Athletic Training and Sports Health Care

Original Research Supplemental Data

Perceived Barriers to Musculoskeletal Injury and Illness Reporting in the Fire Service

Kirsten A. Potts, DAT, LAT, ATC; Zachary K. Winkelmann, PhD, SCAT, ATC; Lindsey E. Eberman, PhD, LAT, ATC; Kami N. Thews, DAT, LAT, ATC; Kenneth E. Games, PhD, LAT, ATC

Abstract

Purpose:

To identify structural and cultural barriers firefighters face when reporting musculoskeletal injuries in the fire service.

Methods:

Three hundred fourteen active firefighters from across the United States completed a web-based survey. Fire-fighters who completed the survey (mean age: 40 ± 9 years) were predominantly male (283 of 314, 90.1%), with an average of 16.79 ± 9.55 years of experience serving a city community. The online survey tool was adapted from a previous focus group study comparing the perceptions of fire chiefs and fire-fighters on the factors that contribute to musculoskeletal injuries in the fire service. The survey consisted of 32 items containing a list of cultural and structural barriers. The perceived level of challenge was rated for each selected barrier using a 4-point Likert scale ranging from “slightly challenging” to “extremely challenging.” The survey was content validated and pilot tested prior to data collection.

Results:

The most frequent barriers to musculoskeletal injury reporting included accepting pain as a natural part of the job (167 of 314, 53.1%) and change in duty status (144 of 314, 45.8%). Firefighters identified fear of the worst-case scenario (84 of 314, 26.7%), medical services provided as not helpful (46 of 314, 14.6%), lack of benefits (32 of 314, 10.1%), and commitment to their family (44 of 314, 14.0%) as extremely challenging barriers to reporting.

Conclusions:

Firefighters indicated cultural barriers to be more challenging than structural barriers to reporting musculoskeletal injuries. The most frequent and most challenging barriers were related to potential long-term health consequences from musculoskeletal injury, which may not be apparent to this population.

[Athletic Training & Sports Health Care. 20XX;X(X):XX–XX.]

Abstract

Purpose:

To identify structural and cultural barriers firefighters face when reporting musculoskeletal injuries in the fire service.

Methods:

Three hundred fourteen active firefighters from across the United States completed a web-based survey. Fire-fighters who completed the survey (mean age: 40 ± 9 years) were predominantly male (283 of 314, 90.1%), with an average of 16.79 ± 9.55 years of experience serving a city community. The online survey tool was adapted from a previous focus group study comparing the perceptions of fire chiefs and fire-fighters on the factors that contribute to musculoskeletal injuries in the fire service. The survey consisted of 32 items containing a list of cultural and structural barriers. The perceived level of challenge was rated for each selected barrier using a 4-point Likert scale ranging from “slightly challenging” to “extremely challenging.” The survey was content validated and pilot tested prior to data collection.

Results:

The most frequent barriers to musculoskeletal injury reporting included accepting pain as a natural part of the job (167 of 314, 53.1%) and change in duty status (144 of 314, 45.8%). Firefighters identified fear of the worst-case scenario (84 of 314, 26.7%), medical services provided as not helpful (46 of 314, 14.6%), lack of benefits (32 of 314, 10.1%), and commitment to their family (44 of 314, 14.0%) as extremely challenging barriers to reporting.

Conclusions:

Firefighters indicated cultural barriers to be more challenging than structural barriers to reporting musculoskeletal injuries. The most frequent and most challenging barriers were related to potential long-term health consequences from musculoskeletal injury, which may not be apparent to this population.

[Athletic Training & Sports Health Care. 20XX;X(X):XX–XX.]

