Your last breath?

Your last breath?
The dangers of diesel engine exhaust fumes
Trainer notes
Click to start.
This slide includes sound, so please make sure you have access to speakers and that your
computer’s volume is turned up. The image is of a man dying from occupational cancer.
Click to move to the next slide.
Explain: This short presentation is designed to raise awareness of cancer caused by work,
specifically from exposure to diesel engine exhaust fumes. It’s aimed at everyone – at some
point, we all come into contact with diesel. Print and hand out the delegate factsheet.
Click to move to the next slide.
This slide lists the key learning points.
Explain: There are four key learning points:
 What does occupational health mean to you?
 What does occupational cancer mean to you?
 How can diesel fumes be deadly?
 How can we reduce exposure to diesel fumes?
Click to move to the next slide.
What does occupational health mean to you?
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This slide introduces the term ‘occupational health’.
Ask delegates what occupational health means to them. Give them a minute or two
and ask for their answers. They may come up with suggestions such as yoga,
health checks by a nurse, healthy meals at lunchtime, bike schemes and a work
sports club. Explain that these are examples of wellbeing, not occupational health.
The wellbeing of employees is important. Influencing employees to make positive
lifestyle choices can help improve the sustainability and productivity of a workforce.
Click to reveal the first two bullet points on the slide:
• health problems workers bring to the workplace
• health issues caused or made worse by work.
Explain to delegates that the effects may be immediate and visible, but are more often
unseen and take a long time to develop.
Click to move to the next slide.
Additional support information
There’s a lot of confusion as to what ‘occupational health’ means. Occupational ill health
refers to all health problems in the work environment. The term covers health problems
workers bring to the workplace, as well as health issues caused or made worse by work. It
covers serious and fatal diseases, physical effects on skin, breathing, hearing, mobility and
functioning, and psychological effects on mental wellbeing.
Effects may be immediate and visible, but are more often unseen and take a long time to
develop, so vigilance and monitoring can be key to identifying problems. Some effects can
be cured if diagnosed early; many can only be prevented from getting worse. Of course,
some diseases are terminal.
In summary
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Occupational health management should focus primarily on dealing with the risks caused
by workplace exposure to hazardous substances or activities.
Occupational health management should integrate with other health checks or initiatives.
The aim of an integrated approach is a healthier, more productive workforce.
Workplace ill health kills and ruins lives
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Managing workplace health helps employers retain experienced and skilled workers, and
helps keep employees in productive employment.
Workplace ill health is preventable. It’s possible and practicable to carry out work without
causing ill health.
Risks to health can be managed by eliminating the risk; controlling and minimising
exposure; and taking precautions to prevent adverse effects.
Checking workers’ health is not a substitute for managing and controlling health risks.
Monitoring shouldn’t be given priority over managing the risk by eliminating, controlling
and minimising exposure.
Helping workers tackle other lifestyle risks to their health is not a substitute for managing
workplace health risks.
This slide explains what occupational cancer is. It has three bullet points.
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Before you reveal the bullet points, ask delegates what they understand occupational
cancer to be. Typical answers may include exposure to asbestos, dust, fumes and the
Sun.
Click to reveal first bullet and explain: When you get diagnosed at hospital, you would
be told, ‘You have lung cancer’, for example. The term occupational cancer is used to
describe all cancers contracted following exposure to a cancer-causing agent
(carcinogen) at work. Cancer-causing agents include:
o asbestos fibres
o coal tars
o metalworking fluids
o mineral oils
o pesticides
o pitches
o silica dust
o solar radiation
o solvents
o tetrachloroethylene
o varnishes
o wood dusts
o welding fumes
o shift work
o diesel engine exhaust fumes
Explain: The focus for the rest of the presentation is on one of these only – diesel
engine exhaust fumes.
Click to move to the next slide.
Support information
Cancer caused by what people do at work is nothing new. The first case of an occupational
cancer in the UK was identified in 1775 – ‘soot wart’, a skin carcinoma suffered by chimney
sweeps who were diagnosed as young as their late teens. It took another 150 years to find
out that it was down to a carcinogen found in coal soot.
