Which of the following are the leading injuries among emergency services personnel?

Report: NFPA's "Firefighter Injuries in the United States"
Author: Richard Campbell
Issued: December 2021

Report highlights

• An estimated 64,875 firefighter injuries occurred in the line of duty in 2020, an increase of seven percent over the 20189 injury total.
• In addition to injuries, there were 20,900 documented exposures to infectious diseases and 17,050 exposures to hazardous conditions.
• Firefighters were more likely to be injured at fireground operations than other types of duties. In 2020, 22,450 injuries, or 35 percent of all reported firefighter injuries, occurred at the fireground.
• The leading cause of fireground injuries was overexertion or strain [31 percent of total injuries].
• Strain, sprain, or muscular pain injuries accounted for nearly two of five [40 percent] injuries on the fireground.
• Non-fireground injuries included 4,975 injuries while responding to, or returning from an incident; 7,550 injuries incurred during training activities, 13,650 injuries at non-fire emergency incidents, and 16,250 injuries during other on duty activities.

• "Firefighter Injuries and Fireground Operations" report [PDF], May 2015
• "Trends in Firefighter Injuries" report [PDF], May 2015
• "An Analysis of Volunteer Firefighter Injuries, 2012-2014" report

Please contact us with any questions.

Sirpa Lusa, Anne Punakallio, Rauno Pääkkönen, Finnish Institute of Occupational Health

Contents

• 1 Introduction
• 2 Definition of emergency workers
• 3 Specific work demands
  • 3.1 Physical work demands
  • 3.2 Mental work demands
  • 3.3 Environmental and task specific work demands
  • 3.4 Major incidents
• 4 Occupational health and safety issues
  • 4.1 Work related accidents and injuries
  • 4.2 Work related diseases and symptoms
• 5 Work ability
  • 5.1 Ageing
• 6 Promotion of occupational safety and health
  • 6.1 Safety and health management
  • 6.2 Co-operation and communication
• 7 Future challenges
• 8 References
• 9 Links for further reading

Introduction

Emergency workers are people, who work in emergency response situations, such as fire-fighters, paramedics and police officers. Their specific work demands can be divided into physical, mental, environmental and task defined. Time pressure, significant physical and psychological stress and unpredictable, rapidly changing work conditions increase stress and create special characteristics of the demands of the work in emergency situations. Important OSH issues are accidents, work related diseases and symptoms, work ability and problems arising from physiological ageing.

Definition of emergency workers

Emergency workers work in emergency response situations protecting human life, property and the environment during accidents and major incidents and disasters. In emergency situations, many professional groups are involved depending on the extent and consequences of the accidents. It is difficult to define the exact numbers of European emergency workers even for the everyday work situations, and especially for major incidents [for example according to one ILO report [1] there is about one fire-fighter for every 1,000-1,200 inhabitants]. In addition to permanent workers, there are many part-time and voluntary workers working in this area. The article focuses mainly on permanent fire-fighters, police officers, paramedics and to some extent on special forces for disaster control, e.g. military forces, mostly emphasizing the OSH issues encountered in [every day] emergency situations.

Specific work demands

Physical work demands

In emergency situations, the physical work demands imposed on fire-fighters, paramedics and police officers are high, versatile and task specific. Without taking into consideration work equipment and methods, it is almost impossible to influence the physical exposure of emergency situations. Smoke-, gas- and chemical-diving, roof work, and handling patients, victims and heavy tools are typical fire and rescue work tasks in which the physical capacity of the rescuer is critical for safe and efficient work performance [2]; [3]. Temporary thermal and ground conditions, and the use of protective equipment further increase the demands on the cardiorespiratory and musculoskeletal systems, as does the requirement for postural and movement control [4]; [5]. The typical physical work demands to be met by police officers involve sudden and occasional very severe physical efforts e.g. in chasing and tackling suspects and between these kinds of operations, there are long inactive periods, accounting for about 67% of the working time at the daytime [6].

The dynamic stress imposed on the emergency workers can be assessed via the measurement of oxygen consumption during work. Depending on the task and the environmental demands, the average body oxygen consumption in simulated smoke-diving ranges between 31–44 and ml/kg min-1 [7]; [8]; [9], and between 18–40 ml/kg min-1 in ambulance service and first aid tasks [10]; [11]. The mean oxygen consumption of the correctional officers while they were responding to an incident and then controlling and restraining inmates was 39 ml/kg min-1 [12]. The body's oxygen consumption at rest is 3,5 ml/kg min-1, 14 in walking at 4 km/h and 35 when jogging at 10 km/h. Light office work demands 5 and cleaning work 12 ml/kg min-1 of body's oxygen consumption. The higher the demand of oxygen consumption of the work, the higher is the strain imposed on the worker. Therefore, it is important that emergency workers maintain sufficient fitness in accordance with their work demands. For example, in Finland, the minimum fitness levels of aerobic capacity required for rescue-diving tasks are set at 3.0 l min-1 and 36 ml/kg min-1.

Furthermore, working with heavy tools, rescuing and carrying patients and victims and working at height demand a great deal of muscular strength and endurance as well as balance and agility . For example, the opening of a ceiling with a motor saw in simulated fire-fighting, the compressive force exerted on the low back was found to be so high that the risk for back injuries increased considerably [13]. According to Lavender [14], the most demanding tasks requiring muscular strength as well as hazardous tasks for the low back involved moving a victim from a bed to a stretcher, the initial descent of a set of stairs when using the stretcher, and lifting a victim off the floor. On average, male correctional officers needed 60 kg force in body control, 49 kg in wrist hold and 47 kg in arm retraction to control and restrain on inmates [15].