Tactical athletes are individuals in service professions (eg, military, firefighters, law enforcement, and emergency responders) who operate in stressful and demanding scenarios to achieve their missions.1–3 Tactical athletes must meet significant fitness and physical performance requirements associated with their work.1–3 These athletes often work under life-threatening conditions, including burning buildings, wildfires, war zones, gun fire, and extreme weather conditions.1,3 Specifically in the fire service, firefighters are employed by one of three groups (municipalities, federal, and private) with work in settings combating structural (building) and wildland (nature) fires.3,4 Although characteristics vary within each employer type, all firefighters are governed by Occupational Safety and Health Administration (OSHA) standards requiring them to report mandated injuries resulting from the job.4–6 Work-related injuries and illnesses that are routinely reported to OSHA include a loss of consciousness, days away from work, restricted work, transfer to another job, or those that require medical treatment beyond first aid.6 Firefighters must follow the injury reporting process to receive workers' compensation benefits, including coverage of medical bills, lost wages, and disability.7

Firefighters are the first responders of our country, and to protect their livelihoods and perform their job to their maximum potential they wear heavy protective equipment and gear.3 The added weight from the equipment and gear, which can range between 45 and 75 pounds, increases the risk of musculoskeletal injuries (MSKIs) when having to operate in strenuous conditions.8 The clothing requirements of firefighters matched with the environmental exposures to heat, smoke, and chemicals can lead to fatigue causing slips, trips, and falls, resulting in MSKIs such as sprains and strains.9,10 Firefighting presents high risks for sustaining a MSKI, with overexertion and muscular strain accounting for 27.1% of all injuries.11 A firefighter's job includes strenuous physical demands and limited modified-work opportunities; therefore injury duration and risk of sustaining further injuries is higher.12 The repetitive bending, squatting, kneeling, and lifting firefighters perform has been shown to increase their risk for osteoarthritis.12 Research has noted that firefighters face an increase in perceived physical strain due to the postural demands and heavy lifting tasks along with poor perceived health and poor work ability due to symptoms associated with MSKIs.13 MSKIs are associated with cumulative factors, meaning they worsen over time if not properly cared for and put the firefighter at a greater risk for more injuries, which leads to physical impairment.12 MSKIs can cause economic strain and long-term physical repercussions, and may lead to early retirement.12,14 Long-term effects associated with MSKIs are more prevalent in firefighters as compared to other public safety and private sector workers due to the nature of a firefighter's job, leading to joint damage and permanent disability that reduces the firefighter's vitality in the profession.3,12 The multi-faceted environment a firefighter must navigate alludes to the importance of identifying the structural and cultural factors associated with MSKIs.

The National Fire Protection Association (NFPA) conducted a needs assessment that demonstrated only 27% of all fire departments have prevention and wellness programs.15 Previous research has proposed that prevention and wellness programs may help to lower the rate and risk of disability, while decreasing the cost of health care services and increasing public safety and protection.12,14 One avenue that is emerging with tactical athletes is the use of athletic trainers to assist in the health care delivery. Needs assessments are often completed to help an organization determine the needs or gaps between the organization's mission and the current state. It is important for athletic trainers to discover the similarities and differences between patient populations to uphold a high standard of care that caters to the needs of the population.

Although MSKI statistics in the fire service are available, there is limited research on how accurate and honest MSKI reporting is implemented, including the barriers a firefighter might face when choosing to report.11,16 Inadequate reporting behaviors increases the risk to a firefighter's longevity of serving due to delays in treatment.17 This can create a burden on not only the firefighter's health but their families, departments, health care systems, and national economies.17 Inadequate injury reporting compromises the accuracy of surveillance data and the identification of health and safety concerns related to workplace incidences.18 For policy makers and management to implement the most appropriate interventions to mitigate unsafe workplace conditions and ensure worker safety, challenges to injury reporting must be explored. Therefore, the aim of this study was to identify the barriers firefighters experience when reporting work-related MSKIs.

Methods

We used a cross-sectional survey design through a web-based survey platform (Qualtrics, Inc., Provo, UT) to sample active firefighters in the United States. This study was approved by the Indiana State University Institutional Review Board.

Participants

We recruited career and volunteer firefighters through public databases, snowball sampling, and word of mouth.19 The only inclusion criterion for the study was the firefighter had to be active in the fire service. We chose to recruit in this manner because no comprehensive database of firefighters in the United States exists. We contacted fire chiefs and fire chief organizations across the United States, asking them to distribute the survey to the firefighters currently serving their department.

