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Firefighters continue to face elevated risk of work-related MSDs

• Firefighters are particularly prone to injuries to the lower extremities and trunk.
• Although the rate of occupational injuries throughout the U.S. labor force has declined steadily, no discernable trend for firefighters or police officers exists.
• Compared to workers in similar occupations, firefighters have the highest share of injuries that are musculoskeletal in nature.

Earnings losses for firefighters worsened after the Great Recession of 2008–2009, but economic consequences of MSDs for firefighters remain less severe than for workers in similar occupations

• Postinjury earnings in the second year after injury were sharply lower in comparable occupations.
• Fire departments appear to do better than other employers — including other public-sector employers — at retaining injured workers.

California Disability Evaluation Unit ratings and statutory permanent disability benefits rose for firefighters after Senate Bill 863 implementation

• Implementation of Senate Bill 863 was followed by higher final ratings for firefighters with MSDs who received summary ratings.
• Firefighters have relatively high occupational adjustments, and their slightly older age at injury may also result in more-favorable adjustments under the current disability rating schedule.

There is no evidence that treatment caps on chiropractors, occupational therapy, and physical medicine had a substantial impact on most workers

• The lack of evidence that workers are substantially constrained by the treatment caps suggests that other, more-harmful consequences of the treatment caps may not be a major concern.

Musculoskeletal disorders (MSDs) are the most common type of occupational injury or illness suffered by firefighters, so there is considerable interest among policymakers and stakeholders about how best to monitor, prevent, and treat firefighter MSDs. In this report, the authors update analyses from a 2010 RAND study on firefighters in California and consider the impacts of the 2013 workers' compensation reforms and the economic shocks of the late 2000s on outcomes for firefighters with MSDs.

The California Department of Industrial Relations requested that the authors address a wide range of specific research questions on various aspects of firefighters' injury risk and outcomes in the workers' compensation system, from case mix and economic consequences to permanent disability rating and medical treatment patterns. The authors analyzed administrative data from the California workers' compensation system linked to data on earnings for workers injured between 2005 and 2015, with additional analyses to tailor the results to the new reforms. They compare firefighters with three groups of workers in broadly comparable occupations — police, other public-sector workers, and private-sector workers with job demands that resemble firefighting — and supplement the analysis using outside data.

The authors found, among other things, that firefighters continue to face elevated risk of work-related MSDs and that earnings losses for firefighters worsened after the Great Recession of 2008–2009. Their findings will be of interest to policymakers in California and other states and to other audiences concerned with the occupational health and safety of firefighters.

• Chapter One

  Introduction

• Chapter Two

  Background on Work-Related Musculoskeletal Disorder Risk for Firefighters Compared to Workers in Other Occupations

• Chapter Three

  Recent Trends in Injury Rates and Composition Among California Firefighters

• Chapter Four

  Economic Consequences of Musculoskeletal Injury for Firefighters and Other Workers

• Chapter Five

  Incidence of Post-Traumatic Stress Disorder and Other Psychiatric Comorbidities for Firefighters with Musculoskeletal Disorders

• Chapter Six

  Disability Ratings and Benefits for Firefighters with Musculoskeletal Disorders

• Chapter Seven

  Treatment Caps and Claim Denials

• Chapter Eight

  Conclusion

• Appendix A

  Additional Details on Methods

• Appendix B

  Sensitivity Analyses and Additional Results