1. Promoting First Responders’ Resilience Resources through Safety Climate and Safety Management Systems Bengt B. Arnetz, MD, PhD, MScEpi, MPH Wayne State University Detroit, MI

2. Context First responders: Large group Exposed to dangerous situations Short decision times (High risk and High Consequences) Second guessed from non-First responders Increased media and institutional scrutiny

3. Statement of Problem First responders: Stress-related disorders (depression, anxiety, Post-traumatic stress disorder) Cardiovascular disorders Metabolic disorders Misuse of alcohol and pharmaceuticals Performance

4. Peri-traumatic: emotional, cognitive, Physiological & professional responses CI 1 Stressor Genetics Demographics Psychiatric hx Intellectual funct. Coping skills Fitness Spirituality Optimism, Social support Determinants Fear Fear condit. Memory cons. Hyperarousal Mechanisms Mental & Somatic Health disord. Alcohol misuse Behavior/ Performance (e.g., MVA) Moral hazards Job dis- engagement Downstream Outcomes Chronic work stressors; Organizational and Safety climate New critical incident 1 exposure Risk Reactions Stress – Safety Climate – Health and Safety Model Psycho-Biological and Environmental Resilience Resources

5. High Risk – Decisions & Consequences Source: Japantimes.co.jb Source: mintpressnews.com “Affective realism: feelings influence what you see – not what you think you see, but the actual content of your perceptual experience.” Lisa Feldman Barrett, Jolie Wormwoods NYT, Sunday Review April 17, 2015

6. Statement of Need Optimal decisions and behavior in high stress situations requires: Established decision support system Safety Climate Individual and group values Perception Competencies Behavior Safety Management Systems

7. National Study of First responders Stress, Risk & Resilience Factors, Health & Professional Performance Organization and Safety Climate 3,656 First Responders in Sweden (60% response rate) Measure: Professional Stress (Work, Threats, Organizational challenges) Organizational Climate (Support, Safety culture, Work strategy)

8. First Responders’ Job Perception Unsafe at work (11.8%) Differences across First Responder Groups: Defense (12.8%) Customs (12.4) Law Enforcement (12.3) Coast Guard (10.3) Fire (5.8) P<.001

9. Adverse stress effects on job performance P<.001 Adverse stress effects on performance (43.3%) Differences across First Responder Groups: Fire (31.1%) Coast Guard (37) Defense (37.8) Customs (48.1) Law Enforcement (56.2)

10. Organizational support P<.001 Clear workplace strategy to deal with professionally— induced stress (31.6%) Differences across First Responder Groups: Fire (55.3%) Coast Guard (32.2) Law Enforcement (29.8 Defense (29.2) Customs (27.3)

11. Work has become more dangerous P<.001 Work among the public more dangerous (45.8%) Differences across First Responder Groups: Customs (71.1) Law Enforcement (67.4) Fire (52.4%) Coast Guard (45.8) Defense (18.1)

12. Alcohol to cope with work stress P<.001 I do not use alcohol to cope with work stress (87.5%) Differences across First Responder Groups: Fire (95.5%) Coast Guard (91.6) Customs (88.3) Law Enforcement (86.7) Defense (85.2)

13. Self-esteem at work P<.001 Adjusted for general self-esteem

14. Work Stress – Coping – Mental Health

15. Organizational climate scale across FR 1 Organizational Climate Scale Aggregated questions related to organizational support, culture of safety, and strategy at work to manage stressors. Organizational Climate Scale: 56.5 out of 100. Highest ratings: Military Lowest ratings: Coast Guard and Firefighters Organizational Climate Scale explained 9% of the variance in work stress (p<.001) 1 First Responder P<.001

16. Law enforcement stress in real life The video demonstrates how a law enforcement officer within a brief period of time has to make critical strategic and tactical decisions when he faces a man, armed with a large knife that already had cut the throat of three other people. The video also demonstrates the responses of other law enforcement officers and shines light on the importance of established safety climate and safety management systems. High Risk & High Consequence P<.001

17. Conclusion Stress among First Responders 1 Numerous stressors from within and outside the profession A major challenge to health and professional performance Implications for the safety of both the public and the safe practice of the profession Need for: Safety climate and Safety management systems that are: Adapted to FR 1 special situations Proactive Integral part of the organizational culture and behavior Inclusive and supportive – also when things go wrong Transparent P<.001

18. Acknowledgement Bengt Arnetz and work reported here was partially supported by: NIMH/NIH R34MH086943 NIEHS/NIH P30ES020957 CURES – Center for Urban Responses to Environmental Stressors Kungafonden (Royal Foundation of Sweden) P<.001