Category Archives: Emergency Services

Mortality among World Trade Center rescue and recovery workers, 2002–2011

Source: Cheryl R. Stein, Sylvan Wallenstein, Moshe Shapiro, Dana Hashim, Jacqueline M. Moline, Iris Udasin, Michael A. Crane, Benjamin J. Luft, Roberto G. Lucchini and William L. Holden, American Journal of Industrial Medicine, Early View, Article first published online: January 4, 2016
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From the abstract:
Background: Rescue and recovery workers responding to the 2001 collapse of the World Trade Center (WTC) sustained exposures to toxic chemicals and have elevated rates of multiple morbidities.

Methods: Using data from the World Trade Center Health Program and the National Death Index for 2002–2011, we examined standardized mortality ratios (SMR) and proportional cancer mortality ratios (PCMR) with indirect standardization for age, sex, race, and calendar year to the U.S. general population, as well as associations between WTC-related environmental exposures and all-cause mortality.

Results: We identified 330 deaths among 28,918 responders. No cause-specific SMRs were meaningfully elevated. PCMRs were elevated for neoplasms of lymphatic and hematopoietic tissue. Mortality hazard ratios showed no linear trend with exposure.

Conclusions: Consistent with a healthy worker effect, all-cause mortality among responders was not elevated. There was no clear association between intensity and duration of exposure and mortality. Surveillance is needed to monitor the proportionally higher cancer mortality attributed to lymphatic/hematopoietic neoplasms

Cancer in World Trade Center responders: Findings from multiple cohorts and options for future study

Source: Paolo Boffetta, Rachel Zeig-Owens, Sylvan Wallenstein, Jiehui Li, Robert Brackbill, James Cone, Mark Farfel, William Holden, Roberto Lucchini, Mayris P. Webber, David Prezant and Steven D. Stellman, American Journal of Industrial Medicine, Early View, Article first published online: January 4, 2016
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From the abstract:
Background: Three longitudinal studies of cancer incidence in varied populations of World Trade Center responders have been conducted.

Methods: We compared the design and results of the three studies.

Results: Separate analyses of these cohorts revealed excess cancer incidence in responders for all cancers combined and for cancers of the thyroid and prostate. Methodological dissimilarities included recruitment strategies, source of cohort members, demographic characteristics, overlap between cohorts, assessment of WTC and other occupational exposures and confounders, methods and duration of follow-up, approaches for statistical analysis, and latency analyses.

Conclusions: The presence of three cohorts strengthens the effort of identifying and quantifying the cancer risk; the heterogeneity in design might increase sensitivity to the identification of cancers potentially associated with exposure. The presence and magnitude of an increased cancer risk remains to be fully elucidated. Continued long-term follow up with minimal longitudinal dropout is crucial to achieve this goal.

Expecting the unexpected: A mixed methods study of violence to EMS responders in an urban fire department

Source: Jennifer A. Taylor, Brittany Barnes, Andrea L. Davis, Jasmine Wright, Shannon Widman and Michael LeVasseur, American Journal of Industrial Medicine, Early View, Article first published online: January 4, 2016
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From the abstract:
Background: Struck by injuries experienced by females were observed to be higher compared to males in an urban fire department. The disparity was investigated while gaining a grounded understanding of EMS responder experiences from patient-initiated violence.

Methods: A convergent parallel mixed methods design was employed. Using a linked injury dataset, patient-initiated violence estimates were calculated comparing genders. Semi-structured interviews and a focus group were conducted with injured EMS responders.

Results: Paramedics had significantly higher odds for patient-initiated violence injuries than firefighters. Females reported increased odds of patient-initiated violence injuries compared to males, but this relationship was entirely mediated through occupation. Qualitative data illuminated the impact of patient-initiated violence and highlighted important organizational opportunities for intervention.

Conclusions: Mixed methods greatly enhanced the assessment of EMS responder patient-initiated violence prevention.

The Effects of Collective Bargaining Rights on Public Employee Compensation: Evidence from Teachers, Firefighters, and Police

Source: Brigham R. Frandsen, ILR Review, Vol. 69 no. 1, January 2016
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From the abstract:
Widespread public-sector unionism emerged only in the 1960s, as individual states opened the door to collective bargaining for state and municipal workers. In this study, the author exploits differences in timing of legislative reforms across states to construct estimates of the causal effects of public-sector collective bargaining rights on pay, benefits, and employment for teachers, firefighters, and police. Perhaps surprisingly, estimates that allow for state fixed effects and state-specific trends show little effect on teachers’ pay, benefits, or employment, despite significantly increasing union presence among teachers. For firefighters, the results show a substantial positive effect on wages. For police, the wage effect was more modest but the workweek was significantly shortened.

