Health Of First Responders Research Articles

"Breaking down in tears, soaked in sweat, and sick from the heat": Media-based composite narratives of first responders working during the 2021 Heat Dome.

During the summer of 2021, a deadly, unprecedented multiday Heat Dome engulfed western Canada. As a result of this extreme heat event (EHE), emergency dispatchers received an unparalleled increase in incoming 911 calls for ambulance, police, and fire (as first responders) services to attend to hundreds of heat-vulnerable community members succumbing to the heat. With 103 all-time heat records broken during this EHE and indoor temperatures of nearly 40°C, the first responders attending these calls faced extensive job demands and highly challenging operating conditions. Initial investigations have explored the health system-level impacts; however, little has been done to explore the impact on the first responders themselves. Therefore, this study aimed to improve our understanding of EHEs' impacts on the operational capabilities and health of first responders, specifically police, fire, ambulance, and dispatch services. A systematized review and content analysis of media articles published on the 2021 Heat Dome in Canada was conducted (n = 2909), and four media-based composite narratives were developed highlighting police, fire, ambulance, and dispatch services. The Job Demands-Resources (JD-R) model was applied as atheoretical framework for occupational burnout. The media-based composite narratives highlighted that first responders faced record-breaking call volumes, increased mental-health-related claims, and exhaustive heat-related physiological stress. Using the JD-R model as a theoretical framework for occupational burnout, we identified three measures of stressful job demand: work overload (e.g., the surge in call volume, firefighters responding to medical emergencies), emotional demands (e.g., severe medical emergencies, sudden deaths, unresponsive patients, distraught family members), and physical demands (e.g., resuscitation in personal protective equipment, heat-related illness). The experiences described underscore the importance of supporting first responders during work in extreme heat conditions. These findings have important implications for addressing rising rates of burnout during and following public health crises, such as EHEs, a problem that is increasingly being recognized as a threat to the Canadian public healthcare system.

After the fall: Responding to the Champlain Towers building collapse.

In June 2021, a condominium in Florida collapsed, with the loss of 98 lives. Search and rescue teams spent 2 weeks, recovering the victims. This study's objective was to assess the presence of psychological symptoms that might emerge in the following months, using the PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7), Suicide Cognitions Scale-Short (SCS-S), and the Insomnia Severity Index (ISI). A monthly survey conducted for 3 months found that overall, mean scores on these measures did not indicate significant emotional distress. We then compared the scores when the group was divided into responders who recovered human remains and those who did not. Scores were significantly higher among the subgroup that recovered human remains. Fifty-three percent (53%) of this sub-group met the cut-off score for a provisional diagnosis of PTSD, depressive disorder or generalized anxiety disorder-15% met the cut-off score criteria on the PCL-5 for probable PTSD, 36.8% for probable depressive disorder on the PHQ-9, and 26.3% for probable generalized anxiety disorder on the GAD-7. The results are consistent with other investigations examining mental health after mass disasters. Specifically, not all first responders will develop emotional distress but certain recovery activities may put some responders at higher risk, with a percentage displaying psychological distress. The results emphasize the need to assess the impact of these events on the mental health of first responders and to consider strategies to prevent or mitigate the development of impairing psychopathology.

