Emergency workers pay high price for being first on the scene

Senior firefighter Peter Kirwan suffered a back injury that fed into depression.  Photo: Fire and Rescue NSW
Senior firefighter Peter Kirwan suffered a back injury that fed into depression. Photo: Fire and Rescue NSW

Peter Kirwan thought he was "bulletproof" when he started as a firefighter, unaware that first responders are on average three times more likely to suffer a serious work-related injury or mental illness than other professions.

For some ambulance workers, the rate is five to seven times higher than the general public, while police, often facing hostile aggressors, face much higher rates of mental illness.

When Mr Kirwan's fire truck crashed injuring his back, his life on the front line was over.

Emergency workers are three times on average more likely than the average profession to make a workers' compensation claim. Photo: SMH

Emergency workers are three times on average more likely than the average profession to make a workers' compensation claim. Photo: SMH

"As a 30-year-old, having what you had seen as your life path dramatically change direction is something I didn't anticipate," said the senior firefighter. Chronic pain fed into depression, and a series of small incidents brought everything to a head.

"If someone had said, prior to my breakdown, that I was suffering depression and anxiety, or heading down that path from chronic pain and related injuries I wouldn't have believed them," said Mr Kirwan, now 44 and a technical rescue instructor with NSW Fire and Rescue.

To the public, emergency workers are larger than life figures who run towards dangers the rest of us cower from. But this stereotype creates "unrealistic images of strength in first responders", said Mr Kirwan, whose goal is to raise awareness of mental health. "At the end of the day, we are still human."

Already at increased risk from shiftwork and erratic hours, a new study finds emergency workers are paying a high psychological and physical price for being the first on the scene of deaths, traumas, violence, chaos, disease and extreme temperatures.

Nearly always working in unfamiliar and unpredictable surroundings, they are three times more likely than the average profession to make a workers' compensation claim, with 15-21 per cent of some groups likely to be out sick on workers compensation over a nine-year period, according to the study published in the journal Injury last month.

Ambulance officers were at greatest risk of injury to their upper bodies. Firefighters and emergency workers were more likely to hurt their lower bodies, legs and feet, while police officers had 13 times greater risk of mental health conditions than others, the study's lead author Shannon Gray from Monash University told the Australian Injury Prevention Network conference in Ballarat last week.

The study found about 15 per cent of ambulance officers/paramedics, 10 per cent of fire and emergency workers, and 9 per cent of police claimed workers' compensation for an injury/illness (compared with an average of less than 3 per cent of all other occupations) in the nine years to 2012.

The review of 2.4 million workers' compensation claims by Dr Gray and co-author Alex Collie, also found female ambulance officers and paramedics had a 21 per cent chance of an accepted claim versus 13 per cent for males, compared to fewer than 3 per cent among other professionals.

Police officers' claims for physical injuries had declined over the nine years studied, but the risk of claiming for mental health conditions was nearly 13.8 times higher than for people in other professions.

The study also found the "injury burden of disability" – the incident rate as well as the time spent away from work – was also higher among first responders. Dr Gray said this injury burden had increased significantly among police, with each police officer losing a week's worth of work compared to only .2 weeks among average workers.

Getting first responders back to work

Most programs designed to get first responders suffering mental illness back to work faster have shown little evidence of success, but the results of a new trial by NSW Fire and Rescue may provide some hope.

The results of the study of 43 managers and more than 2100 first responders found that managers who were given a half-day training program on how to provide regular, early and practical help for mental health problems got firefighters back to work about a day and a half faster, saving $35 for every dollar spent.

Mark Dobson, the former wellbeing manager with NSW Fire and Rescue, said the study – published in Lancet Psychiatry in October – was the first to prove a link between manager training and the reduction of hours off sick on workers' compensation.

While many commanders were effective fire fighters, they sometimes lacked the softer skills and confidence to tackle these problems, he said.

The two organisations, NSW Police and Fire and Rescue NSW, have put in place a range of early intervention treatments, including counselling, peer support programs and professional help to tackle physical injuries and trauma before they become long-term.

NSW Police's commander, workforce safety, Robert Redfern said the police were now working on normalising the idea that "occasions of psychological ill health were as normal as occasions of physical ill health, and that it was equally normal to seek help, recover and be able to return to work".

While a traumatic event, such as a dead child or a gun to a head, was sometimes the trigger, it was often the cumulative effect of trauma over time that causes ill health. New tools used by managers, including an incident support database, were designed to identify signs an officer could be in trouble.

"An incident that may objectively not been seen as traumatic can often subjectively be the final straw," he said.

Major reviews of wellness programs for first responders had so far provided little empirical evidence that wellness programs work.

"The reality is that this is a very difficult space to work in," Commander Redfern said. "Everyone keeps putting up silver bullets, and there simply aren't any," he said.

Like Fire and Rescue, whose programs have been assessed by experts at the University of NSW, the police are also working to have their programs assessed.

"There is always more to do," he said. "However, I am quietly confident that we are on the right track," he said.

Considering the $300,000 cost of training a paramedic, it was prudent to prevent injuries, particularly as physical injuries were often the gateway to psychological problems, said Gerard Hayes, NSW secretary of the Health Services Union. 

"In one instance, a paramedic permanently damaged his back after lifting an unconscious patient. As he performed CPR, he felt the injury worsen, but his priority was trying to keep the patient alive. That paramedic is now permanently disabled. These are the adrenalin-fuelled, fine judgments paramedics must make when someone's life hangs in the balance," Mr Hayes said.

Pneumatic lifting devices in every ambulance would make a huge dent in the rate of lifting injuries paramedics suffer.

Dr Gray said the study suggests that for some conditions, such as delayed onset conditions (some musculoskeletal and mental health problems), first responders may benefit from early treatment and/or counselling, to reduce the severity of injuries, leading to better health outcomes.

"Now that we know first responders have an elevated risk of injury, we need to find out the causes of these injuries, as in order to develop injury prevention strategies, we need to know the injury mechanisms."

This story first appeared on The Sydney Morning Herald.