The following are highlights from the “Fire- fighter Fatalities: Enough Is Enough, Stopping Them Once and for All” panel discussion at the 2003 Fire Department Instructors Conference in Indianapolis, Indiana.
Participants were Chief Alan Brunacini, Phoenix (AZ) Fire Department; Chief John Buckman, German Township (IN) Volunteer Fire Department, Evansville, Indiana; Battalion Chief Dave Dodson (ret.), Loveland and Eagle River (CO) Fire Departments, and chief instructor, Response Solutions; Chief Billy Goldfeder, Loveland-Symmes (OH) Fire Department; Deputy Chief Robert Halton, chief of operations, Albuquerque (NM) Fire Department; Chief Rick Lasky, Lewisville (TX) Fire Department; Battalion Chief John J. Salka Jr., Fire Department of New York; District Chief for Officer Development Peter Sells, Toronto (Canada) Fire Services; and Chief Bill Shouldis, Philadelphia (PA) Fire Department. Deputy Chief of Fire Prevention John (Skip) Coleman, Toledo (OH) Fire Department, and William Manning, associate publisher and editor in chief of Fire Engineering and FDIC coordinator, were facilitators.
The focus of the discussions was fatalities that occur on the fireground. Line-of-duty deaths related to cardiovascular disease/events (close to 50 percent) and motor vehicle accidents (about 25 percent) were excluded from this discussion.
WHY FIREFIGHTERS ARE DYING INSIDE OF STRUCTURES
Sells: We’re in the profession of saving people from fires, and we know that the killer is smoke. We have the best equipment we can afford within each of our localities in terms of breathing apparatus. So, we are puzzled by how this is happening. But, if a firefighter dies from asphyxiation and he wasn’t wearing breathing apparatus, it becomes a no-brainer.
If the firefighters were wearing breathing apparatus, were they being managed properly? Was somebody aware of where they were? How much time had they been in there? When did they go on air? Did they have a partner? Most of the time, it’s going to boil down to a failure in incident management or in strategic management, going right back to the fire department’s culture and its acceptance of discipline and personal discipline and adherence to policy. Without looking at each one of those incidents [line-of-duty deaths] individually and looking at the factors, it would be difficult to draw conclusions on each factor.
Goldfeder: It seems to me it’s leadership, training, and staffing. Leadership at two levels, at the top where the policies are decided and at the company officer level, making sure [company officers] take care of their people and keep track of their personnel.
[We ask], ‘What’s the best accountability system?’ Right now, at least until I see something better, it’s a good company officer.
Obviously, we don’t train enough. The average fire crew on duty doesn’t train. When you tell [people] that our department is training one to two hours per every 24-hour shift worked, they look at you as if you’re from Mars. But, the good news is that there seems to be a lot more interest in getting back to training on a regular basis.
You’ve got to have the staffing to get the tasks done. When you have more staffing, additional training, and [accountable] leadership, you have a safer fireground.
Buckman: It’s not firefighter staffing; it’s staffing the command structure. We don’t have a position in the command structure for airway management. This is something new. We’ve got to start managing more than just the strategy and tactics. We’ve got to manage what firefighters are doing. We have to look at the command structure, and we’ve got to ask, ‘Well, do we want to leave the second battalion chief sitting in the fire station or do we want to have two battalion chiefs making the run?’
‘Do we want to volunteer our smaller departments, or do we need to call mutual aid to help manage the incident and manage all the things that the firefighters are doing?’ I mean, if you have 12 firefighters on the fireground, most of us have one overall incident commander (IC) who’s trying to keep track of all these things. There are too many things. We’ve got to look at having more people in the command row.
Halton: We go into house fire after house fire; we suck our air back down to where we’re doing negative pressure. We leave by a window or a door that is eight or 10 feet away, and we live. So, we develop a mindset that we can pull that off. We can’t pull that off in every structure.
When you start talking about fixing the problem, you start with the firefighter and the command system and the tactical system and the company officer at the same time. Airway management is not something we’re really good at right now. The first thing we [should do] is convince the firefighters that what we’re telling them is the truth: ‘Breathe smoke in, and you die,’ and we beat them over the head [with this] in school.