Instrumentation

The online survey tool was adapted from a previous focus group study comparing the perceptions of fire chiefs and firefighters on the factors that contribute to MSKIs in the fire service.14 The participants responded to questions that assessed their current status as a fire-fighter, age, sex, years of experience, size of fire department, type of community they served, and if they had internal access to a health care provider (eg, physical therapist, athletic trainer) who could treat MSKIs and injury reporting habits. Additionally, the variables of interest were separated into two categories: perceived structural and cultural barriers to reporting MSKIs and perceived level of challenge of each self-selected barrier. The cultural and structural barriers included in this survey tool derived from the focus group study previously mentioned.14 For the purpose of this study, structural barriers were defined as factors beyond one's personal control that are part of the context or environment.20 For example, the fire service typically uses worker's compensation as part of the health care structure, whereas the barrier related to the structure would be difficulty filing worker's compensation claims. The cultural barriers were defined as factors that shape and guide a firefighter's life within the fire service.21 An example of a cultural barrier may be that a firefighter is fearful of the worst-case scenario when dealing with his or her MSKI and how it will affect his or her work and home life. Cultural barriers can impede workplace safety improvements due to a lack of focus and resources allocated to developing a safe reporting environment that is not punitive in nature.22

A group of five athletic trainers developed the survey instrument. The group was composed of both practicing clinicians (KAP, KNT) and researchers (ZKW, LEE, KEG) with experience providing patient care and studying the tactical athlete population. The group separated a list of 30 compiled barriers identified in previous work into two categories: structural and cultural barriers.14 First, the survey was content analyzed by an expert panel including two athletic trainers in the fire service and two active fire chiefs. Next, we shared the survey tool with the two athletic trainers to assess the appropriateness of the language used and questions included to conduct the content analysis. We asked the expert panel to provide suggestions for improvement. Once the feedback was received, the research team made necessary edits. Finally, the survey tool was sent to three different active fire service leaders (one fire chief and two battalion chiefs) to separate the barriers into the two categories. The fire service leaders were given a working definition of structural and cultural barriers. The fire service leaders were asked to drag and drop each barrier into the corresponding category that was most appropriate. After review, a consensus was obtained on the categorization of the barriers using 100% agreement from the fire service leaders, with the authors settling any two-thirds disagreements. There were 15 structural barriers and 15 cultural barriers included in the final instrument. Pilot testing was completed with a local fire department (n = 17) that was excluded from the final data analysis for survey flow and instrument face validation. Minor changes were made prior to survey distribution.

Procedures

For individuals who wished to volunteer for this study, an electronic informed consent and background on the study were presented via a web-based survey. Participants was presented with a list of the 15 cultural and 15 structural barriers and asked to select all that were considered a self-perceived barrier to reporting MSKIs in the fire service. Based on each selected barrier, participants proceeded to rate the level of challenge on a 4-point Likert scale ranging from slightly challenging (1) to extremely challenging (4), indicating how much that barrier impacted their ability to report MSKIs. Data collection concluded after 5 weeks of continuous recruitment from October to November 2018.

Statistical Analysis

Data were exported from the web-based survey platform and analyzed using a spreadsheet program (Microsoft Excel 2010; Microsoft Corporation, Redmond, WA). If participants exited the survey after consent was granted but did not complete the instrument, their partial data were excluded from the analyses. The mean, standard deviation, mode, frequency of mode, and percentages were calculated for each barrier and degree of challenge.

Results

Participants

A total of 382 firefighters from across the United States accessed the survey and 314 firefighters completed the survey (82% completion rate). Because we used snowball sampling, we could not calculate an access rate. The participants (age = 40 ± 9 years) were predominantly male (283 of 314, 90.1%), with an average of 17 years of experience in the fire service. Most of the participants (289 of 314, 92%) were active career fire-fighters. More than half of the firefighters served a city with a population of more than 100,000 (118 of 314, 37.6%) and metropolitan community with a population of more than 1 million (96 of 314, 30.6%). The other communities served were almost equally distributed as rural (49 of 314, 15.86%) and suburban (46 of 314, 14.89%). Complete demographic data are provided in Table 1.

