Other Health and Safety Issues

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Other Safety and Health Concerns in the Emergency Services


There are other safety and health concerns in the emergency services. Included among them are stress, burnout, and depression; violence and domestic violence in the workplace; and drug and alcohol issues, along with others. While we cannot deal with each of these areas in its entirety, a few comments and observations regarding each is in order.

Stress, Burnout, and Depression


While most of us know the basic definitions of stress, burnout, and depression, let's define them just to make certain we are thinking about the same phenomena. Mondy and Noe define stress as "the body's non-specific reaction to any demand made on it" (Mondy & Noe, 2005). It does impact people in different ways and what might be stressful to one person, may not be so to another. While that definition is fine, we know that stress does activate what is commonly referred to as the general adaptation syndrome, a series of physiological changes triggered by stressful events, and that over time, without adequate stress management, the impact will be negative.

Burnout is defined as "an incapacitating condition in which individuals lose a sense of the basic purpose and fulfillment of their work" (Mondy & Noe, 2005). Dessler tells us burnout is "the total depletion of physical and mental resources caused by excessive striving to reach an unrealistic work goal" (Dessler, 2005). There is fairly wide agreement that burnout is a result of unresolved stress.

Depression is becoming more widely recognized as yet another work related health issue. Defined as "an illness that causes a person to feel sad and hopeless for much of the time" (WebMD, Inc., 2006), it is a state of mind more pervasive than normal feelings of sadness, grief, apathy, and/or low energy.

Depression results in more than 200 million lost workdays per year due to absenteeism (WebMD, Inc., 2006). Additionally, depressed individuals tend to have worse safety records than their co-workers (Nighswonger, 2002).

While the position of clinical lab technician is cited as one of the twelve jobs with the most stress, the next grouping of high stress jobs includes those of the firefighter, police officer, and several health and medical occupations. The position of an EMS responder and/or paramedic are not specifically ranked. (From a ranking of 130 occupations by the federal government's National Institute for Occupational Health and Safety as cited in Mondy & Noe [2005].)

The common denominator among these jobs is the workers' sense of a lack of control over their work. They cannot control when events requiring their undivided attention occur nor, with any certainty, what the outcomes will be (Mondy & Noe, 2005).

This suggests that addressing stress, burnout, and depression as part of an agency's health and safety program is highly desirable.

Traditionally, and contemporarily, commonly cited causes of increased stress in emergency service organizations, other than a lack of control, include the long hours, the non-traditional schedules, and in some cases, the interruption of sleep, meals, and other duties.

Similarly, commonly cited causes of job stress have to do with role ambiguity, role conflict, workload variance, job overload, and job under-load (Mondy & Noe, 2005).

However, Portia Rawles takes exception to the commonly cited reasons such as those above and the traditional approaches to stress management. She points out that while the above are true, "Firefighters continue to identify organizational dynamics as more stressful than emergency operations. These stressors include clashes between labor and management, conflict among co-workers at the fire stations, unsupportive and inadequate commanding officers, lack of proper equipment, and inadequate policy and procedures" (Rawles, 2004).

In the case of firefighters, she points out that "the IAFF and IAFC consistently have recommended that fire departments address organizational dynamics in their wellness initiatives, but many of today's stress management programs neglect organizational stressors' impact on firefighters" mental and physical health. Because of this neglect, the fire service continues to observe tremendous strain in its personnel" (Rawles, 2004).

A number of studies suggest that the support network of the person is one of the most important factors in helping individuals cope with stress. While we typically cite the support of family and friends as being among the more important in helping the individual to cope with job stress, others have stated that co-worker and supervisor support matter the most (Rawles, 2004).

Therefore in addition to continuing some of the more traditional approaches to stress management, it would be wise for progressive emergency service leaders to take a look at the organizational dynamics and culture and address those relationships – or lack thereof – that may be the more important stressors. Certainly the agency leadership can reduce the impact of the more commonly cited stressors relating to role ambiguity, role conflict, and job overload as referenced above.

Reading Assignment Read the following article by Rawles, Portia. "Some Friendly Advice." Fire Chief. August, 2004 at http://firechief.com/mag/firefighting_friendly_advice/index.html

Workplace and Domestic Violence

While they respond to other workplace and domestic violence incidents, emergency service management and workers have historically not felt particularly vulnerable to such in their own work environments. Since 1993 and 1996, if not before, emergency service leaders ought to be aware of and alert to the very real potential for violence in the workplace.

