Each year, about 100 U.S. firefighters die and at least 80,000 are injured in the line of duty. Even though a 30-year overview prepared by the National Fire Protection Association (NFPA) reveals that the death rate at structure fires has dropped steadily since 1999, recent events remind us that the need for diligent safety efforts is critical when responding to fires in residential and commercial structures ("Firefighter Fatalities Studies 1977–2006" by R.F. Fahy, P.R. LeBlanc and J.L. Molis, NFPA Journal, Vol. 101, No. 4, pages 48–55). Lessons learned from these tragedies, if acted on, may prevent future deaths.
The National Institute for Occupational Safety and Health (NIOSH) Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) investigates firefighter line-of-duty deaths. Investigators visit the scene of each incident to take photographs and measurements and to diagram the area. Investigators travel to the fire department to interview emergency personnel who were on the scene at the time of the incident and review all applicable documents. Each investigation results in a report that describes what happened and includes recommendations for preventing injuries or fatalities. (Investigators from NIOSH's FFFIPP may review documents such as department standard operating procedures (SOPs), dispatch records, training records for the victim, the victim's medical records, coroner/medical examiner's reports, death certificates, blueprints of the structure, police reports, photographs and video. NIOSH may also work closely with other investigating agencies.) Since the FFFIPP program began in 1998, NIOSH has issued hundreds of recommendations based on scientific findings and recommendations adopted by other experts, such as the NFPA and the Occupational Safety and Health Administration (OSHA).
Among the most frequent FFFIPP safety recommendations are those that involve the way resources are managed at the fire scene (NIOSH, 2008). NIOSH recommends that fire departments:
- Establish and implement an Incident Command System with written SOPs for all firefighters
- Ensure that the incident commander maintains close accountability for all personnel at the fire scene, conducts an initial size-up of the incident before initiating firefighting efforts and continually evaluates the risk versus gain during operations
- Ensure that the incident commander appoints a separate incident safety officer at all significant emergency incidents
- Immediately upon arrival at the scene, establish a rapid intervention team (other NIOSH recommendations address such topics as training, SOPs, motor vehicle safety, personal protective equipment, radio communication, risk versus gain, apparatus specifications, radio communication, and firefighter fitness and wellness)
In 2006, NIOSH comprehensively assessed whether such recommendations have improved safety practices in the fire service. To inform this review, RTI International, under a contract with the Centers for Disease Control and Prevention (CDC), surveyed more than 3,000 fire departments nationwide to learn whether officers are aware of and compliant with the recommendations (NIOSH is part of CDC). The respondents for the fire departments were fire chiefs or their designees, usually a safety or training officer. In addition to surveying officers, RTI conducted a series of focus groups to learn what frontline firefighters had to say.
As a safety research agency, NIOSH encourages fire departments to adopt and follow FFFIPP recommendations; however, individual fire departments choose whether and to what extent to adopt and adhere to them. (NIOSH publishes Alerts, which briefly present new information about occupational illnesses, injuries and deaths, as well as other documents that summarize patterns and lessons learned from similar incidents. NIOSH periodically mails the line-of-duty-death reports, Alerts and other documents to the nation's fire departments and makes them available at http://www.cdc.gov/niosh/fire/. A full list of reports appears at http://www2a.cdc.gov/NIOSH-fire-fighter-face/state.asp?state=ALL&Incident_Year=ALL&Submit=Submit.)
If you are a fire department officer and choose to develop and enforce procedures for deploying resources as safely as possible at the fire scene, then you will help lower the risk that firefighters will die on your watch. Three key tools for effectively deploying resources at the fire scene are the Incident Command System, the incident safety officer and the rapid intervention team.
• Establish and follow incident command procedures — According to officers' responses to the NIOSH survey, most fire departments establish incident command routinely when responding to structure fires (84% report that incident command is established "most of the time" or "always"). Despite this reassuring finding among officers, several focus group participants — the frontline firefighters — identified failure to implement incident command at the fire scene as the major contributor to "the worst safety incident" they had experienced during their careers. Firefighters in four of the focus groups said "a lot of freelancing" occurs. (There is a difference between establishing incident command and actually implementing incident command. Officers may, in fact, establish incident command at the scene, but if it is not enforced or implemented effectively, then freelancing, real or apparent, could occur.)
It is less likely that incident command is used in a volunteer, part-volunteer department or in a rural (fewer than 825 persons protected per square mile) or small jurisdiction (fewer than 5,000 persons protected all together). According to the officers' survey responses, career fire departments are much more likely (79%) than volunteer (59%) and part-volunteer (53%) fire departments to report that they "always" establish incident command at structure fires. Likewise, not only are fire departments in urban jurisdictions (96%) more likely than those in rural jurisdictions (82%) to report that they "most of the time" or "always" establish incident command, but 10% of rural fire departments report that they "rarely" or "never" establish incident command. Fire departments in large jurisdictions (87%) and medium-sized jurisdictions (72%) are also much more likely to "always" establish incident command than are departments in small jurisdictions. In fact, not only do fewer than half (48%) of small-jurisdiction departments "always" establish incident command, but 12%, as identified by their own officers, "rarely" or "never" establish incident command.
Throughout the fire service, gaps exist in incident command use, but much the same pattern emerges with regard to departments' establishment of incident command SOPs that are needed for firefighter safety. In volunteer fire departments, there is a 15% chance that no SOP on incident command exists in the department and a 41% chance that incident command is not always established at the fire scene. In small-jurisdiction fire departments, there is a 21% chance that no SOP on incident command exists in the department and a 51% chance that incident command is not always established at the fire scene. Likewise, in rural fire departments, there is a 17% chance that no SOP on incident command exists and a 47% chance that incident command is not always established.