Electron beam technology for Re-processing of personal protective equipment

Beginning with the outbreak of COVID-19 at the dawn of 2020, the continuing spread of the pandemic has challenged the healthcare market and the supply chain of Personal Protective Equipment (PPE) around the world. Moreover, the emergence of the variants of COVID-19 occurring in waves threatens the sufficient supply of PPE. Among the various types of PPE, N95 Respirators, surgical masks, and medical gowns are the most consumed and thus have a high potential for a serious shortage during such emergencies. Considering the unanticipated demand for PPE during a pandemic, re-processing of used PPE is one approach to continue to protect the health of first responders and healthcare personnel. This paper evaluates the viability and efficacy of using FDA-approved electron beam (eBeam) sterilization technology (ISO 11137) to re-process used PPE. PPEs including 3M N95 Respirators, Proxima Sirus gowns, and face shields were eBeam irradiated in different media (air, argon) over a dose range of 0–200 kGy. Several tests were then performed to examine surface properties, mechanical properties, functionality performance, discoloration phenomenon, and liquid barrier performance. The results show a reduction of filtration efficiency to about 63.6% in the N95 Respirator; however, charge regeneration may improve the re-processed efficiency. Additionally, mechanical degradation was observed in Proxima Sirus gown with increasing dose up to 100 kGy. However, no mechanical degradation was observed in the face shields after 10 times donning and doffing. Apart from the face shield, N95 Respirators and Proxima Sirus gown both show significant mechanical degradation with ebeam dose over sterilization doses (>25 kGy), indicating that eBeam technology is not appropriate for the re-processing these PPEs.

Peer support facilitates post-traumatic growth in first responders: A literature review

Introduction First responders are routinely exposed to traumatic workplace incidents that can result in post-traumatic stress disorder (PTSD). First responder organizations utilize different types of peer led programs to support first responders following a critical incident including the Critical Incident Stress Management Program (CISM) and stand-alone peer support programs. Little research has been done to determine the benefits or limitations of stand-alone peer support programs on the mental health of first responders. The aim of this project was to understand what characteristics of peer support facilitate post-traumatic growth (PTG) in first responders. Methods A literature search was completed using the City University of Seattle library database, ResearchGate and Google Scholar. The studies used in this review were found on EBCSOhost, ProQuest, PubMed and Wiley Online. This review includes literature published since 2006 that references post-traumatic growth in first responders, and/or their preferences for support, their coping styles and organizational impacts on growth. Thematic analysis was conducted to identify the themes and patterns in the final 10 research papers. Results This literature review identified five themes of formal and informal peer interactions that support PTG in first responders. (1) Peer support assists first responders with the processing of traumatic events and (2) managing organizational stressors. (3) Peer support alone may not lead to PTG and requires the use of adaptive coping behaviours. (4) First responders who actively engage with peer support experience increased well-being and (5) relational safety with peers encourages disclosure that leads to post-traumatic growth. Conclusion Formal and informal peer support contribute to post-traumatic growth (PTG) in first responders. Further research needs to be done to differentiate between the effects of trained peer support and support from colleagues.

The protective effects of perceived cohesion on the mental health of first responders.

First responders are repeatedly exposed to traumatic and stressful situations. Perceived cohesion can mitigate the potentially harmful psychological impact of these stressors. While the positive effects of cohesion have been established in other trauma-exposed populations such as the military, these effects have not been examined in first responders. Furthermore, prior studies have not ruled out the possibility that perceived cohesion may be acting as a proxy for another well-established protective factor, social support. We therefore examined how perceived cohesion among first responder organizations impacts psychological health and resilience, even after accounting for the effects of social support. First responders (N = 182) completed measures of perceived cohesion, social support, psychological symptoms (including depression, stress, anxiety, posttraumatic stress symptoms, secondary traumatic stress symptoms, and burnout), and psychological resilience. Even after controlling for social support, perceived cohesion was associated with lower levels of psychological symptoms (β = -.18 to -.33; p < .05; for secondary traumatic stress, posttraumatic stress, depression, and each facet of burnout) and higher levels of resilience (β = .37; p < .05). These results suggest that perceived cohesion promotes psychological health among first responders, even after controlling for social support. Thus, perceived cohesion does not seem to be acting as a mere proxy for social support. Further examination of how perceived cohesion benefits first responders could lay the groundwork for interventions to improve their mental health and psychological resilience. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for The Protective Effects of Perceived Cohesion on the Mental Health of First Responders

Supplemental Material for The Protective Effects of Perceived Cohesion on the Mental Health of First Responders

