Using a severity threshold to improve occupational injury surveillance: Assessment of a severe traumatic injury-based occupational health indicator across the International Classification of Diseases lexicon transition.

BACKGROUND: Traumatic injury is a leading cause of death and disability among US workers. Severe injuries are less subject to systematic ascertainment bias related to factors such as reporting barriers, inpatient admission criteria, and workers' compensation coverage. A state-based occupational health indicator (OHI #22) was initiated in 2012 to track work-related severe traumatic injury hospitalizations. After 2015, OHI #22 was reformulated to account for the transition from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to ICD-10-CM. This study describes rates and trends in OHI #22, alongside corresponding metrics for all work-related hospitalizations. METHODS: Seventeen states used hospital discharge data to calculate estimates for calendar years 2012-2019. State-panel fixed-effects regression was used to model linear trends in annual work-related hospitalization rates, OHI #22 rates, and the proportion of work-related hospitalizations resulting from severe injuries. Models included calendar year and pre- to post-ICD-10-CM transition. RESULTS: Work-related hospitalization rates showed a decreasing monotonic trend, with no significant change associated with the ICD-10-CM transition. In contrast, OHI #22 rates showed a monotonic increasing trend from 2012 to 2014, then a significant 50% drop, returning to a near-monotonic increasing trend from 2016 to 2019. On average, OHI #22 accounted for 12.9% of work-related hospitalizations before the ICD-10-CM transition, versus 9.1% post-transition. CONCLUSIONS: Although hospital discharge data suggest decreasing work-related hospitalizations over time, work-related severe traumatic injury hospitalizations are apparently increasing. OHI #22 contributes meaningfully to state occupational health surveillance efforts by reducing the impact of factors that differentially obscure minor injuries; however, OHI #22 trend estimates must account for the ICD-10-CM transition-associated structural break in 2015.

Workers' compensation injury claims among firefighters in Ohio, 2001-2017.

BACKGROUND: Firefighters are at high risk for nonfatal and fatal occupational injuries. While some past research has quantified firefighter injuries using various data sources, Ohio workers' compensation injury claims data largely have not been used. METHODS: Public and private firefighter claims, including volunteer and career firefighters, from Ohio's workers' compensation data for 2001-2017 were identified based on occupational classification codes and manual review of the occupation title and injury description. The task during injury (firefighting, patient care, training, other/unknown, etc.) was manually coded based on the injury description. Injury claim counts and proportions were described across claim type (medical-only or lost-time), worker demographics, task during injury, injury events, and principal diagnoses. RESULTS: 33,069 firefighter claims were identified and included. Most claims were medical-only (66.28%, <8 days away from work) and involved males (93.81%) aged 25-54 years (86.54%). While the task during injury could not be categorized for many narratives (45.96%), the largest percentage that could be categorized occurred during firefighting (20.48%) and patient care (17.60%). The most common injury events were overexertion involving outside sources (31.33%) and struck by objects or equipment (12.68%). The most frequent principal diagnoses were back, lower extremity, and upper extremity sprains (16.02%, 14.46%, and 11.98%, respectively). CONCLUSIONS: This study provides a preliminary basis for the development of focused firefighter injury prevention programming and training. Obtaining denominator data, enabling rate calculation, would strengthen the risk characterization. Based on the current data, prevention efforts focusing on the most frequent injury events and diagnoses may be warranted.

An analysis of suicides among first responders ─ Findings from the National Violent Death Reporting System, 2015-2017.

INTRODUCTION: First responders, including law enforcement officers (LEOs), firefighters, emergency medical services (EMS) clinicians, and public safety telecommunicators, face unique occupational stressors and may be at elevated risk for suicide. This study characterized suicides among first responders and identifies potential opportunities for additional data collection. METHODS: Using suicides identified from the three most recent years of National Violent Death Reporting System data with industry and occupation codes from the NIOSH Industry and Occupation Computerized Coding System (2015-2017), decedents were categorized as first responders or non-first responders based on usual occupation. Chi-square tests were used to evaluate differences in sociodemographic and suicide circumstances between first and non-first responders. RESULTS: First responder decedents made up 1% of all suicides. Over half of first responders (58%) were LEOs, 21% were firefighters, 18% were EMS clinicians, and 2% were public safety telecommunicators. Compared to non-first responder decedents, more first responders served in the military (23% vs. 11%) and used a firearm as the method of injury (69% vs. 44%). Among first responder decedents for whom circumstances were known, intimate partner problems, job problems, and physical health problems were most frequent. Some common risk factors for suicide (history of suicidal thoughts, previous suicide attempt, alcohol/substance abuse problem) were significantly lower among first responders. Selected sociodemographics and characteristics were compared across first responder occupations. Compared to firefighters and EMS clinicians, LEO decedents had slightly lower percentages of depressed mood, mental health problems, history of suicidal thoughts, and history of suicide attempts. CONCLUSIONS: While this analysis provides a small glimpse into some of these stressors, more detailed research may help inform future suicide prevention efforts and interventions. PRACTICAL APPLICATION: Understanding stressors and their relation to suicide and suicidal behaviors can facilitate suicide prevention among this critical workforce.

