A large majority of public safety personnel – police officers, firefighters, EMTs, paramedics and corrections officers – are required by department policy, directive or standard to wear a face mask to reduce COVID-19 transmission.
Nearly 4,000 responses to a survey on mask practices help us understand mask policy and use among public safety personnel, as well as the opinions of public safety personnel regarding masking use, mask effectiveness and the impact of face masks on communication with the members of the public.
Face masks and COVID-19
According to the Centers for Disease Control and Prevention, mouth and nose-covering face masks are important to reducing the spread of COVID-19. A mask, worn by an infected individual, reduces the dispersion of droplets. Some experts now believe masks of any type, including cloth or paper, may reduce the inhalation of virus-laden droplets or airborne viruses and the potential severity of the infection.
Early in the pandemic, public health officials, likely to their regret, did not recommend widespread use of masks. Instead, the public was encouraged to avoid hoarding or unnecessarily wearing masks to ensure adequate PPE was available for EMS providers and hospital personnel. But, since early April, mask-donning has been widely recommended for any situation where individuals are unable to maintain social distancing of at least 6 feet, or when an individual is known or suspected to be infected with COVID-19.
Face mask requirements or recommendations in workplaces, schools, churches, restaurants, bars and other businesses have become controversial. Americans are increasingly wearing masks when leaving home (86% of all respondents in a July poll reported mask wearing), even though face mask support continues to be variable from local, state and federal officials. Some states have mandated face masks, while other states have left the decision up to local leaders. Some elected officials have actively campaigned against a face mask mandate, requirement or recommendation.
Meanwhile, public safety personnel are caught in the middle. Police officers, in particular, have responded to altercations and assaults related to mask use or requirements. All public safety personnel, but especially EMS personnel and corrections officers, have had to re-use N95 masks or provide their own face masks because the PPE supply chain hasn’t kept up with the demand and shifting geography of the COVID-19 crisis.
Face mask survey methodology
A 13-question survey was developed by the Lexipol editorial director and editors-in-chief of Corrections1, EMS1, FireRescue1 and Police1. The survey was open from July 17 to July 27, 2020, and 3,970 responses were collected using a Microsoft Form. The survey was promoted to corrections officers, EMTs, firefighters, paramedics and police officers on Corrections1, EMS1, FireRescue1 and Police1, and on the social channels for those media sites.
The convenience sample of respondents was asked to self-identify as corrections, EMS, fire, police or other. The respondents who selected “other” were not asked to answer any additional questions.
Majority of Responses from Police
Sixty-percent (2,388) of poll responses were from police. The number of responses from corrections (530), EMS (433), and fire (457) were the balance of survey responses. This survey didn’t collect any additional demographic information, such as years of experience, location, department size or age. The survey didn’t ask respondents about political-party affiliations. Other face mask surveys have reported differences in mask-wearing in public places based on party affiliation, race and age.
Are face masks required by department policy?
A high percentage of respondents (84%) reported their department had a policy, directive or standard for wearing a face mask to reduce COVID-19 transmission. Given that the CDC has recommended face masks since early April, it isn’t surprising that three months later, the number of respondents with a policy requirement is this high.
A requirement for face masks was highest for corrections and EMS respondents (95%) and lowest for police respondents (78%). Reassuringly, only a low number of respondents indicated they were unsure if their department had a face mask policy.
Respondents who answered “no” or “unsure” to the question about their department having a policy were directed past the questions about specific policy components.
Does the face mask policy apply to off-duty use?
Respondents were asked, “Does your department policy, directive or standard address off-duty mask wearing?” It is not unprecedented for a department policy to address off-duty behavior, such as alcohol consumption or drug use, especially when off-duty behavior can impact on-duty performance.
Addressing off-duty use in a face mask policy was unusual (8%) for all respondents and highest for EMS providers (13%). Given the increase of state and local mask requirements, as well as the large number of national retailers, such as Walmart and Costco, requiring masks, it seems unlikely and possibly unnecessary for a public safety agency policy to specifically address the off-duty use of a face mask. Though it is reasonable a chief, infection control officer or operation director to encourage all personnel to vigilantly practice handwashing, social distancing and face mask use off-duty at home and in public places to control the spread of COVID-19 and maintain a healthy workforce.
Are responders required to wear a face mask in buildings and vehicles?
The survey asked a series of questions about the requirements for mask use when on-duty. Corrections officers reported the highest rate (87%) of face mask requirements in buildings or vehicles, and firefighters the lowest (44%).