Today, asbestos claims well over 100,000 lives a year worldwide, and is the biggest work
cancer killer. It was flagged up as a danger by the UK’s Chief Factory Inspector in 1898 – the
first recorded case of an occupational pulmonary death caused by exposure to asbestos
followed the next year.
But it wasn’t until 1931 that the UK introduced the first law on asbestos. And it wasn’t
completely banned as a building material until 1999. In some parts of the world, it’s still used
as a building material.
Now we have the most compelling evidence yet of how much damage work-based
carcinogens can cause – and it’s not just down to asbestos. In 2012, Dr Lesley Rushton of
Imperial College London published her comprehensive research report linking thousands of
different cancer deaths with occupations – in other words, joining the dots between what
killed an individual, and what they did for a living. This type of research has never before
been tackled on such a scale, anywhere in the world, and shows the true cost of cancer in
the UK:
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almost 14,000 new cases of cancer caused by work are registered each year
around 8,000 people die annually from occupational cancer.
Cancer caused by work is the fifth biggest cause of avoidable cancer in the UK, behind
lifestyle choices such as smoking or diet. Five per cent of avoidable cancers in the UK are
caused by work, often unknowingly. The annual financial cost to the UK government,
employers and individuals for work-caused cancer is estimated to be more than £10 billion.
Someone’s chances of developing cancer caused by what they’ve been exposed to at work
is, of course, influenced by factors ranging from whether they smoke to their family’s health
history. But it’s widely accepted that exposure has a strong impact on the likelihood of
getting a work-caused cancer, even without these. For example, the International Agency for
Research on Cancer, part of the World Health Organization, compared the risks from diesel
fumes to those from passive smoking, and estimated that people regularly exposed to diesel
fumes at work are about 40 per cent more likely to develop lung cancer.
Some cancers are diagnosed up to 10 years after the sufferer has been exposed to a
carcinogen at work. Others can take more than 35 years to develop. Many cancers can be
prevented by cutting down exposure to carcinogens. Some cancers can be detected early
enough to be treated and cured. Even with late-stage cancer, the pain can be reduced and
the disease slowed down. Early intervention is critical to increasing the chances of surviving
cancer – and it relies on early detection.
This slide asks ‘How can diesel fumes be deadly?’ There are three bullet points. Before
you click to reveal them, ask delegates what they think makes diesel fumes deadly.
Before you click to the next slide, explain to delegates they are now going to get involved
in something called the straw walk. As soon as you click to the next slide, a short film will
begin automatically.
Support information
At the very least, short term, high level exposures to diesel exhaust fumes can irritate the
eyes and lungs. Continuous exposure to diesel exhaust fumes can cause long term, or
chronic, respiratory ill health, with symptoms including coughing and feeling breathless. At
worst, if people are exposed to diesel engine exhaust fumes regularly and over a long
period, there is an increased risk of getting lung cancer. This is the same type of cancer
that’s caused by asbestos and some other industrial chemicals, and doesn’t just affect
people who smoke. There is limited evidence to suggest that chronic exposure is also
linked to a higher chance of suffering bladder cancer.
Scientists agree that the risk of cancer is linked with the particulate emissions in the fumes
– the soot, rather than the gases or vapours. The particulates are easily inhaled and drawn
deep into the lungs. Diesel engine exhaust exposure is now often measured by the
elemental carbon concentrations in the air inhaled by workers.
Even if people lead a healthy life, don’t smoke and don’t have a strong history of cancer in
the family, exposure to diesel exhaust fumes may still cause lung cancer, depending on
the amount of airborne particulate.
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Diesel fumes can cause lung and bladder cancer
Cancer caused by diesel fumes has killed thousands worldwide
About 650 people in Britain will die this year from cancer caused by diesel fumes
they were exposed to at work
Here are some typical questions you may get asked:
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The figures on this seem high – how can it be proved?
Research has been done in a number of different countries linking diesel fume
exposure to the work people do and the cancer they get. In the UK, a recent
research report, funded by the Health and Safety Executive and the largest of its
kind in the world, looked at patients who suffered from different forms of cancer and
then linked it to the work they did. Dr Rushton and her team of researchers found a
strong link between diesel exposure at work and lung and bladder cancers.
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What about if people smoke – isn’t that what gives them lung cancer?