Temporal trends in occupational injuries treated in US emergency departments, 2012-2019.

BACKGROUND: Evidence suggests that rates of occupational injuries in the US are decreasing. As several different occupational injury surveillance systems are used in the US, more detailed investigation of this trend is merited. Furthermore, studies of this decrease remain descriptive and do not use inferential statistics. The aim of this study was to provide both descriptive and inferential statistics of temporal trends of occupational injuries treated in US emergency departments (EDs) for 2012 to 2019. METHODS: Monthly non-fatal occupational injury rates from 2012 to 2019 were estimated using the national electronic injury surveillance system-occupational supplement (NEISS-Work) dataset, a nationally representative sample of ED-treated occupational injuries. Rates were generated for all injuries and by injury event type using monthly full-time worker equivalent (FTE) data from the US Current Population Survey as a denominator. Seasonality indices were used to detect seasonal variation in monthly injury rates. Trend analysis using linear regression adjusted for seasonality was conducted to quantify changes in injury rates from 2012 to 2019. RESULTS: Occupational injuries occurred at an average rate of 176.2 (95% CI = ± 30.9) per 10,000 FTE during the study period. Rates were highest in 2012 and declined to their lowest level in 2019. All injury event types occurred at their highest rate in summer months (July or August) apart from falls, slips, and trips, which occurred at their highest rate in January. Trend analyses indicated that total injury rates decreased significantly throughout the study period (- 18.5%; 95% CI = ± 14.5%). Significant decreases were also detected for injuries associated with contact with foreign object and equipment (- 26.9%; 95% CI = ± 10.5%), transportation incidents (- 23.2%; 95% CI = ± 14.7%), and falls, slips, and trips (- 18.1%; 95% CI = ± 8.9%). CONCLUSIONS: This study supports evidence that occupational injuries treated in US EDs have decreased since 2012. Potential contributors to this decrease include increased workplace mechanization and automation, as well as changing patterns in US employment and health insurance access.

Prepandemic Mental Health and Well-being: Differences Within the Health Care Workforce and the Need for Targeted Resources.

BACKGROUND: Occupational stress and diminished well-being among health care workers were concerning even before the coronavirus disease 2019 pandemic exacerbated existing stressors and created new challenges for this workforce. Research on the mental health of health care workers has focused on physicians and nurses, with less attention to other occupations. METHODS: To assess pre-coronavirus disease mental health and well-being among workers in multiple health care occupations, we used 2017 to 2019 data from the Behavioral Risk Factor Surveillance System. RESULTS: Across the health care workforce, insufficient sleep (41.0%) and diagnosed depression (18.9%) were the most common conditions reported. Counselors had the highest prevalence of diagnosed depression. Health care support workers had elevated prevalences for most adverse health conditions. CONCLUSIONS: Ensuring a robust health care workforce necessitates identifying and implementing effective occupation-specific prevention, intervention, and mitigation strategies that address organizational and personal conditions adversely affecting mental health.

Occurrences of Workplace Violence Related to the COVID-19 Pandemic, United States, March 2020 to August 2021.

As businesses dealt with an increasingly anxious public during the COVID-19 pandemic and were frequently tasked with enforcing various COVID-19 prevention policies such as mask mandates, workplace violence and harassment (WPV) emerged as an increasing important issue affecting worker safety and health. Publicly available media reports were searched for WPV events related to the COVID-19 pandemic that occurred during 1 March 2020, and 31 August 2021, using Google News aggregator services scans with data abstraction and verification. The search found 408 unique WPV events related to COVID-19. Almost two-thirds involved mask disputes. Over half (57%) of the 408 events occurred in retail (38%) and food service (19%). We also conducted a comparison of events identified in this search to a similar study of media reports between March 2020 to October 2020 that used multiple search engines to identify WPV events. Despite similar conclusions, a one-to-one comparison of relevant data from these studies found only modest overlap in the incidents identified, suggesting the need to make improvements to future efforts to extract data from media reports. Prevention resources such as training and education for workers may help industries de-escalate or prevent similar WPV events in the future.

