Frontline Workers & Stress: COVID-19 Reminds Us to Pay Attention to What Matters

Crawford Coates

A recent study out in the Journal of the American Medical Association surveyed 1,257 healthcare workers in China who worked on the frontlines of the COVID-19 pandemic response. It finds a significant number of those surveyed experiencing symptoms of distress, including depression, anxiety, and insomnia.[1] The closer to the epicenter of the pandemic, the greater the degree of distress.


As someone who has worked with first responders here in the United States for nearly 15 years, this is not surprising. Symptoms of distress are overrepresented among this population as well. We know, for example, first responders experience higher rates of alcohol abuse.[2] We also know that the sort of shift work common to their work is inherently carcinogenic.[3] Far more law enforcement officers and firefighters take their own lives in a given year than are killed in the line of duty, and EMS personnel die from suicide at elevated rates.[4][5]

This isn’t to say that trauma experienced in the line of duty accounts for or explains each malady or individual experience. But there is no question that being on the frontlines—whether in the U.S. or Wuhan—takes a toll and, moreover, that the more stressful the environment, the more destructive that toll can potentially be. With COVID-19 spreading throughout the U.S. population and first responders out there on the front lines, that stress is undoubtedly heightened at this time among police, fire, EMS and dispatch personnel.

I recently spoke with an EMS captain at a major U.S. metropolitan agency who is at the heart of their response. “All I can do is wash my hands, wipe down surfaces and all the other stuff I typically due to ward off viruses and bacteria. Our policies are changing daily, to conserve the limited personal protective equipment we have, while at the same time keeping our staff and public safe,” she told me. “It’s very stressful for my people, especially those with families. They don’t want to bring this home and infect them. And there’s just so much uncertainty right now.”

The good news is those first responders and their agencies have been focusing on mental health and wellness in the last five years to a degree unprecedented in their histories. For example, through a labor-management partnership, LAFD now employs three full-time staff psychologists. The International Association of Fire Chiefs has made suicide prevention as its organizing principle at the annual conference. The National Association of Emergency Medicine Technicians has a wellness and resilience program.[6] Law enforcement now has at least three wellness- and resilience-focused conferences nationally—up from none at all in 2014. Emergency dispatch now has several programs and events aimed at alleviating telecommunicator stress. Peer support teams are seeing increasing interest and participation. Anecdotally, I see topics such as stress management, wellness, trauma, mindfulness, and eye movement desensitization and reprocessing (EMDR) gaining interest across public safety.

But what about the stress of now? My cousin, a firefighter at one of New York City’s busiest stations, is under quarantine at home with serious coronavirus symptoms after responding to several calls with presumed and confirmed infections. Also at home with him are his wife and two children, doing all they can to avoid infection themselves. I know cops and EMS personnel with similar experiences. I know several more with milder symptoms—which might be cold or flu, we don’t know because of lack of testing capacity—who have been mandated to return to work because of staffing shortages. Many more are working without the protection of adequate personal protective equipment (PPE) and training just to keep our communities safe.

Dr. David Black, a clinical psychologist working with first responders, suggested to me that we keep things simple and focused. (These apply to MPPA students as well.)

  • Attend to proper hygiene and best practices for avoiding contamination;
  • Embrace healthy routines, such as eating, exercising, and sleeping well;
  • Avoid maladaptive responses, such as excessive alcohol consumption or screen time and poor eating;
  • Maintain social connections via phone and video calls;
  • Serve your mission professionally, in a way that reflects your core values;
  • Take care of your family; and
  • Consider pursuing a mindfulness practice.

As someone who has written a book on mindfulness and meditation for first responders, I can attest that these practices can help reduce stress.[7] The literature suggests as much.[8] But as Elton Mayo demonstrated in his Hawthorne studies, while modern and postmodern societies expend considerable resources in addressing the technical and managerial challenges of our time, we have failed at, and I believe continue to fail at, is addressing the emotional and psychological needs of those doing the actual work.[9] We are facing many challenges in public policy: housing, substance abuse, environmental degradation, healthcare, criminal justice, and political divisions that were, until recently, top of mind. They remain urgent. Frederick Taylor’s “Scientific Management” isn’t going to end, for example, California’s epidemic of homelessness. To do that we will need whole and healthy human beings, supported and empowered to make the difference.


Crawford Coates is an MPPA student, content marketing manager at Lexipol, which specializes in policy and information for public safety and local governments, and author of Mindful Responder. He maintains the site and can be reached at




[1]                Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976. doi:10.1001/jamanetworkopen.2020.3976

[2]             Wojciechowska B, P., & A, P. (2016). Sources, consequences and methods of coping with stress in police officers. Journal of Alcoholism & Drug Dependence, 4(4). doi:10.4172/2329-6488.1000244

[3]             Carcinogenicity of night shift work. (2019). Lancet Oncology, 20(8), 1058-1059. doi:10.1016/S1470-2045(19)30455-3


[5]             Neil H. Vigil, Andrew R. Grant, Octavio Perez, Robyn N. Blust, Vatsal Chikani, Tyler F. Vadeboncoeur, Daniel W. Spaite & Bentley J. Bobrow (2019) Death by Suicide—The EMS Profession Compared to the General Public, Prehospital Emergency Care, 23:3, 340-345, DOI: 10.1080/10903127.2018.1514090


[7]     Coates, Crawford. (2019) Mindful Responder: The first responder’s field guide to improved resilience, fulfillment, presence & fitness—on & off the job. Calibre Press.

[8]             Khoury, B., Sharma, M., Rush, S., & Fournier, C. (2015). Mindfulness-based stress reduction for healthy individuals: A meta-analysis. Journal of Psychosomatic Research, 78(6), 519-528. doi:10.1016/j.jpsychores.2015.03.009

[9]            Kraft, Michael E, and Scott R. Furlong. Public PolicyPoliticsAnalysis, and Alternatives. Washington, D.C: CQ Press, 2010.

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