CFA Fixville – No one here gets out alive

Technological progress has merely provided us with more efficient means for going backwards

Aldous Huxley 1

imageThe Country Fire Authority (CFA) has legislative responsibility for handling fire and other related emergencies throughout regional Victoria in Australia. It employed a significant proportion of volunteers and regularly conducted firefighting and emergency response exercises at its spiritual home, the Fiskville training college near Ballan, approximately 80 kilometres northwest of Melbourne. The site provided residential accommodation for career firefighters and activities typically included classroom delivery of contemporary theory supplemented by rigorous practical exercises on a designated training pad to simulate an extensive range of emergency scenarios. The facility was also occasionally used by the Metropolitan Fire Brigade and selected corporate clients. 26

A former chief fire officer and instructor spent 25 years with the organisation and lived at the Fiskville accommodation quarters for several years during the late 1970s. The senior employee was eventually diagnosed with a rare autoimmune disease and battled multiple cancers for almost 15 years. Following extensive personal research serious concerns emerged regarding the use of contaminated recycled water, chemical exposure and the prevalence of cancer amongst numerous other firefighters and instructors who lived and worked for many years at the Fiskville complex. A meeting was arranged with a board member to discuss the abnormal corollary although it was suddenly cancelled for unexplained reasons. Meanwhile, the employee’s condition deteriorated rapidly, which required hospitalisation with specialised intensive health care. A casual and rather indifferent corporate response left the victim and immediate dependents somewhat disenchanted. There was no alternative but to seek assistance through various media outlets via an intense focus on their traumatic plight and the travesty of justice. 717

Extensive investigations via Sun Herald journalists revealed many further disturbing allegations, some of which dated back almost 30 years. A slops or muck truck was frequently used to supply a cocktail of flammable or combustible liquids to the facility, which were often donated from various petrochemical companies and fuel depots throughout Melbourne and regional Victoria. The toxic solvents were ignited and extinguished using perfluorinated chemical foams and contaminated recycled dam water during emergency scenarios at the firefighting training pad. Liquids were usually mixed and often handled, decanted and stored haphazardly in unlabelled corroded containers. Redundant drums frequently contained dregs or residues and were subsequently buried in the immediate environs. Many of the chemicals were linked to heart, kidney and liver damage and an extensive range of autoimmune and blood disorders. At least nine people died from cancer related illnesses, which were correlated to chemical exposure at the site and a further eight individuals experienced serious health problems. 1826

Despite a geotechnical investigation in 1988, which reviewed waste disposal protocols and identified environmental contamination and exposure to benzene and other aromatic carcinogens, Fiskville employees and local residents were never informed of the associated risks. Indeed, there was increasing substantive evidence that firefighters and instructors were exposed to a lethal cocktail of carcinogenic chemicals from the specific firefighting activities. This included incorrect use, handling and storage of dangerous goods at the Fiskville site. Political pressure was also escalating and the smoke alarms awoke Rip Van Winkle (aka the torpid state premier Toorak Ted Baillieu), from his slumbers. The laissez faire acolyte and free market fundamentalist promised a full investigation, which was corporate doublespeak for a superficial whitewash using taxpayers money. 2735

 

 

The decision was supported by the Country Fire Authority and its senior executives although the entire process degenerated into a sinister but somewhat familiar sanitised ritual that merely sacrificed truth and accountability to protect reputations. Its subsequent report attracted extensive criticism, especially from several Fiskville victims, the United Firefighters Union of Australia and some local residents. Serious concerns were raised regarding a perceived conflict of interest, which undermined any skerrick of integrity. The organisation’s chief executive officer and lead investigator were former colleagues and previously held senior roles within a principal state regulator, the Environment Protection Authority Victoria. Its subsequent investigation would inevitably assess their previous public service performance and the duo remained silent about the anomaly and failed to disclose any incongruity. Furthermore, an independent review regarding the decision to appoint Professor Rob Joy conducted by Pricewaterhouse Coopers inexplicably disregarded or evaded the enigma. 3646

The manicured terms of reference constrained the investigation and failed to examine any events or dangerous practices at the facility beyond 1999. This unilaterally prescribed limit circumvented a critical recruitment campaign, which conveniently excluded many conscripts that passed through the training college at the turn of the millennium. The investigation was restricted to arbitrarily and qualitatively defined target groups and was unable to establish any statistical significance between exposure to carcinogens and the abnormal cluster of cancer related illnesses. However, it did recommend additional epidemiological health studies, which were eventually undertaken by the Monash University Centre for Occupational and Environmental Health under its Department of Epidemiology and Preventive Medicine. The health study was designed to investigate overall cancer incidence and mortality rates amongst Fiskville firefighters, instructors and other defined target groups. Despite several limitations, the extensive research ultimately confirmed a statistically significant increased cancer rate amongst the high risk category, which encompassed firefighters and instructors working on the Fiskville training pad. 4755

Meanwhile, the initial whistleblower eventually succumbed to numerous cancers and many other victims and distraught dependents were left chasing smoke in their quest for compensation and justice. Most of the claimants were dehumanised and frequently encountered a tyranny of bureaucracy, which defused and diffused their anger and sorrow into a vacuous officialdom. The patronising disposition of unaccountable power was exacerbated by traditional and somewhat sinister but all too familiar delay, deny and die tactics……The time to hesitate is through no time to wallow in the mire, try now we can only lose and our love become a funeral pyre. 5661

