The influence of a disaster on the health of rescue workers: a longitudinal study

Background: Rescue workers strive, after disasters, to help victims and restrict damage, often in dangerous circumstances. We examined the effect of a disaster on the physical and psychological health of rescue workers ( firefighters, police officers and medical emergency services personnel) who provided assistance after the explosion of a fireworks depot in the Netherlands in May 2000. Methods: We carried out a 4-year longitudinal study of 1403 rescue workers employed in or near the affected neighbourhood ( the study group) and a control group of 1650 uninvolved rescue workers ( from another city of similar size and urbanization). Health outcomes were measured as prevalence, incidence ( both measured as the percent of workers who took sick leave), frequency of the absences and number of sick days ( both per 100 workers), and duration ( mean length of sickness absences, in days). Results: Sick leave among the study workers increased substantially during the 18 months after the explosion. For example, the prevalence of absences attributed to psychological problems increased from 2.5% of workers during the 6 months before the disaster to 4.6% during the first 6- month period after the explosion and 5.1% during the second. That for respiratory problems rose from 5.4% predisaster to 14.9% 6 - 12 months afterward. In comparison with controls, immediate increases occurred in musculoskeletal, psychological, respiratory and nonspecific ill health ( e. g., malaise, fatigue) during the first year postdisaster. Rates of sick leave for musculoskeletal and respiratory reasons remained elevated until 3 years postdisaster, whereas leave for psychological problems and other ill health had returned to predisaster levels by then. Neurological problems increased after a 1-year delay. No significant increase in gastrointestinal problems was observed among the study workers, in comparison with controls. Interpretation: Many health problems arise immediately after a disaster and may persist for years. Health care workers should realize, however, that some disaster-related effects may not emerge until a year or more after the event.