Public Safety

Participating core and specialty program: Center for Motor Vehicle Safety, Emergency Preparedness and Response, Personal Protective Technology

Public safety managers, labor organizations, and consensus standards organizations adopt interventions based on NIOSH research to prevent negative mental health outcomes among public safety workers.

  Health Outcome Research Focus Worker Population Research Type
A Post-traumatic stress disorder (PTSD), substance misuse, depression Identify problems before they evolve to PTSD, substance abuse, and depression Law enforcement, fire service, emergency medical service (EMS), and Corrections Surveillance research Intervention
B Stress, anxiety, depression, compassion fatigue Psychosocial impact of responding to opioid misuse and illicit drugs Law enforcement, fire fighters, EMS, corrections Surveillance research Intervention

Activity Goal 7.4.1 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to prevent negative mental health outcomes among public safety workers.

Activity Goal 7.4.2 (Surveillance Research): Conduct surveillance research to characterize and describe physical and psychosocial risks to public safety workers that includes unintentional exposures to drugs and the psychosocial toll of frequent exposure to traumatic incidents.

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]. 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). 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.

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.

Public safety and health department managers, labor organizations, professional associations and consensus standard organizations effectively integrating protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being (i.e. Total Worker Health® [TWH] approach) in the Public Safety sector.

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; illnesses Work and non-work factors that contribute to worker safety, health, and well-being (i.e. Total Worker Health [TWH] approach) (e.g., fatigue, shift work, obesity, violence, stress) Law enforcement, fire service, Emergency Medical Service (EMS), corrections and wildland fire subsectors Intervention
B Fatal and non-fatal injuries; illnesses Improve data around risks to worker safety, health, and well-being Law enforcement, fire service, Emergency Medical Service (EMS), corrections and wildland fire subsectors Surveillance research
C Fatal and non-fatal injuries; illnesses Barriers and facilitators to implementing TWH research findings Law enforcement, fire service, Emergency Medical Service (EMS), corrections and wildland fire subsectors Translation
D Fatal and non-fatal injuries; illnesses Evaluate effectiveness and adoption of TWH polices, practices and programs Law enforcement, fire service, Emergency Medical Service (EMS), corrections and wildland fire subsectors Intervention Translation

Activity Goal 7.14.1 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being in Public Safety.

Activity Goal 7.14.2 (Translation Research): Conduct translation research to understand barriers and aids to implementing policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts in Public Safety.

Activity Goal 7.14.3 (Surveillance Research): Conduct surveillance research to better track risks to worker safety, health and well-being in Public Safety.

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].

APA [2016]. Stress Effects on the Body. Washington, DC: American Psychological Association, http://www.apa.org/helpcenter/stress-body.aspxExternalexternal icon

BLS [2015a]. Census of fatal occupational injuries summary, 2014. Washington, DC: U.S. De­partment of Labor, Bureau of Labor Statistics, http://www.bls.gov/news.release/cfoi.nr0.htm.

BLS [2015b]. Employer-reported workplace injuries and illnesses in 2014. Table 2. Washing­ton, DC: U.S. Department of Labor, Bureau of Labor Statistics, http://www.bls.gov/news.release/pdf/osh.pdfpdf iconexternal icon.

Boffa JW, Stanley IH, Hom, MA, Norr AM, Joiner [2016]. PTSD symptoms and suicidal thoughts and behaviors among firefighters. J Psych Res 84:277-283.

Bower J [2013]. Correctional officer wellness and safety literature review. Washington, D.C.: U.S. Department of Justice Office of Justice Programs Diagnostic Center. Retrieved from www.ojpdiagnosticcenter.org/sites/default/files/spotlight/download/NDC_CorrectionalOfficerWellnessSafety_LitReview.pdfpdf iconexternal icon

Bucerius, SM, and Haggerty, KD [2019].   Fentanyl behind bars: The implications of synthetic opiates on prisoners and correctional officers.  International Journal of Drug Policy 71:133-138.

Carlier IV, Lamberts RD and Gersons BP [1997]. Risk factors for posttraumatic stress symptomology in police officers: A prospective analysis. J Nerv and Ment Disord 185:498-506.

Carey MG, Al-Zaiti SS, Dean GE, Sessanna L, Finnell DS [2011]. Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters. JOEM 53(8): 928-33.

DeJoy D, Southern D [1993]. An integrative perspective on work-site health promotion. J Occup Med. 35: 1221–1230Fujishiro K, Roux AV, Landsbergis P, Kaufman JD, Korcarz CE, Stein JH [2015]. Occupational characteristics and the progression of carotid artery intima-media thickness and plaque over 9 years: the Multi-Ethnic Study of Atherosclerosis (MESA). Occup Environ Med 72(10):690-698 doi:10.1136/oemed-2014-102311.

