Mental health of Japanese firefighters administering emergency medical treatments during COVID-19

This is the first study investigating the determinants of mental health among Japanese firefighters with the COVID-19 outbreak. Firefighters who respond to emergency calls and administer emergency medical treatment face numerous serious threats to their mental health because of the spread of COVID-19. These threats range from significant infection risks to changes in daily operations. We conducted an online questionnaire survey with Japanese firefighters (n = 2,748, valid responses = 2,204) who also served as ambulance workers during the second COVID-19 wave in August 2020. The questionnaires inquired about personal and occupational demographics, occupational stress resulting from COVID-19, social support, germ aversion using a subscale of tire Perceived Vulnerability to Disease (PVD) scale, and the General Health Questionnaire (GHQ-12). The results indicated that the burdens of infection prevention, anxiety about infection and furloughs, interpersonal conflicts related to COVID-19, reduced social support, and germ aversion were associated with deterioration of mental health. Measures for maintaining the mental health of firefighters are discussed based on these results. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

What Members Need in Work Situations: Two Samples of Essential Managerial Leadership Behaviors: JMI

Violent incidents, terrorist attacks, senseless shootings, health issues such as the Coronavirus, and natural disasters call attention to managerial leadership in crisis situations. Yukl and Van Fleet (1982) did the seminal work on this topic extended by Peterson and Van Fleet (2008) and Peterson et al. (2012). More recently, Geier (2016) reported findings based on firefighters while Htway and Casteel (2015) and Kapucu and Ustun (2018) studied public sector organizations. Since these studies all involved nonprofit organizations, an extension to for-profit organizations is warranted. There are differences between profit organizations and not-for-profit organizations (Collins, 2001;Collins, 2005). Because of the goals involved, there may be differences in the managerial leadership behaviors required by these types of organizations. Hannah and Parry (2013) specifically recommend expanding leadership research to many different extreme situations in an effort to understand different managerial leadership behaviors that adapt to varying crisis situations. Two samples reported here identify the critical managerial leadership behaviors desired by for-profit organizational participants in both stable and crisis situations. Finally, implications, limitations, and future research are discussed.

Impact de la Covid-19 sur les arrêts cardiaques extrahospitaliers en phase de suractivité épidémique : données du registre RéAC

Introduction : Notre objectif était d'analyser la survie des patients victimes d'un arrêt cardiaque extrahospitalier (ACEH) durant la pandémie Covid-19 et de comparer les données en fonction du centre de traitement de l'appel choisi, le 15 ou le 18. Méthode : Nous avons extrait les données exhaustives du Registre des arrêts cardiaques (RéAC), entre le 1er mars et le 30 avril 2020. Nous avons effectué trois comparaisons de la survie à 30 jours (J30) de cohortes de patients : 1) Covid vs non-Covid ;2) appels arrivés au service d'aide médicale urgente (Samu) (15) vs aux sapeurs-pompiers (SP) (18) et 3) appels arrivés au 15 vs 18 pour les patients Covid. Résultats : Sur un total de 870 ACEH, 184 étaient atteints de la Covid. Nous avons observé 487 (56 %) appels arrivés au 15 et 383 (44 %) au 18. La survie à J30 était de 3 %. Les ACEH Covid avaient une survie à J30 plus faible que les non-Covid (0 vs 4 %, p < 0,001). Le délai d'arrivée de SP était plus long lors d'un appel au 15. En revanche, aucune différence de survie n'est observée entre les appels arrivés au 15 ou au 18. Conclusion : La survie consécutive à un ACEH durant la pandémie est extrêmement faible. Cependant, quel que soit le numéro composé (15 ou 18), la survie n'est pas différente, même si le délai d'arrivée des prompts secours est plus court lors d'un appel au 18.Alternate abstract: Introduction: Our aim was to analyze the outof-hospital cardiac arrest (OHCA) care and patients' survival during COVID-19 pandemic by comparing the emergency phone number called to initiate the alert [EMS(#15) or firefighters(#18)]. Procedures: We used data from the French OHCA Registry (RéAC), between March 1, 2020 and April 30, 2020. We performed three comparisons of patient cohorts: 1) COVID vs non-COVID;2) 15 vs 18 calls and 3) in COVID patients, 15 vs 18 calls. Results: We included 870 OHCA, among them, 184 were affected by COVID-19. There were 487 (56%) calls to 15 and 383 (44%) to 18. Patient survival at D+30 during the study was 3%. COVID+ patients had a lower survival rate at D+30 than non-COVID patients (0% vs. 4%, P < 0.001). Firefighters had a long time to arrive on the scene for calls to 15. No difference in survival was observed between 15 or 18 calls. Conclusion: The poor survival of patients during the pandemic is multi-causal but does not appear to be related to the emergency phone number called to initiate the alert [EMS (#15) or firefighters (#18)] even if the arrival time for prompt assistance is shorter on the call to 18.