Fire departments that have experienced a line-of-duty death are more likely to establish incident command at least "most of the time." Some 94% of those departments with a previously FFFIPP-investigated death and 93% of those departments with an uninvestigated death establish incident command at least "most of the time." compared with only 84% of departments that have not suffered the loss of an on-duty firefighter. Among fire departments that have never experienced an on-duty firefighter fatality, there is a 16% chance that they do not have an SOP on incident command and a 44% chance that incident command is not always established.
The important lessons are: If you are a fire officer, particularly for a small, rural or volunteer department, enhance your department's safety by developing and implementing standard incident command procedures; likewise, if you are a front-line firefighter, encourage compliance with incident command procedures once they are adopted.
• Train all firefighters on incident command — Fire departments that do not regularly use incident command or that lack SOPs on incident command should develop and implement SOPs for incident command and provide firefighters with incident command training. The NIOSH survey showed that 30% of all fire departments did not require incident command training; about a quarter (27%) of all fire departments, however, provided optional training on incident command. In the Midwest, 23% of the fire departments did not require incident command training. In rural jurisdictions, 31% of the departments did not require such training. In small jurisdictions, 38% of the departments did not require such training. In all-volunteer fire departments, 30% of the departments did not require such training.
Departments in Midwestern, rural, small or volunteer jurisdictions and those that have not suffered the loss of an on-duty firefighter are generally more likely than other departments to allow such training to be optional, when it is provided. If you are a firefighter in one of these kinds of departments, you may need to request this training through your department; moreover, all departments should be urged to make incident command training available and accessible. (NFPA 1561, 4.8.1, states that "All responders who are involved in emergency operations shall be trained in the incident management and personnel accountability systems to the anticipated level of their involvement.")
• The incident commander's responsibilities — The incident commander should develop an Incident Action Plan (IAP), always maintain an awareness of the location and function of all companies or units at the scene of the incident, and always conduct an initial assessment upon arrival at the fire scene. The incident commander should appoint an incident safety officer at all significant emergency incidents. However, only about half of fire departments (52%) assign a safety officer at least most of the time; 13% of fire departments never assign a safety officer. According to survey responses, incident commanders in rural and small jurisdictions appear to be least likely to assign a safety officer. Slightly less than 50% of incident commanders in rural fire departments assign a safety officer at least most of the time; 14% of rural fire departments never assign a safety officer. Only 49% of those in small jurisdictions assign a safety officer at least most of the time; 16% never do. All fire departments should — by means of SOPs, training and enforcement — emphasize the importance of assigning an independent safety officer.
• Use rapid intervention teams — Fire departments should ensure that a rapid intervention team (RIT) is immediately established at the fire scene, yet only about two fifths (42%) of all departments surveyed say they have RITs available at least most of the time at structure fires. About two fifths (43%) of all fire departments say they are sometimes unable to establish RITs because too few firefighters are at the scene of the fire. In our focus group discussions, firefighters said that among their main safety concerns was the failure to routinely use RITs. If you arrive and there are too few personnel on the scene to establish a RIT, and enter structures without a team in place, you may be taking an unnecessary risk.
According to the NIOSH survey, the use of RITs is common in large jurisdictions, but much less so in small jurisdictions. Only about a third (33%) of small jurisdictions have RITs available at least most of the time. In the South, only 37% have teams available most or all of the time; In the Midwest, the figure is 30%, with two fifths (39%) never having RITs available at structure fires. Almost three quarters (71%) of urban fire departments have RITs available "most of the time" or "always," compared with fewer than two fifths (38%) of rural fire departments. Only 45% of volunteer and 39% of part-volunteer fire departments "always" have teams available at structure fires. Finally, only 42% of departments that have never experienced an on-duty firefighter fatality establish RITs at least most of the time.
Firefighters in fire departments that have had a prior FFFIPP investigation are much more likely (60%) than those in the fatality-without-investigation (36%) and the no-fatality (35%) departments to require training on RITs. Similarly, fire departments with a prior fatality establish a team more often than departments that have not experienced a firefighter fatality: 64% of those reporting an investigated fatality reported use of RITs "most of the time" or "always," compared with only 42% of those departments without a history of fatality. Fire departments that have experienced a firefighter fatality are, finally, more likely than fire departments that have not experienced one to have SOPs on RITs: 64% of those having experienced an investigated fatality have SOPs, compared with only 40% of those with no fatalities.
For all categories of NIOSH recommendations considered here, whether you are an officer or a frontline firefighter you should continually inform yourself and your department members of these and all NIOSH recommendations. As a result, your department may effectively implement and use these recommendations to improve the chances that you will walk away safely and uninjured whenever you battle a structure fire. As one focus group participant said, "Most deaths occur because the fundamentals were ignored. A lot of times, the firefighter was trained incorrectly. You need to train as you work and work as you train."
JAMES T. WASSELL, Ph.D. is a research mathematical statistician who has been with the National Institute for Occupational Safety and Health for 17 years. His publications include work in statistical methodology, occupational injury, back injury, workplace violence and risk assessment. His publications have been recognized through the 2001 NIOSH Alice Hamilton Award and the 2000 CDC and ATSDR Statistical Science Award.
KRISTINA PETERSON, Ph.D., is a senior survey director at RTI International with over 25 years of research experience. She has expertise in evaluation methodology, survey design and qualitative methodologies. Her cross-national research experience has focused on workplace health and safety, work organization, and workforce development, as well as public health promotion interventions.
HARLAN AMANDUS, Ph.D., serves as chief, Analysis and Field Evaluations Branch, which is responsible for evaluation of injury interventions to reduce risk of occupational injuries. He has over 30 years experience as an epidemiologist and over 15 years experience in the epidemiology of occupational injuries. He has authored papers on occupational lung disease, cancer and workplace violence. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health.