In actual emergency work situations, the contact surfaces are frequently insecure, narrow, inclined or slippery. Workers may have to climb ladders, work on roofs or work in moving emergency vehicles. Sometimes the environment is smoky, dim or completely dark. Then the visual feedback will be poor. All these aspects pose major challenges on the postural control system. First aid tasks and the use of different tools also require good hand-eye coordination and motor coordination of fingers.

Due to these high and versatile physical work demands, it is important to systematically follow-up the physical work capacity of emergency workers.

Mental work demands

Emergency workers deal with fatalities, injured people and their families. They undertake irregular and long [even 24 hours] working hours and can encounter violence while doing their work. Many work tasks have to be done under severe time pressure. These kinds of situations can trigger fear technical failure of equipments and workers need quick decision-making capabilities. They need to rely on co-workers and be aware that they run the risk of death themselves. Mental stress increases also during major accidents, for example during a shooting or a bomb attack [16], and there is intense interest from both the general public and the media.

Mental stress can also be attributed to poor management especially in operative situations where many different security professional groups are involved at the same time; there may be incorrect or incomplete information, traffic congestion, lack of protective equipments or other necessary resources as well as lack of social support or psychosocial assistance after major accidents. One risk factor for emergency workers, especially for paramedics, which seem to be associated with burnout, is the requirement to suppress their own emotions at work but at the same time to be emotionally empathetic [17]. Incidents that involve children, suicides, or traumatic amputation are considered as the most distressing for ambulance personnel [18].

Environmental and task specific work demands

Disasters can be categorised into four main groups: [1] disasters of natural origin [e.g. floods, seismic events, hurricanes, forest fires], [2] disasters caused by industrial accidents [e.g. nuclear accidents, release of chemicals, mining accidents], [3] disasters caused by transport accidents [e.g. major car crashes, airplane crashes, rail accidents], and [4] disasters caused by terrorist or criminal attacks and any combination of these four groups. Emergency aid and disaster control are mentally and physical extremely challenging and demanding tasks.

Environmental problems can be caused by weather conditions [rain, snow, heavy wind, bright lights, and heat], the time of day [night, dawn], and the place where the disaster strikes. These can pose specific OSH risks to emergency workers and complicate their mission. There are different types of environmental work risks e.g. chemical emissions [carbon monoxide, loss of oxygen, impurities etc.], extreme thermal conditions [cold, heat], risk of drowning or radiation [ionising, optical and non-ionising], noise and vibration. The Infrastructure and its related systems can be destroyed and emergency workers must work inside ruined buildings.

Working in confined spaces is also a very common scenario for rescue workers in all forms of natural disasters. Fire-fighters, employees of relief organisations or soldiers often have to clear various layers of debris in order to reach the victims, and on occasions it may even be necessary for them to enter the confined spaces in which the victims are themselves entrapped. Particular vegetation fires put emergency workers at risk of strong smoke development and negative health and safety problems due to confrontations with wild or domestic animals. Landslides and earthquakes cause dust production. All those factors [ash, gases, smoke, and dust] together can cause many kinds of irritative and subsequent health effects.

Major incidents

Emergency workers have to respond to serious accidents in industrial installations such as toxic releases or major fires or explosions in manufacturing plants or mines when flammable and/or explosive substances are present. Explosions can also be caused by physical processes e.g. if the energy present in compressed gas or vapour is suddenly liberated [vessel explosions].

An explosion is a sudden and violent release of energy that causes a blast. Energy can be released as physical, chemical and nuclear energy. Physical energy for example can be released when a vessel containing a high pressure gas is suddenly ruptured. Chemical explosions related to chemical reactions are of major importance for studying major accidents involving hazardous materials. Explosion related to the combustion of flammable gases can be either “deflagration” or “detonation” depending on the burning velocity. For example Industrial installations that can potentially create a major accident are: chemical and petrochemical industries, oil refineries, sites storage of gas and flammable liquids, chemical warehouses, fertiliser manufacturing plants, water treatment works using chlorine, and mines [19].

The increasing density of transportation routes also increases the probability of small-scale emergencies and disasters during transport. This also enhances the probability of emergency workers being deployed to deal with transport disasters. The hazards to which emergency workers are exposed in transport accident scenes can vary greatly depending on the type of transport, the products being transported, and the location of the accident. In transport accidents, it is not always possible to undertake an appropriate assessment of the hazards present, because not all hazards are immediately visible. The incident combines different elements that need to be taken into account: search for victims, risks of fire and explosions, presence of hazards and hazardous material, heavy equipment, water rescue, extrication and multiple casualties.

Occupational health and safety issues

Due to the many kinds of risks involved in emergency work, there may not only be many health and safety consequences but these may also be manifold and severe. Emergency workers can suffer from accidents and work-related diseases and symptoms throughout their whole work career. These negative outcomes can lead to decreased work ability, sick leaves and early retirement.