Then the fire’s out, and we start doing overhaul. We all pull our masks, and we’re breathing smoke, and we’re not dying. We go to house fire after house fire, and we wait until somebody’s bells go off or we see the guy’s vibrating alarm or the guy’s literally pulling that mask to his nose, and then we tell him to get out. I think there’s a problem at the most basic level. That’s the best place to start.
Salka: A little disagreement here. I realize we probably need some staffing at the command level for the management of that particular aspect, but I feel that the responsibility for that falls with the company officer.
Number one—as we teach firefighters in our survival class—you are responsible for your own survival, you personally. There could be a hundred teams there. There could be 10 command chiefs with air bottles and helicopters, but you are responsible for your own survival. If we need to educate ourselves on whether we are in a house fire or in a commercial factory or whether we’re three levels belowground or in a submarine—obviously, we can’t consume air and use the same equipment in the same manner in different facilities—that’s all down at the bottom level.
People in the smoke have to be able to manage and use their own equipment and know their limitations. First-line supervisors, company officers, need to wear out the toe of their right boot kicking people in the butt and getting them out if they have to get them out.
We have to be able to pull out our people when the time arrives—before the bell, after the bell, whatever the procedure is that we set up. I’m not recommending any particular one. Everybody’s got different equipment with different time limitations and different things like that, but I think the responsibility resides at the lower level, not that we couldn’t improve it by having somebody doing that in the command level.
Dodson: I like to play off that individual role, too. From day one in academies, we’re teaching our firefighters to swim around in zero-visibility smoke. We pride ourselves in that ability to manipulate, maintain orientation in zero-visibility environments. The bottom line is, a zero-visibility environment is an IDLH [immediately dangerous to life and health] environment. You are on the edge. There’s one thin small barrier between that IDLH environment and your living or dying. We have to recognize that if you can’t see, you are in a high, high-risk mode. We train for that. We try to find comfort in that, but we have to match that to, Is that an acceptable risk having just that thin barrier between that environment?
Firefighters take smoke and look at it as either light or heavy. There’s a lot more to reading that smoke and reading what’s a volatile environment. That’s an environment you can get lost and disoriented in. You start adding heat on top of that, and you start looking at some of the modern fire behavior stuff that’s happening out there, where we’re getting flashover and smoke cloud ignition at lower and lower temperatures; we’re setting the stage for more asphyxiations and more traumatic asphyxiations caused by SCBA failure caused by thermal exposure. So, we have a changing environment right now that we need to get a handle on.
Sells: I don’t think anybody’s going to disagree that not enough training results in an unsafe fireground and that not enough staffing—whether it be at the task level or the strategic level—is going to result in an unsafe fireground, but if you’ve got a problem with your training program, if you’ve got a problem with your staffing, if you don’t have a good SCBA and air management policy and practice it within your incident management system, then the failure is at the strategic level—not necessarily the strategic level at the incident. It’s at the level of strategic management of your fire service, because that problem shows up at the fireground after years of a lack of training, after years of undisciplined operations.
Lasky: I don’t think we’re training enough when it comes to SCBA usage, period. [We often put] a lot of our younger guys, if you sit there and think about it, in SCBAs and run them through evolutions. We have a lot of nice training towers. But, again, they go in, they do what they have to do, and they come out. This is what Bobby [Halton] talked about. Chief Brunacini had mentioned once before that we’re fighting a lot of large fires, whether they’re commercial or not, like they’re small residential fires.
To be honest about air management, I think some of the haz-mat folks have had this for a lot of years. Before they send someone in, they figure real working time. Before you send someone in a level A suit, you’re supposed to figure out which crew member has the lowest pressure. You have your alarm time, whatever you need in decon time, travel time to and from the hot zone. What time is left is work time. It tends to get [firefighters] thinking about how much air they’ve got, whether there’s an officer who can sit there and supervise or whether they have to pull hose …. You’ve got someone in there who’s a little more aware of where they’re at. It’s not that easy to see how much air you have yourself. I think a lot of it has to come back to really pounding into our people, ‘You’re going to be absolutely no good whatsoever if you have no air when you’re inside a building.’