Following a Victoria state election in November 2014 the Liberal National Party coalition government under Denis Napthine was defeated and the Australian Labor Party assumed office via the leadership of Daniel Andrews. The incumbent premier promptly announced a public inquiry into the operation and management of the CFA Fiskville training academy. The terms of reference were extended to cover operational activities beyond the new millennium, which triggered the resignation of its chief executive officer on the eve of the inquiry in February 2015. 6269

CFA Fiskville was the spiritual home for many rural Victoria firefighters and epidemiological evidence suggests that contamination from its operational activities contributed to a cluster of occupational cancers and other related illnesses. Moreover, health and safety concerns, especially regarding contaminated water and the handling and storage of dangerous goods, which included perfluorinated firefighting foams were abruptly disregarded or ignored. The egregious performance of senior executives and management left numerous firefighters and community members feeling angry, frustrated and betrayed with many abandoned families shrouded under a brume of despair and anxiety. 7076

 

 

This was exacerbated by obstructive and uncooperative document recovery processes during the public inquiry. It merely prolonged proceedings, consumed valuable resources and shredded any skerrick of organisational accountability. Meanwhile, the lingering panjandrums and deadwood sacrificed truth via an obedience to the orthodoxy to preserve power and protect reputations. Evidence throughout the public inquiry indicates it was inconceivable that senior management was unaware of the operational or material risks. The regular engagement of independent consultants to review site activities and document extensive reports confirms recognition of their occupational health, safety and environmental responsibilities although the organisation often failed to address many of the recommendations. Furthermore, a dictatorial organisational culture persistently discouraged any internal criticism or complaints. This invariably left many subordinates and trainees somewhat reluctant to report any concerns about environmental contamination or potential occupational health and safety risks in case it jeopardised professional career expectations and future job opportunities. 7782

During March 2015 extensive potable water quality testing identified significant widespread quantities of perfluorooctane sulfonate across the site. The pollution extended to previously uncontaminated locations, which included hydrants and auxiliary pipework surrounding the training pad. The surfactant is classified as a persistent organic pollutant and was used as an additive in several perfluorinated firefighting foams. There is conflicting information regarding its toxicity and inconclusive evidence to categorise the substance as a human carcinogen. However, amidst the public inquiry the CFA board members confirmed it could no longer guarantee the safety of people and the environment at the site and announced its permanent closure. The state government under Daniel Andrews endorsed and reinforced the decision and a media release was issued accordingly. 8389

 

 

During the public inquiry the role of WorkSafe Victoria came under intense scrutiny and the regulatory authority attracted extensive and often excoriating criticism. Over ten years its inspectors made 117 visits to the site but failed to address many significant operational risks, which included the handling and storage of dangerous goods and potable water quality. It even provided a letter of assurance confirming the safety of firefighting water at the site although it did not conduct any testing and its understanding of the water source was somewhat vague. Following the decision to close the facility for safety reasons WorkSafe Victoria merely acted as a nonchalant observer. Its egregious performance as a safety ombudsman provoked the state government to demand accountability, which resulted in the resignation of its chief executive officer and chairman. 9096

It is indisputable that many people were harmed following a persistent litany of unsafe conditions and practices across the Fiskville site and the victims have a right to meaningful justice. However, it is much more than financial compensation and justice delayed is merely justice denied. The existing avenues for compensation were a deplorable and somewhat dehumanising tyranny of bureaucracy, which prompted the state government to introduce presumptive legislation for its firefighters. 97102

Another disappointing feature throughout the public inquiry and recurring theme was the lassitudinous response Australia’s peak industry health and safety body over such a significant operational or material risk. Despite or maybe in spite of its grandiloquent vision and proclamation as a voice for the unique perspective of its profession, it failed somewhat predictably to afford official representation at the numerous public hearings or provide any written submissions. Meanwhile, it repeatedly promotes shallow national and regional safety conferences and other regular events that merely regurgitate Heinrich’s junk science and Skinner’s black box psychology amongst its cohorts of solipsistic, acquiescent and pseudo-academic recreants….You know that it would be untrue, no time to wallow in the mire. Try now we can only lose; Come on baby light my fire. 103110

Arbeit macht frei

Arbeit macht frei is a phrase meaning work sets you free. It was used throughout Germany in the 1930s to counteract the scourge of unemployment and eventually appeared above the entrance gates of Auschwitz, Mauthausen-Gusen and many other Nazi concentration camps during the second world war. The slogan originated from a novel by Lorenz Diefenbach and extolled the virtue of labour for many disparate vagabonds on the road to Damascus. It promised liberation but the eventual outcome with its devastating humanitarian consequences was not the kind anyone wanted or envisaged. 111115

Sinister strategic planning underpinned by an ideology of hostility and hatred became a bureaucracy of death. The mechanisation of slaughter began with exclusion, dehumanisation, internment and atrocity, which is a biproduct of apathy and the bastard child of a complacent public. An insidious impiety was embedded into language and quotidian transactions until it induced a collective paralysis and the inertia became normalcy. The dehumanisation of others via prejudice, racism, narcissism, solipsism and intimidation sets us on the slippery slope to barbarism. This drift into failure or navigating the treacherous safety space between the production and protection dichotomy is a deceptively narrow trajectory, especially amidst a vulgar climate of casino capitalism. 116120

