Dan Gillard explains the ways in which the occupational health service in Surrey and Sussex monitors the health and well-being of workers who work in high-pressure environments and are under pressure to ensure safety.
Surrey Police, Sussex Police and East Sussex Fire and Rescue Services signed an agreement in 2018 to extend the existing occupational healthcare collaboration, which covered both police forces, to fire and rescue services.
The four blue-light services created a structure to drive quality, efficiency, and clinical governance. This would allow the parties involved to fulfill their statutory obligations and reduce the impact of budget cuts.
The new OHWS (OHWS for short) has been established. The shared OHWS is staffed by staff employed in the different services.
The team is led by nurses: two senior OH Nurse Advisors (OHNAs), and five OHNAs support the clinical lead. Two screening nurses – one of whom is completing a degree of OH nursing – two occupational health technicians and a personal secretary for the head service are also present.
The advice on occupational medicine is divided between an internal physician and a third-party, resulting in a full-time equivalent. This is done to maintain resilience and prevent a single point failure.
Some OHNAs are remote workers, while others have a hybrid work style. The flexible hours allow them to fulfill their family obligations and other duties outside of work.
A manager is also assigned to the OHWS team who is responsible for assessing ill-health retirement (IHR). The OHWS team can then easily access the medical and OH records needed for IHR assessments, and to determine any injury on duty awards.
A wellbeing team is also in place, which includes a wellbeing specialist with a background as an HR professional, a wellness lead with a background of recruitment, a multifaith priest and a practitioner who has a background with health education. The wellbeing screening practitioner visited 241 locations across the two counties to carry out mini-MOT health assessments and promote health. This will be extended to support the NHS Blood Pressure Campaign by offering a free blood pressure test for every employee. The wellbeing is a natural part of OH, or closely aligned with it.
The employer has an obligation to ensure that any information or programmes relating to health and well-being are evidence-based, and professionally delivered. A registered health professional’s oversight can help ensure good governance and service quality (Miller, 2022).
Psychological hazards
The Health and Safety Act requires that “health surveillance be conducted when workers continue to face health risks after taking control measures” (HSE, undated). HSE, undated). To justify the collection of health information, a legal basis (NHS Research Authority undated) is needed.
A job description and risk assessment is used to determine the hazards that an individual may face, and if statutory health surveillance will be required. An OH physician will conduct additional medical surveillance if a worker is exposed to physical or chemical hazards, such as asbestos. To get all the information needed, we must have a strong working relationship with health and safety and line managers.
Risk management is based on the principle that hazards should be eliminated first. If they cannot be removed, then they must be minimized. Psychological stressors are not easily removed in policing, firefighting, and rescue, so it is important to monitor psychological health.
We use a third-party specialist provider for police roles with an established process of assessment. Nine roles in policing are considered at high-risk of psychological stress, and only a few within fire and emergency services.
“Psychological stressors are not easily removed from the work of police, firefighters and rescue workers. Therefore we need to conduct psychological health surveillance.”
Online assessments are required for those whose job could expose them to stress. The assessment includes questions regarding the worker’s mental history, coping abilities and any current symptoms. The assessment is used to determine the level of performance. Individuals with high scores are invited for a follow-up session with a clinician that has received additional training. This structure of monitoring and assessment is designed to identify those who may need treatment for psychological symptoms.
We cannot remove the psychological stress experienced by emergency service workers. Therefore, we must reduce their exposure to triggers whenever possible. Line managers are able to adjust the work day but this may not be possible depending on their role due to demands from the police and fire services.
The system ‘Trauma Tracker,’ which measures exposure of response officers and CIDs, has been implemented. Employees exposed to trauma must have a discussion with their manager who records the incidents. Support is needed once a certain threshold has been reached.
Managers can arrange sessions with ‘diffusers,’ who are trained in trauma support. These may be firefighters, police officers or members of the team. The role is an additional duty to the normal duties of the firefighters, police officers and staff. The firefighters, police officers, and staff have access to a 24-hour counselling service. They can also refer themselves to OH.
