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The impact of post-traumatic stress on first responders: analysis of cortisol, anxiety, depression, sleep impairment and pain

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The impact of post-traumatic stress on first responders: analysis of cortisol, anxiety, depression, sleep impairment and pain

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EMS personnel with PTSD, depression, and/or anxiety, have been found to have higher levels of musculoskeletal pain than their peers without those mental health conditions .

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Anxiety and Pain Comorbidity in Public Safety Personnel

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Anxiety and Pain Comorbidity in Public Safety Personnel

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Mental disorders and pain appear highly comorbid for public safety personnel.

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Anxiety related pschopathology and chronic pain comorbidity among public safety personnel

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Stress and law enforcers: testing the relationship between law enforcement work stressors and health-related issues

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Stress and law enforcers: testing the relationship between law enforcement work stressors and health-related issues

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Chronic pain among law enforcement officers has been significantly associated with chronic occupational stress

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Associations of Physical Activity and Obesity With the Risk of Developing the Metabolic Syndrome in Law Enforcement Officers

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Associations of Physical Activity and Obesity With the Risk of Developing the Metabolic Syndrome in Law Enforcement Officers

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Over 48% of law enforcement officers are overweight.

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Functional Movement Screen: Pain versus composite score and injury risk

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Functional Movement Screen: Pain versus composite score and injury risk

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Responders that experience pain during any part of FMS have a statistically higher risk of injury than those that are pain-free during the assessment

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Examining Risk for Persistent Pain among Adults with Overweight Status

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Examining Risk for Persistent Pain among Adults with Overweight Status

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In assessing risk for chronic pain among overweight adults, adults are 14 – 71% more likely to report chronic pain than adults of a healthy weight

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A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain.

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A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain.

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Nutritional interventions have a tremendous impact on pain, whether altering the diet as a whole, or just one nutrient

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Weight loss advice and prospective weight change among overweight firefighters

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Weight loss advice and prospective weight change among overweight firefighters

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It is estimated that over 70% of firefighters are overweight.

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Decreased physical fitness is associated with injury for firefighters.

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Evaluation of a fitness intervention for new firefighters injury reduction and economic benefits

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Mindful Nonreactivity Moderates the Relationship Between Chronic Stress and Pain Interference in Law Enforcement 

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Mindful Nonreactivity Moderates the Relationship Between Chronic Stress and Pain Interference in Law Enforcement 

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Mindful Nonreactivity Moderates the Relationship Between Chronic Stress and Pain Interference in Law Enforcement Officers

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Mindful Nonreactivity Moderates the Relationship Between Chronic Stress and Pain Interference in Law Enforcement Officers

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Evaluation of a fitness intervention for new firefighters: injury reduction and economic benefits.

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Evaluation of a fitness intervention for new firefighters: injury reduction and economic benefits.

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Decreased physical fitness is associated with injury

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Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation

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Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation

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Cumulative and/or exaggerated stress is found to lead to prolonged cortisol dysfunction, widespread inflammation, and pain

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Research has found that functional fitness is a common thread in effective fire service fitness programs.

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As a scientist who focuses on firefighter health and spends a lot of time collecting data in firehouses around the country, I often am asked what the data says about one health issue or another.

One of the common questions is about exercising on duty.

Sometimes it is the chiefs saying their risk-management team is concerned about the rates of line-of-duty injury (LODI) from exercise - or that they are receiving push back from the community about firefighters "wasting taxpayer money" by spending their time in the gym.

This has led them to ask whether exercise should be encouraged - or even allowed - on duty. This is where the data comes in.

Survey says
Studies are consistently finding that working out while on duty is the leading cause of LODI for firefighters. However, just stopping at the rate of injury from exercise only tells part of the story.

In a FEMA-funded study, we studied risk for injury among firefighters using a sample from the Midwest. Using surveys and asking about health practices and injuries over the last year, we were able to look at the relationship between on-duty exercise and LODI.

The participants were 462 career firefighters from 11 randomly selected fire departments.

We did find that exercise injuries accounted for about a third of on-duty injuries - a rate similar to what other scientists have found. But the data tells us more.

