Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Health Sciences


Rehabilitation Sciences

First Advisor

Dr. Nicholas R. Heebner


Firefighting is considered one of the most dangerous occupations in the workforce. Musculoskeletal injuries are consistently the most frequent, and most costly, documented non-fatal injuries in the firefighting setting. An increase in job stress, job exposure, and deprived sleep secondary to job-related duties are plausible explanations for the frequency in musculoskeletal injury. The aims of this dissertation were to ascertain not only how occupational exposure via firefighter emergency call volume may influence outcomes contributing to job stress and objective and subjective sleep metrics, but also its influence on the incidences of musculoskeletal pain.

The results showed that emergency call volume negatively impacts sleep duration (r = -0.386) and subjective sleepiness (r = 0.325), as well as increases in perceived exertion experienced on-duty (r = 0.283). In fact, a one-minute increase in total run time was associated with a 0.00582 increase in RPE and a 0.00208 increase in sleepiness (AIC = 4070.30; AIC = 3719.20, respectively). Conversely, a one-hour increase in on-duty sleep was associated with a 0.228 decrease in reported RPE and a 0.485 decrease in subjective sleepiness. In addition, sleep disturbances on-duty as well as sleep experienced off-duty were the strongest predictors of self-reported pain a firefighter experiences while on-duty (AIC = 5188.30). Furthermore, sleep duration both on- and off-duty may impact self-reported recovery (AIC = 3680.20). In addition to sleep, subjective sleepiness and self-reported pain, along with perceived exertion and the presence of a stressful event), also appear to influence self-reported pain and recovery, respectively (AIC = 3932.60; AIC = 5721.90). It is the intent of this work to provide sufficient data and evidence for clinicians, researchers, and administration alike to further promote clinical and policy changes that, ultimately, benefit the individual firefighter.

Digital Object Identifier (DOI)

Funding Information

This work is supported by the Central Appalachian Education and Research Center (no.: T42OH010278) in 2021.

Available for download on Friday, November 28, 2025