Occupational exposure to respirable crystalline silica among US metal and nonmetal miners, 2000-2019.

BACKGROUND: In metal and nonmetal (M/NM) mines in the United States, respirable crystalline silica (RCS) exposures are a recognized health hazard and a leading indicator of respiratory disease. This study describes hazardous exposures that exceed occupational exposure limits and examines patterns of hazardous RCS exposure over time among M/NM miners to better inform the need for interventions. METHODS: Data for this study were obtained from the Mine Safety and Health Administration (MSHA) Open Government Initiative Portal for the years 2000-2019, examining respirable dust samples with MSHA-measured quartz concentration >1%. Descriptive statistics for RCS were analyzed for M/NM miners by year, mine type, sector, commodity, occupation, and location in a mine. RESULTS: This study found the overall geometric mean (GM) for personal exposures to RCS was 28.9 µg/m3 (geometric standard deviation: 2.5). Exposures varied significantly by year, mine type, sector, commodity, occupation, and location in a mine. Overall, the percentages of exposures above the MSHA permissible exposure limit (PEL for respirable dust with >1% quartz, approximately 100 µg/m3 RCS) and the National Institute for Occupational Safety and Health RCS recommended exposure limit (REL, 50 µg/m3 ) were 11.8% and 27.3%, respectively. GM exposures to RCS in 2018 (45.9 µg/m3 ) and 2019 (52.9 µg/m3 ) were significantly higher than the GM for all years prior. The overall 95th percentile of RCS exposures from 2000 to 2019 was 148.9 µg/m3 , suggesting a substantial risk of hazardous exposures above the PEL and REL during the entire period analyzed. CONCLUSIONS: The prevalence of high exposures to RCS among M/NM miners continues in the past 20 years and may be increasing in certain settings and occupations. Further research and intervention of the highest exposures are needed to minimize the risks of acquiring silica-induced respiratory diseases.

NIOSH Risk-Based Model to Resume Field Research and Public Health Service in 2020 During the COVID-19 Pandemic.

In the early months of the COVID-19 pandemic, field research and public health service work conducted by the National Institute for Occupational Safety and Health (NIOSH) was put on hold. During this time, NIOSH developed a risk-based model to resume fieldwork, balancing the public health benefit of such fieldwork with the risks of severe acute respiratory syndrome coronavirus 2 exposure and transmission. We describe our experiences with this model, along with the broader public health significance of the methods used to inform risk management decisions. (Am J Public Health. 2022;112(8):1138-1141. https://doi.org/10.2105/AJPH.2022.306882).

Automobile injury trends in the contemporary fleet: Belted occupants in frontal collisions.

Objective: As vehicle safety technologies and evaluation procedures advance, it is pertinent to periodically evaluate injury trends to identify continuing and emerging priorities for intervention. This study examined detailed injury distributions and injury risk trends in belted occupants in frontal automobile collisions (10 o'clock to 2 o'clock) using NASS-CDS (1998-2015). Methods: Injury distributions were examined by occupant age and vehicle model year (stratified at pre- and post-2009). Logistic regression models were developed to examine the effects of various factors on injury risk (by body region), controlling for delta-V, sex, age, height, body mass index (BMI), vehicle model year (again stratified at 2009). Results: Among other observations, these analyses indicate that newer model year vehicles (model year [MY] 2009 and later) carry less risk of Abbreviated Injury Scale (AIS) 2+ and AIS 3+ injury compared to older model year vehicles, with odds ratios of 0.69 (AIS 2+) and 0.45 (AIS 3+). The largest reductions in risk between newer model year vehicles and older model year vehicles occur in the lower extremities and in the risk of skull fracture. There is no statistically significant change in risk of AIS 3+ rib fracture or sternum injury between model year categories. Females are at greater risk of AIS 2+ and AIS 3+ injury compared to males, with increased risk across most injury types. Conclusions: For belted occupants in frontal collisions, substantial reductions in injury risk have been realized in many body regions in recent years. Risk reduction in the thorax has lagged other body regions, resulting in increasing prevalence among skeletal injuries in newer model year vehicles (especially in the elderly). Injuries also remain common in the arm and hand/wrist for all age ranges studied. These results provide insight into where advances in the field have made gains in occupant protection and what injury types remain to be addressed.

Efficacy of a proactive health and safety risk management system in the fire service.