Cause and severity
First, most of the injuries that resulted from exercise were minor strains or sprains. Second, the majority of the injuries did not lead to lost days from work or extended absences. Finally, and maybe most importantly, those who exercised on duty most days were half as likely as their peers to have a non-exercise injury.

So, while on-duty exercise can lead to minor injuries, it is extremely protective against more catastrophic injuries on the fireground or during other duty activities.

Another unexpected note from the findings was the number of injuries that occurred during typical duty activities - often during truck checks.

It is interesting that, while something as basic as a truck check leads to injuries, I have yet to have anyone argue that truck checks shouldn't occur due to the risk. Obviously, it's important to know that a truck is well equipped and prepared to go at a moments' notice.

It seems obvious that it's equally - if not more important - to have the men and women getting on the truck just as prepared.

Doing it right
The risks of exercise injuries does bring up the importance of proper training and safe exercise which should be an important focus of any firefighter's fitness routine.

Doing exercise with poor form, more weight, or more intensity than one can handle can be a dangerous practice. While it is important firefighters push themselves to see improvements, it's equally important they know their limits and exercise in a smart and thoughtful way.

Effective exercise should focus on fitness across domains - strength, flexibility, endurance, mobility, stability and agility - rather than any one alone. Exercise, like firefighting, should require firefighters to be ready for anything.

An article by Dr. Mark Abel published by the National Strength and Conditioning Association outlined a number of suggestions for effective firefighter fitness programs.

Based on the literature, his suggestions include that departments provide supervision and training for firefighters, training take place during times of the day with lower call volume when possible, exercise be intense enough to create positive adaptive changes but not to the point of exhaustion, and firefighters should maintain proper hydration.

Functional fitness
Common threads seem to underlie the effective fitness programs I've observed or participated in through the course of our data collection with firefighters from Maine to Guam.

Most focus on functional fitness where activities mirror what firefighters might be tasked with doing on the fireground whether that is lifting and carrying items or running up stairs - activities that engage the whole body.

Exercise also seems to be more effective when crews are working out together. It keeps people motivated and can create friendly competition. Another benefit can be that firefighters critique each other on form and keep each other on task for completing exercises properly.

All in all, while injury is admittedly a risk of on-duty exercise, the data is clear - the overall benefits far outweigh the risks for the firefighters, departments, community and even risk management.

Strong programs can benefit not only firefighters' individual health parameters, but reduce the departments' overall risk of LODI on the fireground.

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Research solves firefighter injury, exercise link

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As a scientist who focuses on firefighter health and spends a lot of time collecting data in firehouses around the country, I often am asked what the data says about one health issue or another. One of the common questions is about exercising on duty.

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Correlation Between Physical Activity, Fitness, and Musculoskeletal Injuries in Police Officers

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Correlation Between Physical Activity, Fitness, and Musculoskeletal Injuries in Police Officers

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It has been found that law enforcement officers with the highest self-reported fitness levels are less likely to have chronic pain and injuries than officers that consider themselves less fit. Additionally, officers that classify as the most physically active are less than half as likely to report chronic pain than those who engage in less activity.

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Core strength: A New Model for Injury Prediction and Prevention

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Core strength: A New Model for Injury Prediction and Prevention

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Firefighters were 1.68 times more likely to fail a Functional Movement Screening if they had a history of injury.

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Chronic pain has been identified as a risk factor for suicide

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“the psychical adjunct of an imperative, protective reflex”
- Dr. Charles Sherrington

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The National Cohesive Wildland Fire Management Strategy helps local fire departments and residents in wildfire-prone regions to create cities and neighborhoods that can survive wildfire events.
Read the bulletin
The strategy encourages everyone to work together using the best management practices and good research to make progress in three main goals: resilient landscapes, fire-adapted communities, and safe and effective risk-based wildfire response.

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The National Cohesive Wildland Fire Management Strategy helps local fire departments and residents in wildfire-prone regions to create cities and neighborhoods that can survive wildfire events. Read the bulletin The strategy encourages everyone to work together using the best management practices and good research to make progress in three main goals: resilient landscapes, fire-adapted communities, and safe and effective risk-based wildfire response.

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Urbanized Areas (UAs) of 50,000 or more people;

Urban Clusters (UCs) of at least 2,500 and less than 50,000 people.

