The nature and burden of occupational injury among first responder occupations: A retrospective cohort study in Australian workers

doi:10.1016/j.injury.2017.09.019

Injury

Volume 48, Issue 11, November 2017, Pages 2470-2477

https://doi.org/10.1016/j.injury.2017.09.019 Get rights and content

Abstract

Introduction

Workers in first responder (FR) occupations are at heightened risk for workplace injury given their exposure to physical/psychological hazards. This study sought to (1) characterise the occupational risk of injury; (2) determine factors associated with injury; and (3) characterise the burden of injury-related disability in police, ambulance officers, fire/emergency workers, compared with other occupations.

Methods

A retrospective cohort of 2,439,624 claims occurring between July 2003 and June 2012 was extracted from the Australian National Dataset for Compensation-Based Statistics. Cases aged 16–75 years working 1–100 pre-injury hours per week were included. Regression models estimated risk of making a workers’ compensation (WC) claim by age, gender, occupation and injury type. Injury burden was calculated using count and time loss, and statistically compared between groups.

Results

The risk of making a WC claim among FR occupations was more than 3 times higher than other occupations. Risk of claiming was highest among female FRs and those aged 35–44 years. Ambulance officers had the greatest risk of upper-body MSK injuries and fire and emergency workers the greatest risk of lower-body MSK injuries. The risk of mental health conditions was elevated for all FR occupations but highest among police officers. The total burden of injury (expressed as working weeks lost per 1000 workers) differed significantly between groups and was highest amongst police.

Discussion and conclusions

First responders record significantly higher rates of occupational injury claims than other occupations. Using a national population based dataset, this study demonstrates that not only are first responders exposed to significantly higher rates of occupational injury than all other occupations combined, but they experience differential injury patterns depending on their occupation. This suggests that among FR occupations injury prevention efforts should reflect these differences and be targeted to occupation-specific patterns of injury.

Introduction

Workers in first responder (FR) occupations, including police officers, fire fighters, emergency service workers, and ambulance officers and paramedics, are often the first workers attending an emergency situation. These occupations respond to medical emergencies, fires, hazardous incidents, alarms, critical incidents, and vehicle accidents. They provide assistance during natural disasters, resolve disputes, investigate crime, and coordinate and assist in search and rescue missions, among others. First responders also help communities prepare for or prevent emergency situations, particularly emergency service workers, and are involved in recovery following adverse incidents.

Workers in these occupations are exposed to a range of physical and psychological hazards that are unique to their roles, and these include heavy lifting, vehicle accidents, physical altercations, direct interaction with drug or alcohol-affected people, and exposure to extreme temperatures, communicable diseases, chemicals, biological factors, trauma and violence [1], [2], [3]. These workers are expected to attend emergencies in unfamiliar locations and often do not have a full understanding of the environment, the situation in which they are about to enter or the people with which they must engage. This unpredictability could mean that they are at increased risk of injury. In addition to physical injury hazards, FRs may be exposed to direct or indirect stressors in the workplace. These include witnessing trauma or the suffering of others [4], potentially contributing to mental health consequences. Additionally, FRs regularly work shifts, which can sometimes result in working lengthy and erratic hours, with some studies finding a link between fatigue and increased injury risk [5], [6], [7].

Previous research has acknowledged that FRs are at an increased risk for work-related injury and fatality [8], [9]. Australian workers compensation claims data demonstrates that ambulance officers had an average rate of 94.6 serious injuries per 1000 workers (those resulting in more than one week time loss), more than seven times the national average [10]. Risk of fatality was six times higher than the national average. Another Australian study compared workers’ compensation claims of ambulance officers with other healthcare professionals between 2003 and 2012 in Victoria [11]. This found that there was an upward trend in claim rates and their risk of claiming was significantly higher than other occupations at 102.2 claims per 1000 full-time equivalent (FTE) workers. This study also found that ambulance officers had a significantly higher risk of musculoskeletal (MSK) injuries and mental health conditions (MHC) than other healthcare professionals.

Studies from the United States (US) have also found high injury rates among emergency workers that were consistently above the national average. Maguire and Smith [12] used a nationwide dataset to determine ambulance workers reported 453.8 injuries per 10,000 workers. Other studies that have used administrative data from local ambulance organisations found injury rates varied from 4.5 to 81.2 injuries per 100 FTE workers (average 15.6) [13], and 27.6 to 50.2 per 100 FTE workers, averaging 34.6 [14]. These rates were higher than a self-report study that observed an injury rate of 8.1 injuries per 100 workers [14]. Injury rates among firefighters were also high at 8.9 to 34.3 injuries per 100 FTE workers (average 18.6) [1]. Suyama et al. stated that ambulance workers had higher injury rates than police and fire fighters [15], however another study found among first responders requiring treatment in an emergency department, police and firefighters had higher injury rates (8.5 and 7.4 injuries per 100 FTE workers, respectively) than ambulance workers [3]. The risk of occupational-related fatality is also elevated for first responders, yet it has been found to be similar between emergency personnel [16].

