The nature of a firefighter’s job is hazardous, and involves rescuing people as well as preventing further escalation of dangerous situations. Hence, the health and well-being of firefighters is key to preserving public safety. However, extinguishing fires and rescuing people, along with the risks inherent in the nature of the job, can threaten firefighters’ health and safety (1). The main hazards include physical, chemical, and psychological stress, which are often unpredictable (23). In biomechanics, intrinsic as well as extrinsic energy that surpasses the normal threshold of physiological tolerance can cause injury in affected body regions (4). Firefighters often overexert themselves and are often in unpredictable, extremely dangerous situations, increasing their risk of occupational injuries.

Analysis of injury data from 6 federal agencies in the USA showed that the risk of injury to a firefighter on the job is 2–7 times higher than that of all other industrial workers (5). The National Fire Protection Association (NFPA) in the USA (2015) reported 63,350 firefighter injuries in 2014. Among those cases, 27,015 (43%) were fire-ground injuries corresponding to 20.8 injuries per 1,000 fire incidences (6). Falls, slips, and jumps were the most common causes of injuries, followed by over-exertion and strain. Six percent of injuries occurred enroute to or while returning from incident locations.

Generally, the duty of a firefighter can be categorized into extinguishing fires and participating in emergency medical services (EMS, including rescue work). Firefighting and EMS have somewhat different risks for work-related accidents. The injuries that require treatment in hospital emergency departments are almost 2 times higher in career firefighters compared to EMS workers (8.2 vs. 3.0 per 100 workers, respectively) (7). The relative risk (95% confidence interval [CI]) of injuries for fire suppression compared to EMS activities was 2.7 (2.35–3.06) in California compared to 0.6 (0.58–0.73) in New York City (8). Hence, injury characteristics between fire suppression and EMS workers vary widely according to the social system (8). In a study of the rate of compensated occupational injuries among firefighters in Korea, fire suppression caused more on-duty injuries than EMS; the rate of injuries per 100,000 workers was 193.5 in firefighters and 25.4 in EMS personnel (9). However, this study only investigated compensated cases, which did not provide a complete illustration of the nature of injury among firefighters. Furthermore, there has been a lack of investigation on the size and characteristics of injury among firefighters in Korea.

To determine the actual firefighter injury statistics in Korea, we conducted a survey of the nature of on-duty injuries among all firefighters in the country. Our aim was to provide as comprehensive an evaluation as possible to aid in improving safety strategies for firefighters, as well as to improve their health and well-being.

Our analyses of nationally representative data show that there were 116 injured workers and 372 cases of injuries per 1,000 firefighters that required clinical care during the past 12 months. The number of absence days from work due to injuries per 1,000 firefighters was 1,044 days. Roughly, an injury case needs 2.8 days of absence. The EMS and fire suppression workers have much more experience with injuries on duty compared to officer workers, and their odds of injuries were three and two times higher, respectively. Traffic accident is the most common cause of injuries and wound, cut, bleeding and bruising are the most common types of injuries across all job categories.

A study from Poland consisted of a survey with a nationally representative sample of 1,503 firefighters over a 3 years period. There were 352 injuries with 301 victims, responsible for 14,675 days of work absence (12), but the criteria for the injuries were not defined. The annual injury rate and days of absence were 70.3 and 2,937 days per 1,000 workers (12). One injury required approximately 40 or more absence days in the study. In our current study, the annual injury rate and days of absence were 372 and 1,044 days per 1,000 workers, which means less than 3 days of absence were needed for one injury. Because of the lack of definition for injuries, it is impossible to determine the factors responsible for the differences in the results. A survey using questionnaires was conducted with 462 Missouri Valley region firefighters. The definitive criteria for injury on duty included all cases for which an accident report was completed, the workers compensation program was invoked, or medical care was required (13). In the study, 115 firefighters experienced injuries on duty during the past 12 months. Roughly, 25% of all firefighter suffered from injuries. This is similar to a previous report by the US department of Commerce in 2004 (10). The researchers used all on-duty injuries during fire suppression, providing emergency medical service and rescue, and other services for preventing and investigating disasters. The injury rates per 1,000 firefighters were from 22.4 to 25.2 between 2000 and 2002. A retrospective study of Australian firefighters showed that 117 victims per 1,000 workers annually suffered from injuries on duty (14): the injuries were defined as cases when the worker reported the injury to their supervisor. The injury rate for our current analysis (11.6%) was much higher than the Poland report (7%), was similar to the Australian (11.7%) report, but was much lower than the Missouri Valley region and USA (22%-25%) report. Different criteria for injuries on duty might be one of the reasons for such differences. The injury criteria in the Missouri Valley region and USA report was similar to our current study, in that any injuries that needed hospital care were defined as injuries on duty. Hence, the reporting criteria for the Missouri Valley region and USA report, which included all injuries for which an accident report was completed, might be one of the reasons why they reported somewhat higher prevalence of injuries than our current study. Our analysis did not include cases of minor injury that did not need hospital care.