Summary of recommendations from the National Institute for Occupational Safety and Health Fire Fighter Fatality Investigation and Prevention Program, 2006-2014.

INTRODUCTION: The NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) conducts independent investigations of selected fire fighter line-of-duty deaths (LODD) and offers recommendations to prevent similar deaths. The purpose of the current study was to provide information on more recent FFFIPP recommendations and to determine if recommendations have changed over time. METHODS: Fatality investigations completed from 2006 to 2014 were selected for this study with recommendations being assigned into twelve major categories when possible. The most frequently occurring recommendations were then rank ordered overall and then by medical and traumatic fire fighter LODD. RESULTS: There were 1,067 total recommendations made in the published fire fighter investigative reports for both medical and trauma-related fire fighter fatalities for the period 2006-2014. Of these, 784 (73%) could be placed within one of the 12 categories noted previously. The top 10 recommendation categories overall were: 1. Medical screening, 2. Fitness and wellness program, 3. Training, 4. Medical clearance, 5. Standard Operating Procedures/Standard Operating Guidelines (SOPs/SOGs), 6. Incident command, 7. Strategy and tactics, 8. Communications, 9. Personal protective equipment and 10. Staffing. CONCLUSIONS: The leading recommendations from the NIOSH FFFIPP medical investigations between 2006 and 2014 did not change compared to those made between 1998 and 2005, with the exception of the addition of "medical clearance for duty". There were changes for the traumatic injury leading recommendations for 2006-2014, with the major change being "training", which was the leading FFFIPP recommendation for traumatic injuries for this time period. Practical applications: The intent of the FFFIPP is to influence fire departments and fire fighters to critically assess and evaluate situations/circumstances similar to those identified by NIOSH investigations and implement the recommendations offered to prevent additional fire fighter fatalities.

Suicide Rates by Major Occupational Group - 17 States, 2012 and 2015.

During 2000-2016, the suicide rate among the U.S. working age population (persons aged 16-64 years) increased 34%, from 12.9 per 100,000 population to 17.3 (https://www.cdc.gov/injury/wisqars). To better understand suicide among different occupational groups and inform suicide prevention efforts, CDC analyzed suicide deaths by Standard Occupational Classification (SOC) major groups for decedents aged 16-64 years from the 17 states participating in both the 2012 and 2015 National Violent Death Reporting System (NVDRS) (https://www.cdc.gov/violenceprevention/nvdrs). The occupational group with the highest male suicide rate in 2012 and 2015 was Construction and Extraction (43.6 and 53.2 per 100,000 civilian noninstitutionalized working persons, respectively), whereas the group with the highest female suicide rate was Arts, Design, Entertainment, Sports, and Media (11.7 [2012] and 15.6 [2015]). The largest suicide rate increase among males from 2012 to 2015 (47%) occurred in the Arts, Design, Entertainment, Sports, and Media occupational group (26.9 to 39.7) and among females, in the Food Preparation and Serving Related group, from 6.1 to 9.4 (54%). CDC's technical package of strategies to prevent suicide is a resource for communities, including workplace settings (1).

Nonfatal Injuries to Firefighters Treated in U.S. Emergency Departments, 2003-2014.

INTRODUCTION: Several studies of nonfatal firefighter injuries have been conducted but are limited by the inclusion criteria used and coverage. The aim of this study was to enhance current knowledge by providing national estimates of nonfatal injuries to firefighters treated in U.S. emergency departments. METHODS: Nonfatal injuries from 2003 through 2014 were extracted from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work). NEISS-Work captures nonfatal occupational injuries, illnesses, and exposures treated in a sample of U.S. emergency departments. Nonfatal injury rates were calculated based on NEISS-Work counts (numerator) and counts from the National Fire Protection Association (denominator). Data were analyzed from 2016 through 2017. RESULTS: Between 2003 and 2014, an estimated 351,800 firefighters were treated in emergency departments for nonfatal injuries. The overall rate was 260 injuries per 10,000 firefighters. Career firefighters had an annual rate of 699 injuries per 10,000 firefighters; volunteers had a rate of 39 injuries per 10,000 firefighters. Leading injury events were fires and explosions (36%) and overexertion and bodily reactions (20%). A majority (38%) of injuries occurred during firefighting activities, 7% occurred during training, and 7% occurred during patient care. Sprains and strains accounted for the largest proportion of injuries in all three of these activities: 28% firefighting activities, 32% training, and 36% patient care. CONCLUSIONS: The results demonstrate that nonfatal injuries for firefighters remained high throughout the study period. The predominance of sprains and strains in all firefighting activities suggests the need for additional research and prevention needs in areas of improved fitness, safer body postures and movements, and situational awareness.

