Emergency medical services (EMS) responders and firefighters face a considerable amount of stress on the job and witness traumatic events on a regular basis. Exposure to stress and trauma among first responders can cause them to develop mental health conditions, such as anxiety, depression, and post-traumatic stress disorder. This can lead to low morale, burnout, and decreased physical well-being if left untreated.

Workers' compensation laws specify the types of support for physical injuries and traumatic events on the job. However, research from the Center for Firefighter Injury Research and Safety Trends (FIRST) at Drexel University's Dornsife School of Public Health revealed significant differences in how states prioritize workers' compensation for first responders experiencing mental injury.

This research, Inventory of State Workers’ Compensation Laws in the United States: First Responder Mental Health, published in the Journal of Public Health Policy and led by FIRST Center affiliate faculty member Sherry Brandt-Rauf, JD, MPhil, a professor at Dornsife, is a comprehensive review of state workers' compensation laws in the United States that evaluates how these laws support first responders suffering from psychological conditions.

Findings revealed that, in most states, mental health falls into one of three categories:

1. Physical-to-mental injury, or mental health issues arising from experiencing a physical injury
2. Mental-to-physical injury, or physical harm resulting from a mental health crisis
3. Mental-to-mental injury, or a mental health issue stemming from previous unresolved psychological concerns

All 50 states were found to support physical-to-mental injury claims, 44 supported mental-to-physical claims, and 40 supported mental-to-mental claims.

Further, the number of states that have presumption of causation laws for diseases associated with firefighting and EMS work such as cardiovascular disease, respiratory disease, and infectious disease far outweighs the number of states that have mental health presumption laws. For example, 23 states were able to pass presumption laws for COVID-19 during the pandemic, while only 9 states have presumption of causation laws for mental health conditions.

In addition to gaps in presumption policy from state to state, several barriers can serve as challenges to first responders seeking support through the workers' compensation claims process. These include latency periods, time limits, and pre-existing health conditions. When an injury is psychological rather than physical in nature, responders are likely to struggle with the burden of proof that the injury stems from the workplace.

To bridge these gaps in policy, states could implement presumptive coverage for first responder mental illness as a statute with a built-in "sunset" clause, or termination date. This models the pattern states utilized during the COVID-19 pandemic.

"There is a precedent in this country to protect people who put their lives at risk in service of others," says Jennifer Taylor, PhD, MPH, CPPS, director of the FIRST Center. "We have a moral duty to make first responders whole again after they serve our communities. While presumptive laws are neither perfect nor uniform, they are an important tool in caring for the unique needs of first responders."

The authors were Sherry Brandt-Rauf, JD, MPhil, professor, lawyer, and sociologist; Jennifer Taylor, PhD, MPH, CPPS, FIRST Center director; and Andrea Davis, MPH, CPH, past FIRST Center associate director, at the Dornsife School of Public Health at Drexel University.

The FIRST Center is a research, education, and practice enterprise dedicated to supporting the United States fire and rescue service through objective data collection and analysis. The Center's Policy: r2p portfolio examines what data elements are needed to support first responder safety and health, what legal benefits exist to protect first responders, and how departments can alleviate stress and workplace violence.

For more information, please contact Victoria Gallogly, Outreach and Communication Manager: vhg25@drexel.edu