Economic benefit of the PHLAME wellness programme on firefighter injury

Individual responses to the implementation of mandatory fitness testing within a fire department

OBJECTIVES

To examine the effects of implementing a consequential fitness assessment (pull-ups, curl-ups, push-ups, 3 min step test) in a fire department on an individual level.

METHODS

We used a repeated-measures design to analyse fitness assessment data from 2019 to 2020 in Northern Virginia. A total of 631 professional firefighters completed the fitness assessment in both years. Repeated measures analysis of variances (ANOVAs) and multiple regression modelling were used to examine the effects of the fitness assessment and factors associated with changes in fitness, respectively.

RESULTS

Overall all aspects of fitness improved over the first year of implementation with a majority of firefighters improved on all components of the fitness assessment except for pull-ups (16.1% improved). Greater levels of baseline fitness and being female were negatively associated with changes in all fitness measures. Older firefighters had smaller changes in pull-up, curl-up and push-up performance.

CONCLUSIONS

During the first year of fitness assessment implementation, the fire department generally improved. The findings suggest that fire departments which enforce mandatory fitness assessments must establish policies for dealing with inadequate performance and offer resources to aid individual firefighters.

Safer tomorrow: Irish dairy farmers' self-perception of their farm safety practices

INTRODUCTION

Encouraging safe work practices (SWPs) is challenging in agriculture. Group-based social learning has effectively promoted SWPs and health behaviors in other occupations, and could be applied in agriculture (e.g., through farmer discussion groups (DGs)). In Ireland, dairy DG members are more likely to adopt novel technologies and practices, a relationship that might extend to SWPs. The extent of SWP adoption among Irish dairy farmers is unknown. This paper evaluates a 2018 baseline study of SWP implementation, conducted as part of a dairy DG-based intervention study.

METHOD

A paper-based survey of SWP implementation and safety self-perception was distributed to 1,220 farmers from 84 dairy DGs. For eight SWPs, associated with high-risk farm hazards (livestock, slurry, machinery, or tractors), farmers were asked how frequently they implemented these practices in the previous year, and how frequently they intended to do so next year (0: never, 1: rarely, 2: sometimes, 3: most of the time, 4: all of the time).

RESULTS

Surveys were completed by 460 farmers. For the previous year, three SWPs, related to slurry, machinery, and tractor hazards, scored a median frequency of four. Four SWPs, related to livestock, slurry, and machinery hazards, scored a median frequency of three. The lowest median score (two) was for tractor exit behavior. Median intention scores matched or exceeded past frequency for all SWPs, while 73% intended to increase implementation of at least one SWP. Most (96%) considered themselves a "safe farmer."

CONCLUSIONS

Farmers generally perceived themselves to be safe at work, which is reflected in their SWP implementation. Most farmers intended to increase SWP implementation, suggesting awareness of safety shortcomings and a desire to farm more safely.

PRACTICAL APPLICATIONS

This study can inform farm safety promotion initiatives. The disconnect between farmers' safety self-perception and SWP implementation merits further research.

Safety interventions for the prevention of accidents at work: A systematic review

BACKGROUND

Limited knowledge regarding the relative effectiveness of workplace accident prevention approaches creates barriers to informed decision-making by policy makers, public health practitioners, workplace, and worker advocates.

OBJECTIVES

The objective of this review was to assess the effectiveness of broad categories of safety interventions in preventing accidents at work. The review aims to compare effects of safety interventions to no intervention, usual activities, or alternative intervention, and if possible, to examine which constituent components of safety intervention programs contribute more strongly to preventing accidents at work in a given setting or context.

DATE SOURCES

Studies were identified through electronic bibliographic searches, government policy databanks, and Internet search engines. The last search was carried out on July 9, 2015. Gray literature were identified by searching OSH ROM and Google. No language or date restrictions were applied. Searches done between February and July of 2015 included PubMed (1966), Embase (1980), CINAHL (1981), OSH ROM (NIOSHTIC 1977, HSELINE 1977, CIS-DOC 1974), PsycINFO (1806), EconLit (1969), Web of Science (1969), and ProQuest (1861); dates represent initial availability of each database. Websites of pertinent institutions (NIOSH, Perosh) were also searched.

