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Spotlight on female firefighter injuries

A new North American study suggests that health and safety policies and protocols developed for male firefighters do not provide the same level of protection for women who choose firefighting careers.

Published in May 2022 in the journal Frontiers in Public Health, the peer-reviewed article “Female Firefighter Work-Related Injuries in the United States and Canada: An Overview of Survey Responses” explored circumstances leading to work-related injuries for female firefighters in the U.S. and Canada as well as the impact of demographic characteristics, lifestyle and firefighting experiences.

The study – based on a survey of 1,160 active female firefighters from June, 2019 to July, 2020 along with a comprehensive literature review – points out the unique aspects of work-related injuries for women when compared to men in firefighting, and a lack of female-specific equipment and protocols to protect women.

“Our survey results indicate that work-related injuries are a significant issue among female firefighters in the U.S. and Canada,” said lead author Samantha Pawer, of the BC Injury Research and Prevention Unit at British Columbia Children’s Hospital. “The intent is to arm decision-makers with information that aids them in developing effective protocols and policies that reduce injury risk for female firefighters. The work will also add to the limited body of research currently available on female firefighter injury.”

Based in B.C., the study team included Pawer, Kate Turcotte, Ediriweera Desapriya, Alex Zheng, Amanat Purewal, Alyssa Wellar, Kenneth Kunz, Len Garis, Larry Thomas and Ian Pike. The authors brought their knowledge of injury prevention, fire fighting and medicine to the work, with affiliations to the BC Injury Research and Prevention Unit at British Columbia Children’s Hospital, the School of Culture, Media and Society at the University of the Fraser Valley, Surrey Fire Service and the Department of Pediatrics at the University of British Columbia, as well as expertise in medical oncology and firefighter cancer.

Study Background

Based on 2018 statistics, women account for about eight per cent of all U.S. firefighters and four per cent of career firefighters, with similar trends observed in Canada. The two countries had about 95,145 female volunteer and career firefighters in total in 2018, with 93,700 of those in the U.S. and 1,445 in Canada.

Data collected from 2010 to 2014 in the U.S. indicated similar overall injury rates for male and female firefighters, although at that time, men were making up about 95 per cent of injured firefighters treated by U.S. emergency departments.

Despite the gradually growing numbers of women in the ranks, little research has been conducted specifically on female firefighter work-related injuries. As a step toward addressing this gap, the research team developed a detailed online survey for female career and volunteer firefighters and promoted it through industry blogs and magazines, including Firefighting in Canada, as well as North America firefighting associations and fire/rescue research and health organizations.

Participants provided their consent and answered 85 questions approved by the University of British Columbia Children’s and Women’s Research Ethics Board. The survey was available in English and French from June 7, 2019 to July 19, 2020, using REDCap electronic data capture tools hosted by the Provincial Health Services Authority in B.C.

Survey results were considered alongside a comprehensive literature review of 30 relevant studies in the U.S. and Canada.

Findings Highlight Female-specific Risks

The study noted a general lack of female-specific PPE designed for women’s body shapes, sizes and compositions. Ill-fitting equipment impairs movement, reduces agility and does not adequately protect against injury. Despite this, only a quarter of female firefighters reported having access to female-specific PPE, and 69 per cent of career and 80 per cent of volunteer female firefighters were injured while using the PPE available to them.

Overall, a higher proportion of female firefighters in the U.S. suffered injury than those in  Canada, reflecting a similar trend for overall firefighter injuries. The data also indicates that female firefighters in the U.S. have more of the characteristics linked with higher rates of firefighter workplace injury. For example, when compared to their counterparts in Canada, they are older, have higher body mass indexes, had attended more fires and toxic exposures, and on average had been on the job longer.

Other lifestyle triggers for injury included smoking and alcohol consumption. A slightly higher proportion of injured respondents reported tobacco and alcohol use. Previous research found that 16.5 per cent of female firefighters who consume alcohol were problem drinkers, which are 40 per cent more likely to report work-related injuries. Female firefighters with a history of smoking were also found to have higher odds of injury.

