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We are experiencing a period of profound economic, environmental and social upheaval, the impact of which can sometimes be felt most sharply by emergency workers dealing with dynamic incidents out on the front line. But how do we protect these workers from the emerging health and safety risks associated with such events? Malgorzata Milczarek explains.

It’s unlikely to have escaped your notice but the UK played host to two massive events this summer – the Queen’s Diamond Jubilee celebrations and the Olympic and Paralympic Games – which, in turn, involved two of the largest security operations the UK has ever seen.

Thankfully, in neither case were the many thousands of emergency workers who were involved – police officers, fire-fighters and medics among them – faced with any serious incidents. However, it is not necessary to look back too far for examples of emergency workers being hurt in the line of duty. For example, during the riots that affected London last summer, more than 180 police officers and ten fire-fighters were injured.¹

Further afield, the last few years have seen several high-profile events in which emergency workers have been put at risk. Chief among these are a number of natural disasters, including the Haiti earthquake of January 2010, the flooding in Pakistan in the same year, and the earthquake and subsequent tsunami in Japan in 2011.

Global warming and pollution have already contributed to a significant increase in the number of recorded natural disasters over the past 20 years, according to the United Nations Office for Disaster Risk Reduction.² Not only are natural disasters occurring on a more frequent basis but, as the world’s population grows and urbanisation and deforestation increase, so the number of people vulnerable to such crises is also increasing.

The emergency-worker population

As a large and diverse professional group, emergency-services workers called upon to deal with catastrophic events and help communities recover include police officers, fire-fighters and emergency medical staff, but in major disasters, especially, they can also include rescue workers, military personnel, and volunteers.

Although the total number of emergency workers in the EU is difficult to estimate, the numbers that can be involved in a major disaster can be huge. For instance, up to 70,000 emergency workers were involved in the rescue and clean-up operation following the attacks on the World Trade Centre in 2001,³ while around 200,000 were involved following the disaster at the Chernobyl nuclear plant in 1986.⁴

Emergency workers in Europe can often find themselves dealing with catastrophes elsewhere in the world. Following the 2010 Haiti earthquake, for example, more than 500 rescue workers and other personnel were sent from France; some 500 troops, doctors and other specialists from Spain; and a 64-member search-and-rescue team from the UK.^5,6

What risks do they face?

The specific risks that emergency workers face when they arrive at the scene of an incident vary widely.
There are the physical strains of having to carry out heavy manual work, often with critical time pressures and no opportunity to take a break. There are also the emotional and psychological strains of emergency work – the stress of having to deal with fatalities and injuries, the degree of responsibility that emergency workers have placed on them, the time pressures that they work under, and their long, unpredictable working hours.

Then, there are the specific threats posed by a particular incident. A natural disaster, for example, can expose emergency workers to a variety of diseases. Industrial accidents can expose workers to the risk of explosion, toxic substances, or radiation. Incidents of public disorder can lead to threats of, or actual, violence from the public.

These threats aren’t just theoretical: there is ample evidence of emergency workers being harmed in these ways in recent years. In Sweden in 2002, for example, some 80 per cent of emergency paramedics reported that they had been threatened with physical violence, or experienced it directly.⁷ By way of illustration, fire-fighters continue to be killed in fires – in the UK, between 2003 and 2008, some 22 died while on duty, and this number doesn’t include those who died from heart attacks during an emergency, or were killed in traffic accidents travelling to or from an incident.⁸

There is, of course, a number of famous incidents in which large numbers of emergency workers lost their lives. In 2001, for example, more than 400 emergency workers died as they responded to the attacks on the World Trade Centre in New York.⁹

The effects of psychological trauma – including depression, anxiety, and post-traumatic stress disorder (PTSD) – suffered by emergency workers have been a particular focus of attention in recent years. A study in Sweden showed that up to a quarter of emergency workers have some form of PTSD,¹⁰ while in the United States up to a quarter of rescue workers and 21 per cent of fire-fighters were also reported to be suffering from the condition; this compares to a prevalence rate of just 4 per cent in the general population.¹¹ Higher rates of ‘burnout’ and substance abuse have also been reported among emergency workers, compared with the general population.

Physical conditions from which emergency workers are at risk include musculoskeletal disorders – back injuries and injuries to the upper and lower extremities are the most common type of injury suffered by emergency workers. Fire-fighters have to lift around 30kg of personal equipment in dealing with fires, on top of the extra tools they carry. It is small wonder, therefore, that injuries incurred while handling, lifting, or carrying account for a large proportion of non-fatal accidents among fire-service personnel.

Then, there are cancers that can result from exposure to radiation. Many new cases of thyroid cancer emerged among the emergency workers who dealt with the Chernobyl disaster.¹² The risks of developing respiratory disorders, meanwhile, are perhaps best illustrated by the fire-fighters and police officers who dealt with the aftermath of the World Trade Centre attacks, and who suffered long-term exposure to dust and various toxic pollutants. Studies show that nearly three-quarters of a sample of emergency workers dealing with the incident reported respiratory symptoms.¹³

Protective measures

Inevitably, given the nature of what emergency workers do, it may be impossible to eliminate entirely the risks that they face. But what can be done to protect them?

