Support for firefighters
Living for the health of those who help us
The fire service is his passion and he is committed to preventing cancer among firefighters. Marcus Bätge has been a firefighter at Hamburg professional fire service for over 30 years. In 2016, as he was rising up the ranks, Marcus founded FeuerKrebs gUG, a non-profit organisation which raises awareness of the increased cancer risk among firefighters and provides a simple route to support for people affected. Bätge and his team are also pushing for a legal basis for compensation. They want certain cancers to be recognised as occupational diseases in Germany. In this interview, he explains why this is difficult despite international studies supporting the connection.
In June 2022, the International Agency for Research on Cancer (IARC), part of the WHO, classified firefighting as ‘known to be carcinogenic in humans’ (group 1a). To what extent did the IARC classification help with recognising certain cancers as occupational diseases in Germany?
Barely at all. The IARC classification was received without a great deal of public commentary and some people even perceived it as scaremongering. In some quarters here, the IARC's work is regarded as insufficient because no German expertise was included. This the case for the German Statutory Accident Insurer (DGUV), the umbrella organisation for the fire service accident insurers and the body responsible for processing insurance cases. They assume that 10–20 fires per year, i.e. the usual quantity for smaller fire services, is not enough to link the work to cancer.
That means that no straightforward, unbureaucratic help is available like we may soon see in Canada, where 19 specific cancers have now been recognised as occupational diseases in firefighters. If people in Germany are affected, what can they do?
If a Canadian firefighter develops cancer, say leukaemia, and they have been active in the fire service for several years, then they are insured by the Canadian government. In Germany, when a firefighter receives a cancer diagnosis, they make a complaint to their accident insurer or their employer's liability insurance via their treating doctor. But, since cancer is not categorised as an occupational disease for firefighters, the burden of proof is on the patient, i.e. they must actively provide evidence that the disease has been caused by their work as a firefighter. They have to answer questions like, ‘Do you smoke?’ and ‘Do you handle mechanical lubricants in your leisure time, e.g. working on old vehicles?’ Everything is scrutinised and all other activities must be ruled out as potential causes.
Things are even tougher for volunteer firefighters. Since they do not actually work for a professional fire service, they cannot have their cancer classified as an occupational disease. They can go through the Fire Service Accident Insurer or their own health insurance. While they are active volunteers, they should ensure that their names are registered in an exposure database following any call-outs where carcinogenic substances are present. This is even legally stipulated in the German Hazardous Substances Ordinance and also applies to other emergency services like the ambulance service, emergency technical aid and certain parts of the police force.
Employers can use the Central Exposure Database (ZED) to record the names of employees who are exposed to carcinogenic substances. Is it standard practice for voluntary fire services to use the Central Exposure Database?
Unfortunately not. Even though the German Hazardous Substances Ordinance made documenting these cases a legal requirement in 2006 and the German Statutory Accident Insurer provides this registry at no cost. The incident commander at the fire service is required to document the names of everyone involved in fighting a fire. In reality, this does not often happen or, when it does, only partially. For example, the response team is recorded but not others who were involved. The requirement may have existed since 2006 but that by no means translates to everyone knowing about it and complying. Many municipalities and incident commanders just don't know. Hamburg professional fire service has been making entries into the Central Exposure Database since 2019.
You founded FeuerKrebs in 2016 as a non-profit organisation aiming to raise awareness of the increased cancer risk among firefighters and to provide unbureaucratic access to help for those affected. What does that look like exactly?
Our organisation has three pillars. The first is awareness raising. We provide fire service members with information on cancer risk and the consequences of insufficient operational hygiene, unnecessary exposure to contamination and cross contamination. We hope to provide firefighters with a new level of awareness and encourage them to think differently. Mostly, we implement this by holding informative events at fire services and other civil society bodies. These days, our organisation's expertise is in high demand at gatherings for political decision-making, even outside Germany. We also attend public events like open days and fire service sporting fixtures to talk to interested participants and provide education around operational hygiene. The Internet and social media help us to share and discuss scientific work and the latest findings with firefighters and anyone else who might be interested anywhere in the world.
Our second pillar is connecting firefighters who have cancer and their loved ones to support and treatment options. Sadly, they are often left to fend for themselves with the impact of the disease. FeuerKrebs® provides psychological, legal and financial aid. We aim to ensure that care and compensation claims made by firefighters' loved ones are upheld. This extends to getting cancers legally recognised as occupational diseases – on the proviso that all occupational health and safety measures have been applied, i.e. consistent operational hygiene practices.
In our third pillar, we work with manufacturers and are in constant conversation with fire service technology dealers and makers of fire service clothing. Together, we are able to improve both the protection and ease of use delivered by equipment.
‘I don't think any new studies are needed. We can use the international scientific investigations and the IARC assessment. They are clear.’
Why do you think that Germany has not yet seen legal recognition of cancer as an occupational disease for fire services?
Occupational diseases are conditions suffered by insured parties due to their professional activities and they are listed in the Occupational Diseases Act (BKV) . They can be caused by a wide range of health-damaging effects. It is the statutory accident insurer who decides whether to recognise a condition as an occupational disease.
A disease is recognised as occupational if it was caused by harmful exposure in the workplace. The accident insurance underwriters are responsible for assessing whether this is the case. The following points must be fulfilled for a case to be accepted:
- The insured parties are suffering a disease listed in the Occupational Diseases Act.
- The insured parties experienced the relevant harmful exposure in their workplace.
- There is a causal link between workplace activity, the exposure and the occurrence of the disease.
In our interpretation, fire services meet all of these requirements. The German government is advised by bodies who primarily make decisions based on records rather than investigating medical causality. Individual cases are rarely considered. Those almost always come down to the case worker. I don't think any new studies are needed. We can use the international scientific investigations and the IARC assessment. They are clear.
For these cancers to be recognised in this way, a change would have to be made to Book VII of the German Social Code – Statutory Accident Insurance – (Section 1 of the Law of 7 August 1996, German Civil Code Part I, p. 1254) para. 9 on Occupational Diseases. Recognising a disease in this way means huge outlay for treatment and care. This money does not exist. For some reason, voluntary work is not valued like it should be.
Another point on this matter: if a condition is not listed as an occupational disease, it can still be recognised as equivalent. However, this is only possible in exceptional cases where new discoveries have been made about the causal link in the wider medical science community. A causal link in the one specific case is not sufficient.
Cancers with definite fire-related cause according to the IARC:
- Mesothelioma
- Bladder cancer
Cancers with limited evidence of a fire-related cause in humans:
- Colon cancer
- Prostate cancer
- Testicular cancer
- Skin melanoma
- Non-Hodgkin lymphoma
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