Fire departments are increasingly switching to gear that doesn’t contain potentially cancer-causing chemicals.

The department in East Providence, Rhode Island, is the first in the country to replace all its gear with coats and pants that don’t contain PFAS, or perfluoroalkyl and polyfluoroalkyl substances.

The man-made substances are known as "forever chemicals" because their strong bonds resist breaking down naturally, persisting for hundreds or even thousands of years in the environment and in people's bodies.

The PFAS in the multi-layered coats and pants used by firefighters – primarily meant to repel water and contaminants like oil and prevent moisture-related burns – has been a growing concern among firefighters for several years.

Cancer has replaced heart disease as the biggest cause of line-of-duty deaths, according to the International Association of Fire Fighters, a union that represents firefighters and EMS workers.

Firefighters are at higher risk than the general population of getting skin, kidney and other types of cancer, according to a study released in July led by the American Cancer Society.

Firefighters are exposed to smoke from faster and hotter blazes in buildings and wildfires, many which contain toxic chemicals like arsenic and asbestos.

In addition to the PFAS in their gear, the IAFF is also concerned about firefighting foam that contains the chemical and is being phased out in many places.

It can be difficult to determine the cause of a firefighter's cancer since the disease can take years to develop and genetics, diet and other lifestyle factors can play a role, experts say.

Where a firefighter works – cities, suburbs or rural areas – also can impact the level of exposure to toxins.

Still, health concerns among firefighters have sparked a flurry of lawsuits against makers of gear and PFAS chemicals.

Six states, including Massachusetts and Rhode Island, have passed laws banning PFAS in gear and three others introduced bills calling for bans this year, according to the IAFF.

Firefighters have also targeted the agency that sets voluntary standards for firefighting gear and other safety requirements.

In a 2023 lawsuit, the union accused the National Fire Protection Association, or NFPA, of setting standards that can only be met with PFAS-treated material and working with several gear makers to maintain that requirement – something the association denied.

Last year, the agency announced new standards restricting use of 24 classes of chemicals including PFAS in gear – though it is considering delaying the law until March to give companies more time to comply.

Amid the state bans and legal fights, some of the largest gear makers are shifting away from PFAS.

Smaller companies have also emerged marketing what they claim is PFAS-free gear.

Hydrocarbon wax or silicone-based finish often replaces PFAS in the outer shell and removes it from the middle, moisture barrier.

The changing gear landscape is giving fire departments an opportunity to make the switch to safer alternatives.

Vancouver, Canada, purchased PFAS-free gear last year while Manchester, New Hampshire, bought new gear in March.

Gilroy, California, and Belmont, Massachusetts, are in the process of making the switch, the IAFF said.

But the transition to PFAS-free turnout gear hasn't been smooth nationwide.

The Massachusetts town of Quincy and city of San Francisco discovered their "PFAS-free" gear still contained the chemicals despite manufacturer claims.

Researchers at Duke University and North Carolina State argue concerns over the new gear suggest the transition away from PFAS has been rushed – potentially exposing firefighters to new chemicals and giving them gear that hasn't been proven safe.

In East Providence, testing showed the fire department's first attempt to buy PFAS-free gear contained flame retardants that pose increased cancer risk and didn't adequately protect from heat.

A new supplier provided PFAS-free materials that offered the heat protection.

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AP Video shot by Rodrique Ngowi and Allen Breed.