Exploring the Effect of Emotional Labor on Turnover Intention and the Moderating Role of Perceived Organizational Support: Evidence from Korean Firefighters.

Synthesizing the conservation of resource theory, proximal withdrawal state theory, and job demands-resources theory, the present study examined the relationships between two dimensions of emotional labor (i.e., surface and deep acting) and turnover intention, as well as the moderating role of perceived organizational support in these relationships, such as the context of Korean firefighters. Using survey data drawn from fire organizations in Gyeonggi-do, the largest province of South Korea, we found that both surface and deep acting are positively related to firefighter turnover intentions. Further analysis indicates that the perceived organizational support of firefighters, vital for public health and safety, attenuates the positive relationship between surface acting and turnover intention but has no significant moderating effect on the relationship between deep acting and turnover intention. Our results suggest that perceived organizational support acts through essential psychological resources to recover the loss of emotional resources and contributes to the retention of firefighter personnel who primarily perform challenging and stressful work, including firefighting and offering emergency medical services. Thus, this study examines a crucial tool to ensure firefighters' public mental health.

Factors affecting health-related quality of life among firefighters during the COVID-19 pandemic: A single-center study.

During the coronavirus disease 2019 (COVID-19) outbreak, firefighters have been working in an environment that is both physically and mentally taxing. This study aimed to investigate factors affecting health-related quality of life (HRQOL) among firefighters in Japan during the COVID-19 pandemic. A total of 227 firefighters from a single firefighting organization were surveyed in June 2021, during the fourth infection spread period of COVID-19 in Japan. Regression analysis was performed to examine factors affecting HRQOL of firefighters measured with the SF-8. In the present study, factors affecting HRQOL among firefighters during the COVID-19 pandemic were lack of sleep, physical abnormalities due to infection control measures, exercise habits, living with family members, and history of suspected COVID-19 infection. The present findings may help develop support services for first responders, including firefighters during the COVID-19 pandemic.

The Impact of COVID-19 Prevention Measures on Interagency Hotshot Crews in 2020

In the 2020 fire season, the fire management community developed and tested a wide range of new practices to meet challenges posed by the coronavirus pandemic. To better understand the effectiveness of different innovations and which should be considered for more permanent use, we surveyed Interagency Hotshot Crew (IHC) superintendents in January 2021. We focused on identifying innovations that, regardless of COVID-19, the IHCs would want to keep and why, as well as those that proved problematic. The survey focused on paperwork, briefings, and fire camp and incident command post setup. Results found clear benefits from many of the changes to operational efficiency and crew health and wellbeing;challenges were generally tied to logistical and communication issues. The results of this survey speak to the logistics of running large incident command operations and could be applied both outside the US and outside the field of wildland fire management. Study Implications: There may be meaningful benefits beyond mitigation of COVID-19 spread for continuing to use virtual paperwork, virtual briefings, and dispersed camp setups while supporting large fire suppression operations. Operational efficiency was seen as a clear benefit of many of these changes, with the often-mentioned advantage to a particular practice enabling crews to spend more time on the fireline. The new practices also appear to contribute to overall crew physical health. However, the benefits to crew health, efficiency, and effectiveness will need to be assessed against the increased logistical support required from incident management teams.

Antibody responses elicited by mRNA vaccination in firefighters persist six months and correlate inversely with age and directly with BMI.

