Public Safety Program

Burden

One of the greatest threats to public safety workers’ health involves the stress they encounter through their occupation. If not managed properly, stress can increase the risk of heart disease, hypertension, diabetes, stroke, and a host of other physical ailments.⁵ 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.⁶ Acute physiological changes in the human body, including thermal and cardiac strain, may occur during emergency response operations and can increase the risk of sudden cardiac death. Physiological changes are especially susceptible during alarming situations (i.e. fire suppression, suspect restraints, altercations, or chases).^{7, 8} Researchers also suspect that exposure to particulates and other contaminants, heavy physical exertion, underlying risk factors, and excess cardiovascular strain may also increase public safety worker’s risk for sudden cardiac events.^{9, 10, 11} In addition, recent studies conducted by NIOSH have indicated evidence of a relationship between firefighting and certain types of cancer.¹² Little is known about cancer and other chronic disease risks among other workers in the public safety sector, despite their potential for exposures to a variety of carcinogenic agents, lifestyles, or risk factors that may increase their risk for cancer and other illnesses.¹³

Need

Additional data and research is needed to clarify how the risk factors identified above may increase public safety workers’ risk for sudden cardiac death and other chronic disease that may be affected by their job. While several physiological and workplace factors are shared between public safety workers, such as stress, and intense physical workload, other risk factors differ between these the groups. Other risk factors include work shift duration and schedule, environmental conditions, specific exposures, demographics, use of respiratory protection and other personal protective equipment (PPE), and access to medical care and treatment during responses. Epidemiologic, exposure assessment, and other field studies are needed to better understand these factors and how these factors impact public safety workers’ health. Once exposures and risk factors are better understood, researchers can develop effective strategies to reduce illnesses.

Potential for Impact

An improved understanding of work-related factors for chronic diseases among public safety workers, and the development of effective, science-based intervention and prevention strategies, should lead to decreased exposures, a reduction in risk factors, and ultimately a reduction in illnesses. While NIOSH is conducting preliminary field and epidemiologic studies to better understand risks for certain chronic diseases, such as firefighter’s risk for mortality due to cancer and other cardiovascular diseases, more research is needed.

Burden

While public safety workers face a variety of hazards and exposures as they perform their job, the most commonly reported work-related injuries are often musculoskeletal disorders (MSDs). The strenuous physical demands of the job and limited modified work opportunities suggest that MSDs are potentially disruptive and costly to public safety workers. Based on Bureau of Labor Statistics data for private, state, and local government work in 2014, firefighters reported within the highest incidence rate of MSDs, 178.8 per 10,000 full-time workers out of all occupations. This is more than five times the national average of 33.8.¹⁴ Police and sheriff patrol officers reported an MSD injury rate of 91.0, which is more than double the national average.

U.S. Bureau of Labor Statistics Table 16. Number, incidence rate, and median days away from work for nonfatal occupational injuries and illnesses involving days away from work and musculoskeletal disorders by selected worker occupation and ownership, 2014.

To better understand nonfatal injuries and illnesses among EMS workers, NIOSH used the occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work )—a national probability-based sample of U.S. hospital emergency departments. Data from this project indicates that among injuries and illnesses in connection with EMS workers, sprains and strains were the most common diagnosis. Most injuries affected the upper and lower trunk, hands, and fingers. The greatest portion of injuries or illnesses involved overexertion and bodily reaction. About half of the overexertion and bodily reaction events were specifically identified as overexertion during lifting.¹⁵ In 2014, a survey conducted by the National Fire Protection Association found that strain, sprain, and muscular pain resulted in more than half the major types of injuries received during fireground operations (53%) and non-fireground injuries (60%).¹⁶

Need

A variety of studies and surveys conducted by NIOSH and other agencies have attempted to provide insight into the different types of injuries and illnesses that affect public safety workers. While these studies provide perspectives based on individual goals and study design, the studies are limited when it comes to providing a detailed understanding into the characteristics and circumstances surrounding the injuries experienced by public safety workers. NIOSH continues to work toward providing effective and practiced research to better understand the characteristics and circumstances that surround the most reported type of injury of public safety workers.

Potential for Impact

It is likely that incidence and prevalence of MSDs can be reduced among public safety workers through effective and practical research. Research will provide a better understanding as to how MSDs occur among public safety workers, to better design and facilitate interventions, provide guidance, and establish standards.

Check out the NIOSH Musculoskeletal Disorders Prevention Program to see recent accomplishments and upcoming work.

Burden

Most fatal traumatic injuries among public safety workers are related to motor vehicles.

• In 2014, 1,157 U.S. workers died in work related transportation incidents, resulting in 24% of all deaths.¹⁷
• In the Public Safety Sector, from 2011-2014, motor vehicle incidents on public roadways accounted for 28% of all fatally injured public safety workers. Law enforcement workers accounted for the 80% of fatalities from all work-related motor vehicle accidents in this sector.¹⁸

Need

While NIOSH has begun to conduct preliminary research and fatality investigations through both the Fire Fighter Fatality Investigation and Prevention Program and a pilot program investigating motor vehicle deaths with law enforcement officers, additional information is needed.^{19, 20} In order to develop and validate focused, evidence-based interventions, recommendations, and prevention information, NIOSH needs a better understanding of work-related risk factors associated with motor vehicle incidents among public safety workers. There is also a need for science-based interventional and translational research to reduce the incidences of motor vehicle crashes among public safety workers.

Impact

Through considerable outreach and partnerships with emergency response employers, associations, and stakeholder organizations, NIOSH has developed a strong understanding of the safety and operational concerns related to motor vehicle incidents. These concerns have cultivated a market for guidance and information products for motor vehicle crash prevention. NIOSH plans to work with the public safety community when conducting future research and when developing and evaluating effective and comprehensive vehicle-related prevention programs. This research and dissemination of prevention programs should reduce the incidences that cause injuries and fatalities.

Check out the Fire Fighters Fatality Investigation and Prevention Program for prevention information researched through firefighter fatality investigations.

Burden

Timely and high-quality surveillance data about public safety workers’ injuries and illnesses can reduce morbidity and mortality, and improve health.

Need

Even though many of surveillance systems provide timely and accurate information about the injuries and illnesses that occur among public safety workers, there are still substantial gaps in the knowledge about non-fatal injury and illness rates among public safety workers.

Impact

Data from a high-quality public health surveillance system can be used for immediate public health action, program planning and evaluation, trend analysis, and formulating research hypotheses.

Better surveillance datasets in the Public Safety Program could be used to:

• Guide immediate action for cases of public health importance
• Measure the burden of an injury or illness including changes in related factors, the identification of populations at high risk, and the identification of new or emerging health concerns
• Monitor trends in the burden of an injury or illness including the detection of epidemics and pandemics
• Guide the planning, implementation, and evaluation of programs to prevent and control disease, injury, or adverse exposure
• Detect changes in health practices and the effects of these changes
• Prioritize the allocation of health resources
• Provide a basis for epidemiological research

Check out current surveillance systems used by NIOSH to conduct occupational safety and health research, including the NIOSH Industry and Occupation Computerized Coding System (NIOCCS) .