White Paper from Drew Aversa (C) 2016. Revised 2019.
Issue: First responders, firefighters included, are routinely seen in local healthcare systems that do not understand the unique health issues of this special population. As cancer and suicide rates rise in firefighters, healthcare providers must begin better screening measures when encountering first responders. Currently, first responders are not recognized as an at-risk population within a healthcare system’s electronic health records system, such as EPIC.
This must change if we want to control costs and improve health outcomes for our nation’s heroes.
Given the differences of opinion on who is a first responder, we will assume, for the purpose of this brief, that there are approximately two million first responders across fire, EMS, and law enforcement. Out of this group of dedicated professionals, there are approximately 330,000 professional firefighters in the United States who work in hazardous environments during prolonged shifts and over the length of their careers.
Insight: First Responders receive preventative healthcare screenings from general practitioners across America in local municipalities from healthcare providers who are largely unaware of the complex physical and mental exposures that haunt first responders as stress-related disease processes manifest in people who outwardly seem healthy. Further, each provider has different perspectives on the standard of care, not considering the specific recommendations of research studies focused on first responders.
First Responders, unlike veterans who receive their care from day one in the VA system, do not have their whole health history tracked from recruit academy throughout retirement, up to death, in a national database. While the CDC recently added a cancer registry for firefighters to begin tracking cancer, this falls short as it does not address total health, nor does it prompt providers to offer early detection screenings; data is still lacking at the provider level where patient care outcomes can be improved.
When treated within a local healthcare system, population specific health screening measures for first responders’ exposures are also not populated into electronic health records – these first responders are given the same consideration as the public; physicians with limited time are not getting a holistic view of what is happening to their patient at work; general care standards are not working as evidenced by the rising rate of suicide and constant impact of cancer, heart disease, musculoskeletal injuries, and chronic pain.
Behind The Times
While PTSD was publicly recognized by firefighters as an issue in 2016, the veteran community has acknowledged this for years, tackling the co-morbid illnesses prevalent in mind-body stress responses; as a society, we are behind the times in prevention and treatment of the health and wellness needs of our nation’s first responders because of cultural issues within first responder leadership and the lack of a unified, national narrative on what it means to be a first responder.
The Battle For Care
Across America, first responders also fall under workers’ compensation which is adversarial in nature, as these systems are designed to protect employers and the insurance industry.
If you Google search first responder workers compensation, numerous stories across America highlight how many first responders are denied care for work-related injuries or illnesses.
Unlike veterans who routinely receive compensation and care for mental injuries, there is no national standard or benefit for mental health injuries in first responders. The insurance industry often conducts harsh evaluations to discredit claims, pitting the injured worker against a system that is not looking out for the best interest of the worker and their family members.
The denial in the claims evaluation process is also stressful to injured first responders and can result in employees being terminated, and in turn, forcing them off of quality health insurance as they battle cancer, heart disease, mental illness, etc.
As we look to veterans, we see that service is not equal, and that for first responders, they are at risk and treated no better than a civilian who is injured at a desk job. Given state law, a firefighter who has presumptive coverage in California may have their cancer treatment covered, while another firefighter in another state may be denied. This is absurd as cancer is cancer and a firefighter no matter where they serve, is still a firefighter. This would be a nightmare if veterans in California received care while others in neighboring states were rejected.
We truly have a moral and ethical dilemma at the forefront of getting our first responders the help they need, in addition to leveraging the existing technology architecture to begin better data collection and screenings.
First Responders and policy leaders need to look to the veteran community to see areas needing improvement to ensure our first responders receive the support needed in order to keep our communities safe. Should a first responder be medically retired, there are major gaps in protecting their welfare which only perpetuate increased stress, health issues, poor resiliency, and social challenges.
Recommendations: The technology exists to reduce first responder injury, illness, and pre-mature death across 50 states via integrating these men and women as an at-risk population in the existing architecture of electronic medical records, such as EPIC. This will allow providers to deliver targeted questions and preventative care to reduce illness, injury, and death.
Researchers will also have readily available access to longitudinal data to advance best practices for this population key to our national security.
Stakeholder groups can also explore national best practices, policy, and funding to create a unified approach in how we support first responders and those who are medically retired needing support as they transition.
Policy leaders at the federal government can begin to push easy to win legislation that supports first responders to begin changing the landscape for our nation's heroes at home. An easy win is to implement a federal employer tax credit to employers who hire disabled first responders. This positions first responders alongside veterans as two key groups deserving of our nation's support.
In conclusion, we must understand that today’s first responders are exposed to dynamic, hazardous environments that negatively impact total health at rates higher than the general population, both physically and mentally. We have the technology and need policy to be implemented to start changing the healthcare and total health outcomes of our first responders. As Uber did to disrupt the taxi industry, let's start looking at what is already in place and how we can quickly scale using the existing ecosystem to fuel needed change.
Author Background: Drew Aversa served as a professional first responder for 10 years. After a career ending injury as a firefighter, he began advocating for first responders and their health needs. The aforementioned insight is part of the vision he presented before California first responders and government leaders to form the First Responders Health Research Institute to begin research of California's diverse first responder population in partnership with a leading veterans health research organization.