Public Safety/Immune, Infectious and Dermal Disease Prevention (PSSxIID)
Participating core and specialty programs: Emergency Preparedness and Response, Personal Protective Technology
Employers, workers, professional associations, policy-makers, researchers, and consensus standard organizations use NIOSH information to prevent transmission of infectious disease among public safety workers.
NOTE: Goals in bold in the table below are priorities for extramural research.
| Health Outcome | Research Focus | Worker Population | Research Type | |
|---|---|---|---|---|
| A | Infectious disease (e.g., tuberculosis, hepatitis) | Adapt guidelines to prevent exposure to blood and bodily fluids | Corrections and law enforcement subsectors | Intervention |
| B | Infectious disease (e.g., tuberculosis influenza, SARS-CoV-2) | Exposures to and long-term effects of airborne and vector-borne infectious diseases | Corrections, law enforcement, fire service, wildland firefighting, and emergency medical service (EMS) subsectors | Basic/etiologic
Surveillance research |
| C | Infectious disease (e.g., tuberculosis, influenza) | Underutilization of personal protective equipment (PPE) to prevent infectious disease transmission | Corrections and law enforcement subsectors | InterventionTranslation |
| D | Infectious disease (e.g., tuberculosis, influenza) | No reporting of infectious disease exposures; Industry/occupation variables not included in existing surveillance systems | Corrections, law enforcement, and EMS subsectors | Surveillance research |
Activity Goal 3.6.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand relationship between exposures to airborne and vector-borne infectious diseases among public safety workers.
Activity Goal 3.6.2 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to prevent the transmission of infectious diseases among law enforcement and corrections workers.
Activity Goal 3.6.3 (Translation Research): Conduct translation research to understand barriers and aids to effective use of PPE to prevent infectious disease transmission among law enforcement and corrections workers.
Activity Goal 3.6.4 (Surveillance Research): Conduct surveillance research to develop new methods and tools to measure infectious disease exposures among public safety workers.
Burden
The public safety sector workforce includes emergency medical service (EMS), corrections, law enforcement, fire service, and wildland firefighting. These public safety professionals can be exposed to airborne and vector-borne infectious diseases and blood and bodily fluid disease causing pathogens in performing their duties. These regularly include tuberculosis, human immunodeficiency virus (HIV), Hepatitis B and C, influenza, and methicillin-resistant Staphylococcus aureus (MRSA), with the additional potential to involve emerging or epidemic threats such as but not limited to Ebola.[Thomas et al. 2017; Roberts 2014; Amiry et al. 2013; Sayed et al.2011; Gershop et al. 2007; Speers 2014; IAFF 2000] This also includes SARS-CoV-2, the virus that causes COVID-19. EMS and fire service workers provide lifesaving, medical support and other functions in unpredictable and uncontrolled environments and under adverse conditions which can increase the risk of exposure. [Sayed 2011]. Corrections officers can be exposed to a variety of infectious agents when interacting with detainees and inmates [Bick 2007; Gershop et al. 2007]. Infectious agents vary in their routes of transmission and can occur via contact with the skin, mucous membranes such as the eyes and nose, or inhalation. Not wearing appropriate personal protective equipment (PPE) such as respiratory protection, eye/face protection, gloves and gowns can increase the risk of exposures.
Need
Public safety workers, especially law enforcement and corrections officers face volatile work situations and encounters with uncooperative individuals. The work environment often is an uncontrolled setting with the possibility of exposure to large amounts of blood and bodily fluids. Surveillance research needs to be conducted on the development and implementation of new methods and tools to gather data, measure and report the extent of infectious disease exposures among these workers. Basic research needs to be conducted to better define the exposure pathways to airborne and vector-borne diseases among public safety workers. Additionally, etiologic research and surveillance efforts are needed to address knowledge gaps in the long-term effects of airborne and vector-borne infectious diseases. For example, there is a lack of understanding of the potential long-term health outcomes associated with COVID-19, such as “long COVID”, for public safety workers who perform highly strenuous and physical work [Graham, 2021]. Interventions to prevent exposures and transmissions of infectious diseases needs to be developed and studies conducted to demonstrate their effectiveness. Translational research is needed to understand the barriers to the adoption and use of PPE among law enforcement and corrections workers and to translate OSHA and NIOSH fact sheets and publications to other languages to increase their utility to the public safety workers.
Employers, workers, professional associations, policy-makers, researchers, and standard setting bodies use NIOSH information to prevent dermal exposure to illicit drugs among public safety workers.
| Health Outcome | Research Focus | Worker Population | Research Type | |
|---|---|---|---|---|
| A | Fatality, systemic toxicity | Exposure to fentanyl and other illicit drugs | Law enforcement and emergency medical service (EMS) subsectors | Basic/etiologic
Surveillance research |
| B | Fatality, systemic toxicity | How to respond to potential exposures to fentanyl and other illicit drugs | Law enforcement and EMS subsectors | Intervention |
Activity Goal 3.7.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand the health effects of dermal exposures to illicit drugs among law enforcement and EMS workers.