Faust KL, Ven TV [2014]. Policing disaster: an analytical review of the literature on policing, disaster, and post-traumatic stress disorder. Sociol Compass 8:614-626.

Haddock CK, Jahnke SA, Poston WS, Jitnarin N, Kaipust CM, Tuley B Hyder ML. [2012]. Alcohol use among firefighters in the Central United States. Occup Med (London) 62(8):661-664

Haugen PT, Evces M, Weiss DS [2012]. Treating posttraumatic stress disorder in first responders: a systematic review. Clin Psychol Rev 32:370-380.

James, L, Todak, N, Best, S [2017].  The negative impact of prison work on sleep health.  Am J Ind Med. 60:449-456.

 

Kuehl KS, Elliot DL, MacKinnon DP, O’Rourke HP, DeFrancesco C, Miočević M, Valente M, Sleigh A, Garg B, McGinnis W, Kuehl H [2016]. The SHIELD (Safety & Health Improvement: Enhancing Law Enforcement Departments) study: mixed methods longitudinal findings. J Occup Environ Med 58(5):492.

Kuehl H, Mabry L, Elliot D, Kuehl K, Favorite KC [2013]. Factors in adoption of a fire department wellness program: Champ-and-chief model. J Occup Environ Med 55(4):424-429. https://doi.org/10.1097/JOM.0b013e31827dba3fexternal icon

Leigh JP [2011]. Economic burden of occupational injury and illness in the United States. Milbank Q 89(4):728–772.

Lerman, A [2017].  Officer health and wellness:  Results from the California correctional officer survey.  Goldman School of Public Policy, University of California, Berkeley.

 

Mabry L, Elliot DL, Mackinnon D, Thoemmes F, Kuehl KS [2013]. Understanding the durability of a fire department wellness program. Am J Health Beh 37(5), 693-702. https://doi.org/10.5993/AJHB.37.5.13external icon

Martin CE, Vujanovic AA, Paulus DJ, Bartlett B, Gallagher MW, Tran JK [2016]. Alcohol use and suicidality in firefighters: associations with depressive symptoms and posttraumatic stress. Compr Psychiatry 74:44-52.

Neria Y, DiGrande L, Adams BG [2011]. Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: a review of the literature among highly exposed populations. Am Psychol 66:429-446.

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

NFPA [2015]. Firefighter Injuries in the United States. Quincy, MA: National Fire Protection Association, http://www.nfpa.org/news-and-research/fire-statistics-and-reports/fire-statistics/the-fire-service/fatalities-and-injuries/firefighter-fatalities-in-the-united-statesexternal icon

NIOSH [2019]. Opioids in the workplace field investigations. Cincinnati, OH: 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

NIOSH [2018]. Current U.S. Workforce Data by NORA sector. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Prevention and Control, National Institute for Occupational Safety and Health, https://www.cdc.gov/niosh/topics/surveillance/default.html

NIOSH [2012]. Research Compendium; The NIOSH Total Worker Health™ Program: Seminal Research Papers 2012. Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2012-146, https://www.cdc.gov/niosh/docs/2012-146/default.html.Oliver A and 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

Sauter SL [2013]. Integrative approaches to safeguarding the health and safety of workers. Ind Health 51: 559–561.

Sorensen G, McLellan D, Dennerlein JT, Pronk NP, Allen JD, Boden LI, Okechukwu CA, Hashimoto D, Stoddard A, Wagner GR [2013] Integration of health protection and health promotion: Rationale, indicators, and metrics. J Occup Environ Med 55(12 Suppl.): S12–S18.

Taylor JA, Davis AL, Barnes B, Lacovara AV, and Patel R [2015]. Injury risks of EMS responders: evidence from the National Fire Fighter Near-Miss Reporting System. BMJ Open 5(6). http://bmjopen.bmj.com/content/5/6/e007562external icon

Violanti JM, Robinson CF, Shen R [2013]. Law enforcement suicide: a national analysis. Int J Emerg Ment Health, 15(4):289-97.

Violanti JM [2010]. Police suicide: A national comparison with fire-fighter and military personnel. Int J Police Strat Manag, 33:270-286.

Violanti, JM, Fekedulegn D, Charles LE, Andrew ME, Hartley TA, Mnatsakanova A, Burchfield CM [2009]. Suicide in Police Work: Exploring Potential Contributing Influences. Am J Crim Justexternal icon 34:41-53.

Note: Goal 7.14 was expanded to include opioid misuse and illicit drugs in October 2019.

Page last reviewed: April 24, 2018