Exploring the impact of the COVID-19 pandemic on the mental health of first responders

ABSTRACT The present investigation evaluated the preliminary impact of COVID-19 exposure on first responder mental health. Data were collected between June and August 2020. The sample was comprised of 189 first responders (M age = 47.58, SD = 10.93; 21% female), recruited nationally, who completed an online survey. Results indicated that COVID-19-exposed first responders were more likely to be emergency medical services [EMS] personnel (vs. non-EMS) in career (vs. volunteer) roles. COVID-19-exposed first responders reported higher alcohol use severity; no other between-group differences were noted. COVID-19-related worry and medical vulnerability were incrementally associated with more severe symptoms of anxiety and depression; only COVID-19-related worry was associated with alcohol use severity. Among the subset of first responders (n = 122) who reported COVID-19 exposure, COVID-19-related worry was significantly associated with PTSD symptom severity. Covariates included gender, trauma load, years as a first responder, and COVID-19 exposure. Clinical and policy implications as well as future directions will be discussed.

Work-related factors in the etiology of symptoms of post-traumatic stress among first responders: the Brazilian Firefighters Longitudinal Health Study (FLoHS).

Two important aspects must be accounted for when discussing the mental health of first responders and, in particular, their report of post-traumatic stress symptoms (PTSS). The first concerns the provision of quantitative data from longitudinal study designs, the second concerns the sophistication of the work-related model used to frame such studies. This is a report on the development of a model for Brazilian firefighters who also work as first responders, from the establishment of a longitudinal panel design study, the Brazilian Firefighter Longitudinal Health Study (FLoHS). The first objective was to compare trainee and active firefighters based on their follow-up data with a nationwide sample of similarly aged Brazilians. The second was to test the effect that operational and organizational experiences had on firefighters' PTSS level during follow up. At baseline, trainee firefighters came from higher socioeconomic backgrounds, were healthier and less exposed to trauma compared to a similarly aged national sample. At follow up, they reported higher prevalence of smoking, sleep problems, anhedonia and were more likely to be overweight. PTSS was predicted by operational and organizational stressors, even when controlled for health status at baseline. The results present not only the differences in the predictive status of operational and organizational events in relation to PTSS, but also how the effects of such events might interact. The data suggest the need for evidence-based interventions, support provided and changes at work environments to improve report rates for mental health in general and for PTSS in particular.

Compassion for Oneself and Others Protects the Mental Health of First Responders.

ObjectivesFirst responders are at elevated risk for psychological distress from frequent exposure to potentially traumatic events. Self-compassion may buffer against the negative impact of these stressors, and the potential emotional challenges of having high levels of compassion for others. However, little is known about the psychological impact of compassion in first responders. We examined how self-compassion, compassionate love for others, and service role interacted to predict mental health in a diverse group of first responders.MethodsFirst responders (N = 171) with both traditional and emotional support roles completed an online survey including measures of self-compassion, compassionate love, psychological distress, post-traumatic stress, secondary traumatic stress, burnout, resilience, compassion satisfaction, and life satisfaction.ResultsGreater self-compassion and compassionate love both independently predicted less depersonalization (|β|s ≥ .18, ps < .01). Greater self-compassion predicted less general psychological distress, post-traumatic stress, secondary traumatic stress, and emotional exhaustion, as well as greater resilience and life satisfaction (|β|s ≥ .35, ps < .001). Greater compassionate love predicted greater personal accomplishment and compassion satisfaction for all first responders (|β|s ≥ .30, ps < .001); for traditional first responders only, greater self-compassion predicted greater personal accomplishment and compassion satisfaction (role x self-compassion; |β|s ≥ .16, ps < .05). Emotional support first responders reported less emotional exhaustion and greater resilience than traditional first responders (|β|s ≥ .21, ps < .05).ConclusionsSelf-compassion and compassionate love each play important roles in promoting mental health among first responders. Programs designed to increase compassion could be beneficial in this population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12671-020-01527-y.