“Rural” encompasses all population, housing, and territory not included within an urban area.

To qualify as an urban area, the territory identified according to criteria must encompass at least 2,500 people, at least 1,500 of which reside outside institutional group quarters.

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The Census Bureau's urban-rural classification is fundamentally a delineation of geographical areas, identifying both individual urban areas and the rural areas of the nation. The Census Bureau's urban areas represent densely developed territory, and encompass residential, commercial, and other non-residential urban land uses.

For the 2010 Census, an urban area will comprise a densely settled core of census tracts and/or census blocks that meet minimum population density requirements, along with adjacent territory containing non-residential urban land uses as well as territory with low population density included to link outlying densely settled territory with the densely settled core. To qualify as an urban area, the territory identified according to criteria must encompass at least 2,500 people, at least 1,500 of which reside outside institutional group quarters. The Census Bureau identifies two types of urban areas:

Urbanized Areas (UAs) of 50,000 or more people;

Urban Clusters (UCs) of at least 2,500 and less than 50,000 people.

"Rural" encompasses all population, housing, and territory not included within an urban area.

Component ID: #ti433364548

Component ID: #ti433364547

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2010 Census Urban and Rural Classification and Urban Area Criteria

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The Census Bureau's urban-rural classification is fundamentally a delineation of geographical areas, identifying both individual urban areas and the rural areas of the nation. The Census Bureau's urban areas represent densely developed territory, and encompass residential, commercial, and other non-residential urban land uses.

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Physical activity is known to reduce pain and injury

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We have all heard it many times before - regular exercise is good for you, and it can help you lose weight. But if you are like many Americans, you are busy, you have a sedentary job, and you haven't yet changed your exercise habits. The good news is that it's never too late to start. You can start slowly, and find ways to fit more physical activity into your life. To get the most benefit, you should try to get the recommended amount of exercise for your age. If you can do it, the payoff is that you will feel better, help prevent or control many diseases, and likely even live longer.

What are the health benefits of exercise?

Regular exercise and physical activity may:

Help you control your weight. Along with diet, exercise plays an important role in controlling your weight and preventing obesity. To maintain your weight, the calories you eat and drink must equal the energy you burn. To lose weight, you must use more calories than you eat and drink.

Reduce your risk of heart diseases. Exercise strengthens your heart and improves your circulation. The increased blood flow raises the oxygen levels in your body. This helps lower your risk of heart diseases such as high cholesterol, coronary artery disease, and heart attack. Regular exercise can also lower your blood pressure and triglyceride levels.

Help your body manage blood sugar and insulin levels. Exercise can lower your blood sugar level and help your insulin work better. This can cut down your risk for metabolic syndrome and type 2 diabetes. And if you already have one of those diseases, exercise can help you to manage it.

Help you quit smoking. Exercise may make it easier to quit smoking by reducing your cravings and withdrawal symptoms. It can also help limit the weight you might gain when you stop smoking.

Improve your mental health and mood. During exercise, your body releases chemicals that can improve your mood and make you feel more relaxed. This can help you deal with stress and reduce your risk of depression.

Help keep your thinking, learning, and judgment skills sharp as you age. Exercise stimulates your body to release proteins and other chemicals that improve the structure and function of your brain.

Strengthen your bones and muscles. Regular exercise can help kids and teens build strong bones. Later in life, it can also slow the loss of bone density that comes with age. Doing muscle-strengthening activities can help you increase or maintain your muscle mass and strength.

Reduce your risk of some cancers, including colon, breast , uterine, and lung cancer.

Reduce your risk of falls. For older adults, research shows that doing balance and muscle-strengthening activities in addition to moderate-intensity aerobic activity can help reduce your risk of falling.

Improve your sleep. Exercise can help you to fall asleep faster and stay asleep longer.

Improve your sexual health. Regular exercise may lower the risk of erectile dysfunction (ED) in men. For those who already have ED, exercise may help improve their sexual function. In women, exercise may increase sexual arousal.

Increase your chances of living longer. Studies show that physical activity can reduce your risk of dying early from the leading causes of death, like heart disease and some cancers.

