RAND Report Offers New Insight into PTSD Among Firefighters

Nancy Grover

Sarasota, FL (WorkersCompensation.com) – A new report might allay concerns about potentially high costs from claims for firefighters with post-traumatic stress disorder. As an increasing number of states enact or consider legislation to provide benefits for first responders who develop PTSD after exposure to a traumatic event, critics have questioned whether these could have a severe financial impact on the affected municipalities.

While the report mainly looks at firefighters who also sustain a physical injury, it suggests these workers may have a far lower incidence rate of developing PTSD after a trauma than other workers. However, the authors also speculate that the stigma associated with mental health conditions may be coloring the numbers.


Firefighters are more likely to be injured than workers in other fields and are especially susceptible to musculoskeletal disorders, mainly of the lower extremities and trunk. An updated RAND reportalso found that employment at the at-injury employer is substantially higher for firefighters than it is for those in most occupations. Caps on chiropractic visits and other types of physical medicine do not appear to have a negative impact on these workers. Also, legislative changes from Senate Bill 863 enacted in 2013 have significantly increased benefits for many workers, especially firefighters.

The report, The Frequency and Economic Impact of Musculoskeletal Disorders for California Firefighters, is posted on the website of the California Commission on Health and Safety and Workers’ Compensation, which is seeking public feedback by Aug. 22.

The authors updated findings from a similar study on California firefighters published in 2010. It looked at the frequency nature and consequences of firefighter injuries in California with a special emphasis on MSDs. Data from injuries that occurred between 2005-2015 were analyzed and compared to those for police officers, other public-sector employees and private-sector workers with similar observed job characteristics.

“Firefighters with MSDs rarely receive treatment or permanent disability benefits for PTSD or other psychiatric conditions,” the report said. “[The] data indicate that firefighters and police have similar rates of psychiatric comorbidities, but incidence rates for public safety workers are substantially lower than rates observed among other public-sector workers or comparable private-sector workers.”

The authors examined diagnosis codes on medical services and prescriptions sent to workers’ compensation payers to detect those with MSD injuries and comorbid psychiatric conditions. They described the results as somewhat surprising, but noted that some of the public-sector workers may be treated outside the workers’ compensation system, including for psychiatric issues.

“A second, and more troubling, caveat is that mental health stigma could also lead to the patterns observed in these data,” they wrote. “Stigma is widely recognized as a barrier to diagnosis and treatment of PTSD and mental disorders more generally among public-safety workers. Because this study views the world through the lens of care provided through the workers’ compensation system, we are not in a good position to evaluate the magnitude of stigma or to identify workers who might fail to seek and receive necessary mental health care.”

The authors say additional research and different methods and data collection may provide better insight into whether and why firefighters and police are “far less likely” to be treated for psychiatric conditions through workers’ compensation. “The potential for stigma suggests a need to go beyond claims data and use complementary approaches to assess firefighters’ and police officers’ mental health, potentially including surveys or analysis of group health claims.”

Additional Findings

The above-average rate of MSDs among firefighters was also found in the 2010 report. The latest analysis shows that nearly half of firefighters’ injuries — 47 percent — are MSDs. That compares to 38 percent for police offices, 42 percent for other public-sector workers, 37 percent in the private-sector comparison group, and 42 percent for other private sector workers. Strains are the main cause of injury. Burns were found to be more common among firefighters than other workers, but represent just 6 percent of their injuries. Cumulative trauma accounted for a lower share of the firefighters’ injuries compared to other workers.

The high proportion of firefighters who earn more than the pre-SB 863 maximum weekly wage was a likely factor in the “significantly raised benefits” for firefighters and other, similar workers. Also impacting the increased benefits was the prevalence of knee impairments, “which received the second-largest possible increase in final ratings from changes to the formula used to calculate ratings,” the report said.

The authors suggested “continued research and investment” to identify strategies to reduce the number of injuries among firefighters.

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