Knowledge regarding the sustainability of immune responses after COVID-19 vaccination is important, e.g., to decide whom and when to booster. Thus, we analyzed antibody titers in firefighters six months after vaccination with the mRNA-based vaccine Comirnaty. SARS-CoV-2 spike-binding antibodies (bAb) were quantified and compared to peak responses determined in healthcare workers (HCW). For the firefighters, neutralizing antibodies (nAb) were also analyzed. Six months after the second vaccine dose, all analyzed firefighters had detectable bAb, and 91% exhibited nAb titers above 1:16. However, actual titers six months after vaccination were over 12-fold lower than in the HCW control group four weeks after vaccination. bAb and nAb responses showed a significant correlation, and age correlated inversely with antibody responses. Unexpectedly, participants with a body mass index over 25 had higher neutralization titers after six months. All participants with very low neutralization titers were offered booster vaccination. The booster vaccination improved the extent and sustainability of antibody responses.

A review of infectious disease epidemiology in emergency medical service clinicians.

BACKGROUND: The emergency medical service (EMS) workforce is at high risk of occupationally-acquired infections. This review synthesized existing literature on the prevalence, incidence, and severity of infections in the EMS workforce. METHODS: We searched PubMed, Embase, CINAHL, and SCOPUS from January 1, 2006 to March 15, 2022 for studies in the US that involved EMS clinician or firefighter populations and reported 1 or more health outcomes related to occupationally-acquired infections. RESULTS: Of the 25 studies that met the inclusion criteria, most focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with prevalence rates ranging from 1.1% to 36.2% (median 6.7%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in 4 studies ranged from 1.9% to 6.4%, and the prevalence of Hepatitis C in 1 study was 1.3%. Few studies reported incidence rates. The prevalence or incidence of these infections generally did not differ by age or gender, but 4 studies reported differences by race or ethnicity. In the 4 studies that compared infection rates between EMS clinicians and firefighters, EMS clinicians had a higher chance of hospitalization or death from SAR-CoV-2 (odds ratio 4.23), a higher prevalence of Hepatitis C in another study (odds ratio 1.74), and no significant difference in MRSA colonization in a separate study. CONCLUSIONS: More research is needed to better characterize the incidence and severity of occupationally-acquired infections in the EMS workforce.

Effects of Covid-19 Related Government Budget Shortfall on Funding and Provision of Essential Public Services

This study investigates COVID-19 related budget revenue losses in US local governments, and their effects on funding and provision of essential public services such as EMS, healthcare, firefighters, police, welfare and public housing services. A survey was sent to county and city governments to learn about their revenue losses for fiscal year 2020 and their effects on funding and service provision. Results show budget revenue loss significantly impacts funding cuts for essential services and is most impactful on welfare and public housing services. Additionally, although funding cuts significantly influence levels of services provided, aid from federal government restrains the extent of funding cuts and the influence of cuts on EMS and healthcare. The findings imply intergovernmental transfers play a pivotal role in averting deep cuts that could be detrimental to saving lives during a crisis. Furthermore, funding availability is key to maintaining appropriate levels of services to help care for the sick and protect the vulnerable in society.

Editorial

In our first article, entitled “Mental health patterns during COVID-19 in emergency medical services (EMS)”, Silvia Monteiro Fonseca et al. have explored the patterns of EMS personnel’s mental health regarding their levels of anxiety, depression and stress during COVID-19 pandemic. The study recommendations from this research include, but are not limited to, ensuring a more equitable distribution of protective equipment to paramedics across unevenly funded services and recognizing paramedics face unique and additional stressors in public health emergencies. The study used validated instruments such as the Pittsburg Sleep Quality Index (PSQI), the World Health Organization Quality of Life (WHOQOL) instrument, the Epworth Sleepiness Scale (ESS), the PSS and the post-traumatic stress disorder (PTSD) checklist on a sample of UK police officers. In a fascinating paper, John Hylander et al. explore the collaborative challenge of emergency response to major incidents in road tunnels for the emergency services, emergency dispatch centers and local authorities next.