BACKGROUND: This study evaluated the efficacy of a fire department proactive risk management program aimed at reducing firefighter injuries and their associated costs. METHODS: Injury data were collected for the intervention fire department and a contemporary control department. Workers' compensation claim frequency and costs were analyzed for the intervention fire department only. Total, exercise, patient transport, and fireground operations injury rates were calculated for both fire departments. RESULTS: There was a post-intervention average annual reduction in injuries (13%), workers' compensation injury claims (30%) and claims costs (21%). Median monthly injury rates comparing the post-intervention to the pre-intervention period did not show statistically significant changes in either the intervention or control fire department. CONCLUSIONS: Reduced workers' compensation claims and costs were observed following the risk management intervention, but changes in injury rates were not statistically significant.

Crash safety concerns for out-of-position occupant postures: A look toward safety in highly automated vehicles.

OBJECTIVE: Highly automated vehicle occupants will all be passengers and may be free to ride while in postures for which existing occupant safety systems such as seat belts and airbags were not originally designed. These occupants could therefore face increased risk of injury when a crash occurs. Given that current vehicles are capable of supporting a variety of occupant postures outside of the normal design position, such as reclined or turned passengers, an evaluation of current field data was performed to better understand the risks of being out of position. METHODS: We investigated the frequency, demographics, and injury outcomes for out-of-position occupants using NASS-CDS. A matched analysis was performed to compare injury outcomes for out-of-position passengers with in-position drivers involved in similar crashes. Finally, case studies for out-of-position occupants were examined in the Crash Injury Research (CIREN) database. RESULTS: Only 0.5% of occupants in NASS-CDS with a coded posture were out of position at the time of crash. Of the out-of-position occupants, being turned or seated sideways was almost as likely as being reclined. Out-of-position occupants were younger and less likely to be belted than their in-position counterparts. Analysis of the injury data indicated a trend that being out of position was associated with an elevated risk for serious injury. However, the number of out-of-position occupants was too small to provide a definitive or statistically significant conclusion on injury outcome. CONCLUSION: Though highly automated vehicles may eventually reduce the number of crashes and traffic fatalities in the future, there will be a transition period when these vehicles remain at risk from collisions with human-driven vehicles. These crashes could cause higher than anticipated rates of injury if occupants are less likely to be belted or tend to be in positions for which restraints are not optimized. This study highlights the need for future research on occupant response and countermeasure design for out-of-position occupants.

Development of thoracic injury risk functions for the THOR ATD.

The Test Device for Human Occupant Restraint (THOR) 50th percentile male anthropomorphic test device (ATD) aims to improve the ability to predict the risk of chest injury to restrained automobile occupants by measuring dynamic chest deflection at multiple locations. This research aimed to describe the methods for developing a thoracic injury risk function (IRF) using the multi-point chest deflection metrics from the 50th percentile male THOR Metric ATD with the SD-3 shoulder and associating to post-mortem human subjects (PMHS) outcomes that were matched on identical frontal and frontal-oblique impact sled testing conditions. Several deflection metrics were assessed as potential predictor variables for AIS 3+ injury risk, including a combined metric, called PC Score, which was generated from a principal component analysis. A parametric survival analysis (specifically, accelerated failure time (AFT) with Weibull distribution) was assessed in the development of the IRF. Model fit was assessed using various modeling diagnostics, including the area under the receiver operating characteristic curve (AUC). Models based on resultant deflection consistently exhibited improved fit compared to models based on x-axis deflection or chord deflection. Risk functions for the THOR PC Score and Cmax (maximum resultant deflection) were qualitatively equivalent, producing AUCs of 0.857 and 0.861, respectively. Adjusting for the potential confounding effects of age, AFT survival models with Cmax or PC Score as the primary deflection metric resulted in the THOR injury risk models with the best combination of biomechanical appropriateness, potential utility and model fit, and may be recommended as injury predictors.

Implementing risk management to reduce injuries in the U.S. Fire Service.