STUDY ELIGIBILITY CRITERIA PARTICIPANTS AND INTERVENTIONS

Included studies had to focus on accidents at work, include an evaluation of a safety intervention, and have used injuries at work, or a relevant proxy, as an outcome measure. Experimental, quasi-experimental, and observational study designs were utilized, including randomized controlled trials (RCTs), controlled before and after (CBA) studies, and observational designs using serial measures (interrupted time series, retrospective cohort designs, and before and after studies using multiple measures). Interventions were classified by approach at the individual or group level, and broad categories based on the prevention approach including modification of: Attitudes (through information and persuasive campaign messaging).Behaviors (through training, incentives, goal setting, feedback/coaching).Physiological condition (by physical training).Climate/norms/culture (by coaching, feedback, modification of safety management/leadership).Structural conditions (including physical environment, engineering, legislation and enforcement, sectorial-level norms). When combined approaches were used, interventions were termed "multifaceted," and when an approach(es) is applied to more than one organizational level (e.g., individual, group, and/or organization), it is termed "across levels."

STUDY APPRAISAL AND SYNTHESIS METHODS

Narrative report review captured industry (NACE), work setting, participant characteristics, theoretical basis for approach, intervention fidelity, research design, risk of bias, contextual detail, outcomes measures and results. Additional items were extracted for studies with serial measures including approaches to improve internal validity, assessments of reasonable statistical approaches (Effective Practice of Organization of Care [EPOC] criteria) and overall inference. Random-effects inverse variance weighted meta-analytic methods were used to synthesize odds ratios, rate ratios, or standardized mean differences for the outcomes for RCT and CBA studies with low or moderate levels of heterogeneity. For studies with greater heterogeneity and those using serial measures, we relied on narrative analyses to synthesize findings.

RESULTS

In total 100 original studies were included for synthesis analysis, including 16 RCT study designs, 30 CBA study designs, and 54 studies using serial measures (ITS study designs). These studies represented 120 cases of safety interventions. The number of participants included 31,971,908 individuals in 59 safety interventions, 417,693 groups/firms in 35 safety interventions, and 15,505 injuries in 17 safety interventions. Out of the 59 safety interventions, two were evaluating national prevention measures, which alone accounted for 31,667,110 individuals. The remaining nine safety interventions used other types of measures, such as safety exposure, safety observations, gloves or claim rates. Strong evidence supports greater effects being achieved with safety interventions directed toward the group or organization level rather than individual behavior change. Engineering controls are more effective at reducing injuries than other approaches, particularly when engineered changes can be introduced without requiring "decision-to-use" by workplaces. Multifaceted approaches combining intervention elements on the organizational level, or across levels, provided moderate to strong effects, in particular when engineering controls were included. Interventions based on firm epidemiologic evidence of causality and a strong conceptual approach were more effective. Effects that are more modest were observed (in short follow-up) for safety climate interventions, using techniques such as feedback or leadership training to improve safety communication. There was limited evidence for a strong effect at medium-term with more intense counseling approaches. Evidence supports regulation/legislation as contributing to the prevention of accidents at work, but with lower effect sizes. Enforcement appears to work more consistently, but with smaller effects. In general, the results were consistent with previous systematic reviews of specific types of safety interventions, although the effectiveness of economic incentives to prevent accidents at work was not consistent with our results, and effectiveness of physiological safety intervention was only consistent to some extent.

LIMITATIONS

Acute musculoskeletal injuries and injuries from more long-time workplace exposures were not always clearly distinguished in research reports. In some studies acute and chronic exposures were mixed, resulting in inevitable misclassification. Of note, the classification of these events also remains problematic in clinical medicine. It was not possible to conduct meta-analyses on all types of interventions (due to variability in approach, context, and participants). The findings presented for most intervention types are from limited sources, and assessment of publication bias was not possible. These issues are not surprising, given the breadth of the field of occupational safety. To incorporate studies using serial measures, which provide the only source of information for some safety interventions such as legislation, we took a systematic, grounded approach to their review. Rather than requiring more stringent, specific criteria for inclusion of ITS studies, we chose to assess how investigators justified their approach to design and analyses, based on the context in which they were working. We sought to identify measures taken to improve external validity of studies, reasonable statistical inference, as well as an overall appropriate inferential process. We found the process useful and enlightening. Given the new approach, we may have failed to extract points others may find relevant. Similarly, to facilitate the broad nature of this review, we used a novel categorization of safety interventions, which is likely to evolve with additional use. The broad scope of this review and the time and resources available did not allow for contacting authors of original papers or seeking translation of non-English manuscripts, resulting in a few cases where we did not have sufficient information that may have been possible to obtain from the authors.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

