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Public emergency services:
Sector-specific information on violence and stress

Scope and impact of violence and stress on emergency services

Although workplace violence is reported to be increasing even in places that have been relatively safe, emergency services workers have always faced violence in one way or another, some more than others. For example, a study on ambulance staff in South Africa reported that 70% of them had been subjected to verbal abuse, 50% to physical violence, bullying and mobbing, 40% to racial harassment and 30% to sexual harassment. There were also 376 attacks on fire-fighting crews in Northern Ireland in 2001.

Many studies on occupational stress among emergency services workers found that organizational and administrative factors cause more stress than aspects specifically related to their tasks. In a study of emergency medical service workers, sources of stress included rotating shift work, interference with family life and fear of contracting a disease such as HIV/AIDS or hepatitis. Similarly, research on stressful and rewarding aspects of police work in the Netherlands revealed that organizational stressors were more prevalent than task-related stressors. Burnout was associated with a lack of reciprocity between investment and outcomes in the relations that officers have with citizens, colleagues and their organizations and was positively related to attitudes towards use of violence and officers’ use of violence while on duty. Again, a study of potential sources of stress among Scottish police officers indicated that the stressors stemming from organizational aspects, such as perceived staff shortages, inadequate resources, time pressures and lack of communication were more significant than those relating to police work. It found that stress possibly had an adverse effect on the development and maintenance of working relationships with the public, and that officers under stress could pose a real threat to their own safety and that of others. A study on police stress in the United States also found that the key stressors were more related to organizational factors than to the dangers faced in police work or encounters with human misery. Research on perceived sources of stress among firefighters in New South Wales, Australia revealed that the most stressful incidents were motor vehicle accidents, deaths, major fires and incidents involving children, in addition to which dealing with injured persons was the other most frequently mentioned stressful aspect of their work, while administrative and organizational factors could not be ignored as stressors.

Many studies refer to high suicide rates among police officers. The availability of means might be associated with their high suicide rate, and the suicide ratio of police in the United States was found to be 1.8 times that of those in all occupations combined. Suicide accounted for 13.8% of police deaths as opposed to 3% of deaths in all other occupations. In fact, more officers killed themselves than were killed by others. A mortality study of police officers in Rome, Italy, also indicated a higher suicide ratio among police, which was 1.97 times higher than that of the general population. Their stress or inability to cope adequately with stress might be a contributing factor leading them to take such drastic action. Other studies also point to a high risk of police officers taking their own lives. If stress is left untreated, the consequences can be tragic, both for the police officers concerned and for the general public who rely on them for their protection.

Harassment within emergency services has been recognized as a problem, particularly in multi-ethnic societies, many of which are now adopting various policies to recruit more officers representing minority communities. It is reported to have often led to premature resignation of staff. The very low representation of women in fire-fighting and police workforces may be partly due to harassment, and female firefighters may encounter sexist attitudes of male colleagues. In a nationwide survey of female firefighters in the United States, over half the respondents reported experiencing sexual harassment. While 43% of them noted sexual stereotyping in task assignments, 16.5% experienced acts of violence to themselves or their property. The study revealed that sexual harassment is a legitimate problem in fire departments, contributing to firefighter stress that may seriously affect emotional and physical well-being and morale of all concerned. While individual employees are to be blamed for harassment, the study underscored the interplay between organizational context and individual characteristics that not only produces certain workplace behaviour patterns but also perpetuates sexist attitudes.

Risk assessment, management and counselling strategies

Stress management and counselling is a key issue for emergency services workers, many of whom are seriously affected psychologically by critical incidents specifically related to their jobs, such as death, serious injuries, and life-threatening situations. For those who have dealt directly with or survived such incidents, there is often a period of denial, followed by critical incident stress (CIS) or post-traumatic stress disorder (PTSD), which may include symptoms such as anger, recurrent recollections or dreams of the event, hyper-vigilance, diminished interest in activities, estrangement from others, difficulty concentrating and memory difficulties. Emergency services workers have high rates of PTSD, especially when people died because it was impossible for rescue workers to save them, in spite of their best efforts. To address this, many services now provide critical incident stress debriefing, as part of an organizational stress management programme, in which affected workers discuss the event in detail, including their feelings, usually in the presence of a trained mental health worker. Debriefings have proved effective in preventing or mitigating PTSD following critical incidents. Organizational stress management programmes may be provided during initial training, as general counselling, and specifically for management of critical incident stress. The study on firefighters in New South Wales reported that about 30% of respondents had experienced stress severe enough to seek help, but 39% of these did not seek help for various reasons. Only 9% reported that the information on the availability of such help was given to them during initial training. Although firefighters perceived their jobs as stressful, they also believed that their chances of being psychologically affected were below average. The study noted growing acceptance of stress management programmes.