Public Safety

Participating core and specialty programs: Center for Occupational Robotics Research, Center for Workers’ Compensation Studies, Center for Motor Vehicle Safety, Center for Direct Reading and Sensor Technologies, Health Hazard Evaluations, National Center for Productive Aging and Work, Surveillance, and Translation Research

Public safety department management, labor organizations, workers, and consensus standard organizations adopt interventions based on NIOSH research to prevent motor vehicle incidents and resulting injuries 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 Fatal and non-fatal injuries Collision as vehicle occupant (including fatigue as a risk factor) Law enforcement, fire service and emergency medical service (EMS) subsectors Intervention Translation
B Fatal and non-fatal injuries Struck-by on the side of the road Emergency medical service (EMS) and fire service subsectors Intervention Translation
C Fatal and non-fatal injuries Struck-by on the side of the road Law enforcement subsector Intervention Translation
D Fatal and non-fatal injures Violent encounters related to prescription drug (incl. opioids), illicit drug, and substance use/misuse Law enforcement, EMS, fire service, and corrections subsectors Intervention

Activity Goal 6.11.1 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to prevent motor vehicle collisions, roadside struck-by incidents, and resulting injuries among law enforcement, fire service, and EMS workers.

Activity Goal 6.11.2 (Translation Research): Conduct translation research to understand barriers and aids to disseminating and implementing effective interventions to prevent motor vehicle collisions, roadside struck-by incidents, and resulting injuries among law enforcement, fire service, and EMS workers.

Burden

Over 3.2 million people are employed in occupations in the public safety sector in the U.S. Public safety employees, particularly those engaged in law enforcement, firefighting, and emergency medical service (EMS), have substantial workplace exposure to road traffic hazards, often in emergency situations. Motor vehicle crashes (MVCs) are the leading cause of fatal occupational injuries in the U.S., accounting for 37% of all fatalities in 2015 [BLS 2016a] and among public safety workers, MVCs account for 44% of all fatalities [BLS 2016b]. Law enforcement officers were involved in the highest number of fatal MVCs (n=48), followed by firefighters (n=8) and EMS workers (n=8) [BLS 2016b]. Most of the incidents were due to collisions with other vehicles while the decedent was a vehicle occupant, but 25% occurred when a public safety worker was struck by another vehicle while working outside their vehicle [BLS 2016b]. Risk factors for MVCs involving public safety workers include non-use of occupant restraints, unsafe driving practices, non-use of high visibility clothing, inappropriate incident management, fatigue, and distractions from in-vehicle technology.

Need

In general, MVC risk factors for public safety employees are well-understood. For this worker population, intervention and translation research are the most critical for reducing crashes, injuries, and fatalities. Intervention research is needed because there is limited research to date that has assessed the effectiveness of road safety interventions within the unique operating environments of public safety organizations. Translational research is also important to ensure that information about effective interventions will be accepted and adopted, given the unique cultures of public safety organizations where workers routinely accept risk to help others. Research on implementation of connected vehicle technology may also lead to reduction of MVCs involving public safety workers. NIOSH research that follows the public health model from surveillance through to implementation of effective interventions complements the efforts of other agencies to prevent MVCs and injuries. In addition, NIOSH has built strong working relationships with professional and labor organizations and academic researchers with interest in public safety, increasing the likelihood that NIOSH research results will be adopted.

Public safety and health department management, labor organizations, and consensus standard organizations will adopt interventions based on NIOSH research to prevent injuries among high-risk populations in public safety workplaces.

NOTE: Goals in bold in the table below are priorities for extramural research.

  Health Outcome Research Focus Worker Population Research Type
A Fatal and non-fatal injuries Assault and violent encounters, civil disturbances Law enforcement subsector Intervention
Translation
B Fatal and non-fatal injuries Patient assault, bystander violence Emergency medical service (EMS) and fire service subsectors Intervention
Translation
C Fatal and non-fatal injuries Violent encounters and daily interactions, bystander violence Corrections subsector Intervention
Translation
D Fatal and non-fatal injures Violent encounters related to prescription drug (incl. opioids), illicit drug, and substance use/misuse Law enforcement, EMS, fire service, and corrections subsectors Intervention

Activity Goal 6.12.1 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to prevent violence in public safety worksites.