Many decades have passed since the killing fields of Hawks Nest, Aberfan, Farmington or Moura 4 and some sociologists familiar with Godwin’s Law may repudiate any comparison with death camp atrocities. However, despite prescriptive or performance based legislation and a trojan horse of industrial manslaughter offences, the industrial carnage continues relentlessly. The doublespeak and insincerity is evident throughout many Australian factories, construction projects and mine sites via their entrance gates, which are frequently festooned with similar beguiling propaganda and turgid sludge such as Zero Harm or Safety is our No. 1 priority. It is usually supported by indoctrinating inductions and misinformation using manipulated reactive metrics such as lost time or total recordable injury frequency rates, which perverts the significance of events and insinuates false intentions….Oh what a tangled web we weave, when first we practise to deceive. 121129

In Australia, its self-proclaimed peak industrial safety body has recently responded by changing its brand name to the Australian Institute of Health and Safety. However, without a skerrick of vision the organisation is morally bereft and philosophically rudderless. It is merely polishing a turd or putting lipstick on a pig in a belated, desperate and otiose attempt to repair a tattered image and restore its diaphanous integrity. Moreover, a maxim from Edmund Burke resonates………….The only thing necessary for the triumph of evil is for good men to do nothing. 130131

Speak up

 

First they came for the socialists, and I did not speak out –

Because I was not a socialist.

 

Then they came for the trade unionists, and I did not speak out –

Because I was not a trade unionist.

 

Then they came for the Jews, and I did not speak out –

Because I was not a Jew.

 

Then they came for me and there was no one left to speak for me.

Martin Niemöller (1892 – 1984) 132

 

 

References

1. Huxley A. Technological progress has merely provided us with more efficient means for going backwards [Internet]. BrainyQuote. [cited 8 July 2019]. Available from: Technological progress has merely provided us with more efficient means for going backwards. Read more at: https://www.brainyquote.com/quotes/aldous_huxley_101185

2. Hopkins J, Sugarman D. No one here gets out alive [Internet]. Amazon. 1995 [cited 8 July 2019]. Available from: https://www.amazon.com/One-Here-Gets-Out-Alive/dp/0446602280

  1. CFA – About us [Internet]. Country Fire Authority (CFA). [cited 8 July 2019]. Available from: https://www.cfa.vic.gov.au/about
  2. CFA Training College, Fiskville [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/CFA_Training_College,_Fiskville

  3. Ballan, Victoria [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/Ballan,_Victoria

6. About the MFB [Internet]. Metropolitan Fire Brigade (MFB). [cited 8 July 2019]. Available from: http://www.mfb.vic.gov.au/About-Us/About-the-MFB.html

7. Fiskville report: Firefighters deserve ‘justice’ over toxic CFA training facility, report finds [Internet]. ABC News. 2016 [cited 8 July 2019]. Available from: https://www.abc.net.au/news/2016-05-24/report-into-cfa-fiskville-training-facility-tabled-in-parliament/7440840

  1. Hobday L. CFA investigates Fiskville cancer claims [Internet]. ABC News. 2011 [cited 8 July 2019]. Available from: https://www.abc.net.au/news/2011-12-06/cfa-investigates-fiskville-cancer-claims/3714708?site=melbourne
  • Truth comes at great cost for Country Fire Authority’s Fiskville [Internet]. Sun Herald. 2011 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/news/opinion/truth-comes-at-great-cost-for-country-fire-authoritys-fiskville/news-story/b4b0bbbc3b2ddacf0acf26c7d33f0f5d

  • Drill S. Documents show CFA was told dam water at Fiskville was polluted but did not fix problem [Internet]. Herald Sun. 2013 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/news/victoria/documents-show-cfa-was-told-dam-water-at-fiskville-was-polluted-but-did-not-fix-problem/news-story/d53c72437dc72d7133628e4ba2067aa9

  • CFA knew of contamination; made it worse [Internet]. SBS News. 2015 [cited 8 July 2019]. Available from: https://www.sbs.com.au/news/cfa-knew-of-contamination-made-it-worse

  • Fiskville fears over cancer cluster [Internet]. United Firefighters Union of Australia – Aviation Branch. [cited 8 July 2019]. Available from: http://ufuav.asn.au/fiskville-fears-cancer-cluster/

  • Hodge K. I was healthy before Fiskville [Internet]. Herald Sun. 2011 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/news/opinion/i-was-healthy-before-fiskville/news-story/25a9e4270f67c4e9ecd6b8ad59db81a2

  • Inquiry into the CFA Training College at Fiskville Final Report – May 2016 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf

  • Fiery questions need answers [Internet]. Herald Sun. 2011 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/news/opinion/fiery-questions-need-answers/news-story/785a54c47ed2356b814e64aed9d32872

  • Drill S, Lamperd R. CFA ignored Fiskville warnings for more than three decades, inquiry finds [Internet]. Perth Now. 2012 [cited 8 July 2019]. Available from: https://www.perthnow.com.au/news/nsw/cfa-ignored-fiskville-warnings-for-more-than-three-decades-inquiry-finds-ng-6cf3adad93e847eff3845380085a1bd7