Firefighters’ Perceptions of Psychological Intervention Programs in South Korea during the COVID-19 Pandemic

Purpose: Firefighters belong to an occupational group that is consistently exposed to psychological challenges, such as post-traumatic stress disorder (PTSD). This study examines firefighters’ perceptions of psychological intervention programs. Methods: Semi-structured interviews were conducted with 12 firefighters who were divided into two focus groups. Qualitative data were analyzed using content analysis. Results: Six barriers and seven suggestions regarding psychological intervention programs were identified. The barriers were “work overload”, “uncomfortable counseling situation”, “perfunctory programs”, “lack of consulting specialists”, “limited number of participants”, and “lack of replacement workers while attending the intervention programs”. Suggestions to overcome these barriers included developing “sustainable” and “highly accessible” intervention programs “focused on positive aspects of traumatic events”, considering “job characteristics” and “individual psychosocial characteristics”, as well as employing “experts with knowledge of firefighters’ duties”, and “creating a supportive work environment for psychological intervention”. Conclusion: Based on these findings, the interventions should focus on the positive aspects of traumatic events, with flexibility and practicality, tailored to the individual and occupational characteristics of firefighters. © 2022 The Korean Academy of Psychiatric and Mental Health Nursing.

Differences in salient beliefs associated with voluntary exercise training among South Korean firefighters before and after COVID-19.

BACKGROUND: Participating in voluntary exercise training is important to meet occupational requirements as well as firefighters' health and safety. The purpose of this study is to identify salient beliefs associated with voluntary exercise training among firefighters in the pandemic era by comparing outcomes with those from a previous elicitation study, which was carried out before the COVID-19 outbreak. METHODS: A total of 57 firefighters are recruited to participate in an elicitation study. Participants are requested to respond to six open-ended questions related to voluntary exercise training. Content analysis is used to create categories that combine similar factors in each belief. Beliefs mentioned by more than 30% of participants are used for comparison with the results of the previous research. RESULTS: "Improves my physical ability" (n = 44) and "cause injury" (n = 17) are identified as behavioral beliefs in the present study, whereas "makes me tired" and "takes too much time" were also elicited in Lee's study. Normative beliefs are "family members" (n = 45) and "colleagues" (n = 27) and these results are consistent with those in Lee's study. "Lack of time" (n = 28), "exercise facilities" (n = 19), and "COVID-19" (n = 19) are elicited as control beliefs in the present study, whereas "physical condition" (n = 21) and "exercise partners" (n = 14) were elicited as other control beliefs, and "COVID-19" was not mentioned in Lee's study. CONCLUSION: This study can contribute valuable information about salient beliefs associated with exercise training behavior among firefighters, particularly under pandemic conditions. Future researchers should develop tailored exercise training programs for firefighters based on current elicited beliefs.

Investigation of COVID-19 Outbreak among Wildland Firefighters during Wildfire Response, Colorado, USA, 2020.

A COVID-19 outbreak occurred among Cameron Peak Fire responders in Colorado, USA, during August 2020-January 2021. The Cameron Peak Fire was the largest recorded wildfire in Colorado history, lasting August-December 2020. At least 6,123 responders were involved, including 1,260 firefighters in 63 crews who mobilized to the fire camps. A total of 79 COVID-19 cases were identified among responders, and 273 close contacts were quarantined. State and local public health investigated the outbreak and coordinated with wildfire management teams to prevent disease spread. We performed whole-genome sequencing and applied social network analysis to visualize clusters and transmission dynamics. Phylogenetic analysis identified 8 lineages among sequenced specimens, implying multiple introductions. Social network analysis identified spread between and within crews. Strategies such as implementing symptom screening and testing of arriving responders, educating responders about overlapping symptoms of smoke inhalation and COVID-19, improving physical distancing of crews, and encouraging vaccinations are recommended.

Anomalies and Breakpoint Detection for a Dataset of Firefighters’ Operations During the COVID-19 Period in France

Firefighters are exposed to many hazards. The main objective of this study is to apply machine learning techniques to tailor the need for firemen operations to their demands. This strategy enables fire departments to organize their resources, which leads to a reduction of human, material and financial requirements. This work focuses on predicting the number of firefighters’ interventions during the sensitive period of the global pandemic COVID-19. Experiments applied to a dataset from 2016 to 2021 provided by the Fire and Rescue Department, SDIS 25, in the region Doubs-France have shown an accurate prediction and revealed the existence of a turning point in August 2020 due to an increase in coronavirus cases in France. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

The Health of Firefighters Deployed to the Fort McMurray Fire: Lessons Learnt.