INTRODUCTION: Risk management, a proactive process to identify and mitigate potential injury risks and implement control strategies, was used to reduce the risk of occupational injury in a fire department. The objective of this research was to study the implementation of the risk management process for future replication. A second objective was to document changes in fire personnel's knowledge, attitudes, and behaviors related to the selected control strategies that were implemented as part of the risk management process. METHOD: A number of control strategies identified through the risk management process were implemented over a 2-year period beginning in January 2011. Approximately 450 fire personnel completed each of the three cross-sectional surveys that were administered throughout the implementation periods. Fire personnel were asked about their awareness, knowledge, and use of the control strategies. RESULTS: Fire personnel were generally aware of the control strategies that were implemented. Visual reminders (e.g., signage) were noted as effective by fire personnel who noticed them. Barriers to use of specific control strategies such as new procedures on the fireground or new lifting equipment for patient transfer included lack of knowledge of the new protocols, lack of awareness/access to/availability of the new equipment, and limited training on its use. Implementation challenges were noted, which limited self-reported adherence to the control strategies. CONCLUSIONS: Fire personnel generally recognized the potential for various control strategies to manage risk and improve their health and safety; however, implementation challenges limited the effectiveness of certain control strategies. The study findings support the importance of effective implementation to achieve the desired impacts of control strategies for improving health and safety. PRACTICAL APPLICATIONS: Employees must be aware of, have knowledge about, and receive training in safety and health interventions in order to adopt desired behaviors.

Functional recovery patterns in seriously injured automotive crash victims.

OBJECTIVE: The functional capacity index (FCI) is designed to predict functional loss 12 months post-injury for each injury in the 2008 Abbreviated Injury Scale (AIS) manual on a scale from 0 (death) to 100 (full recovery), but FCI has never been validated. This study compared FCI predicted loss with patient-reported 12-month outcomes as measured through the Short Form 36 (SF-36) health assessment survey. METHODS: Using follow-up data collected on 2,858 adult car crash occupants in the Crash Injury Research and Engineering Network (CIREN) database, we compared FCI predicted outcomes to occupants' Physical Component Summary (PCS) scores, which are weighted averages of the SF-36 items addressing physical function. Our analyses included descriptive statistics, plots of typical recovery patterns, and a mixed effects regression model that describes PCS as a function of FCI, demographics, comorbidities, and injury pattern while also adjusting for the occupants' pre-crash physical capabilities. We further examined injuries in patients who report a significant drop in PCS 12 months post-crash despite being predicted to fully recover. RESULTS: At baseline, the CIREN population exhibited PCS scores similar to the overall population (mean = 51.1, SD = 10.3). Twelve months post-crash, occupants with predicted impairment (FCI < 100) report a substantial decrease in physical function, and those who were predicted to fully recover still report some, albeit less, impairment. In the multivariate mixed-effects regression model, FCI is a strongly significant (P-value <.0001) predictor of PCS, with each 1-point drop in FCI predicting a 0.27-point drop in PCS. Maximum AIS severities in the head, spine, and lower extremity body regions were also significantly associated with PCS (P-values <.05). Among occupants who were expected to fully recover but who report a significant drop in PCS at 12 months, spinal fractures without cord involvement account for 5 of the 10 most common AIS 2+ injuries. CONCLUSIONS: FCI was associated with 12-month outcomes but may not adequately describe the recovery from some head, spine, and lower extremity injuries. Some occupants who were expected to recover still report functional loss 12 months post-injury.

Fire fit: assessing comprehensive fitness and injury risk in the fire service.

PURPOSE: This study sought to develop a comprehensive measure of fitness that is predictive of injury risk and can be used in the fire service to assess individual-level health and fit-for-duty status. METHODS: A retrospective occupational cohort of 799 career fire service employees was observed over the years 2005-2009. An equally weighted score for comprehensive fitness was calculated based on cardiovascular fitness, muscular strength, endurance, flexibility, and body composition. Repeated measures survival analyses were used to estimate the risk of any injury, sprain or strain, and exercise-related injuries in relation to comprehensive fitness. RESULTS: A well-distributed comprehensive fitness score was developed to distinguish three tiers of overall fitness status. Intraclass correlations identified flexibility, total grip strength, percent body fat, and resting heart rate as the most reliable fitness metrics, while push-ups, sit-ups, and aerobic capacity demonstrated poor reliability. In general, individuals with a lower comprehensive fitness status had an increased injury risk of injury as compared to the most fit individuals. The risk of any injury was 1.82 (95% CI 1.06-3.11) times as likely for the least fit individuals, as compared to individuals in the top fire fitness category, increasing to 2.90 (95% CI 1.48-5.66) when restricted to sprains and strains. CONCLUSIONS: This 5-year analysis of clinical occupational health assessments enabled the development of a relevant metric for relating comprehensive fitness with the risk of injury. Results were consistent with previous studies focused on cardiorespiratory fitness, but also less susceptible to inter-individual variability of discrete measurements.

Implications of Functional Capacity Loss and Fatality for Vehicle Safety Prioritization.

