Firefighter Injury Research & Safety Trends-Reliability Study (FIRST-RS)

Oregon Governor's Fire Service Policy Council MeetingOffice of State Fire Marshal

4760 Portland Rd NESalem, Oregon 97305

Mt Hood Conference RoomTuesday, October 27, 2015

Jennifer Taylor, PhD, MPH, CPPS - Associate ProfessorDepartment of Environmental and Occupational Health

Dornsife School of Public Health at Drexel University ~ Philadelphia, PA1

Outline• Our mission• Partnerships and Pilots• Benefits of data analysis and linkage• Drexel responsibilities• State partner responsibilities

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Adapted from Christian et.al JAP 2009, vol 94 (5): 1102-1127

Safety Knowledge

Safety Motivation

SafetyCompliance

HelpingStewardship

Exercising RightsInitiating safety-related

change

Safety Citizenship

Following proceduresUsing protective

equipmentPracticing risk reduction Safety

OutcomesNear Miss

InjuryLODD

Safety Climate

Management commitment

Supervisor supportSafety systems

Job riskWork pressureInternal group

processes

Safety Behaviors

Antecedents to Safety Behaviors

FEMA AFG Grant #: EMW-2011-FP-00069

FEMA AFG Grants #: EMW-2009-FP-00427 EMW-2012-FP-00205

Our Mission

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Mission Relevance• #1 - Define and advocate the need for a cultural change

within the fire service relating to safety…• #4 – All firefighters must be empowered to stop unsafe

practices• #7 - Create a national research agenda and data collection

system that relates to the initiatives• #9 - Thoroughly investigate all firefighter fatalities, injuries,

and near misses.

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How Mission is Accomplished• Data Systems Development and Evaluation

– Non-fatal injury– Near-miss– Policy

• Methods– Data Linkage– Narrative text mining– Interviewing and focus groups– Survey development and assessment

• Emerging Topics– EMT Assaults– Women in the Fire Service– Community Use of 911

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Drexel’s Fire Service Research

2015 IAFF Contract, YFIRES

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publichealth.drexel.edu/FIRST 7

Partnerships

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Advisory Council• Congressional Fire Services Institute • Fire Department Safety Officers

Association • Firehouse Magazine • International Association of Arson

Investigators • International Association of Fire

Chiefs • International Association of Fire

Fighters • International Society of Fire Service

Instructors • Liberty Mutual Research Institute

for Safety

• National Fallen Firefighters Foundation

• National Volunteer Fire Council • National Association of State Fire

Marshals • North American Fire Training

Directors • Retired Fire Chief, Alan Brunacini• The Fire Protection Research

Foundation• The Secret List

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Advisory Board Input• Data that tells a story at the local level • Data collection that does not increase the reporting

burden for firefighters• Data that describe all firefighter injuries • A clear connection between the data collection

system and benefits for the Fire Service

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Why are we doing this research?

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Data Systems Development and Evaluation• Studies that “focus on the design and

feasibility of a new database system” – FIRST and FIRST-RS• FEMA AFG grant # EMW-2009-FP-00427 (2010-2013) • FEMA AFG grant # EMW-2012-FP-00205 (2013-2016)

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Fire Service Deaths and Injuries• Firefighter Fatalities– NFFF– NFPA– NIOSH – USFA

• Firefighter Injuries– No comprehensive national non-fatal injury reporting

system– NFPA Survey – NFIRS by USFA

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What about other data?Injury discharge rates by body region, 1979-2001

Head and neck

Spine and back

Torso

Extremities

1

10

100

1979 1985 1990 1995 2001

Rate per 10,000 population

Source: National Hospital Discharge Survey. Age-adjusted rates are plotted on a log scale.

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Non-fatal Firefighter Injury Data Pilots

Philadelphia, PAState of Florida

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Research & Development Models• Model 1: Department-Level Data Linkage• Model 2: State-Level Data Linkage• Model 3: Industry and Occupation Policy

Initiative

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Model 1: Fire Department-Level (Philadelphia Model)

• Developing fire department-level systems by linking injury reports to other existing data.

• AIMFIRST_RS: testing this model with new departmental partners– New pilot partners• Portland, OR (in due diligence)• Boston, MA (agreements complete)

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Model 2: State-Level (Florida Model)• Developing state-level systems by

linking workers’ compensation, and hospital and emergency department encounters, to a statewide registry of firefighters.

