Jin Lee, Ph.D., Kansas State University; Christian J. Resick, Ph.D. Drexel University; Joseph A. Allen, Ph.D. University of Utah; Andrea L. Davis, M.P.H., Drexel University; Katherine Castro, M.P.H., University of Utah; Alexandra Trautman, M.P.H., Drexel University; Jennifer A. Taylor, Ph.D., Drexel University

The present study aimed at understanding the challenges to the mental health and safety of fire service-based Emergency Medical Service (EMS) workers during the COVID-19 pandemic, while investigating the role of station safety climate. We examined whether safety climate can buffer the effect of burnout on depression over time.

Various demands of their job are a continuous threat to EMS first responders’ well-being, and these demands have been exacerbated since the COVID-19 pandemic. Based on job demands-resources theory, the present study advances a dynamic perspective on first responders’ well-being and the implications for occupational safety. Specifically, we examined the relationship between emotional exhaustion in the work domain and depression in the personal domain (Maslach & Leiter, 2016; Toker & Biron, 2012). We viewed the station safety climate as an essential organizational resource, examining its role in attenuating the spillover of strain from the work domain to the personal domain (Kang & Kang, 2016; Nahrgang et al., 2011).

The COVID-19 RAPID Mental Health Assessment was collected from fire department-based EMS first responders from three large US metropolitan areas. A total of 800 EMS first responders were initially enrolled in the study with response rates varying from 31.9% to 55.5% across six-monthly surveys beginning in May and ending in October 2020. We retained data from participants who completed three or more surveys and from fire stations with three or more respondents to ensure the reliability and representativeness of the station-level safety climate scores. The final sample includes 208 EMS workers nested within 45 stations across the three departments. Missing data were handled at the composite score-level with the predictive mean matching multiple imputation method (Rubin & Schenker, 1986; Little, 1988).

We tested the hypotheses using repeated measures multilevel modeling. We specified 4-level models with department specified at the level 4 to control for nesting of members and stations within departments. The effects of station-level safety climate across times 1-6 were modeled at level 3. Individual-level emotional exhaustion and depression were specified at level 2. Time was specified at level 1 capturing repeated measures within individuals. Also, gender and tenure were included as control variables at the individual-level.

The present study showed that EMS workers experienced deteriorating mental health in terms of depression during the pandemic when their emotional exhaustion levels were high (i.e., 1SD above the overall mean). Additionally, higher station safety climate (i.e., 1SD above the overall mean) was associated with decreased depression when emotional exhaustion was within a low to medium range (i.e., from 1SD below the overall mean to the overall mean), along with lower absolute levels of depression across the entire range of burnout.

These findings suggest that safety climate can buffer the negative effect of burnout on first responders’ depression which can compromise their safety behavior, while safety climate can promote safety behavior over time during the demanding time of the pandemic. The present study extends tenets of job demands-resources theory (Demerouti et al., 2001) by examining the interplay among safety climate as an organizational context and burnout as a psychological context as well as its impact on EMS workers’ depression based on a longitudinal framework. Also, the present study advances the safety climate literature by showing the buffering effect of safety climate on the relationship between EMS worker emotional exhaustion and depression.

The onset of emotional exhaustion in the work domain during the pandemic can prompt a series of downward spirals that further deteriorate mental health and undermine safety precautions unless first responder resources are replenished. Our findings suggest that fire service safety leadership through safety climate is well-positioned to address resource loss. Our study speaks to the importance of organizational interventions to aid first responder resource recovery and strengthen station safety climate.

The deleterious effect of emotional exhaustion on depression over time, as well as the detrimental effect of depression on safety compliance over time were found. The emotional exhaustion to depression relationship can be buffered by station safety climate. Station safety climate is an important organizational resource to safeguard employee safety and health in crisis situations such as the COVID-19 pandemic.

Tags: Applied research, COVID-19, Empirical study, Hazardous Work Environments and Safety, Health care and social assistance, High Risk Jobs; Vulnerable/At-Risk Populations, Organization- and Job-Level Environments and Practices, Organizational Practices, Psychological and Biological Effects of Job Stress, Safety Climate; Safety Management; and Training, Social and Organizational Environment, Theoretical and Conceptual Issues in Job Stress, Workplace Stress; Outcomes; and Recovery