OBJECTIVE: We investigate the use of the Functional Capacity Index (FCI) as a tool for establishing vehicle safety priorities by comparing the life year burden of injuries to the burden of fatality in frontal and side automotive crashes. We demonstrate FCI's utility by investigating in detail the resulting disabling injuries and their life year costs. METHODS: We selected occupants in the 2000-2013 NASS-CDS database involved in frontal and side crashes, merged their injuries with FCI, and then used the merged data to estimate each occupant's overall functional loss. Lifetime functional loss was assessed by combining this measure of impairment with the occupants' expected future life spans, estimated from the Social Security Administration's Actuarial Life Table. RESULTS: Frontal crashes produce a large number of disabling injuries, particularly to the lower extremities. In our population, these crashes are estimated to account for approximately 400,000 life years lost to disability in comparison with 500,000 life years lost to fatality. Victims of side crashes experienced a higher rate of fatality but a significantly lower rate of disabling injury (0.3 vs. 1.0%), resulting in approximately 370,000 life years lost to fatality versus 50,000 life years lost to disability. CONCLUSIONS: The burden of disabling injuries to car crash survivors should be considered when setting vehicle safety design priorities. In frontal crashes this burden in life years is similar to the burden attributable to fatality.

Survival Model for Foot and Leg High Rate Axial Impact Injury Data.

OBJECTIVES: Understanding how lower extremity injuries from automotive intrusion and underbody blast (UBB) differ is of key importance when determining whether automotive injury criteria can be applied to blast rate scenarios. This article provides a review of existing injury risk analyses and outlines an approach to improve injury prediction for an expanded range of loading rates. This analysis will address issues with existing injury risk functions including inaccuracies due to inertial and potential viscous resistance at higher loading rates. METHODS: This survival analysis attempts to minimize these errors by considering injury location statistics and a predictor variable selection process dependent upon failure mechanisms of bone. Distribution of foot/ankle/leg injuries induced by axial impact loading at rates characteristic of UBB as well as automotive intrusion was studied and calcaneus injuries were found to be the most common injury; thus, footplate force was chosen as the main predictor variable because of its proximity to injury location to prevent inaccuracies associated with inertial differences due to loading rate. A survival analysis was then performed with age, sex, dorsiflexion angle, and mass as covariates. This statistical analysis uses data from previous axial postmortem human surrogate (PMHS) component leg tests to provide perspectives on how proximal boundary conditions and loading rate affect injury probability in the foot/ankle/leg (n = 82). RESULTS: Tibia force-at-fracture proved to be up to 20% inaccurate in previous analyses because of viscous resistance and inertial effects within the data set used, suggesting that previous injury criteria are accurate only for specific rates of loading and boundary conditions. The statistical model presented in this article predicts 50% probability of injury for a plantar force of 10.2 kN for a 50th percentile male with a neutral ankle position. Force rate was found to be an insignificant covariate because of the limited range of loading rate differences within the data set; however, compensation for inertial effects caused by measuring the force-at-fracture in a location closer to expected injury location improved the model's predictive capabilities for the entire data set. CONCLUSIONS: This study provides better injury prediction capabilities for both automotive and blast rates because of reduced sensitivity to inertial effects and tibia-fibula load sharing. Further, a framework is provided for future injury criteria generation for high rate loading scenarios. This analysis also suggests key improvements to be made to existing anthropomorphic test device (ATD) lower extremities to provide accurate injury prediction for high rate applications such as UBB.

Establishing a proactive safety and health risk management system in the fire service.

BACKGROUND: Formalized risk management (RM) is an internationally accepted process for reducing hazards in the workplace, with defined steps including hazard scoping, risk assessment, and implementation of controls, all within an iterative process. While required for all industry in the European Union and widely used elsewhere, the United States maintains a compliance-based regulatory structure, rather than one based on systematic, risk-based methodologies. Firefighting is a hazardous profession, with high injury, illness, and fatality rates compared with other occupations, and implementation of RM programs has the potential to greatly improve firefighter safety and health; however, no descriptions of RM implementation are in the peer-reviewed literature for the North American fire service. METHODS: In this paper we describe the steps used to design and implement the RM process in a moderately-sized fire department, with particular focus on prioritizing and managing injury hazards during patient transport, fireground, and physical exercise procedures. Hazard scoping and formalized risk assessments are described, in addition to the identification of participatory-led injury control strategies. Process evaluation methods were conducted to primarily assess the feasibility of voluntarily instituting the RM approach within the fire service setting. RESULTS: The RM process was well accepted by the fire department and led to development of 45 hazard specific-interventions. Qualitative data documenting the implementation of the RM process revealed that participants emphasized the: value of the RM process, especially the participatory bottom-up approach; usefulness of the RM process for breaking down tasks to identify potential risks; and potential of RM for reducing firefighter injury. CONCLUSIONS: As implemented, this risk-based approach used to identify and manage occupational hazards and risks was successful and is deemed feasible for U.S. (and other) fire services. While several barriers and challenges do exist in the implementation of any intervention such as this, recommendations for adopting the process are provided. Additional work will be performed to determine the effectiveness of select controls strategies that were implemented; however participants throughout the organizational structure perceived the RM process to be of high utility while researchers also found the process improved the awareness and engagement in actively enhancing worker safety and health.