Shouldis: This subject’s pretty personal to the Philadelphia Fire Department because we lost three firefighters at One Meridian Plaza who ran out of air. When we ask who’s responsible, [the answer is] it’s a tiered responsibility, but the company officer has to have a good frame of reference as to where that crew’s operating. If we take the real-life case at Meridian Plaza, the facts are that the three firefighters were given a ventilation task. They thought they were on the 30th floor. In actuality, they were on the 28th floor. Meridian Plaza is 100 by 300, so when you start deploying that search and rescue or RIT team, it’s a pretty big area to cover. So, when we talk about air management, there’s a responsibility for you to know, based on your physical conditioning, how long you can last on a cylinder. Your company officer has to have a good escape route, and the management team should have some good time management skills and resource capability pertaining to the time people can work on an SCBA cylinder.
GOING BY THE BOOK VS. PRACTICAL APPLICATION
Editor’s note: This discussion pertains to the death of a firefighter in Memphis, Tennessee, who became entangled in wires and died five feet from an exit. He never knew he was that close to escaping because he did not take off his SCBA facepiece. Firefighters are trained never to take off their facepieces in such an environment. The question posed was, Is firefighter SCBA training “too much by the book, or is “practical application” covered?
Goldfeder: It depends on what school you go to. That’s the problem: It depends on who’s teaching it. You go to the ABC Fire Department, you get an hour in SCBA, and you’re on the truck. If you go to the DEF Fire Department, it will be six months before they even let you ride the truck. And, then there are classes that cover every other way in between these two examples—and then continuing education.
How often do [we] train our [firefighters] in emergency procedures? When’s the last time [we] took our crew in the fire house and just crawled around wearing air packs and shut a bottle off and said, ‘Now what are you going to do?’
That’s the basis for a lot of our problems. Even in the biggest cities, the training firefighters get depends on what fire station or battalion you’re in. So, [who really knows if our firefighters are getting enough training?]
Salka: You have a great point. This is a national problem …. It’s really a local problem because one fire department gives you an hour of training and another fire department says you’ve got to be a smoke diver within 36 hours. We have all these different levels of training. There’s no standard. This could possibly be our number-one cause of firefighter fatalities, and we don’t have a standard on how much training we should have in SCBA use. Yet, we get standards [on things such as] how many ounces some of our equipment should be per square foot.
FIREFIGHTER FATALITIES AND TACTICAL ERRORS
Brunacini: If you look at [these deaths], they’re all task-level deaths. Firefighters die on the task level. But, if you look at the way we structure incident operations, there are two other levels. There are three levels. There’s a task level, where we have fire companies. We have a tactical level, where we have sectors or divisions or groups or whatever you call them. Then we have a strategic level of command. [These levels] are closely connected, but they’re separate.
Sending firefighters to SCBA school isn’t going to help the incident command part of the system if you have ICs who can’t manage the strategic part of that event. By the same token, you can have the best incident command system and chief officers, but if you can’t operate on the task level, then you’re going to be continually trying to correct mistakes and problems you have on that level.
But, forgive me for being sort of simplistic, the reason firefighters die in structural firefighting is simply that they’re in offensive positions under defensive conditions. The IC is the only person, place, or thing in most of our operations that can manage the overall strategy of that incident. No one else is in a position or has the resources to receive, process, decide, evaluate, and revise the overall incident strategy. I think part of the challenge we have in this discussion is, What are we going to do differently? [One definition of insanity] is doing the same thing and expecting a different result.
One of the problems is that everyone on this stage came in on the task level. We were socialized on the task level. Our culture revolves around task-level work. When we lose a firefighter [therefore], our inclination is to say, ‘We have to go back to the basics on the task level.’ I don’t think anybody would argue that it is critical to be able to execute at basic task levels, but I would submit to you—let me just use an example [that] broke everybody’s heart in the American fire service. The Worcester (MA) Fire Department knows how to lay hose and raise ladders. It is a tough-[butted] northeastern fire department that fights tough fires every day; they’re very, very skilled at it. Sending those firefighters back to hose and ladder school would not solve the problem of having only one person trying to manage the 78 firefighters from 18 fire companies on that incident, a point Chief Buckman mentioned.
We’ve got to solve the problem in those three places because each one of those places has its own capability to manage that event in a way that will prevent those fatalities. We’re not going to solve air management until we build a command system and a logistic system that creates about 12-minute work cycles—in other words, when that battalion chief … gets there, he can continually supply relief crews in 10- or 12- or 13-minute cycles. [Otherwise], you’re going to continue to have air-management problems.