Overall, human error contributed the most to injury, followed by firefighter fatigue. When it comes to injury types, the most common identified were strains, strains and muscle pain, followed by dislocations and fractures, and finally, wounds, cuts, bleeds and bruises. This was consistent with other U.S. research on female firefighters. Extremities were most often injured, followed by backs and shoulders/chests.

In both countries, female career firefighters and those assigned to an engine made up the largest proportion of injuries. Based on the responses, the fire ground and training both present a high risk of injury for female firefighters. As well, as severity of injury increased, company and station officers made up a larger proportion than fire ground firefighters – consistent with studies on primarily male firefighters.

It is important to note that the nature of the study results in some limitations. Accuracy cannot be verified because data was self-reported. In some cases, respondents may not have been comfortable answering questions honestly, or may have forgotten about common minor injuries such as bruises and cuts. Conversely, the study may not have captured severely injured or deceased firefighters. Additionally, the survey only captured an estimated 0.8 per cent of female firefighters in the U.S. and 5.8 per cent in Canada.

Implications and Next Steps

Reform is needed for female firefighters to work safely, including increased availability of female-specific PPE, appropriate protocols to prevent overexertion, and female-specific safety practices at the individual and organizational level, with increased attention to training and the fire ground. Focused efforts in these areas will reduce strain on the fire service in terms of chronic injury and time-loss claims.

There would also be value in programs that promote higher overall health, fitness and exercise, all of which are related to increased operational readiness and reduced injury risk.

The findings also have implications for firefighter recruitment. While a growing number of departments have adjusted recruitment practices to attract more women and diverse populations, the overall slow growth in female candidates indicates there is still work to do in welcoming them into the fire service. Canadian female firefighters, for example, reported discrimination and hostility at work, and difficulties performing physically demanding duties amid an environment with a lower tolerance of requests for assistance.

This challenging work environment is a female-specific issue in firefighting and likely contributes to injuries among women. Based on the survey results, policy to protect female firefighters is slow to evolve. For example, even though female-specific challenges had previously been reported, only nine per cent of the 339 respondents who had an injury-time loss claim reported that a new policy following their injury.

“The study results brought many insights, but also revealed more questions,” noted Pawer. “We want to dig deeper into the circumstances of injuries, personal characteristics and other factors to more accurately pinpoint when, why and how female firefighters are being injured. The answers will play a role in a larger conversation about the fire service adapting its policies and practices to reflect the makeup and values of a modern-day department, not one that existed decades ago.”

Further work on this topic could include looking at additional variables that could influence injury, such as when they occur during the course of a career. Other areas to explore include a closer examination of the incidence, severity and timing of work-related injuries by service function and by gender, in order to directly compare the female and male firefighter experience.

A focus on female-specific work-related cancers will also form part of the next stage of research.

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Larry Thomas is the Fire Chief for the City of Surrey B.C. and is an Executive Chief Fire Officer, ECFO and Chartered Manager, C. Mgr with 31 years’ experience. He has a background in Science from Simon Fraser University and Economics from Douglas College. Contact him at LSThomas@surrey.ca

Len Garis is director of research for the National Indigenous Fire Safety Council, Fire Chief (ret) for the City of Surrey, B.C., associate scientist emeritus with the B.C. Injury Research and Prevention Unit, and a member of the Affiliated Research Faculty at John Jay College of Criminal Justice in New York. Contact him at Lwgaris@outlook.com  

Ian Pike is a professor with the Department of Pediatrics in the Faculty of Medicine at the University of British Columbia, Director of the British Columbia Injury Research and Prevention Unit, Investigator for the BC Children’s Hospital Research Institute, and Co-Executive Director for the Community Against Preventable Injuries. Contact him at ipike@bcchr.ca.