Policy: Research to Practice (r2p)
Policy is one of the strongest tools in the public health toolbox. Policy often arises to address a problem that ideally has been identified through data collection and analysis. Once enacted, policy addresses the problem by prompting change. The FIRST Center recognizes the fundamental interconnectedness of policy, data, and change. Change cannot happen without policy, and policy cannot be enacted without data. Change can also demand new data collection, which leads to new policy, and so on.
When it comes to the fire and rescue service, policy research and implementation is lacking. Therefore, the FIRST Center works in collaboration with the fire service to develop model policies that can be modified for local implementation in departments around the country. FIRST conducts primary research to determine what data elements are needed to support fire and rescue service safety and health and investigates state policies to determine what legal benefits exist to protect first responders. Much of our work to date focuses on alleviating stress and workplace violence. If a fire department has developed an SOP or other policy that may benefit others seeking to do likewise, such documents can be found in the Fire Department Model Policies section. Publications specific to our policy work are cross-referenced here and can also be found on the main Publications tab.
Inclusion of Industry & Occupation Data Elements in National Healthcare Data
Through our previous FEMA funding, we launched a national policy effort regarding data standards for occupational surveillance. The ultimate goal was to convince national data standards maintenance organizations (under HIPAA and the US Department of Health and Human Services) to include data elements of industry and occupation (I/O) in all hospital encounters. The FIRST Center proposed using existing federal standards to facilitate this: the North American Industrial Classification System (NAICS) and standard occupation codes (SOC) developed by the Bureau of Labor Statistics (BLS). A national coalition of stakeholders in support of this national policy change was developed, including resolutions adopted by the Council for State and Territorial Epidemiologists and the Congressional Fire Services Institute. The halfway point was reached in the policy adoption process by obtaining 'Accredited Standard Committee X12' approval. To date, NUBC approval remains elusive. This paper discusses the rationale for I/O data inclusion and highlights the costs, benefits, and facility with which these missing data elements could benefit all workers.
Achieving NUBC approval would enable all inpatient and emergency department hospital visits by career and volunteer firefighters to be systematically captured. The documentation of industry and occupation information will not only benefit the fire service, but everyone who works. The politically charged reaction to the proposed policy changes hampered the initiative. The national coalition built around this initiative continued its efforts through the FIRST Reliability Study's pilot study to asses how long it takes to capture industry and occupation data during the patient registration process. The pilot study was conducted in two hospitals in Philadelphia, Pennsylvania.
The SAVER Systems-Level Checklist and Model Policies
Research has shown that violence is a significant contributor to stress. Stress is also the most frequently reported injury among EMS providers. Violence exposure is associated with increased anxiety, stress, and fear among EMS workers. In the FIRST Center's systematic review of violence against fire-based EMS responders, between 57 and 93% of EMS responders experienced an act of verbal and/or physical violence at least once. Combined with the increasing demand for services, the threat of violence adds another significant source of workplace stress.
Our systematic literature review led to the Stress and Violence to fire-based EMS Responders (SAVER) project, which was the first FEMA-funded grant to look at the EMS side of fire. This was important because EMS is 60 to 90% of what fire departments do. SAVER used an innovative application of traditional checklists by developing a systems-level intervention designed to shift the onus of safety and health from that of the individual first responder back onto the organization for whom they work.
Three high EMS volume fire departments participated in SAVER: Dallas Fire-Rescue, Philadelphia Fire Department, and San Diego Fire Rescue. In July of 2019, we convened over 40 fire and EMS thought leaders from 27 organizations for the SAVER Systems Checklist Consensus Conference (SC3). For two days, we asked attendees to modify and revise the Checklist to ensure it would meet the needs of responders.
The SAVER Systems-Level Checklist contains items focused on actions that leadership can institute through training and policy. From 174 original items, the fire service chose 80 as being feasible to implement in their departments within 3 to 6 months. In February of 2020, fire and EMS leadership, frontline workers, dispatchers, and labor union representatives from the three SAVER study sites re-convened to take these 80 checklist items and codify them into 8 domains that form the SAVER Model Policies:
- Mission Statement
- Defining Violence
- Dispatch: Communication & Coordination
- Assessment & Communication of Scene Conditions
- Standard Operating Procedures During Patient Care
- Readiness to Return to Service
- Event Reporting
- Mental & Physical Health Support
This family of policies are intended to be adopted together as a cohesive chapter within a fire department's policy manual. They express to members that there is a strong commitment to their safety, zero tolerance for violence against them, and that remedies to address job stress are being codified in policy.
While the organization has 80 items to worry about, the fire-based EMS responders only have six. These are called the SAVER Pause Points:
Pause Points empower the individual responder to speak up to the organization by sharing their experiences in the field as a way to give feedback on how the SAVER Model Policies are working. Pause Points flatten the organizational hierarchy by giving autonomy and decision-making to those who previously had little.
Please contact the FIRST Center if you are interested in implementing the SAVER Systems-Level Checklist and/or Model Policies in your department.