  • 17. JUSTICE FOR FISKVILLE AFFECTED PERSONS: APPROACHES AND OPTIONS [Internet]. Parliament of Victoria. 2015 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/other_docs/Clayton_Full_Discussion_Paper.pdf

    18. Lamperd R. CFA buries cancer time bomb [Internet]. Herald Sun. 2011 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/ipad/cfa-buries-cancer-time-bomb/news-story/7f0b8484cce09d9f52dddffdf9d36134

    1. CFA knew Fiskville was contaminated [Internet]. SBS news. 2016 [cited 8 July 2019]. Available from: https://www.sbs.com.au/news/cfa-knew-fiskville-was-contaminated
  • Hodge K. I was healthy before Fiskville [Internet]. Herald Sun. 2011 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/news/opinion/i-was-healthy-before-fiskville/news-story/25a9e4270f67c4e9ecd6b8ad59db81a2

  • Inquiry into the CFA Training College at Fiskville Final Report – May 2016; pp. 279-282 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf

  • Per- and poly-fluorinated substances (PFAS) [Internet]. Australian Government – Department of Health National Industrial Chemicals Notification and Assessment Scheme. 2019 [cited 8 July 2019]. Available from: https://www.nicnas.gov.au/chemical-information/Topics-of-interest2/subjects/Per-and-poly-fluorinated-alkyl-substances

  • ALS CFA Fiskville Training College Water Reuse Investigation Report – February 2012 [Internet]. Parliament of Victoria. 2012 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/other_docs/01_-ALS_Water_Reuse_Investigation_Report-_February_2012.pdf

  • Inquiry into the CFA Training College at Fiskville Final Report – May 2016; pp. 79-116 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf

  • Inquiry into the CFA Training College at Fiskville Interim Report; pp. 23-38 [Internet]. Parliament of Victoria. 2015 [cited 8 July 2019]. Available from: https://s3.ap-southeast-2.amazonaws.com/hdp.au.prod.app.vic-engage.files/2414/8609/8798/Attachment_-UFU_Submission_to_FSR-_ANNEXURE_60.PDF

  • 26. Monash University Centre for Occupational and Environmental Health School of Public Health & Preventive Medicine Faculty of Medicine, Nursing and Health Sciences Final Report Australian Firefighters’ Health Study [Internet]. Parliament of Victoria. 2014 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/other_docs/10_-_Monash_Australian_Firefighters_health_study_2014.pdf

    27. James A. Report # 72074 Fiskville Training Centre Geotechnical Investigation [Internet]. Parliament of Victoria. 1988 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/other_docs/09_-_A.S._James_report_1988.pdf

    1. Nolan K, Iaria M. CFA failed to warn of dangers: ex-officer [Internet]. The Sydney Morning Herald. 2011 [cited 8 July 2019]. Available from: https://www.smh.com.au/national/cfa-failed-to-warn-of-dangers-ex-officer-20111206-1ofui.html
  • Hobday L. Fiskville inquiry: Former fire chief denies railroading family into accepting compensation offer [Internet]. ABC News. 2016 [cited 8 July 2019]. Available from: https://www.abc.net.au/news/2016-01-28/fiskville-former-fire-chief-denies-railroading-family-into-offer/7122580

  • Lamperd R. Fiskville scandal boss Justin Justin moves on [Internet]. Herald Sun. 2014 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/news/victoria/fiskville-scandal-boss-justin-justin-moves-on/news-story/9748fac870aac7b93c6662b1ff696ada

  • Dangerous goods [Internet]. WorkSafe Victoria. [cited 8 July 2019]. Available from: https://www.worksafe.vic.gov.au/dangerous-goods

  • Rip Van Winkle [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/Rip_Van_Winkle

  • Ted Baillieu [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/Ted_Baillieu

  • Jouet M. Religious and Free-Market Fundamentalism Have More in Common Than Their Fans in the Tea Party [Internet]. Truthout. 2012 [cited 8 July 2019]. Available from: https://truthout.org/articles/religious-and-free-market-fundamentalism-have-more-in-common-than-the-tea-party/

  • 35. Lamperd R, Drill S. Baillieu to call inquiry into suspected cancer cluster at Fiskville [Internet]. Herald Sun. 2011 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/news/country-fire-authority-in-cancer-timebomb-claim-at-fiskville/news-story/c75ad47fb9f1e35cb412920d86267125

    36. Response to the Professor Joy Report of the Independent Investigation into the CFA Facility at Fiskville [Internet]. Country Fire Authority (CFA). 2012 [cited 8 July 2019]. Available from: https://www.cfa.vic.gov.au/documents/20143/3057823/CFA-response-to-Professor-Joy-report.pdf/0d59480c-dd96-3748-460e-ba7ce86498aa

    1. Joy R. Fiskville Understanding the Past to Inform the Future Report of the Independent Fiskville Investigation June 2012 [Internet]. Country Fire Authority. 2012 [cited 8 July 2019]. Available from: https://www.cfa.vic.gov.au/documents/20143/3057823/The+Joy+Report.pdf/5d72324e-b638-7ddf-7ec9-9e86d2cc8eed
  • Claims of cancer cluster from chemicals burned at Fiskville CFA training centre [Internet]. ABC Radio Melbourne. 2011 [cited 8 July 2019]. Available from: http://www.abc.net.au/local/stories/2011/12/08/3386487.htm?site=melbourne

