Researchers with Sylvester Comprehensive Cancer Center’s Firefighter Cancer Initiative helped establish an environmental and exposure monitoring program to keep first responders safe at the Surfside condo collapse and help inform mitigation guidelines for future disasters.
Researchers with Sylvester Comprehensive Cancer Center’s Firefighter Cancer Initiative helped establish an environmental and exposure monitoring program to keep first responders safe at the Surfside condo collapse and help inform mitigation guidelines for future disasters.
by Maya Bell
ABOUT 30 HOURS AFTER THE SHOCKING COLLAPSE OF THE 12-STORY CHAMPLAIN TOWERS SOUTH CONDOMINIUM IN SURFSIDE, DR. ALBERTO CABAN-MARTINEZ 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 say. Each contained the dish soap, scrub brushes, wipes, spray bottles, and hoses that Caban-Martinez, B.S. ’01, Ph.D. ’11, hoped search-and-rescue workers would use to eliminate microscopic toxins he knew would cling to their skin and gear after 12 hours of sifting through the rubble that entombed nearly 100 people.
“Prevention is key,” explains Caban-Martinez, 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 Erin Kobetz, who began collaborating with South Florida firefighters in 2014 to learn why cancer was stalking them, ordered hundreds of air-filtering P-100 masks to replenish the supply at the collapse site. Turning an unthinkable tragedy into a valuable learning opportunity, she and 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,” says Kobetz, Sylvester’s associate director for population sciences and cancer disparity, the University’s vice provost for research and scholarship, and the John K. and Judy H. Schulte Senior Endowed Chair in Cancer Research. “Our hope is that we and our firefighter colleagues learn together how to mitigate the risks that emerge in a different disaster scenario.”
At the annual meeting of the American College of Epidemiology in September, Caban-Martinez presented the first of what will likely be several environmental exposures studies from data collected in Surfside. Conducted with Miami- Dade Fire Rescue (MDFR) and the Department of Science and Research at the International Association of Fire Fighters (IAFF), that initial study found that first responders who searched the debris pile were exposed to high concentrations of polyaromatic hydrocarbons (PAHs), the massive class of known and possible carcinogens that firefighters all too often encounter at fire scenes.
Caban-Martinez also launched SAFE—for the Surfside Assessment of First-Responder Exposures study—which aims to collect two years’ worth of toenail clippings from hundreds of members of the Urban Search and Rescue teams who rotated on and off the collapse site. Like slow- growing rings of a tree, Caban-Martinez says, toenail growth can provide snapshots of a person’s exposure to heavy metals.
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But the hope is that rescue workers mitigated the risks posed by PAHs, or other toxins released by the building’s collapse and ensuing fires, by adhering to the health and safety rules that the MDFR and IAFF developed with guidance from Caban-Martinez and Dr. David Prezant, the chief medical officer of New York City’s fire department and co-director of the World Trade Center Health Program. 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 personnel informed of the hazards and motivated to follow decontamination and personal protective equipment (PPE) protocols.
“There are usually two aspects to encouraging PPE use,” says 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 initiate environmental and occupational exposure monitoring at Surfside.
“One is enforcement—when your boss tells you to do it,” Urwin continues. “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.”
Photo courtesy of Miami-Dade Fire Rescue
You can’t see them, you can’t smell them, but there are respiratory hazards here.
It was, ironically, the growing awareness of those health impacts that inspired the creation of the FCI, which the Florida Legislature has continuously funded since its 2015 inception. During the 20 years since terrorists crashed planes into the World 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 Kobetz to connect the dots between firefighting and cancer.
Butch Smith, who died at age 54 nearly nine years after his 2008 diagnosis, and his comrades knew too many other front-line firefighters in Florida who had been stricken 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.
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 says. “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 collapse site or in the lab.
Naresh 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 efforts 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,” recalls Kumar, who was assisted by graduate students Johnathan Penso, B.S. ’21, and Samantha Abelson, B.S.M.A.S. ’21. “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.’ ”
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, B.A. ’21. He provided Urwin and Kumar vital in-the-field support. And Helena Solo-Gabriele, B.S. ’87, M.S. ’88, 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. Soon after, her graduate student, Afeefa Abdool-Ghany, began analyzing dust samples and metal readings collected at the site.
The only researcher with early access to the disaster zone, Urwin was also instrumental in organizing the PAH study that Caban-Martinez presented in September. For that study, graduate student Umer Bakali, B.S. ’18, processed and analyzed the data collected from 29 silicone 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 continued the grueling search of the debris pile afterward.
