NFPA Journal

OVER THE COURSE OF HER research career, Jennifer Taylor, a PhD in occupational injury epidemiology, says she’s “listened and learned at countless kitchen tables” to responders talk about their jobs and the challenges they face. Those experiences have led her to become a fiery, energetic advocate for responder safety, and the founding director of the Center for Firefighter Injury Research & Safety Trends (FIRST) at Drexel University. Whip-smart, opinionated, and sometimes foul-mouthed, especially when describing what she sees as the public’s neglect for first responders on the front lines, Taylor and her team in Philadelphia are currently conducting some of the most comprehensive work on EMS workplace safety in the country.

In September 2017, Taylor’s FIRST program was awarded a $1.5 million Assistance to Firefighters grant to fund a project called “Stress and Violence in fire-based EMS Responders (SAVER).” The project has two main objectives: to better understand how often violent incidents against first responders occur, and to test methods in four pilot fire departments to better protect responders from violence and the physical and emotional injuries that result.

A huge challenge to reducing violence and stress is the ever-increasing volume of medical calls that responders must handle. The growing number of calls, Taylor believes, is due largely to a host of systematic societal failures that policymakers haven’t adequately addressed, leaving EMS providers to bear the brunt. Those failures include an inadequate health care system, where uninsured people call 911 for routine medical help; poverty and a lack of public transportation that results in people calling EMS looking for a way to get to the hospital; alcohol and drug abuse that results in a skyrocketing number of calls for drug overdoses; an inability to address homelessness and mental illness, leading to a high volume of calls to aid these underserved populations; and even a misunderstanding of the purpose of 911, such as people who call to report mundane, non-emergency issues like a missing television remote. “Whatever new problem comes along in society, firefighters and EMS inherit it and have to respond to it,” Taylor said.

Working with the understanding that these underlying social issues aren’t likely to soon change, Taylor’s team at Drexel has focused instead on what EMS departments can control to better insulate workers from the daily onslaught. The “systems-level checklists” the team has developed consist of questions for department leaders intended to provoke a closer look at their own policies and procedures to ensure workers have the training, resources, counselling, down time, and institutional support they need.

“When a worker is injured, we usually ask ‘What did you do wrong?’ rather than ‘How did we set you up for failure?’” Taylor said. “The checklist process turns that around. What is the organizational responsibility? What kind of policies are departments missing? What is the basic standard minimum of what we should be doing in fire departments to protect workers on the job? This is implemented and followed at the fire department and union levels as opposed to asking the workers, who are already overwhelmed, to do more.”

To develop the systems checklist, FIRST conducted an extensive review of available research on the causes of EMS workplace violence, then held a two-day workshop with industry experts to vet and refine it. Fire departments in Chicago, Philadelphia, San Diego, and Dallas will implement the systems checklist guidance this spring; later in the year, researchers will evaluate what has worked and what hasn’t, if reported injuries and stress levels were reduced, and then work to improve the checklist. Eventually, a final version will be disseminated to departments across the country for use.

“If the organizations make these changes, we should see the needles move on lower burnout, higher engagement with work, better morale, and less anxiety and depression—those are our expectations for what we’re doing,” Taylor said.

Another part of the project involves an effort to finally get a more accurate picture of the true levels of violence fire-based EMS personnel are seeing on the streets. Researchers will work closely with the fire departments and unions in each of the four pilot fire departments to develop a customized confidential violence reporting system via a mobile app that responders will be strongly encouraged to use.

“We’ll be able to look at that data and say, for instance, here in Chicago, of 200 assaults reported last year, 75 percent were verbal threats, 25 percent were actual physical assaults, and 10 percent of those who were assaulted didn’t return to the job,” Taylor said. “For the first time, we’ll be able to really describe what is going on.”

The new violence reporting app will be rolled out to firefighters early this year, and researchers will collect data throughout 2019. “As responders get on board with it, see the resulting evidence, and understand that they are finally being heard, we intend to take this system to the larger fire rescue industry as a proven data collection tool,” Taylor said.

ASKING THE RIGHT QUESTIONS

The Center for Firefighter Injury Research & Safety Trends at Drexel University has developed a “systems-level checklist” for fire departments to ensure that EMTs have the institutional support they need to deal with the growing threat of violence on the job. The checklist questions, which are already being implemented at four pilot departments in the U.S., are intended to provoke leaders to take a closer look at departmental operations and policies. Here are some examples of checklist questions:

» Does your department have trainings and simulations for EMS responders and dispatchers on professional behavior?

» Does your department have a policy in place for EMS responders to communicate scene conditions upon arrival?

» Does your department have policies on assessing patients/bystanders and their environment/immediate vicinity for threats (i.e., physical, mental, metabolic conditions)?

» Do all EMS responders receive recurrent training on how to recognize acute, cumulative, and chronic stress exposures from on-duty sources and their personal lives in themselves and others?

» Does your department issue guidance (SOP/SOG) for dispatchers and supervisors on how to interact with an injured EMS responder?

JESSE ROMAN is staff writer for NFPA Journal. Top Photograph: Drexel University