Our synthesis of the relative effectiveness of workplace safety interventions is in accordance with the Public Health Hierarchy of Hazard Control. Specifically, more effective interventions eliminate risk at the source of the hazard through engineering solutions or the separation of workers from hazards; effects were greater when these control measures worked independently of worker "decision-to-use" at the worksite. Interventions based on firm epidemiological evidence of causality and clear theoretical bases for the intervention approach were more effective in preventing injuries. Less effective behavioral approaches were often directed at the prevention of all workplace injuries through a common pathway, such as introducing safety training, without explicitly addressing specific hazards. We caution that this does not mean that training does not play an essential function in worker safety, but rather that it is not effective in the absence of other efforts. Due to the potential to reach large groups of workers through regulation and enforcement, these interventions with relatively modest effects, could have large population-based effects.

Female Firefighter Work-Related Injuries in the United States and Canada: An Overview of Survey Responses

Objectives

This study explored how demographic characteristics, life experiences, and firefighting experiences have an impact on work-related injuries among female firefighters, and described events surrounding such work-related injuries.

Methods

This online survey was available from June 2019 to July 2020. Questions related to demographic characteristics, life experiences, firefighting experiences, and work-related injuries. Descriptive analyses characterized variables by the presence or absence of work-related injury, injury severity, job assignment, and country of residence.

Results

There were 1,160 active female firefighter survey respondents from the US and Canada, 64% of whom reported having at least one work-related injury. US respondents made up 67% of the total but 75% of the injured sample. Injured respondents were older, had been in the fire service longer, and had a greater number of fires and toxic exposures than non-injured respondents. Heavier weight, tobacco use, and alcohol consumption were more common among injured respondents. The two most common contributing factors to work-related injuries were human error and firefighter fatigue. Among respondents who reported an injury-related time loss claim, 69% were wearing protective equipment when injured, and 9% of the injuries directly resulted in new policy implementation.

Conclusions

These findings can help inform resource allocation, and development of new policies and safety protocols, to reduce the number of work-related injuries among female firefighters.

Comprehensive Assessment of Implementation Factors Related to Worksite Exercise in Firefighters

OBJECTIVE

This study sought to identify key implementation factors to a 12-month worksite exercise intervention in career firefighters.

METHODS

Implementation factors related to the hybrid type 1 effectiveness-implementation trial were assessed by exercise adherence, implementation questionnaires, focus groups, and observations from stakeholders.

RESULTS

The primary identified implementation themes spanned intrapersonal, interpersonal, and institutional factors including: 1. Time and desire to exercise on shift; 2. Financial incentives to exercise; 3. Structured fitness programs; 4. Group competition, cohesion, and camaraderie; 5. Leadership engagement and support; and 6. Health, fitness, and occupational preparedness benefits.

CONCLUSIONS

Future worksite exercise programs should address the barriers and facilitators identified herein and consider utilizing a hybrid delivery approach combining supervised and telehealth exercise interventions to optimize enthusiasm, adherence and improve safety and health.

Changes in Health and Physical Fitness Parameters After Six Months of Group Exercise Training in Firefighters

Proper training methods may be used as an effective preventative measure for many of the musculoskeletal injuries sustained as a first responder that are inherent to the profession. The traditionally low fitness levels and poor exercise habits of city firefighters may predispose this population to an increased risk of chronic conditions, such as cardiovascular and metabolic disease. The purpose of this study was to analyze changes in the health and fitness parameters of professional firefighters across North Texas during a six-month training program. Twenty-two professional firefighters completed six months of group training, consisting of two training sessions per week. These individuals underwent a pre- and post-fitness testing protocol that consisted of body composition, range of motion, anaerobic power, muscular endurance, and cardiorespiratory fitness. Improvements (p < 0.05) in flexibility, anaerobic performance, fatigue index, muscular endurance, and aerobic fitness were found following the six-month training program. No differences in body composition or peak power were observed (p > 0.05). Six months of group exercise improves aerobic and anaerobic fitness, exercise tolerance, muscular endurance, and flexibility in firefighters.