Activity Goal 6.12.2 (Translation Research): Conduct translation research to understand barriers and aids to implementing effective violence-prevention strategies among public safety workers.

Burden

Violence is a leading cause of injury and death for public safety sector workers. Among correctional officers, assaults account for 40% of fatal injuries and 38% of non-fatal injuries occurring in the workplace from 1999-2008 [Konda et al. 2013]. Correctional officers are in close contact with inmates, often work alone and late at night and may experience institutional and organizational factors that may contribute to increased risk for correctional officer violence such as inmate overcrowding, inadequate officer training, and staffing shortages all of which may increase corrections officers’ risk of workplace violence [Konda et al. 2012]. Correction officers may also encounter violence when conducting person or cell searches for illicit drugs including opioids. They may also be exposed to violence when responding to inmates under treatment for Opioid Use Disorder (OUD) who may be experiencing withdrawal symptom or when responding to inmate overdose situations where the officer may administer naloxone to reverse the overdose.

While just 8% of emergency medical service (EMS) provider fatalities have been attributed to assaults and violent acts [Maguire and Smith 2013], 67% of nationally registered EMS providers reported experiencing verbal violence and 44% reported experiencing physical violence within a one-year period [Gormley et al. 2016]. Recent research has indicated that many EMS workers are required to respond to calls that involve patients under the influence of alcohol or drugs (such as opioids), violent patients, or patients with weapons [Oliver and Levine 2015; Taylor et al. 2015]. They may also experience violence from patients whose overdose is reversed through naloxone. A substantial proportion of emergency medical services are also provided by the many fire departments within the U.S. [NFPA 2016]. Nationwide, 46% of fire departments report providing basic life support and 16% providing advanced life support between 2015-2017 [NFPA 2019]. Firefighters are increasingly encountering violence in the varied first responder responsibilities, particularly EMS calls [Dean 2016; Taylor et al.. 2016]. The latest NFPA Fireground injuries report shows 7% of injuries were due to assault by a person, animal, or object [Campbell 2016]. While NFPA does not have data on injuries or trends in attacks on firefighters, there were nine murders of firefighters while on duty over the past ten years and 19 over the past 20 years [Fahy 2019].

Among law enforcement officers, assaults accounted for 40% of duty-related fatalities in the last decade according to the National Law Enforcement Officers Memorial Fund [2017]. Regarding non-fatal injuries, 35% of law enforcement officers sought treatment at an emergency department for on-duty injuries due an assault or violent encounter [Tiesman et al. 2018]. Multiple factors impact the risk of assaults for law enforcement officers, including region of the country, type of force used on the suspect, type of call, number of officers on scene, and time of day.

Need

The public safety and emergency response community recognizes that violence-related injuries and fatalities are an important and preventable cause of injury. Risk factors for workplace violence in the public safety sector, however, vary widely based on occupation. Accordingly, preventive strategies are also occupation-dependent. Research is limited on effective and realistic strategies to reduce the risk of workplace violence in corrections facilities that take into account the unique work organization factors in this setting. For EMS and firefighters, research is needed to better understand how to protect these workers as they are required to respond to emergency situations. The inherent nature of police work puts law enforcement officers at an elevated risk for physical assault, and evidence-based interventions are needed to reduce risk factors.

Training, protocols, and protective gear all may impact the risk for workplace violence, however, studies on evidence-based strategies to decrease workplace violence incidents in public safety sector employees are rare. Effective safety management systems can play a part in this from the perspective of encouraging workers to report incidents of violence, monitoring those reports, and implementing interventions as appropriate.

Employers, workers, professional associations, policy-makers, researchers, and standard setting bodies use NIOSH information to prevent adverse health effects from unintentional occupational exposure to illicit drugs among public safety workers.

