Emergency and security services exist to deal with extraordinary and threatening situations. The people who work in such services are therefore confronted with events and circumstances that lie outside the usual experience of human beings in their daily lives. Although each of the occupations has its own set of hazards, risks and traditions, they share several features in common. These include the following:
- long periods of relative quiet or routine interrupted abruptly by periods of intense psychological stress
- long periods of relative inactivity interrupted abruptly by periods of intense physical activity
- rigid codes of behaviour and high expectations for performance, often accompanied by detailed orders for how to do the job and high penalties for failure
- personal danger; the worker allows himself or herself to be exposed to hazards that are unusual for anyone else in the community
- a primary objective of rescuing or protecting others who are not able to save themselves
- a secondary objective of protecting property from destruction or damage
- teamwork under demanding conditions
- a rigid hierarchy or “chain of command” to reduce uncertainty and to make sure that procedures are followed correctly.
The form of organization and the means by which the mission of these services is carried out varies. The circumstances of the mission of a service affect the attitude and approach to the job; these differences are perhaps best understood by considering the object of control for each emergency service.
Firefighting is perhaps the most representative emergency and security service. This occupation arose historically as a way to limit property damage from fires, and started as a private service in which fire-fighters might save the businesses and houses of persons who paid insurance premiums but would let the property of others burn, even if they were right next door. Soon, society determined that private fire services were inefficient and that it would be much more practical and useful to make them public. Thus, firefighting became a municipal or local government function in most parts of the world. Private firefighting services still exist in industry, at airports and in other settings where they are coordinated with municipal services. In general, fire-fighters enjoy a great deal of trust and respect in their communities. In firefighting, the object of control, or the “enemy”, is the fire; it is an external threat. When a fire-fighter is injured on the job, it is perceived as the result of an external agent, although it might be an indirect assault if the fire were set by an arsonist.
Police services and the military are given the responsibility by society to maintain order, generally in response to an internal threat (such as crime) or to an external threat (such as war). Armed force is the essential means of accomplishing the mission, and the use of appropriate tactics and investigative techniques (whether criminal investigation or military intelligence) is standard procedure. Because of the high potential for abuse and misuse of force, society in general has imposed strict limitations on how force is used, especially toward civilians. Police especially are watched more closely than other emergency and security personnel to ensure that they use their monopoly on force correctly. This sometimes leads to the perception by police officers that they are not trusted. For the police and for soldiers, the object of control, or the “enemy”, is another human being. This creates many situations of uncertainty, feelings of guilt and questions about rights and proper behaviour that fire-fighters do not have to face. When police or soldiers are injured in the line of duty, it is usually the direct result of intentional human action taken against them.
Paramedical and rescue personnel are responsible for recovering, stabilizing and rendering initial treatment to people who are injured, ill or trapped in circumstances from which they cannot escape by themselves. Often they work side by side with fire-fighters and police. For them, the object of control is the patient or victim whom they are trying to help; the victim is not an “enemy”. Moral and ethical issues in these occupations are most prominent when the victim is partially responsible for his or her condition, as when a driver is intoxicated by alcohol or a patient refuses to take medication. Sometimes, victims who are not rational or who are angry or under stress may act in an abusive or threatening way. This is confusing and frustrating for paramedical and rescue personnel, who feel that they are doing their best under difficult circumstances. When one of these workers is injured on the job, it is perceived as almost a betrayal, because they were trying to help the victim.
Hazardous materials response teams are often part of fire services and have a similar organization on a small scale. They evaluate and take initial steps to control chemical or physical hazards that may present a threat to the public. Hazardous waste remediation workers are less tightly organized that these other occupations and exist to clean up a problem that has been around for a while. In both cases, the workers are dealing with a potential hazard in which the fundamental problem is uncertainty. Unlike the other occupations, in which it was clear who or what was the object of control, these workers are controlling a risk that may be difficult to identify. Even when the chemical or hazard is known, the future risk of cancer or disease is usually uncertain. Workers often cannot know whether they have been injured on the job because the effects of exposure to chemicals may not be known for many years.