Evaluating Nutrient Intake of Career Firefighters Compared to Military Dietary Reference Intakes

The primary goals of the Dietary Reference Intakes (DRI) are to plan and assess nutrient intakes to promote health, reduce chronic disease, and prevent toxicity. Firefighters have unique nutrient needs compared to the public due to their job demands. The military provides the only published guidance for tactical athletes’ nutrient needs. The purpose of this study was to determine whether firefighters were meeting the Military Dietary Reference Intakes (MDRI). A cross-sectional study was conducted in a sample of career firefighters (n = 150, 37.4 ± 8.4 year-old males) employed in Southern California. Data were gathered during baseline assessments from a Federal Emergency Management Agency-funded Firefighter Wellness Initiative. Participants were asked to log their food and beverage consumption over a 72-h period. Descriptive statistics (means, standard deviations, 95% confidence intervals) were calculated for all participant characteristics and average three-day nutrient intakes. A 95% confidence interval compared their nutrient intake to MDRI to identify differences in nutrient intakes, significance accepted at p = 0.05. Compared to MDRI reference values, firefighters consumed an inadequate amount of total calories, linolenic and alpha-linolenic fatty acid, fiber, vitamins D, E, and K, potassium, magnesium, zinc, and carbohydrates. Vitamin D, magnesium, and potassium had the greatest shortcomings (95.3%, 94.0%, and 98.7%, respectively, under MRDA). Thus, firefighters are not meeting the established MDRI for several key nutrients required to promote health, improve performance, and reduce chronic disease. Dietitians and health care providers may use the results of this study to help design health promotion programs for this population. Future research should develop a customized reference intake for firefighters.

Obesity prevalence in Brazilian firefighters and the association of central obesity with personal, occupational and cardiovascular risk factors: a cross-sectional study

OBJECTIVES

This study aimed to investigate the obesity prevalence in a population of Brazilian firefighters and the association of central obesity (CO) with sociodemographic, occupational, life habits, fitness and health status variables.

DESIGN

Cross-sectional study.

SETTINGS

The data were collected during annual health inspections of firefighters from the Military Fire Service of the State of Espírito Santo, a state in Southeast Brazil.

PARTICIPANTS

The study encompassed 1018 active military firefighters. After exclusion criteria, 892 male firefighters were analysed.

PRIMARY AND SECONDARY OUTCOME MEASURES

The collected data included: sociodemographic, occupational, lifestyle, fitness and health status variables. The associations between these factors and CO were calculated by adjusted OR through a hierarchical logistic regression model.

RESULTS

Obesity estimation by body mass index indicated that 48.65% of the firefighters were overweight and 10.99% were obese. Concerning the body fat percentage, 26.23% of the participants were considered obese, while 18.61% of the firefighters were considered centrally obese or at risk using the waist circumference measure. After adjusted OR analysis, CO was more likely associated with the age range of 50 to 59 years old (OR 2.93; 95% CI 1.05 to 8.14), low self-reported physical activity (OR 1.95; 95% CI 1.14 to 3.34), low cardiorespiratory fitness (OR 5.15; 95% CI 3.22 to 8.23), hyperglycaemia (OR 1.70; 95% CI 1.07 to 2.72) and hypertriglyceridaemia fasting status (OR 3.12; 95% CI 1.75 to 5.55).

CONCLUSIONS

Our study identified an overall high prevalence of overweight and obese individuals in the examined firefighter population. Age and cardiovascular risk factors were directly associated with CO among the firefighters. Cardiovascular risk factors should be routinely inspected within the Brazilian firefighters' corporations in order to improve the health condition and wellness of these workers. These endeavours will improve the performance of the services provided to the population.