How can I make exercise a part of my regular routine?

Make everyday activities more active. Even small changes can help. You can take the stairs instead of the elevator. Walk down the hall to a coworker's office instead of sending an email. Wash the car yourself. Park further away from your destination.

Be active with friends and family. Having a workout partner may make you more likely to enjoy exercise. You can also plan social activities that involve exercise. You might also consider joining an exercise group or class, such as a dance class, hiking club, or volleyball team.

Keep track of your progress. Keeping a log of your activity or using a fitness tracker may help you set goals and stay motivated.

Make exercise more fun. Try listening to music or watching TV while you exercise. Also, mix things up a little bit - if you stick with just one type of exercise, you might get bored. Try doing a combination of activities.

Find activities that you can do even when the weather is bad. You can walk in a mall, climb stairs, or work out in a gym even if the weather stops you from exercising outside.

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Regular exercise is one of the best things you can do for your health. Learn about all of the benefits, plus tips on adding exercise to your routine.

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NFPA's report on " Firefighter Fatalities in the United States"
Overall statistics on line-of-duty firefighter fatalities, including non-incident-related deaths. Includes patterns, trends, career vs. volunteer comparisons, and brief narratives on selected incidents.

*Non-municipal firefighters are those who are not employed by local, public fire departments. They can be full-time, paid firefighters, or not. The can include employees of forestry agencies, industrial fire brigades, the military, the Federal government, prison crews and impressed civilians.

**Includes 340 firefighters at the World Trade Center, September 11, 2001.

Source: Firefighter Fatalities in the United States, Rita F. Fahy and Joseph L. Molis, NFPA, June 2019 and previous reports in the series.
Updated 6/19

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NFPA's report on " Firefighter Fatalities in the United States" Overall statistics on line-of-duty firefighter fatalities, including non-incident-related deaths. Includes patterns, trends, career vs. volunteer comparisons, and brief narratives on selected incidents. *Non-municipal firefighters are those who are not employed by local, public fire departments. They can be full-time, paid firefighters, or not.

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Hello,

I work in emergency services. A few years ago, I assisted with an EMS training and noticed nearly everyone was reflecting poor health and/or health behaviors. What was more startling was that it had become engrained into the work culture?. You could tell by their behavior it was the norm and even celebrated.

EMTs are trained to utilize a standard patient assessment, regardless if the patient received a papercut or lost their whole arm to a table saw (wow, that’s a lot of blood). In that patient assessment is a series of questions known as, “OPQRST”; onset, provocation, quality, radiation, severity, and time. OPQRST is often applied to situations of pain and discomfort. We communicate with pain since it is the body’s way of trying to tell us what is wrong.

“Your arm hurts? Well, no wonder! A table saw went right through it. That is a problem. Yikes! We are going to need a bigger Band-Aid.”

I thought that the same principles could be applied to emergency responder health. If we could communicate with the pain, we could figure out what was wrong.

I wish I had become comfortable with the padlet format much earlier. Now that I am finally comfortable with it I can see what a great tool it would have been to use! Speaking and collaborating with classmates outside of class was helpful. Some of you (especially Viviene) provided excellent feedback that helped me direct and narrow my focus of exploration. I appreciated that Lisa Kay was also exploring health factors of emergency responders. It was fun in some of the discussions to be able to provide some of my resources to what she was looking at. The moral support the last few weeks was much appreciated. I had to scratch my original worksite plan and go to a strictly online form of research. With covid-19 there was not a way that any of the local police or fire departments would be able to take me on.

For this summer I will be executing a state wide survey to Wisconsin public career fire and police departments in order to communicate with the state’s emergency responder pain. If I could do things differently, I would start my very first semester and focus on learned helplessness instead of chronic pain in emergency services. I so badly want to publish a nationwide study on learned helplessness of emergency responders, but it is just not feasible to accomplish in our allotted time frame.

I very much enjoyed spending the semester with all of you and wish your capstone experiences the very best! Stay healthy.

