Dr. Alberto Caban-Martinez on Firefighter Cancer Risks From EV Fires

Author(s): Scott Douglas Jacobsen

Publication (Outlet/Website): The Good Men Project

Publication Date (yyyy/mm/dd): 2025/04/26

Dr. Alberto Caban-Martinez, Deputy Director of Sylvester’s Firefighter Cancer Initiative, discusses the unique hazards of electric vehicle (EV) fires. Unlike conventional fires, EV fires release toxic metals from battery combustion, posing long-term health risks to firefighters. His research examines exposure levels through environmental and biological sampling, including toenail analysis. He emphasizes the need for improved decontamination protocols, PPE, and long-term tracking of occupational cancer risks. Future studies will leverage AI for predictive modeling to assess cumulative exposure risks. With increasing EV adoption, understanding these hazards is crucial for firefighter safety and public health policies.

Scott Douglas Jacobsen: Today, we’re here with Dr. Alberto Caban-Martinez. He is the Deputy Director of Sylvester’s Firefighter Cancer Initiative at the Sylvester Comprehensive Cancer Center. He holds a Ph.D., D.O., M.P.H., C.H.P., F.C.R., and F.A.C.E., specializing in occupational and environmental health, focusing on firefighter cancer research. His work aims to assess and mitigate cancer risks associated with occupational exposures, particularly in high-risk professions like firefighting. Thank you for joining me. I appreciate it.

Dr. Alberto Caban-Martinez: Yes, no problem.

Jacobsen: What unique chemical hazards are present in electric vehicle fires compared to conventional gas vehicle fires? This topic has only come up in one other interview, and that discussion was highly critical of a prominent EV figure, focusing on how hot these vehicles can get. However, this conversation is different—it’s about the chemical hazards that arise from those fires.

Martinez: Yes, that is the focus of the research we’re conducting at Sylvester—to understand how electric vehicle fires differ from traditional combustion engine fires. Our primary interest is metals, as they are present in all vehicles, whether they have a combustion engine or an electric powertrain. The key questions are: Are there different types of metals? Do they release in different quantities when a battery fire occurs?

From our firefighter colleagues, we’ve learned that EV battery fires can take a long time to suppress once ignited. So, are the smoke plume and the effluent from an electric vehicle fire different? That’s what we’re investigating—analyzing what firefighters are exposed to and the effects on soil, water, and the broader environment in the areas where these fires occur.

Jacobsen: Something I recently learned—relevant here, trust me—is that Coolio, the rapper behind Gangsta’s Paradise, trained as a firefighter in his youth. Before his music career, he worked trained as a firefighter in San Jose, California. He passed away in 2022 from an accidental fentanyl overdose. He also had a history of asthma.

Martinez: I had no idea.

Jacobsen: Yes. The shift over time has been interesting. It used to be that gangsters pretended to be rappers. Now, it’s the other way around—rappers pretending to be gangsters.

He passed away in 2022. He trained as a firefighter. I, however, am not a firefighter. I have never taken part in firefighting outside of a live simulation. That said, I would assume that firefighters experience significantly more exposure to fires than I do.

With that increased exposure, are firefighters at greater risk for cancer due to prolonged exposure to effluents and fumes from electric vehicle fires?

Martinez: You bring up an important point for your readers: The fire service is comprised largely of volunteer firefighters. Many think firefighters are full-time first responders working in major metropolitan areas. However, about 65 percent of firefighters are volunteers in the United States.

These volunteers have primary jobs outside of firefighting. Some might be musicians, some work in trade professions, and others have entirely different careers. This dynamic makes studying firefighter cancer risk particularly interesting from a research perspective.

Examine and determine what people are exposed to in their primary and secondary jobs. Even in rural settings, electric vehicles are present, and firefighters are exposed to them.

What’s interesting, Scott is that there are many different types of firefighters. In the press, we often see wildland firefighters on TV, especially when wildfires rage across the West Coast of the United States. That situation isn’t much different from an entire community being exposed to a fire because the air pollution from large-scale brush fires affects the general population’s air quality.

In the firefighting world, though, firefighters are on the front lines, getting a first-row seat to those fires and experiencing intense exposure. The personal protective equipment (PPE) used by firefighters varies. Wildland firefighters, for instance, often use a gaiter—a cloth or sock-like covering over their face—rather than an air tank. This is because they work in the field for hours or even days and can’t refill an air tank every 30 minutes.