Robust research takes lifestyle issues into account. The Rushton research was
adjusted to reflect what are known as ‘confounding factors’, such as smoking.
People who don’t smoke can still get lung cancer as a result of diesel fume
exposure. People who do smoke and are exposed to diesel fumes are more likely to
get lung cancer than if they just smoked
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Diesel is much cleaner now – is this still a problem?
It depends on the standards in the country you’re operating in. For example, in EU
countries, there should are higher standards – since 1992/93 there has been a
steady reduction in allowable emissions on new vehicles, including cars, trucks,
trains, tractors and barges. The latest reductions were in 2008/09 with the Euro 5/V
standard and in 2013/14 with the Euro 6/VI standard. In other parts of the world, for
example Africa and Asia, standards for diesel are lower. Different equipment will
have different standards too – for example, a diesel generator would not be covered
by some vehicle exhaust emission standards, and seagoing ships are excluded. In
addition, remember that more recent vehicle emission standards only apply to new
vehicles, so older vehicles are likely to produce higher emissions
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What is it in diesel that causes cancer?
The risk of cancer is linked with the particulate emissions in the fumes – the soot,
rather than the gases or vapours. Diesel engine exhaust exposure is now often
measured by the elemental carbon concentrations in the air inhaled by workers.
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Who is most likely to be at risk?
Anyone working with or around diesel-powered equipment or vehicles can be
affected. Emissions from diesel vehicles, such as forklifts, lorries, buses, trains and
tractors – particularly in enclosed spaces like garages or workshops – can cause a
problem. People working with fixed power sources, such as compressors,
generators or power plants – in sectors like tunnelling, mining or construction –
could also be at risk.
The main risk employment areas for exposure to diesel engine fumes include:
 agriculture
 construction
 energy extraction
 mining
 rail
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shipping
transport/logistics
tunnelling
vehicle repair
warehousing.
People who could be at risk include:
 bridge and tunnel workers
 bus, lorry and taxi drivers
 car, lorry and bus service and repair workers
 construction workers
 depot and warehouse workers
 farmworkers
 heavy equipment operators
 loading dock and dockside ferry workers
 maritime workers
 material handling operators
 miners
 oil and gas workers
 railway workers
 refuse collection workers
 toll booth and traffic management workers.
To give delegates an indication of what it’s like breathing with damaged lungs from
diseases such as those caused by cancer, ask them to do the straw walk.
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Make sure everyone who wants to take part is in good health and no one is
asthmatic.
Give each person a straw and ask them to walk at least 50 metres and go up and
down a flight of stairs.
When they return, ask them to pinch their noses and breathe through the straw.
Discuss with delegates how they feel.
Now it’s time for another activity. But, before you begin, ask delegates to think of a time
when they’ve been driving when the car in front is billowing out black or blue smoke. Ask
them ‘What did you do – close the air vents, open the window? Or perhaps, you’ve been
walking down a high street when a car passes, doing the same, and you’ve had to hold
your breath. Explain to delegates: If you’ve been in such situations, you’ve been exposed
to diesel exhaust fumes.
How the second activity works:
 Use an aerosol; for example, an air freshener.
 You should stand at one end of the room.
 Give a short, sharp spray of the aerosol to release a few millilitres.
 Ask each delegate in the room to raise their hand when they can smell the
fragrance. You’ll notice that all delegates, even those who are furthest away, raise
their hand almost immediately.
 Explain that this demonstrates how quickly you could be exposed to even a small
amount of diesel fumes in an enclosed space.
Think about Oxford Street in London. Ask delegates to raise their hand if they’ve been
there, and ask them: ‘What can you see?’ Some typical answers might be ‘lots of shops’,
‘Marble Arch’, ‘lots of people’, ‘lots of traffic’. Explain that there are lots of diesel-powered
taxis and buses, and one thing you can’t see is the diesel engine fumes. Pollution from
road traffic is a serious health hazard, and diesel exhaust fumes have become an
increasing concern.
This slide looks at how we can reduce exposure to diesel exhaust fumes.
Explain: Small changes in how work is managed or carried out can make a big difference
to exposure levels and the resulting risk of getting cancer. Put simply, cutting exposure to
carcinogens stops cancers developing.
Ask: How can we reduce our exposure to diesel fumes?