Injury to FRs also impacts their colleagues, employers and the community. High injury rates among emergency workers may be associated with a high employee turnover rate, increased staff absence, or a shortened career span [1]. Aside from the obvious negative impacts to FRs, all of these factors could lead to a reduction in the quality of emergency response provided to the community, which could therefore adversely impact those relying on their assistance [9]. In contrast to the numerous reports of injury rates, there is very little information regarding the duration of time lost to injury and illness among FRs. Estimates of work disability duration are an important indicator of injury burden and can help to characterise the true impact of work-related conditions.

The objectives of this study are to (1) characterise the occupational risk of injury among first responders across whole of Australia compared to other occupations; (2) determine factors associated with injury in FRs, in particular aspects of their personal characteristics and type of condition; and (3) characterise the burden of disability arising from injury in FRs compared to other occupations.

Section snippets

Setting

The vast majority of Australia’s labour force (approximately 11.9 million in early 2016) are covered by compulsory workers’ compensation (WC) insurance regulated by state, territory and Commonwealth government authorities, which provides coverage should a work-related injury or illness occur [17]. There are nine major workers’ compensation schemes in Australia, typically organised geographically by state or territory, with one major national scheme that covers Commonwealth government employees,

Results

Over the nine-year observation period, there were 2,439,624 claims, of which 2.7% were from first responders (n = 65,003). Fig. 1 shows the rate of claims over the three time periods for each occupational group. The claim rate was 2.6 times or higher for all FRs than all other occupations. The rate of claims decreased among ambulance officers and all other occupations, however claim rates fluctuated for fire and emergency workers and police. Ambulance officers had the highest rate of claims of

Discussion

This study has demonstrated that workers in FR occupations including police, fire and emergency personnel, and ambulance officers, are at significantly greater risk of occupational injury resulting in a WC claim than workers in other occupations. Further, this study demonstrated differential risks among three major FR occupations. Ambulance officers were at greatest risk for upper body MSK injury, fire and emergency workers at greatest risk for lower body MSK injury, and police officers at

Conclusion

Findings from this study show that FRs are at a greater risk of compensated work-related injury than other occupations. Injury prevention efforts should be directed to minimise exposure to occupational hazards in these groups. Based on these results, future research or injury prevention approaches should be directed but not limited to upper body (including the back) MSK injuries among ambulance officers, lower body MSK among fire and emergency workers and mental health conditions among police.

Conflicts of interest

The authors declare they have no conflicting interests.

Funding

This study was supported with financial input from Safe Work Australia and WorkSafe Victoria, via the Insurance Work and Health Group.

Acknowledgements

Safe Work Australia has provided the data reported in this document. The following workers’ compensation authorities have given permission for claims administrative data to be used in the study, and have provided input and assistance with data quality assurance and interpretation: WorkSafe Victoria, WorkCover WA, ReturnToWork SA, Comcare, Office of Industrial Relations Queensland Treasury, State Insurance Regulatory Authority of New South Wales, NT Worksafe, WorkCover Tasmania, and Chief

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The nature and burden of occupational injury among first responder occupations: A retrospective cohort study in Australian workers

Abstract

Introduction

Methods

Results

Discussion and conclusions

Introduction

Section snippets

Setting

Results

Discussion

Conclusion

Conflicts of interest

Funding

Acknowledgements

Accid Anal Prev

Ann Emerg Med

Ann Emerg Med

Occupational injuries among emergency medical services personnel

Prehosp Emerg Care

Occupational injury rates in personnel of emergency medical services

Ann Agric Environ Med: AAEM

Occupational injuries among emergency responders

Am J Ind Med

Work-related post-traumatic stress disorder

Occup Med

Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers

Prehosp Emerg Care

Shift work and the incidence of injury among police officers

Am J Ind Med

Occupational health and safety risks faced by police officers

Occupational injury risk among Australian paramedics: an analysis of national data

Med J Aust

Occupational injury risk among ambulance officers and paramedics compared with other healthcare workers in Victoria, Australia: analysis of workers’ compensation claims from 2003 to 2012

Occup Environ Med

Injuries and fatalities among emergency medical technicians and paramedics in the United States

Prehosp Disaster Med