Nature and etiology of hollow-organ abdominal injuries in frontal crashes.

UNLABELLED: Injuries to the hollow organs of the lower digestive system carry substantial risk of complication due to infection and blood loss, and commonly require invasive abdominal surgery to diagnose and treat. The causes of, and risk factors for, lower abdomen injury in automobile collisions are poorly understood. The goal of this study was to investigate the risk factors and potential mechanisms of hollow-organ, lower abdomen injury in belted automobile occupants in frontal collisions. A field survey data analysis was performed to examine the relationship between various occupant and collision factors and the risk of moderate or greater severity injury (i.e., Abbreviated Injury Scale, AIS 2+) to the small intestine, large intestine, or mesentery among belted occupants involved in frontal collisions. Descriptive and comparative risk factor analyses were performed with data originating from that National Automotive Sampling System Crashworthiness Data System (NASS-CDS) over the years 2000-2011. Multivariable logistic regression models were developed to describe the effects of these factors on hollow-organ injury risk. Potential injury mechanisms were further investigated through in-depth examination of select cases exhibiting hollow-organ injuries from the Crash Investigation Research and Engineering Network (CIREN). The inclusion criteria yielded 25,407 individual cases from NASS-CDS, representing a weighted population of 11,373,358 exposed automobile occupants. Within this dataset, 143 cases (weighted frequency: 7962 occupants) exhibited AIS 2+ injury to hollow abdominal organs. Multivariable regression analysis indicated a statistically significant increased risk of moderate or greater severity injuries to the hollow organs of the abdomen with increased in ΔV (odds ratio (OR) 1.07, 95% confidence interval: 1.06-1.09) and age (OR: 1.03, 1.01-1.06). Albeit non-statistically significant, a positive association between BMI and injury risk was observed, especially among obese individuals (OR: 3.55, 0.82-15.2). No association was observed for gender or seated location within the vehicle. RESULT: from this study indicate that hollow abdominal organ injury is a universal problem in frontal collisions, not confined to a specific gender or seating location. Examination of CIREN cases suggests these types of injuries are associated with direct loading of the lower abdomen by the lap belt, either through poor initial belt positioning or through a "submarining" type of kinematic where the lap belt slips off of the pelvis and loads into the abdomen. Potential countermeasures against hollow-organ abdominal injury should include measures to improve initial lap belt fit, and to retain engagement of the lap belt on the pelvis throughout the collision event.

Statistical considerations in the development of injury risk functions.

OBJECTIVE: We address 4 frequently misunderstood and important statistical ideas in the construction of injury risk functions. These include the similarities of survival analysis and logistic regression, the correct scale on which to construct pointwise confidence intervals for injury risk, the ability to discern which form of injury risk function is optimal, and the handling of repeated tests on the same subject. METHODS: The statistical models are explored through simulation and examination of the underlying mathematics. RESULTS: We provide recommendations for the statistically valid construction and correct interpretation of single-predictor injury risk functions. CONCLUSIONS: This article aims to provide useful and understandable statistical guidance to improve the practice in constructing injury risk functions.

The association of aerobic fitness with injuries in the fire service.

