The State of Health Surveillance Across the Public Safety Sector

Surveillance is the cornerstone of public health practice, including in occupational safety and health (OSH). OSH surveillance systems have the ability to generate data that drives decision making and action.^{1, 2} There are multiple steps in a surveillance system including timely and accurate data collection; data quality monitoring; data management; data analysis; interpretation of results; and dissemination and application of information.¹ OSH researchers have used surveillance systems to improve understanding of occupational exposures, injuries, illnesses, and fatalities. These systems have also contributed to improved injury prevention and intervention efforts. However, more comprehensive surveillance systems are needed to fully understand and improve OSH among the public safety workforces.

The National Occupational Research Agenda (NORA) Public Safety Sector (PSS) focuses on the health and safety needs of public safety workers including structural firefighters, wildland firefighters, law enforcement and corrections officers, emergency medical services clinicians, and public safety (911) telecommunicators. These are among some of the most dangerous jobs as these workers respond to emergencies that often put their own health, safety, and lives on the line. Public safety workers are exposed to a variety of risks and stressors that impact their mental, physical, and emotional well-being.

In October 2022, the NORA Public Safety Sector Council hosted a meeting focused on the state of surveillance across the sector. Speakers with a nationwide perspective described the vision, scope, and maturity of numerous surveillance efforts across the nation related to the public safety workforce. These speakers represented:

• The National Institute for Occupational Safety and Health (NIOSH)
• The National Center for Injury Prevention and Control
• The U.S. Fire Administration (USFA)
• The National Highway Traffic Safety Administration (NHTSA)

What is happening in public safety worker health surveillance?

Efforts are currently underway to expand, modernize, or create new health surveillance systems to address the OSH needs of public safety workers. Mental health issues among public safety officers have created a need for improved data on the incidence of public safety officer suicide. To address this gap, the National Center for Injury Prevention and Control developed a new module for the National Violent Death Reporting System that will collect more detailed data on suicides among public safety officers including public safety telecommunicators. Decision makers will be able to use these improved data to inform, develop, and tailor prevention strategies for this workforce.

Improved health surveillance is needed for EMS clinicians and public safety telecommunicators who answer calls that expose them to various physical and mental hazards daily. Limited data exist on injury, violence, post-traumatic stress injury/disorder, and suicide among these workers. Additionally, when compared to other first responder communities, they often have less access to mental health resources. NHTSA is developing resources for these workers to close existing knowledge gaps, keep workers resilient, and help grow the workforce. They partnered with the Agency for Healthcare Research and Quality to publish a topic development brief on EMS/911 workforce mental or behavioral health issues. A systematic review of the literature is planned that will inform the development of an evidence-based guideline for EMS/911 workforce mental health. Additionally, NHTSA previously partnered with NIOSH to develop national estimates of non-fatal EMS clinician injuries using the National Electronic Injury Surveillance System – Work.

NHTSA is also working with EMS and 911 communities to improve their use of public health surveillance systems. When EMS clinicians and public safety telecommunicators respond to an incident or answer a call, they generate powerful data that can help improve outcomes, interventions, and public health surveillance. For example, response and patient data voluntarily submitted into the National EMS Information System are used to improve patient care. By giving responders the right resources and educating them on the importance of the data they are collecting, they can provide better care for the caller or patient and improve data capture.

Improving data capture is also a focus of USFA’s modernization of the National Fire Incident Reporting System. USFA is working to develop a new cloud-based analytic platform to improve the ability to capture, integrate, analyze, and report data in a timely manner. To aid this effort, USFA is also creating a new data standard that will leverage existing standards and focus on collecting need-to-know information. By collecting high-quality and relevant data through this new system, USFA can better inform operational decisions and advise on safety issues currently facing the fire service.

NIOSH is working to tackle one of the issues facing the fire service, cancer in firefighters, through the development of a National Firefighter Registry (NFR). Studies have suggested a link between cancer and firefighting, but questions remain about the impact different incident types, risk factors, behaviors, and demographics have on cancer rates. The NFR will use data from participants and state cancer registries to help fill these knowledge gaps and reduce cancer in firefighters. NIOSH encourages all firefighters to join the NFR especially women, minority, and volunteer firefighters as these groups are often understudied. Although participation is voluntary, having broad eligibility and participation will allow NIOSH to gain a better understanding of cancer in the fire service.

What are current challenges and gaps?

