The National Fire Fighter Near-Miss Reporting System reports that there have been an average of 100 fatalities and 100,000 injuries per year since 1977 (the 2012 number of fatalities is 81 as reported by the U.S. Fire Administration). Non-fatal firefighter injuries and prevention efforts cost from $2.8 billion to $7.8 billion per year. Fire personnel are retiring with injuries that are significantly affecting their quality of life during retirement. It doesn't have to be this way. Reducing Injuries and Improving Wellness is Everyone's Responsibility.
What can we do to reduce SOME of the injuries? What can we do to LESSEN the effects of some of the injuries? What can we do to improve our likelihood of a HEALTHIER RETIREMENT?
It is the responsibility of Your Agency, Your Labor Group, and Yourself. Here are some job-proven programs and ideas that have worked.
Review injuries and claims regularly... ... if you don't or can't, it will be difficult to reduce and eliminate their effect.
Show employee concern ... there are so many activities and positive/proactive things that we can do.
Treat injuries like our professional sports teams and our military... get on them quickly. Personnel not on the job cost everyone something.
Ensure that you have EFFECTIVE injury and claims service ... don't let injuries and claims go un-attended.
The National Fire Fighter Near-Miss Reporting System has developed ideas on a monthly calendar concept to help us implement effective programs. Examples include the following taken from a two year recent period.
January... Know Your Job
February... Emergency Driver Safety
March... Incident Command
April... Training Safety
May... Annual Medical Exams
July... Personal Protective Equipment
September... Situational Awareness
November... Technical Rescue Safety
December... EMS Safety
January... Mayday Command
February... Roadway Safety
March... Crew Resource Management
April... Personal Protective Equipment
May... EMS Scene Safety
July... Hazardous Materials Safety
August... Crew Integrity
September... Firefighter/EMT Fitness
October... Violent Scenes
November... Rapid Intervention Teams
December... Help Yourself; Help Your Family
Actively participate in a dialogue to improve the process.
Implement mandatory fitness program participation. We all agree on the necessity and importance, but implementing it for on-duty personnel is somewhat difficult for many.
Support "modified-duty" programs ... for both on and off-duty if feasible. This one can be difficult to accept, but it can benefit both off-duty and on-duty injuries.
Here are some additional ideas and programs from the Everyone Goes Home® Newsletter - August 2013.
1. Define and advocate the need for a cultural change within the fire service relating to safety; incorporating leadership, management, supervision, accountability and personal responsibility.
2. Enhance the personal and organizational accountability for health and safety throughout the fire service.
3. Focus greater attention on the integration of risk management with incident management at all levels, including strategic, tactical, and planning responsibilities.
4. All firefighters must be empowered to stop unsafe practices.
5. Develop and implement national standards for training, qualifications, and certification (including regular recertification) that are equally applicable to all firefighters based on the duties they are expected to perform.
6. Develop and implement national medical and physical fitness standards that are equally applicable to all firefighters, based on the duties they are expected to perform.
7. Create a national research agenda and data collection system that relates to the initiatives.
8. Utilize available technology wherever it can produce higher levels of health and safety.
9. Thoroughly investigate all firefighter fatalities,
injuries, and near misses.
10. Grant programs should support the implementation of safe practices and/or mandate safe practices as an eligibility requirement.
11. National standards for emergency response policies and procedures should be developed and championed.
12. National protocols for response to violent incidents should be developed and championed.
13. Firefighters and their families must have access to counseling and psychological support.
14. Public education must receive more resources and be championed as a critical fire and life safety program.
15. Advocacy must be strengthened for the enforcement of codes and the installation of home fire sprinklers.
16. Safety must be a primary consideration in the design of apparatus and equipment.
Stop doing activities... that cause serious injuries. Pretty basic and it applies to us all, both active-duty and retirees. If it causes serious injuries, stop doing it and be innovative and find other ways to do something.
Get surgery early ... if surgery is necessary, generally speaking the body heals quicker and perhaps better the quicker we get surgery.
Take an active role in YOUR healing and medical care. Don't wait for the medical professionals or the risk manager to do everything.
Participate ACTIVELY in "daily" or regular fitness !!!
If an injury is NOT improving... CORRECT IT !!! Find out what is the "hang-up" and participate in getting it going again. Generally, we do not let an incident run itself, your injury recovery is not that much different.