The impact of worksite interventions promoting healthier food and/or physical activity habits among employees working 'around the clock' hours: a systematic review

We conducted a systematic review of randomised studies on the impact of worksite interventions to promote healthier food and/or physical activity among people who work irregular hours ‘around the clock’, that is, outside of ordinary daytime working hours. The population–intervention–comparator–outcomes–study (PICOS) design format was used. Data sources were PubMed and CINAHL. An updated search was conducted on October 2017 using Google Scholar and the related articles function in PubMed on initially included studies to identify additional studies. Risk of bias was used to assess study quality. A total of seven studies (reports published in 14 papers) were included in the systematic review: Two interventions with a broader lifestyle approach, three focusing on physical exercise and two on providing healthier food or meal options. The studies had sample sizes from 30 to 1,000 and targeted a mixture of occupations, including both male- and female-dominated occupational groups. The interventions lasted from 2 to 12 months. Only one had an extended follow-up. In general, the studies showed small-to-moderate effect sizes on several measures, including dietary and/or physical activity measures, suggesting acceptable effectiveness for interventions involving community-level behaviour change. Our findings highlight a need to further develop and implement well-designed health promotion interventions with comparable outcome measures and effect size reports. A mixture of health promotion strategies is recommended for future practice in this target population, including individually tailored programmes, improving the food and physical activity environment and using broader lifestyle approaches including the use of participatory and empowerment strategies. While more research is needed in this field, the existing knowledge base on effective approaches awaits translation into practice.

Efficacy of a proactive health and safety risk management system in the fire service

Background

This study evaluated the efficacy of a fire department proactive risk management program aimed at reducing firefighter injuries and their associated costs.

Methods

Injury data were collected for the intervention fire department and a contemporary control department. Workers’ compensation claim frequency and costs were analyzed for the intervention fire department only. Total, exercise, patient transport, and fireground operations injury rates were calculated for both fire departments.

Results

There was a post-intervention average annual reduction in injuries (13%), workers’ compensation injury claims (30%) and claims costs (21%). Median monthly injury rates comparing the post-intervention to the pre-intervention period did not show statistically significant changes in either the intervention or control fire department.

Conclusions

Reduced workers’ compensation claims and costs were observed following the risk management intervention, but changes in injury rates were not statistically significant.

Relating Older Workers' Injuries to the Mismatch Between Physical Ability and Job Demands

OBJECTIVE

We examined the association between job demand and occupational injury among older workers.

METHODS

Participants were workers aged 50+ enrolled in the Health and Retirement Study, 2010 to 2014. Participants reported physical ability within three domains: physical effort, stooping/kneeling/crouching, and lifting. To measure subjective job demand, participants rated their job's demands within domains. We generated objective job demand measures through the Occupational Information Network (ONET). Using Poisson regression, we modeled the association between physical ability, job demand, and self-reported occupational injury. A second model explored interaction between job demand and physical ability.

RESULTS

The injury rate was 22/1000 worker-years. Higher job demand was associated with increased injury risk. Within high job demands, lower physical ability was associated with increased injury risk.

CONCLUSIONS

Older workers whose physical abilities do not meet job demands face increased injury risk.

Empiric validation of a process for behavior change

Most behavior change trials focus on outcomes rather than deconstructing how those outcomes related to programmatic theoretical underpinnings and intervention components. In this report, the process of change is compared for three evidence-based programs' that shared theories, intervention elements and potential mediating variables. Each investigation was a randomized trial that assessed pre- and post- intervention variables using survey constructs with established reliability. Each also used mediation analyses to define relationships. The findings were combined using a pattern matching approach. Surprisingly, knowledge was a significant mediator in each program (a and b path effects [p<0.01]). Norms, perceived control abilities, and self-monitoring were confirmed in at least two studies (p<0.01 for each). Replication of findings across studies with a common design but varied populations provides a robust validation of the theory and processes of an effective intervention. Combined findings also demonstrate a means to substantiate process aspects and theoretical models to advance understanding of behavior change.

Randomized, Prospective Study of the Impact of a Sleep Health Program on Firefighter Injury and Disability

Study Objectives

Firefighters' schedules include extended shifts and long work weeks which cause sleep deficiency and circadian rhythm disruption. Many firefighters also suffer from undiagnosed sleep disorders, exacerbating fatigue. We tested the hypothesis that a workplace-based Sleep Health Program (SHP) incorporating sleep health education and sleep disorders screening would improve firefighter health and safety compared to standard practice.