  • Fiskville fears over cancer cluster [Internet]. United Firefighters Union of Australia – Aviation Branch. [cited 8 July 2019]. Available from: http://ufuav.asn.au/fiskville-fears-cancer-cluster/

  • Savage A. Fiskville sheep farmers tell inquiry toxic firefighting chemical ‘in soil, grass, sheep … and our children’ [Internet]. ABC News. 2015 [cited 8 July 2019]. Available from: https://www.abc.net.au/news/2015-05-18/fiskville-sheep-farmers-tell-inquiry-of-contaminated-land/6477898

  • Inquiry into the CFA Training College at Fiskville Final Report – May 2016; pp. 59-62 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf

  • Country Fire Authority CEO Mick Bourke responds to the Fiskville cancer report [Internet]. ABC Radio Melbourne. 2012 [cited 8 July 2019]. Available from: https://www.abc.net.au/local/audio/2012/07/12/3544159.htm

  • TRANSCRIPT ENVIRONMENT, NATURAL RESOURCES AND REGIONAL DEVELOPMENT COMMITTEE Inquiry into the CFA training college at Fiskville Melbourne — 21 December 2015 [Internet]. Parliament of Victoria. 2015 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/transcripts/Mick_Bourke.pdf

  • Environment Protection Authority Victoria – About us [Internet]. Environment Protection Authority Victoria. [cited 8 July 2019]. Available from: https://www.epa.vic.gov.au/about-us

  • Fiskville CFA [Internet]. Liberal Victoria – News Media Releases. 2015 [cited 8 July 2019]. Available from: https://vic.liberal.org.au/news/2015-03-03/fiskville-cfa

  • 46. PwC Australia – About us [Internet]. Pricewaterhouse Coopers (PwC). [cited 8 July 2019]. Available from: https://www.pwc.com.au/about-us.html

    47. Joy R. Understanding the Past to Inform the Future Report of the Independent Fiskville Investigation June 2012; p. 4 [Internet]. Country Fire Authority. 2012 [cited 8 July 2019]. Available from: https://www.cfa.vic.gov.au/documents/20143/3057823/The+Joy+Report.pdf/5d72324e-b638-7ddf-7ec9-9e86d2cc8eed

    1. Inquiry into the CFA Training College at Fiskville Final Report; p. 85 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf
  • Inquiry into the CFA Training College at Fiskville Final Report – May 2016; p. 60 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf

  • What is a carcinogen? [Internet]. Cancer Council. [cited 8 July 2019]. Available from: https://cancer.org.au/about-cancer/causes-of-cancer/environmental-causes/proven-risk.html?_ga=2.182809891.425013161.1562422529-1599001349.1562422529#jump_9

  • Occupational and Environmental Health [Internet]. Monash University – School of Public Health and Preventive Medicine. [cited 8 July 2019]. Available from: https://www.monash.edu/medicine/sphpm/coeh

  • School of Public Health and Preventive Medicine Annual Report 2015 [Internet]. Monash University. 2015 [cited 8 July 2019]. Available from: http://www.med.monash.edu.au/assets/docs/sphpm/sphpm-annual-report-2015.pdf

  • Fiskville Firefighters’ Health Study [Internet]. Monash Centre for Occupational and Environmental Health. 2014 [cited 8 July 2019]. Available from: https://www.monash.edu/__data/assets/pdf_file/0004/982219/fiskvillereport1.pdf

  • All cancers in Australia [Internet]. Australian Government – Cancer Australia. [cited 8 July 2019]. Available from: https://canceraustralia.gov.au/affected-cancer/what-cancer/cancer-australia-statistics

  • 55. Statistical significance [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/Statistical_significance

    56. CFA Fiskville whistleblower Brian Potter dies [Internet]. ABC News. 2014 [cited 8 July 2019]. Available from: https://www.abc.net.au/news/2014-02-13/cfa-fiskville-whistleblower-brian-potter-dies/5256928

    1. Lamperd R, Hadfield S. Ex-CFA chief launches legal fight over Fiskville [Internet]. Sun Herald. 2013 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/news/victoria/ex-cfa-chief-launches-legal-fight-over-fiskville/news-story/7fcac56b8881a63ef1943fb0d6e96d9e
  • The Tricks of the Trade: [Internet]. American Association for Justice. [cited 8 July 2019]. Available from: https://www.justice.org/sites/default/files/file-uploads/InsuranceTactics.pdf

  • Jones J. ‘The patronising disposition of unaccountable power’ A report to ensure the pain and suffering of the Hillsborough families is not repeated [Internet]. Assets Publishing Service UK. 2017 [cited 8 July 2019]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/656130/6_3860_HO_Hillsborough_Report_2017_FINAL_updated.pdf

  • Stiles J. The ‘deliberate tactic’ insurers use to deny claims [Internet]. The New Daily. 2017 [cited 8 July 2019]. Available from: https://thenewdaily.com.au/money/your-budget/2017/03/09/insurance-tactic/

  • 61. Light my Fire – The Doors [Internet]. Genius. [cited 8 July 2019]. Available from: https://genius.com/The-doors-light-my-fire-lyrics

    62. 2014 Victorian state election [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/2014_Victorian_state_election

