The severity of recent wildfire seasons underscores the importance of a healthy firefighting workforce, and awareness of the psychiatric burden borne by public safety workers exposed to traumatic events has grown in recent years. Musculoskeletal disorders (MSDs) are the most common type of occupational injury or illness suffered by firefighters.

A 2010 RAND study on MSDs in California firefighters confirmed that firefighters experience MSDs at a significantly elevated rate compared to other workers, even compared to workers in other high-risk jobs. The California Commission on Health and Safety and Workers’ Compensation (CHSWC) commissioned RAND to update the analyses from the 2010 RAND study. and consider the impacts on outcomes for firefighters with MSDs.

According to the new 2019 Study, as expected, firefighters continue to face elevated risk of work-related musculoskeletal disorders, especially injuries to the lower extremities and trunk.

As in the 2010 study, firefighters with musculoskeletal disorders appear to have less severe economic consequences from their injuries than do workers in similar occupations. Post-injury earnings relative to in the second year after injury were sharply lower in comparable occupations: 88 percent for police, 85 percent for other public-sector workers, and 87 percent for private-sector workers.

This is an unusual pattern of post-injury outcomes, both because at-injury employment is nearly as high as overall employment and because it is much higher than observed in comparison occupations. Fire departments appear to do better than other employers – even public-sector employers – at retaining injured workers.

DEU ratings and statutory permanent disability benefits rose for firefighters after SB 863 implementation. Firefighters have relatively high occupational adjustments, and their slightly older age at injury may also results in more favorable adjustments under the current disability rating schedule.

Firefighters with musculoskeletal disorders rarely receive treatment or permanent disability benefits for PTSD or other psychiatric conditions. A troubling, caveat is that mental health stigma could lead to the patterns observed in these data. Stigma is widely recognized as a barrier to diagnosis and treatment of PTSD and mental disorders more generally among public-safety workers, but the scope of this study did not encompass measurement of firefighter mental health independently of care provided through workers’ compensation.

RAND did not find evidence that treatment caps on chiropractors, occupational therapy, and physical medicine had a substantial impact on most workers.