It is concerning that so many EMS, fire and police respondents reported that their policy does not require the use of a face mask inside department buildings. Presumably, many of these buildings have shared common areas for training, working, resting and eating. Public safety personnel are encouraged to continue to examine if some administrative or support personnel can work from home, set up indoor traffic flows to minimize close contact with other personnel and determine when personnel should be donning face masks inside department buildings.
Just under half of all respondents (49%) reported a department requirement to wear a face mask whenever riding in a vehicle with two or more occupants. The low response from EMS respondents (55%) is especially surprising given the anecdotal media and social media accounts of EMTs and paramedics having to wear a mask their entire 12-hour or longer duty shift. Overall, 11% of all respondents were unsure if their department requires wearing a mask in a vehicle with two or more people. This represents an opportunity to clarify a face mask policy, alter the policy if needed, and ensure the policy is clearly communicated to all personnel.
What are the face mask expectations when interacting with the public?
The primary assumption underpinning widespread face mask use is that the wearer is potentially infectious and a face mask limits the likelihood of the wearer spreading disease. A face mask is most important in indoor spaces when social distancing is impractical or impossible. A high percentage of respondents reported their policy required face mask use during any indoor interaction with a member of the public. There is always room for nuance or field judgment, but it is surprising that the EMS response was not 100%. It seems a reasonable risk mitigation step during the COVID-19 pandemic to assume any patient is COVID-19 positive until proven otherwise.
A high percentage of police respondents (89%) also reported a mask wearing requirement during any indoor interaction with a member of the public. Recall that only 58% of police officers reported a policy requirement to wear a face mask inside a department building.
A policy requirement for outdoor face mask use was lower for all survey respondents, but still, 71% of respondents reported an outdoor requirement. The difference was smallest for EMS respondents (89% versus 81%) and firefighters (85% versus 76%). Even outdoors, it is likely that public safety personnel will have difficulty performing their duties, such as treating a patient, extricating a motorist from a motor vehicle or apprehending a suspect, without coming in contact with others. It seems sensible that a mask policy would require outdoor use.
Can a face mask have a logo, emblem or flag?
In early May, the San Francisco Police Dept.’s police chief ordered officers to wear neutral face coverings after officers wore masks with the “thin blue line” flag. News reports and social media photos make it clear that public safety personnel are wearing a wide variety of masks with sports team mascots or logos, different types of flags or emblems, or official department shields. A face mask, as an extension of the department uniform, might be an opportunity for individual expression or be a piece of duty gear that requires conformity with official department colors and styling.
Compared to other policy-related questions, a relatively high number of all respondents (38%) reported their policy doesn’t allow use of face masks with a logo, emblem or flag, while 20% of all respondents were unsure.
Are departments issuing face masks to personnel?
A face mask is a type of personal protective equipment. Like nitrile exam gloves and eye protection, masks should be available to all public safety personnel to protect them from exposure to potentially infectious material.
EMS personnel are most likely to be issued a face mask by their employer. Respondents reported 61% of their employers provide all EMS employees with masks, while 36% provide frontline EMS personnel a mask. This is unsurprising given the high-likelihood that EMS personnel will come into contact with patients known or suspected to have COVID-19.
One-fifth (21%) of police respondents answered “No” to the question, “Is your department issuing face masks to employees?”, more than double any other group of respondents. Police officers have regular and sometimes prolonged contact with citizens and other responders, and they should have access to department-issued PPE, including a face mask.
What type of mask are public safety personnel wearing?
Nearly one-third (31%) of all respondents are wearing a “Personally-owned reusable cloth face mask” when required. Nearly half (47%) of corrections respondents and one-third (33%) of police respondents are wearing their own cloth mask. Transferring the responsibility of PPE or duty gear procurement, maintenance and replacement to officers may increase risk and cost of doing the job to personnel who are already under physical, mental and financial stress.
Another interesting finding is that just 38% of EMS respondents are wearing a department-issued N95 face mask versus 34% wearing a paper mask. An ongoing issue throughout the pandemic has been the limited availability of PPE, especially N95 masks, and the lengths departments and individuals are forced to go through to disinfect and re-use an N95 mask, which are intended for single use.
With nearly 10% of all respondents reporting wearing something other than a cloth face mask, paper face mask or N95, an area of additional study is to identify those alternatives, which might include buffs, neck gaiters, bandanas, half-face or full-face respirators, or other devices.