Design

Prospective station-level randomized, field-based intervention.

Setting

US fire department.

Participants

1189 firefighters.

Interventions

Sleep health education, questionnaire-based sleep disorders screening, and sleep clinic referrals for respondents who screened positive for a sleep disorder.

Measurements and Results

Firefighters were randomized by station. Using departmental records, in an intention-to-treat analysis, firefighters assigned to intervention stations which participated in education sessions and had the opportunity to complete sleep disorders screening reported 46% fewer disability days than those assigned to control stations (1.4 ± 5.9 vs. 2.6 ± 8.5 days/firefighter, respectively; p = .003). There were no significant differences in departmental injury or motor vehicle crash rates between the groups. In post hoc analysis accounting for intervention exposure, firefighters who attended education sessions were 24% less likely to file at least one injury report during the study than those who did not attend, regardless of randomization (OR [95% CI] 0.76 [0.60, 0.98]; χ2 = 4.56; p = .033). There were no significant changes pre- versus post-study in self-reported sleep or sleepiness in those who participated in the intervention.

Conclusions

A firefighter workplace-based SHP providing sleep health education and sleep disorders screening opportunity can reduce injuries and work loss due to disability in firefighters.

Return on investment of public health interventions: a systematic review

BACKGROUND

Public sector austerity measures in many high-income countries mean that public health budgets are reducing year on year. To help inform the potential impact of these proposed disinvestments in public health, we set out to determine the return on investment (ROI) from a range of existing public health interventions.

METHODS

We conducted systematic searches on all relevant databases (including MEDLINE; EMBASE; CINAHL; AMED; PubMed, Cochrane and Scopus) to identify studies that calculated a ROI or cost-benefit ratio (CBR) for public health interventions in high-income countries.

RESULTS

We identified 2957 titles, and included 52 studies. The median ROI for public health interventions was 14.3 to 1, and median CBR was 8.3. The median ROI for all 29 local public health interventions was 4.1 to 1, and median CBR was 10.3. Even larger benefits were reported in 28 studies analysing nationwide public health interventions; the median ROI was 27.2, and median CBR was 17.5.

CONCLUSIONS

This systematic review suggests that local and national public health interventions are highly cost-saving. Cuts to public health budgets in high income countries therefore represent a false economy, and are likely to generate billions of pounds of additional costs to health services and the wider economy.

The cost and distribution of firefighter injuries in a large Canadian Fire Department

BACKGROUND

There is limited data available regarding the cost of firefighter injuries. This information is necessary to develop targeted injury prevention strategies.

OBJECTIVE

To categorize the cost of injuries filed in 2012 by firefighters from a from a large department by job duty, injury type, body part affected, and the general motion pattern employed at the time of injury.

METHODS

Data were taken from reports filed by CFD personnel and claims filed with the Workers' Compensation Board (WCB) of Alberta between January 1, 2012 and December 31, 2012.

RESULTS

Of the 244 injuries reported, 65% were categorized as sprains and strains, the most frequent of which affected the back (32%). The total cost of all claims was $555,955; 77% were sprain/strain-related. Knee and back injuries were most costly ($157,383 and $100,459). Categorized by job duty, most sprains/strains (31%) were sustained while attending to fire station responsibilities, although physical training was associated with the highest costs (34%). Fireground operations were attributed to 18% of sprains/strains and 16% of costs. Lifting injuries were more frequent (23%) and costly (20%) than all injuries.

CONCLUSIONS

The most common and costly injuries occurred while attending to fire station-related responsibilities and during physical training.

Cost-effectiveness of workplace wellness to prevent cardiovascular events among U.S. firefighters

BACKGROUND

The leading cause of death among firefighters in the United States (U.S.) is cardiovascular events (CVEs) such as sudden cardiac arrest and myocardial infarction. This study compared the cost-effectiveness of three strategies to prevent CVEs among firefighters.

METHODS

We used a cost-effectiveness analysis model with published observational and clinical data, and cost quotes for physiologic monitoring devices to determine the cost-effectiveness of three CVE prevention strategies. We adopted the fire department administrator perspective and varied parameter estimates in one-way and two-way sensitivity analyses.