Work related accidents and injuries

Emergency workers often have to work in an environment which is multi-hazardous, unpredictable and dynamic and thus they are vulnerable to suffer many kinds of accidents. The most common fatal work related accidents consist of cardiovascular and motor-vehicle accidents, asphyxiation and homicide. Even a minor accident can require an emergency worker to take sick leave because of the heavy physical demands of the job. In the long run, if not rehabilitated properly, accidents often lead to musculoskeletal problems and carry the possibility of early retirement. In emergency workers, in most cases, the length of sick leave because of accidents has been less than three days. However about 20% of accidents [i.e. one out of every five] do require sick leave lasting over 15 days [20].

The number of non-fatal work related accidents suffered by Finnish police officers has varied between 500 to nearly 900 per year between the years 2003 and 2010, being under 700 in 2010. The same figures for full-time, compensated part-time and volunteer fire-fighters in Finland have varied between 500 and 600 cases per year during the years 2003-2010 [21]. The frequency of accidents in fire-fighters was about 61.5 accidents per million work hours. In comparison, the frequency of accidents in police officers has been about 30 accidents per million work hours for the entire civil workforce in Finland and even less, about 22 accidents per million work hours in military personnel [22].

The most frequent non-fatal accidents suffered by emergency workers are injuries while handling, lifting and carrying or moving equipment, people or vehicles associated with physical overstrain [20-41%]. Slips, trips or falls on the same level [14-28%] were the secondly frequent accidents followed by being hit by a moving, flying or falling object or being trapped between objects and equipment [6-9%]. The most prevalent injuries were muscle and tendon strains and sprains and dislocations. Wounds, laceration and other superficial injuries are the second most common injuries. The back, lower and upper extremities were the body parts most often injured [23]; [24]; [25]. The risk of burn injuries always exists in rescue work, but the number of burn injuries is not very high. The extent of burn injuries among fire-fighters has decreased although the numbers of structural fires has remained constant. This apparent contradiction can be explained by the improved protective equipment being used by fire-fighters.

A considerable number of injuries happen during training at work and free time. According to Konttinen et al [26], only 38% of all accidents in police officers were work-related with 51% being associated with physical exercise. A further 33-38% of all accidents were due training at work. There are several other studies from Sweden, Poland, Finland and Germany revealing that on-duty fitness training has been responsible for injuries to fire-fighters and police officers. The proportion of injuries due by physical training ranges from 25 to 50% of all accidents [27]; [28].

Emergency workers also suffer the risk of assaults and injuries by violent or combative patients [29]. For example, in Sweden 80% of emergency paramedics had been threatened or subjected violence, 67% subjected to physical violence, and over one third had experienced threats of violence every 3 months, usually from a patient, a relative or a friend of the patient. Similar results about the prevalence of violence targeted at Finnish emergency workers have been reported: 73% of them had been threatened or been targets of violence. Moreover, in Finland, 14% of police officers' and 2% of fire-fighters' injuries were attributed to shock, violence, aggression, etc. In France, 23% of the ambulance personnel have experienced one or more assaults during their careers, of which 4% resulted in sick leave [30].

Work related diseases and symptoms

Work related diseases and symptoms can be divided into musculoskeletal disorders [MSD], and health outcomes as a consequence of risks to mental health or related to chemical or biological risks or radioactive exposure .

The genesis of MSDs is multifactorial and occurs as a consequence of exposure to many stressors observed in the emergency work [31] [32]; [33]; [34]. The risks for MSD among emergency workers are physical [high physical work load, sedentary activity, whole-body vibrations, for example related to driving large vehicles etc.] as well as psychological. Most frequently the back, neck, shoulders, upper limbs [including shoulders, arms, hands and wrists] although in fire-fighters knees are also affected. MSDs have been proved to be the leading cause for early retirement in many countries, also in Finland. For example, the most common reason for early retirement among fire-fighters between years 2000-2010 was MSD accounting for 43 % out of all reasons [35], whereas for other municipal workers MSDs accounted for 40 % of all reasons. The most common medical diagnoses for early retirement among fire-fighters were related to low back: 16 % of all diagnoses [e.g. degeneration of lumbar disc] and osteoarthritis of knees: 9 % of all diagnoses [35]. Furthermore, psychological overload can increase the risk for MSDs, especially those related to major disasters. For example Morren et al [36] claimed that cases of MSDs increased among fire-fighters, police officers and emergency service personnel involved in an explosion of a fireworks depot in the Netherlands in 2000. This was confirmed by the results of Berrios-Torres et al [37], who studied rescue workers who worked in New York during the 11 September 2001 disaster.

The consequences of exposure to traumatising situations can range from stress reactions to more severe consequences like post-traumatic stress disorders, burnout and depression. Most emergency workers experience stress reactions during and after a traumatic event. These reactions can include emotional reactions [e.g. shock, anger, and helplessness], cognitive reactions [e.g. disorientation, memory loss, guilt], physical reactions [e.g. tension, fatigue, pain, elevated heart rate] and psychosocial reactions [e.g. isolation, distrust, becoming distant] [38]. Some workers have a higher risk of developing more serious psychological problems due to their experiences of prior events or during the actual event. Many studies indicate that emergency workers are at a higher risk of developing post-traumatic stress disorders [PTSD], even if they are not exposed to major disasters [e.g. Jonsson, Segesten and Mattsson [39]]. PTSD can only be diagnosed if different diagnostic criteria are met and the duration is at least one month [40]. The symptoms are persistent re-experiences, intense psychological distress and increased arousal [e.g. concentration problems]. The most important characteristics of burn-out are exhaustion together with tension complaints, reduced efficiency or motivation, problematic attitudes and behaviour characteristics. Depression is very complex mental disorder with many different types. Most often people talk about the first type of depression: a major depressive episode with the symptoms of depressed mood and loss of interest in daily activities. The study of Bennett et al [41] found that 10% of the ambulance drivers reported clinical levels of depression.