We tend to default to the task level because that’s where you die. There aren’t a lot of battalion chiefs dying in command posts unless they fall out of the seat or they have a stress-induced coronary. If we look at it, we in this country have not yet invested in what Chief Buckman said. Let me just give an example. I went to a second-alarm fire in Phoenix the other night. We had about 25 fire companies, about 15 ambulances, and this modest little command vehicle. We had nine people in that vehicle managing that incident … and every one of those people were assigned and busy and integrated in that system. Again, that’s a simple little old three-story apartment building that decided to have a gas explosion in it and produce 12 or 15 customers who were beat up pretty bad and a bunch of people displaced and a pretty good-size fire that exposed the rest of the complex. I’m sitting down on the street. In most of America, John [Buckman] said it, we respond, one tired old battalion chief in a Crown Victoria, and the dome light doesn’t work. So, the guy’s literally in the dark. We have not invested in that part of the strategic level of the system.
Salka: I agree with my colleague from Arizona [Chief Brunacini] in one way, that having some more responsibility at the top end may limit or reduce to some degree some of the incidents, but I still think … most firefighters die singly or in groups in fires as a result of asphyxiation. That’s the cause of their physical death. But, that’s not what killed them …. I think we do need to stay down at the tactics level …. We don’t have whole groups of firefighters being found overcome and dead because they ran out of air, because they miscalculated, because they weren’t relieved in time, or because the air chief didn’t get there. I’m not being sarcastic.
What I’m saying is, we’re dying one and two and three at a time because we’re getting separated from our crew, because we’re not competent to operate in a smoky IDLH environment, because we don’t know how to react when our low-air alarm goes off, because we have penetrated too far, or because of one of many other tactical reasons.
I submit that most firefighters who die from smoke inhalation and carbon monoxide poisoning, and even some who die as a result of burns and exposure to products of combustion, died because they got lost—and that’s a tactical thing we can improve. I’m not saying it will take all the numbers down … we’re going to that level to examine why it’s happening, I think, because that is where the problem is. The problem is that the firefighters in the smoke are making mistakes, whether they be company officers making decisions for a unit or firefighters making individual mistakes …. We have a second alarm in Manhattan (New York City); we have seven chief officers at a working fire, none of whom are specifically assigned to air management. We can put 18 chiefs in a command van, and I still don’t think that’s going to stop a firefighter from getting lost in a building or getting separated from his crew and not being able to get himself out, and having to take off his facepiece. The autopsy will say, ‘Product of combustion or exposure to CO.’
Buckman: In going back to making a general comment about why firefighters die, whether it’s from asphyxiation or from whatever it might be, I think we have to look back to the attitude ICs and firefighters have about interior structural firefighting. If you ask people generally, not those on this panel, about interior structural firefighting, they don’t think of it as going to war. They say, ‘We’re going to war,’ but they think war is a romantic experience. When you talk about evacuating in a romantic experience, it’s not going to happen without responsible adult leadership. David [Dodson] thinks about the IDLH atmosphere. Very few of us think of that. What we think is, ‘This is fun. This is what I’ve been waiting for. This is my one time in the career.’ It goes back to attitude. We have to have more respect for the fire. We have to have more respect for the fact that the building will fall down on our firefighters. If we don’t change the firefighters’ and the commanders’ attitude, we will go back to, as Chief Brunacini commented, doing the same thing over and over and over.
Goldfeder: I agree with the need for enough command officers and all the sectors, but when all else fails, it falls down to a competent company officer keeping track of the personnel …. Competent company officers spend time training their personnel. A department might not have a training program, but you can have a captain in a lone engine company who says, ‘I don’t care. I’m still going to train my personnel.’ On the emergency scene, if command fails, if safety fails, if this fails, if that fails, the last resort of survival in many cases, in my opinion, is the competent company officer. That’s where the rubber meets the road.
[At this point, several panelists interjected, ‘So far it hasn’t worked.’]
Goldfeder: The bottom line is, if [we] want to stop from getting asphyxiated [we talked about SCBA training], let them [the federal government] create a law that says you must have blank number of hours for initial certification and a specified number annually before you can ride a fire truck and wear an airpack. [Make this applicable to all]—the Ongo Bongo Fire Department as well as the New York Fire Department. [We should] set up a task group to figure out what the best SCBA training is [and use it for all departments].
Brunacini: How do we explain that to well-trained, experienced firefighters on the fireground who went through smoke divers school, who went to hundreds of fires—the competent firefighters?