• AIMFIRST_RS: testing this model with new state partners, including technological data transfer innovation– New pilot partner

• State of Oregon

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Data Sources from Florida• Fire College Department of Insurance and

Continuing Education– FC-DICE

• Workers’ Compensation– Medical– Lost-time

• Agency for Health Care Administration– AHCA (hospital data)

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FC-DICE• Source population• Basic demographic data• Denominator data– Important for calculating prevalence and

proportions

• Longitudinal data– Important for calculating incidence and risk

• Rank, training, fire department/station20

Workers’ Compensation• Medical Claims– Line-item list of medical procedures and costs– Confirms that injuries are work-related

• Lost Time Claims– Severity of injury– Indemnity data for total cost of injuries

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AHCA• Four data sources:– Emergency Department Discharge– Inpatient Discharge– Ambulatory– Rehabilitation

• Detailed information on cause and nature of injury

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Linkage of Data

FC-DICE

Workers Comp AHCASSN

SSNNameDOB Inpatient

Ambulance

Rehab

ED

Med Claims

Lost Time Claims

Provider

Hospital

Drug

Dental

ID Control Number

Inj Date NameDOB

E-Codes

Work-RelatedCost of Injuries

SSNDate of Injury

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Benefits of data analysis and linkage

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Descriptive StatisticsTotal

Total 2372 (100%)Race

White 1514 (63.9%)Black 700 (29.5%)Hispanic 142 (6%)Asian or Pacific Islander 3 (0.1%)American Indian or Alaskan Native 10 (0.4%)

SexMale 2082 (87.8%)Female 290 (12.2%)

RankNon-Officer 1926 (81.2%)Lieutenant 337 (14.2%)Captain 109 (4.6%)

Light DutyYes 833 (35.1%)No 1539 (64.9%)

Injury occurred on a runYes 1479 (62.4%)No 893 (37.6%) 25

Cause of InjuryStrain or Injury By 645 (27.2%)Burn or Scald-Heat or Cold Exposures-Con 486 (20.5%)Fall, Slip, or Trip Injury 402 (16.9%)Struck or Injured By 313 (13.2%)Miscellaneous Causes 140 (5.9%)Motor Vehicle 115 (4.8%)Cut, Puncture, Scrape Injured By 106 (4.5%)Caught In, Under, or Between 71 (3%)Striking Against or Stepping On 55 (2.3%)Foreign Matter (Body) in Eye(s) 39 (1.6%)

AgeMean (std) 45.26 (0.203)

Median (IQR)43.97 (37.42-

51.88)Age at Injury

Mean (std) 40.41 (0.197)

Median (IQR)39.29 (32.46-

46.72)Years of Experience

Mean (std) 15.47 (0.181)

Median (IQR) 13.14 (7.96-19.87)Years of Experience at Injury

Mean (std) 11.25 (0.183)Median (IQR) 8.56 (3.79-15.91)

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PFD Injury Burden

• Strains, fall/slip/trips, and burns…– 74% of all injuries – 85% of total cost ($22 million) between the years

2005 and 2013. – Burns had highest lost time claim payout • $4.8 million (36%) of lost time claim expenditures

– Strain injuries had highest medical claim costs• $4 million (38%) all claims.

PFD Safety Office

COP Risk Mgmt

(Workers’ Comp)

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A Deep Dive into InjuryEx. Philadelphia Fire Department

• Females reported increased odds of assault injuries compared to males (OR=6.25, 95% CI 3.8-10.2).

• This relationship was entirely mediated through occupation (AOR=1.64, 95% CI 0.94-2.85).

• Paramedics had significantly higher odds for assault injuries than firefighters (OR 14.4, 95% CI: 9.2-22.2, p<0.001).

PFD Human Resources

DemographicsPFD Safety

Office

COP Risk Mgmt

(Workers’ Comp)

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Florida Descriptive Statistics Cohort: 2005-2009

• Data from 42,981 Firefighters Linked from FCDICE to hospitalizations– 88% career; 12% volunteer– 93% males, 7% females

• Mean age of 42 (18-79)– Career mean age 43 (18-79)– Volunteer mean age 36 (18-79)

• Mean years of experience 14.9 Years (0-59)– Career mean work experience 16.2 years (0-

59)– Volunteer mean work experience 5.48 years

(0-57)• 14,375 (34%) identified as having had an

injury between 2005-2009

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Florida: Years of Experience

FCDICEWorkers’

Comp

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Florida: Years of Experience

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Recommended Core Variables

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Drexel responsibilities• Secure Funding• Contact data stewards and stakeholders• Initiate legal agreements• Secure IRB and FEMA Research Compliance

Approvals• Provide secure, encrypted data environments

at rest and in motion• Share analysis with stakeholders– Customize as needed

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State Partner Responsibilities• Identify and Convene

Stakeholders & Data Stewards– State Fire Marshal– State Workers’ Compensation

Contact– State Fire College or

Firefighter Registry holder– State Hospital Authority who

contains hospital discharge records

– IT Contact– Legal Counsel– Any other Fire Service leaders

• Timely response to Drexel data needs• In-person• Remote

• Data Stewards available for technical support

• Provide representative to FIRST Advisory Board

• Joint presentations

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Questions

Jennifer Taylor, PhD, MPH, CPPSAssociate Professor

Principal Investigatorjat65@drexel.edu

267-359-6060

Fireman’s Hall Museum, Philadelphia

Shannon Widman MPH, Project Manager

Non-fatal Injury Datasaw68@drexel.edu

267-359-6180

publichealth.drexel.edu/FIRST

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