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RAPID Mental Health Study Raises Concern for First Responders

Throughout the COVID-19 pandemic, first responders underwent a transformation of work to mitigate the spread of this highly contagious disease and protect their own health and safety as they serve the needs of the community.

"Working as a fire-based EMS provider is an inherently stressful occupation: lack of sleep, high call volume, and long hours lead to burnout and mental health concerns like anxiety, depression, and post-traumatic stress disorder," said Arthur L. and Joanne B. Frank professor Jennifer Taylor, PhD, MPH, CPPS, Director of the Center for Firefighter Injury Research and Safety Trends (FIRST). "The beginning of the COVID-19 pandemic introduced a high degree of uncertainty about transmission, impact, and safely administering patient care. These workers were almost certain to compound the existing physical and mental toll on EMS workers."

In response to the COVID-19 pandemic, the FIRST Center combined assessment tools, metrics, and scales from two pre-existing projects to develop the COVID-19 RAPID Mental Health Assessment (RAPID). Monthly surveys were given to first responders from May to October of 2020 to analyze the impact of the pandemic on burnout, job satisfaction, work engagement, and mental health.

This study was supported by funding from the Drexel University Board of Trustees and the Office of Research & Innovation COVID-19 Rapid Response Research & Development awards, along with a matching donation from Arthur Frank, MD, PhD, a professor and chair emeritus of the department of Environmental & Occupational Health at Drexel's Dornsife School of Public Health.

The RAPID study utilized two samples of first responders. One included a geographically stratified random sample of 17 departments who had previously participated in the Fire service Organizational Culture of Safety (FOCUS) survey. The other included three large metropolitan fire departments involved in the Stress and Violence to fire-based EMS Responders (SAVER) study.

Analysis of data collected from firefighters and EMS responders led to the publication of three manuscripts.

It was bad before the pandemic.

The first, published in April in the Journal of Occupational and Environmental Medicine and led by Dornsife School of Public Health Phd candidate Madison Raposa, MS, examined organizational and personal factors that contribute to how EMS responders pivot and adapt to intense work demands, like those brought on by the pandemic.

Findings from this paper, titled, 'Assessing the Mental Health Impact of the COVID-19 Pandemic on US Fire-Based EMS Responders: A Tale of Tow Samples (The RAPID Study I),' indicated strong decreases in first responder mental health and diminished workplace support. A lack of communication from leadership, combined with little ability to advocate for certain decisions, may have led to higher levels of burnout, anxiety, depression, and a desire to leave EMS work.

Departments in the FOCUS arm of the study experienced a shift in work that occurred during the beginning of the pandemic: firefighters were doing more EMS work. This change likely contributed to an increase in emotional exhaustion and the desire to leave the profession.

The RAPID Study I concluded that the pandemic exacerbated the problems already present in a workforce that is consistently asked to do more with less.

Wellbeing takes a nosedive.

A subsequent study examining departments in the SAVER arm of the RAPID study revealed that firefighters and EMS responders experienced declining morale and increased burnout on the job during the COVID-19 pandemic.

These findings were published in December 2022 in a paper titled, 'Interplay between Safety Climate and Emotional Exhaustion: Effects on First Responders' Safety Behavior and Wellbeing Over Time,' in the Journal of Business Psychology. This research was led by Jin Lee, PhD, an associate professor of the Department of Psychological Sciences as Kansas State University and affiliate faculty of the FIRST Center.

Analysis of results from three metropolitan fire and rescue departments revealed that the pandemic caused a decrease in overall wellbeing. Departments reported high levels of emotional exhaustion - a key component of burnout - which led to decreased morale, increased risk for depression, and a lack of adherence to safety protocols.

However, it was found that safety climate - the shared perceptions of employees regarding their organization's safety protocols - can work to boost morale and limit the risk for depression, even when first responders are burnt out.

These results indicate that, through empathetically communicating the importance of on-the-job safety and through maintaining behavioral health resources, department safety climate can be improved and mental health concerns can be addressed.

Work-life balance hangs in the balance.

The third study examined demands placed on firefighters during the pandemic and the resources fire departments provided to their personnel to help them cope. The research, led by University of Utah PhD candidate Katherine Castro, MPH, a graduate of Drexel's MPH program, found that firefighters faced both increased demands related to job and work-life balance - but that departments provided more resources to address the former than the latter.

''By nature, we're doers and problem-solvers': Evolving job demands and resources in response to COVID-19 among US-based fire service personnel (The RAPID Study II),' was also published in the Journal of Occupational and Environmental Medicine alongside the RAPID Study I.

Researchers conducted interviews and focus groups with 15 of the 20 departments participating in the RAPID study. Analysis revealed that the job demands of the pandemic on firefighters ranged from changes in daily operations aimed at limiting virus transmission, to mental fatigue regarding COVID-related restrictions. Work-life demands firefighters encountered included burdens such as isolating from their families and seeing their families less due to working longer shifts.

Departments provided resources related to both kinds of demands, but firefighters perceived that greater emphasis was placed on addressing the job demands.

The findings underscore that the fire and rescue service was better prepared to respond to work environment needs during an unanticipated event, but requires additional resources to better support firefighters and their families during times of crisis.

By examining how the COVID-19 pandemic impacted first responder mental health, the industry now has data to inform policy, behavioral health, and staffing needs. if action is taken, it will help the fire and rescue service support their rank-and-file and their families in usual operations and crisis situations.

This research was a large collaboration of the FIRST Center's Madison Raposa, MA, Gabrielle Mullin, MPH, Alexandra Fisher, MPH, Victoria Gallogly, MPH, Andrea Davis, MPH, and Jennifer Taylor, PhD, from the Drexel University Dornsife School of Public Health, Christian Resick, Phd, from the Drexel University LeBow College of Business, Drexel alumni Regan Murray, MPH, now at the University of Arkansas, and Lauren Shepler, MPH, now at Spaulding Rehabilitation Hospital and Harvard Medical School, Jin Lee, PhD, from Kansas State University, and Katherine Castro, MPH, and Joseph Allen, PhD, from the University of Utah.

The FIRST Center is hosting a RAPID webinar series, allowing each author a chance to explain their findings and lead a dialogue on the affects of the coronavirus pandemic on the first responder workforce. Please visit the FIRST Center website for more details.

For more information, please contact Victoria Gallogly, FIRST Center Outreach & Communication Coordinator For reporters seeking information or an interview, please contact Greg Richter, Drexel University Assistant Director of Media Relations, at