One positive outcome of the COVID-19 pandemic is that the general public is now more familiar with PPE. However, it’s important to note that the broader community is also exposed to these fire-related contaminants.

Regarding electric vehicle fires, we recently conducted a case study in July here at Sylvester that provided insights into the specific hazards associated with these fires. This study focused on a single electric vehicle fire involving a Nissan LEAF. We examined the presence of metals before and after the fire in different environmental samples—water, soil, ambient air—and the biological samples of the firefighters involved.

We are learning that the metals found in EV batteries, as well as those from other burning materials inside the vehicle—such as electronics, tire rims, and structural components—are released into the environment. The challenge with EV battery fires is that they involve thousands of small cells, akin to 8,000 AA batteries igniting in a chain reaction. This domino effect leads to prolonged burning, potentially increasing the concentration and types of metals released.

We know that some metals are essential for human health—calcium is critical for bones and nails, while zinc plays a key role in metabolism. However, other metals are harmful and can be carcinogenic. The International Agency for Research on Cancer (IARC) identifies certain metals as hazardous when exposure exceeds specific concentrations.

We aim to support first responders by understanding what they are exposed to. This research helps determine whether their current PPE is adequate or needs to be modified for EV fire responses, considering the potentially higher concentrations of toxic metals and other hazardous substances.

Jacobsen: Do you notice a difference between short-term acute exposure and long-term cumulative exposure?

Martinez: That’s the million-dollar question right now, right? Research is just beginning on the health effects and environmental impacts of these hazards, so the long-term effects are still uncertain. At Sylvester, one innovative way we track long-term heavy metal exposure is by collecting firefighters’ toenail clippings. I know it sounds gross—that’s why we have graduate students helping with these research projects. But if you think about the nails on our fingers and toes, they resemble the rings on a tree. When you cut a tree stump, you can see rings that indicate the tree’s age and environmental conditions. The same applies to fingernails and toenails—when they form at the base, whatever is circulating in the blood then gets incorporated into the nail. As the nail grows to the tip, it captures approximately six to nine months of exposure history.

One of our ongoing studies involves systematically collecting toenails from firefighters responding to electric vehicle fires, hazardous material incidents, and explosions. This allows us to analyze how heavy metals accumulate and change in the human body over time. The nails act as a “frozen-in-time” biological matrix, helping us assess long-term exposure. However, scientific research takes time, and that’s a challenge when working with first responders who want immediate results. The reality is that science moves much slower than operational demands. But in the future, studies like this will help answer your key question: Are there significant differences between acute, short-term exposure and long-term cumulative exposure to the metals and toxins released in EV fires?

Jacobsen: Based on early indications, what safety protocols and protective equipment can reduce firefighters’ exposure to carcinogens known to be released from EV fires?

Martinez: Yes, we know that decontamination procedures are highly effective. In fact, our colleagues at NIOSH have shown that using basic soap and water—despite what commercial cleaning product ads may suggest—is one of the most effective ways to remove a variety of toxins encountered during fire suppression. The key is to start decontamination immediately at the fire scene, right after the fire is suppressed. This helps prevent the transfer of toxic residues from the fire site into fire trucks and back to the fire station, where secondary exposure could occur. It’s similar to how a surgeon wouldn’t leave the operating room covered in blood—you don’t want to bring contaminants from the fire scene into clean spaces. Implementing preliminary decontamination procedures at the fire site is critical.

Another important safety measure is the proper use of personal protective equipment (PPE), even for those who are not directly entering a fire. Firefighters establish hazmat zones, which are colour-coded to indicate levels of risk. The red zone is the immediate area where the fire is burning. A certain distance away is the yellow zone, where fire service leaders typically stand to evaluate fire suppression efforts. Beyond that is the green zone, where community observers, including people like you and me, might be standing. Our research has shown that toxic particles travel beyond the red zone, reaching the yellow and green zones.

A common misconception is that open air provides adequate protection from harmful substances, but low-dose particle exposure still occurs. This is similar to what happens in wildland firefighting—when large areas of land burn, people in surrounding areas still inhale harmful particulates. This means that firefighters who are not directly inside a burning structure but positioned in the yellow zone should still be equipped with PPE to minimize exposure.

Jacobsen: Do you think that with wider EV adoption, this research will become increasingly relevant?