Fatal work-related falls in the United States, 2003-2014.

BACKGROUND: Falls are the second leading cause of work-related fatalities among US workers. We describe fatal work-related falls from 2003 to 2014, including demographic, work, and injury event characteristics, and changes in rates over time. METHODS: We identified fatal falls from the Bureau of Labor Statistics (BLS), Census of Fatal Occupational Injuries and estimated rates using the BLS Current Population Survey. RESULTS: From 2003 to 2014, there were 8880 fatal work-related falls, at an annual rate of 5.5 per million FTE. Rates increased with age. Occupations with the highest rates included construction/extraction (42.2 per million FTE) and installation/maintenance/repair (12.5 per million FTE). Falls to a lower level represented the majority (n = 7521, 85%) compared to falls on the same level (n = 1128, 13%). CONCLUSIONS: Falls are a persistent source of work-related fatalities. Fall prevention should continue to focus on regulation adherence, Prevention through Design, improving fall protection, training, fostering partnerships, and increasing communication.

Occupational Injuries and Exposures among Emergency Medical Services Workers.

OBJECTIVE: Emergency medical services (EMS) workers incur occupational injuries at a higher rate than the general worker population. This study describes the circumstances of occupational injuries and exposures among EMS workers to guide injury prevention efforts. METHODS: The National Institute for Occupational Safety and Health collaborated with the National Highway Traffic Safety Administration to conduct a follow-back survey of injured EMS workers identified from a national sample of hospital emergency departments (EDs) from July 2010 through June 2014. The interviews captured demographic, employment, and injury event characteristics. The telephone interview data were weighted and are presented in the results as national estimates and rates. RESULTS: Telephone interviews were completed by 572 EMS workers treated in EDs, resulting in a 74% cooperation rate among all EMS workers who were identified and successfully contacted. Study respondents represented 89,100 (95% CI 54,400-123,800) EMS workers who sought treatment in EDs over the four-year period. Two-thirds were male (59,900, 95% CI 35,200-84,600) and 42% were 18-29 years old (37,300, 95% CI 19,700-54,700). Three-quarters of the workers were full-time (66,800, 95% CI 39,800-93,800) and an additional 10% were part-time or on-call (9,300, 95% 4,900-13,700). Among career EMS workers, the injury rate was 8.6 per 100 full-time equivalent EMS workers (95% CI 5.3-11.8). Over half of all injured workers had less than ten years of work experience. Sprains and strains accounted for over 40% of all injuries (37,000, 95% CI 22,000-52,000). Body motion injuries were the leading event (24,900, 95% CI 14,900-35,000), with 90% (20,500, 95% CI 12,800-32,100) attributed to lifting, carrying, or transferring a patient and/or equipment. Exposures to harmful substances were the second leading event (24,400, 95% CI 11,700-37,100). CONCLUSION: New and enhanced efforts to prevent EMS worker injuries are needed, especially those aimed at preventing body motion injuries and exposures to harmful substances. EMS and public safety agencies should consider adopting and evaluating injury prevention measures to improve occupational safety and promote the health, performance, and retention of the EMS workforce.

Characterizing emergency department patients who reported work-related injuries and illnesses.

