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First Responders Behavioral Health Concerns

First responders are usually the first on the scene to face challenging, dangerous, and draining situations. They are also the first to reach out to disaster survivors and provide emotional and physical support to them. These duties, although essential to the entire community, are strenuous to first responders and with time put them at an increased risk of trauma.

It is estimated that 30 percent of first responders develop behavioral health conditions, including, but not limited to, depression and post-traumatic stress disorder (PTSD), as compared with 20 percent in the general population.¹ In a study about suicidality, firefighters were reported to have higher attempt and ideation rates than the general population.² In law enforcement, the estimates suggest between 125 and 300 police officers commit suicide every year.³

Those who are among the first to respond to a disaster are referred to by different terms, depending on whether the speaker and audience are part of federal government, state and local government, or other entities, and they may not be clearly defined at all. According to Title 6—Domestic Security of the U.S. Code, first responders include these individuals and groups:

• The term emergency response providers includes Federal, State, and local governmental and nongovernmental emergency public safety; fire; law enforcement; emergency response; emergency medical (including hospital emergency facilities); and related personnel, agencies, and authorities.²
• The terms first responders and public health workers (the term used in some papers) are somewhat arbitrary; the terms include police, firefighters, search-and-rescue personnel, and emergency and paramedical teams.⁵ This article focuses on three major groups that will be combined under the term first responders:
  • Emergency medical services (EMS)
  • Firefighters
  • Police officers

Background—First Responders' Behavioral Health

Protecting the population's health is a vital part of preserving national security and the continuity of critical national functions. However, public health and public safety workers experience a broad range of health and mental health consequences as a result of work-related exposures to natural or human-caused disasters.⁵ First responders involved in these occupations are exposed to hazards inherent in the nature of their jobs.⁶ Examples include the exposure (direct or indirect) to death, grief, injury, pain, or loss as well as the direct exposure to threats to personal safety, long hours of work, frequent and longer shifts, poor sleep, physical hardships, and other negative experiences.^7–11

Many natural or technological disasters produce overwhelming disruption to the social, familial, economic, and physical structure of the affected community.^12,13 Disaster response is usually made up of a wide array of professional and volunteer organizations with varying levels of disaster experience. Collateral damage, or the intra- and interpersonal disturbances that arise from disaster work, can be observed among both professional and volunteer first responders.¹²

Ideas Forward

To improve the behavioral health of the first responders, a cooperative effort is needed between organizational leadership and coworkers to establish a work environment that provides adequate training, ensures the resiliency and health of first responders by protecting them from overwork and excessive stress, and supports them in seeking help when needed. First responders carry the weight of their own safety and wellbeing as well as that of those they serve. Thus, making programmatic changes to educate them, offer them support, and protect their health and wellbeing would reduce the risk of burnout, fatigue, or other behavioral health issues associated with being overworked, uncertain, or stressed.

Behavioral and public health agencies can help prevent or alleviate behavioral health issues in first responders through preventive training on resiliency and behavioral health prior to disasters or other events, interventions to address burnout, and peer-support programs. As noted, such efforts and programs are a cultural shift in these fields—professions in which workers sometimes have coped with disastrous and traumatic experiences on the job by trying to disregard their reactions or using other maladaptive techniques, such as substance misuse. As more first responders discover the resilience they can access through others, and particularly their peers, they become better able to maintain their own behavioral health while addressing the myriad challenges of disaster response.

References

1. Abbot, C., Barber, E., Burke, B., Harvey, J., Newland, C., Rose, M., & Young, A. (2015). What's killing our medics? Ambulance Service Manager Program. Conifer, CO: Reviving Responders. Retrieved February 1, 2024, from www.revivingresponders.com
2. Stanley, I.H., Hom, M.A., & Joiner, T.E. (2016). A systematic review of suicidal thoughts and behaviors among police officers, firefighters, EMTs, and paramedics. Clinical Psychology Review, 44, 25–44. doi: 10.1016/j.cpr.2015.12.002
3. Badge of Life. (2016). A study of police suicide 2008–2016. Retrieved February 1, 2024, from https://badgeoflife.org
4. United States Code (U.S.C.). (2011). Title 6 – Domestic security, 6 U.S.C. § 101 (2010). Washington, DC: U.S. Government Publishing Office. Retrieved February 1, 2024, from https://www.govinfo.gov
5. Benedek, D.M., Fullerton, C., & Ursano, R.J. (2007). First responders: Mental health consequences of natural and human-made disasters for public health and public safety workers. Annual Review of Public Health, 28, 55–68. doi: 10.1146/annurev.publhealth.28.021406.144037
6. Plat, M.J., Frings-Dresen, M.H., & Sluiter, J.K. (2011). A systematic review of job-specific workers' health surveillance activities for fire-fighting, ambulance, police and military personnel. International Archives of Occupational and Environmental Health, 84(8), 839–857. doi: 10.1007/s00420-011-0614-y
7. Botha, E., Gwin, T., & Purpora, C. (2015). The effectiveness of mindfulness based programs in reducing stress experienced by nurses in adult hospital settings: A systematic review of quantitative evidence protocol. JBI Database of Systematic Reviews and Implementation Reports, 13(10), 21–29. doi: 10.11124/jbisrir-2015-2380
8. Heavey, S., Homish, G.G., Andrew, M.E., McCanlies, E., Mnatsakanova, A., Violanti, J.M., & Burchfiel, C.M. (2015, March). Law enforcement officers' involvement level in Hurricane Katrina and alcohol use. International Journal of Emergency Mental Health, 17(1), 267–273.
9. Marmar, C.R., McCaslin, S.E., Metzler, T.J., Best, S., Weiss, D.S., Fagan, J., et al. (2006). Predictors of posttraumatic stress in police and other first responders. Annals of the New York Academy of Sciences, 1071, 1–18. doi: 10.1196/annals.1364.001
10. Patterson, P.D., Weaver, M.D., Frank, R.C., Warner, C.W., Martin-Gill, C., Guyette, F.X. et al. (2012). Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehospital Emergency Care, 16(1), 86–97. doi: 10.3109/10903127.2011.616261
11. Quevillon, R.P., Gray, B.L., Erickson, S.E., Gonzalez, E.D., & Jacobs, G.A. (2016). Helping the helpers: Assisting staff and volunteer workers before, during, and after disaster relief operations. Journal of Clinical Psychology, 72(12), 1348–1363. doi: 10.1002/jclp.22336
12. Mitchell, J.T. (2011). Collateral damage in disaster workers. International Journal of Emergency Mental Health and Human Resilience, 13(2), 121–125.
13. Miller, L. (2011). Psychological interventions for terroristic trauma: Prevention, crisis management, and clinical treatment strategies. International Journal of Emergency Mental Health and Human Resilience, 13(2), 95–120.