It was almost the very same kind of simple wristbands that originally helped Kobetz, Caban-Martinez, and other FCI investigators begin linking firefighting to cancer. Firefighters who wore similar wristbands in earlier studies eventually learned that the soot-covered fire gear they proudly stowed in their trucks, 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,” Caban-Martinez says. “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.”
Photo courtesy of Miami-Dade Fire Rescue
It’s our job to make sure they know how to protect themselves from hazards and reduce their risks.
University Provides Multifaceted Support for Surfside
The University of Miami has provided an extensive array of services, resources, and academic expertise to support the Surfside recovery operation, the community, and aggrieved families.
Obed Frometa, a lieutenant with Miami-Dade Fire Rescue Task Force 1 who gathers and packages vital debris data, was among the first responders on the scene the morning of the disaster. By midday, he would be joined by Howard Lieberman, an assistant professor of surgery in the Division of Trauma and Surgical Critical Care at the Miller School of Medicine, who was deployed to the site as the medical manager of Miami-Dade Fire Rescue’s Urban Search and Rescue Team/Florida Task Force 1. In his role, Lieberman served to treat the injured and to oversee the medical well-being of team members who navigated the precarious piles of rubble and debris in search of survivors.
Another University physician, Brandon Parker, an assistant professor of surgery in the Division of Trauma and Surgical Critical Care, worked at the site as medical team manager of the City of Miami’s South Florida Urban Search and Rescue Team/Florida Task Force 2.
Pediatric critical care physician G. Patricia Cantwell joined Parker in Surfside, contributing what he described as “tremendous experience and insight” to the effort. A longtime veteran of Task Force 2, Cantwell has been deployed to disaster areas both at home and abroad, including Ground Zero in Lower Manhattan after the 9/11 terrorist attacks and in Port-au-Prince, Haiti, after the devastating 2010 earthquake.
On the medical campus, Vincent J. Torres, director of emergency management for the University of Miami Health System, and his Hospital Incident Command Team sprang into action as soon as they got word of the disaster, ordering additional liters of blood and ensuring that adequate medicines were in place in UHealth Tower’s emergency department. Elyzabeth Estrada, manager of emergency preparedness for UHealth, volunteered at the site of the collapse, supporting Miami-Dade County’s Office of Emergency Management.
Using high-tech sensors, Naresh Kumar, an associate professor of environmental health in the Department of Public Health Sciences, assisted first responders in monitoring levels of particulate matter—a mixture of solid particles and liquid droplets—produced by the collapsed building.
The Gordon Center for Simulation and Innovation in Medical Education has taught advanced practice interventions to firefighters and paramedics in the field for decades. Frometa, Lieberman, and other members of Miami-Dade Fire Rescue’s Florida Task Force 1 credited that extensive training with preparing them to manage the trauma and devastation in Surfside.
More than 18,000 first responders and front-line workers from across Florida train at the center each year. Countless nursing and medical students, physicians, physician assistants, nurses, paramedics, firefighters, and instructors worldwide have all received their essential disaster training at the center during its 40-year history.
University demographer Ira Sheskin, who has been documenting the changes in South Florida Jewish communities for four decades, was much in demand in the days and weeks following the tragedy.
As one of the nation’s preeminent scholars of U.S. Jewish life and migration, Sheskin was deluged with phone calls and emails from reporters around the country and the world seeking his insights to the response of the close-knit Jewish community of Surfside.
In the wake of the collapse of Champlain Towers South, the Florida Bar set up task forces to explore how to promote more responsible condo management and safety.
Bill Sklar, B.B.A. ’77, J.D. ’80, a long-standing adjunct professor at the School of Law who has taught condo law for several decades, was named chair of the Condominium Law and Policy Life Safety Task Force of the Bar’s Real Property, Probate, and Trust Law Section.
“Our mission is to review all aspects of Florida Condominium Law to determine if any changes are necessary that could prevent this terrible tragedy from recurring,” Sklar explains.
He says the group is committed to critical reforms regarding inspection and certifications.
Members of the ’Canes football team and staff members were among many University volunteers who supported the recovery operation by providing food and water for first responders.
The players’ efforts were coordinated through Second Spoon, a student-athlete nonprofit organization that delivers meals to hungry families in Miami and other cities.
—Robert C. Jones Jr. and Michael R. Malone
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The Hurricanes football team and staff members were among many University volunteers who supported the recovery operation by providing food and water for first responders.
Photo courtesy of Jorge Baez
Naresh Kumar, professor of environmental health in the Department of Public Health Sciences, facilitated the airmonitoring efforts and employed multiple instruments and realtime pollutant sensors to monitor particles and gases circulating.
Photo courtesy of Miami-Dade Fire Rescue
Brandon Parker, a University physician, also worked at the site as a medical team manager.