    1. Victoria election 2014: Labor takes back government [Internet]. ABC News. 2014 [cited 8 July 2019]. Available from: https://www.abc.net.au/news/2014-11-29/labor-wins-victoria-election-2014-led-by-daniel-andrews/5928296
  • Denis Napthine [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/Denis_Napthine

  • Daniel Andrews [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/Daniel_Andrews

  • Fiskville inquiry call for submissions [Internet]. Parliament of Victoria. 2015 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/about/news/2427-fiskville-inquiry-call-for-submissions

  • CFA Training College, Fiskville [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/CFA_Training_College,_Fiskville

  • Inquiry into the CFA Training College at Fiskville Final Report – May 2016; p. xv [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/file_uploads/ENRRDC_Fiskville_Inquiry_Final_Report_myHbwdGN.pdf

  • 69. Willingham R. CFA chief executive Mick Bourke quits ahead of inquiry [Internet]. The Age. 2015 [cited 8 July 2019]. Available from: https://www.theage.com.au/national/victoria/cfa-chief-executive-mick-bourke-quits-ahead-of-inquiry-20150209-139ysx.html

    70. CFA Training College, Fiskville [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/CFA_Training_College,_Fiskville

    1. Fiskville Firefighters’ Health Study [Internet]. Monash University – Department of Epidemiology and Preventive Medicine Monash Centre for Occupational and Environmental Health. 2014 [cited 8 July 2019]. Available from: https://www.monash.edu/__data/assets/pdf_file/0004/982219/fiskvillereport1.pdf
  • Occupational exposures to carcinogens in Australia: Workers’ compensation claims paid in Australia 2000-2012 [Internet]. Cancer Council – Western Australia. 2015 [cited 8 July 2019]. Available from: https://www.cancer.org.au/content/pdf/News/MediaReleases/2015/web%20%20Occupational%20report.pdf

  • Lamperd R, Drill S. Documents show CFA was told dam water at Fiskville was polluted but did not fix problem [Internet]. Herald Sun. 2013 [cited 8 July 2019]. Available from: https://www.heraldsun.com.au/news/victoria/documents-show-cfa-was-told-dam-water-at-fiskville-was-polluted-but-did-not-fix-problem/news-story/d53c72437dc72d7133628e4ba2067aa9

  • Dangerous goods [Internet]. WorkSafe Victoria. [cited 8 July 2019]. Available from: https://www.worksafe.vic.gov.au/dangerous-goods

  • Cuthbertson D. Is Fiskville the tip of an iceberg? PFAS detected across Victoria [Internet]. The Age. 2018 [cited 8 July 2019]. Available from: https://www.theage.com.au/national/victoria/is-fiskville-the-tip-of-an-iceberg-pfas-detected-across-victoria-20180615-p4zlox.html

  • 76. Inquiry into the CFA Training College at Fiskville Final Report – May 2016; pp. 173-193 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf

    77. Inquiry into the CFA Training College at Fiskville Special report on production of documents November 2015 ENRRDC Report No. 2, 58th Parliament [Internet]. Parliament of Victoria. 2015 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/INTERIM_REPORT_-_2/ENRRDC_58-02_Report.pdf

    1. George Orwell Identifies the Main Enemy of the Free Press: It’s the “Intellectual Cowardice” of the Press Itself [Internet]. Open Culture. 2018 [cited 8 July 2019]. Available from: http://www.openculture.com/2018/07/george-orwell-identifies-main-enemy-free-press-intellectual-cowardice-press.html
  • Inquiry into the CFA Training College at Fiskville Final Report – May 2016 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf

  • Operational risk [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/Operational_risk

  • Inquiry into the CFA Training College at Fiskville Government Response [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/393-enrrdc/inquiry-into-the-cfa-training-college-at-fiskville

  • 82. Corden B. Organisational Culture [Internet]. SafetyRisk. 2018 [cited 8 July 2019]. Available from: https://safetyrisk.net/organisational-culture/

    83. Potable Water Assessment Victorian Emergency Management Training Centre – Fiskville [Internet]. Parliament of Victoria. 2015 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/other_docs/02_-Senversa_Potable_Water_Assesment_2015-_CFA_water_assessment_for_Fiskville_closure.pdf

    1. Technical Fact Sheet – Perfluorooctane Sulfonate (PFOS) and Perfluorooctanoic Acid (PFOA) [Internet]. US Environmental Protection Agency. 2017 [cited 8 July 2019]. Available from: https://www.epa.gov/sites/production/files/2017-12/documents/ffrrofactsheet_contaminants_pfos_pfoa_11-20-17_508_0.pdf
  • All POPs listed in the Stockholm Convention [Internet]. Stockholm Convention. [cited 8 July 2019]. Available from: http://chm.pops.int/TheConvention/ThePOPs/AllPOPs/tabid/2509/Default.aspx

  • Lerner S. The U.S. Military Is Spending Millions to Replace Toxic Firefighting Foam with Toxic [Internet]. The Intercept. 2018 [cited 8 July 2019]. Available from: https://theintercept.com/2018/02/10/firefighting-foam-afff-pfos-pfoa-epa/

