What Is Killing America's Firefighters?

Everybody goes! Phone alarm both companies 1st due, report of a fire in a multiple dwelling. Fire's in apartment 4B, on the fourth floor.

Whether you are the chief officer or a firefighter, we all start our size-up: time of day, weather, type of occupancy, and resources responding. These questions we ask all pertain to our safety responding to and operating at the fire scene. Anyone who has ever responded to a report of a fire knows that there is another process that is going on, one that we don't think about every time we respond.

Manhattan to Engine 58, report of people trapped fourth floor.

As we get more information we focus even more on the task at hand. How many people, what apartment, are there others? The situation becomes more intense. We now know there could be a job. You can feel your heart beat with a purpose.

Manhattan to Engine 58, we're getting numerous calls, looks like you're going to work!

When we hear those words from the dispatcher we have a good idea that this could be a job. Our thoughts clear and we concentrate on the task at hand without anything distracting us. The situation is vital. Our hearts begin to beat immensely. We focus our thoughts on all our training and drills that we have done to prepare ourselves for this very call. Backdraft, flashover, collapse, burns? We suddenly remember everything every instructor ever taught us. Otherwise, we are regretting not paying close enough attention. As we turn into the block we see smoke and fire blowing out the windows.

Engine 58 to Manhattan, 10-75 the box. Fire in a multiple dwelling, fire is on the fourth floor.

It's confirmed, you run to the back step and grab the nozzle you start the stretch. As you snake the line down the street you think about what you are going to do. Don't let the line get hung up on anything. Is there a well, rope stretch? Can we snake it? As we enter the building you can feel you chest pounding.

Ladder 26 to Engine 58, we need a line up here. We've got two 10-45's (code for unconscious civilians) with reports of children trapped.

You know now you have to make that apartment no matter what it takes. You start to think of those kids as your own. As you carry that line up the stairs you feel your chest begin to tighten, as you move up each step you fight the need to stop for a second and catch your breath. The officer is calling for the line but your not there yet.

58 to 58 chauffeur we have fire on the fourth and fifth floors with people trapped order a second alarm.

You make it to the fire floor. You now see for yourself what you are up against. Remembering your size up, thinking about the apartment layout, you crack the nozzle. Now the pain in your chest is radiating to your left jaw and down your arm. It doesn't really hurt, its just there.

Ladder 26 to Engine 58, the fire's coming down the hall to the left. Looks like a colliers mansion. We're right behind you.

You take one last breath. As the door opens the fire begins to roll out into the hallway. As you hit the fire and move in, the pain in your chest gets tighter and breathe shorter. The heat and smoke increase as you knock down each room. Reaching the back room is your goal and your heart is now maxed out. As you knock down the last room you hear the boss on the radio.

Engine 58 to Battalion 12, the fire is knocked down on the fourth floor, trucks are opening up.

As you hear those words, the boss tells you to go down and take a blow. Your thoughts become focused on yourself and the pain becomes more intense. As you reach the street you become concerned as you realize this could be a heart attack. The rest of your company becomes concerned and summons a paramedic to take a look. As they work to rush you to the emergency room, it's confirmed you are having a heart attack.

Engine 58 to Division3, EMS is transporting one of my members in critical condition to the hospital. My nozzle man is having a heart attack.

Each year heart attacks take the lives of more firefighters than all of the other line of duty deaths, and hundreds more are forced into early retirement. Firefighters are more at risk than the general population to develop heart disease. Stress, diet, lack of exercise and irregular sleep patterns vary with each individual. A death suit, consisting of over 75 pounds of tools, equipment and personal protective gear affects the whole profession.

Protective gear and equipment is over working the firefighter in structural fires. The encapsulating gear and 75 pounds of weight per firefighter causes our cardiovascular systems to work in overload. This added stress on the heart with associated risk factors can lead to a disaster. SCBA is now designed to give us up to an hour of working time. With the amount of stress we are under for that length of time I am amazed there are not more deaths. After the fire is knocked down, during overhaul, is when most injuries occur. No matter how hard we train and prepare we are going to take feeds at fires. This exposure puts us at great risk for coronary artery and pulmonary disease's.

As we have seen in the past decade, the number of firefighters killed in the line of duty by heart attacks is at the top of the list. Thirty-seven firefighters died from heart attacks in 2002 and in 2003, 42 suffered a similar fate as did 61 firefighters in 2004. In 2005, 55 firefighters died in the line of duty from heart attacks and that number increased by six when legislation passed to allow firefighters who suffered a heart attack within 24 hours of duty their death benefits.

