Impact of a design modification in modern firefighting uniforms on burn prevention outcomes in New York City firefighters

Our aim was to determine the impact of three different firefighting uniform s (traditional, modern, and modified modem) on the incidence and severity o f thermal burn injuries, the major occupational injury affecting firefighte rs. Injury data were collected prospectively for the entire New Pork City F ire Department (FDNY) firefighting force wearing FDNY's traditional uniform (protective over-coat) from May 1, 1993 to August 31, 1993 FDNY's modern u niform (protective over-coat and over-pant) from May 1, 1995 to August 31, 1995; and FDNY's modified modem uniform (short sleeved shirt and short pant s, rather than long-sleeved shirt and long pants, worn under firefighter's protective over-clothes) from May 1, 1998 to August 31, 1998. Outcome measu res were burn incidence and severity. Adverse outcomes were heat exhaustion and cardiac events. During this 12-month study, 29,094 structural fires oc curred. The incidence rate for upper extremity bums was 2341 per 100,000 fi res and for lower extremity bums, 2076 per 100,000 fires. With the change f rom the traditional to modern uniform, the distribution of burns per fire d ecreased significantly (P = 0.001) for upper extremity burns (86 %) and lov er extremity bums (93 %). With the change from traditional to modem uniform , days lost to medical leave for upper or lower extremity bums decreased by 89%. The majority of burns occurred at the lower arm and mid-leg, and the change to the modern uniform decreased such bums by 87% and 92%. Burn incid ence and severity were not significantly affected by the change to the modi fied modern uniform. The distribution of heat exhaustion or cardiac events per fire was not significantly affected by the change from the traditional to modern uniform, and heat exhaustion was decreased (P < 0.001) by the cha nge to the modified modem uniform. In conclusion the modern uniform dramati cally reduced burn incidence and severity without adverse impact. The modif ied modem uniform significantly reduced heat exhaustion without significant ly affecting thermal protection.