FHWorld18: Using Data to Create Better Health Programs

It is undeniable that health and fitness is a critical area of the fire service, and there are countless resources available to firefighters looking for exercises and nutrition-related information. But on a larger scale, many departments are looking for the resources they need to develop health-related programs or policies—and many are turning to data to help them in their efforts.

In her Firehouse World session “Chasing Health and Fitness in the Fire Service: Using Big and Little Data to Inform This Noble Pursuit,” Tiffany Lipsey addressed the risk factors and behaviors that should be targets for education and programming, and shared data and case studies from her own work with firefighters. As the director of the Heart Disease Prevention Program at the Human Performance Clinical/Research Laboratory at Colorado State University, Lipsey directs the Firefighter Testing Program, which serves 24 fire agencies in Colorado and has provided testing for over 1,200 firefighters. 

Lipsey said that when it comes to health, many people have the attitude of “If I don’t know, I don’t have to work on it,” but added that “if you do you know, you are empowered to change it”—and that’s where data can come into play on both a big and small scale.

Lipsey explained the differences between “big data” and “little data” to underscore how they can be used in different capacities in the fire service. Big data is defined by three factors—high volume, wide variety and high velocity (the speed at which the data is processed)—and is often used in government and business, healthcare, and media and marketing. Little data, on the other hand, is primarily used to track trends within smaller datasets and focuses on individual goals. Lipsey underscored that both types of data can be of great use to the fire service. Quoting Carly Fiorina, former CEO of HP, “The goal is to turn data into information, and information into insight.”

For those departments that may not yet be convinced of the value of data, Lipsey suggested a variety of objectives for how data can be used to help improve health within the fire service:

• Reduce workplace injury and fatality
• Improve longevity in the fire service
• Develop medical treatment and/or lifestyle/fitness plans to empower firefighters to maintain/improve health, fitness and wellness
• Establish baselines
• Lower insurance and workers’ compensation costs
• Determine if firefighters are medically qualified for duty
• Detect and diagnose medical conditions that could result in an injury or fatality

When departments are ready to begin working with data, the key, Lipsey said, is to first consider the areas that impact health and safety programs, and then determine what data is needed and why. It’s also important to understand the myriad factors that can impact health and safety programs. To this point, Lipsey presented an Activity System Diagram for Occupational Health and Safety Programs that includes five components:

1. Tools: comprehensive medical and fitness programs, PPE, on-scene rehab, objective data like EKGs, pulse ox, treadmill tests, etc., and subjective data like sleep and food logs
2. Actors: policymakers (e.g., NFPA, IAFC, NFFF), care providers (physicians, mental health counselors, insurance companies, fire department personnel)
3. Rules: NFPA standards, laws (HIPAA), SOPs/SOGs, departmental policies, insurance policies
4. Community stakeholders: residents and taxpayers, business owners, politicians, workers, community leaders, community organizations
5. Division of Labor: medical and fitness personnel conduct tests; executive fire officers implement health and fitness programs; and fire service leaders, researchers and industry members develop standards

Lipsey underscored the importance of going beyond just box-checking when collecting data, explaining that in order for the process to work, the data must be meaningful and accurate. Merely checking boxes can result in data that has no meaning and was therefore a waste of time and money to collect. Further, many chiefs use data to make important decisions, which makes it even more important that the data is accurate and used correctly.

And for those departments that already have data, Lipsey raised several key questions that should be considered before actions are taken based on the data:

• Where is the data? Is the data in the chief’s file cabinet, with HR or occupational health, or even in the individual firefighter’s personnel files?
• What kind of data is it? Is it objective data, like blood pressure and lipid values, or is it subjective data that is collected in the form of surveys?
• How was it collected? Was the data collected with a consistent technique?
• Who collected the data? Was it collected by a medical professional or peer fitness trainer, and was the collector part of an internal or external team?
• When was it collected? Was the data collected at the time of hire or perhaps seasonally?
• At what frequency was it collected? Is the data collected annually, monthly, at every shift, for example?
• Why was it collected? 

Lipsey also discussed her work with the Firefighter Testing Program, sharing big picture trends for the departments involved as well as individual case studies of firefighters whose health was tracked over several years. The program focused on individual interaction with the firefighters, helping them with goal-setting and lifestyle modification based on the data collected about them. She explained that a key to programs like this is to make the data meaningful for the individual firefighters: “We don’t need to punish them,” Lipsey said. “We need to give them the tools to improve and get better.”

Further, the data must also be meaningful to the departments by demonstrating the value of its members, assisting in the creation of meaningful wellness initiatives, and reducing workers’ compensation, sick leave, etc.

While there are many factors involved in the data discussion, Lipsey concluded with a call to action: “You just need to start!”