Firefighters, paramedics, and EMTs 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. Research published in 2024 and led by FIRST Center affiliate faculty member Sherry Brandt-Rauf, JD, MPhil, includes a comprehensive review of state workers' compensation laws in the United States that evaluates how these laws support first responders suffering from psychological conditions.

In most states, mental health falls into one of three categories:

1. Physical-to-mental injury: Mental health issues that arise from experiencing a physical injury
2. Mental-to-physical injury: Physical harm resulting from a mental health crisis
3. Mental-to-mental injury: Mental health issues stemming from previous unresolved psychological concerns

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

Presumption of Causation

The number of states that have presumption of causation laws for diseases associated with firefighting and EMS work, like 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.

Mitigating Barriers to Seeking Help

In addition to these gaps in presumption policy from state to state, several challenges exist for first responders who are seeking support through the workers' compensation claims process:

• Latency periods
• Time limits
• 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 policy gaps, states could implement presumptive coverage for first responder mental illnesses 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. 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.

More information about the FIRST Center's research, education, and practice work related to policy can be found on the Policy: r2p webpage.

Questions? Contact Dr. Jennifer Taylor, FIRST Center Director jat65@drexel.edu