How perception of risk affects COVID-19 infections in aircraft rescue and firefighting personnel

One category of first responders had close, daily contact with travelers during the COVID-19 pandemic: aircraft rescue and firefighting personnel. Now, the first study of its kind reveals that those workers who perceived themselves as more susceptible to COVID-19 reported more COVID-19 infections during the pandemic.

"These personnel not only respond to fires and other emergencies onboard aircraft, but also provide medical assistance to anyone on the tarmac and within the airport terminals throughout the United States - and they do this 24 hours a day, every day," said Aurora Le, who led the study, which was published in the journal WORK: A Journal of Prevention, Assessment & Rehabilitation. "They are often overlooked in the first responder research, however, despite having had a higher risk for COVID-19 exposure."

Aircraft rescue and firefighting personnel, the only U.S. civilian fire protection service personnel regulated by the government, are staffed based on airport capacity and number of daily departures. For example, Hartsfield-Jackson Atlanta International Airport, currently the world's busiest airport, has about 260 of these workers to handle an average of 286,000 passengers on about 2,100 arrivals and departures daily.

"We wanted to find out how those who reported being diagnosed with the virus early in the pandemic perceived their risk for contracting it, the steps they took to prevent this and the resources available to them for doing so," said Le, with the Texas A&M University School of Public Health.

For their study, conducted in April 2021 - one year into the pandemic - Le and colleagues from Indiana University and Indiana State University conducted an online, cross-sectional survey of 155 aircraft rescue and firefighting personnel who had had tested positive for COVID-19. Participants were recruited through the group's email listserv. More than 83 percent of participants had not tested positive for COVID-19 at the time of the survey. More than 92 percent were male, and the majority were white, middle-aged and reported that their health was good.

Safety behaviors were measured through a validated, three-item safety compliance scale from Neal and Griffin for safety compliance, safety participation, mask use at work and mask use in public. Perceived risk of being infected with COVID-19 was measured using items from the Risk Behavior Diagnosis Scale, as adapted by Zhang and colleagues to measure this specific risk perception.

Resources for the prevention of COVID-19 at participants' workplaces were adopted from the Occupational Health Clinics for Ontario Workers survey. Six statements were used to measure training effectiveness, and nine items were used to measure resource adequacy. Participants also provided demographic data and information about the state of their health before COVID-19.

The team found significant associations between participants' perceived risk factors of COVID-19, which include perceived severity and perceived susceptibility, and the COVID-19 outcome. Perceived susceptibility was associated with increased likelihood of COVID-19, but perceived severity was associated with decreased likelihood of reported COVID-19.

Our main takeaway is that these first responders would improve their likelihood of preventing infection if they had more relevant information about a disease, more physical and emotional resources for prevention, and more support to shape their perceptions of risk and their behaviors for prevention."

Aurora Le, lead author

Le added that these findings have implications for all kinds of illnesses, not just respiratory diseases such as the one studied.

"Stronger communication about the risk of any disease could lead more of these workers to engage in protective behaviors, and increasing the focus on risk severity within interventions could be a way to prevent injuries among these workers," she said.

In addition, those who supervise emergency response workers should focus on infection control outcomes, Le said. These could include relevant information, physical resources such as training, and personal protective equipment and mental health resources such as employee assistance programs.

"While our study was cross-sectional, so causation cannot be inferred, it did demonstrate significant associations between these emergency responders' perceived risk factors for COVID-19 and their actual outcomes during the early pandemic," Le said. "This information could help inform approaches to keeping these workers safe during future respiratory and other pandemics."