By Steve Weissman
As the fire service continues to experience an unimaginable increase of occupational cancer diagnosis within our ranks, as a supervisor, leader, or co-worker, you are likely in a place of discomfort in your support efforts. A diagnosis not only affects the individual, but it can also have a profound effect on you professionally and personally. Receiving a diagnosis of cancer is devastating in all rights and should not be compounded by a lack of empathy from a department leader, supervisor, or co-workers. Most organizations and supervisors are not prepared for dealing with a firefighter who has received a cancer diagnosis.
This is a difficult time for that firefighter as you guide him through many challenging days. As a supervisor, you simply might not have all the answers needed nor the direction required to provide assistance. This article will provide a basis for what to say and not say, how to react, how to offer support, and how to coordinate assistance.
When you’re informed of a cancer diagnosis
You may be the first person other than family members who is informed of the diagnosis. Allow the firefighter to control the conversation and share personal information; you need to listen! Listen to understand his experience rather than listening to respond. This is the most common mistake. You will likely witness bouts of sadness, fear, anger, or confusion; this is normal. Express your support, remain positive, choose your words wisely, and don’t be intrusive. If notified in person, be aware of your body language and facial expression, as it can exhibit and communicate a negative effect.
If possible, find a private place to discuss the diagnosis where you will not be interrupted. People have many communications styles, gender and religious beliefs, fears, humor, and personal discomforts. Be prepared to adapt and refocus your discussion.
Do Say: “Your priority is to get healthy.” “Your job is safe and will be here when you are ready (if career and it’s true).” “The department will help you and your family any way we can.” “How can I assist you?” “What do you need me to do for you?”
Don’t say: “You will be okay.” “I know how you’re feeling.” “Don’t worry … you’ll be fine.” “I know someone who had the same diagnosis.” “What you need to do is …,” as this phrase tends to be disrespectful to the individual’s sense of autonomy. These phrases are not helpful. Do not share any stories of bad outcomes. Don’t promise anything you or the department are not 100% sure you can do, and be cautious of providing advice.
Be sure that any statement or discussion you have can be validated, and do not make any assumptions. Research and obtain copies of department policies and benefits if time permits before you meet. Discuss who will make notifications to department members.
Department notifications
Informing department members can be an emotional experience. Allow the firefighter to decide who to notify and how to do it. He might want to do it in a group setting or individually. There is always a possibility that he wants to have the diagnosis remain personal and confidential; respect that! The firefighter might also want to bring family members along for support. Department members might experience the same fears, emotions, and reactions as discussed earlier.
As a supervisor, you must remain honest and transparent about the diagnosis and how it might affect work assignments and status. You must refrain from speculation and assumptions; discuss and release information only approved by the individual.
Do: Only release information with the consent of the firefighter and to those with a need to know. Make the necessary arrangements for the meeting. Provide support for the individual and department members if necessary.
Don’t: Make assumptions, be dramatic, or tell department members how to react. Do not release medical information without approval.
Work status
Once notified of a cancer diagnosis, research your department policies and contact your Human Resources Department. Your organization should have a clear policy on sick leave, extended leave, and leave without pay. Ensure compliance and submission for benefits within the Family and Medical Leave Act (FMLA). Depending on treatment modalities, a light-duty position or flex time might be an alternative. Explore the use of trade time, exchange of shifts, or leave donations to cover days if necessary.
Returning to full duty has many challenges. Cancer treatments can have a lasting and long-term physical and behavioral (emotional and psychological) impact. Ensure your organization has a policy for returning to work that includes a fitness-for-duty evaluation.
DO: Clearly communicate the firefighter’s options as directed in department policy. Assist the individual with the completion and submission of appropriate documentation. Maintain communication during the treatments.
Don’t: Make any promise that cannot be fulfilled. Don’t fail to maintain regular communication.
Legal/Workers’ Compensation
It is important to understand your role in providing assistance with the filing of medical and workers’ compensation claims. Each department and state have different filing requirements and you must fully understand their complexities. Many states’ workers’ compensation laws are rebuttable, requiring detailed documentation to a known toxic exposure. Reach out to individuals who are completely familiar with workers’ compensation claims; this may be a local attorney. Remember, you are required to maintain medical confidentiality and obtain permission to release any medical information as required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Ensure the firefighter has all legal, insurance, and medical documents up to date. These include but are not limited to wills, power of attorney, and medical directives to include “Do not resuscitate” orders. Many insurance policies exist that offer cancer protection along with short- and long-term medical care.
Do: Refer the firefighter appropriately for legal advice. Maintain copies of medical records, workers’ compensation filings, and correspondences. Encourage all department personnel to maintain up-to-date medical and legal documents.
Don’t: Offer legal advice unless you are trained to do so. Don’t release any medical information without consent of the firefighter or that would violate HIPPA regulations.
Financial
The unfortunate simple fact is that cancer may have a devastating effect on the department member’s financial stability. Medical Insurance plans differ, as do many state workers’ compensation benefits. They may cover many of the treatments and financial costs; however, depending on your department’s medical insurance plan; the out-of-pocket costs can be expensive.
