Emergency responder health: what have we learned from past disasters?

Abstract

As the Deepwater Horizon disaster unfolds in the Gulf of Mexico, public health practitioners are having a sinking deja vu feeling. Once again, environmental disaster has struck, and tens of thousands of emergency responders—some professionals, but many more volunteers—have swung into action, potentially risking their health as they work to clean up the worst oil spill in U.S. history. Veterans of similar disasters are wondering if historical lessons learned can help keep the damage to a bare minimum. But a paucity of hard data on emergency responder health makes it difficult even to ask the right questions. “Emergency responders have not been adequately studied,” says Gina Solomon, codirector of the occupational and environmental medicine residency and fellowship program at the University of California, San Francisco, and a senior scientist with the Natural Resources Defense Council. “They tend to be ignored.” Professional emergency responders such as firefighters may not put much emphasis on health effects studies. “They are going to do what they need to do regardless of their own safety,” says Don Donahue, executive director of the Center for Health Policy & Preparedness at the Potomac Institute for Policy Studies, who has firefighters in his extended family. “They have to be a little crazy by definition.” That heroic approach is manna for the people they save, but firefighters may pay a price with disorders such as cancer. Studies of cancers in firefighters have had mixed results, but there is evidence linking this occupation with brain, thyroid, esophageal, bladder, testicular, prostate, and cervical cancers, as well as melanoma and Hodgkin disease (Bates1 and Ma et al.2 are two such studies). Health risks tend to be even greater for the many nonprofessional emergency responders who rush to the scene of crises such as oil spills, terrorist attacks, hurricanes, train derailments, and chemical releases. Those workers often don’t have the training and advanced equipment that protect professional emergency responders to some degree. These and many other factors make it a daunting challenge to protect the health of emergency responders during disasters.