Emergency workers are often exposed to chemical substances during major accidents but also in everyday life. The main pathways by which these agents enter the body are via skin, airways or digestive tract. Their effects can appear immediately [e.g. irritation of eyes] or be delayed [e.g. cancer]. Exposure to hazardous materials can lead even to fatalities, injuries and disorders; chemical agents may also have negative effects on reproductive capabilities. An extreme case of exposure to dust and smoke was encountered after the collapse of the World Trade Center. Emergency workers experienced mainly respiratory disorders: according to the CDC [42] 60 % suffered lower and 74% experienced upper respiratory symptoms. The study of Holopainen et al [43] noted that the use of pepper sprays by police officers can lead to corneal erosions in the policemen.

Emergency workers might come into contact with blood or body fluids from other individuals and therefore face the risk of transmission of blood-borne diseases. Three main diseases are of concern: HIV, hepatitis B and hepatitis C [e.g. Sulsky et al [44]]. Transmission of hepatitis B and C is mostly to result from [Prevention of sharp injuries | needle stick]injuries in public safety workers [45]. During disasters, where rescuers from many countries are working together, for example floods in highly populated areas water- and vector-borne diseases might also be a risk e.g. cholera or malaria. With respect to air-borne diseases even tuberculosis can be a risk in regions where it is prevalent. For example mosquitoes can transmit for example malaria and dengue fever. In extreme situations rescuers might become victims of bioterrorism, release of e.g. smallpox.

Other serious health outcomes caused by exposure to hazardous material and combustion products are different types of cancer and asbestosis. The recent study of Bates [46] suggests that fire fighting is a rather clear risk factor for testicular and brain cancer, melanoma leukemias, prostate, as well as possibly for thyroid and oesophageal cancer.

Work ability

There are many demands associated with the work ability of emergency workers. The concept of work ability is multidimensional and therefore difficult to operationalize. Therefore there are few valid methods for measure work ability. The holistic approach of work ability involves assessing of both the resources of the individual and factors related to work and working and the environment outside the work [47]. A questionnaire-based measure, the work ability index [WAI] [48]; [49] has been devised to operationalize the concept of work ability. The WAI is a sum variable which reflects perceived work ability and number of diseases. Work ability index has four categories: excellent, good, moderate and poor. When WAI is good or excellent, it is important to support and maintain work ability. For those individuals whose WAI is moderate, measures to help improve work ability are recommended. Measures directed toward restoring work ability or additional evaluations of work ability are needed by those whose WAI is poor. WAI can be used as one of the methods for assessing work ability in health examinations, workplace surveys and it can be used in Workplace Health Promotion programs. Especially among middle-aged and older workers, the WAI can also be used for early detection of a decline in work ability. The Index is in use in several countries in Europe and other countries, and it has been translated into 26 languages.

Among different aged Finnish police officers in 2011 [mean age 38 and 49 years], the WAI can classified as good [50]; [51]. In fire-fighters with a mean age of 36 years the WAI was also good but after 13 years follow-up their average WAI had decreased to moderate [52]. The mean value of WAI among paramedics aged 36 years [21-56 years] was also good [53]. However, although the mean value of WAI in emergency workers was mostly good, in about 3 to 15% of the subjects WAI was poor or moderate, which is risk for disablement [e.g. Ilmarinen et al [54]. Sörensen et al [55]] with actions for restoring and improving work ability being needed.

Age is strongly associated with WAI. For example, in fire-fighters with a 13-years follow-up, the risk for poor work ability in fire-fighters over 45 years was as elevated as seven-fold compared to those under 30 [56]. In addition to age, individual life style factors were very powerful risk factors in fire-fighters in a three-year follow-up, but no longer after a 13-year follow-up. Factors related to work skills and the organization of work were emphasized in both time periods. The significance of those factors related to leadership even increased with the longer follow-up time period. Life dissatisfaction and lack of positive feedback regarding work were also associated with WAI [57].

In police officers and fire-fighters, good physical capacity was significantly associated with good WAI [58]; [59]; [60]. Moreover, good muscular capacity was a protective factor whereas poor motor control was a risk factor for reduced perceived physical work ability in relation to the physical demands of the fire and rescue work [61]. It is the responsibility of every emergency worker as well as his/her superiors and management in the workplace to maintain and support the individual's work ability.

Ageing

If one extrapolates statistics from Eurostat [62], the EU population is expected to age with the median age projected to rise from 40.4 years in 2008 to 47.9 years in 2060. The proportion of the population aged 65 years or over in the total population is predicted to increase from 17.1% to 30.0%. These scenarios pose challenges for emergency workers, not only will they themselves be older, but also the people they will be rescuing are aging.

