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COVID-19 RAPID Mental Health Assessment

Crying EMT 

From 1980 to 2016, the number of calls in the US for fire declined 5%, while the number of calls for EMS increased 320%. On average, 64% of national fire department responses were for medical emergencies. For example, pre-COVID-19, the Philadelphia Fire Department (PFD) responded to 700 to 1,000 EMS calls per day (75% of their total call volume) with 200 paramedics and EMTs in service at any given time. Fire departments can run out of ambulances on any given day under normal conditions, and the FIRST Center's previous research showed that fire-based EMS responders were already concerned about their mental health. The coronavirus pandemic is shining a light on a system under incredible stress.

The purpose of the COVID-19 RAPID Mental Health Assessment (RAPID) is to assess firefighter mental health throughout the pandemic. This will enable tracking of their ability to respond to emergencies and the capacity for their organizations to maintain optimal responsiveness in this unprecedented environment. This will help prepare for the unique resources needed in subsequent waves of the pandemic and for future outbreaks.

The FIRST Center took two research activities already in the field and quickly expanded them to measure the mental health impact of the coronavirus outbreak on fire-based EMS responders. The first program is the Fire service Organizational Culture of Safety (FOCUS) survey, a previously-validated tool to measure organizational safety climate. The second program is the Stress and Violence against fire-based EMS Responders (SAVER) study that developed a systems-level checklist to reduce stress and workplace violence.

In FOCUS, a geographically-stratified random sample of 18 career and volunteer fire departments was selected to represent the US. These departments recently completed a FOCUS assessment between December 2019 and March 2020, right as the pandemic was causing state shutdowns. Firefighters, paramedics, EMTs, and leadership are included.

SAVER uses a different design and case inclusion. For three years, the Dallas, Philadelphia, and San Diego fire departments worked on the development of the systems-level checklist intervention. These are large, metropolitan fire departments with high EMS call volumes and high COVID-19 case counts. This mental health assessment focuses primarily on paramedics and EMTs.

For all FOCUS and SAVER study sites, repeated measures occurred monthly from May through October 2020. Trend analysis on the pandemic's impact is being conducted in addition to interviews and focus groups with departments.

The COVID-19 RAPID monthly assessments allowed the FIRST Center to measure the impact on burnout, job satisfaction, work engagement, PTSD, and a host of additional mental health indicators over time. Such repeated measures assessment is like the air quality monitoring during 9/11. Passive surveillance around the World Trade Center detected unprecedented levels of heavy metals, sulfur, particulate matter, and acidic aerosols, among other harmful and dangerous compounds. This research led to the creation of the James Zadroga 9/11 Health and Compensation Act of 2010, paving the way for presumptive legislation for cancer and other diseases prevalent among 9/11 first responders. By initiating RAPID, the FIRST Center is conducting passive surveillance that will be used to inform policy, behavioral health, and staffing needs of the fire and rescue service, both in usual operations as well as during crisis situations.