Firefighters extinguish a helicopter fire during a training exercise in 2007. (U.S. Army)
(Tribune News Service) — Donating blood can save lives, but in the future, doctors may also prescribe rolling up a sleeve and exposing a vein for the health of certain donors.
Research from Australia published in 2021 suggests blood donations reduce the donor's concentration of a class of toxic substances called "per- and polyfluoroakyl substances," or PFAS, popularly called "forever chemicals."
PFAS don't really last "forever," but they earned the moniker because some stay in the body for almost 10 years and accumulate in organs, blood and bones with repeated exposures.
Recent research link PFAS to higher cancer rates, decreased birth weight, hormone disruption, elevated blood pressure and increased incidence of preeclampsia in pregnant women.
Firefighters are at higher risk of PFAS exposure due to the chemicals in foams and protective gear as well as in household products burned in fires.
The Australian study showed firefighters with high PFAS levels who gave blood regularly saw a 10% decrease in their levels after a year and those who gave plasma — the clear part of the blood — dropped 30%.
Arizona firefighters could play a key role in developing the next chapter of this insight when the University of Arizona, Arizona State University and the Arizona Fire Chiefs Association partner on a $4 million study this year that hopes to enroll 1,500 Arizona firefighters.
The study came in response to a call from the AFCA for more research on PFAS and firefighter safety.
At roughly 20% of the professional firefighters in Arizona, the Arizona study could provide a pool to confirm whether regular blood and plasma donations lower PFAS and produce measurable health improvements.
Arizona firefighters who volunteer will have their PFAS levels tested and those with the top 20% of concentrations will give blood every 12 weeks or plasma every six weeks. Their PFAS levels and DNA health indicators will be tested at the beginning and end of the study.
Those with lower levels will have the option to join other studies and participate in other interventions involving diet and exercise.
Lead investigator Dr. Jeff Burgess, a professor and director of the U of A's Center for Firefighter Health Collaborative Research, said the Arizona study aims to validate the Australian study and take it a step further by also measuring firefighters for "biomarkers of toxicity."
The biomarkers will provide data on whether lowering PFAS blood levels improves health, as researchers suspect it will.
"It's going to be a big deal," he said of the study. "In addition to being able to determine whether we can lower the PFAS levels in firefighters and have a beneficial effect, these same findings should be generalizable to individuals in the general population that also have elevated PFAS levels."
Burgess and collaborator Dr. Floris Wardenaar of Arizona State University's College of Health Solutions don't expect any difficulty recruiting the target number of participants because the research questions came from local firefighters.
Burgess said firefighters want to know their PFAS levels, and one immediate perk of the study is getting that information.
Burgess said the results of the study could have implications far beyond the firefighting community.
"There's a lot of those people out there who have higher levels of PFAS exposure," Burgess said. "Maybe it's in their drinking water. Maybe they get exposed to it at work. ... This will help all those individuals."
Some may wonder, what happens to those who receive donated blood from people with elevated PFAS — won't they inherit the health risks?
PFAS could be passed to blood recipients, but Burgess said the benefits of the donated blood outweighs the risks of the limited exposure to blood with elevated PFAS.
"We've been really close to talking with the main blood and plasma donation centers in the state, and … they are supportive of this study," Burgess said. "There's a strong benefit of giving blood and plasma. It's needed. These are life saving products."
Everybody's problem
Due to their surprising heat-, water- and stain-resistant properties, developed in the '40s and '50s, PFAS have been used in both household products like non-stick pans and stain protectors as well as industrial uses like aerospace manufacturing.
With a chemical bond between carbon and fluorine atoms, one of the strongest in nature, PFAS molecules resist breaking down in the body and environment.
PFAS are slowly being phased out from many consumer products, but because of their persistence in the environment, they have found their way into the soil, air and water all across the world, including Arizona, and will continue to pose dangers.
To get a sense of the volume of PFAS used in the modern world, consider that just one large PFAS producer, 3M, reported to shareholders last month that it currently sells $1.3 billion worth of PFAS each year.
That disclosure was part of a December announcement in which the company said it would be phasing out production of PFAS by 2025.
Burgess said global PFAS blood levels are slowly decreasing, a shift that he compared to the drop in lead levels in blood after changes to laws regarding lead in gasoline and other products.
But due to PFAS' persistence and wide usage, change will not be overnight.
One way PFAS spread from industrial sites and firefighting training facilities is by leaching from contaminated soils into groundwater.
Testing by the Arizona Department of Environmental Quality has shown this process happening in Arizona, and with long-term drought potentially pushing Arizona cities to rely more heavily on groundwater reserves in the near future, the question of groundwater contamination by PFAS and its health consequences could not be coming at a more critical time.
In 2018, the ADEQ checked for PFAS in 109 public water service wells across the state, out of the state's approximately 1,500 public water wells.
The good news was 81% of samples had no detectable PFAS, but 5.5% of wells it tested contained PFAS levels above the EPA Health Advisory.
The report concluded that PFAS groundwater contamination in Arizona "tends to be localized near potential sources" of PFAS, such as firefighter training facilities, airports, factories and active or former military sites.
In the East Valley, wells with PFAS detections have been found in the City of Tempe water system and Salt River Public Works on the Salt River Pima-Maricopa Indian Community.
In Mesa, PFAS have been found in groundwater near the landfill of the former Williams Air Force Base, now Phoenix-Mesa Gateway Airport.
ADEQ research determined PFAS have never been manufactured in Arizona.
"Most people in the United States have been exposed to some PFAS," an EPA website concludes. "Most known exposures are relatively low, but some can be high, particularly when people are exposed to a concentrated source over long periods of time."
Why Arizona?
One reason Arizona is pioneering the question of PFAS and blood donation is the strong relationships between local researchers and the fire service.
Another is the availability of grant money to do community-directed research.
The $4 million price tag for the PFAS study comes from the Technology and Research Initiative Fund, a pot of money created through Prop. 301 in 2000 and funded by sales taxes.
Fred DuVal, chair-elect of the Arizona Board of Regents, said the fund is intended to encourage the world-class researchers who work at state universities to tackle Arizona-specific projects.
"We're trying to fund projects that taxpayers relate to and address problems people are facing," DuVal said, adding that governors' priorities also influence the selections.
The projects funded by this year's TIRF grants include Valley Fever and dust research, managing waste from abandoned mines, mitigating wildfire risk and smart tree watering to cool down cities.
DuVal said the TIRF grants, which are approved by the Board of Regents, are selected in a more subjective way than other competitive scientific grants might be.
He said winning projects for TIRF grants should be able to pass "the Circle K test."
"If you can't explain your research in the time it takes to buy a cup of coffee, then you aren't doing your job," DuVal said.
He added that this principle was especially important because the research is funded directly by taxpayers, who should be able to understand what they're funding.
DuVal is excited about the firefighter blood donation study, the second-largest grant this year behind the Valley Fever project.
"We want to take this to scale," he said. "If we can solve (this problem), it's a national-scale, global project."
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