Soaking in Carcinogens: Are we Keeping Ourselves Safe in Flood Response?

1. Introduction

Climate change has led to an increase in the frequency and severity of flooding events worldwide, placing greater demands on emergency services personnel who respond to these incidents (Alderman et al., 2012). Whilst much attention has been given to the immediate dangers associated with flood rescue operations, such as drowning and physical injuries, a seldom discussed yet potentially significant risk is the long-term health impact on rescue operators exposed to contaminated floodwaters. This article aims to explore the potential issue of increased cancer risk for flood rescue personnel, with a particular focus on the unique challenges faced in tropical and warm climates like Australia.

2. Literature Review

2.1. Flood Rescue Operations and Chemical Exposure

A Floodwaters, particularly in urban and industrial areas, can contain a complex mixture of chemical contaminants. These may include petroleum products, heavy metals, pesticides, industrial solvents, and various other hazardous substances (Powell, 2021; Euripidou & Murray, 2004). During flood rescue operations, emergency personnel are often required to work in direct contact with these contaminated waters, potentially exposing them to carcinogenic compounds. Events in New Zealand have highlighted the challenges of operating in highly polluted water in warm conditions following storm induced floods (Glassey, 2017; Glassey et. al., 2024).

The risk of chemical exposure during flood events is well-documented. A study by the World Health Organization highlighted that chemicals released during floods can cause dermal, respiratory, and systemic toxic effects following direct exposure to both victims and rescuers (World Health Organization, 2018). The same report noted that runoff from inundated waste sites may contain a variety of toxic chemicals, depending on what was stored at the site. This is further supported by research from Tak et al. (2007), who found that firefighters involved in flood response in New Orleans experienced various health symptoms related to floodwater exposure.

2.2. The Challenge of Protective Equipment in Warm Climates

In colder regions, dry suits provide an effective barrier against contaminated floodwaters. However, in tropical and warm climates like Australia, the use of dry suits presents a significant risk of hyperthermia. This creates a challenging dilemma for rescue operators and emergency service organisations.

The risk of heat stress in warm environments when wearing protective gear is not trivial. As noted by Gilliam (2019), neoprene wetsuits retain moisture and heat, which can lead to dizziness and nausea, symptoms similar to motion sickness. These effects can be exacerbated in the high-stress, physically demanding conditions of flood rescue operations. Sim (2011) emphasises the need for adequate protection of disaster response workers, highlighting the complex balance between protection from hazards and the practicality of protective equipment in various environmental conditions.

This situation creates a potential 'catch-22' for flood rescue operators in warm climates. They must choose between adequate protection from contaminated waters and the risk of heat-related illnesses. This dilemma underscores the need for innovative solutions in protective equipment design that can offer chemical protection without increasing the risk of hyperthermia.

2.3. Health Risks Associated with Flood Response

Research has shown that flood response workers face a variety of health risks beyond the immediate physical dangers. Rusiecki et al. (2014) found that US Coast Guard responders to Hurricanes Katrina and Rita reported various health symptoms related to their disaster response work. Similarly, Johanning et al. (2014) highlighted the health hazards associated with mold and dampness for response and recovery workers following flooding events.

Respiratory issues are of particular concern. Prezant et al. (2008) noted that upper and lower respiratory diseases are common among workers responding to environmental disasters, including floods. This is supported by studies on sewage workers and waste collectors, who face similar exposures to those encountered in flood response. Thorn et al. (2002) found a high prevalence of work-related symptoms among sewage workers, while Douwes et al. (2003) highlighted the potential health effects of bioaerosol exposure in such environments. New safe systems of work such as Water Rescue Breathing Apparatus (WRBA) may provide some protection against ingestion and inhalation of flood water contaminants (Glassey, 2024).

The long-term health effects of these exposures, particularly in relation to cancer risk, remain understudied. However, the presence of known carcinogens in floodwaters, combined with the often prolonged and intense nature of flood rescue operations, suggests that this is an area requiring urgent attention.

3. Discussion

3.1. Presumptive Legislation: A Gap in Protection

In Australia, as in many other countries, presumptive legislation has been introduced to support firefighters who develop certain types of cancer presumed to be related to their occupational exposures. This legislation simplifies the process for firefighters to claim workers' compensation for specified cancers, recognising the increased cancer risk associated with their profession (Cook Government, 2023).

However, a significant gap exists in this protective legislation. In Australia, the State Emergency Service (SES) is often the lead agency for flooding emergencies, yet SES personnel are not covered by the same presumptive legislation as firefighters. This disparity in coverage raises important questions about the equitable protection of emergency service workers.

