A specialized occupational health alert system: the GAST (Occupational Health Alert Group)

Santé publique France regularly receives reports, both at the national level and in the regions, of unusual health events occurring in the workplace, which are submitted by field personnel. The majority of these reports concern clusters of cases of the same disease—primarily cancers—or of the same symptoms. More rarely, they involve reports of exposure that potentially endangers workers’ health.

In response to the increase in the number of such reports since 2006, Santé publique France sought to develop a regionalized system, the GASTs (Occupational Health Alert Groups), whose objective is to organize the regional response to reports of unusual health events occurring in the workplace.

This alert system relies on formalized information channels between the Regional Health Agencies (ARS), Santé publique France (DiRe-Cire and DST), and the regional authorities responsible for protecting workers’ health in the workplace. It enables a rapid, structured, and coordinated response to each report, in order to alert health authorities if necessary and to contribute to the development and implementation of prevention and control measures.

A pilot group was thus established in 2008 in the Aquitaine region. This system is intended to be expanded to the entire national territory, including the overseas departments.

GAST’s Mission

In each region, the GAST’s mission is to handle reports of unusual health events in the workplace. This involves validating and evaluating reports of unusual health events in the workplace. The outcome of this evaluation is the decision on whether or not to conduct an investigation and to formulate recommendations regarding actions to be taken.

Composition of the GAST

Drawing on multidisciplinary and complementary expertise, each Gast is composed of permanent members, specialists in occupational health risks, and intervention epidemiologists. As such, it includes:

• a labor inspector from the Regional Directorate for Enterprises, Competition, Consumer Affairs, Labor, and Employment (Direccte);

• a physician from the Occupational Pathology Consultation (CPP);

• an epidemiologist from the Occupational Health Directorate of Santé publique France;

• an epidemiologist from the relevant Regional Intervention Unit (Cire);

• possibly representatives from other agencies such as the Pension and Occupational Health Insurance Fund (Carsat), the Poison Control and Toxicovigilance Center, etc.;

The Cire coordinates the group.

Alerts are transmitted to the GASTs via the regional health surveillance and emergency platform located within the ARS. The platform, a functional unit between Santé publique France (via the Cire) and the ARS, is tasked with receiving, analyzing, investigating, and managing all events that may pose a risk to public health.

Definition of an unusual health report occurring in the workplace

Any unusual health event occurring in the workplace must be reported to the ARS’s regional health surveillance and emergency platform: clusters of cases of the same disease or symptoms (cancer, fainting spells, etc.), apparent excess deaths, or exposure to a chemical, physical, or biological agent that may impact health.

The report may be made by any occupational health professional, prevention officer, or witness to the event: a member of a Health, Safety, and Working Conditions Committee (CHSCT), a company manager, an occupational or private physician, a company employee, etc.

Charter on Health Expertise and Public Statements of Interest

The organization of the response to occupational health reports through the GAST system falls under the framework of the Charter on Health Expertise (Decree No. 2013-412 of May 21, 2013). In accordance with the provisions of this text, permanent members of the GAST are required to declare any conflicts of interest in order to uphold the principle of independent expertise. To this end, they must complete and sign a public declaration of interests (DPI). An update to the DPI is required once a year. In the event of a change in circumstances, the DPI must be updated.