Introduction: Firefighters were working in exceptionally difficult conditions during the Fort McMurray/Horse River fire in May 2016. Methods: From mid-May, we recruited firefighters from 13 fire services as they returned from the fire. In October 2016 we extended recruitment to all Alberta-based firefighters deployed to the fire. In December 2017-May 2018 we sent a first online follow-up: this concentrated on mental health supports. The second follow-up, in October 2018-January 2019, included screening scales for respiratory ill-health and PTSD. All three contacts included visual analogue scales for chest symptoms and the Hospital Anxiety and Depression Scale. We estimated exposure to PM2.5, and calculated an exposure mitigation index from reports of respiratory protective equipment (RPE). Results: We recruited 1,234 firefighters and examined the relation of respiratory symptoms to estimated particulate exposure. The relation was strong immediately post fire but weakened over time. We found less chest tightness and cough in those whose RPE in the first week mitigated exposure by at least 10%. We examined the relation between particulate exposure and mental ill-health from screening questionnaires and found those with high exposure (reflecting the ferocity of the fire) had poorer mental health scores. Firefighters reporting their "worst moment during the fire" was life threatening were more anxious at second follow-up. Overall both anxiety and depression scores increased at successive contacts, more so in those with mental ill-health recorded in physician billing records before the fire. Discussion: The results from this study overall suggest on-going fire-related health effects in a substantial minority of firefighters, similar to those reported in the longitudinal follow-up of firefighters after the collapse of the World Trade Centre. Self-reports of both respiratory symptoms and mental ill-health were strongly related, soon after the fire, to estimated particulate exposures. Anxiety increased over time since the fire in those who felt their life or safety had been threatened, underlining the need for ongoing support. Our conclusions about the benefits of rapid research relate particularly to the collection of biomarkers of exposure as quickly and widely as possible, and the establishment of a nominal list of participants before they are too widely dispersed.

A Scoping Review on the Prevalence and Determinants of Post-Traumatic Stress Disorder among Military Personnel and Firefighters: Implications for Public Policy and Practice.

INTRODUCTION: Firefighters and military personnel are public safety personnel who protect the safety of individuals and their properties. They are usually exposed to traumatic events leaving them at risk of developing mental health conditions such as post-traumatic stress disorder (PTSD). Increasing concern is being raised regarding the mental health impacts, specifically PTSD, among military personnel and firefighters. OBJECTIVE: There is an increased exposure of firefighters and military personnel to traumatic events and the attendant risk of developing post-traumatic stress disorder. It is crucial to ascertain the level of PTSD amongst this cohort and determinants to formulate policies and practices that mitigate the risk and protect public safety personnel. This scoping review sought to determine the prevalence of PTSD among this cohort globally and to explore determinants of this mental health condition. METHODS: A literature search in databases including MEDLINE, CINAHL, PubMed, PsycINFO, and EMBASE was conducted electronically from May 2021 to 31 July 2021. Two reviewers independently assessed full-text articles according to the predefined inclusion criteria and screening process undertaken to identify studies for the review. Articles were screened with a third reviewer, resolving conflicts where necessary and further assessing them for eligibility. During article selection, the PRISMA checklist was adopted, and with the Covidence software, a total of 32 articles were selected for the final examination. For the eligible studies, data extraction was conducted, information was collated and summarized, and the findings were reported. Original qualitative and quantitative data on the prevalence and predictors of PTSD among veterans, military, and firefighters were reported. RESULTS: The prevalence of PTSD was 57% for firefighters and 37.8% for military personnel. Demographic factors, job factors, social support, injuries, physical and psychological factors, and individual traits were the main predictors of PTSD in this cohort. CONCLUSION: This information is vital for developing and implementing prevention and intervention strategies for PTSD in military personnel and firefighters. Recognizing and addressing factors that predict PTSD will help to improve mental wellbeing and increase productivity. More peer-reviewed studies are needed on the prevalence of PTSD amongst these cohorts.

SARS-CoV-2 seroprevalence among firefighters in Los Angeles, California.