What are public safety’s perceptions of mask use and impact?
Respondents were asked to agree or disagree with a series of statements about face mask usefulness, impact on their job and community face mask requirements.
Agreement with the statement, “Wearing a face mask helps keep me safe” didn’t include a mention of COVID-19, which might explain that only 43% of respondents selected strongly agree or agree. EMS had the highest level of agreement (61%) and police (37%) had the lowest level of agreement with the statement.
Another of the statements was specific to COVID-19 and asked respondents for their agreement with the statement, “A face mask is an effective tool for reducing the spread of COVID-19.” Most EMS respondents (68%) agreed with this statement. Fire respondents (36%) had the lowest level of agreement with this statement.
Nearly one-third (29%) of respondents either disagreed or strongly disagreed with this statement. The use of face masks to reduce the spread of COVID-19 has been a central theme of public health messaging, which is often amplified by public safety agencies, for nearly four months. The high-level of disagreement with this statement amongst public safety personnel may speak to the difficulty of this message gaining traction with the public and the polarization around face mask use.
Off-duty face mask use by public safety respondents is likely a reflection of their perceptions about a face mask’s ability to keep a person safe and prevent the spread of COVID-19. Two-thirds (66%) of all respondents wear a face mask off-duty in a public place. Off-duty mask use is highest with EMS (77%) respondents and lowest with police (37%) respondents.
Off-duty public safety mask use is lower than the general population. An NBC/SurveyMonkey poll, reported July 28, 2020 found “a strong majority of adults say they regularly wear masks. Sixty-eight percent of adults say they wear masks "every time" they leave home and may be in contact with others, 16% say they do so "most of the time," 10 percent say they wear masks "some of the time," and just 5% say "never.""
An AP-NORC poll asked, “Which of the following measures, if any, are you taking in response to the outbreak of the new coronavirus.” In the poll conducted July 16-20,2020, 86% of Americans report wearing a mask when leaving home.
Facial expressions, as well as the ability to give clear directions and ask questions, are critical to verbal and non-verbal communication with suspects, patients, bystanders and coworkers. A face mask is likely to make communication more difficult and increases the importance of clear, non-ambiguous communication. Respondents were asked for their agreement or disagreement with the statement, “Wearing a face mask reduces my ability to effectively communicate with members of the public.”
Almost two-thirds (63%) of all respondents agreed with the statement. Agreement was highest among police (69%) and lowest with EMS (49%). Perhaps EMS respondents have more experience before COVID-19 and during the pandemic wearing a mask while assessing and treating patients.
Public safety personnel, especially police, are increasingly expected to communicate their value to the community and are judged by citizens, elected officials and journalists as to how the department is perceived by the community. The statement, “Wearing a face mask improves public perception of our department” had agreement from a bit more than half of all respondents (54%). Agreement was highest among fire and EMS respondents (71%) and lowest with police respondents (47%). Seventeen percent of all respondents disagreed or strongly agreed with the statement, perhaps indicating that mask use harms perception of the department.
Should public safety personnel be expected to enforce face mask mandates?
One of the enduring controversies of the COVID-19 pandemic is the role of public safety, especially law enforcement officers, to enforce face mask mandates in public spaces and businesses. Many chiefs and officers are reluctant or resistant to enforce a face mask mandate. For example, Sheriff Don Barnes, Orange County, Calif. told the county Board of Supervisors, “We are not the mask police — nor do I intend to be the mask police.”
Half of the respondents (50%) agreed with the statement, “Businesses should require employees and customers to wear a mask.” About one-third (29%) disagreed with the statement and the rest were neutral.
Mask enforcement has put public safety personnel in the midst of the controversy and often pits citizens, alleging their rights are being violated, against employees stuck with enforcing a government mandate or corporate decision.
Almost one-third (31%) of all respondents agreed with the statement, “As a public safety official, I need to ask citizens to wear masks in areas where masks are mandated.” The agreement was highest from corrections (48%) respondents and lowest from police (22%) respondents.
This statement could also be interpreted as applying to mask use inside an ambulance, jail or prison, or in department buildings.
Finally, respondents were asked to select the most appropriate consequence for a business customer who refuses to wear a mask. “Escort from business” and “No consequence” were the most selected by all (86%) respondents. There was little support for “Misdemeanor fine” or “Felony arrest” among the survey respondents.