Participant Demographics

Table 1:

Participant Demographics

Access to Health Care and Reporting Behaviors

More than half of the firefighters (179 of 314, 57%) had internal access to a health care provider. Many of the firefighters reported suffering from a MSKI off-duty and not reporting it to their superior (207 of 314, 65.9%), whereas few firefighters reported sustaining a MSKI off-duty and reporting it (96 of 314, 30.6%). There were different findings when asked if they had suffered from a MSKI on-duty and reported it; 64% (201 of 314) of the firefighters said they did report the injury, whereas 32.5% (102 of 314) did not report the injury.

Barriers

The most frequent barriers to MSKI reporting included accepting pain as a natural part of the job (167 of 314, 53.2%) and change in duty status, meaning being put on light duty or time off for injury healing (144 of 314, 45.9%). The firefighters perceived the following as the most challenging barriers to reporting MSKIs: lack of organizational support during the probationary period (8 of 17, 47.1%); lack of commitment to their family, meaning they do not receive the time they need with their family (20 of 44, 45.5%); medical services provided as not helpful (20 of 46, 43.5%); fear of the worst-case scenario, meaning the consequences that could follow a significant diagnosis or change in their health status that affects their work (35 of 84, 41.7%); and lack of benefits provided by the department (12 of 32, 37.5%). The firefighters who identified a lack of education of health care services (15 of 34, 44.1%) as a barrier to reporting MSKI perceived it as the only “slightly challenging” barrier. The cultural barriers that were selected as “very challenging” centered on the stigma of being a part of the brotherhood, such as not letting fellow firefighters down, accepting pain as part of the job, and fear of losing their job. Similarly, the structural barriers of a change in duty status and difficulty filing worker's compensation were frequent and moderately challenging barriers to reporting MSKIs. Table 2 provides the measures of central tendency for the complete list of barriers, whereas Tables 34 detail the perceived degree of challenge for the participants who selected the specific cultural and structural barriers, respectively.

Firefighters' Frequency of Self-Perceived Barriers to Reporting Musculoskeletal Injuries in the Fire Service

Table 2:

Firefighters' Frequency of Self-Perceived Barriers to Reporting Musculoskeletal Injuries in the Fire Service

Firefighters' Perceived Challenge Related to Cultural Barriers With Reporting Musculoskeletal Injuries in the Fire Service

Table 3:

Firefighters' Perceived Challenge Related to Cultural Barriers With Reporting Musculoskeletal Injuries in the Fire Service

Firefighters' Perceived Challenge Related to Structural Barriers With Reporting Musculoskeletal Injuries in the Fire Service

Table 4:

Firefighters' Perceived Challenge Related to Structural Barriers With Reporting Musculoskeletal Injuries in the Fire Service

Discussion

Reporting Behaviors

Identifying the barriers that prevent firefighters from reporting MSKIs is critical in determining sustainable solutions for reducing the long-term impact MSKI has on their health and well-being. It is important to report MSKIs to determine safety and environmental changes that need to be made to decrease risk of injuries. Injuries related to overexertion are reported to be 89% more costly than other causes of injury in firefighters.23 Injuries such as sprains and strains are 80% more costly than other injury outcomes compared to harmful exposures, extreme weather, struck by incidents, and contact with objects.23 Previous research states that the per-claim average worker's compensation cost of injury to firefighters was $5,168 and the average for injuries caused by overexertion was $9,715.23 Literature is sparse regarding the efficacy of workplace interventions, but the implementation of these interventions may help to decrease costs of injury to firefighters.23,24 To achieve the best state of physical, mental, and social well-being of firefighters in the workplace, the organization must have policies and procedures that address the health and safety of these individuals.25

