Public Safety

Burden

Public safety workers have stressful jobs and regular exposures to potentially traumatic and unpredictable events such as exposure to threatened or actual assaults, fires, explosions, and natural disasters. 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].

Exposure to these events one time, or multiple times over a career has been associated with the development of mental disorders, such as PTSD and depression, as well as a vulnerability for alcohol and substance misuse [Bucerius, et al 2019; Lerman 2017; James et al 2017; Boffa et al 2016; Faust & Ven 2014; Haugen et al, 2012; Haddock et al 2012; Neria et al 2011; Carey et al 2011; Carlier et al 1997]. This includes the effects of cumulative and critical incident stress experienced by wildland firefighters. In some cases, these disorders and other influences may increase public safety workers risk for suicide [Lerman, 2017; Martin et al 2016; Violanti 2013; Violanti 2010; Violanti et al 2009]. Public Safety workers often ignore their own emotional wellbeing during emergency responses and may not receive the training to engage in appropriate self-care before, during, and after a disaster, waiting instead to seek care only once symptoms appear, significantly interfere with work, or become severe.

Need

Despite early, emerging research on this topic, additional insights into the scope and nature of these risks and the appropriate, population-specific mitigations and interventions are lacking. In response to these limitations, accurate surveillance data is needed and more comprehensive approaches need to be developed and tested to evaluate risk and resiliency among various response and recovery worker populations and disaster scenarios, including traumatic incidents. Training is needed pre-event to enable responder populations (e.g., EMS, law enforcement, fire fighters) to enhance their own coping and resiliency skills based on scenario types (e.g., mass casualty, infectious disease outbreaks, responding to the opioid crisis). Such efforts have been recently initiated for subsectors such as wildland firefighting with the addition of mental health checklists within the National Wildfire Coordinating Group’s Incident Response Pocket Guide update [NWCG, 2022]. Additionally, field-friendly tools, such as mobile applications, are needed to rapidly identify those incidents and exposures requiring immediate follow-on medical care. Other needs include training for managers and team leads in this scenario to be aware of preventive efforts they can put in place in real-time to mitigate the hazards workers face, and training on early detection and intervention for workers at risk. This has been a traditionally overlooked area of need for specific subsectors, including wildland. firefighting

There is a virtual absence of data to describe exposures and risks to workers who may be exposed to opioids by the nature of the work they do, or the environments where they work. This includes law enforcement who respond to crime scenes, emergency response workers who respond to overdoses, and corrections officers who conduct inmate or cell searches for illicit drugs including opioids or respond to inmate overdoses. Data are needed to characterize and describe physical and psychosocial risks, like the trauma, and long-term stress resulting from responding to overdose victims.

Burden

There are over 2.7 million people in the United States employed in occupations in the public safety sector [NIOSH 2018]. This estimate does not account for volunteers as they make up a large proportion of firefighters, wildland firefighters, and EMS personnel. A variety of occupational hazards potentially affect the health of public safety workers. Due to a variety of risks and stressors, emergency response activities expose public safety workers to the possibility of serious injuries from traumatic injuries, exposure to hazardous substances (including drugs), and acute and chronic diseases. The nature of occupations within the Public Safety sector requires workers to be in close contact with various hazards that may expose them to workplace violence. For example, 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 a. 2015]

Chronic diseases, such as cardiovascular disease (CVD) and cancer, are some of the greatest threats to public safety workers’ health. Occupational stress can lead to high blood pressure and cholesterol levels, which increases the risk of heart disease, hypertension, diabetes, stroke, and a host of other physical ailments [APA 2016, Fujishiro et al. 2015]. Sudden cardiac deaths are one of the leading causes of death for law enforcement officers, wildland firefighters, and correctional officers; and are the main cause of death for firefighters [NFPA 2015].

Systemic changes to our economy and socio-demographic workforce factors are ren­dering some past approaches to protecting workers ineffective. Increasingly, employ­ers face tighter profit margins, demanding timelines and global completion. Workers and employers must navigate new types of work arrangements, the aging of the workforce, high levels of work-related stress, and the growing challenges of both work and home life. Many public safety employers continue to confront the legacy hazards of the traditional workplace, such as traumatic injury, chemical exposures, and shift work. At the same time, scientific evidence now supports what many safety and health professionals, as well as workers themselves, have long suspected—that risk factors in the workplace can contribute to common health problems previously considered unrelated to work.

Need

Total Worker Health promotes the integration of occupational safety and health (OSH) protection with workplace policies, programs, and practices to prevent injury and illness and advance overall health and well-being through research, interventions, partnerships, and capacity-building to meet the needs of the 21st century workforce. Evidence suggests that integrating occupational safety and health protection program activities with health promotion program activities may be more effective for safeguarding worker safety, health, and well-being than either of these programmatic activities on their own (Sorensen et al, 2013; NIOSH, 2012; DeJoy, 1993; Sauter, 2013). Despite these developments, there is need for continued research to better understand the benefits of integrated approaches to prevention and to promote more comprehensive intervention, especially among certain occupations and industries.

According to the NFPA, 73% of fire departments do not have a program to maintain basic fire fighter fitness and health, such as is encouraged by NFPA 1500, Standard on Fire Department Occupational Safety and Health Program [NFPA, 2016].  Although the number of Total Worker Health® programs in other Public Safety sub-sectors (law enforcement, corrections, and emergency medical services) is not known, it is anticipated there are few agencies with active and effective programs that emphasize Total Worker Health® and it is likely that participation in many of these programs is voluntary.  Studies have shown positive correlations between programs on health-related behavior and medical cost outcomes, evidence for positive effects on diet, exercise, smoking, alcohol use, physiologic markers and healthcare costs and various studies with Public Safety departments and agencies have shown similar findings as well [Bower 2013; Kuehl et al. 2013, 2016; Mabry et al. 2013].