Published last year, a review of the existing research on the health and safety of emergency workers concludes that there are often shortcomings in the protection afforded to emergency workers. The report called for better risk assessment in evaluating the health and safety risks that emergency workers face, and awareness of those risks needs to be raised, especially given the increasing demands that are being made on this particular group of employees.14

Better preventive measures need to be put in place at a number of different levels to help keep emergency workers safe.

Firstly, at national and international levels, there needs to be better preparedness, with the health and safety of emergency workers taken into account when drawing up emergency-response plans. There needs to be better coordination and communication between different groups of emergency workers who may be dealing with a disaster, with common language and communication systems, and common training procedures. Organisations should have designated public-information officers, so that emergency workers do not have to deal with intense media attention.

At a planning level, the risks to emergency workers need to be considered when deciding on land use – for example, not siting buildings in areas that may be vulnerable to natural disasters, and designing buildings in such a way so that they can be safely accessed by emergency workers. In particular, further studies are needed on the possible use of lifts to evacuate people in different emergency scenarios.

On the ground, we need to see better training of emergency workers, preparing them for the hazards they may encounter at the scene of a disaster, and for the possible physical and mental effects of their work. In particular, we need to see emergency workers being given better psychological support, both immediately after an incident and in the longer term.

Personal protective equipment needs to be provided wherever it is needed, but it needs to be further developed, taking into account the specific risks that emergency workers face – for example, by helping reduce physical strain and enabling emergency workers to operate in difficult conditions. It would be helpful if representatives of emergency organisations could be directly involved in these efforts to improve protective equipment, and to help standardise it.

Finally, beyond the mandatory medical examinations to which emergency workers are subject, there needs to be better long-term care and surveillance of emergency workers’ health to help identify particular issues as they arise. Clearly, further longitudinal research is needed on the health effects on this important group of workers, as they face new and emerging risks.

References
1    CNN (2011): ‘Britain’s suspected rioters face courts as order restored’, 12 August 2011 – http://edition.cnn.com/2011/WORLD/europe/08/12/uk.riots/
2    United Nations International Strategy for Disaster Reduction (UNISDR) (2008): ‘Disaster risk-reduction strategies and risk-management practices: Critical elements for adaptation to climate change.’ Available online at: www.unisdr.org/eng/risk-reduction/climate-change/docs/IASC-ISDR_paper_cc_and_DDR.pdf
3    The Guardian (2009): ‘9/11’s delayed legacy: cancer for many of the rescue workers’, 11 November 2009 – www.guardian.co.uk/world/
2009/nov/11/cancer-new-york-rescuers
4    WHO/IAEA/UNDP (2005): Joint news release, ‘Chernobyl: the true scale of the accident’. Chernobyl’s Legacy: Health, Environmental and Socio-Economic Impacts – www.who.int/mediacentre/news/
releases/2005/pr38/en/index.html
5    Buenos Aires Herald (2010):  ‘A look at foreign quake aid for Haiti’, 18 October 2010 – www.buenosairesherald.com
6    www.dfid.gov.uk/news/latest-news/2010/haiti-earthquake/
7    Grange, JT and Corbett, SW (2002): ‘Violence against emergency medical services personnel’, Prehospital Emergency Care, vol. 6, 2002, pp186-190
8    The Fire Brigades Union (2008): ‘In the line of duty. A report by the Labour Research Department (LRD) for the Fire Brigades Union’ – www.firetactics.com/
fbu_fatalities_report.pdf
9    http://en.wikipedia.org/wiki/
September_11_attacks
10    Jonsson, A, Segesten, K and Mattsson, B (2003): ‘Post-traumatic stress among Swedish ambulance personnel’, in Emergency Medicine Journal, vol. 20, 2003, pp79-84
11    Perrin, MA et al (2007): ‘Differences in PTSD prevalence and associated risk factors among World Trade Center disaster-rescue and recovery workers’, in American Journal of Psychiatry, vol. 164, 2007, pp1385-1394 – www.ajp.psychiatryonline.org/cgi/
reprint/164/9/1385
12    Ivanov, VK et al (2008): ‘Risk of thyroid cancer among Chernobyl emergency workers of Russia’, in Radiation and Environmental Biophysics, vol. 47, 2008, pp463–467
13    Levin, S et al (2002): ‘Health effects of World Trade Center site workers’, in American Journal of Industrial Medicine, vol. 42, no 6, 2002, pp545-547
14    European Agency for Safety and Health at Work (2011): Emergency Services: A literature review on occupational safety and health risks – http://osha.europa.eu/en/
publications/literature_reviews/
emergency_services_occupational_
safety_and_health_risks/view

Malgorzata Milczarek has been working as a project manager in the European Risk Observatory unit at EU-OSHA since 2006.