This study assessed the cultural and structural barriers a firefighter may experience when reporting MSKIs. Firefighters indicated cultural barriers as more challenging than structural barriers to reporting MSKIs. Although firefighters seldom report a lack of education of health care services available as a barrier, the most frequent and challenging barriers allude to the fact that long-term health consequences of MSKIs may not be apparent to this population. According to this study's findings, 57% of the participants reported having internal access to a health care provider (eg, physical therapist). Approximately 14% of firefighters found that the medical services provided were not helpful and an extremely challenging barrier to firefighters reporting MSKIs. A lack of trust in a health care provider may cause a firefighter to avoid seeking out appropriate care when injury resolution is not achieved.26 The lack of trust may stem from the type of health care providers used within departments, which should be considered when working to find solutions to MSKI reporting challenges. Additionally, there needs to be a focus on MSKI education, because that is still the leading cause of injury within the fire service nationwide.11,27 Health care providers who focus on musculoskeletal health and safety, such as athletic trainers and physical therapists, may be ideally suited to assess and mitigate risks, encourage honest injury reporting, and treat the common MSKIs reported in the fire service.

Difficulty of the Barrier

In this study, the most challenging barriers to reporting MSKIs among firefighters were evenly distributed between structural and cultural barriers, which is an important consideration when tailoring health care to a multifaceted occupation. Firefighters' time commitment to their family was reported as the most challenging barrier found in this study. Commitment to family may be an important factor to consider when consequences of MSKIs may involve being put on light duty, resulting in pay reduction, lack of time off for personal healing, and lack of support when injured during probationary period as reported by firefighters in this study. Firefighters might not be able to afford the consequences of an injury if the appropriate resources are not available to them; therefore, they may be more willing to suffer long-term health implications rather than place their own financial security at risk.14

Under-reporting of injuries can result in delay of treatment, which then places a significant burden on employees and their families, departments, health care systems, and national economies.17 When examining other occupations with an injury under-reporting challenge, construction workers may provide insight into possible reasons for injury under-reporting.18 Firefighters and construction workers embody many similarities, such as being a male-dominated profession,18,28 the requirement of protective gear,3,29 and participation in labor-intensive work.3,30 Previous research also identified that construction workers dealt with work-related pain and injuries by using sick and vacation days instead of being put on light-duty and risk losing their income.18

Workers increase their risk for reinjury and additional lost time at work when they do not take the necessary time off to recover.31 Ensuring that firefighters have the necessary time off to heal and seek appropriate care is crucial to their long-term health. However, this cannot occur if firefighters are not transparent in injury reporting processes and procedures. As athletic trainers begin to provide health care services to public safety providers, the health care provider must consider whole-person care using the social determinants of health framework that explores how social context and income status influence key health issues.32

Injury Reporting and Career Longevity

The inability to determine if the injury was caused at work or otherwise is another commonly perceived barrier reported from the study's sample of active firefighters. Previous research has identified that firefighters admitted to not reporting every injury they sustained due to the lack of knowledge that they were hurt, and that they considered the injury to be minor.14 The perceived barriers to reporting MSKIs within our study paralleled identified barriers in construction workers.18 Construction workers felt that symptoms were not serious enough to seek help, and that the pain and discomfort were an inevitable consequence of the job.18 The failure to determine where the injury was caused and if the injury is too minor leads to firefighters perceiving the paperwork as burdensome and being seen as a liability or an adversary to their department for reporting minor injuries.14 The results of our study align similarly with previously identified perceptions of construction workers with injury reporting, including concerns about abandoning their team, fear of being labeled by their supervisors as unable to do their job or as a complainer, and belief that having symptoms was a sign of weakness.18

Previous responses from firefighters expressed thoughts on the possible loss of career due to not reporting or addressing MSKIs and the importance of documenting injuries that could become serious in the future.14 Although firefighters may recognize the importance of reporting injuries, the data identified that firefighters still do not report MSKIs because they perceive pain as a natural part of the job and fear jeopardizing their current or future career.14 Nonetheless, the latter may occur when firefighters exaggerate injuries to be put on lighter duty. The negative impacts of light duty may result in the firefighter feeling isolated at the fire station, which may result in the department spending extra money to temporarily fill the position.33

