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Analyzing the pandemic’s impact on fire and EMS personnel

The COVID-19 RAPID Mental Health Assessment highlights key concerns related to first responder stress, general wellbeing, and work-life balance


By understanding how the COVID-19 pandemic impacted first responder mental health, the industry now has data to inform policy, behavioral health and staffing needs.

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By Victoria Gallogly

Throughout the COVID-19 pandemic, first responders underwent a transformation of work to mitigate the spread of this highly contagious disease and protect their own health and safety as they served the needs of the community.

As Jennifer Taylor, PhD, MPH, CPPS, director of the Center for Firefighter Injury Research and Safety Trends (FIRST), explained: “Working as a fire-based EMS provider is an inherently stressful occupation – lack of sleep, high call volume, and long hours lead to burnout and mental health concerns like anxiety, depression, and post-traumatic stress disorder. The beginning of the COVID-19 pandemic introduced a high degree of uncertainty about transmission, impact, and safely administering patient care. These factors were almost certain to compound the existing physical and mental toll on EMS workers.”

In response to the COVID-19 pandemic, the FIRST Center combined assessment tools, metrics and scales from two preexisting projects to develop the COVID-19 RAPID Mental Health Assessment, named RAPID for short.

Monthly surveys were given to first responders from May to October 2020 to analyze the impact of the pandemic on burnout, job satisfaction, work engagement and mental health. The study was supported by funding from the Drexel University Board of Trustees and Office of Research & Innovation COVID-19 Rapid Response Research & Development Awards, and a matching donation from Arthur Frank, MD, PhD, a professor and chair emeritus of the department of Environmental and Occupational Health at Drexel’s Dornsife School of Public Health.

The RAPID study used two samples of first responders. One included a geographically stratified random sample of 17 departments that had previously participated in the Fire service Organizational Culture of Safety (FOCUS) survey. The other included three large metropolitan fire departments involved in the Stress and Violence to fire-based EMS Responders (SAVER) study.

Analysis of data collected from firefighters and EMS responders led to the publication of three manuscripts, each with concerning key takeaways.

1. It was bad before the pandemic

The first paper was published in April 2023 in the Journal of Occupational and Environmental Medicine and led by Dornsife School of Public Health PhD student Madison Raposa, MS. The study examined organizational and personal factors that contribute to how EMS responders pivot and adapt to intense work demands, like those brought on by the pandemic.

Findings from this paper, “Assessing the Mental Health Impact of the COVID-19 Pandemic on US Fire-Based EMS Responders: A Tale of Two Samples (The RAPID Study I),” indicated strong decreases in first responder mental health and diminished workplace support. A lack of communication from leadership, combined with little ability to advocate for certain decisions, may have led to higher levels of burnout, anxiety, depression and a desire to leave EMS work.

Departments in the FOCUS arm of the study experienced a shift in work that occurred during the beginning of the pandemic, namely firefighters were doing more EMS work. This change likely contributed to an increase in emotional exhaustion and the desire to leave the profession.

The RAPID Study I concluded that the pandemic exacerbated the problems already present in a workforce that is consistently asked to do more with less, as many respondents reported.

2. Wellbeing takes a nosedive

A subsequent study examining departments in the SAVER arm of the RAPID study revealed that firefighters and EMS responders experienced declining morale and increased burnout on the job during the COVID-19 pandemic.

These findings were published in December 2022 in the paper “Interplay between Safety Climate and Emotional Exhaustion: Effects of First Responders’ Safety Behavior and Wellbeing Over Time” in the Journal of Business and Psychology. This research was led by Jin Lee, PhD, an associate professor of the department of Psychological Sciences at Kansas State University and affiliate faculty of the FIRST Center.

Analysis of results from three metropolitan fire and rescue departments revealed that the pandemic caused a decrease in overall wellbeing. Departments reported high levels of emotional exhaustion – a key component of burnout – which led to decreased morale, increased risk for depression, and a lack of adherence to safety protocols. However, it was found that safety climate – the shared perceptions of employees regarding their organization’s safety protocols – can work to boost morale and limit the risk for depression, even when first responders are burnt out.

These results indicate that, through empathetically communicating the importance of on-the-job safety and through maintaining behavioral health resources, department safety climate can be improved, and mental health concerns can be addressed.

3. Work-life balance hangs in the balance

The third study examined demands placed on firefighters during the pandemic and the resources fire departments provided their personnel to manage these demands. The research, led by University of Utah PhD candidate Katherine Castro, MPH, a graduate of Drexel’s MPH program found that firefighters faced both increased demands related to job and work-life balance, but that departments provided more resources to address job-related demands than work-life balance.

This paper, “By nature, we’re doers and problem solvers: evolving job demands and resources in response to COVID-19 among US-based fire service personnel (The RAPID Study II),” was published in the Journal of Occupational and Environmental Medicine, alongside the RAPID Study I.

Researchers conducted interviews and focus groups with members from 15 of the 20 fire departments participating in the RAPID study. Analysis revealed that the job demands of the pandemic on firefighters ranged from changes in daily operations aimed at limiting virus transmission, to mental fatigue regarding COVID-related restrictions. The work-life demands that firefighters encountered included burdens such as isolating from their families and seeing their families less due to working longer shifts.

Departments provided resources related to both kinds of demands, but firefighters perceived that greater emphasis was placed on addressing the job-specific demands.

The findings underscore that the fire service was better prepared to respond to work environment needs during an unanticipated event, but it requires additional resources to better support firefighters and their families during times of crisis.

Ready to act

By understanding how the COVID-19 pandemic impacted first responder mental health, the industry now has data to inform policy, behavioral health and staffing needs. If action is taken, it will help the fire and rescue service support their rank-and-file and their families during both standard operations and crisis situations.

This research was a large collaboration of the FIRST Center’s Madison Raposa, MS, Gabrielle Mullin, MPH, Alexandra Fisher, MPH, Victoria Gallogly, MPH, Andrea Davis, MPH, Jennifer Taylor, PhD, from the Drexel University Dornsife School of Public Health, as well as Christian Resick, PhD from the Drexel University LeBow College of Business, Drexel alumni Regan Murray, MPH, now at the University of Arkansas, and Lauren Shepler, MPH, now at Spaulding Rehabilitation Hospital and Harvard Medical School, Jin Lee, PhD, from Kansas State University, and Katie Castro, MPH, and Joe Allen, PhD, from the University of Utah.

About the Author

Victoria Gallogly, MPH, is the outreach and communication coordinator for the Center for Firefighter Injury Research & Safety Trends (FIRST Center), part of the Department of Environmental and Occupational Health at Drexel University’s Dornsife School of Public Health. Gallogly can be reached at