IAFF Symposium Examines Multiple LODDs, Lessons Of 9-11
Line-Of-Duty Death and Injury Investigations
The majority of the symposium Thursday dealt with mistakes and challenges that contributed to multiple lodds in 2002 and 2003.
Gary Hass, past president of IAFF Local 3316 in Manlius, NY spoke about the deaths of John Ginochetti and Timothy Lynch on March 7, 2002. Hass said the combination department was short on training and education and that the incident commander, despite many years in the fire service, had only 211 hours of fire training, which is less than a professional rookie has upon graduation from a fire academy.
Hass said firefighters at the scene made assumptions about the actions of others, and up until the collapse that led to the two deaths, no water had ever been put on the fire. The IC refused help for providing water, and his one water supply later failed twice. Also, at one point the county fire coordinator showed up, failed to report, and particpated in response efforts while wearing only partial firefighting gear. He has since been forced to retire, Hass said.
In addition to other problems on the fireground, Hass criticized the lax requirements for firefighters in New York state, which he said only require volunteer departments and departments with fewer than six paid firefighters to have their members take OSHA classes. Hass said that with the help of the International, he is working to get NY to mandate minumum training standards for all firefighters.
Kevin McCabe, Deputy Commissioner of the NJ Department of Labor, presented their findings on the deaths of the three firefighters who died in Gloucster City on July 4, 2002 while trying to rescue three little girls; firefighters Thomas G. Stewart, James Sylvester and John West.
According to the investigation there was a breakdown in incident command, PASS devices were not worn or not activated, there was a lack of accountability, no safety or information officers or rapid intervention crew was designated, and there was no liason officer or radio capabilities for communicating with the mutual aid fire department.
In addition, no evacuation signal was sounded following a communication that the second floor was starting to give way. When an evacation was ordered, firefighters didn't know why - some thought it was because of the floor, and others thought it was to help locate a missing firefighter. Also, the building was demolished and removed within 48 hours instead of being secured for investigation.
Lt. Dan Fleming of the Orlando Fire Department spoke about the live-fire training deaths of Lt. John Mickel and Firefighter Dallas Begg in Osceola County, Florida on July 30, 2002.
Fleming was present at the incident and had often shared or observed Osceola's training exercises. There were a total of three engines and 16 people involved. They did a pre-fire walk through of the site, placed a safety crew inside and set fire to three pallets and two bales of straw.
"The safety crew thought let's put a matress on top of it to give it a little more fire," Fleiming said. The polyurethane matress created so much dark smoke, so quickly, that the safety officers didn't see two firefighters go past them into the fire room.
The room flashed over, and the safety crew and the crew on the first hand line receievd thermal burns and backed out. A second hand line went in to put the fire out and found Mickel. However, "They initially thought it was a mannequin," Fleming said. When they realized it was a firefighter they brought him out and went back to discover Begg by the window.
Fleming recommends not using mannequins, and says if you do, don't dress him up as a firefighter. If his firefighters do use mannequins for RIT drills, they only do it with artificial smoke. Also, they do not hold any surprise RIT drills. "I don't play those games," Fleming said, recommending that all firefighters involved know exactly how each drill is supposed to happen.
He said that prior to this tragedy, the departments would put anything on top of a training fire, and they now realize that disaster could have struck at any time. They have since studied NFPA 1403 and now train their safety officers, man at least three safety lines which are charged before the fire is lit, and limit fuels to pallets and straw. Also, interior safety officers have a thermal imaging camera, and all participants strictly follow a personnel assignment sheet.
Firefighters also remove any questionable items from the fire site, such as carpet and polyurethane padding, which were determined to play a major role in the tragic flashover.
IAFF Oregon State Representatives Paul Esselstyn and Rob McGregor presented findings on the November 25, 2002 deaths of Coos Bay, Oregon Lt. Randall E. Carpenter and Firefighters Jeffrey E. Common and R. Chuck Hanners.
They said the city was cited with 16 violations by the state OSHA. They said the battalion chief had no plan, allowed freelancing, had no accountability, did not assign RIT teams and failed to call additional resources. In addition, the two in, two out rule was not followed, the buddy system was violated, and no continuous water supply was provided.
Esselstyn and McGregor said they believe the actions of the IC directly contributed to the deaths of the three firefighters, which has caused controversy because the chief of the department disagrees. They criticized the chief for publicly saying, "I never thought it could happen here."
"If this is how you think you need to get out of the business," Esselstyn said.
The IAFF representavives said they were present during OSHA's interviews with Coos Bay firefighters and that they agree with OSHA's findings, except that OSHA did not agree with them that there was a willful violation and disregard for rules.
Esselstyn and McGregor also believe that NIOSH's report on the Coos Bay incident is in conflict with the OSHA report and appears less critical. They asked that anyone studying the incident look at either OSHA or both reports.
They closed by stressing that OSHA compliance is no joke. "If you're in charge, make the right choice please," McGregor said.
The final multiple lodd study was presented by Battalion chief Henry Posey of the Memphis, Tennessee fire department, on the arson fire of June 15, 2003 that claimed the lives of Lt. Trent A. Kirk and Firefighter charles A. Zachary.
The two firefighters entered the burning strip-mall store to perform a search. Although firefighters had been told the store manager might be inside, it turned out that he had set fire to the store to cover up a theft, Posey said.
Although the investigation is still ongoing, the department has already learned a few lessons from the tragedy.
Posey said it's important that firefighters take rapid intervention seriously, and never think of it as a punishment that they are waiting while others are fighting the fire.
