A year after the devastating fire ravaged the Lubrizol plant in Rouen, France we take a look into the emerging issues related to the health of around 900 firefighters who combated the blaze at the plant.
Doubts since 2007
In 2007, the IARC (International Agency for Research on Cancer, an agency that reports to the WHO) published a monograph classifying the firefighting profession as “probably carcinogenic”. This means that epidemiological arguments are pointing to a higher risk of cancer among firefighters but not enough evidence to conclude that there is definite causality. Although fire fumes contain proven carcinogens such as fine particles, PAHs and other toxic substances for the cardio-respiratory system such as nitrogen oxides and carbon monoxide, epidemiological studies come up against a number of obstacles preventing them from being formally conclusive. In particular, the levels of exposure are difficult to re-establish and the risks observed in these studies, although significantly high in number, are relatively weak, leaving room for bias. Besides, very few studies have been able to assess the long-term risks due to a lack of organised medical supervision following the end of active service.
The current situation
Several overviews of what we know about the risks incurred by firefighters have recently been published. They consistently conclude the following: we can observe significantly high risks, but the causal link between fire fumes and other factors such as arduousness and psychosocial aspects can’t be affirmed with any certainty.
For example, the Anses (French Agency for Food, Environmental and Occupational Health & Safety) has just published a report on this very issue. So has the IRSST (Occupational Health and Safety Research Institute) in Quebec. A recent article analysing the available publications indicates several parts of the body with a high risk of developing cancer among firefighters, including the colon, rectum, prostate, testicles, bladder, thyroid, pleura, skin and blood. Similarly, a hazard assessment study concludes that there are high risks of cancers and cardiovascular diseases.
The implications for prevention
These different studies, although not entirely conclusive, are sufficient to counsel a reinforcement of the preventive measures for firefighters.
Firstly, with regard to primary prevention, by being thorough in the use of protective equipment and developing the courses of action in the event of a fire. Thus, the recent study carried out by the Cnam [Conservatoire national des arts et métiers] showed that a new approach known as a mitigative attack could reduce the risks.
Secondly, in terms of secondary prevention, by reinforcing the medical and epidemiological supervision of the exposed firefighters.
Firefighters’ honour involves taking risks so as to save lives. There’s no reason why they should be exposed to avoidable risks.
William Dab is a Professor and Health and Safety Chair at Cnam – France, where he trains specialists in occupational health and environmental risks, notably through an engineering course in risk management. He is a doctor specialised in epidemiology. His career has been entirely devoted to health and safety, whether it be developing tools for risk assessment, monitoring and management. As a former Director-General of Health, he was a member of the WHO Executive Committee and Chairman of the European Environment and Health Committee for the WHO European Region. He has also published a number of books related to health and safety.
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