Here are some wellness and injury program pointers from an effective physical therapy organization, Team PT in Rancho Cucamonga.
1. Wellness programs are designed to reduce likelihood of injury and improve daily strength and function. They should include the following:
Body mechanics and movement
Weight and nutrition
2. Wellness program components should include each of the following twice a week:
3. Here are some activities to focus on to lessen injuries now and future pain:
Knees â€“ avoid deep squats and kneeling
Lower Back â€“ maintaining the natural extension curves in the spine; avoid "dead lifting"
Shoulders â€“ avoid outstretched and overhead lifting; build rotator cuff strength
To emphasize the importance that it is also our responsibility, here are three examples, a fifty year old, sixty and seventy (yes, we all expect to get to 70 but how many fire service personnel do we know that have significant life limitations because of injuries or medical conditions?). A seventy year old neglected regular medical exams and the importance of colonoscopies and was faced with sudden onset abdominal pain and a polyp the size of a golf ball necessitating a sectioning of the colon and months of recovery. The sixty your old ignored the chest pain warning signs and the result was five blockages in three coronary arteries necessitating open heart surgery, instead of stents, and 6-12 months of recovery (fortunately, he was an active cyclist and there are no signs of heart damage). The fifty year old exercises regularly and when diagnosed with stenosis of several vertebrae and was told he would not be a candidate for surgery because of the number of discs involved; the reason there was no severe pain was due to the exercise program. Regular exercise has resulted in two of the above individuals continuing with a full and active life.
Here is an excerpt from the author's article in Fire Engineering that is the basis for the CSFA presentation and an effective program.
STOP activities that cause serious injuries... immediately
Stopping the activities that cause severe employee injuries is easier to say than to do, but unless one wants to keep paying inordinate fees and costs, is the critical first step. Stop the activity, or change the way the operations are conducted. If it is predictable, it is certainly preventable. Generally, everyone in business understands this first component, but often times it is difficult to do something about it. Even small changes in the way business is conducted can deliver big dividends.
Review active injuries and claims regularly
It is imperative that someone be assigned the responsibilities of reviewing the workers compensation cases and claims (claims) REGULARLY. This means a review of each claim at least every two weeks for EACH AND EVERY WC claim. One of the most frequent complaints by employees is that "I never hear anything". Delays are one of the most "predictable and preventable" costs to agencies. The reviewer should have the authority to "move the claim along" or get some attention to the claim (the old adage that the squeaky wheel... ). This important component does NOT mean changing or adjusting the claim, but KEEPING TRACK and ensuring that the claim does not stall.
Demonstrate to employees a true desire to improve wellness
Employee wellness programs can and do deliver dividends to employers. They can be implemented in a very basic scope, or can be as extensive as sports programs; it is truly up to each business. Starting small can be as simple as "choosing from a menu of options". Options can include the following:
Wellness contests should be considered. Maybe the decision will be not to incentivize a program, but it should be evaluated for each business's needs. There is a big variety in the types of contest "prizes" that can be awarded. Prizes are not always necessary, but if business is to be successful, some form of motivation can provide significant benefits.
Contests must be verifiable. Use measurements that show wellness improvements such as weight loss, reduced blood pressure systolic numbers, reduced resting pulse rates, etc. A combination of several measurements gives more employees an equal playing field; not everyone loses weight quickly, but combining with other measures can make contests fairer. Imagine a formula where weight loss x blood pressure reduction x reduced pulse equals the contest winner.
Wellness, fitness and WC can be synonymous and concurrent, just like counseling and discipline can occur at the same time. It can be of great benefit to get employees engaged and involved in various, appropriate aspects in order to gain a better understanding and acceptance of the WC process.
If your business provides vending machines, drinks, and snacks, are they contributing to the overall wellness, or do they have the reverse effect? Consider the efforts in our public schools; they are removing the "bad" foods in exchange for healthier living. Lead by example is important here too. If not, imagine what kind of example we set for our workforce and their children.
Implementing wellness and fitness programs can and do have a tremendous effect on the overall health and wellbeing on employees. Professional sports programs would not engage in competitive games without having workout programs and medically monitored treatment. Why should employers not consider, develop, and implement feasible and applicable components, especially for their physically demanding job classifications.
