Research D isasters strike suddenly, often involve large groups of people, cause substantial personal and societal damage, and lay a considerable burden on economic and public health resources. [1][2][3][4] Rescue workers who rush to help victims and secure the area to prevent further casualties often face dangerous and demanding tasks that involve the risk of possibly fatal injury. Because of potential traumatic effects from these experiences, rescue workers are at risk of health problems after a disaster event.
5Although the negative effects of disasters on the health of primary victims are well documented, 1,6-9 research on health consequences for rescue workers is relatively scarce. Rescue workers are, however, known to suffer psychological and physical health problems after disasters, 5,10-14 and interest in this group is increasing.15 For example, after the 9/11 attack in Manhattan, rescue workers experienced high levels of musculoskeletal, respiratory and eye disorders; 10 after the Oklahoma City bombing, firefighters showed significantly higher rates of posttraumatic stress disorder, depression and anxiety than before that event.14 Although rescue workers may suffer disaster-related health problems, their health seems to be affected less than that of primary victims, which suggests some level of additional resilience. 1,5,14,[16][17][18][19] Rescue work is generally performed by young, healthy men with extensive training and experience with calamities. Moreover, employers probably select personnel according to their suitability for emergency work, and self-selection makes it probable that only suitable individuals remain working in this demanding field. 1,14,16,20 Because prior health information on people who undergo a calamity is ordinarily unavailable, it remains uncertain whether the health problems observed can be attributed to the disaster. 21,22 In some countries, however, health information is routinely recorded in general practice, in hospitals and by occupational health services; this policy allows researchers to collect health data pre-and postdisaster and to validate whether the event directly affected the health of victims and rescue workers. [22][23][24][25][26] Predisaster health information has previously been used to examine the effect of a disaster on the health of rescue workers in 2 studies: in Oklahoma 14 and the Netherlands, 25 respectively. To investigate how a disaster affected the health of rescue workers, we made use of information on absences from work