Firefighting On-Duty Injuries and Decreasing Potential Risk Factors
By Hussien Jabai, MS, CSCS, CPT
At times as citizens within a community, we call upon first responders to aid us in daily emergencies that take place. We might place a 911 call and be met with an law enforcement officer, ambulance, or fire department engine. The type of call will dictate who rushes to your aid, as fire departments respond to fires, search and rescue, and protection of community property and health (Nazari, MacDermid, Sinden, & Overend, 2018). In the instance that we do receive assistance or emergency aid by personnel of a fire department, we hope that the firefighters can withstand external factors in the field. We also hope that personnel are in good health to not only perform the necessary tasks at the time of incident, but also overall job-related tasks. From a city stand point, departments should want their staff to perform at optimal levels, while reducing the likelihood of injury to occur on-duty. In order to evaluate preventative measures, we must review previous literature on statistics of firefighter death and injury, cause of injury and death, and concepts behind coordinating effective wellness programs.
With a range in cause of injury, whether it be due to their medical calls or hazardous material exposures, there is a firefighter injury presented every 8 minutes (Phelps et al., 2018). This should display a concern for fire departments that wish to maintain healthy and functional staff to performance job-related tasks. In 2015, the National Fire Protection Association reported approximately 1.16 million firefighters, with a reported 68,085 experiencing injuries in the line of duty (Phelps et al., 2018). According to that data, nearly 17% of firefighters encounter some form of injury each year. With 43% of injuries taking place at the fire grounds, falls, slips, and jumps, along with overexertion and strain had the highest presence, both at 27.2% (Phelps et al., 2018). Taking into account the high injury rate among firefighters, we must also glance at the fatality rate within the profession. With a reported 68 firefighter deaths in 2015, nearly 51% of death were associated to sudden cardiac death (Phelps et al., 2018). How does this impact firefighter agendas and wellness programs? How does this impact program budget and staff wellness initiatives? You have workers compensation claims ranging from $5,168 to $34,000 per claim (Phelps et al., 2018), but do fire departments have structured programs to prevent and manage injuries during job related calls and day to day tasks? The literature analyzed by Phelps et al. (2018) found conflicting research when observing risk factors based on demographics and personal factors, although the researchers found situational awareness to be the leading cause of on-duty injury as 37.4% of all injuries, while physical fitness claimed 28.6%, and human error took up 10.6% (Phelps et al., 2018). These statistics show that situational awareness, alongside an elevated and optimal level of physical fitness, could possibly prevent a high percentage of on-duty injuries. From a general perspective of injury, we see situational awareness as the leading cause of on-duty injuries, but strains, sprains, and/or muscular pain claims the leading type of injury with 55.3% of injuries reported in 2015. Looking at fireground injuries, falls/slips/jumps leads with 28.7% of all reported injuries, while overexertion/strain consists of 25.9% of all reported fireground injuries (Phelps et al., 2018).
Hypertension and Sudden Cardiac Death
When considering possible risk factors for sudden cardiac death, we must take a swift glance toward systemic arterial hypertension, the “modifiable risk factor for all-cause morbidity and mortality worldwide” (Oparil et al., 2018). As hypertension is not only a major risk factor but also an ongoing worldwide problem, researchers Tereshchenko, Soliman, Davis, and Oparil (2017) observed that the “lifetime risk of sudden cardiac death at 30 years of age is higher by 30% in individuals with hypertension.” The sudden cardiac death risk of individuals increases 20% for each 20/10 mmHg that the systolic/diastolic blood pressure increases (Tereshchenko et al., 2017). Not only does more than half of the population with hypertension do not realize that they have it, but many individuals that are aware might not even receive treatment or are treated insufficiently (Oparil et al., 2018). Presenting an issue with hypertension, and the possible concern that fire departments face when analyzing the health status of their staff. In regards to hypertension being a major concern for departments due to the sudden cardiac death rates of 2015, Choi, Schnall, and Dobson (2016) observed 330 California firefighters for an obesity project. 11% out of the 330 participants had hypertension, while 50% of those had uncontrolled high blood pressure (Choi et al., 2016). Based on this small sample group of 330 firefighters, we could analyze and hypothesize that 1 out of every 10 firefighters have hypertension. This could also mean that 1 out of every 10 firefighters walks around with a higher chance of falling victim to sudden cardiac death. An increase in job demands and the number of 24 hr shifts performed by the individuals are suggested factors in hypertension and blood pressure (Choi et al., 2016). Based on this, those who take on more overtime responsibilities and off-duty work might be setting themselves up for a higher chance of hypertension, unless awareness and counter actions are performed. Fire department should make a strong wellness initiative for their personnel when aiming to decrease the presence of hypertension, cardiovascular disease’s most common preventable risk factor (Oparil et al., 2018). Other risk factors of sudden cardiac death explored in research suggests “carrying heavy equipment with protective gear, heat stress, and working at near maximal heart rates for extended periods of times” could potentially contribute (Nazari et al., 2018).