Very respectfully,

Kyra

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Chronic pain is the ongoing message of the potential threat of damage. Three key areas of concern for emergency responder health are physical fitness, diet, and cumulative trauma of the job. Physical fitness, diet, and cumulative trauma all have ties to chronic pain. Chronic pain can serve as a guide to risk prevention and health promotion for emergency responders. Conducting a statewide survey on the prevalence and significance of chronic pain and its ties to fitness, diet, and mental health of emergency responders can give direction to implementing population-specific health and wellness interventions.

Keywords: emergency responders, law enforcement, firefighters, EMS, chronic pain, fitness, diet, mental health

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Driving Question:
What is the prevalence of chronic pain in Wisconsin police officers and fire department emergency responders in relation to nutrition, fitness, and mental health?

Support Questions:

What percentage of Wisconsin police officers and fire department emergency responders experience chronic pain?

What is the severity of the chronic pain that is experienced by those emergency responders?

Is there a noticeable difference in the chronic pain experienced by police officers and fire department emergency responders?

Is there a relationship between physical activity patterns and chronic pain among police officers and fire department emergency responders?

Is there a relationship between diet and chronic pain among police officers and fire department emergency responders?

Is there a relationship between mental health and chronic pain among police officers and fire department emergency responders?

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"The Emergency Service Health Crisis: A Painful Observation"

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"The Emergency Service Health Crisis: A Painful Observation"

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"The Emergency Service Health Crisis: A Painful Observation"

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The Emergency Service Health Crisis: A Painful Observation

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A bidirectional relationship has been found between chronic pain and mental health.

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Chronic Pain and Mental Health Disorders Mayo

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Even incentives with low monetary value increased the response participation of nurses filling out surveys.

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Surveying Nurses Identifying Strategies to Improve Participation

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This Inventory is based off the AAFP Brief Pain Inventory. I tweaked it a bit to fit my audience. It uses predominantly Likert scale, followed by a couple of open ended questions and finishes with a human body illustration they may shade to demonstrate pain areas. Colored pencils will be provided.

I am considering adding a few questions on diet and fitness to the survey. It may seem appropriate to create a separate survey for those, but I suspect my participation rate will drop considerably if I go that route.

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Brief Pain Inventory belongs to a Practice-based toolkit that was "designed to help family physicians identify gaps in practice flow, standardize evaluation and treatment of chronic pain patients, and facilitate conversations surrounding pain and treatment goals, as well as identify and mitigate risk. It contains primary care, patient-centered resources that highlight key workflow features in order to streamline delivery and offer best-care medicine".

AAFP Chronic Pain Management Toolkit. (2016, June 9). Retrieved March 5, 2020, from https://www.aafp.org/patient-care/public-health/pain-opioids/cpm-toolkit.html

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Determining Best Practices to Reduce Occupational Health Risks in Firefighters

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Determining Best Practices to Reduce Occupational Health Risks in Firefighters

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What I like most about this article/study is that it highlights that, "Cognitive awareness regarding personal fitness and wellness alone does not sup;port behavior change. Health behavior change comes from the knowledge of personal status and having the reasonable opportunity and environment conducive to making those changes.

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Determining Best Practices to Reduce Occupational Health Risks in Firefighters

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You need a paid membership to access the study by the Firefighter Behavioral Health Alliance, but this free article provides an overview.
https://www.delmarvanow.com/story/life/2019/09/23/firefighter-suicide-mental-health-culture-maryland-delaware-virginia-salisbury/1300515001/

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There were 172 law enforcement suicides in 2018. This is a website that has the suicide count from 2016 to present day.
https://bluehelp.org/

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United States Firefighter Injury Report 2018

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Law Enforcement Assault Injury Report with website.

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Law Enforcement Assault Injury Report with website.

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The website is better than the report as far as accessing specific data sets.
https://ucr.fbi.gov/leoka/2018/topic-pages/officers-assaulted

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Law Enforcement Officers Assault Injuries 2018

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2018 Law Enforcement Officers Fatalities Report

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Law Enforcement Mental Health and Wellness Programs Case Studies

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Law Enforcement Mental Health and Wellness Programs Case Studies

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These case studies focus on law enforcement, but many of them also include fire. I personally spoke with Aaron Snyder, the sergeant in charge of the wellness program for Indianapolis Metropolitan Police Department. I was highly impressed!

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Law Enforcement Mental Health and Wellness Programs