Resilience
Resilient individuals are less likely than others to experience psychological stress. Other stressors and individual differences are the main factors that affect resilience. Resilience refers to the individual differences in how people respond to risk (Rutter 1987). Some people are overwhelmed by the constant stressors of emergency service work, while others can handle the challenges they face.
Training, experience and support are all factors that help develop resilience. The more prepared and knowledgeable the staff is about their role, and what they can expect from interactions with the public and how to handle them, the better they are able to deal with stress at work. As they gain experience, their knowledge and skills increase.
Both the manager and the employee are responsible for initiating support. The department of training, learning, and professional development is responsible to train managers. Individuals are responsible for seeking out support. OH is accountable for ensuring support mechanisms are relevant, accessible, evidence-based, and governed appropriately.
Assessments for pre-placement, periodic and post-placement
It is rare to reject an employee on the basis of their health.
A panel of senior operational personnel, recruitment staff, OH, HR and other relevant parties will review the advice of OH. They will then weigh this against possible risks, and if necessary, develop a plan to protect the applicant’s health and well-being. The panel must balance this with the risk to the public of limiting the applicant’s abilities. The employer can refuse to hire the applicant if they cannot make the necessary adjustments.
It is rare to reject employment because of the health of the employee.”
It is vital that firefighters and police officers are physically fit because they face significant physical demands. The pulmonary function test may be required for those who are exposed to radiation, chemical, biological or nuclear materials. The respiratory system is evaluated in detail, including the patient’s history, physical examinations and function tests. This allows for the identification of any pulmonary impairment, and a baseline to assess any potential exposure.
Pre-employment medicals should include a check of the eyesight, including any color deficiencies, as well as other measurements, such a blood pressure.
For a variety of specialist police roles, including those deemed safety-critical, periodic medicals are also required. Individuals who have a physical or mental limitation or are unable to perform their role will be removed from the role, either temporarily or permanently.
Sometimes, the OH clinical team will assess individuals who have a condition such as high blood pressure that could put them at risk or others. The OH clinical team must inform the individual and manager of the findings, and advise them that they should not return to their safety-critical position until OH has cleared the decision.
Physical Hazards
Health surveillance is required for those who work with dogs and horses (which can cause respiratory sensitisers and noise), firearms (which can be noisy), and vibrating machines such as motorcycles and helicopters.
Firefighters, crime scene investigators (including fire investigators), and the CBRN team are all roles that can expose people to chemicals. CBRN teams can reduce their exposure to chemicals by using a variety of safety measures. These include a paper respirator, a respirator that has a removable filtering canister, or a self-contained breathing device. Six different PPE suits are available for CBRN and firefighters.
“Some breathing apparatus require a seal around your face. You must be clean-shaven at the point where the seal meets the skin.”
Some breathing apparatus require a seal around your face. You must shave cleanly where the seal meets your skin. To ensure proper fitting, the breathing apparatus must be fitted with a Moldex Fit Test Kit. A sufficient lung capacity is also required.
OH
The police and firefighter roles are associated with many physical and mental hazards. It is impossible to remove hazards from emergency services, and in some cases it is even unlikely that they can be reduced.
OH plays a significant role in employment and specialist selection, including periodic assessments, fitness and health assessments for specialist positions, support training, and referrals from management to provide advice on adjustments.
Emergency services are not complete without occupational health. They support the health and well-being of emergency service personnel and enable the employer to meet their legal and ethical duties.
The frontline function of an organisation is supported by the professionalism of a team of OH specialists who are qualified, understand the work done by firefighters and police officers, and have developed strategies to promote their health and well-being.
References:
Health and Safety Executive Health surveillance: Understand the type of health surveillance your business requires
Miller, J. Miller, J. Bristol University Press. pg. 184
NHS Research Authority. Legal basis of processing data
Rutter, M. (1987). Psychosocial Resilience and Protective Mechanisms. American Journal of Orthopsychiatry 57: 316-331
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