Research suggests Ontario paramedics face an elevated risk of developing all cancers compared to other workers but face a particularly high risk for melanoma and prostate cancer.
 
These findings are similar to cancer risks identified in firefighters and police in the same cohort of Ontario workers studied by a team of researchers from the Occupational Cancer Research Centre. Despite the differences in job tasks among these three categories of emergency service workers, similar elevated cancers may indicate some common exposures.
 
“Paramedics share many of the same exposures as firefighters and police as they respond to calls in private homes, public spaces and emergency incidences such as fires, building collapses, motor vehicle incidents and also natural disasters,” says Dr. Jeavana Sritharan, who led the team of OCRC researchers examining the cancer risk for these groups of emergency service workers.
 
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Shared carcinogenic exposures

Dr. Sritharan presented the findings of two related studies on June 13, 2024, at an event hosted by the Institute for Work and Health (IWH) in partnership with the Workplace Safety and Insurance Board (WSIB) and the Ministry of Labour, Immigration, Training, and Skills Development (MLITSD).
 
“Our findings potentially indicate there are some similar carcinogenic exposures that need to be further investigated such as vehicle exhaust, solar radiation and night shift work. There may be other occupational exposures involved that we can’t assess such as stress, for example.” The researchers also identified contaminants in smoke when attending fire events that may add to elevated cancers among paramedics.
 
This was highest for melanoma, with paramedics found to have a 2.18 times greater risk compared to other workers. This was very similar to the significantly elevated cancers identified in firefighters and police. Researchers suggest exposure to solar radiation through open windows or when working outdoors along with exposure to polychlorinated biphenyls (PCBs) and polycyclic aromatic hydrocarbons (PAHs) in smoke when at fires may explain this increase.
 
The risk of developing prostate cancer was next highest for paramedics at 1.73 times compared to other workers. Possible causes of these cancers noted by researchers included shift work and exposure to heavy metals such as cadmium and arsenic when at fires.
 
Overall, OCRC researchers found elevated risks of at least five per cent for 11 specific cancer sites including stomach, colon, rectum, pancreas, female breast, prostate, testis, kidney, thyroid, and leukemia. These findings were identified from more than 7,000 paramedics included in this study. These workers were identified from the Occupational Disease Surveillance System (ODSS) from 1996 through 2019—a cohort established to examine occupational diseases among Ontario workers.
 
The same researchers reviewed data for more than 13,000 firefighters and 22,000 police found in the ODSS from 1983 through 2020. Both groups had statistically significant increased risk for any cancer, cancer of the prostate and colon, along with melanoma. Firefighters also had increased risk of pancreatic, testicular and kidney cancer, and non-Hodgkin’s lymphoma and leukaemia. Police faced increased risk of thyroid, bladder and female breast cancer. Both firefighters and police also faced elevated risks of at least five per cent for many other specific cancer sites.

Evidence supports pursuit of prevention

This research provides important insight helping to better understand the hazardous exposures adding to elevated cancers among understudied Ontario paramedics.
 
The OCRC researchers feel the findings underscore the importance of future investigative work looking into the potential shared exposures among all three emergency services worker groups. They also suggest, “Better resources and education efforts could be provided to increase awareness about the importance of precautions and appropriate controls to reduce carcinogen exposures. This can lead to better understanding of carcinogens and other exposures among paramedics and inform cancer prevention strategies.”
 
For police and firefighters, the researchers suggest, “Findings from this larger worker population may have important implications for workplace and policy-level changes to improve preventative measures and reduce potential exposures to known carcinogenic hazards."

Legal obligations to protect workers

Employers of paramedics and other emergency services workers should take heed of this advice considering, like all employers, they have the most significant obligations to protect their safety and health. Chief among these obligations is to prepare and review at least annually a written occupational health and safety policy that should include a commitment to identify carcinogens and implement measures to eliminate or reduce exposure. Employers are also required to develop, in consultation with the Joint Health and Safety Committee (JHSC), and maintain programs to implement this policy, including training for workers and supervisors.
 
Employers are also specifically required to ensure a worker who performs work for the employer completes basic occupational health and safety awareness training. This training must cover a range of topics such as carcinogens and other common hazards, worker rights, along with employer and supervisor obligations to protect workers.   
 
To this last point, employers must ensure supervisors complete occupational health and safety awareness training and be competent to carry out their significant obligations.
 
They must also provide training programs necessary to enable a JHSC member to become certified and remain certified. This training can help JHSC members meet their obligations including identifying, assessing and recommending measures to protect workers from carcinogens and other hazards. 
 
This OCRC research underscores the need to continue efforts to identify and address work-related carcinogens and for cancer surveillance among paramedics and other emergency services workers. Training can help prepare workplace parties for this critical, life-saving work.

WHSC can help

As Ontario’s official government-designated occupational health and safety training centre for more than 35 years, Workers Health & Safety Centre (WHSC) helps workplaces comply with many training requirements including worker health and safety awareness, JHSC Certification, HSRs in small workplaces, supervisors and WHMIS. We also offer several hazard-specific training programs.
 
Each WHSC program is developed to ensure participants learn practical, applicable information and skills they can apply in pursuit of safer, healthier work.
 
To ensure our training programs are accessible, we offer sessions in virtual classrooms and in-person in multiple locations across the province including Hamilton, London, Markham, Ottawa, Sudbury, Toronto, and Windsor.

Don’t see what you need beyond our scheduled classes? Where participant numbers warrant, one of our Training Services Representatives located in communities across Ontario can work with you to coordinate almost any of our training courses in-person or online in our virtual classrooms.
 
Related resources
Cancer Risks among Emergency Medical Services Workers in Ontario, Canada
Cancer Risk among Firefighters and Police in the Ontario Workforce
Shift Work (WHSC)
Diesel Exhaust (WHSC)
Sun Safety (OHCOW)
Work Stress (WHSC)
Occupational Cancer Research Centre (OCRC)

For service or training in French, contact Training Services Representative, Christopher Gervais, cgervais@whsc.on.ca or 613-407-2187.

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