RESULTS

A wellness-fitness program prevented 10% of CVEs, for an event rate of 0.9% at $1440 over 10-years, or an incremental cost-effectiveness ratio of $1.44 million per CVE prevented compared to no program. In one-way sensitivity analyses, monitoring was favored if costs were < $116/year. In two-way sensitivity analyses, monitoring was not favored if cost was ≥ $399/year. A wellness-fitness program was not favored if its preventive relative risk was >0.928.

CONCLUSIONS

Wellness-fitness programs may be a cost-effective solution to preventing CVE among firefighters compared to real-time physiologic monitoring or doing nothing.

The COMPASS pilot study: a total worker Health™ intervention for home care workers

OBJECTIVE

To develop a team-based Total Worker Health™ (injury prevention + health promotion) intervention for home care workers and estimate intervention effects on workers' well-being and health and safety behaviors.

METHODS

Home care workers (n = 16) met monthly in teams for education and social support using a scripted, peer-led approach. Meeting process measures and pre-/postintervention outcome measures were collected.

RESULTS

Knowledge gains averaged 18.7% (standard deviation = 0.04), and 62.0% (standard deviation = 0.13) of participants reported making safety or health changes between meetings. Workers' well-being improved significantly (life satisfaction, d = 0.65, P < 0.05; negative affect, d = 0.64, P < 0.05), and the majority of other safety and health outcomes changed in expected directions.

CONCLUSIONS

COMPASS is a feasible intervention model for simultaneously preventing injuries and promoting health among home care workers.

Evaluation of a fitness intervention for new firefighters: injury reduction and economic benefits

Background

Firefighting is a hazardous profession and firefighters suffer workplace injury at a higher rate than most US workers. Decreased physical fitness is associated with injury in firefighters. A physical fitness intervention was implemented among Tucson Fire Department recruit firefighters with the goals of decreasing injury and compensation claims frequency and costs during the recruit academy, and over the subsequent probationary year.

Methods

Department injury records were analysed and described by body part, injury type and mechanism of injury. Injury and workers’ compensation claims outcomes from the recruit academy initiation through the 12-month probationary period for the intervention recruit class were compared with controls from three historical classes.

Results

The majority of injuries were sprains and strains (65.4%), the most common mechanism of injury was acute overexertion (67.9%) and the lower extremity was the most commonly affected body region (61.7%). The intervention class experienced significantly fewer injuries overall and during the probationary year (p=0.009), filed fewer claims (p=0.028) and experienced claims cost savings of approximately US$33 000 (2013) from avoided injury and reduced claims costs. The estimated costs for programme implementation were $32 192 leading to a 1-year return on investment of 2.4%.

Conclusions

We observed reductions in injury occurrence and compensation costs among Probationary Firefighter Fitness (PFF-Fit) programme participants compared with historical controls. The initiation of the PFF-Fit programme has demonstrated promise in reducing injury and claims costs; however, continued research is needed to better understand the programme's potential effectiveness with additional recruit classes and carryover effects into the recruit's career injury potential.

Healthy Team Healthy U: A Prospective Validation of an Evidence-Based Worksite Health Promotion and Wellness Platform

Objective

To evaluate the effects of a research-tested, team-based health promotion and wellness program combined with digital technologies and implemented in a diverse worksite setting among hospital, clinic, and university employees.

Methods

A prospective cohort study of employees completing biometrics and questionnaires before and after the initial 12-session wellness program and its 12-session booster, 1 year later.

Results

After both the initial intervention and booster, blood pressure and weight were reduced, with greater reductions among employees with pre-hypertension and hypertension and those with a body mass index ≥25. After both the initial intervention and booster, there was a significant increase in (1) daily intake of fruit and vegetable servings, (2) days/week of ≥30 min of exercise, (3) days/week of strength training, and (4) levels of moderately vigorous and vigorous daily physical activity. Self-reported indices of both depression and work-related stress were reduced, while participants reported increased happiness. Post booster, average sleep quality, and sleep duration increased among higher risk employees reporting ≤6 h of daily sleep. Employees reported receiving encouragement from co-workers to engage in healthful diet and physical activities, and exercised together more, and indicated that they would recommend the program to other employees. Longitudinal analysis revealed the durability of the initial intervention outcomes with further beneficial effects after the booster.