Fire Department Model Policies and Success Stories
This area is under development, but is important because there is no centralized resource for fire departments to find policies that exist that may be of use to them. Our intention is to inventory as much as fire departments are willing to share here so that you do not have to reinvent the wheel. If your department is interested in sharing its model policies, we are happy to post them here. You must demonstrate your department's permission to do so.
Chief Dennis B. Light - Prescott Fire Department, AZ: Firefighter Health & Well-Being
"Coming on the heels of the greatest loss of Wildland Firefighters in recent history, Prescott has worked towards the necessary cultural change to minimize the chances of any future loss of life. Such loss presented an opportunity to capitalize on enhanced awareness for our members. Firefighter wellness has for many years been at the forefront of Prescott leadership and is considered to be fully inclusive of firefighter physical and mental well-being. The FOCUS survey provided myself as the Fire Chief a very solid baseline from which to seek process or other incremental improvements in our employee's overall wellness. The added focus demonstrates a top-down/bottom-up approach towards doing the right things to shift a culture regardless of generational differences. We fully support the continuing efforts being undertaken and hope that funding will continue for the immediate and long-term future to benefit firefighters everywhere."
HSO Christopher Cavender - DeKalb County Fire Rescue, GA: The Clean Cab Concept
"Our Safety Committee was tasked to research the Clean Cab Concept and see if we would adopt the concept on our trucks. At the conclusion of our research and colorful debate, we reached an agreement that DCFR should move toward the Clean Cab Concept to reduce exposures to cancer-causing carcinogens. But, the decision to go Clean Cab ultimately lied with the Deputy Chief of Operations who was still on the fence. I asked him to wait until I presented the FOCUS Survey to make a final decision on whether to go Clean Cab or not. He agreed to wait. Long story short, after the FOCUS Survey presentation the entire executive staff was behind it and voted to go with Clean Cab Concept on the next 5 Engine purchases. This was huge, as you know firemen don't like change! I believe this was due to the fact that they understood the concepts behind Management Commitment to safety. So, DCFR is in the process of purchasing 5 Engines with the Clean Cab Concept. I just want to thank you guys for what you are doign in the fire industry and encourage you to keep at it.
Chief Mike Stanley - Oshkosh Fire Department, WI:
"I thought you might want some follow up on how we have utilized the results of the FOCUS survey to improve the Oshkosh Fire Department. We were recently awarded funding from the Oshkosh Area United Way to bring in a trainer from the ResponderStrong organization to spend a day working with our Peer Support Team and then three days of training our entire staff on ways they can deal with stress, become more resilient, recognize risk factors and several other mental health topics. We presented the results of our FOCUS study to them and the validity and data from the survey made a very compelling case that led to the funding.
Additionally, we have requested 3 additional firefighter FTE's in 2021 to reduce overtime expenses. We utilized the FOCUS survey to illustrate the fatigue and burnout that our personnel are experiencing. The request is having a favorable response from our City Council. The local newspaper also references the study. Here is a link if you'd like to review it.
Hopefully, you feel as I do that this is a demonstration of the great work that your team is doing and how it can have a huge impact on an organization."
Summary of Policy Publications
Inclusion of Industry-Specific and Occupation Data Elements in National Healthcare Data
- Taylor JA, Widman SA, James SJ, Green-McKenzie J, McGuire C, Harris EJ (2017). Time Well Spent: Patient Industry and Occupation Data Collection in Emergency Departments. Journal of Occupational & Environmental Medicine, 59(8), 742-745. DOI: 10.1097/JOM.0000000000001088
- Taylor JA, Frey LT (2013). The Need for Industry and Occupation Standards in Hospital Discharge Data. Journal of Occupational and Environmental Medicine, 55(5), 495-499. DOI: 10.1097/JOM.0b013e318293af12
The SAVER Systems-Level Checklist and Model Policies
- Taylor JA, Murray RM, Davis AL, Brandt-Rauf S, Allen JA, Borse R, Pellecchia D, Picone D (2022). Model Policies to Protect US Fire-Based EMS Responders From Workplace Stress and Violence. New Solutions, 32(2), 119-131. DOI: 10.1177/10482911221085728
- Murray RM, Allen JA, Davis AL, Taylor JA (2020). Meeting science meets public health: Results from the "Stress and Violence in fire-based EMS Responders (SAVER)" Systems Checklist Consensus Conference (SC3). Journal of Safety Research, 74. DOI: 10.1016/j.jsr.2020.06.009
- Murray RM, Davis AL, Shepler LJ, Moore-Merrell L, Troup WJ, Allen JA, Taylor JA (2020). A Systematic Review of Workplace Violence Against Emergency Medical Services Responders. New Solutions, 29(4), 487-503. DOI: 10.1177/1048291119893388
- Taylor JA, Murray RM, Davis AL, Shepler LJ, Harrison CK, Novinger NA, Allen JA (2019). Creation of a Systems-Level Checklist to Address Stress and Violence in Fire-Based Emergency Medical Services Responders. Occupational Health Science, 3, 265-295. DOI: 10.1007/s41542-019-00047-z
- USFA (2017). Mitigation of Occupational Violence to Firefighters and EMS Responders.