• The Gast program is being rolled out across mainland France: Gast Île-de-France was established in late 2018.

• An extraordinary meeting of the National Steering Committee for the Gast program will take place in December 2018: presentation and approval of the action plan for the internal evaluation of the Gast program.

• A training session on occupational risks and vigilance, including a presentation of the Gast system and the investigative methods used, will be held as part of the Master’s 2 program in Public Health and Environmental Risks offered by Paris Descartes University in December 2018.

Monitoring the Health Impact of Heat Waves on Workers from June 1 to September 15, 2018

Dr. Yuriko Iwatsubo,
Epidemiologist at the Occupational Health Division, Santé publique France

Public Health France conducted a surveillance study on the impact of summer heat waves on workers’ health from June 1 to September 15, which corresponds to the activation period of the Heat Wave and Health Alert System (SACS). It is based on the transmission by the Occupational Health Inspection (IMT) of the General Directorate of Labor (DGT) to Santé publique France of reports on fatal workplace accidents potentially linked to heat. Mortality surveillance was supplemented in 2018 by a pilot study on morbidity surveillance conducted in two regions: Île-de-France (IDF) and Provence-Alpes-Côte d’Azur (PACA).

Surveillance of worker mortality potentially linked to heat

The surveillance is based on information collected by labor inspectors, who systematically conduct an administrative investigation following a fatal workplace accident. The labor inspector completes an initial “fatal workplace accident” report (date and location of the accident, the worker’s identity and age, the employer’s name and address, and a description of the circumstances of the death).

All “fatal workplace accident” forms are forwarded to the Occupational Health Inspection. The latter identifies fatal workplace accidents that may be heat-related and then emails the corresponding forms to Santé publique France after anonymizing them.

During the heatwave period from July 24 to August 11, four cases of fatal workplace accidents potentially linked to heat were reported to Santé publique France.

Furthermore, over the entire monitored period (June 1 to September 15), 8 deaths possibly linked to heat were observed. These deaths occurred among men, most of whom worked outdoors.

Morbidity Surveillance

A pilot study was conducted in the Île-de-France and PACA regions in 2018

Ile-de-France Epidemiological
surveillance of morbidity potentially linked to heat occurring among workers was based on the analysis of emergency department visit data from 51 public or private hospitals.

For each emergency department visit with the circumstantial variable coded as “work-related accident” (which corresponds to a health event occurring at the workplace or related to occupational activity), the following variables were extracted from the database of emergency department visit summaries (RPU): identity of the emergency department, date of the visit, mode of patient arrival, patient’s sex and age, diagnosis(es), whether the patient died, and discharge status after the emergency department visit.

These data were transmitted weekly to Santé publique France between June 1 and September 15, 2018.

In addition, all RPU data from the facilities participating in the pilot study were accessible via the Sursaud system managed by Santé publique France. These data were used to analyze the rates of RPU visits for work-related accidents across all RPU visits by diagnostic group (heat-related illnesses, fainting spells, isolated fever, trauma, etc.).

During the heatwave period from July 24 to August 11, among those aged 15–64, 1,387 emergency department visits were coded as “work-related accidents,” representing 2.1% of all visits. The peak was observed on July 26 with 122 visits, or 3.4% of the total activity in the emergency departments of the facilities participating in the pilot study.

No visits for conditions specifically related to heat (heatstroke/hyperthermia, dehydration, and hyponatremia) were coded as “work-related accidents.” The diagnoses coded as work-related accidents were primarily trauma: 681 over the period, representing 49.1% of work-related accidents.

It is necessary, on the one hand, to have access to data from previous years in the Île-de-France region in order to compare them with the 2018 data and, on the other hand, to extend the system to other regions in 2019

PACA
The Cire (regional response unit) in PACA receives daily data from 5 of the region’s 6 emergency medical services (SAMU) via the interconnected database of the PACA Regional Emergency Observatory (ORU).

The pilot program conducted in 2018 involved identifying, among the health incidents that prompted a call to the SAMU, those that occurred in the workplace or were related to the victim’s professional activity.

The indicators tracked as part of this pilot project are: the number of dispatch records (DR) related to work; the number of DRs with the reason for call listed as “Trauma” or “Illness” and related to work; the number of DRs with the diagnosis “Illness” and related to work; the number of DRs with the diagnosis “work-related accident.”

These data were analyzed by Cire-PACA, and the results of the analyses were sent to the Occupational Health Directorate of Santé publique France every two weeks outside of heatwave periods and once a week during heatwaves.

The number of cases handled by emergency medical services (SAMU) for incidents occurring in the workplace between weeks 30 and 32 was 1,640, including 225 patients diagnosed with “illness,” representing 13.7% of incidents occurring in the workplace during those two weeks.

Catherine Buisson,
Director of the Occupational Health Division, Santé publique France

As a “co-creator” of the Gast program, can you tell us about the early days of this project? What challenges did you face?

What stands out to me is that it got off to an extremely positive start; the pilot of the program conducted in Aquitaine since June 2008 was carried out with energy and enthusiasm, as the Cire and the partners strongly believed in the project. The local context greatly facilitated its gradual rollout in other regions.

As for the challenges, I would mention the lack of consistency in responses from partners (ARS, Direccte, etc.), since they were required to conduct separate investigations, resulting in uncoordinated responses to the reporting entity.

In your opinion, what is the added value of such a system?

In terms of added value, it breaks down institutional barriers and bridges the gap between public health and occupational health. I would also say that it fosters regional dynamism in the field of occupational health.

How do you view this system today? And in the future?

The Gast system is now indispensable, fully integrated into our healthcare system. It is now recognized by health authorities.

I believe it is imperative to continue expanding it until it covers the entire country, including the overseas departments. The “environment” component will eventually need to be integrated into it. In my view, it is important in the future to maintain and strengthen the sociological approach, which is essential to any investigation.

This is a real step forward! I wish the program a long life!

Imported malaria cases among temporary workers.

In July 2018, the Infectious Diseases Division of Santé publique France was notified of several cases of malaria among temporary workers employed on a bridge construction project in Sierra Leone.

In total, three people employed by two different companies and working on the same construction site were affected upon their return from the assignment, one of whom died from complications of the disease.

The Direccte (Regional Directorates for Enterprises, Competition, Consumer Affairs, Labor, and Employment) of Brittany and Auvergne launched an investigation to determine the health conditions of the personnel working on this site prior to their departure (medical examination, travel advice, provision of antimalarial prophylaxis, etc.). The two malaria cases, in which the patients did not die, were reported as work-related accidents.

Following the intervention of the Labor Inspectorate, the absence of a risk assessment and an action plan regarding the specific situation of expatriates was identified. The company was referred to the occupational physician to organize employee information sessions and follow-up. The Health, Safety, and Working Conditions Committee (CHSCT) conducted an investigation and made recommendations.

This report highlighted shortcomings in health risk prevention for temporary staff. Such measures appear even more necessary prior to the expatriation of staff to regions involving risks other than those directly identified in job descriptions, particularly the risk of infection—which is often minimized or ignored—or the risk of traffic accidents.

• A course on the characteristics and investigative methods for unexplained mass illness (EMI) will be offered in March 2019 as part of the University of Angers’ University Diploma (DU) program in “Building Health Quality—Undergraduate Level.”

• The Gast system will be presented to the Occupational Medicine Society of the PACA region in April 2019