Potential Occupational Hazards
The common hazard to all of these workers is psychogenic stress. In particular, they are all subject to so-called critical events, which are situations perceived to be of grave or uncertain but probably serious danger that a person cannot escape. Unlike a member of the general public, a worker in one of these occupations cannot simply walk away or leave the scene. Much of their own sense of self-esteem comes from how they handle just such situations. For workers who survive critical events, there is often a period of denial followed by a period of depression and distracted behaviour. Thoughts of what the worker has seen and a sense of guilt or inadequacy intrude on his or her thinking. It is difficult to concentrate, and the worker may have nightmares. The worst critical events are generally considered to be those in which victims have died because of a mistake or because it was not possible for the rescuer to save them, in spite of his or her best efforts.
Many of these occupations also involve the rescue and stabilization of people who may be ill with communicable diseases. The infections that most commonly present a problem are AIDS and HIV infection generally, hepatitis B and C and tuberculosis. HIV and hepatitis B and C viruses are both transmitted by human body fluids and may therefore pose a hazard to emergency response personnel when there is bleeding or if the worker is deliberately bitten. Emergency response personnel are now usually trained to consider all subjects (victims or criminals) as potentially infected and infective. HIV precautions are described elsewhere. Tuberculosis is transmitted by sputum and by coughing. The risk is particularly great during the resuscitation of persons with active cavitary tuberculosis, an increasingly frequent problem in economically disadvantaged inner city areas.
Injury is a risk common to all of these occupations. Fires are always unsafe, and the hazards of the fire itself may be combined with the risk of structures breaking apart, unstable floors, falling objects and falls from a height. Violence is a more common hazard of police and military combat services, obviously, because that is what they were created to control. However, aside from intentional violence there is a potential for hazards from traumatic incidents involving automotive traffic, mishandling of weapons and, especially in the military, occupational injuries in support areas. Hazardous materials workers may deal with a variety of unknown chemicals which may have a hazard of explosion or fire in addition to their toxic properties.
These occupations vary greatly in their potential for health problems. Aside from stress-related outcomes and the potential for communicable diseases mentioned, each occupation is different in its health concerns.
Preventive Guidelines
Each occupation differs in its approach to prevention. However, there are a few measures that are common to all or most of them.
Many services now require their workers to go through a process called critical event debriefing following such incidents. During these debriefings, the workers discuss the event in the presence of a trained mental health worker-how they feel about it, and their feelings about their own actions. Critical event debriefing has been shown to be very effective in preventing later problems, such as post-traumatic stress syndrome, following critical events.
Rigorous fitness screening at the time of hire is usually part of the selection process for police and fire personnel, and many services require these members to stay fit through regular exercise and training. This is intended to ensure satisfactory and consistent performance, but it has the additional effect of reducing the likelihood of injuries.
Infectious hazards are difficult to anticipate because victims may not show outward signs of infection. Emergency response personnel are now taught to use “universal precautions” in handling body fluids and to use protective equipment such as gloves and safety eyeglasses if there is a risk of coming into contact with body fluids. Often, however, such events are unpredictable or difficult to control if the victim is violent or irrational. Routine immunization with hepatitis B vaccine is advised where the risk is high. Disposable resuscitation equipment is recommended to reduce the risk of transmitting communicable diseases. Special care should be taken with needles and other sharp objects. Human bites should be cleaned thoroughly and treatment given with penicillin or a penicillin-like drug. When HIV infection has been confirmed in the person who was the source, or contamination and transmission may have taken place by needlestick or invasive contact with blood or body fluids, a physician’s advice should be sought about the advisability of prescribing antiviral drugs that reduce the chance of infection in the worker. Tuberculosis infection in an exposed worker can be confirmed by skin test and then treated prophylactically before it becomes a serious disease.
Other preventive measures are specific to the particular occupations.