Our profession is a profession of stress. Along with the inherit risk of the job itself, we are exposed to emergency situations that most people in this country only read about. This stress is a risk factor that firefighters cannot control. It is our job to handle this type of work professionally and expeditiously to ensure the safety of the citizens we protect. Bunker gear, SCBA, and new age technology is great for the fire service, if used correctly.

As we can see this also adds a greater burden on the firefighter. We are expected to carry more equipment, operate longer, get in deeper, and be encapsulated tighter. This allows firefighters the means to save more civilian lives, leaving us to ponder. What is the cost to us? Although our job is to save the public from harms way, we must never let a firefighter's death be acceptable. In order for our profession to grow and to make the public safe, we must first ensure our own safety and the safety of those we work with.

Many people I have come across in my career as a firefighter are genuinely concerned with firefighter safety and well being. Although, there have been those who have not mastered this aspect of our profession. We must concentrate more on firefighters' health at a fire scene than we do. Those days of over working firefighters are gone and those who feel this is appropriate are setting themselves up for a devastating reality, death. We are not capable of working as long as we do at the routine brush fire. Turn that same fire into two or three alarms and you have to start worrying about relief and your member's health.

Company officers should know their company's limits. If you have an older crew you may want to think about relief early into the operation, as with a younger crew they want and need the experience so they may be able to stand extra work but must be monitored closely for fatigue, dehydration and exposure. It is better to be safe with a second alarm and early relief companies, than it is to tell a loved one their son or daughter die from being overworked.

It is no longer acceptable to command a fire without the thought of relief for your members. We must set the standard that we need to work together for a solution to this problem of poor leadership. As a commander, your member's safety should be the first thought of any decision that you make when attacking the fire. You are responsible for the safe return of your men and all decisions should compliment that.

A recuperating vehicle should respond to all major fires. In the summer it should be equipped with air conditioning, wet towels, and cold sports drinks. During the winter months it should have the same plus heat, blankets, and warm fluids. Throughout the year this vehicle should be staffed with a medical professional, for example: Medical Doctor, Physicians Assistant, or Nurse Practitioner. This person would able to treat injuries at the scene (if minor), facilitate transport to the hospital and coordinate the injured firefighter's care, to a level that is consistent with the work we ask of our firefighters.

As we look to the future of medicine, as it relates to the fire service, prevention is the new horizon. The firefighting profession needs to accept this concept for the safety and wellbeing of its members. We need to look out for one another on the fireground. Knowing the sign and symptoms of a heart attack or life threatening condition may be your only chance to prevent your co-worker from death or disability. Any medical training that is offered to you through your department should be taken full advantage of. The life you save could be your own.

Testing is available for cardiac and pulmonary diseases. EKG, blood work, pulmonary function testing, echocardiograms, and stress tests should all be done for those who have risk factors for cardiac and pulmonary problems. Nuclear stress tests provide a cardiologist the ability to see coronary artery disease before the patient experiences a heart attack. This test, along with the other tests described, can reduce morbidity and mortality amongst firefighters over the next decade. The real challenge is to reduce firefighter fatalities to zero.

Although there is no guarantee for our safety, we cannot sit back and accept that firefighters are dying needlessly in the line of duty. Over the past three decades we have seen firefighter deaths decrease and then increase with the advent of bunker gear. This is during a time of decreased major fires. This can be attributed to a couple of factors:

  1. Bunker gear is not being used properly or we are not trained properly in its limitations
  2. Wellness and screening programs are not being utilized to the full benefit of the firefighter
  3. Manpower is not sufficient to meet the needs of a changing work environment
  4. Company officer's need to be more aware of the health and wellbeing of members when operating at fires.

To correct these problems and concerns as a profession we need to come up with ways to improve, training, healthcare, awareness, and develop more intense medical screening for high risk individuals. Performance incentives for firefighters to maintain physical fitness standards, and the resources to do it, would greatly reduce injuries and encourage a healthy lifestyle to a profession that deserves only the best.


Robert J. Brown Jr., Registerd Physican Assistanct-Certified (RPA-C), has 14 years in the fire service and is currently with the FDNY where he serves as a Lieutenant with Ladder 120 in Brownsville, Brooklyn. He has been with the FDNY for over 10 years, including the last two as an officer. Previously, he served with the Glenwood Fire Company in Long Island, for 11 years.

Robert is the director of the New York Firefighter's Heart and Lung Institute and speaks nationally on firefighter health and safety. You can contact Robert at rbrownpa@yahoo.com.

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