The relationship between aging and work ability is complex. The diversity of the various demands [i.e. physical, mental or psychosocial] to which the emergency workers need to respond needs to be considered in any assessment of work ability [63]. According to the meta-analysis conducted by Sehl and Yates [64] the capacities of the different physiological systems of body/bodily decline by between 0.3-1.3% per year and the loss rates in integrative tasks, requiring interaction and function of almost all organ systems on average linear decline were by 0.97% per year. The most robust decline in cognitive human functions is thought to occur in general slowness [other functions are reaction time, memory and decision-making], whereas intellectual abilities do not appear to change with aging. Although there are general estimates for the rates at which ageing affects specific bodily systems and capacities, information is lacking on the extent to which these indices correlate with real work ability. Furthermore, general population data may not reveal valid data to be extrapolated to high-demand jobs, such as emergency work. Older emergency workers have longer work experience for example they have better work techniques and greater ability to cope with demanding work situations than younger workers. The main goals should be to keep aging workers healthy in their jobs, increase the safety of [co]workers and optimise the worker-job interaction [65].

Promotion of occupational safety and health

Safety and health management

Occupational health and safety [OSH] management should be performed systematically as one part of normal daily routines and management. Implementing an OSH management system as a part of company practice is essential for enhancing the health and safety of workers. Employers have the responsibility in co-operation with OSH personnel to create conditions that protect emergency workers from adverse health outcomes.

The risks in emergency work are not only serious but also multiple. They can cause major injuries and health problems. In addition to the traditional risks, emergency workers can encounter new risks, such as disturbances in technology disenabling efficient communication. In emergency work, especially in the case in major accidents, all of the measures can sometimes fail simultaneously. Therefore it is vital that there is efficient management of risks [Figure 1]. The risk management process at a disaster scene can be divided into three steps: information gathering, analysing alternative options for action and decision making and taking action [66].

In all emergency situations, the key to protecting the health and safety of workers is planning and preparedness [67]. Highly trained emergency workers may have been claimed to experience a lower prevalence of psychological problems following disasters compared to their less trained colleagues [68]. Experience and preparedness can reduce the stress faced by emergency workers in disaster situations [69] and therefore emergency workers should also be trained and prepared for different types of major disasters [70]. Training helps emergency workers to cope better with violence during their work. In order to increase safety in emergency situations, it has been proposed that there should be common training procedures for all personnel working in the safety sector [71]; [72]. In addition, organisations need to undertake joint drills, and they should also be prepared to cope with intense media interest surrounding major incidents. It has been stated that strategic planning and implementation of standardised systems and procedures that have been tested beforehand enhance the probability of successful disaster control [73].

Figure 1: Managing risks in emergency work

Source: Drawn by the authors

An important managerial issue is how best to provide relevant training and education in order to ensure that expertise and knowledge of emergency workers is up to date. It is important that there is shared responsibility between the individual and the management and work community against this issue. The use of appropriate protective equipment is essential for protection against chemical, biological and physical risks. The PPE must be selected according to the type of disaster and typical work tasks of each group of emergency workers [74]. Good protection is needed against thermal risks, exposure to chemical releases or nuclear radiation.

Vaccination should be provided where emergency workers might be at risks of hepatitis B, water-borne diseases or exposed to some biological agents that may be used in bioterrorism.

Social support during and after deployment in a disaster and providing psychological long-term care after the disaster are important preventive measures. However, emergency workers should be provided with primary and secondary prevention from mental problems emerging not only after major disasters but also those related to everyday work. These activities include psychological preparedness, post-intervention psychological support and help, and also long-term psychological care when needed. [75]

Maintaining a sufficient level of health and physical capabilities in relation to emergency work demands represents the foundation for good work ability. Good work ability and individual resources can help emergency workers to manage risks, which they face in their daily work. Regular health examinations and physical fitness testing with individualized exercise prescriptions are important preventive factors to combat the decline in work ability. Attention should be paid to exercise, smoking and drinking habits and adopting a healthy lifestyle in general. Employers can help emergency workers to stay in good health and maintain their work ability e.g. by Workplace Health Promotion.

The one wishes to prevent accidents and injuries in emergency workers, it is of primary importance to invest in preventive measurements and good management e.g. through spontaneous communication and clear instructions. Since emergency workers are especially prone to injuries in the back and lower limbs due to physical overexertion and slipping accidents, it is essential to utilize ergonomic devices and to provide lifting training.

Co-operation and communication

Excellent co-operation between emergency workers is vital in every kind of disaster situation. The co-operation must be coordinated not only between national, regional and local emergency forces but also between the different occupational groups of emergency workers. Successful co-operation requires training between emergency workers and efficient action within remits must be trained.

A lack of information or only partial availability of information regarding the conditions at the disaster site may lead to severe accidents in emergency workers and also victims of the disaster. Appropriate help can also be given to victims only if information on their situation and condition is properly passed along the chain of command.

Reliable information is necessary in order to ensure efficient and resource conserving coordination of the taskforces and to protect them in the best way possible. Therefore emergency plans including alarm and information systems must be devised for different kinds of disasters at regional, state, country, European and international level with responsibilities being clearly defined and allocated before a disaster strikes.

Future challenges

There are several critical areas of protection of safety and health of emergency workers i.e. management, co-operation and communication, protection, training, and physical work capacity. In the future, the work and development of OSH activities of emergency workers will face new challenges.

Increased energy use, dispersion of industrialisation around the globe, expansion of transportation systems, global warming, increased pollution, continuous population growth, and national and international terrorism are only some of the underlying phenomena that may increase the frequency and intensity with which disasters strike as well as the vulnerability of the population to disasters. Major disasters will always occur in addition to the daily emergencies that emergency workers need to face.