Firefighters in this study frequently reported injury-related work reduction/elimination as a challenging barrier to reporting their MSKIs. Firefighters being physically incapable of performing their job duties due to injury may lead to early retirement, causing firefighters to not report their injuries.33 Due to economic strain on the firefighters, it may be assumed that they would rather stay on full duty status and continue to receive their paychecks rather than report their injuries and be put on light duty or take a pay cut during their healing time. In 1990, the cost of absenteeism in the U.S. industry was approximately $12 billion.33 The cost of replacing the absentee workers was approximately $700 million per year to replace approximately 200,000 employees.33 When comparing the demographics of the U.S industry and national statistics of firefighters, they are similar in that they are middle-aged men.28,33 MSKIs are considered one of the major sources for disability and absenteeism in firefighters.11 Therefore, preventing and appropriately managing MSKIs early on may help to decrease injury-related work reduction and save large sums of money not only for fire departments but for the U.S. industry.

Implications for Clinical Practice

There are potential solutions to eliminating perceived barriers within the fire service to injury reporting. The ambiguity of MSKIs and the implications of that injury may lead to improper care and lack of education on the long-term effects of MSKIs. Therefore, firefighters may feel that accepting pain is a natural part of the job because of the lack of education on MSKIs and proper ergonomics within their job duties. Athletic trainers are skilled providers in the reduction of MSKIs and could serve as the link in improving injury reporting while reducing injury risk.34

There are various types and levels of interventions in preventing the risk of sustaining MSKIs in the work-place (Figure A, available in the online version of this article). Primary prevention is focused on reducing the stressors and risks within the environment, whereas secondary and tertiary prevention are limiting or managing the effect of the stressors on the individual.25 Primary prevention is adapting the environment to “fit” an individual or group of individuals.25 Some suggested strategies for implementing primary prevention include redesigning the work environment, providing social support and feedback, and building cohesive teams.25,33 Using primary prevention strategies may be a vehicle for cultural change within the fire service to help promote injury reporting.

Prevention Methods related to the Fire Service. Definitions adopted from: Hoffman M, Bovbjerg V, Hannigan K, Hootman JM, Johnson ST, Kucera KL, Norcross MF. Athletic training and public health summit. J Athl Train. 2016;51(7):576–580.

Figure A.

Prevention Methods related to the Fire Service. Definitions adopted from: Hoffman M, Bovbjerg V, Hannigan K, Hootman JM, Johnson ST, Kucera KL, Norcross MF. Athletic training and public health summit. J Athl Train. 2016;51(7):576–580.

One of the perceived barriers to injury reporting selected by firefighters in this study is a lack of social support such as home, family, and friends outside of work. Social support is a modifiable risk factor that can be addressed through primary prevention strategies.35 An increase in social support can aid in workers' abilities to resolve and handle stressors within their environment, which may help to increase injury reporting behaviors.35 Despite social support being focused on the firefighters' personal relationships outside of work, the fire department could evaluate and develop better policies that encourage injury reporting and provide appropriate benefits for injured employees. A comprehensive approach to workplace injury rate reduction programs may help to decrease the risk for sustaining a MSKI and providing the resources needed after responding to emotionally impactful calls.

To decrease the risk of MSKI, it is important to implement injury reduction programs aimed to improve injury reporting behaviors. With the integration of an athletic trainer in the fire service, the potential benefits include a reduction in injury time loss, assistance with worker's compensation claims, education on MSKIs, development of MSKI reduction programs, decrease in medical costs for the firefighters and departments, and the encouragement of reporting injuries without the fear of being put on light duty, or being seen as an adversary. When firefighters report injuries to athletic trainers or on-site health care providers, their health information is confidential. On-site health care providers may be able to keep firefighters on full duty by providing the appropriate resources and interventions to treating their muscular aches and pains.

