Objective: This proposed research involves the application of a tailored risk management intervention to reduce injuries in firefighters. Background: Firefighters are at high risk of injury due in part to the need to perform strenuous activities in a dynamic environment. Risk management involves the creation and application of standard operating procedures for all processes with significant health and safety risks. We previously demonstrated that adoption of a risk management-based regulatory approach in Australian coal mining was associated with a marked reduction in lost-time injuries compared to the United States, which maintains a compliance based system. We hypothesize that the injury prevention strategies successfully utilized in the Australian mining industry can be tailored to high risk processes in firefighting, reducing injury incidence and severity. Specific aims: 1) Implement task-specific, risk-based intervention strategies within the Tucson Fire Department; and 2) Compare injury rates pre- and post-intervention within Tucson, and with a control population of firefighters from the Phoenix Fire Department. Study design: This study will employ a quasi-experimental, controlled longitudinal intervention design to address Aim 1. The intervention is participatory in nature and involves continual feedback from the firefighters. Formative and process evaluation methods will be used to document and analyze the early development and actual implementation of the risk management intervention. The intervention will include scoping sessions to identify hazards, analysis and characterization of the risks associated with each job task, introduction of a set of clear control measures including department-wide training, and provision of gap analysis identifying the need for additional or combined intervention strategies. The risk management intervention will be employed for three job-specific tasks associated with a high frequency of injury and severity, including (1) physical exercise/drilling, (2) patient transport and (3) fireground protocols. An evaluation of protocol adherence will also be conducted among injured and uninjured firefighters. Aim 2 addresses intervention outcomes. Pre- and post-intervention data from the study sample within the Tucson Fire Department will be used to assess intervention effectiveness on injury rates, using both a simple change model and a time-series approach. Data from the Phoenix Fire Department will serve as a non-intervention comparison population. Overall injuries and process-specific injuries will be compared between fire departments for a period of seven years - 5 years of historical health surveillance data and 2 years of post intervention follow-up. Relevance to public health: We expect that the risk management intervention will significantly reduce injuries and their severity in firefighters, and serve as a model strategy for other fire departments and industry. This proposal will address the NORA priority area of improving public safety sector/firefighter health and safety. Risk management, involving the creation, tailoring, and application of standard operating procedures for all processes with substantial health and safety risks, provides an ideal approach to reducing injuries in hazardous professions including firefighting. We expect that the proposed risk management intervention will significantly reduce injuries in firefighters. If successful, this intervention can be adapted for use in fire departments across the nation and internationally.