A 34-year-old male recruit suffers severe back strain and is placed on light duty. He is removed from the recruit school and is placed into the next school to give his injury time to heal.

A 30-year-old female recruit suffers a knee injury while performing practical evolutions in recruit school. After two surgeries and more than a year on light duty, she retires on disability.

A 49-year-old male, with 20 years of service, suffers cardiac arrest while responding to an emergency. He is resuscitated, survives the event and retires on disability.

The Prince William County (Va.) Department of Fire and Rescue experienced these and many more injuries. However, now the department is fighting back — against injuries, against heart disease, against Type II diabetes, against that unsightly spare tire, and against general deconditioning.

Program assessment

We knew we had a problem, but how bad was it? A review revealed 576 injuries, costing $1.1 million in worker's compensation claims, between 1991 and 2001. To put this in perspective, we had 216 employees in 1991, growing to 290 by 2001. More than 50% of the injuries were musculoskeletal (sprains, strains, dislocations), with a large number occurring during recruit school.

In 2002, the training and personnel divisions, along with the health and safety officer, pushed for the adoption of the IAFF/IAFC Joint Labor Management Wellness/Fitness Initiative as the base model for the department's program. A group worked throughout that year to develop the program, wrote and submitted a grant request through the FIRE Act, and put in motion the steps for the Candidate Physical Ability Test to become our entry-level physical ability test. We learned early in the process that the department couldn't put a program of this magnitude in place by itself. Therefore, we reached out to the other county agencies.

We had developed a positive relation with the county's Office of Risk Management, which contracted a consultant to review firefighter task requirements, evaluate the current physical fitness program used in the recruit school, and provide recommendations to improve the process and reduce injuries. A key part of this review involved having the consultant and risk management personnel don PPE and perform firefighting training tasks. The consultant recommended a program and substantiated our choice of CPAT as our entry-level physical abilities test.

We presented our proposal, with identified goals and objectives, to the senior staff, the finance department, risk management officials and the Office of Executive Management. We proposed six components of our wellness/fitness program and tied the program to customer service enhancements, as well as monetary savings in terms of reducing injuries and sick leave use.

1. Occupational health

   The occupational health component consists of medical physicals, both pre-employment and incumbent, and an employee assistance program for behavioral health issues. The employee medical system has been in place for about 20 years and is in the process of being upgraded to meet NFPA 1582, Comprehensive Occupational Medical Program for Fire Departments.

2. Candidate Physical Ability Test

   In January 2003 we opened our CPAT facility, the first-known indoor facility in the country that is totally dedicated to CPAT. This 13,000-square-foot warehouse space consists of a classroom, offices, locker rooms, weight training/conditioning area, and the CPAT course. What's different about this facility is that the CPAT course is permanently set up and ready to run. In addition, the facility is completely climate-controlled so the CPAT test can be conducted virtually any day of the year. The department has held two test dates so far in this facility and has experienced tremendous success. Overall, the passing rate has been 80% for women and 83% for men.

   We currently are experiencing a 100% pass rate for those candidates participating in our mentor program, which we feel has been the major contributor to the overall success rate. The department uses a 12-week mentoring session to prepare the candidates for CPAT, with candidates participating in flexibility, cardiovascular, core stabilization and functional resistance training. Members of our wellness team were introduced to the concepts of core stability and functional training by Div. Chief Scott Peltin of the Phoenix Fire Department at the Public Safety Wellness conference in Orlando, Fla., in January 2003. We were so excited about the potential benefits of the training that we immediately introduced the training into our first-ever CPAT mentoring session and our recruit school physical fitness regimen.

3. Physical fitness

   We introduced a new exercise program to the recruit school in January 2003. The program incorporates integrated training using resistance tubes, stability balls, medicine balls and core stability exercises. The program is based on the theory that the employee will strengthen the core muscles (abdomen, back and hips), develop good balance, increase joint strength and flexibility, and increase stamina, all of which have been proved to reduce injuries. By creating different circuits to run through, the recruit is getting aerobic activity while performing the basic strength exercises. By adding the core stabilization exercises, we actually have improved the running performance of the recruits while reducing running-related injuries.