Another administration method which can have significant benefits, is to "regularly check in" with the medical providers, treatment providers, and physical therapy (with in the allowable provisions of WC laws and in conjunction with risk management and WC administrators) to see how employees are doing, if there are any issues, and yes, to ensure that all "interested parties" are doing their part and what is expected, in order to get the employee fully recovered. There is no doubt that some agencies and employee organizations will feel this is a privacy and confidentiality issue; this will take trust on all sides and open dialog to implement.
Treat WC injuries similar to "high priced" sports and wartime/combat injuries
Rapid triage and appropriate treatment is the key to sports injuries and the combat injuries encountered during wartime. M.A.S.H. treatment made famous during the Korean Conflict and injured professional athletes seen on television receive very rapid assessment and diagnostic testing. Those two components set the stage for all future treatment programs. The U.S. Army has been conducting some studies on injured Soldiers and the emphasis was on getting surgery and rehabilitation started within thirty days of injuries. The result of those Soldiers with rapid assessment and prompt treatment resulted in better and quicker return to combat duty.
Sports programs often utilize diagnostic testing at the venue; they often have X-ray and MRI capabilities on site. Off-site and "outsourced" MRI services are common in many urban areas and their costs can be negotiated under some contract provisions. The readily availability of these diagnostic tests can increase the "speed" at which treatment can begin for some injuries, especially the musculoskeletal ones.
Quality Physical Therapy (PT) may be as important as getting "quality" surgery, perhaps even more so. Physical therapy is often looked at by the employers as a waste of money. That may be due to the PT not being a well-designed and injury specific program. One-size-fits-all and cookie-cutter programs are NOT appropriate. Everyone's body is just a little different from the next, and thus the PT program should be tailored for the injury and the individual. Not all athletes train the same exact way and an injury re-habilitation program should not be the same just because it is the same body part injury. Check out the credentials of the PT company/organization, and that of your physical therapist, not all are equally trained and qualified. Review their "success stories" and letters of reference; the PT firm should be able demonstrate that their PT programs are specifically designed. The quality of PT programs range from A-Z and selecting the most appropriate program is of critical importance. The PT firm's Web site should detail their programs, indicate the credentials of the therapists, and photos should show a wide range of equipment. Couldn't our objective be to treat our employee with the goal of getting them back to 100% and helping them to make it to a healthy and long retirement?
Perform surgery early... injuries heal better the quicker that surgery occurs after injury
If surgery is going to be necessary, generally the quicker it occurs and rehabilitation begins, the quicker and better the employee heals.
If you leave a good steak for weeks and wait to BBQ it, the quality of dinner will be less than if you marinate it and properly care for it before it hits the grill. Muscle is muscle. Enough said?
Develop and implement programs aimed at improving WC program
Much has been said of recent about empowering employees, quality circles, improving customer service, etc. WC programs are just customer service for the internal customer. We should look for ways to improve our WC programs just like our business programs. Medicine is improving, science is always advancing... shouldn't we consider doing the same for one of the programs that has significant effect on our employees (our most valuable asset)?
Providing standardized policies and procedures for the agency on how to access medical providers for specific injury types can speed diagnosis and treatment, and provides consistency (something we all shout for). Examples can include shortness of breath/chest pain, burns, musculoskeletal injuries, etc.
Another critical aspect is providing "guidance and direction" to the treating physician(s) and medical practitioners. Depending on the level of the relationship that exists between the agency and its WC program administrator and the various physicians and medical practitioners, it is possible and actually very feasible to provide guidance and direction for individual claims, including diagnosis and treatment. This is not to suggest that an agency be the "medical director" but rather develop relationships that foster regular dialog and discussion on how employees are diagnosed and treated. For example, direction that all musculoskeletal injuries receive an X-ray and MRI early on in order to speed diagnosis and subsequent treatment.
Implement "modified duty" programs
Getting an employee back to work as soon as feasible just makes good business sense. Too much of the time there are too many delays, of all kinds. One delay is the one that occurs from an employee who does not feel ready to return to work, and those who desire not to return quickly.
Modified duty programs can and do provide appropriate-level work that employees can perform. The modified duty program will need to meet certain requirements and there are generally medical/physical limitations based on the employee's condition(s).
The other big advantage of modified duty programs is that they can also be utilized for non-work related injuries in order to allow an employee to save sick-leave time, and in cases when the employee does not have sick-leave.
Most employees and employers want similar outcomes, a safe and healthy workplace and reduced injuries. Implementing one or more of these components can result in big dividends for everyone.