BACKGROUND: Per a Congressional directive and funding, this study describes worker and workplace characteristics of emergency department (ED) patients who reported their injury/illness to their employer. The study also responds to Congress's request to enumerate injured/ill self-employed workers and workers with chronic conditions. METHODS: We conducted a follow-back study on injured/ill workers, including self-employed, identified from a national ED surveillance system from June 2012 through December 2013. RESULTS: An estimated 3,357,000 (95%CI: 2,516,000-4,199,000) workers treated in EDs reported their injury/illness to their employer or were self-employed. Of those, 202,000 (95%CI: 133,000-272,000) had a chronic condition. Of all reporters, excluding self-employed, 77% indicated they received instructions as to whom to report. CONCLUSION: The study did not identify underreporting issues and revealed that medical records data may not be appropriate for assessing underreporting. Additional research is needed to examine workplace characteristics that encourage injury and illness reporting. Am. J. Ind. Med. 59:610-620, 2016. © 2016 Wiley Periodicals, Inc.

Using emergency department surveillance data to assess occupational injury and illness reporting by workers.

OBJECTIVE: Researchers from the National Institute for Occupational Safety and Health (NIOSH) share detailed methodologies from conducting two follow-back studies initiated in 2010 that were designed to assess whether workers reported their injuries and illnesses to their employers and to identify worker incentives and disincentives for reporting work-related injuries to employers. METHODOLOGY: Study respondents were sampled from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work), an emergency department-based surveillance system. Telephone interviews were used to collect information directly from workers. OUTCOMES: Among persons treated in emergency departments who could be identified as working at the time of injury or illness, most reported their injury or illness to their employer. Our studies did not assess if these reported injuries and illnesses were recorded on the Occupational Safety and Health logs. DISCUSSION: Our approach suggests that emergency department-based surveillance data are limited in their utility to investigate underreporting among workers. Am. J. Ind. Med. 59:600-609, 2016. © 2016 Wiley Periodicals, Inc.

Reported work-related injuries and illnesses among Hispanic workers: Results from an emergency department surveillance system follow-back survey.

BACKGROUND: Research suggests Hispanic workers underreport injuries/illnesses to their employer. METHODS: The National Electronic Injury Surveillance System-occupational supplement was used to conduct a follow-back study of workers treated in emergency departments (EDs) from June 2012 through December 2013. RESULTS: An estimated 448,000 (95%CI 230,000-665,000) Hispanic workers treated in EDs for a work-related injury or illness were represented by 362 completed interviews. Of these, an estimated 443,000 (95%CI 228,000-657,000) workers reported the injury or illness to their employer or were self-employed. The majority had not heard of workers' compensation. Only 10% expected workers' compensation to cover their medical payment while 62% expected payment to be covered by their employer. CONCLUSION: We characterized our respondent workforce who reported their injury or illness. We determined that NEISS-Work data are not the most appropriate source to capture underreporting of work-related injuries and illnesses to employers among Hispanic workers. Am. J. Ind. Med. 59:621-629, 2016. © 2016 Wiley Periodicals, Inc.

Trends of occupational fatalities involving machines, United States, 1992-2010.

BACKGROUND: This paper describes trends of occupational machine-related fatalities from 1992-2010. We examine temporal patterns by worker demographics, machine types (e.g., stationary, mobile), and industries. METHODS: We analyzed fatalities from Census of Fatal Occupational Injuries data provided by the Bureau of Labor Statistics to the National Institute for Occupational Safety and Health. We used injury source to identify machine-related incidents and Poisson regression to assess trends over the 19-year period. RESULTS: There was an average annual decrease of 2.8% in overall machine-related fatality rates from 1992 through 2010. Mobile machine-related fatality rates decreased an average of 2.6% annually and stationary machine-related rates decreased an average of 3.5% annually. Groups that continued to be at high risk included older workers; self-employed; and workers in agriculture/forestry/fishing, construction, and mining. CONCLUSION: Addressing dangers posed by tractors, excavators, and other mobile machines needs to continue. High-risk worker groups should receive targeted information on machine safety.

Examining occupational health and safety disparities using national data: a cause for continuing concern.

BACKGROUND: Occupational status, a core component of socioeconomic status, plays a critical role in the well-being of U.S. workers. Identifying work-related disparities can help target prevention efforts. METHODS: Bureau of Labor Statistics workplace data were used to characterize high-risk occupations and examine relationships between demographic and work-related variables and fatality. RESULTS: Employment in high-injury/illness occupations was independently associated with being male, Black, ≤high school degree, foreign-birth, and low-wages. Adjusted fatal occupational injury rate ratios for 2005-2009 were elevated for males, older workers, and several industries and occupations. Agriculture/forestry/fishing and mining industries and transportation and materials moving occupations had the highest rate ratios. Homicide rate ratios were elevated for Black, American Indian/Alaska Native/Asian/Pacific Islanders, and foreign-born workers. CONCLUSIONS: These findings highlight the importance of understanding patterns of disparities of workplace injuries, illnesses and fatalities. Results can improve intervention efforts by developing programs that better meet the needs of the increasingly diverse U.S. workforce.