The Effectiveness of Interventions Aimed at Improving Well-Being and Resilience to Stress in First Responders

Abstract. First responders are routinely exposed to traumatic critical incidents, placing them at higher risk for developing stress-related psychopathology and associated health problems than the general population. Interventions which could improve resilience to stress may help to protect the health of this high risk population. We systematically reviewed such interventions for first responders to determine which ones work and why. We searched the Cochrane and Campbell Collaboration Library, EMBASE, IBSS, Medline, PILOTS, PubMed, PsycINFO, and SCOPUS from January 1, 1980 to June 28, 2018 for randomized and quasi-randomized controlled studies aiming to improve well-being, resilience, or stress management for police, ambulance, fire, or search and rescue workers using non-pharmacological interventions. Data were extracted from published reports and obtained from authors. Within- and between-group effect sizes were calculated for mental and physical health outcomes. Risk of bias was assessed using the Cochrane Collaboration’s Risk of Bias Tool. The initial search identified 3,816 studies, 13 of which were eligible for analysis ( n = 634 cases, n = 628 controls). Six studies demonstrated intervention-related improvements. However, risk of bias was mostly unclear or high. Within-group intervention effect sizes ranged from −0.82 (95% CI [−1.48, −0.17]) to 2.71 [1.99, 3.42] and between-group intervention effect sizes ranged from −0.73 [−1.25, −0.21] to 1.47 [0.94, 2.01], depending on the outcome. Largest effects were seen for interventions that targeted modifiable risk factors for trauma-related psychiatric disorders. Targeting modifiable predictors of trauma-related psychiatric disorders through training may protect the health of first responders who routinely face trauma in their line of work.

Risk factors for incident prostate cancer in a cohort of world trade center responders

BackgroundDespite a relatively young average age and no routine screening, prostate cancer is one of the most common cancers in men who worked at the World Trade Center (WTC) following the 9/11/2001 disaster. This study evaluated whether re-experiencing stressful memories of a traumatic event was associated with prostate cancer incidence.MethodsParticipants were males from one clinical center that monitors the health of first-responders (N = 6857). Monitoring began in July 2002 and occurs annually but does not include prostate cancer screening. Severity of physical exposures and of re-experiencing memories and stress responses were measured at study enrollment using standardized and validated methods in all participants. The outcome was incidence of diagnosed prostate cancer after enrollment (n = 68). Bivariate analyses provided age-adjusted incidence rates (aIR). Cox proportional hazards modeling was used to calculate incidence; hazards ratios (HR) were reported.ResultsThe mean age of responders on 9/11/2001 was 37.9 years. Prostate cancer incidence was lowest in responders with no re-experiencing stress (aIR = 250.83/100,000 person-years, [233.41–268.25]) and highest in responders with severe re-experiencing stress (aIR = 818.49/100,000 person-years, [801.07–835.91]). Cox proportional hazards regression revealed that re-experiencing the stressful events of 9/11/2001 was associated with increased prostate cancer incidence (HR = 1.96 [1.26–3.05], P = 0.003), even upon adjusting for confounders.ConclusionsThis is the first study to identify a positive association between re-experiencing a traumatic event and prostate cancer incidence. Our results are consistent with recent rodent model evidence demonstrating a direct biological link between stress pathways and prostate tumorigenesis and offer new hypotheses in the causality of prostate cancer.