The expansion of presumptive legislation in various Australian states to include more cancer types for firefighters is a positive step. For instance, Western Australia recently expanded its list from 12 to 20 cancers covered under the legislation (Cook Government, 2023). However, this expansion does not address the gap in coverage for flood rescue operators who may face similar, if not greater, chemical exposure risks during their duties.

3.2. The Shifting Landscape of Risk: Climate Change and Flooding

As climate change continues to alter weather patterns globally, the frequency and severity of flooding events are projected to increase (Cann et al., 2013). This shift in environmental risks suggests that flood rescue operations may become more common and more hazardous in the future.

Despite this trend, the focus on cancer risk in emergency services remains heavily skewed towards firefighting. While the risks associated with firefighting are undoubtedly significant and deserve attention, the potential cancer risks for flood rescue operators warrant equal consideration, especially in the context of climate change.

The chemicals commonly found in floodwaters, such as polycyclic aromatic hydrocarbons (PAHs), heavy metals, and various industrial chemicals, have been associated with increased cancer risk (World Health Organization, 2018; Hoppe et al., 2012). As flooding becomes more frequent and widespread, the exposure to these contaminants may increase for flood rescue operators.

4. Research Gaps and Future Directions

The lack of comprehensive research into the long-term health effects of exposure to contaminated floodwaters for rescue operators represents a significant gap in our understanding. While studies have examined the immediate health risks associated with flood exposure (Fewtrell & Kay, 2008; Barbeau et al., 2010), long-term outcomes, particularly cancer risk, remain understudied.

4.1. Future Research Should Focus on Several Key Areas

1

Longitudinal studies of flood rescue operators to assess long-term health outcomes, including cancer incidence.

2

Analysis of chemical contaminants in floodwaters across different geographical and industrial contexts, building on work such as that by Euripidou and Murray (2004).

3

Development and testing of protective equipment suitable for use in warm climates that can provide adequate chemical protection without increasing the risk of heat stress.

4

Examination of the effectiveness of decontamination procedures following flood rescue operations, considering findings from studies on other occupational exposures (Thorn & Kerekes, 2001).

5

Assessment of the potential benefits of extending presumptive legislation to cover flood rescue operators.

4.2. Policy Implications

The findings of this review have several important implications for policy makers in emergency services:

1

Equitable Protection: There is a need to review and potentially expand presumptive legislation to include flood rescue operators, ensuring equitable protection for all emergency service personnel exposed to hazardous conditions (Teixeira & Augusto, 2014).

2

Investment in Protective Equipment: Increased funding and research should be directed towards developing protective equipment suitable for flood rescue operations in warm climates, considering the unique challenges highlighted by Sim (2011).

3

Enhanced Training and Awareness: Flood rescue operators should receive comprehensive training on the potential long-term health risks associated with exposure to contaminated floodwaters and strategies to minimise exposure, drawing on lessons from other high-risk occupations (Gershon et al., 2007).

4

Improved Monitoring and Surveillance: Implementing systems to monitor and record injuries and disease occurrences among flood rescue operators could provide valuable epidemiological data to inform future policy decisions, similar to approaches used in post-disaster health surveillance (Svendsen et al., 2014).

5

Interdisciplinary Collaboration: Encouraging collaboration between emergency services, environmental scientists, and health researchers could lead to more comprehensive understanding and management of risks, as demonstrated in studies on other environmental disasters (Noji, 2005).

5. Conclusions

The potential cancer risk for flood rescue operators working in contaminated waters represents a significant yet often overlooked occupational health concern. As climate change alters the landscape of environmental emergencies, with flooding events becoming more frequent and severe (Alderman et al., 2012), it is crucial that we reassess our approach to protecting these vital emergency service personnel.

The challenges are complex, particularly in warm climates where traditional protective equipment may introduce additional risks. However, these challenges should not deter us from seeking solutions. Instead, they should spur innovation in equipment design, drive more comprehensive research into long-term health outcomes, and prompt a reconsideration of legislative protections for all emergency service workers.

As we continue to rely on the bravery and dedication of flood rescue operators, it is our responsibility to ensure that their long-term health and wellbeing are protected. This requires a concerted effort from researchers, policy makers, and emergency service organisations to address this hidden hazard and develop comprehensive strategies to mitigate the risk of cancer and other long-term health impacts for these crucial frontline workers.