Conclusion

A research tested, comprehensive team-based health promotion and wellness program, combined with digital technologies, improved employee health behaviors, mood, sleep, elements of co-worker cohesion, and biometrics among a diverse multi-site workforce. Positive program effects were durable, with enhanced results after the booster.

The safety and health improvement: enhancing law enforcement departments study: feasibility and findings

This randomized prospective trial aimed to assess the feasibility and efficacy of a team-based worksite health and safety intervention for law enforcement personnel. Four-hundred and eight subjects were enrolled and half were randomized to meet for weekly, peer-led sessions delivered from a scripted team-based health and safety curriculum. Curriculum addressed: exercise, nutrition, stress, sleep, body weight, injury, and other unhealthy lifestyle behaviors such as smoking and heavy alcohol use. Health and safety questionnaires administered before and after the intervention found significant improvements for increased fruit and vegetable consumption, overall healthy eating, increased sleep quantity and sleep quality, and reduced personal stress.

The ageing Australian firefighter: an argument for age-based recruitment and fitness standards for urban fire services

Currently, there is no enforcement of physical standards within Australian fire services post-recruitment, possibly leading to inappropriate fitness and body composition. This study evaluated the impacts of ageing on physical standards of Australian firefighters. Seventy-three firefighters from three different 10-year age groups [25-34 years (n = 27), 35-44 years (n = 27), 45-54 years (n = 19)] volunteered for physical testing using dual-energy X-ray analysis and existing fitness tests used for recruitment by an Australian fire service. Older (45-54 years) participants demonstrated significantly poorer physical standards compared with younger participants including cardiovascular fitness (p < 0.05), strength (p = 0.001) and simulated operational power testing tasks (p < 0.001). Age-related body composition changes were also observed independent of body mass index. Minimum recruitment standards and fitness programs need to account for age-related declines in physical capabilities to ensure that the minimum standard is maintained regardless of age.

An examination of the benefits of health promotion programs for the national fire service

BACKGROUND

Firefighters suffer from high prevalence of obesity, substandard fitness, and cardiovascular-related deaths. There have been a limited number of firefighter health promotion programs that have been developed and empirically-tested for this important occupational group. We evaluated the health of firefighters from departments with well-developed health promotion programs and compared them with those from departments not having such programs using a large national sample of career fire departments that varied in size and mission. We measured a broad array of important individual firefighter health outcomes (e.g., body composition, physical activity, and general and behavioral health) consistent with national fire service goals and addressed significant statistical limitations unaccounted for in previous studies.

METHODS

Using the approach of purposive sampling of heterogeneous instances, we selected and conducted a national evaluation of 10 departments already implementing wellness and fitness programs (Wellness Approach; WA) with 10 departments that did not (Standard). Participants were 1,002 male firefighters (WA n = 522; Standard n = 480) who underwent assessments including body composition, fitness, and general/behavioral health (e.g., injury, depressive symptoms).

RESULTS

Firefighters in WA departments were healthier than their Standard department counterparts. For example, they were less likely to be obese (adjusted [A]OR = 0.58; 95% CI = 0.41-0.82), more likely to meet endurance capacity standards for firefighting (AOR = 5.19; 95% CI = 2.49-10.83) and have higher estimated VO2max (40.7 ± 0.6 vs. 37.5 ± 1.3 for firefighters in Standard departments; p = 0.001). In addition, WA firefighter were substantially less likely to smoke (AOR = 0.30; 95% CI = 0.17-0.54) or ever have been diagnosed with an anxiety disorder (AOR = 0.27; 95% CI = 0.14-0.52) and they expressed higher job satisfaction across several domains. However, WA firefighters were somewhat more likely to have reported an injury to Workers' Compensation (AOR = 1.74; 95% CI = 1.05-2.90). It was notable that both groups evidenced high prevalence of smokeless tobacco use and binge drinking.

CONCLUSIONS

Firefighters in departments selected based on having strong wellness programs (WA) were healthier along a number of dimensions important to firefighter wellness and operational readiness. However, several health areas require greater attention including problematic alcohol consumption and smokeless tobacco use, suggesting that more emphasis on these behavioral health issues is needed in the fire service.