Additionally, if the firefighter is out of work for a long time, will the department allow for the use of his earned leave to include annual, compensatory, and vacation time? If he has exhausted all of his earned leave, will the firefighter be placed on leave without pay? How will his salary be maintained? Will this diagnosis result in early retirement? This discussion is imperative and will be difficult. It may place both of you in an uncomfortable position.
Do: Ask the firefighter if he has long- or short-term medical insurance or a supplemental cancer insurance policy. Contact your Human Resources Department to clarify what benefits are offered. Focus on the firefighter’s well-being and not the cost. Offer assistance in gathering information to assist the firefighter in making an informed decision. If permitted, file a workers’ compensation claim, as many states offer benefits to provide limited financial assistance.
Don’t: Lose focus on the well-being of the firefighter as he battles through this disease. Do not make any financial recommendations or advice regarding pension or retirement options until you speak directly to your department’s benefits representative.
Support
Cancer affects everyone differently. The type of cancer, treatment modalities, and recovery play important roles in the journey. In some cases, the effects of cancer and treatment prohibit the return to duty. As a leader, you might be the most important source of support. It’s incumbent that you understand this and educate yourself as well as co-workers. With this knowledge, you can plan for challenges and guide co-workers in support roles.
Suggest that the firefighter identify a caregiver or an individual to act as a point of contact to coordinate support efforts. This will minimize stress and allow the firefighter to focus on treatment and recovery. A caregiver takes care of daily tasks and coordinates support activities such as food shopping, travel for treatments and doctor appointments, coordinating visits, home projects, childcare, and solving problems. Engage employee organizations to provide support and coordinate family assistance. Reach out to local groups that support cancer care; almost every community has one.
Do: Reach out to a behavioral health resource. Ensure that you and your administration acknowledge the experience of the cancer diagnosis on the firefighter as a human being. Identify a caregiver to assist with family needs. Educate yourself and department members about occupational cancer. Contact the Firefighter Cancer Support Network (FCSN) for assistance and guidance.
Don’t: Don’t minimize behavioral health effects. Do not take any action that could be interpreted as minimizing the psychological and emotional impact of the diagnosis for the firefighter and his family. Don’t forget to maintain contact with the firefighter, his family, as well as his crew.
Resources
You and your department shouldn’t have to go through this alone. There are many local and national organizations that can provide assistance. Reach out to other departments where a member was diagnosed with cancer and ask for their guidance. Here are a few national-based organizations that offer resources:
Firefighter Cancer Support Network; www.firefightercancersupport.org
The FCSN is a nonprofit organization that focuses on assisting firefighters and EMS providers and their immediate families diagnosed with cancer by providing badge-to-badge support, training, and guidance.
American Cancer Society; www.cancer.org
The American Cancer Society researches cancer and its causes in an effort to determine better treatment options. It also promotes healthy lifestyles to assist in the prevention of cancer and provides a 24-hour support call-in line.
National Cancer Institute; www.cancer.gov
The National Cancer Institute (NCI) is the federal government’s principal agency for cancer research and training.
First Responder Center for Excellence; www.firstrespondercenter.org
The FRCE focuses on educating the firefighter community about health and disease prevention.
Taking Action
I would be negligent if I didn’t discuss the need to take action within your department to develop a cancer reduction program. The implementation of a cancer reduction program will be a cultural change from the way we currently do business. It must be embraced by all department members; however, it must start with leadership setting the standard.
The focus of this program is to promote the recognition of potential contamination hazards, implement precautionary measures, reduce and minimize the risk of exposure, and ensure that personnel who are exposed to contaminants document their exposures. It should also address the need for annual medical examinations and long-term medical surveillance and promote personal and PPE decontamination.
Resources-Cancer Reduction Programs
The following organizations have resources that will assist you in the development of a Cancer Reduction Program:
The National Fire Protection Association (NFPA) has recognized the increase in cancer diagnosis and has made revisions to its standards. NFPA 1500, Standard on Fire Department Occupational Safety, Health and Wellness Program, now includes discussions on incident contaminant reduction, personal hygiene, and exposure reporting requirements. NFPA 1582, Standard on Comprehensive Medical Program for Fire Departments, should be used to develop your annual medical evaluations.
The Firefighter Cancer Support Network, in partnership with the International Association of Fire Fighters, designated January as Firefighter Cancer Awareness Month. The content of the FCSN Web site contains research, educational presentations, training briefs, and survivor stories. These materials are open to all and can be viewed at https://firefightercancersupport.org/firefighter-cancer-awareness-month/about-cancer-awareness-month/.
The Firefighter Cancer Support Network has a repository of SOPs, research documents, educational programs, and articles that can be referenced. It also has a portal to seek assistance if you or someone you know has been diagnosed with cancer.
Advances in early detection, diagnosis, and treatment have increased the likelihood for a successful return to full duty. Remember, you as the supervisor are not alone. There are many paths that you can take to obtain support and assistance. Those diagnosed with cancer are eager and motivated to return to full duty, and with your positive assistance this can have a successful outcome.
BIO:
Steve Weissman is a retired deputy chief from the Stafford County (VA) Fire and Rescue Department. He is a 46-year veteran of the fire service, starting his career with the Fairfax County (VA) Fire and Rescue Department. In 2016, he was diagnosed with occupational cancer. He is the Virginia state director for the Firefighter Cancer Support Network and can be reached at sweissman@fcsn.net.