Emergency workers often lack sufficient knowledge about the hazards they may encounter. Hence, in the future, their vocational education should focus even more on risk awareness, risk assessment and empowerment. Emergency workers should have some knowledge about the properties of hazardous substances and their effects and they should be able to understand hazardous material symbols. This is particularly important to ensure OSH of emergency workers in case of industrial accidents and accidents in the transportation of dangerous goods.

Future disaster situations must also be anticipated so that appropriate [Personal Protective Equipment | personal protection equipment [PPE]] will be available. In addition to an improved availability of PPE, it is necessary to increase the knowledge of managers, OSH specialists and emergency workers about what PPE to choose in which emergency situation. The development of so-called intelligent PPE ‘complicates’ further their use and selection, and appropriate training is even more important.

The population of EU is aging and naturally emergency workers are also becoming older. There are also financial reasons to strive to prolong working careers. In high-demanding physical jobs, this can be very challenging. In fact, the only criterion determining how well an individual can cope with work demands should not be only chronological age. Because of individual differences in capacities functional and biological age should also be taken into account. For example this might involve developing functional tests for job-specific work ability. By applying these kinds of tests, individual functional aging could be monitored and well-timed interventions planned so that workers should be able to work for longer [76]. Work ability issues should be a focus during the whole work career of emergency workers, starting from recruiting methods/criteria to conduct certain activities, followed by interventions during the training and finally in different phases at work. Elderly rescuers can also suffer from illnesses that can limit their possibilities to work in the field; for these individuals retraining possibilities should be available.

Emergency workers are experts in disaster control and vital for a community in the process of returning to normality after a disaster. Moreover, awareness should be raised on the increasing demands imposed on emergency workers as disasters will be more severe in the future and will occur with increased frequency. For example, authority operations and measures in response to shooting emergencies or shipwrecks should be rehearsed beforehand as thoroughly as possible.