Mental health and mindfulness amongst Australian fire fighters

BackgroundWhile extensive research has highlighted the positive mental health outcomes associated with mindfulness, little work has examined how mindfulness may protect the mental health of first responders exposed to trauma. This is important as there is increasing evidence that mindfulness skills, if protective, can be taught to groups of at-risk workers. The purpose of the current research was to examine the potential role mindfulness may have in supporting the mental health of Australian fire fighters.MethodsThe sample consisted of 114 professional fire fighters who completed demographic and job-related questions followed by measures of mindfulness (FMI-14), well-being (WHO-5), depression (HADS-D) and anxiety (HADS-A). Hierarchical multiple linear regressions were performed to determine whether levels of mindfulness were associated with anxiety, depression and wellbeing after accounting for age and number of years of fire service.ResultsHigh levels of mindfulness were associated with decreased depression (p ≤ .001) and anxiety (p ≤ .001) as well as increased psychological well-being (p ≤ .001). Measures of mindfulness were able to explain a substantial amount of the variability in well-being (26.8%), anxiety (23.6%) and depression (22.4%), regardless of age and years of fire service.ConclusionsThe present study provides evidence for robust associations between dispositional mindfulness and mental health markers of depression, anxiety and well-being in Australian fire fighters recently exposed to trauma. Mindfulness is a psychological characteristic that may be able to be modified, although further research is required to substantiate these findings and to formally test mindfulness interventions. Such studies would allow greater insight into the underlying mechanisms through which mindfulness may exert its beneficial effects.

Stress among on-duty firefighters: an ambulatory assessment study.

BackgroundStress at work has been broadly acknowledged as a worldwide problem and has been the focus of concern for many researchers. Firefighting, in particular, is frequently reported as a highly stressful occupation. In order to investigate firefighters’ occupational health in terms of stress events, perceptions, symptoms, and physiological reactions under real-world conditions, an ambulatory assessment protocol was developed.MethodsSeventeen firefighters’ cardiac signal was continuously monitored during an average of three shifts within a working week with medical clinically certified equipment (VitalJacket®), which allows for continuous electrocardiogram (ECG) and actigraphy measurement. Psychological data were collected with a software application running on smartphones, collecting potential stressful events, stress symptoms, and stress appraisal.ResultsA total of 450.56 h of medical-quality ECG were collected, and heart rate variability (HRV) analysis was performed. Findings suggest that although ‘fire’ situations are more common, ‘accidents’ are more stressful. Additionally, firefighters showed high levels of physiological stress (based on AVNN and LF/HF HRV metrics) when compared to normative healthy population values that may not be diagnosed using merely self-reports.DiscussionThe proposed ambulatory study seems to be useful for the monitoring of stress levels and its potential impact on health of first responders. Additionally, it could also be an important tool for the design and implementation of efficient interventions and informed management resolutions in real time. Potential applications of this research include the development of quantified occupational health (qOHealth) devices for real life monitoring of emergency personnel stress reactions.

Protecting the Mental Health of First Responders: Legal and Ethical Considerations

The public safety, human services, health, and relief workers who comprise the first wave of a response to natural or man-made disasters play a critical role in emergency preparedness. These first responders provide care and services in the immediate aftermath of emergencies and may remain in affected communities for weeks or months. They often work long hours under stressful conditions, witnessing the human harms, physical destruction, and psychological devastation that can accompany disasters.

Stress and First Responders: The Need for a Multidimensional Approach to Stress Management

AbstractFirst responders are exposed to traumatic, nontraumatic and organisational stressors that conspire to create stress, potentially leading to emotional issues and/or physical or psychological illness. In addition to individual consequences, stress also takes a toll on the function of emergency departments and their communities. Fortunately, police, fire and ambulance agencies have initiated various preventive measures in an effort to mitigate the ill-effects of continued exposure to stressors by their personnel. However, combating stress effectively requires more than offering individual coping skills and access to counseling for first responders. To best preserve the wellbeing of their workers, emergency service administrators must recognise the impact of stress from a variety of sources, including organisational factors, and approach stress prevention in a multi-staged and comprehensive manner, paying special attention to primary stage interventions. When agencies embrace and act on a broad, holistic view of stress management that includes instituting cultural and organisational changes to support stress prevention, significant improvements in the stress level and health of first responders will be possible.