Public Safety

Participating core and specialty program: Emergency Preparedness and Response

Public safety department management, labor organizations, and consensus standards organizations adopt interventions based on NIOSH research to prevent PTSD, suicide, and depression among public safety workers.

  Health Outcome Research Focus Worker Population Research Type
A Post-traumatic stress disorder (PTSD), substance abuse, depression Identify problems before they evolve to PTSD, substance abuse, and depression Law enforcement, fire service, emergency medical service (EMS), and


Surveillance research


Activity Goal 7.4.1 (Intervention Research): Conduct studies to develop and assess the effectiveness of interventions to prevent PTSD, substance abuse, and depression among public safety workers.

Activity Goal 7.4.2 (Surveillance Research): Conduct surveillance to identify the relationship between occupational exposures and PTSD, substance abuse, and depression among public safety workers.


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. 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 abuse [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 [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.


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). 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.

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.

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.

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.

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.

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 34:41-53.

Page last reviewed: April 24, 2018