Click to reveal each bullet and let your delegates discuss each point in turn:
 Ask if you want more information
Ask delegates: Do you know who to ask about protecting yourself from diesel fumes
in your workplace?
 Do what you’re asked to protect yourself – always do your job in the way
you’ve been directed
Ask delegates: Are you doing your job in the way you’ve been asked to? Are you
doing it correctly every time or sometimes taking short cuts?
 If you need to wear protective kit, make sure it fits properly and you use it the
right way – and use it every time you need to
Ask delegates: How often does your kit get changed or replaced? Do you know who
to speak to if you need replacement kit or if you think your kit is faulty? How often
does your company invest in new kit?
 Make sure your work mates do the same
Ask delegates: Having now sat through this presentation, would you feel
comfortable seeing somebody working where they’re exposed to diesel fumes?
Would you feel confident challenging them to wear their PPE now you know the
dangers?
 Report any problems to your employer, eg faulty or missing equipment
Ask delegates: Do you know who to report faulty equipment to?
Support information
In many countries, controlling exposure to carcinogens is a legal requirement – either
under explicit laws or under general health and safety protection legislation. Employers
who don’t get it right could be prosecuted and fined – and see their reputation take a hit
too. There is also, of course, a strong moral argument for making sure that workers aren’t
exposed to dangerous substances as part of what they do for a living.
When employers assess the risks of diesel exhaust fume exposure to their employees,
they need to ask themselves:
 are diesel engines or equipment used in the workplace?
 do engines or machines emit blue or black smoke?
 are diesel exhaust fumes released into enclosed working areas such as garages?
 are diesel exhaust fumes drawn into the workplace through ventilation inlets?
 are diesel exhaust fumes concentrated in confined spaces or areas in buildings
where there’s limited air movement?
 are there visible soot deposits on surfaces in the workspace?
 is there a visible haze?
 do those in the work environment suffer from irritated eyes or lungs?
If they answer ‘yes’ to some or all of these basic questions, there could be a risk of people
being harmed by diesel exhaust fumes. If so, they’ll need to arrange a formal assessment
of the hazard, which could include measuring elemental carbon concentrations.
Depending on the results of the assessment, they may need to either prevent or control
the potential exposure.
Typical actions to control exposure include:
 switching to other forms of fuel where possible, eg gas or electric
 replacing old engines with newer versions with lower emissions
 making sure that engines are maintained properly – especially fuel delivery systems
 making sure diesel engine exhausts have filters
 using ‘local exhaust ventilation’ and good general ventilation in fixed or enclosed
workplaces
 using forced ventilation to draw fresh air into the workplace
 using connecting extraction pipes for vehicle exhausts in workshops
 filtering air in vehicle cabs
 making sure that engines are turned off when they’re not needed
 if engines have to be left running, making sure the vehicle or equipment is moved
outside (checking that no one else is then exposed)
 making sure cold engines are warmed up in spaces with good ventilation
 keeping building doors and windows open if it’s practicable
 rotating jobs between different employees to minimise exposure.
This slide lists some of the signs that could mean that diesel engine fume exposure is too
high. Click through each bullet point and let delegates discuss each point.
Ask them if they’ve noticed any of these signs in their workplace, and encourage them to
speak out at their workplace if they think things need checking out or changing.
Also, encourage them to be active about getting professional medical advice if they have a
lingering health problem. In most cases, it won’t be serious – but if there’s a significant
health issue, getting it diagnosed early can help make treatment more effective.
This slide gives you a chance to review what delegates have learned in the session.
Reveal each of the two bullet points in turn and ask delegates to share their answers to
these questions with the whole group.
Click to move to the next slide.
This is the final slide. Thank your delegates for listening and give them the link to the
campaign website for them to find out more.
Support information
IOSH’s ‘No time to lose’ campaign focuses on a range of carcinogenic exposures that are
caused by work activities. We’re aiming to raise awareness and offer practical support to
businesses to help them tackle this significant occupational health issue. Go to
www.notimetolose.org.uk to:
 access free information
 download or order free practical resources
 ask our expert panel for advice
 find out about events and CPD opportunities
 support the campaign
 pledge your commitment to tackling harmful exposures at work
 get the latest news on occupational cancer
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read our national action plan.