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Non-Fatal Firefighter Injuries

The Firefighter Injury Research and Safety Trends Reliability Study (FIRST-RS) is a follow-up study to the Firefighter Injury Research and Safety Trends (FIRST) project. FIRST & FIRST-RS were created to research and develop the minimum data elements necessary to conduct public health surveillance of non-fatal firefighter injuries in the United States. These investigations employed the following strategies: 

  • learn from existing firefighter data collection; 
  • explore how non-firefighter data sources can contribute to a comprehensive, national database of firefighter injuries; 
  • examine relevant federal, state, and local regulations that empower or challenge the functions of non-fatal firefighter injury data collection; 
  • develop and test data systems in the city of Philadelphia (Pennsylvania), Boston (Massachusetts), and the State of Florida; and 
  • provide recommendations for a national implementation plan for non-fatal injury data collection to FEMA.

The FIRST project proposal was made in response to the DHS/FEMA’s Assistance to Firefighter Grant Program Research and Development (AFG R&D) grant guidance calling for proposals that “focus on the design and feasibility of a new database system.”

Currently, firefighter data are gathered by multiple organizations, including the NFPA (National Fire Prevention Association) and NFIRS (National Fire Incident Reporting System). Firefighter injury estimates from NFPA and NFIRS are very different from one another and do not allow for analysis of the granular data the Fire Service is asking for: data that allow departments and states to compare themselves to others, and thoroughly investigate what is happening to their members.

Our team found that a national firefighter nonfatal injury data system can be developed through 3 potential paths: at the fire department-level, the state-level, and the national policy-level.

Fire Department-Level 

By linking injury reports to relevant existing data sources, a fire department-level system can be developed. This methodology was aptly demonstrated by the Philadelphia Fire Department pilot site. Through standardizing of the resulting master database, the data can be used for comparative purposes. At the department level, we found that linking dispatch run data, human resources demographic data, risk management data, and disability data were critical to create a robust and longitudinal understanding of injuries to firefighters. Data at the fire department-level yield the most detailed information, ranging from first aid/treated on-scene injuries, to hospitalizations and lost time injuries, to line of duty deaths. However, capturing this information is the most resource-intensive of the three paths because there are more than 30,000 fire departments in the United States, and linkage would have to be done individually for each of them.


The State of Florida also served as a pilot site providing tremendously accurate and complete workers’ compensation and hospital and emergency department discharge data. These data were linked to a statewide registry of firefighters thus creating a state-level system. This system offered a vision for faster national implementation than the fire department-level model. The limitation of the state-level system is that it does not contain the depth and breadth of injury data available at the department-level. However, efficiencies are gained in this model because there are only 50 states in which data linkage would need to be conducted.

National Policy-Level 

Policy can be changed to adopt standards for industry and occupation data collection in all hospital-level healthcare encounters in the United States. FIRST reached the halfway point in the policy adoption process by obtaining ‘Accredited Standards Committee X12’ approval. Achieving NUBC approval would enable all inpatient and emergency department hospital visits by career and volunteer firefighters to be systematically captured. The documentation of industry and occupation information in this fashion will not only benefit the fire service, but everyone who works. The politically charged reaction to the proposed policy changes hampered the initiative. The national coalition built around this initiative continued its efforts through the FIRST Reliability Study’s pilot study to assess the time it takes to capture industry and occupation during the patient registration process. This pilot study was conducted at two hospitals in Philadelphia, PA.

We continue to work with the Philadelphia Fire Department, Boston Fire Department, and the State of Florida while pursuing expansion sites.  As we consider new sites and enter into due diligence with them, we assess the potential for inclusion by applying the following selection criteria rubric. 

Considerations for State sites Considerations for Department sites
Demonstrated interest Demonstrated interest
Presence or absence of a state mandate Injury reports available (usually from Safety Office)
Workers’ compensation data available Workers’ compensation data available
Hospital discharge and/or Emergency department data Human resources demographic data
Firefighter registry (career, volunteer or both) Dispatch data (fire, EMS, other runs)
Ability to access unique identifiers for linkage Ability to access unique identifiers for linkage
Permission for Drexel project team to retain de-identified linked data Department size and area demographics (service area, age of built environment, etc.)
Permission for Drexel project team to retain de-identified linked data

The due diligence process calls for an assessment of access to the necessary existing data elements to develop these systems.  These datasets include, but are not limited to, a roster or registry of firefighters, first reports of injury, workers’ compensation claims, and hospital discharge data.

The FIRST project begins by identifying the availability of the necessary datasets at each potential expansion site, including sensitive personally identifiable information (data available on the individual level), and continues with an assessment of the federal, state, and local regulations, laws, and statutes that help or hinder access to those data elements.  Legal counsel from both parties work together to develop legal data-sharing agreements with flexibility on how to effectuate based on the legal assessment and both parties’ needs.  Once legal counsel is in agreement, the data are acquired and the FIRST project team goes on to perform data linkage and analysis. Upon completion of linkage and analysis with the expansion sites, the FIRST project team will be able to confirm or improve upon the previously developed minimum core data elements for the development of a comprehensive non-fatal injury reporting system.  These core data elements were recommended to FEMA for a national implementation plan at the end of the original FIRST pilot project (in Philadelphia and the State of Florida).

If you would like more information, please email Shannon Widman,