  • TOXICITY OF PERFLUOROOCTANE SULFONATE (PFOS), PERFLUOROOCTANOIC ACID (PFOA), AND RELATED ORGANIC FLUOROCHEMICALS [Internet]. US Environmental Protection Agency. [cited 8 July 2019]. Available from: https://cfpub.epa.gov/si/si_public_record_Report.cfm?Lab=NHEERL&dirEntryID=72506

  • Hatch P. CFA closes Fiskville training facility after chemical find [Internet]. The Age. 2015 [cited 8 July 2019]. Available from: https://www.theage.com.au/national/victoria/cfa-closes-fiskville-training-facility-after-chemical-find-20150302-13t68t.html

  • 89. Fiskville Shut Forever [Internet]. Premier of Victoria. 2015 [cited 8 July 2019]. Available from: https://www.premier.vic.gov.au/fiskville-shut-forever/

    90. Edwards J. Worksafe Victoria defends decision not to prosecute CFA over Fiskville handling [Internet]. ABC News. 2015 [cited 8 July 2019]. Available from: https://www.abc.net.au/news/2015-11-20/worksafe-defends-no-prosecution-cfa-fiskville-handling/6960460

    1. Segal T. Operational Risk [Internet]. Investopedia. 2019 [cited 8 July 2019]. Available from: https://www.investopedia.com/terms/o/operational_risk.asp
  • Dangerous goods [Internet]. WorkSafe Victoria. [cited 8 July 2019]. Available from: https://www.worksafe.vic.gov.au/dangerous-goods

  • Inquiry into the CFA Training College at Fiskville Final Report – May 2016; p. 221 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf

  • WorkSafe Victoria Annual Report 2017 [Internet]. Parliament of Victoria. 2017 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/file_uploads/WorkSafe_Annual_Report_2017_C3Rrqqy5.pdf

  • Whittaker J. ‘Thanks for your service, liars’: did Dan Andrews go too far? [Internet]. The Mandarin. 2015 [cited 8 July 2019]. Available from: https://www.themandarin.com.au/25632-thanks-service-liars-daniel-andrews-go-far/

  • 96. Labor Government Acts to Restore Public Confidence [Internet]. Premier of Victoria. 2015 [cited 8 July 2019]. Available from: https://www.premier.vic.gov.au/labor-government-acts-to-restore-public-confidence/

    97. Willingham R. Cancer cluster led to 16 deaths at Fiskville CFA training centre, study finds [Internet]. The Age. 2015 [cited 8 July 2019]. Available from: https://www.theage.com.au/national/victoria/cancer-cluster-led-to-16-deaths-at-fiskville-cfa-training-centre-study-finds-20150121-12ur7b.html

    1. Fiskville report: Firefighters deserve ‘justice’ over toxic CFA training facility, report finds [Internet]. ABC News. 2016 [cited 8 July 2019]. Available from: https://www.abc.net.au/news/2016-05-24/report-into-cfa-fiskville-training-facility-tabled-in-parliament/7440840
  • Justice delayed is justice denied [Internet]. Monash University – Australian Centre for Justice Innovation. 2013 [cited 8 July 2019]. Available from: https://www.monash.edu/news/articles/justice-delayed-is-justice-denied

  • JUSTICE FOR FISKVILLEAFFECTED PERSONS: APPROACHES AND OPTIONS [Internet]. Parliament of Victoria. 2015 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/other_docs/Clayton_Full_Discussion_Paper.pdf

  • Carey A. ‘A lot of pain’: Labor’s contentious fire services reforms pass into law [Internet]. The Age. 2019 [cited 8 July 2019]. Available from: https://www.theage.com.au/politics/victoria/a-lot-of-pain-labor-s-contentious-fire-services-reforms-pass-into-law-20190620-p51zra.html

  • 102. Presumptive workers compensation law for Victorian firefighters [Internet]. Australian Emergency Law. 2019 [cited 8 July 2019]. Available from: https://emergencylaw.wordpress.com/2019/06/23/presumptive-workers-compensation-law-for-victorian-firefighters/

    103. About AIHS [Internet]. AIHS – Australian institute of Health and Safety. [cited 8 July 2019]. Available from: https://www.aihs.org.au/about

    1. 2016-2021 Strategic Plan [Internet]. AIHS Australian Institute of Health and Safety. 2016 [cited 8 July 2019]. Available from: https://www.aihs.org.au/sites/default/files/SIA_Strategic_Plan_2016_2021_final.pdf
  • Inquiry into the CFA Training College at Fiskville Final Report – May 2016; p. 411 [Internet]. Parliament of Victoria. 2016 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/images/stories/committees/enrc/Fiskville_training_college/Final_report/ENRRDC_58-03_Text_WEB.pdf

  • First submissions for Fiskville inquiry [Internet]. Parliament of Victoria. 2015 [cited 8 July 2019]. Available from: https://www.parliament.vic.gov.au/about/news/2442-first-submissions-for-fiskville-inquiry

  • Safety Institute of Australia – Albums [Internet]. AIHS Australian Institute of Health and Safety. [cited 8 July 2019]. Available from: https://www.flickr.com/photos/safetyinstituteofaustralia/albums

  • Herbert William Heinrich [Internet]. Wikipedia. [cited 8 July 2019]. Available from: https://en.wikipedia.org/wiki/Herbert_William_Heinrich

