A review of the health risks associated with the activities of firefighters
Every day, firefighters face an array of risk factors, including exposure to the chemicals usually produced by combustion products during fires, and to biological and physical agents. They also face organisational constraints, such as irregular working hours, and psychosocial hazards, such as exposure to violence. ANSES has examined the health risks associated with the activities of firefighters and reviewed the preventive measures. The Agency is underlining the benefits of centralising health monitoring data. It is also recommending continued medical follow-up for firefighters who have retired from the job, in order to improve knowledge of their health and exposure, as well as to identify the activities with the highest levels of risk. Lastly, it is emphasising the need to take better account of the chronic risks faced by firefighters following exposure during and after firefighting operations.
As part of an overall risk prevention approach to the work of firefighters, ANSES has compiled a summary of the preventive measures recommended in reports by a number of national and international health and safety organisations. The Agency also organised an international consultation along with a series of hearings with health and prevention players and other stakeholders working with firefighters.
Firefighting: a profession facing multiple risks
France has some 248,000 firefighters. Most are volunteers, with a smaller number of professionals and military personnel. Their main activities are emergency assistance, firefighting and responding to traffic accidents. In 2017, actual firefighting accounted for just 7% of operations.
Looking beyond the risks of inhaling toxic fumes during fires, and the physical demands of their work, firefighters also face other forms of exposure, such as to viruses, bacteria, mould, noise and extreme levels of temperature and pressure. They also face organisational constraints, such as irregular hours or night work, and psychosocial constraints. Furthermore, they are sometimes confronted by violence. These many different types of exposure can contribute to a greater number of accidents and to the development of various disorders.
Take better account of chemical risks as well as organisational and psychosocial constraints
Current preventive measures relating to chemical risk primarily focus on the phase of active firefighting. However, the risk of exposure to toxic fumes remains even after the fire has been extinguished, during the monitoring, inquiry, and clearing phases. The risk is still present when firefighters return to the station, owing to the contamination of equipment, material or vehicles by soot and fire-extinguishing water. Greater efforts are therefore needed to take account of the chronic risks faced by firefighters during and after firefighting operations.
It is also important not to overlook the risks arising from organisational constraints, such as irregular hours and night work, or the psychosocial risks. In 2016, ANSES published an assessment of the health risks arising from these professional constraints. It recommended improving the way night work is organised in order to minimise the impact on professional and personal lives.
Turning more specifically to psychosocial risks, the Agency noted that some firefighters sign up primarily to fight fires and subsequently find it hard to cope with the realities of a job where their main role is to provide emergency assistance. This disconnect between perception and reality may lead to a form of occupational distress. A number of ways forward have been discussed, such as improving the information provided during recruitment, or conducting a study on how activities are organised within the departmental fire and rescue services (SDISs), where the firefighters are based.
Increase epidemiological monitoring and the traceability of exposure, and adapt the organisation of work
Few epidemiological studies on the health of firefighters are available. The main problems highlighted by the medical files available, primarily through the SDISs, concern joint and/or muscle disorders, knocks and bruising. At the same time, data from the National Network for Monitoring and Prevention of Occupational Diseases (RNV3P) describe respiratory diseases and psychological problems such as episodes of depression or anxiety.
The Agency recommends setting up a database to centralise health monitoring data for professional, military and voluntary firefighters, and to track their activities. This would improve the knowledge available on the health of firefighters in France, while also contributing to the traceability of exposure and helping to identify the activities with the highest levels of risk. It is important for the database to cover the accumulated activities of professional firefighters who also work as voluntary firefighters, where applicable.
Finally, ANSES also recommends putting in place post-professional medical follow-up for firefighters in order to better prevent long-term risks after their retirement.