Should You Implement a Health and Wellness Program?

By John Hofman

There is constant debate within the fire service on the cost justification of a health and wellness program. Some people could argue that it does not help because, according to a study published in Injury Prevention (2012) “One third of all injuries resulted from physical fitness.” However, another study published in Injury Prevention in 2013 showed that, although the injuries from exercise were high, the severity of them were low. But, more importantly, those who did exercise were half as likely to sustain a nonexercise injury (i.e., fireground activities). In other words, there were benefits of physical training for firefighters.

Still, the debate goes on, and some departments do not have any type of health and wellness program. According a PHLAME (Promoting Healthy Living: Assessing More Effects) study, most department annual budgets are structured in the manner as shown in Figure 1:

FIGURE 1. PHLAME Study

It is not about how many engines or trucks you have on scene, but rather how many firefighters are there. Yet, many departments will spend more money keeping their engines in service rather than keeping their firefighters healthy. This is would seem to be counterproductive. It would only make more sense to develop a more proactive approach toward firefighters rather than “fix them after they are broke.”

In other industries, research supports the cost-effectiveness of worksite wellness. Most studies have shown a positive return on investment (ROI) to be about $3, but no negative studies have actually been published. There is generally a savings of about $250 per employee at four years. So, what about the fire service?

A few years ago, I was asked to break down our worker compensation numbers and justify not only my position but also to discover if our program actually worked. During that time, we discovered the following:

We analyzed the five years prior to and after my arrival and the five years after, here is what we discovered:

• We averaged 91 injuries per year prior to my arrival (no coach) vs. 90 in my first five years. This is not a huge savings, but again, firefighting is a difficult job, and injuries will happen.
• Average claims per injury did not change before hiring a full-time coach.
• During the first five years of hiring a strength and conditioning professional, the department saw a reduction of $629 per claim per year. This was an average savings of roughly $57,000 per year (not including increase medical costs).

Fast forward to today. Recently, we analyzed our numbers again to ensure our program was heading in the right direction. We discovered the following:

• Total musculoskeletal injury costs have been steadily declining, from $1.2 million down to $740,000 in the past five years.
• The average injury rate is currently 84, down from 90 the previous time we analyzed our numbers. The last two fiscal periods have been averaging 72 (with a peak of 104) injuries.

As previously stated, research has shown that “1/3 of injuries are due to exercise. But again, it still reduces the severity of the injuries on the fireground.” We discovered the following:

• Over the past five years: the average injury rate associated with exercise was 17 per year; the highest being 23 and the lowest being 10 (all our members perform some type of exercise).
• Our average claim because of exercise is still lower ($4,716) than an injury occurring while performing job specific tasks ($10,000). Our lowest year per claim based on exercise was $647! Of course, there were some outliers that increased the cost, but overall, we can still see the benefits.

What does this mean for the department? For a health & wellness program to be truly successful, you need to prescribe the correct exercises vs. doing the latest trend. According to Dr. Stuart McGill, a program should focus on improving movement quality (coaching) vs. simple fitness. In his study (unpublished as of this writing), he took two groups of firefighters—a coaching group and a fitness-based group.

The fitness group was told to do whatever it wanted, whether it be a workout found on the internet or some other means and perform it as they see fit, while the other group (coaching) were provided specific exercises to help them perform better on the job as well as how to perform the exercise properly. The researchers discovered that the coaching group performed better on the fireground because of better movement patterns and muscle memory. The other group did not perform as well; we hypothesized that this could be attributed to bad movement + bad fitness = BAD.

Based off this notion, we wanted to look at what types of programming cost the most regarding musculoskeletal injuries. Exercises were placed into the following categories:

1. Basic weightlifting.
2. High-intensity power training/circuits.
3. Cardio (i.e., running, elliptical, rowing, bike, and so on).

When we analyzed the costs associated with injuries and types of exercise, we were a little surprised to find out the following:

• Running cost the most per injury! More specifically, running on a treadmill. Cardio-based training represented an average of about 24 percent of all injuries to exercise.
• High-intensity power training averaged about 22 percent of injuries.
• Basic exercise average about 42 percent of injuries.

Yes, basic lifting had a high injury rate, but the overall cost was significantly lower than the other two categories. According to our numbers, every injury associated with high-intensity power training equaled three injuries during basic lifting. In other words, the severity associated with high-intensity power training/circuits was much greater.

Finally, we looked at total injuries by body part. Of course, back injuries represented the highest number of injuries. We discovered the following:

• Our department averages about 30 lower back injuries per year.
• Average cost of injury per year is around $40,000.
• Average claim per year is around $10,000.

The second-most injury was shoulder injury, which produced the following numbers:

• Averaged nine per year.
• Average cost per year was roughly $90,000.
• Average claim per year $14,000.

One of our goals for the upcoming year is to focus on better shoulder injury prevention. According to some case management companies, shoulder claims are growing in number quickly. Treatment options are often expensive, particularly for an aging work force. And, with the physical demands placed on our firefighters and the complexity of shoulder joints, it would not be wrong to believe shoulder injuries could eventually surpass lower back injuries.

After shoulder injuries, the next most prominent injuries were to the knees, feet, and ankles.

Last, we did see a decrease in lower back injuries, total cost, and average per claim each year (Figure 2).

FIGURE 2. INJURIES AND COST PER CLAIM

Again, injuries will happen within the fire service. However, it is very clear that exercise does provide savings. As you can tell from these numbers, the benefit of hiring a full-time strength and conditioning professional to develop your health and wellness program is worth its weight in gold and will pay for itself. The idea has merit and could be very beneficial to the firefighter and department.

This concept should be taken seriously, especially with the cost savings associated with it. Let’s take care of our greatest asset: the firefighters!

If you are interested in knowing about our program or how to develop your own health and wellness program check out our webpage www.911tacticalperformance.com. Our two day class will cover everything associated with a first responder health and wellness program.

John Hofman, CSCS, MS, is one of leading experts in the field of firefighter health and wellness. As the strength and conditioning coach for the Sacramento (CA) Fire Department (SFD), Hofman oversees the Wellness Centre, coordinates the SFD’s medical and fitness assessments, develops recruit fitness training and preemployment medical and fitness evaluations, and assists the SFD’s 20 certified peer fitness trainers. In addition, Hofman is the co-founder of 911TacticalPerformance.com, a company focusing on injury prevention and performance training specifically for first responders.

To help keep firefighters safe, Hofman authored “Beyond the Turnouts: A Comprehensive Guide to Firefighter Health & Wellness,” where he combined the latest research and his years of experience developing firefighter health and wellness programs within the fire service.