   By using the new exercise program with this recruit school, the department has reduced the overall recruit injuries by 88.89%. The original goal of the program was to show a reduction of recruit school injuries by 40% within a four-year period. Obviously, we are elated with the current results.

   We recently introduced the core and functional training program to our incumbents, and thus, have formalized a physical fitness program for our department. There has been considerable acceptance from our incumbents regarding the addition of core and functional training to their exercise regiments. If the reductions in injuries are as consistent as they have been with the recruit school, the department will show a significant cost decrease with worker's compensation claims.

4. Peer fitness trainers

   For both CPAT and the fitness program to be successful, we needed to develop a core group of employees to serve as mentors and peer fitness trainers. We solicited interest from department members wanting to get involved with the wellness/fitness program. We developed an interview process, which included comprehensive questions about health, wellness and personal commitment. Each member desiring to become a PFT was granted an interview. A panel consisting of two members from the DFR and a representative from the risk management division went from station to station to conduct interviews over a two-week period. Each PFT candidate's responses were graded on a numerical scale, and a total interview score was given. We chose the top 40 candidates for the program.

   During our initial CPAT mentoring sessions, the PFT candidates were supervised and given guidance by individuals with previous experience in personal training or a college-education background in health and fitness. We are currently going through the certification process with each of our PFT candidates. To meet our specific needs, we selected the National Academy of Sports Medicine Certified Personal Trainer course as our certifying entity. Our goal is to maintain 40 certified trainers within the department for CPAT mentoring and incumbent physical fitness, then expand that number as the department continues its rapid growth over the next several years.

5. Maintenance/education

   In this component, we are looking at providing additional health-screening programs for all of our members, as well as providing continual education training for our PFTs. We currently are in the process of teaming up with a local university and a private contractor to do additional cardiovascular screening of our members. The reason for this is the high rate of heart disease that runs through any fire department. It is our goal to identify members who are at a higher risk of having some type of cardiac event and then assist those members in making lifestyle changes to reduce their risks — a proactive, preventive approach. In the future, we hope to develop and implement various screening components to assist our members with their overall health and wellness needs.

6. Data collection

   Data collection is one of the key components of the entire program. As we all know, the bean counters want data to support financial investments. Prince William County has been a leader in using performance measurement in decision-making and budget justifications. We have already developed several databases to track our successes with CPAT, as well as the types and causes of injuries and the associated cost. Good data will validate your requests at budget time as well as garner the support needed from your risk management officials or worker's compensation claim carriers.

Successful endeavor

We can't emphasize enough the importance of developing professional working relationships between members of your wellness team and personnel in key government agencies such as finance, risk management, budget and the executive office. The department's leadership must buy into this early and be out front leading the charge. The success of your endeavor depends on it.

We are sure there are many more learning experiences on the horizon. No matter how many roadblocks we encountered, we maintained the desire to be successful, kept a positive attitude and never gave up. We are extremely proud of our results.

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Asst. Chief Brett Bowman has been involved in the fire and EMS service for 29 years. He currently is in charge of the system support section of the Prince William County (Va.) Department of Fire and Rescue. He has a master's of public administration from George Mason University and is a graduate of the National Fire Academy's Executive Fire Officer Program.

Bttn. Chief Tim Keen has been with the Prince William County Department of Fire and Rescue for 16 years. He currently is in charge of EMS operations/health & safety. He has an associate's degree in fire science technology and a bachelor's degree in business administration.

Capt. Brian Cooke has been with the Prince William County Department of Fire and Rescue for 15 years. He currently is the health & safety officer for the department. Cooke has an associate's degree in fire science administration.

Lessons Learned

• Put together a wellness team comprised of members with the passion to develop and implement a successful program.
• Talk with other departments about their successful programs and what they learned in the process.
• Gather lots of information from everywhere and anyone for the benefit of your program.
• Develop sound, realistic goals tied to your department's mission statement and local government's vision.
• Market the idea of wellness within your department and to local government, and get people excited about the possibilities.