  Health Outcome Research Focus Worker Population Research Type
A Non-fatal injuries Unintentional occupational exposure to illicit drugs Law enforcement, fire service, corrections, and emergency medical service (EMS) subsectors Basic/etiologic
Surveillance research
B Non-fatal injuries How to respond to potential unintentional occupational exposures to illicit drugs Law enforcement, fire service, corrections, and EMS subsectors Intervention

Activity Goal 6.20.1 (Basic/Etiologic Research): Conduct basic/etiologic research to better understand unintentional occupational exposure to and adverse health effects from inhalation and mucus membrane exposure to illicit drugs among public safety workers.

Activity Goal 6.20.2 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to prevent adverse health effects from unintentional occupational exposure to illicit drugs among public safety workers.

Activity Goal 6.20.3 (Surveillance Research): Conduct surveillance research to develop new methods and tools to track unintentional occupational exposures to illicit drugs and associated health effects among public safety workers.

Burden

In this context, illicit drugs are defined as drugs that are either (1) illegal to process, sell, and consume, or (2) are legally prescribed by a physician but have either been misused by a patient with a prescription or illegally obtained by or for a person for whom the drug was not prescribed. These include opioids, stimulants, and other drugs. Synthetic opioids, like fentanyl and tramadol are designed to provide pain relief by mimicking naturally occurring opioids such as codeine and morphine. They tend to be highly potent, which means only a small amount of the drug is required to produce a given effect. For example, fentanyl is 100 times more powerful than morphine [CDC 2019a].

The U.S. is in the midst of an opioid crisis.overdose epidemic. Opioids (including prescription opioids, heroin, and fentanyl) killed more than 47,600 people in 2017, more than any year on record. Thirty-seven percent of all opioid overdose deaths involved a prescription opioid [Hedegaard et al. 2018]. From 2016 to 2017, synthetic opioid-involved overdose death rates increased 45.2% [CDC 2019b]. Reports from law enforcement agencies indicate that synthetic opioid overdoses may be due to illegally made fentanyl. The opioid crisisoverdose epidemic has grown increasingly complex by co-involvement of prescription and illicit drugs [CDC 2019b]. NIOSH has completed several Health Hazard Evaluations at the request of public safety employers and workers concerned about occupational exposures to opioids and illicit drugs, and mental health impacts associated with responding to the opioid crisis [NIOSH 2019].

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 and tablet form. Inhalation and mucous membrane contact are of particular concern. Contaminated personal protective equipment (PPE) can also serve as a source of exposure via contact and aerosol routes.

Exposures could result in lightheadedness, drowsiness, nausea and vomiting, dizziness, often creating the need for medical attention and preventing emergency responders from performing their duties as needed. Effects of opioid intoxication, including the rapid onset of life-threatening respiratory depression, would be the most severe adverse health effects that could be possible after excessive exposure to illicit opioids. There are no established federal or consensus occupational exposure limits for fentanyl or its analogues.

Need

There is a virtual absence of data to describe exposures and risks to workers who may be exposed to illicit drugs by the nature of the work they do, or the environments where they work. This includes law enforcement who respond to crime scenes and emergency response workers, including firefighters, who respond to overdoses. Data are needed to characterize and describe physical risks like potential inhalation, and absorption of opioids through mucous membranes. There is a critical knowledge gap regarding PPE decontamination and cleaning procedures for reusable PPE used in the presence of illicit drugs.

Surveillance research needs to be conducted to develop new procedures, methods, data sources and tools for gathering illicit drug exposure data for public safety workers. Currently, surveillance research is focused primarily on intentional use/misuse of opioids. More work is needed on low-dose exposure assessment and surveillance to fill these research gaps.

Basic and etiological research is needed to better understand the physical health effects of unintentional occupational exposures to illicit drugs. Studies are needed 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 public safety workers.