In 1993, a former employee, Paul Caldron, walked into the cafeteria at the Fireman's Fund Insurance Company in Florida, and began shooting. Three men were killed and two women injured (Gomez-Mejia, 2001).

In 1996, four fire officers were murdered by a disgruntled employee at a Jackson, Mississippi fire station (Edwards, 2005).

Based on all occupational categories, homicide is the second leading cause of fatal workplace injuries (Mondy & Noe, 2005) and the leading cause of death for women in the workplace (Edwards, 2005). While robbery is seen as the primary motive for workplace homicide, approximately one in seven workplace homicides is at the hands of a co-worker or personal associate (Toscano & Windau, 1994; Grossman, 2002).

Several additional observations are in order. While men have a greater proportion of fatal occupational injuries than women, "women are victims of assault in greater proportion." While most female fatalities occurred from random violence, approximately one-third occurred at the hands of bosses, co-workers, family members, and/or prior friends or acquaintances (Dessler, 2005).

While we have tended to focus on co-workers, be mindful that those perpetrators who are not employees often have access to targeted employees in the latter's workplace (i.e., a perpetrator of domestic violence likely knows where to find the potential victim [i.e., at work]).

Non-physical Violence

So far, as a society, we have tended to focus on physical violence. Be alert to the fact that workplace violence includes such phenomena as verbal abuse, threats, and intimidation.

According to one report, bullying by bosses is the "silent epidemic" of the workplace as threats, intimidation, abusive language, and behaviors go largely unreported ("Bullies Trigger," 2000). As to the causes of workplace violence, there are many. Edwards categorizes them into those associated with individual characteristics, precipitating events or conditions, and system characteristics (Edwards, 2005).

While employers should be taking steps to eliminate workplace violence merely on humanitarian grounds, they must take steps to eliminate it for risk management and legal reasons; there is no choice. When violence is perpetrated by one employee against another or when a third party (a non-employee) directs violence against an employee in the workplace, employers can be held responsible under OSHA, state workers' compensation regulations, and/or by common law principles of negligence in regard to the obligation of providing a safe work environment (Ivanovich, 2004).

So what can employers do? First of all, there should be a workplace violence policy, that has zero tolerance for any acts of violence (including verbal threats and intimidation) perpetrated by one employee against another. Additionally, there should be workplace violence training for managers at every level (including first line supervisors) as well as for employees. Other steps can include improved employee screening, dealing constructively with problem employees (including potential discipline and dismissal), and demonstrating and promoting organizational justice (a culture of mutual respect, equal treatment, civility, and toleration of differences) to reduce the internal threat and introducing heightened security measures to reduce the entry of non-authorized personnel into the work environment. Edwards provides a number of specific suggestions as well (Edwards, 2005).

One other aspect of violence should be noted. While it is well known that law enforcement personnel face the biggest risk of violence on the job in responding to calls, the risk for firefighters and emergency medical personnel in responding to calls is increasing (Edwards, 2005). More attention to protocols in response is in order.

Drug and Alcohol Abuse

Drug free workplace policies notwithstanding, "alcoholism and substance abuse are serious and widespread problems at work" (Dessler, 2005). Alcohol and drug abuse are of particular concern in the emergency services as so much depends upon back-ups, crew members, and teamwork. A back-up or a crew member who is under the influence of alcohol or drugs creates additional risk for others involved with the same call or activity.

When we talk of substance abuse, we typically think of alcoholism and the use of illicit drugs. Remember that substance abuse may also take the form of inappropriate use of legal drugs and/or prescription medications as well.

While many organizations are leaning toward pre-employment drug testing, the reality is that a large percentage of substance abusers are already employed (Dessler, 2005). While there are listings of "signs of possible substance abuse," the operative word is "possible." The potential signs of substance abuse may in reality be reflective of any number of other problems.

According to Jane Bahls, organizations must attack the potential substance abuse problems by establishing a drug free workplace program which may include a clear and consistent zero tolerance program, education and training for all personnel including all employees (and/or volunteers) and supervisors, and a drug testing program (Bahls, 1998). While the latter is controversial, it should be considered.

While substance abuse cannot be tolerated, dealing with alcoholism and drugs in the workplace does entail legal risks. Employers have been sued for invasion of privacy, wrongful discharge, defamation, and illegal searches (Dessler, 2005).