References

1. ↑ ILO - International Labour Organization. International Hazard Datasheets on Occupation. Fire-fighter. Retrieved 5 October 2009, from: [1]
2. ↑ Holmér, I., Gavhed, D., ‘Classification of metabolic and respiratory demands in fire fighting activity with extreme workloads’, Appl Ergon, No 38, 2007; pp. 45-52.
3. ↑ Lusa, S., ‘Job demands and assessment of the physical work capacity of fire fighters’, Studies in sport, physical education and health 33. University of Jyväskylä Jyväskylä, 1994.
4. ↑ Barr, D., Gregson, W., Reilly, T., ‘The thermal ergonomics of firefighting reviewed’, Applied Ergonomics, 2010, Vol 41, pp. 161-172.
5. ↑ Punakallio, A., Lusa, S., Luukkonen, R., ‘Protective equipment affects balance abilities differently in younger and older firefighters’, Aviat Space Environ Med. No 74, 2003; pp. 1151-6.
6. ↑ Konttinen, J., Halonen, J., Niemi, J., Lindholm, H., Luukkonen, R., Toivonen, R.,Lusa, S., ‘Poliisien fyysisen toimintakyvyn arviointi ja kuntotestauskäytännöt -kehittämishankkeen loppuraportti. Poliisihallituksen julkaisusarja 1, Helsinki, 2011. [in Finnish]. Available at: [2]
7. ↑ Holmér, I., Gavhed, D., ‘Classification of metabolic and respiratory demands in fire fighting activity with extreme workloads’, Appl Ergon, Vol 38, 2007, pp. 45-52.
8. ↑ Lusa, S., Louhevaara, V., Smolander, J., Kivimäki, M., Korhonen, O., ‘Physiological responses of firefighting students during simulated smoke-diving in the heat’, Am Ind Hyg Assoc J., Vol 54, 1993, pp. 228-231.
9. ↑ von Heimburg, E., Rasmussen, A., Modbø, J., ‘Physiological responses of fire fighters and performance predictors during a simulated rescue of hospital patients’, Ergonomics Vol 49 , 2006, pp.111-126.
10. ↑ Vehmasvaara, P., ‘Ensihoitotyön fyysinen kuormittavuus ja ensihoitajien työkyvyn fyysisiä edellytyksiä arvioivan testistön kehittäminen’, Kuopion yliopiston julkaisuja D. Lääketiede, 324, 2004. [in Finnish]
11. ↑ Rice, V.J.B., Sharp, M.A., Tharion, W.J., Williamson, T.L., ‘The effects of gender, team size, and a shoulder harness on a stretcher-carry task and post-carry performance’, Part I. A simulated carry from a remote site, Int Jour of Industrial Ergonomics, Vol 18, 1996, pp. 27 - 40.
12. ↑ Jamnik, V.K., Thomas, S.G., Shaw, J.A., Gledhill, N., ‘Identification and characterization of the critical physically demanding tasks encountered by correctional officers’ Applied Physiology, Nutrition, and Metabolism, No 35, Feb 2010, pp.45-58.
13. ↑ Lusa, S., ‘Job demands and assessment of the physical work capacity of fire fighters’, Studies in sport, physical education and health 33. University of Jyväskylä Jyväskylä, 1994.
14. ↑ Lavender, S., Conrad, K., Reichelt, P., Meyer, F., Johnson, P.. ‘Postural analysis of paramedics simulating frequently performed strenuous tasks’, Applied Ergonomics, Vol 31, 2000 pp. 45-57.
15. ↑ Jamnik, V.K., Thomas, S.G., Shaw, J.A., Gledhill, N., ‘Identification and characterization of the critical physically demanding tasks encountered by correctional officers’ Applied Physiology, Nutrition, and Metabolism, No 35, Feb 2010, pp.45-58.
16. ↑ Strömberg, A., Johansson, L., Leino, T., Lusa, S., Mankkinen, T., ‘Pelastajien kokemukset Myyrmannin kauppakeskuksen pommiräjähdyksen pelastusoperaation aikana ja sen jälkeen - haastattelututkimus noin 1,5 vuotta tapahtuman jälkeen’. Palosuojelurahaston rahoittama hanke, Työterveyslaitos, Helsinki, 2005. Available at: [3] [in Finnish]
17. ↑ Cicognani, E., Pietrantoni, L., Palestini, L. & Prati, G., ‘Emergency Workers’ Quality of Life: The Protective Role of Sense of Community, Efficacy Beliefs and Coping Strategies’, Social Indicators Research, 2009. Available at: [4]
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19. ↑ ILO - International Labour Organization, ‘Major Hazard Control – A practical guide’, ILO, Geneva, Switzerland, 1988.
20. ↑ FAII - Federation of Accident Insurance Institutions, ‘Statistics’, 2012. [personal communication].
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23. ↑ FAII - Federation of Accident Insurance Institutions, ‘Statistics’, 2012. [personal communication]
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27. ↑ FAII - Federation of Accident Insurance Institutions, ‘Statistics’, 2012. [personal communication]
28. ↑ EU-OSHA - European Agency for Safety and Health at Work,. Emergency Services: A Literature Review on Occupational Safety and Health Risks’, 2011, Available at: [8]
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31. ↑ Riihimäki, H. ,Overview. ILO, 2009. Available at: [10]
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36. ↑ Morren, M., Dirkzwager, A.J.E., Kessels, F.J.M., & Yzermans, C. J., ‘The influence of a disaster on the health of rescue workers: a longitudinal study’, Canadian Medical Association Journal, Vol. 176, No 9, 2005, pp. 1279-1283. Available at: [13]
37. ↑ Berríos-Torres, S.I., Greenko, J.A., Phillips, M., Miller, J.R., Treadwell, T.& Ikeda, R.M., ‘World Trade Center rescue worker injury and illness surveillance, New York 2001’, American Journal of Preventive Medicine, Vol. 25, No 2, 2003, pp. 79-87.
38. ↑ United States, Department of Veterans Affairs, National Center for PTSD [2011]. Disaster rescue and response workers. Retrieved 11 June 2012, from: [14]
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41. ↑ Bennett, P., Williams, Y., Page, N., Hood, K., & Woollard, M., ’Levels of mental health problems among UK emergency ambulance workers’, Emergency Medicine Journal, Vol. 21, 2004, pp. 235-236.
42. ↑ CDC - Centers for Disease Control and Prevention, 'Physical Health Status of World Trade Center Rescue and Recovery Workers and Volunteers - New York City, July 2002-August 2004', MMWR Morbidity and Mortal Weekly Report 53[35]. 2004, pp. 807-812. Available at: [16]
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46. ↑ Bates, M.N., ‘Registry-Based Case–Control Study of Cancer in California Firefighters’, American Journal of Industrial Medicine, Vol. 50, 2007, pp. 339-344.