The aim of the present study was to understand the risk of injury in relation to fitness in a retrospective occupational cohort of firefighters in Tucson, Arizona, from 2005 to 2009. Annual medical evaluations and injury surveillance data were linked to compare levels of aerobic fitness in injured employees with those in noninjured employees. The individual outcomes evaluated included all injuries, exercise-related injuries, and sprains and strains. Time-to-event analyses were conducted to determine the association between levels of fitness and injury likelihood. Fitness, defined by relative aerobic capacity (Vo2max), was associated with injury risk. Persons in the lowest fitness level category (Vo2max <43 mL/kg/minute) were 2.2 times more likely (95% confidence interval: 1.72, 2.88) to sustain injury than were those in the highest fitness level category (Vo2max >48 mL/kg/minute). Those with a Vo2max between 43 and 48 mL/kg/minute were 1.38 times (95% confidence interval: 1.06, 1.78) more likely to incur injury. Hazard ratios were found to be greater for sprains and strains. Our results suggest that improving relative aerobic capacity by 1 metabolic equivalent of task (approximately 3.5 mL/kg/minute) reduces the risk of any injury by 14%. These findings illustrate the importance of fitness in reducing the risk of injury in physically demanding occupations, such as the fire service, and support the need to provide dedicated resources for structured fitness programming and the promotion of injury prevention strategies to people in those fields.

Environmental arsenic exposure, selenium and sputum alpha-1 antitrypsin.

Exposure to arsenic in drinking water is associated with increased respiratory disease. Alpha-1 antitrypsin (AAT) protects the lung against tissue destruction. The objective of this study was to determine whether arsenic exposure is associated with changes in airway AAT concentration and whether this relationship is modified by selenium. A total of 55 subjects were evaluated in Ajo and Tucson, Arizona. Tap water and first morning void urine were analyzed for arsenic species, induced sputum for AAT and toenails for selenium and arsenic. Household tap-water arsenic, toenail arsenic and urinary inorganic arsenic and metabolites were significantly higher in Ajo (20.6±3.5 µg/l, 0.54±0.77 µg/g and 27.7±21.2 µg/l, respectively) than in Tucson (3.9±2.5 µg/l, 0.16±0.20 µg/g and 13.0±13.8 µg/l, respectively). In multivariable models, urinary monomethylarsonic acid (MMA) was negatively, and toenail selenium positively associated with sputum AAT (P=0.004 and P=0.002, respectively). In analyses stratified by town, these relationships remained significant only in Ajo, with the higher arsenic exposure. Reduction in AAT may be a means by which arsenic induces respiratory disease, and selenium may protect against this adverse effect.

Enhancing severe injury surveillance: the association between severe injury events and fatalities in US coal mines.

This report evaluates the potential of using high degree (or severe) injuries as a proxy for fatal events. Injuries occurring at bituminous coal mines within the United States during the years 1996-2006 were classified by the degree of severity according to the Abbreviated Injury Scale (AIS). Using multivariate discrete and logistic models (via generalized estimating equations) and adjusting for number of employees and underground v. surface status, high degree (AIS≥3) injuries in the prior year were associated with an increased risk (OR 2.02, 95% CI 1.17 to 3.46) of fatalities within the same mine. While there is a need for improvements and standardization of injury surveillance and reporting, the findings support the study hypothesis that mining conditions resulting in high degree injuries can also result in fatalities, thus expanding the use and versatility of high degree injury surveillance data. With an improved understanding of the conditions and activities behind these two injury event types, these results enhance the ability for industry to more readily identify and develop technological advancements for safety and mitigating disasters.

Beyond the fireground: injuries in the fire service.

Background Although firefighting and emergency medical services are high-risk professions, few studies have identified the aetiology of injury in the fire service beyond the fireground. Methods Data were collected for work-related injuries in a medium-sized metropolitan fire department. In a descriptive study, the factors explored included the nature of injury, agent, mechanism, body location, environment, abbreviated injury scale (AIS), functional capacity index (FCI) and lost time status. Results From 2004 to 2009, the annual injury incidence rate averaged 17.7 per 100 employees. One-third of all injuries (32.9%) resulted from physical exercise activities, while patient transport, training drills and fireground operations resulted in 16.9%, 11.1% and 10.2% of injuries, respectively. For all job operations, sprains and strains were the most prevalent type of injury (40.2-85.2%), followed by contusions and lacerations (7.7-26.1%). The third most common injury was related to the conventional hazards of the individual job operation. Most injuries (n=862, 95.6%) were minor in severity, while 4.3% of injuries were classified as having some impedance of normal function (FCI 3). Moderate injuries (AIS 2) were infrequent, but comprised a greater proportion of fireground injuries (8.7%) than the other activities (1.0-4.1%); however, lost time injuries were more frequent for patient transport (46.1%) than other operations (22.0-29.1%). Conclusions Physical exercise, patient transport and training activities were responsible for a greater percentage of injuries than fireground operations. Focused efforts to improve the characterisation of risks during these more diverse set of work processes should help guide the development of salient strategies for injury prevention.