So, what happens if you learn that a co-worker or subordinate may be a substance abuser? Supervisors are responsible for identifying and dealing with drug abuse; however, they must "avoid becoming detectives or medical diagnosticians" (Dessler, 2005).

Prior to taking any action, be sure that your agency or jurisdiction has a clearly written, publicized, and understood drug free workplace policy. This policy should clearly spell out that employees are required to abide by the organization's drug free workplace policy as a condition of employment; if relevant, what testing might be done, under what conditions, and procedures for handling those who refuse to be tested; accommodations for employees who voluntarily seek treatment; and what counseling and disciplinary actions will be taken for those determined to be under the influence (Dessler, 2005).

Recommended steps if you suspect alcohol or drug abuse include asking the employee how he/she feels and observing any potential signs of abuse (i.e., such as slurred speech, incoherent comments, etc.). Document in writing your observations in straightforward terms avoiding any judgmental statements or "diagnostic " terms. Advise the employee of potential disciplinary actions if the employee is in violation of agency policy. And, or course, refer the employee to your organization's employee assistance program (EAP) for assistance, whatever the problem might be (Dessler, 2005).

Additionally, if you do suspect substance abuse, talk with your supervisor and seek guidance from him/her in handling the problem.

Response to employees thought to be in violation of the workplace policy is varied. While someone believed to be under the influence should be relieved of duty at once, what action to take next varies. Disciplining, discharging, in-house counseling, and referral to an EAP or other outside agency are the four traditional responses according to Dessler (2005).

A precautionary note regarding the preceding: While the person should likely be removed from duty, do not "send the person home." If the person is driving, you could potentially be endangering his/her life and creating organizational liability. Instead, take the person home, or at minimum, send the person home in a cab with someone from your organization in order to ensure the person does get home. Occasionally it might be possible to relocate this person to an area in which he/she can do something constructive that would not endanger anyone else. In any event, follow the policies your organization has in place.

The reality is that in practice, virtually every organization tends to develop its own policy, ranging from arranging for voluntary treatment of the abuse problem, mandatory assessments and potential rehabilitation, to immediate discharge.

Some organizations adopt a version of a "three strikes and you're out policy." The three strikes, while they vary with the organization, might include an initial warning along with permission to randomly test the employee at any time for a period of three to five years; a mandatory substance abuse rehabilitation program at employee's expense; and the third violation, immediate termination (Dessler, 2005).

Be mindful that alcoholism and drug abuse are considered physical issues and that the Americans with Disabilities Act (ADA) protects alcoholic employees from discrimination, including, in some instances, requiring an employer to provide reasonable accommodations for the employee. The ADA also protects drug addicts, as long as the employee is no longer actively engaged in the use of illegal drugs. Individuals in rehabilitation programs are to be provided reasonable accommodation (Garofalo & Anker, 2004).

References

"Bullies Trigger 'Silent Epidemic' at Work But Legal Cures Are Hard to Come By." BNA Bulletin to Management. February 24, 2000.

Dessler, G. Human Resource Management. 10th Edition. Upper Saddle River: Pearson, 2005.

Easter Bahls, J. " Drugs in the Workplace." HR Magazine. 43. February 1998.

Edwards, S. Fire Service Personnel Management. 2nd ed. Upper Saddle River, N.J: Pearson Education, 2005.

Garofalo, B. & Anker, N. "Alcoholism and Drug Abuse Under the ADA." The Corporate Counselor, March 2004.

http://www.ljnonline.com/pub/ljn_corpcounselor/18_10/news/142037-1.html

Gomez-Mejia, L., et al. Managing Human Resources. 3rd Edition. Upper Saddle River: Prentice Hall, 2001.

Ivanovich, J. M. Human Resource Management. New York: McGraw-Hill, 2004.

Mondy, W. & Noe, R. Human Resource Management. 9th Edition. Upper Saddle River: Pearson, 2005.

Nighswonger, T. "Depression: The Unseen Safety Risk." Occupational Hazards. April 2002.

Rawles, PhD, P. "Some Friendly Advice." Fire Chief. August, 2004. http://firechief.com/health_safety/firefighting_friendly_advice/.

Toscano, G. & Windau, J. "The Changing Character of Fatal Work Injuries." Monthly Labor Review. October 1994. Robert Grossman, "Bulletproof Practices." HR Magazine. November 2002

WebMD, Inc. Depression Health Center.(2006). http://www.webmd.com/diseases_and_conditions/depression.htm

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