Goldfeder: Then we take it to the next level. We examine the company officer’s role in that incident. All I’m saying is, ‘Where did it fail?’
Brunacini: All I’m saying is that it isn’t working …. How do you pass laws with the American fire service?
Goldfeder: It surely isn’t going to come from the local level. We can’t agree on helmet colors and all that important stuff. Somebody, somewhere is going to have to come up with something that says, ‘You must have a certain amount of training.’ You can be a firefighter in this country with zero training, and there are tons of departments out there each day running that way. So, if we’re not going to do it locally, maybe it has to come from Big Brother. We can’t wait for the IAFC or anybody else to come up with it, because they still can’t agree on logos and patches and all the important stuff. We’re going to have to come up with something; maybe it is someone like Mike Brown [of the Department of Homeland Security] or Dave Paulison [of the U.S. Fire Administration] [who should] propose legislation. I still maintain that company officers may be able to make more of a difference in their little world.
Brunacini: We have said from this podium for the past 15 years that there’s no building worth the life of a firefighter. We ought to start doing that. We also have a risk management plan that says, ‘We’ll risk our lives a lot to protect a savable life. We’ll risk our lives in a highly calculated manner to save property. We won’t risk our lives at all for property that’s already lost.’
Very, very few of the firefighters who get killed in structural fires are involved in getting a primary search completed. So, what we’re doing is, we’re dying over a piece of property. I’m not being self-righteous. It happened in Phoenix two years ago. Brett Tarver died—didn’t get to go home that next morning to his wife and his family—for a 52-year old grocery store. The only answer to that fire was … if we took the risk-management plan seriously, we should have said, ‘This is a high-risk situation’ …. When you have a 40,000-square-foot building with 22-foot ceilings with so much smoke in it, you couldn’t have gotten that smoke off it until you burned the roof off. The only answer then strategically was to get out of the building.
Unidentified speaker: Or not even go in in the first place.
Brunacini: It was a righteous entry in the beginning.
Salka: I’m not trying to treat this too lightly, and there is a valid angle that certainly we’re not going to throw people’s lives away for buildings. But, I know an awful lot of people who own businesses and homes who have worked years and have invested their life savings—and that’s where they live and that’s where all their stuff is. I don’t see that because the place is full of smoke we decide to write this place off. I’m not saying that we’re going to do that unnecessarily or too quickly, but I’ve been to plenty of commercial building fires that didn’t look real good when we got there—heavily charged with smoke, fire showing in certain areas to some degree. I don’t think we’re looking at a bunch of buffoons in a chief’s rank all over the country just throwing people into burning buildings pell-mell without any training or any idea of a plan or strategy. Certainly, some things go wrong. There are no lights on the buildings in New York City that say, ‘Defensive’ or ‘Offensive.’ That’s a decision. That’s an opinion based on facts and conditions there at the scene. We have 153-year-old buildings in which we’ve successfully put out fires …. I am in no way trying to compare … the life hazard with the building hazard, but it’s life and property.
I know we don’t give them the same value, and I know we don’t take the same risk and that we have to have some type of a risk-assessment plan for each situation. But, don’t we do that? Don’t we have the 13 points of a fire? Don’t we consider the extension and the volume of fire and where it’s traveling and the construction of the building? Is it new or old?
Chief Brunacini is right. It’s obviously not working. We’re losing more than 100 firefighters a year, but does someone think we’re going to lose none some year? Is the war in Iraq not being fought properly? Are they failing because they lost 75 soldiers so far? Is this not a dangerous job? I’m not saying, ‘It’s dangerous, so what?’ I’m just asking, ‘What is safe?’ If we have 75 fatalities next year, is it working? If we have 50 next year, is it working? If we’re down to 25 a year nationally, is it working then? Or, do we have to go to zero? I don’t know the answer to the question; I’m just throwing it out there.
Halton: I think if we look at it, everybody agrees there’s absolutely a task-level issue and then it’s the company officer if one of his people runs out of air, and it’s a tactical-level issue if people are fighting fire where they shouldn’t be fighting fire, where the building’s coming down on them, or if there are obvious indications that the fire has gotten beyond the ability of the department—whatever its resources—to fight it and they should be out of that building.