The increase in departmental support and availability of resources can help to limit stressors within the work environment, thus possibly improving a firefighter's likelihood to report MSKIs.35 The decrease in environmental stress and increase in support can then lead to increased productivity and improvements in health.35 When there is an increase in positive health outcomes, the firefighter's longevity to serve increases and overall health costs decrease.33 The promotion of a healthy and positive environment that provides the necessary medical resources and support of the firefighters may help eliminate the cultural barriers to reporting MSKIs that the firefighters identify as being present. Focusing on properly educating the firefighters on their health and health care options, offering them support, and priori-tizing their health and well-being are some programmatic changes that should be made.35

Limitations and Future Research

The limitations of this study included recruitment methods through snowball sampling. There is no current mechanism to recruit firefighters nationwide through a national organization. There should be consideration in allowing the fire service population to be more accessible to continue quality improvement research related to improving the health of firefighters. For this study, a database was developed from online resources including contact information of fire chiefs from various states and regional fire organizations. This study studied the perceptions of firefighters who serve all types of communities, but it was difficult to gather a more representative sample to generalize firefighters across the United States. One aspect related to community type that should be explored is that the lack of MSKI reporting could be related to health literacy and, therefore, future directions should explore the role of health education in this process. Future research should be conducted on the effectiveness of intervention programs in addressing the barriers to injury reporting behaviors of MSKIs through the use of an on-site health care provider for health and wellness initiatives.

Conclusions

Firefighters indicated cultural barriers as more challenging than structural barriers to reporting MSKIs. Although firefighters seldom report a lack of education as a barrier, the most frequent and most challenging barriers allude to the fact that long-term health consequences of MSKIs may not be apparent to this population. Access to health providers, such as athletic trainers, may be a useful resource in educating and managing musculoskeletal injuries.

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Participant Demographics

VariableFrequencyPercentMinimumMaximumMean ± SD
Age187440 ± 10
How many years of experience do you have as a firefighter?15817 ± 10
What is your sex?
  Male28390.1
  Female247.6
  Prefer not to answer20.6
  Missing51.6
What type of community do you primarily serve as a firefighter?
  Metropolitan: population > 1 million)9630.6
  City: population > 100,00011837.6
  Suburban4614.6
  Rural4915.6
  Missing51.6
Do you have access to a health care provider internally with the fire department?
  No12038.2
  Yes17957.0
  Missing154.8

Firefighters' Frequency of Self-Perceived Barriers to Reporting Musculoskeletal Injuries in the Fire Service

VariableCategory of BarrierFrequency of the Mode
Race/ethnicityCultural2/314 (0.6%)
Leadership discourages reportingStructural12/314 (3.8%)
Lack of access to health care servicesStructural16/314 (5.1%)
Nearing retirementCultural16/314 (5.1%)
Lack of organizational support during probationary periodCultural17/314 (5.4%)
Lack of fire department financial resourcesStructural21/314 (6.7%)
Lack of knowledge in reporting structureCultural25/314 (8.0%)
Ease of scheduling appointmentsStructural28/314 (8.9%)
Lack of knowledge about when to seek careCultural28/314 (8.9%)
Lack of benefits (eg, health insurance)Structural32/314 (10.2%)
Lack of education of health care services availableStructural34/314 (10.8%)
Commitment to familyCultural44/314 (14.0%)
Time away from the job needed to reportStructural45/314 (14.3%)
Medical services provided are not helpfulStructural46/314 (14.6%)
Poor communicationStructural46/314 (14.6%)
Fear of discipline from supervisorStructural50/314 (15.9%)
Inadequate support from local authorities (eg, human resources, city officials)Structural60/314 (19.1%)
Not getting time off for personal healingStructural62/314 (19.7%)
Embarrassment of conditionCultural63/314 (20.1%)
Fear of the worst case scenarioCultural84/314 (26.8%)
Home treatments are sufficient to deal with the problems (eg, medicine, ice, heat pad, meditation)Cultural85/314 (27.1%)
Pay reduction/unable to take off without payStructural86/314 (27.4%)
Absenteeism as a result of the injuryCultural90/314 (28.7%)
Stigma of being a healthy and fit firefighterCultural92/314 (29.3%)
Jeopardizing current and/or future careerCultural98/314 (31.2%)
Feeling of letting fellow firefighters downCultural101/314 (32.2%)
Difficulty filing worker's compensation claimStructural126/314 (40.1%)
Inability to determine if the injury was caused at work or otherwiseCultural140/314 (44.6%)
Change in duty statusStructural144/314 (45.9%)
Accepting pain as a natural part of the jobCultural167/314 (53.2%)

