title: A Strained 9-1-1 System and Threats to Public Health.
abstract: The goal of this study was to understand safety climate in the United States (U.S.) fire service, which responded to more than 31 million calls to the 9-1-1 emergency response system in 2013. The majority of those calls (68 %) were for medical assistance, while only 4 % of calls were fire-related, highlighting that the 9-1-1 system serves as a critical public health safety net. We conducted focus groups and interviews with 123 firefighters from 12 fire departments across the United States. Using an iterative analytic approach supported by NVivo 10 software, we developed consensus regarding key themes. Firefighters concurred that the 9-1-1 system is strained and increasingly called upon to deliver Emergency Medical Services (EMS) in the community. Much like the hospital emergency department, EMS frequently assists low-income and elderly populations who have few alternative sources of support. Firefighters highlighted the high volume of low-acuity calls that occupy much of their workload, divert resources from true emergencies, and lead to unwarranted occupational hazards like speeding to respond to non-serious calls. As a result, firefighters reported high occupational stress, low morale, and desensitization to community needs. Firefighters' called for improvements to the 9-1-1 system-the backbone of emergency response in the U.S.-including better systems of triage, more targeted use of EMS resources, continuing education to align with job demands, and a strengthened social safety net to address the persistent needs of poor and elderly populations.
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Anatomy Chemistry Building, Room 145, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA. cannusci@wharton.upenn.edu.|Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, 19104, USA. cannusci@wharton.upenn.edu.
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Cannuscio
authors.affiliation: Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Davis
authors.affiliation: Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
authors.forename: Amelia D
authors.initials: AD
authors.lastname: Kermis
authors.affiliation: Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Khan
authors.affiliation: Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, PA, 19104, USA.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Dupuis
authors.affiliation: Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000071820:Emergency Medical Dispatch / Q000706:statistics & numerical data; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D004634:Emergency Medical Technicians / Q000523:psychology; D005260:Female; D061388:Firefighters / Q000523:psychology; D005390:Fires; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D014481:United States
keywords: Emergencies; Emergency medical technicians; Emergency treatment; Firefighters; Safety