The individuals involved in fire suppression extinguish fires. EMS workers provide urgent care and transfer patients to the hospital system such as emergency departments at hospitals. They usually use ambulances not only for transfer but also to provide suitable care during transportation. The Missouri Valley region report showed that 33% of fire suppression, 21% of EMS, 17% of drivers, and 22% of officers suffered from injuries during the past 12 months (13). A retrospective analysis (8) showed that the rate of injury per 1,000 workers was 186 for fire suppression and 346 for EMS workers. The retrospective analysis showed large differences in the injury rate for fire suppression workers according to the region. The injury rates per 1,000 fire workers were 89 for Maine, 142 for California, 170 For New Jersey and 343 for New York (8). In contrast, EMS showed 1.6 times higher odds of injury compared to fire suppression in the current study: 168 vs. 113 per 1,000 workers, respectively, with an OR of 1.58. Although the definitions of injury may be different in each study, our current study shows differences in injury risk according to job characteristics. The absence days from work due to injuries showed fewer differences between EMS and fire suppression workers, as presented in Table 4. This suggests that the injury might be more severe in fire suppression compared to EMS. Hence, if we used somewhat different criteria for injury that reflect severity, our current results might be different.

A retrospective study of Australian firefighters using the registry database (14) reported that sprains represented almost 70% of all types of injuries. NFPA in the USA analyzed the registry data and reported that the most common type of injuries were strains, sprains and muscular pain (55%) followed by cuts, lacerations and bruises (15%) (6). The Missouri Valley region of the USA report showed that 76.3% of injuries were dislocations, strains and sprains while 13.0% was superficial injuries and open wounds in firefighters (13). A retrospective analysis (8) showed that 55% of total injuries were strains, sprains and tears. To summarize the previous studies, the findings suggested that strains, sprains and muscular pain were the most common types of injuries among firefighters. However, we observed somewhat different results for the common types of injuries. In the current study, wounds, cuts, bleeding, and bruises were the most common types of injuries followed by fractures. This might be due to our definition of injuries, which was all injuries on duty that needed hospital care, whereas other studies used registry data. Generally, registry data have somewhat strict criteria and involve reporting to supervisors or a claim system.

In terms of causes of injuries, falls, jumps and slips accounted for 29% of all injuries, while overexertion and strain accounted for 25% in the 2014 NFPA report. The report did not include the number of car accidents because the NFPA focused only on fire ground injuries. In the current study, commuting car accidents for firefighters was not included under workplace injuries, but car accidents were the most common cause of injuries, accounting for 25% of all cases. With car accidents excluded, falls, jumps and slips were the most common causes of injuries, similar to the USA. The next most common cause of injuries was exposure to fires. Contrary to reports from other centuries, overexertion and strain did not account for a large number of injuries in the current study. This correlated with the observation that strains, sprains and muscular pain were not the most common types of injuries in the current study. We investigated the prevalence of back pain among firefighters (data not shown in current results), and almost 50% of firefighters reported experiencing back pain. These injuries fell under the category of overexertion, strains, sprains and muscular pain that did not need urgent hospital care in the current study.