The relationship between burnout, PTSD symptoms and injuries in firefighters

Source: F. Katsavouni, E. Bebetsos, P. Malliou and A. Beneka, Occupational Medicine, Advance Access, First published online: September 25, 2015
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From the abstract:
Background: Firefighters participate in activities with intense physical and psychological stress.
Aims To examine the correlation between work-related injuries (WRIs), burnout and post-traumatic stress disorder (PTSD) symptoms in firefighters.
Methods: The method used for the recording of the elements was the collection of self-report anonymous questionnaires, the completion of which was optional. The questionnaires used were: (i) a WRIs questionnaire, (ii) the Maslach Burnout Inventory (MBI) and (iii) the Impact of Event Scale-Revised-Greek version. Descriptive statistics along with univariate and multivariate logistic regression analyses were applied.
Results: The study population consisted of 3289 firefighters. There was a significant association between WRIs, burnout syndrome, PTSD symptoms and age, work experience and physical condition. Relationships were found between PTSD symptoms, the MBI–emotional exhaustion dimension and WRIs and between MBI–depersonalization dimension and PTSD symptoms. The most traumatic event was the ‘dealing with death or rescue of a child’ and the top stress factor was ‘depression about the responsibility for quality of victims’ life’.
Conclusions: The occupational obligations may be responsible for the psychological and musculoskeletal problems experienced by firefighters. Early recognition and response to psychosomatic issues in firefighters is of high importance.

Pinch Hitting

Source: Michelle Ancell, State Legislatures, Vol. 41, No. 8, September 2015

Doctor shortages in rural America have paramedics stepping up to the plate when needed. … Community paramedicine systems are popping up in Colorado, Maine, Minnesota, Missouri and Nevada to provide health care where few services exist. Often, they save money for patients, hospitals and insurance companies, mostly in avoided costs. A leg amputation, for example, costs around $76,000. That’s about what it would cost to fund community paramedic home visits to Robert for 11 years. Minnesota reported that because of the paramedicine program there, Medicaid providers serving 100,000 residents spent $10.5 million less in 2014 than analysts projected they would. ….

The New EMS Imperative: Demonstrating Value

Source: ICMA, InFocus, 2015

Despite a tremendous diversity in how emergency medical services (EMS) are provided in municipalities around the country, most U.S. EMS systems share one commonality: They remain primarily focused on responding quickly to serious accidents and critical emergencies even though patients increasingly call 911 for less severe or chronic health problems.

Recent efforts in health care to improve quality and reduce costs pose significant challenges to the existing EMS response model. Health care payers have become increasingly unwilling to reimburse for services that fail to prove their value. As a consequence, EMS agencies will soon be required to demonstrate their worth like never before.

It’s critical for city and county managers to know that despite these challenges, the changing health care landscape also presents opportunities for EMS systems to evolve from a reactive to a proactive model of health care delivery—one that better meets the needs of their communities by preventing unnecessary ambulance transports, reducing emergency department visits, and providing better care at a lower cost. This InFocus is intended as a guide to identify challenges and opportunities and help you measure your efforts and define success.

The association between weekly work hours, crew familiarity, and occupational injury and illness in emergency medical services workers

Source: Matthew D. Weaver, P. Daniel Patterson, Anthony Fabio, Charity G. Moore, Matthew S. Freiberg and Thomas J. Songer, American Journal of Industrial Medicine, Early View, Article first published online August 25, 2015
(subscription required)

From the abstract:
Objective: Emergency Medical Services (EMS) workers are shift workers in a high-risk, uncontrolled occupational environment. EMS-worker fatigue has been associated with self-reported injury, but the influence of extended weekly work hours is unknown.

Methods: A retrospective cohort study was designed using historical shift schedules and occupational injury and illness reports. Using multilevel models, we examined the association between weekly work hours, crew familiarity, and injury or illness.

Results: In total, 966,082 shifts and 950 reports across 14 EMS agencies were obtained over a 1–3 year period. Weekly work hours were not associated with occupational injury or illness. Schedule characteristics that yield decreased exposure to occupational hazards, such as part-time work and night work, conferred reduced risk of injury or illness.

Conclusions: Extended weekly work hours were not associated with occupational injury or illness. Future work should focus on transient exposures and agency-level characteristics that may contribute to adverse work events