COVID-19 and First Responder Occupational Health and Safety

Slide 1: COVID-19 and First Responder Occupational Health & Safety

Hi, my name is Joe Nugent and I would like to talk to you briefly about the intersection of the COVID-19 pandemic and first responder occupational health and safety – specifically that of volunteers, firefighters, and emergency medical services providers.

Slide 2: Background

Many of us are well-aware of the effects of the current pandemic in placing additional strain on an already burdened healthcare system, but we often overlook the fact that first responders are affected at a similar, if not greater, magnitude than their in-hospital colleagues. First responders are firefighters, paramedics, emergency medical technicians, and other out-of-hospital volunteers responding to emergencies in their communities. Hospital systems have an immense infrastructure including laboratory testing, electronic health records, and occupational safety and health systems which enable them to track exposures in their employees. Fire departments and ambulance companies, however, often suffer from outdated equipment, as well as a gross lack of funding since they often provide services to their communities free of charge. These factors compound upon each other to produce a disproportionate risk in these first responders.

Slide 3: First Responders by the Numbers

In the United States in 2018 from a report by the National Fire Prevention Association, nearly 5 in every 7 fire departments are staffed by volunteer personnel – this statistic includes ambulance corps as well. While volunteer departments are more prevalent in rural areas – since urban centers are frequently staffed by around-the-clock paid personnel – these volunteer departments protected over 1/3 of the US population.

Fundraising has, of course, been hindered significantly by the pandemic, with many fundraising events taking place in bingo halls and in the form of seasonal fairs and raffles to provide departmental funding. The International Association of Fire Chiefs estimates that nearly $.18 billion in funding was lost by volunteer departments between March and November of 2020. This is in addition to the fact that many states were attempting to collapse their volunteer systems even before the pandemic. Notably, this funding is what volunteer departments use to provide personal protective equipment, emergency vehicles, and all the medical equipment used on their ambulances.

Slide 4: Challenges

Though this area of research is, of course, subject to rapid growth and new developments, a recent study by the Fire Department of the City of New York showed that there has been an increase in medical leave taken by their medical personnel, but this has resulted in the department being unable to uphold adequate response standards.

In addition, nearly 1 in 4 emergency medical services providers are 50 years of age or older, which in itself conveys an increased risk for severe disease if they were to become infected. More recent studies have shown that air pollution is related to COVID-19 mortality, and consider that first responders are routinely exposed to toxic gasses and substances on the fireground in their line of work. While we have seen a decrease in the use of emergency services as a whole, first responders are routinely involved in the high-risk aerosol-generating procedures that are performed in life-threatening situations. Medical emergencies such as cardiac arrest have shown higher mortality since the onset of the pandemic, and this means fewer of these individuals who die outside a hospital are not being tested.

Slide 5: Opportunities

Being a first responder on its own conveys unique stressors and can cause significant strain on mental health, and this is once again worsened by this pandemic where there is the stress of potentially exposing your families and your loved ones. Due to the lack of surveillance mechanisms and organized responses seen in hospital systems, first responders are forced to balance the desire to serve their community with the desire to not place their loved ones at increased risk of exposure. First responders routinely travel into people’s homes in the community, and between healthcare and skilled nursing facilities – all of which convey an increased exposure risk.

Slide 6: Moving Forward

In terms of some potential interventions and solutions, Los Angeles County has begun to include their first responders in the same category as healthcare providers in their routine testing, surveillance, and reporting. This also allows for easier facilitation of medical leave if they need to self-quarantine following exposure.

Some universities and corporations such as AirBnB have provided additional housing support for first responders to help ensure they’re not exposing their families. In addition, providing routine and readily available access to mental health care is particularly important due to the compounding effects of social isolation.

An antibody prevalence study regarding first responders in Arizona showed that while there was a surprisingly low seroprevalence in their first responders, this testing alleviated a great deal of stress by ruling out exposure to COVID-19 and was found to be easily implementable throughout the state.

Some potential policy interventions would include bolstering stockpiles of protective equipment in case of additional waves of infection. Expanding worker’s compensation programs would be beneficial as well to include coverage for those infected.

Finally, early access to vaccination, as well as regular screening and early access to treatment for these providers would be crucial as they place their lives and well-being at risk daily to serve their communities and travel between the highest risk exposure settings.