47. ↑ Ilmarinen, J., ‘Towards a longer worklife! Ageing and the quality of worklife in the European Union’, Finnish Institute of Occupational Health, Ministry of Social Affairs and Health, Helsinki, 2006.
48. ↑ Tuomi, K., Ilmarinen, J., Eskelinen, L., Järvinen, E., Toikkanen, J., Klockars, M. Prevalence and incidence of diseases and work ability in different work categories of municipal occupations’. Scand J Work Environ Health, 17 Suppl 1:67-74, 1991
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50. ↑ Konttinen, J., Halonen, J., Niemi, J., Lindholm, H., Luukkonen, R., Toivonen, R.,Lusa, S., ‘Poliisien fyysisen toimintakyvyn arviointi ja kuntotestauskäytännöt -kehittämishankkeen loppuraportti. Poliisihallituksen julkaisusarja 1, Helsinki, 2011. [in Finnish]. Available at: [17]
51. ↑ Sörensen, L., Smolander, J., Louhevaara, V., Korhonen, O., Oja, P., ‘Physical activity, fitness and body composition of Finnish police officers: a 15-year follow-up study’, Occup med [Lond], Vol 50, 2000, pp. 3-10
52. ↑ Punakallio, A., Lusa, S., Luukkonen, R., Lindholm, H., ‘Physical Capacities for Predicting the Perceived Work Ability of Firefighters. In: Nygård C-H, Savinainen M, Kirsi T and Lumme-Sandt K eds. Age Management during the Life Course. Proceedings of the 4th Symposium on Work Ability, Tampere, Finland, June 6-9 2010, Tampere University Press, Tampere, 2011; pp. 150-160.
53. ↑ Vehmasvaara, P., ‘Ensihoitotyön fyysinen kuormittavuus ja ensihoitajien työkyvyn fyysisiä edellytyksiä arvioivan testistön kehittäminen’, Kuopion yliopiston julkaisuja D. Lääketiede, 324, 2004. [in Finnish]
54. ↑ Ilmarinen, J., Tuomi, K., Klockars, M., ‘Changes in the work ability of active employees over an 11-year period0146’. Scand J work Environ Health, Vol 23, suppl 1, 1997, pp 49-57.
55. ↑ Sörensen, L., Smolander, J., Louhevaara, V., Korhonen, O., Oja, P., ‘Physical activity, fitness and body composition of Finnish police officers: a 15-year follow-up study’, Occup med [Lond], Vol 50, 2000, pp. 3-10.
56. ↑ Lusa, S., Punakallio, A., Luukkonen, R., Factors Predicting Perceived Work Ability of Finnish Firefighters, In: Nygård C-H, Savinainen M, Kirsi T and Lumme-Sandt K eds. Age Management during the Life Course. Proceedings of the 4th Symposium on Work Ability, Tampere, Finland, June 6-9 2010. Tampere University Press, Tampere, 2011, pp. 161-169.
57. ↑ Lusa, S., Punakallio, A., Luukkonen, R., Factors Predicting Perceived Work Ability of Finnish Firefighters, In: Nygård C-H, Savinainen M, Kirsi T and Lumme-Sandt K eds. Age Management during the Life Course. Proceedings of the 4th Symposium on Work Ability, Tampere, Finland, June 6-9 2010. Tampere University Press, Tampere, 2011, pp. 161-169.
58. ↑ Pokorski, J., Niteck, J., Ilmarinen, J.,: Work ability index in fire fighters and medical doctors. In: Ilmarinen J, Lehtinen S, eds. Past, present and future of work ability. People and Work Research Reports 65. Finnish Institute of Occupational Health Helsinki, 2004, pp. 106-13.
59. ↑ Konttinen, J., Halonen, J., Niemi, J., Lindholm, H., Luukkonen, R., Toivonen, R.,Lusa, S., ‘Poliisien fyysisen toimintakyvyn arviointi ja kuntotestauskäytännöt -kehittämishankkeen loppuraportti. Poliisihallituksen julkaisusarja 1, Helsinki, 2011. [in Finnish]. Available at: [18]
60. ↑ Punakallio, A., Lusa, S., Luukkonen, R., Lindholm, H., ‘Physical Capacities for Predicting the Perceived Work Ability of Firefighters. In: Nygård C-H, Savinainen M, Kirsi T and Lumme-Sandt K eds. Age Management during the Life Course. Proceedings of the 4th Symposium on Work Ability, Tampere, Finland, June 6-9 2010, Tampere University Press, Tampere, 2011; pp. 150-160.
61. ↑ Punakallio, A., Lusa, S., Luukkonen, R., Lindholm, H., ‘Physical Capacities for Predicting the Perceived Work Ability of Firefighters. In: Nygård C-H, Savinainen M, Kirsi T and Lumme-Sandt K eds. Age Management during the Life Course. Proceedings of the 4th Symposium on Work Ability, Tampere, Finland, June 6-9 2010, Tampere University Press, Tampere, 2011; pp. 150-160.
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70. ↑ Oikeusministeriö [Ministry of Justice, Finland], 'Jokelan koulusurmat 7.11.2007' Tutkijalautakunnan raportti, Julkaisu 2009:2. The school shootings of Jokela 7.11.2007. Report of the Court of Inquiry. Available at: [24] [in Finnish]
71. ↑ Jackson, B.A., Baker, J.C., Ridgely, M.S., Bartis, J.T., & Linn, H.I., Protecting Emergency Responders. Volume 3 Safety Management in disaster and terrorism response. Cincinnati: Centres for Disease Control and Prevention National Institute for Occupational Safety and Health. Department of Health and Human Services, 2004. Available at: [25]
72. ↑ Strömberg, A., Johansson, L., Leino, T., Lusa, S., Mankkinen, T., ‘Pelastajien kokemukset Myyrmannin kauppakeskuksen pommiräjähdyksen pelastusoperaation aikana ja sen jälkeen - haastattelututkimus noin 1,5 vuotta tapahtuman jälkeen’. Palosuojelurahaston rahoittama hanke, Työterveyslaitos, Helsinki, 2005. Available at: [26][in Finnish]
73. ↑ Jackson, B.A., Baker, J.C., Ridgely, M.S., Bartis, J.T., & Linn, H.I., Protecting Emergency Responders. Volume 3 Safety Management in disaster and terrorism response. Cincinnati: Centres for Disease Control and Prevention National Institute for Occupational Safety and Health. Department of Health and Human Services, 2004. Available at: [27]
74. ↑ EU-OSHA - European Agency for Safety and Health at Work,. Emergency Services: A Literature Review on Occupational Safety and Health Risks’, 2011, Available at: [28]
75. ↑ EU-OSHA - European Agency for Safety and Health at Work,. Emergency Services: A Literature Review on Occupational Safety and Health Risks’, 2011, Available at: [29]
76. ↑ Sluiter, J.K., ‘High-demand jobs: Age-related diversity in work ability?’ Applied Ergonomics, Vol. 37, 2006, pp 429-440.

Links for further reading

EU-OSHA - European Agency for Safety and Health at Work, Emergency Services: A Literature Review on Occupational Safety and Health Risks, Publications Office of the European Union, Luxembourg, 2011. Available at: [30]