Firefighters' Perceived Challenge Related to Cultural Barriers With Reporting Musculoskeletal Injuries in the Fire Service

VariableModeFrequency of the ModeMean ± SD
Commitment to family420/44 (45.5%)3.30 ± .80
Lack of organizational support during probationary period48/17 (47.1%)3.12 ± 1.0
Fear of the worst-case scenario435/84 (41.7%)2.93 ± 1.1
Feeling of letting fellow firefighters down339/100 (39.0%)2.82 ± .93
Jeopardizing current and/or future career333/98 (33.7%)2.72 ± .98
Stigma of being a healthy and fit firefighter333/92 (35.9%)2.68 ± .90
Absenteeism as a result of the injury335/90 (38.9%)2.66 ± .88
Lack of knowledge about when to seek care312/28 (42.9%)2.57 ± .92
Race/ethnicity21/2 (50.0%)3.00 ± 1.4
Inability to determine if the injury was caused at work or otherwise251/140 (36.4%)2.71 ± .96
Embarrassment of condition222/63 (34.9%)2.70 ± .94
Accepting pain as a natural part of the job261/166 (36.7%)2.63 ± .88
Lack of knowledge in reporting structure28/25 (32.0%)2.56 ± 1.0
Nearing retirement27/16 (43.8%)2.56 ± 1.0
Home treatments are sufficient to deal with the problems (eg, medicine, ice, heat pad, meditation)235/84 (41.7%)2.29 ± .99

Firefighters' Perceived Challenge Related to Structural Barriers With Reporting Musculoskeletal Injuries in the Fire Service

VariableModeFrequency of the ModeMean ± SD
Medical services provided are not helpful420/46 (43.5%)3.22 ± .81
Lack of benefits (eg, health insurance)412/32 (37.5%)3.06 ± .88
Inadequate support from local authorities (eg, human resources, city officials)322/60 (36.7%)3.03 ± .86
Pay reduction/unable to take off without pay337/85 (43.5%)2.96 ± .87
Lack of access to health care services36/16 (37.5%)2.94 ± .93
Not getting time off for personal healing321/62 (33.9%)2.85 ± .92
Lack of fire department financial resources28/21 (38.1%)2.81 ± .93
Poor communication218/46 (39.1%)2.80 ± .91
Leadership discourages reporting24/12 (33.3%)2.67 ± 1.2
Difficulty filing worker's compensation claim245/126 (35.7%)2.67 ± .98
Change in duty status254/144 (37.5%)2.65 ± .88
Time away from the job needed to report316/45 (35.6%)2.51 ± .94
Fear of discipline from supervisor322/50 (44.0%)2.34 ± .94
Ease of scheduling appointments211/28 (39.3%)2.18 ± .90
Lack of education of health care services available115/34 (44.1%)1.82 ± .90
Authors

From the Tactical Athlete Research and Education Center, Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, Indiana (KAP, LEE, KNT, KEG); and Arnold School of Public Health, University of South Carolina, Columbia, South Carolina (ZKW).

The authors have no financial or proprietary interest in the materials presented herein.

Correspondence: Zachary K. Winkelmann, PhD, SCAT, ATC, Arnold School of Public Health, 1300 Wheat Street, University of South Carolina, Columbia, SC 29208. E-mail: winkelz@mailbox.sc.edu

Received: June 12, 2019
Accepted: October 03, 2019
Posted Online: December 16, 2019

10.3928/19425864-20191112-01

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