Activity Goal 3.7.2 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to mitigate potential dermal exposures to illicit drugs among law enforcement and EMS workers.
Activity Goal 3.7.3 (Surveillance Research): Conduct surveillance research to develop new methods and tools to measuring dermal exposures to illicit drugs among law enforcement and EMS workers.
Burden
Between 2000 and 2014, the death rate from drug over dosage in the U.S. has more than doubled, and in 2014, 61% of drug overdose deaths involved some type of opioid, including heroin [CDC 2016]. The rate of drug overdose deaths involving synthetic opioids (e.g., fentanyl and tramadol) and non-pharmaceutical fentanyl manufactured in illegal laboratories (illicit fentanyl) nearly doubled between 2013 and 2014 [CDC 2016]. Reports from law enforcement agencies indicate that synthetic opioid overdoses may be due to illegally made fentanyl. Fentanyl and its analogues pose a potential hazard to a variety of responders who could come into contact with these drugs in the course of their work. Possible exposure routes to fentanyl and its analogues can vary based on the source and form of the drug. Responders are most likely to encounter illicitly manufactured fentanyl and its analogues in powder, tablet, and liquid form. Potential exposure routes of greatest concern include inhalation, mucous membrane contact, ingestion, and percutaneous exposure (e.g., needlestick). Any of these exposure routes can potentially result in a variety of symptoms that can include the rapid onset of life-threatening respiratory depression. Skin contact is also a potential exposure route, but is not likely to lead to overdose unless large volumes of highly concentrated powder are encountered over an extended period of time. Brief skin contact with fentanyl or its analogues is not expected to lead to toxic effects if any visible contamination is promptly removed [NIOSH 2018].
Need
Surveillance research needs to be conducted to development new procedures, methods, and tools for gathering illicit drug exposure data for law enforcement and EMS workers. Basic research is needed to better understand the physical health effects of contacting opioids and the emotional effects including trauma, long term stress resulting from illicit drug exposures among law enforcement and EMS workers. Studies need to be completed to assess the modes of exposure that are of greatest risk and the effectiveness of interventions to mitigate the potential exposures to illicit drugs among law enforcement and EMS workers.
Amiry AA, Bissell RA, Maguire RJ, Alves DW [2013]. Methicillin-resistant staphylococcus aureus nasal colonization prevalence among Emergency Medical Services personnel. Prehosp Disaster Med 28(4):348-352.
Bick R [2007]. Infection control in jails and prisons. Clin Infect Dis 45(8):1047-1055.
CDC [2016]. Increases in drug and opioid overdose deaths – United States, 2000-2014. MMWR 64(50);1378-82 https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6450a3.htm
DEA [2017]. DEA warns local law enforcement and first responders about the dangers of fentanyl exposure. Washington, DC: U.S. Department of Justice, U.S. Drug Enforcement Administration, https://www.dea.gov/divisions/hq/2017/hq060617.shtml
Gershon RRM, Sherman MF, Mitchell C, et al. [2007]. Prevalence and factors for bloodborne exposure and infection in correctional care workers. Infect Control Hosp Epidemiol 28:24-30.
IAFF (International Association of Fire Fighters) [2000]. 2000 death and injury survey. Washington DC: International Association of Fire Fighters. http://www.iaff.org/hs/PDF/2000%20D&I.pdf
NIOSH [2018]. Fentanyl: preventing occupational exposure to emergency responders. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, https://www.cdc.gov/niosh/topics/fentanyl/risk.html
Reed E, Daya MR, Jui J, Grellman K, Gerber L, Loveless MO. [1993]. Occupational infectious disease exposures in EMS personnel. J Emerg Med 11(1):9-16.
Roberts MC [2014]. Environment surface sampling in 33 Washington State fire stations for methicillin-resistant and methicillin-susceptible Staphylococcus aureus. Am J Infect Control 42(6):591-596.
Sayed ME, Kue R, McNeil C, Dyer KS [2011]. A descriptive analysis of occupational health exposures in an urban emergency medical services system: 2007-2009. Prehosp Emerg Care 15(4):506-510.
Speers D [2014]. Infectious disease and the prehospital practitioner. Australasian J Paramed 1(1):1-9.
Thomas B, O’Meara P, Spelton E [2017]. Everyday dangers – the impact infectious disease has on the health of paramedics: a scoping review. Prehosp Diseaster Med. Epub 2017 Jan 30.
Note: The burden statement for Goal 3.7 was revised in March 2019 to reflect the latest science.