Martinez: I do. The reason is that renewable energy sources and rechargeable batteries are now integrated into many aspects of our daily lives. Think about where we use them—scooters, mopeds, micro-mobility devices, and cell phones. We hear warnings about carrying lithium-ion batteries every time we board a plane. As these batteries become more prevalent, so does the need to study their risks.

Urban planning also plays a role. Many buildings now have parking garages with EV charging stations underneath residential spaces. If a fire occurs in an underground parking garage, the resulting smoke plume can become trapped in that confined space, making it even more hazardous. This means we must be thoughtful in designing urban environments and public spaces to ensure first responders have proper access to mitigate fires involving high-energy rechargeable sources.

There is also a significant public education component to this issue, Scott. People must know how to use the correct chargers for their electronic devices. I don’t know about you, but I often see people buying cheap $2 chargers at gas stations because they lost their original ones. These low-quality chargers may not be properly manufactured, and when used, they can cause overheating and even battery fires. First responders are now emphasizing public awareness campaigns about proper charging practices, avoiding overcharging devices, and recognizing potential risks associated with battery misuse.

This is why our research at Sylvester is critical. We are working to understand the environmental and health hazards associated with exposure to high concentrations of metals and other toxins released during EV fires, particularly regarding long-term cancer risks for firefighters.

Jacobsen: Are there any legislative or policy initiatives to address the health risks associated with EV fires for first responders?

Martinez: Yes, thankfully, here in Florida, we have strong legislative support for firefighter cancer research. Our state legislature has provided funding to study cancer risks within the fire service. What makes me especially proud is that our research follows a community-based participatory approach—meaning that firefighters themselves nominate the research topics that are most important to them from a practical, real-world perspective.

For example, the study on EV fires occurred because firefighters asked us to investigate their exposure risks. About three months ago, they said, “We want to know what we’re exposed to during EV fires and how it impacts the environment, including the ground contamination.” Because of their input, we launched this research in response to their concerns.

This process is essential because, as you know, scientific research often takes a long time—usually three to five years of planning. However, by focusing on firefighter-nominated topics, we can apply research more nimbly and responsively. The findings from our studies don’t just stay in academic journals; they directly inform policies and best practices for fire departments and public health officials.

Let me give you an example that I’m particularly proud, I was telling you that someone could work for 30 years as a scientist and only contribute to a small piece of a much larger puzzle. But with the Firefighter Cancer Initiative (FCI), because we are a translational research group, we bridge the gap between basic science—what we learn in the lab—and real-world applications at fire stations. This approach has allowed us to influence policy at both small and large scales.

On the small “p” policy level, we’ve impacted Standard Operating Procedures (SOPs) within fire stations. Our research has demonstrated that decontamination (DECON) procedures are highly effective, especially when implemented early. We’ve shown that proper DECON significantly reduces firefighters’ exposure to carcinogens. This has led to SOP changes at fire departments to improve firefighter safety.

On the big “P” policy level, at the state level, we’ve influenced cancer presumption laws. We track which cancers firefighters develop through our Cancer Epidemiology (Cancer Epi) Program. While this may sound simple, it requires complex legislative coordination, statistical modelling, and extensive data matching to identify cancer cases among firefighters accurately. This research allows us to generate firefighter-specific cancer rates, meaning we can determine which types of cancer occur at higher rates among firefighters compared to the general population.

Our findings confirm that firefighters experience elevated risks for specific cancers, which means something in their work environment is increasing their risk. This has been a humbling yet impactful experience—being able to contribute to state-level policy changes that recognize and address occupational cancer risks for firefighters.

There is still much work to be done. Cancer isn’t caused solely by exposure to hazardous materials like metals; it results from workplace exposures, diet, nutrition, genetics, and lifestyle factors. That’s why we have multiple ongoing research projects at FCI to understand these different risk factors. Our goal is twofold: prevent cancer before it develops and reduce exposure to carcinogens in the hazardous environments firefighters encounter.

Jacobsen: Lithium-ion batteries, as far as I understand, are the most commonly used type of battery in electric vehicles. Given their widespread adoption, does this present a unique national test case for studying the health effects of a specific type of battery? Since most EV-related fires involve lithium-ion batteries, does this provide researchers with a broad dataset to analyze their impact on firefighter health?