BLS [2016a]. TABLE A-2. Fatal occupational injuries resulting from transportation incidents and homicides, all United States, 2015. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshcfoi1.htmexternal icon

BLS [2016b]. Table A-6. Fatal occupational injuries resulting from transportation incidents and homicides by occupation, all United States, 2015. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, https://www.bls.gov/iif/oshwc/cfoi/cftb0300.xlsxexcel iconexternal icon

Campbell R [2016]. Patterns of Firefighter Fireground Injuries. Quincy, MA: National Fire Protection Association Research, https://www.nfpa.org/News-and-Research/Data-research-and-tools/Emergency-Responders/Patterns-of-firefighter-fireground-injuriesexternal icon

CDC [2019a] Synthetic Opioid Overdose Data. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, https://www.cdc.gov/drugoverdose/data/fentanyl.html

CDC [2019b]. Drug and opioid-involved overdose deaths — United States, 2013–2017. MMWR 67(5152):1419–1427, https://www.cdc.gov/mmwr/volumes/67/wr/mm675152e1.htm?s_cid=mm675152e1_w

Dean A [2016]. Scene safety: violence against firefighters. Fire Engineering, 169(10).

Fahy R [2019]. Personal communication from NFPA applied researcher to NIOSH, August 2019.

Gormley MA, Crowe RP, Bentley MA, Levine R [2016]. A national description of violence experienced by emergency medical services personnel. Prehosp Emerg Care 20(4):439–47.

Hedegaard H, Minino AM, Warner M [2018]. Drug overdose deaths in the United States, 1999-2017. NCHS Data Brief No. 329. Hyattsville, MD: National Center for Health Statistics, November. https://www.cdc.gov/nchs/products/databriefs/db329.htm

Konda S, Reichard AA, Tiesman HM [2012]. Occupational injuries among U.S. correctional officers. J Safety Res 43(3):181-86.

Konda S, Tiesman H, Reichard A, Hartley D [2013]. Correctional officers killed or injured on the job. Correct Today 75(5):122–123.

Maguire BJ, Smith S [2013]. Injuries and fatalities among emergency medical technicians and paramedics in the United States. Prehosp Disaster Med 28(4):376–82.

National Law Enforcement Officers Memorial Fund [2017]. Facts and figures: deaths, assaults and injuries over the last decade (2007-2016). Washington, DC: National Law Enforcement Officers Memorial Fund, http://www.nleomf.org/facts/officer-fatalities-data/daifacts.htmlexternal icon

NFPA [2016]. Fourth needs assessment of the U.S. fire service. Quincy, MA: National Fire Protection Association. https://www.nfpa.org/-/media/Files/News-and-Research/Fire-statistics-and-reports/Emergency-responders/Needs-Assessment/OSFourthNeedsAssessment.ashxexternal icon

NFPA [2019]. U.S. Fire Department Profile 2017. Quincy, MA: National Fire Protection Association,  https://www.nfpa.org/-/media/Files/News-and-Research/Fire-statistics-and-reports/Emergency-responders/osfdprofile.pdfpdf iconexternal icon

NIOSH [2019]. Opioids in the workplace: field investigations. 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/opioids/fieldinvestigations.html

Oliver A,Levine R [2015]. Workplace violence: a survey of nationally registered emergency medical services professionals. Epidemiol Res Int 28: https://www.hindawi.com/journals/eri/2015/137246/external icon

Taylor JA, Davis AL, Barnes B, Lacovara AV, Patel R [2015]. Injury risks of EMS responders: evidence from the National Fire Fighter Near-Miss Reporting System. BMJ Open 5(6). doi:10.1136/bmjopen-2014-007562

Taylor JA, Barnes B, Davis AL, Wright J, Widman S, Levasseur M [2016]. Expecting the unexpected: a mixed methods study of violence to EMS responders in an urban fire department. Am J Ind Med 59(2):150-163. https://onlinelibrary.wiley.com/doi/full/10.1002/ajim.22550external icon

Tiesman HM, Gwilliam M, Konda S, Rojeck J, Marsh SS [2018]. Nonfatal injuries to law enforcement officers: a rise in assaults. Am J Prev Med 54(4): 503-509.

Note: In October 2019, goal 6.12 was revised to include row D and goal 6.20 was added.

Page last reviewed: April 24, 2018