Evaluating the potential benefits of a new mode of action for Paris firefighters, the transitional attack, through quantitative risk assessment

Purpose of the study. - As part of their daily jobs, firefighters are exposed to many pollutants, with significant health consequences, as underlined by recent epidemiological studies. The aim of the present study was to quantitatively assess the risks of smoke exposure for the health of Paris firefighters and to determine the potential benefits a new mode of action, the transition attack, could have by altering the patterns of exposure. Methods. - We first established a list of pollutants contained in smoke, and assessed the concentration of four major pollutants in fires in France. Secondly, we determined the lifetime exposure without individual breathing apparatus during the postoperative period and on the way back to the station in a typical Paris fire station. Based on recent studies, we then assessed the level of reduction in this exposure duration that could be obtained by the implementation of fire transitional attacks. Finally, using a Quantitative Health Risk Assessment approach, we quantified the short and long-term health impact of Paris firefighter exposure to smoke with and without a transitional fire attack. Results. - We predicted an average individual excess of cancer risk of 3.7/100 000, ultimately resulting in 0.18 excess cancer cases in the total population of the 4786 firefighters of Paris exposed to fire smoke. For non-cancer toxic effects, the hazard quotient was well above 1 for several pollutants. Transitional fire attacks allowed to reduce the concentration of pollutants and thus reduce the expected cancer rate, as well as cut down by three the hazard quotients. Nevertheless, the global hazard quotient remained above 1. Conclusions. - New prevention measures are needed in order to reduce the health risks associated with smoke exposure. These measures must be practical and the simplest possible. Innovative firefighting approaches, such as the transitional fire attacks, could lead to positive results.