Musculoskeletal Injury Rates And Workers’ Compensation Costs In Male And Female Firefighters: A Comparative Analysis

Musculoskeletal injuries (MSIs) represent the highest reported injury category for career firefighters (FFs), yet limited data exist on MSI volume and cost, particularly for female FFs. Enhanced, gender-stratified injury surveillance could inform cost-effective MSI mitigation strategies. PURPOSE: To compare MSI claims volume and cost for male and female FFs across two fire departments: one using a direct access care model (DACM) and one with a traditional workers’ compensation model (TWCM). METHODS: Workers' compensation claims from FY2022-2023 were collected from two similarly sized fire departments (607 and 625 personnel), with one using a DACM and one a TWCM. Deidentified data excluded no-cost claims and non-MSI-related claims. Descriptive statistics were reported as normalized values per firefighter for departmental comparison. RESULTS: A total of 168 MSIs were reported, with 14 claims from female FFs (31.11% of 45 female personnel) and 144 from male FFs (12.97% of 1,187 male personnel). The DACM department incurred $428,892 in MSI costs, averaging $646.87/FF-year for males and $2,400.62/FF-year for females. In contrast, the TWCM department incurred a significantly higher MSI cost of $4,221,103, or $6,733.69/FF-year for males and $7,256.57/FF-year for females. The normalized claim cost across both departments was $320.08/FF-year for female injuries versus $17.71/FF-year for male injuries. CONCLUSIONS: Across both healthcare models, female FFs reported 2.4 times more injuries than male FFs and incurred on average 18 times higher claim costs, representing an additional $1,262 per claim per FF. Consistent with existing literature, the TWCM model resulted in substantially higher costs overall, with a 9.55-fold increase in workers' compensation expenses compared to the DACM model. Notably, female FF claims incurred higher proportional costs than their male counterparts within the DACM compared to the TWCM, highlighting an area requiring further investigation regarding mechanistic and cultural factors influencing injury occurrence and reporting that disproportionately impacts female FFs. These findings underscore the need for gender-specific MSI mitigation strategies in the fire service to better support cost parity and provide effective MSI prevention and treatment measures for all FFs. Supported by: This grant is funded by the Department of Homeland Security, Federal Emergency Management Agency