Nonfatal work-related injuries and illnesses - United States, 2010.

In 2012, the U.S. civilian labor force comprised an estimated 155 million workers. Although employment can contribute positively to a worker's physical and psychological health, each year, many U.S. workers experience a work-related injury or illness. In 2011, approximately 3 million workers in private industry and 821,000 workers in state and local government experienced a nonfatal occupational injury or illness. Nonfatal workplace injuries and illnesses are estimated to cost the U.S. economy approximately $200 billion annually. Identifying disparities in work-related injury and illness rates can help public health authorities focus prevention efforts. Because work-related health disparities also are associated with social disadvantage, a comprehensive program to improve health equity can include improving workplace safety and health.

Fatal work-related injuries - United States, 2005-2009.

In 2012, the U.S. civilian labor force comprised an estimated 155 million workers. Although employment can contribute positively to a worker's physical and psychological health, each year, many U.S. workers are fatally injured at work. In 2011, a total of 4,700 U.S. workers died from occupational injuries. Workplace deaths are estimated to cost the U.S. economy approximately $6 billion annually. Identifying disparities in work-related fatality rates can help public health authorities focus prevention efforts. Because work-related health disparities also are associated with social disadvantage, a comprehensive program to improve health equity should include improving workplace safety and health.

A comparison of fatal occupational injury event characteristics from the Census of Fatal Occupational Injuries and the Vital Statistics Mortality System.

OBJECTIVES: The aim of this study was to examine utility of appending International Classification of Diseases (ICD) codes from Vital Statistics Mortality (VSM) data to Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI), and compare occupational event characteristics based on ICD external cause and BLS Occupational Injury and Illness Classification System (OIICS) event codes. METHODS: We linked VSM records with CFOI records for 2003 and 2004. RESULTS: Ninety-five percent of approximately 11,000 CFOI cases were linked to VSM cases. Linked data suggest that CFOI OIICS event and VSM ICD codes identified similar leading events. However, VSM data were generally less specific. CONCLUSION: Lack of detail inherent in ICD codes and death narratives limits specificity of injury characteristics in VSM data. Appending ICD codes to CFOI appears to offer little value. Research comparing work- and non-work-related events may be better served by having a defined framework to crosswalk both coding schemes to facilitate comparisons. IMPACT ON INDUSTRY: Over the last two decades, both ICD and OIICS have been used to characterize occupational injury circumstances; however, this is the first study to use linked case comparisons of the OIICS and ICD codes at a detailed level. This study confirmed that multiple source data systems provide more detail surrounding an incident than a single source data system does. Our results suggest that OIICS-coded CFOI data are a better source for occupational injury research and prevention purposes. For future comparison studies requiring ICD, it would be advantageous to have a defined framework that could easily be used to map both coding schemes (OIICS and ICD).

Surveillance of traumatic firefighter fatalities: an assessment of four systems.

OBJECTIVES: Firefighters regularly respond to hazardous situations that put them at risk for fatal occupational injuries. Traumatic occupational fatality surveillance is a foundation for understanding the problem and developing prevention strategies. We assessed four surveillance systems for their utility in characterizing firefighter fatalities and informing prevention measures. METHODS: We examined three population-based systems (the Bureau of Labor Statistics' Census of Fatal Occupational Injuries and systems maintained by the United States Fire Administration and the National Fire Protection Association) and one case-based system (data collected through the National Institute for Occupational Safety and Health Fire Fighter Fatality Investigation and Prevention Program). From each system, we selected traumatic fatalities among firefighters for 2003-2006. Then we compared case definitions, methods for case ascertainment, variables collected, and rate calculation methods. RESULTS: Overall magnitude of fatalities differed among systems. The population-based systems were effective in characterizing the circumstances of traumatic firefighter fatalities. The case-based surveillance system was effective in formulating detailed prevention recommendations, which could not be made based on the population-based data alone. Methods for estimating risk were disparate and limited fatality rate comparisons between firefighters and other workers. CONCLUSIONS: The systems included in this study contribute toward a greater understanding of firefighter fatalities. Areas of improvement for these systems should continue to be identified as they are used to direct research and prevention efforts.