The department also had a problem with accountability. Posey obtained a photo in which one truck company has five firefighters instead of the four it should have had. Nobody has admitted to being the freelancer, and the fire department has not been able to identify him, the chief said.
Posey explained the series of events leading up to a mayday from Kirk. RIT responded, but the firefighter with Kirk got separated while trying to navigate over piles of debris and getting confused by more than one hose line.
Firefighters found Zachary with help of his PASS device after he had been missing for 23 minutes, but then had a hard time carrying the 6 ft. 4 in., 275-lb. man out through all of the debris.
Firefighters then evacuated and the roof collapsed two minutes later. A third alarm was called, defensive operations were set up and they knew they would be recovering Kirk, not rescuing him, Posey said.
Posey stressed the importance of calling for help, and not being macho and trying to deal with a problem yourself. "If you think you're in trouble you probably already are," he said. "For God's sake if you're in trouble don't hesitate."
A presentation was also planned in memory of Captains Robert Morrison and Derek Martin of the St. Louis Fire Department, who died in the line of duty on May 3, 2002. Although the presenter could not attend the conference, organizers still showed the short movie giving background on the tragic incident and the firefighters' lives.
Fire Department Operations - September 11, 2001
Earlier in the day, firefighters gathered at the symposium to hear about the lessons learned from fire department operations at the Pentagon and the World Trade Center on 9-11.
Assistant Chief James Schwartz of the Arlington County Fire Department explained the challenges responders faced at the Pentagon and made recommendations for improving operations at other disasters.
He said one of the problems was the many self-dispatched firefighters arriving on scene, because they complicated accountability and depleted resources from the rest of the region. This is dangerous because experience has shown that terrorist attacks are likely to come in multiples, Schwartz said.
Challenges at the Pentagon included bullet proof glass, poor identification of entrances, the maze of corridors, and the covered road into the center court which required them to cut off the roofs of several cabs. Schwartz said he also had to insist on better site security, especially because in Israel, it is common for terrorists to disrupt response efforts with a second attack.
Schwartz said the most important asset was that the many agencies involved had already developed relationships and had no trouble falling into the command structure.
"Nobody ever preplanned for this kind of event," Schwartz said. "What was important was that we had an incident command structure that we all subscribed to and that we understand each other."
Invaluable resources included crash fire rescue vehicles, USAR teams, and a large piece of heavy machinery called a T-Rex, several of which FEMA has since placed stragically around the country, Schwartz said.
He said military assistance was essential for debris removal, but the members did not have a good understanding of incident command, he said. In the beginning they were trying to go inside and fight fire with nothing but paper masks. Firefighters had to physically block them, probably saving them from the collapse which occurred soon after. Schwartz said the Red Cross also took care of many needs they had not prepared for, such as dry socks at 2 a.m.
Schwartz said three evacuations of the scene went very smoothly but two of them should never have happened. The first evacuation was performed because the FBI informed them that another plane, the one that ultimately crashed in Pennsylvania, could hit the D.C. area within 20 minutes. That FBI source was was later drawn away from the incident commanders, so they listened to warnings from Reagan National Airport when flights came into the area. These turned out to be government officials, including the FEMA director, responding to the scene.
Deputy Assistant Chief Peter Hayden of FDNY spoke about the World Trade Center, saying that the response to the attacks shone a light on FDNY and firefighters around the world. "The actions of the firefighters that day defeated that act," he said.
The many operational problems encountered included the tragic communications failure. The repeater system in the WTC no longer worked, so officials couldn't be sure that communications were raching the upper floors. In addition, there were 99 elevators in each building, from which they received at least a dozen distress calls from people trapped inside. Fire officials were calling all the rest of the elevators to determine which needed rescue. Also, one company in the WTC had specifically hired handicapped workers in wheelchairs. "We knew we were in great danger but that was our mission," Hayden said.
There was no way to extinguish the massive fires, there was a tremendous number of burn victims, and the many jumpers posed a hazard as they landed on apparatus and killed one firefighter.
Hayden described how he was still inside the North Tower when the South Tower collapsed. He ordered an evacuation repeatedly, but "Some companies obviously didn't hear," he said. As he and other firefighters made their way out they found Father Mychal Judge.
Soon after, Hayden was on his way to the main command post when the North Tower collapsed. "I like to say I dove - but I crawled under a pumper," he said. "I just put my head down and figured this is it." After that there was an eerie quiet, and he could barely see or breathe. "You just hear radios, people asking 'Are you there, Are you there,' and you heard absolutely nothing."
The command post had been lost, it was dark, and everybody was in a state of shock. Hayden spoke about re-establishing command and control, and about "miracle company" Ladder 6, which survived in the B stairway of the North Tower during the collapse.
The trapped firefighters didn't know the building had completely collapsed around them and radioed for help. When incredulous rescuers said they couldn't find Stairway B, the captain started giving directions from the former building's lobby. "It was one of the bright spots of a long period," Hayden said.
The chief described difficulties with personnel accountability, site security, concerns about World Trade center building 7 which they knew would also soon collapse, and concerns that the slurry wall might fail and flood the site with water from the Hudson river.
He also described how the fire department established a committee for firefighter safety at the scene and how they dealt with the logistics of planning, staffing, feeding, supplies, medical assistance, mental health issues, and the documentation of found body parts and a morgue.
The chief praised the USAR teams and the use of thermal imaging cameras for tracking fires in the pile.
Hayden said that as a result of the experience FDNY plans to make many improvements. These include plans to increase operational preparedness, improve planning and management, enhance family and member support, increase hazmat capabilities and keep more fire boats. They have also recommended changes in building codes and worked to improve high rise communication.
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