summarizes the current evidence on exposure environments, routes of uptake, contamination and secondary exposure from PPE, and the effectiveness and limits of decontamination approaches. Across incident types, smoke composition varies with the fuels and combustion conditions, but fine and ultrafine particles and semi-volatile organic chemicals are common. Biomonitoring confirms uptake after incidents. Self-contained breathing apparatus reduces inhalation exposure during active suppression, yet exposures persist through dermal absorption at ensemble interfaces and post-incident tasks. Protective ensembles can retain soot-bound polycyclic aromatic hydrocarbons, additive chemicals, and metals; volatiles and particles resuspension in vehicles and stations can extend exposure. Studies show that on-scene preliminary exposure reduction and laundering can lower contaminant burdens on PPE; however, removal remains incomplete and decreases when cleaning is delayed or when gear is aged. Emerging evidence raises additional concern for per- and polyfluoroalkyl substances from foams and coating materials, with limited data on exposure metrics and removability. The field lacks standardized, realistic contamination platforms and a dose-based definition of clean PPE. Integrated intervention studies linking exposure, secondary exposure pathways, biomarkers, and decontamination methods are needed to set performance-based targets and evaluate emerging hazards.