Martinez: Yes. Let me start by saying that I am not a battery expert. I am trained as a physician and an epidemiologist, so we would need to consult some of my colleagues from the College of Engineering for a deeper understanding of battery composition. However, battery technology is constantly evolving. Even as you and I speak, new vehicles are rolling off assembly lines with battery compositions that differ from those used five years ago.

This presents a significant challenge for firefighters. They often ask us, “Is this exposure normal? Is this what we should expect at an EV fire?” I always explain that in medicine, we determine normal ranges—such as systolic and diastolic blood pressure—by measuring them in the general population. But what is “normal” exposure at an EV fire? That depends on many factors: What kind of car is burning? Is it a large SUV? Is it a hybrid? What type of battery does it have?

The global firefighting community is still working to characterize EV fires, analyzing the composition of these batteries and identifying the emissions they release during combustion. Right now, even the basics of EV fire suppression remain inconsistent. Some first responders here in Florida have told me they sometimes don’t even know where the battery is located in a burning vehicle because every manufacturer places it differently. When firefighters arrive at a fire scene, they first see a massive smoke plume. Before effectively suppressing the fire, they need to identify the vehicle type and the battery.

For example, in some city buses, the batteries are mounted on the roof, while in others, they are located under the chassis—the fire suppression strategy changes depending on battery placement. Firefighters are still working to refine best practices for EV fire response—understanding how to contain fires, protect human life, and minimize toxic exposure.

As scientists, we enter this space and characterize the carcinogens firefighters are exposed to. However, the challenge is that exposure levels vary widely, and we do not yet have clear reference points for what is considered “normal” exposure at an EV fire. That is why we are researching to establish these benchmarks.

At Sylvester, we use silicone-based wristbands—similar to the Lance Armstrong Livestrong bracelets—as an innovative tool for measuring environmental exposure. Traditionally, exposure monitoring involved using bulky, vacuum-powered air samplers attached to firefighters. These old-school methods are impractical in real-world firefighting conditions because they are heavy, noisy, and cumbersome. Instead, we’ve found that silicone wristbands can passively capture airborne toxins.

When firefighters wear these wristbands during a real-life fire response, the chemicals and carcinogens in their environment adhere to the silicone. Afterward, we analyze the wristbands to comprehensively overview the firefighter’s exposure—a “37,000-foot view” of what hazardous substances they encountered. Right now, we are in the phase of determining what firefighters are exposed to specifically in EV fires. The goal is to provide clear guidance on personal protective equipment (PPE) and long-term health risks, especially for firefighters who develop symptoms after suppressing an EV fire.

Jacobsen: Let’s imagine this is a paper presentation—where do you see the greatest need for future research?

Martinez: Oh, gosh. You hit the nail on the head—it’s all about long-term tracking. When you consider the career of a first responder, they may work for 30 years, responding to a wide variety of fires every week—a kitchen fire one day, a car fire the next, then a large residential or commercial fire. If you aggregate all those exposures over three decades, you begin to develop a risk profile for cancer and other occupational health concerns.

The long-term focus of our research needs to be on tracking these first responders throughout their careers. Our studies focus on a single fire event, collecting data from that scene. However, as technology advances, we will have greater opportunities to track exposures over time, allowing us to study cumulative exposure risks, which we are not yet fully capable of. We’re still piecing together insights from various individual case studies, but the future of firefighter health research must emphasize longitudinal exposure tracking.

Jacobsen: Could AI and big data sets from all these individual studies be used to develop something like a Firefighter Cancer Risk Index, mapping exposure patterns over time?

Martinez: You should be a scientist on our team! That is exactly where the field is heading. AI and predictive modelling have huge potential to create personalized risk profiles for firefighters. In my field, we use Job Exposure Matrices (JEMs)—which essentially map workers’ exposure histories to various hazards and predict associated risks.

AI can enhance our ability to model and forecast risks by analyzing large datasets from multiple fire events. This can help us predict which firefighters may be at higher risk for certain health conditions based on their cumulative exposure history. We are currently applying generative AI to risk-based modelling, and I believe that in the coming years, AI will play an even bigger role in assessing, mitigating, and responding to occupational cancer risks for first responders.

Jacobsen: Excellent. Alberto, thank you very much for your time today. I appreciate your expertise, and it was great to meet you.

Martinez: Same, Scott. Thank you for your work and for helping us share these findings. You can reach me if you ever need anything.

Jacobsen: Excellent. Thank you. Bye! Have a great day.

Martinez: Stay warm. Bye.

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