Vocational rehabilitation for emergency services personnel: a scoping review.

The objective of this scoping review is to examine and map the range of vocational rehabilitation available for emergency services personnel. Employee work absence due to illness and injury is an international burden. The emergency service sector (police officers, firefighters and ambulance/paramedic staff) workforce has been shown to report a higher prevalence of illness/injury and sick leave compared to the general population. Despite the evidence of physical and psychological problems that emergency service sector workers can face, vocational rehabilitation (VR) interventions and the structure and effectiveness of VR for these workers are less well known. This scoping review considered studies that included adult emergency medical services personnel (e.g. police officers, firefighters and ambulance/paramedic staff), regardless of age, sex or rank. Emergency medical services personnel from any developed nation were included. The interventions included any VR regardless of condition, work status (VR to prevent sick leave or for workers on sick leave) or focus (e.g. mental health issues, neurological problems or musculoskeletal conditions). Vocational rehabilitation interventions can include work conditioning, work hardening, physiotherapy, counseling, functional restoration and occupational rehabilitation. Published and unpublished literature in English from 2007 to 2017 was included in this review. A three-step search strategy was followed that included five databases and nine websites. Data extraction was performed by two reviewers using a pre-determined data extraction form developed by the authors. This review identified 24,271 sources of information, of which 48 were screened at full-text stage, and 22 sources were eligible to be included in the final scoping review. The majority of the sources provided evidence of VR for police officers and firefighters. Vocational rehabilitation is typically provided in residential rehabilitation settings as well as some outpatient, off-site and workplace settings. The main type of VR provided is physical, but there is also evidence of psychological rehabilitation and addiction/substance misuse rehabilitation. This review demonstrated that there is a lack of information in the public domain on VR for staff working in the emergency service sector, as well as a lack of rigorous evaluation available on the effectiveness of VR within the emergency service sector. There is inconsistent provision of VR internationally for emergency service sector staff.