EMERGENCY PREPAREDNESS AND RESPONSE
Input: Occupational Safety and Health Risks
In addition to the tragic events of September 11, in which over 400 emergency responders were killed, an average of 97 firefighters and 155 police officers died each year between 1990 and 2001, and an average of at least 11 non firefighter emergency medical services personnel died each year between 1998 and 2001. These fatality rates do not include the events of September 11 because the magnitude of those events obscures other trends in the data. Both police and career (paid) firefighters are in the top fifteen occupations for risk of fatal occupational injury, and the traumatic fatality rates are approximately three to four times higher than the average for all occupations. The fatality rate for emergency medical services responders is about two and one-half times the rates for all occupations.
The rate of occupational injury and illness for employees of local volunteer fire and police agencies is similarly elevated. Approximately 88,000 firefighters are injured each year; about 2,000 of their injuries are potentially life-threatening. Approximately 100,000 police were injured in 2000.
The injuries most frequently experienced by firefighters are traumatic injuries, cuts and bruises, burns, asphyxiation and other respiratory injuries, and heat stress. Physical stress and overexertion, falls, being struck or making contact with objects, and exposure to fire products are the primary causes of injury at the fire scene. Physical stress, being lost or trapped in a fire situation, and vehicle crashes are the primary causes of death. Physical stress is responsible for nearly half of all on-duty deaths.
Approximately half of all firefighter injuries occur at the scene of fire emergencies, or "on the fireground." Firefighters experience a much higher risk of injury on the fireground than other emergency incidents or during non-emergency duty. The highest number of injuries from all causes occurs during fire attack and search and rescue. Fire attack is not only one of the most dangerous fireground activities, but also one of the most common. In activities other than fire attack, firefighters are injured most frequently from falls during salvage and overhaul, incident scene support activities, or apparatus use; from physical stress and overexertion or being struck by an object; through forcible entry; and during incident scene support activities.
Most injuries to police are traumatic injuries, and cuts and bruises resulting from vehicle accidents, falls, assaults, and physical stress. Nine out of ten line-of-duty deaths are due to vehicle accidents or assaults. Police are most often injured in falls, assaults, vehicle-related crashes, and through stress and overexertion. Information about emergency medical services injuries and hazards are scarce and far less definitive. These workers are most at risk of sprains and strains, and back injuries represent a higher proportion of injuries for emergency medical services personnel than they do for other responders. Emergency medical services personnel also have a high risk of infectious disease exposure, mostly through percutaneous injuries such as needlesticks. Nearly all on-duty deaths for which data are available are due to aircraft and vehicles crashes. Note that stress-related fatalities are coded as occupational illnesses, not traumatic injuries. Thus, these illness-related deaths effectively double the total on-duty fatality rate for firefighters.
This information, concentrated on the traditional first responders, provides us insight into the conditions and resultant morbidity and mortality faced by the broad category of emergency response providers noted above. Natural disasters, major hazardous materials emergencies, structural collapse, civil disturbance, bomb disposal, hostage situations, and terrorism response all involve intense hazards not normally encountered in routine activities. The consequences of other potential hazards that have not yet been realized, such as large-scale terrorist attacks involving biological or chemical weapons, cannot be effectively captured. This presents one of the ongoing challenges to developing a research agenda. All high-risk non routine activities must be considered to fully assess occupational safety and health needs during response and recovery.
Occupational illnesses are also risks for emergency responders. Mental health issues such as cumulative stress, traumatic stress, and post-traumatic stress disorder are concerns for emergency responders. According to the 2004 NIOSH-funded RAND report, "Protecting Emergency Responders," "The traumatic nature of major disasters can have significant effects on individual responders and on response organizations as a whole."
Rand . Emergency responder injuries and fatalities: an analysis of surveillance data. Pittsburgh, PA: RAND Corporation, Publication No. TR-100-NIOSH. (Prepared for the National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory). http://www.rand.org/pubs/technical_reports/TR100/
NIOSH . Protecting emergency responders, Volume 3: safety management in disaster and terrorism response. Cincinnati, OH: Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. DHHS (NIOSH) Publication NO. 2004-144. RAND Publication No. MG-170. http://www.cdc.gov/niosh/npptl/guidancedocs/rand.html
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