OBJECTIVE: We estimate the seroprevalence of SARS-CoV-2 antibodies among a sample of firefighters in the Los Angeles (LA), California fire department in October 2020 and compare demographic and contextual factors for seropositivity. METHODS: We conducted a serological survey of firefighters in LA, California, USA, in October 2020. Individuals were classified as seropositive for SARS-CoV-2 if they tested positive for IgG, IgM or both. We compared demographic and contextual factors for seropositivity. RESULTS: All firefighters in LA, California, USA were invited to participate in our study, but only roughly 21% participated. Of 713 participants with valid serological data, 8.8% tested positive for SARS-CoV-2 antibodies, and among the 686 with complete survey data 8.9% tested positive for antibodies. Seropositivity was not associated with gender, age or race/ethnicity. Seropositivity was highest among firefighters who reported working in the vicinity of LA International Airport, which had a known outbreak in July 2020. CONCLUSIONS: Seroprevalence among firefighters in our sample was 8.8%, however, we lack a full workplace seroprevalence estimate to compare the relative magnitude against general population seroprevalence (15%). Workplace safety protocols, such as access to personal protective equipment and testing, can mitigate increased risk of infection at work, and may have eliminated differences in disease burden by geography and race/ethnicity in our sample.

Underascertainment of COVID-19 cases among first responders: a seroepidemiological study.

BACKGROUND: Providing frontline support places first responders at a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. AIMS: This study was aimed to determine the anti-SARS-CoV-2 seroprevalence in a cohort of first responders (i.e. firefighters/paramedics), to detect the underascertainment rate and to assess risk factors associated with seropositivity. METHODS: We conducted a serological survey among 745 first responders in Germany during 27 November and 4 December 2020 to determine the anti-SARS-CoV-2 seroprevalence using Elecsys® Anti-SARS-CoV-2 immunoassay (Roche Diagnostics, Mannheim, Germany). As part of the examination, participants were asked to provide information on coronavirus disease 2019 (COVID-19)-like-symptoms, information on sociodemographic characteristics and workplace risk factors for a SARS-CoV-2 infection and any prior COVID-19 infection. Descriptive statistics and logistic regression analysis were performed and seroprevalence estimates were adjusted for test sensitivity and specificity. RESULTS: The test-adjusted seroprevalence was 4% (95% CI 3.1-6.2) and the underascertainment rate was 2.3. Of those tested SARS-CoV-2 antibody positive, 41% were aware that they had been infected in the past. Seropositivity was elevated among paramedics who worked in the emergency rescue team providing first level of pre-hospital emergency care (6% [95% CI 3.4-8.6]) and those directly exposed to a COVID-19 case (5% [95% CI 3.5-8.1]). Overall, the seroprevalence and the underascertainment rate were higher among first responders than among the general population. CONCLUSIONS: The high seroprevalence and underascertainment rate highlight the need to mitigate potential transmission within and between first responders and patients. Workplace control measures such as increased and regular COVID-19-testing and the prompt vaccination of all personnel are necessary.

Meat in a Seat: A Grounded Theory Study Exploring Moral Injury in Canadian Public Safety Communicators, Firefighters, and Paramedics.

The work of public safety personnel (PSP) is inherently moral; however, the ability of PSP to do what is good and right can be impeded and frustrated, leading to moral suffering. Left unresolved, moral suffering may develop into moral injury (MI) and potential psychological harm. The current study was designed to examine if MI is relevant to frontline public safety communicators, firefighters, and paramedics. Semi-structured interviews (n = 3) and focus groups (n = 3) were conducted with 19 participants (public safety communicators (n = 2); paramedics (n = 7); and firefighters (n = 10)). Interviews and focus groups were audio-recorded, transcribed, coded, and constantly compared in accordance with the grounded theory method. A conceptual theory of "frustrating moral expectations" emerged, with participants identifying three interrelated properties as being potentially morally injurious: chronic societal problems, impaired systems, and organizational quagmires. Participants navigated their moral frustrations through both integrative and disintegrative pathways, resulting in either needing to escape their moral suffering or transforming ontologically. The current study results support MI as a relevant concept for frontline PSP. Given the seriousness of PSP leaving their profession or committing suicide to escape moral suffering, the importance of the impact of MI on PSP and public safety organizations cannot be ignored or underestimated. Understanding the similarities and differences of morally injurious exposures of frontline PSP may be critical for determining mental health and resilience strategies that effectively protect PSP.