Decreasing Risk of Hypertension
Departments could address lifestyle changes, such as physical activity, monitoring and adjustments of dietary and alcohol intake, and a regulation of sodium and potassium intake (Oparil et al., 2018). Things like physical activity could be issued by standard strength and conditioning programs, with set times set aside for fitness session bouts. Departments have a few options when looking at implementing strength and conditioning programs. The first option includes getting captains or selected personnel per shift to acquire some form of exercise science degree or personal training certification. This option allows for education within the department, but can hinder the overall impact due to presence of bias thoughts in demands of energy for oneself, relationships between individuals, lack of lifelong commitment toward the field of exercise science, and interference of other job related tasks. A second option departments could explore is the option to hire a tactical strength and conditioning facilitator within the department. This person would have specific job tasks with designing and implementing strength programs, performing annual and entry fitness testing, and assign corrective exercise for each individual. The third option would be for the department to bring in a vendor, or independent contractor, hired by the city to perform specific tasks. This individual could perform anything as minimal as fitness testing each year or brought in weekly/monthly for supervised strength and conditioning sessions. The con to bringing in an outside vendor would be the overall impact that the person has on the culture of the department since there would be a hindrance in frequency of communication and day to day supervision. Dietary and alcohol regulations, along with sodium and potassium intake could be more of an educational component within a wellness program. Providing things like information material from recruited health professionals or reliable nutrition sources could be utilized as posters within the department or as weekly/monthly emails.
Decreasing Risk of Injury
With falls, slips, and trips, overexertion, and strain being the leading causes and types of injuries for firefighters in the field (Phelps et al., 2018), we must evaluate prevention techniques toward reducing the likelihood of injury. Griffin et al. (2016) explored the data in which specified those with a lower level of physical fitness were more likely to acquire some form of occupational injury by 220%. In association to this, those who partake in an on-duty physical fitness program were half as likely to be injured due to non-exercise related incidents (Griffin et al., 2016). Simultaneously, you have over one-third of firefighters reporting injury as a result of fitness training or some form of job-related training tasks. Not only do one-third of firefighters reporting injury due to training, but those that do perform physical activity in the form of exercise training has a 4 times risk of acquiring on-duty injury during training (Griffin et al., 2016). With this data, we should understand that strength and conditioning programs should be carried out by professionals that understand both the profession of firefighting, their job-tasks, and energy demands, along with the education of exercise science and tactical performance. Departments can’t afford to both hire strength and conditioning professionals specifically designated toward implementing injury prevention programs, while simultaneously paying out in workers compensation due to training injuries.
Throughout our evaluating of literature regarding risk factors of injury and potentially death, we explored sudden cardiac death and hypertension, as well as physical risk factors such as physical fitness levels. With hypertension being a precursor to sudden cardiac death (Tereshchenko et al., 2017), departments and clinics or medical professionals hired by departments should make an agenda to monitor health markers such as blood pressure. If we don’t monitor these health markers, personnel could be walking around with an elevated level of risk for sudden cardiac death and not be aware that they need to impliment strategies toward preventing progression. Departments should make annual health screenings a priority, along with strategies toward decreasing risk factors. In regards to physical fitness, personnel should partake in proper strength and conditioning programs to decrease the likelihood of injury, but must make sure the program is designed by qualified individuals. Not only should programs be designed properly, but qualified staff or vendors should monitor and regulate the program based on daily needs. The lack of regulation in on-duty physical activity could actually increase the chances of injury, and need some form of supervision or upper level of education within the department staff.
We have investigated potential risk factors of on-duty injury, in efforts to coordinate future research and assist departments in implementing effective and efficient wellness programs for their staff. As statistics reveal the types and cause of injuries in history, we must utilize this to conduct future studies. Analyzing how strength and conditioning programs impact injury prevention initiatives within departments will continue to be an effective form of evaluating what works and what does not. Just because a department has a program in place, does not mean it is effective, nor does it mean the program is built by qualified individuals utilizing proven research. Programs need to be monitored, both on evaluating who the coordinator is and the action plans being executed. Departments could bring in vendors or contractors that not only take time to construct the program, but is also devoted toward continued education and research studies within the profession of firefighting. Research could include 1. HRV, heart rate variability, to monitor recovery post-incident, 2. heart rate training during bouts of on-duty exercise, 3. mobility and flexibility evaluation quarterly in conjunct with annual testing, 4. movement screening to observe and assess movement patterns, and 5. air consumption of firefighters on an annual basis during their career. All areas of study will assist the department at that local level and department around the world if the research is published or shared in conferences or media outlets. However we choose to pursue continued research on firefighter on-duty injuries, it is imperative that all departments construct a well-developed wellness program and health initiative for their personnel.
Choi, B., Schnall, P., & Dobson, M. (2016). Twenty-four-hour work shifts, increased job demands, and elevated blood pressure in professional firefighters. International archives of occupational and environmental health, 89(7), 1111–1125. https://doi.org/10.1007/s00420-016-1151-5
Griffin, S. C., Regan, T. L., Harber, P., Lutz, E. A., Hu, C., Peate, W. F., & Burgess, J. L. (2016). Evaluation of a fitness intervention for new firefighters: injury reduction and economic benefits. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 22(3), 181–188. https://doi.org/10.1136/injuryprev-2015-041785
Nazari, G., MacDermid, J. C., Sinden, K. E., & Overend, T. J. (2018). The Relationship between Physical Fitness and Simulated Firefighting Task Performance. Rehabilitation research and practice, 2018, 3234176. https://doi.org/10.1155/2018/3234176
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Tereshchenko, L., Soliman, E., Davis, B., & Oparil, S. (2017, August 14). Risk stratification of sudden cardiac death in hypertension. Retrieved August 07, 2020, from https://www.sciencedirect.com/science/article/abs/pii/S0022073617302534