  • Shrestha P. Skinner’s theory on Operant Conditioning [Internet]. Psychestudy. 2017 [cited 8 July 2019]. Available from: https://www.psychestudy.com/behavioral/learning-memory/operant-conditioning/skinner

  • 110. Light my Fire – The Doors [Internet]. Genius. [cited 8 July 2019]. Available from: https://genius.com/The-doors-light-my-fire-lyrics

    111. Orphan K. Now We Know [Internet]. Counterpunch. 2019 [cited 1 July 2019]. Available from: https://www.counterpunch.org/2019/06/28/now-we-know/

    1. Auschwitz concentration camp [Internet]. Wikipedia. [cited 1 July 2019]. Available from: https://en.wikipedia.org/wiki/Auschwitz_concentration_camp
  • Mauthausen-Gusen concentration camp complex [Internet]. Wikipedia. [cited 1 July 2019]. Available from: https://en.wikipedia.org/wiki/Mauthausen-Gusen_concentration_camp_complex

  • Lorenz Diefenbach [Internet]. Wikipedia. [cited 1 July 2019]. Available from: https://en.wikipedia.org/wiki/Lorenz_Diefenbach

  • 115. Zavada J. Paul’s Conversion Bible Story Study Guide [Internet]. Learning Religions. 2018 [cited 1 July 2019]. Available from: https://www.learnreligions.com/conversion-of-paul-700197

    116. Return to normalcy [Internet]. Wikipedia. [cited 1 July 2019]. Available from: https://en.wikipedia.org/wiki/Return_to_normalcy

    1. Long R, Fitzgerald R. Tackling Risk, A Field Guide to Risk and Learning [Internet]. Human Dymensions. 2017 [cited 1 July 2019]. Available from: https://www.humandymensions.com/product/tackling-risk/
  • Adorno T, Frenkel-Bruns’wik E, Levinson D, Nevitt Sanford R. The Authoritarian Personality [Internet]. Archive.org. [cited 1 July 2019]. Available from: https://archive.org/stream/THEAUTHORITARIANPERSONALITY.Adorno/THE%20AUTHORITARIAN%20PERSONALITY.%20-Adorno_djvu.txt

  • PUBLIC HEARING: INQUIRY INTO COAL WORKERS’ PNEUMOCONIOSIS – TRANSCRIPT OF PROCEEDINGS – WEDNESDAY, 14 DECEMBER 2016 Tieri [Internet]. Queensland Parliament. 2016 [cited 1 July 2019]. Available from: https://www.parliament.qld.gov.au/documents/committees/CWPSC/2016/CWPSC/CWP-trns-14Dec2016-Tieri.pdf

  • 120. Reason J. Managing the Risks of Organizational Accidents [Internet]. Taylor and Francis. 1997 [cited 1 July 2019]. Available from: https://www.taylorfrancis.com/books/9781315543543

    121. Hawks Nest Tunnel disaster [Internet]. Wikipedia. [cited 1 July 2019]. Available from: https://en.wikipedia.org/wiki/Hawks_Nest_Tunnel_disaster

    1. Jackson C. Aberfan – The mistake that cost a village its children [Internet]. BBC News. 2016 [cited 1 July 2019]. Available from: https://www.bbc.co.uk/news/resources/idt-150d11df-c541-44a9-9332-560a19828c47
  • Farmington Mine disaster [Internet]. Wikipedia. [cited 1 July 2019]. Available from: https://en.wikipedia.org/wiki/Farmington_Mine_disaster

  • Moura 4 Mine 1986 [Internet]. Simtars Mine Accidents and Disasters. [cited 1 July 2019]. Available from: http://www.mineaccidents.com.au/mine-accident/48/moura-4-mine-1986

  • Godwin’s Law [Internet]. Wikipedia. [cited 1 July 2019]. Available from: https://en.wikipedia.org/wiki/Godwin%27s_law

  • The industrial manslaughter offence under Queensland legislation [Internet]. Queensland Government – WHS Queensland. 2018 [cited 1 July 2019]. Available from: https://www.worksafe.qld.gov.au/laws-and-compliance/compliance-and-enforcement/penalties/industrial-manslaughter-offence

  • Ellul J. PROPAGANDA: The Formation of Mens Attitudes [Internet]. Monoskop.org. 1973 [cited 1 July 2019]. Available from: https://monoskop.org/images/4/44/Ellul_Jacques_Propaganda_The_Formation_of_Mens_Attitudes.pdf

  • Long R. For the love of zero – Human fallibility and risk [Internet]. Human Dymensions. 2012 [cited 1 July 2019]. Available from: https://www.humandymensions.com/product/for-the-love-of-zero/

  • 129. Collins D. Safety – Not the Number One Priority [Internet]. SafetyRisk. [cited 1 July 2019]. Available from: https://safetyrisk.net/safety-not-the-number-one-priority/

    130. About AIHS [Internet]. AIHS – Australian Institute of Health and Safety. 2019 [cited 1 July 2019]. Available from: https://www.aihs.org.au/about

    131. Burke E. The only thing necessary for the triumph of evil is for good men to do nothing [Internet]. BrainyQuote. [cited 1 July 2019]. Available from: https://www.brainyquote.com/quotes/edmund_burke_377528

    132. Niemoller M. First they came … [Internet]. Wikipedia. [cited 31 October 2018]. Available from: https://en.wikipedia.org/wiki/First_they_came_

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