Thesis (M.A.)--Naval Postgraduate School, 2008. / Description based on title page of source document ( viewed on April 28, 2008). Includes bibliographical references (p. 137-143).

The effects of occupational stress on public servants who seek to protect and maintain security for the general public have begun to receive more attention in recent years. Most of this research has focused on police officers. Much less attention has been directed towards other first responders (i.e., firefighters, paramedics) except in comparisons with police samples or inclusion in mixed first responder groups. Investigative efforts that specifically target firefighters and their unique responses to occupational stress, the vulnerabilities of negative responses to stress, and the variables that enhance and maintain resiliency in these first responders is limited. Moreover, cardiovascular risk has been recognized in firefighters. However research has been focused on examining physical variables related to this risk with little attention to psychological contributions, particularly the role of posttraumatic stress disorder (PTSD) on cardiovascular disease (CVD). The goals of the current investigation were to (1) review research that has been conducted on stress in firefighters, (2) examine the effects of job stress, length of service, and critical incidents on developing PTSD and CVD risk (3) evaluate the relationship between PTSD and CVD risk in firefighters (4) increase our understanding of the manifestations of stress in this population, and (5) provide organizations and treatment providers potentially useful information for developing and improving assessment and intervention strategies. Firefighters from the Broward Sheriff's Office special operations teams (N=87) were the participants. Self-report measures and annual physical examination data provided information regarding CVD risk (weight, height, blood pressure, cholesterol, smoking, physical exercise), job stress, trauma exposure, service length, and posttraumatic stress symptoms. Results indicated statistically significant relationships between PTSD symptomatology and current smoking status, triglycerides levels, and the number of CVD risk factors. Neither the number of experienced critical incidents, nor the number of service years was associated with PTSD symptomatology. Organizational job stress variables were associated with PTSD symptoms, but not directly with CVD risk. Collectively these findings suggest the reaction to traumatic experiences may be a better indicator of PTSD symptom development, than the actual number of traumatic events experienced. Moreover, the presence of PTSD symptoms may negatively influence overall CVD risk.

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Recent increases in opioid overdose rates have changed the role of first responders on the front lines of this national crisis. The present study used a semi-structured qualitative interview to investigate how the increase in opioids, opioid-related harm, and opioid-related death within Tennessee has affected the first responder population. Law enforcement officers, firefighters, and paramedics (N = 30) from rural-serving counties in Tennessee completed a semi-structured interview. Eight themes emerged from the interviews: (1) mental health symptoms, including posttraumatic stress disorder and secondary traumatic stress symptoms; (2) coping behaviors; (3) available resources; (4) barriers to accessing resources; (5) recommendations for what is needed; (6) hardest circumstances; (7) discrepant thoughts and feelings; (8) perception of role in reducing the impact of the epidemic. This study provides novel insights into the impact of the opioid epidemic on Tennessee first responders, and can inform future efforts to reduce adverse outcomes in these care providers.

Given that the rates of post-traumatic stress disorder (PTSD) are increasing in today’s society, it is important to gain a better understanding of how organizational factors shape the work experiences of those who have suffered or suffer from PTSD. Paramedics constantly face hazardous situations on the job and thus it is reasonable to argue that many of these situations may have lasting negative impacts on their mental health such as depression, anxiety, and alienation. The purpose of my research is to explore the understanding and experiences of workers in these professions who have experienced PTSD either directly or indirectly. I hypothesize that the supports that emergency first responders receive for PTSD are largely based on organizational factors that shape these professions. For example, the inherent masculine culture associated with this line of work, and the emotional and physical labour that is associated with the job. In exploring the aspects of support received by paramedics, a deeper understanding of why the workers in these professions are not talking about PTSD, seeking or offering support will be gained. It will be shown that the support paramedics receive, whether it be through family, friends, doctors, and/or co-workers, determines how PTSD is addressed and viewed within these professions. It is hoped that through this research PTSD within emergency first response professions will be better understood as an occupational illness. / Thesis / Master of Arts (MA)

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Background: First responders have unique and important roles. The duties performed can be dangerous, physically demanding and stressful, leading to high risks of injury and illness. Because of their unique job demands, it is important to identify aspects of the disability management process and predictors of return to work that are specific to first responders Thesis Objectives: To analyze first responder disability management claims associated with injuries and mental health issues to determine predictors of return to work and differences in the disability management claims when comparing first responders to high and low demand occupations. Methods: The claim data were obtained from a disability management company. In the first study, all first responder claims were included in the Cox proportional regression models and the log-rank tests to identify predictors of return to work. For the second study, the claims of high and low demand occupations were randomly age and sex-matched to the first responder claims. Differences in the duration of time off work, the duration of the claim, the injury and mental health diagnoses, and the duties performed when returning to work existed between first responders and the two occupation groups. Results: Musculoskeletal injuries predicted an increased likelihood of returning to work in a shorter duration of time. Medical report lag and claim lag decreased the likelihood of returning to work. First responders returned to work sooner, had shorter disability claim durations, differed in the injuries and mental health issues sustained, and were less likely to return to their pre-injury duties compared to the two occupation groups. Conclusions: Predictors of return to work specific for first responders were identified, yet the results lack generalizability. Although first responders returned to work sooner compared to the other occupations, they were more likely relegated to modified duties. / Thesis / Master of Science (MSc) / First responders perform dangerous and stressful work. They are at risk of injuries and illnesses that require time off work to recover. The goal of this dissertation is to identify features of the return to work process that are specific to first responders. The studies found that first responders with injuries like sprains and strains went back to work sooner than those with mental health issues. The study also found that sooner the injury claim was started and the medical information was received, the sooner first responders could return to work. When compared to other injured workers, first responders returned to work quicker, but were more likely to only be able to do modified work rather than their typical jobs. It is important that first responders fully recovery from injuries before they can get return to responding to emergency calls.

The benefit of regular physical activity and exercise training for the prevention of cardiovascular and metabolic diseases is undisputed. Many molecular mechanisms mediating exercise effects have been deciphered. Personalised exercise prescription can help patients in achieving their individual greatest benefit from an exercise-based cardiovascular rehabilitation programme. Yet, we still struggle to provide truly personalised exercise prescriptions to our patients. In this position paper, we address novel basic and translational research concepts that can help us understand the principles underlying the inter-individual differences in the response to exercise, and identify early on who would most likely benefit from which exercise intervention. This includes hereditary, non-hereditary and sex-specific concepts. Recent insights have helped us to take on a more holistic view, integrating exercise-mediated molecular mechanisms with those influenced by metabolism and immunity. Unfortunately, while the outline is recognisable, many details are still lacking to turn the understanding of a concept into a roadmap ready to be used in clinical routine. This position paper therefore also investigates perspectives on how the advent of ‘big data’ and the use of animal models could help unravel interindividual responses to exercise parameters and thus influence hypothesis-building for translational research in exercisebased cardiovascular rehabilitation.