During the meeting, presenters raised key issues about both adoption and representativeness of the data in any surveillance system. Surveillance systems often depend on voluntary participation which raises questions regarding who participates and why. In general, if a surveillance system is used to answer questions about employee health and safety, there should be broad participation to provide confidence in the data and its quality. Broad eligibility and participation may also allow for data users to make new linkages to gain additional information about subgroups and covariates.

Additionally, reducing the administrative burden for users may increase both adoption and representativeness of surveillance systems. Administrative burden may be reduced through system designs such as simplifying the process to enter data. For example, creating flexible and easy to access systems that can tie into existing data systems may reduce the burden of data entry. It is also critical that steps be taken to ensure data privacy. This is accomplished by either not collecting any personally identifying information or ensuring that data is de-identified before others access a system. Protecting data privacy may help increase adoption and use.

Presenters also highlighted barriers certain worker populations face in regard to conducting surveillance. One NIOSH presenter called attention to the lack of surveillance for wildland firefighters. Wildland firefighters respond to wildfire incidents that span thousands of acres, cross state boundaries, and can last months, making surveillance difficult. Some wildland firefighters may also be seasonal employees, employed privately, or only occasionally respond to wildfire incidents impacting their ability to be studied over multiple fire seasons. NIOSH is currently conducting research to better understand their exposures and well-being in the workplace. However, many questions remain regarding how to best capture data in these very dynamic work environments, recruit firefighters for health studies, and create partnerships with different employers.

Wildland firefighters are not the only worker population that has been overlooked when it comes to surveillance. EMS clinicians and public safety telecommunicators are often not recognized as first responders limiting their access to resources. Improving their recognition as first responders may increase awareness of the need for better surveillance systems for this workforce and lead to more funding opportunities to better address their needs.

What are the key takeaways and next steps?

Following each presentation, the Public Safety Sector Council led facilitated discussions to further probe how these systems may be used to:

• Inform policy and practice.
• Identify additional ways that the data obtained by the systems may be leveraged.
• Identify opportunities for enhanced impact by expanding engagement to additional parties.

Much of the discussion during the meeting centered around opportunities for collaborations and partnerships that could enhance the development, uptake, and use of the surveillance systems presented as well as other similar surveillance systems. Discussion highlighted possible opportunities for collaboration between state health departments, NIOSH, and others who collect and use these data systems.

If you are interested in collaborating, please consider responding to one or both of the questions below by e-mailing WAttwood@cdc.gov or in the comments section below.

1. Are you (or your organization) involved in collecting data on any first responder worker populations that may fill existing knowledge gaps? If so, please describe your current efforts and provide a point of contact. If your work is online, please share a link as well.
2. Are you interested in assisting any of the agencies discussed above in expanding surveillance of first responder worker populations? If so, who would you be interested in connecting with and how would you see yourself contributing?

The NORA Public Safety Sector Council can also look for ways to facilitate collaborative opportunities and explore collaboration across other NORA sectors and cross-sectors as the issues presented during the meeting are not unique to the public safety workforce.

Carol Brown, PhD, is the Deputy Director at the Center for Health, Work & Environment at the Colorado School of Public Health and is Co-Chair of the NORA Public Safety Sector Council.

Suzanne M. Marsh, MPA, is a Research Statistician and Team Lead for the Special Studies Team, Surveillance and Field Investigations Branch, Division of Safety Research, National Institute for Occupational Safety and Health. She is also the Co-Coordinator for the NIOSH Public Safety Sector Program.

Susan M. Moore, PhD, is the Associate Director for Science, National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health and is Co-Chair of the NORA Public Safety Sector Council and Co-Coordinator for the NIOSH Public Safety Sector Program.

Meghan Kiederer, BA, is a Health Communication Specialist within the Research Branch of the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health and is the Communications Coordinator for the NORA Public Safety Sector Council and NIOSH Public Safety Sector Program.

References

1. Groseclose, S. L., & Buckeridge, D. L. (2017). Public Health Surveillance Systems: Recent Advances in Their Use and Evaluation. Annual review of public health, 38, 57–79. https://doi.org/10.1146/annurev-publhealth-031816-044348
2. Nsubuga P, White ME, Thacker SB, et al. Public Health Surveillance: A Tool for Targeting and Monitoring Interventions. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006. Chapter 53.Available from: https://www.ncbi.nlm.nih.gov/books/NBK11770/ Co-published by Oxford University Press, New York.