Recently, some studies reported that noise exposure can aggravate the risk of occupational injury, and the association was related to the degree of exposure (1516). This may be because noise blocks communication with co-workers and masks warning signals at the fire ground (1516). If workers have hearing defects, the risk of occupational injury may be increased (17). High frequency noise can be caused by sirens while driving emergency cars or fire trucks, when handling various equipment such as water pumps and saws or with sudden explosions at the fire ground (18). Hence, to prevent occupational injuries for firefighters, plans and programs for noise exposure and hearing defects are needed.

A study from the USA using the Workers Compensation database reported that overall injury rates for females were lower than those for males (19). The trend was significant in all major industries, but was not observed in the service and agriculture sectors. In terms of injury types, carpal tunnel syndrome as well as burns, sprains and fractures are more common types of injuries in females compared to males. Some articles show that the reporting and claim rate for occupational injuries was higher in females compared to males (20). There is a possibility that the occurrence and types of injuries in firefighters might be different according to gender. Because our current investigation only used male firefighters, careful considerations are needed to generalize our results to female firefighters.

Younger firefighters were found to be at greater risk of injuries in the current study, indicating that low job experience increases the risk of injuries. In contrast, a study involving university employees showed that older populations had a higher risk of injuries compared to younger populations (20). Universities might have different demographic characteristics of employees to firefighters, such as age and gender, as well as heterogenic job differences (professor, student and service workers). However, the study did not include stratification analysis for gender, job and other factors. A different study involved a comprehensive investigation of the risk of injuries and other job factors (21). Short or temporary employment periods are related to a lack of knowledge about hazards, consequently, less job experience increased the risk of occupational injuries (21). Our current results of higher risk in younger firefighters suggest that detailed education programs are needed for younger or beginner firefighters to reduce occupational injuries.

A one year follow up prospective study demonstrated that individual factors such as obesity (body mass index and body fat amount), smoking habits, aerobic power and body flexibility were closely related to occupational injury (22). A cross sectional and prospective study using almost two thousand interview respondents did not show a relationship between heavy alcohol drinking and occupational injuries, although there was evidence that alcohol-induced reduction in motor and decision functions are risk factors of occupational injuries (23). However, the study lacked data about life threatening injuries compared to minor injuries because of the nature of the interview study design. Smoking habit was related to occupational injuries in a prospective study using 2,537 postal employees (24). In the current study, we did not find a significant association between occupational injuries and individual characteristics for smoking (non-smoker vs. current smoker), alcohol drinking, and regular exercise. The homogeneity of the participants, as we only used male firefighters, might be the reason for this result.

Our current nationally representative study showed the amounts, types and causes of injuries in firefighters. However, we should consider the limitations to understand and generalize our results. First of all, we used self-reported questionnaires to measure the amounts, types and causes of injuries. Furthermore, our injury criteria included all kinds of injuries on duty that needed hospital care and occurred in relation to the job. Actually, car accidents were included in the current study as injuries on duty if the car usage was related to the job. However, some previous reports focused only on fire ground injuries and used registry data such as workers’ compensation or formalized report systems. Hence, direct comparison without understanding our limitations can lead to serious errors in generalization. Second, self-reported methods involve a certain amount of recall bias. Third, the number as well as severity of fire accidents or disasters in the past 12 months was not adjusted to calculate the amount of injuries. Generally, the number or severity of fire accidents, fire resistance or disasters affect the risk of injuries among firefighters (25). Fourth, as we discussed above, different survey methods and injury criteria should be carefully considered before generalizing or comparing our results to other populations.

In summary, our nationally representative analyses show the amount, types and causes of injuries among firefighters. Among firefighters, fire suppression and EMS workers experienced almost 2 and 3 times more injuries on duty compared to officers. We observed different characteristics of injuries compared to previous reports from other countries and the differences were due to differences in study design. The use of nationally representative data for Korean male firefighters is the main strength of our current study. Therefore, we hope our report can help in the development of preventive strategies for firefighters’ safety and health.