One place where we’re making some strides is the new NFPA standard that says we should have a heads-up display [which is going to tell a firefighter his air level]. It is hard to pull your regulator up in zero visibility and see what your air is. Even with a flashlight, your officer can’t see what your air is. This heads-up display is a move in the right direction. It helps us to try to get a handle on the task level. Let’s get these displays on every facepiece in America, and let’s get a universal connection so if the battery on the display doesn’t work, you would have a fighting chance [by sharing air with your partner] if he has more air than you.
Goldfeder: Sometimes we don’t go in. When you pull up on a lightweight wood-truss house and you haven’t had water for 40 minutes, you don’t go in. Yet, in upstate New York, two firefighters were killed because they were ordered into a building like that. To me, that starts at the company officer level. What are we thinking? Our job is to go in when there’s a life issue. Our job is to sometimes go in depending on the conditions, but we have some stupid [stuff] going on. When you see this house fully involved and they go in—I mean … the fire was burning in the basement for 40 minutes without water, yet these firefighters were ordered in, and they fell in …. Company officer level.
Sells: Some of the technology that’s becoming available to the fire service is absolutely amazing. When you look at thermal imaging cameras, we’ve got tremendous potential to not only save ourselves but also to make us so much more effective when we are inside. As taxpayers, however, we’re savvy enough to understand when the government is throwing money at a problem. Your government throws money at a problem; my government throws money at a problem …. Don’t be so enamored with technology at the expense of changing the way you think and the way you operate. I don’t think an [SCBA] heads-up display is going to make a better firefighter. I don’t think a heads-up display is necessarily going to save a firefighter any more effectively than a disciplined approach to operations on the fireground.
Halton: Pete [Sells], don’t misunderstand me. [I say] use the technology, combine it with hard-hitting training, put some accountability with those company officers, and get people up where we want them to be, and then reinforce that strategic position so that we don’t have one officer outside trying to manage 28 companies. You want to fix all three levels with the same approach, with the same discipline.
Sells: Show me a high-tech accountability system that’s really any better than [one in which] a disciplined firefighter drops a brass tag in the bucket at the front door. That firefighter is less likely to die because he’s working within the system and he’s following procedures.
OFFICER ACCOUNTABILITY/TRAINING
Goldfeder: Two chiefs, their departments, and their boards were cited within the past two years by the state departments of labor (New York and Illinois). Whether they get big fines or not isn’t necessarily the issue. From a personal liability standpoint, their governing agencies are walking away from them, saying, ‘Hey chiefs, we thought you knew what you were doing. OSHA says that you don’t, so we can’t protect you.’ No comment. I’m just sharing a fact that leads into this kind of discussion.
Brunacini: Ninety-five percent of fire training in North America is on the task level. In other words, it is easy to sit up here and criticize command officers in the way they’re managing the strategic level of operations, but most command officers were never trained, they don’t work in a very strong system, they don’t have much history, and their models were developed on the task level. The organization has never separated them from that. I don’t mean that in a sense of not understanding it and being involved in it. Being an incident commander on the strategic level is completely different from being a firefighter on the task level.
In Indiana, you’ve got to have a license to be a barber. You don’t have to have a license to be an IC. I don’t know of anyone who has died of a haircut. In fairness to the command officers in this country, it’s amazing that we don’t lose more firefighters than we do. I don’t mean any disrespect to the people who are in those jobs.
If you look at the way that most of us got promoted in our careers, I’m glad they’re not training neurosurgeons that way. In fairness to that level, I don’t think we made much of an investment in the American fire service in holding those ‘fireground executives’ accountable because there’s no front-end on it. Sending us to jail in the end doesn’t seem like it’s going to solve the problems.
Lasky: Maybe there ought to be a law [as discussed before] that says you have to be trained before you get on a fire truck. Maybe there needs to be another level … maybe you have to be an NFPA Level II firefighter to be a chief. You’d be shocked at the number of fire chiefs in the country, career AND volunteer, who are not NFPA Level II certified.
Salka: I know guys who are NFPA Level 75. They couldn’t put out a fire in a top hat. In New York City, we happen to have a command course for our chiefs; it has been around only for several years. Nationally, it’s probably an exception. Chief officers, incident commanders, and all the incident management teams and things like that—certainly, all training could not be bad. Something inside me winces a little bit when we paint everybody with a broad brush. I know some fine, terrific chief officers from the battalion and deputy levels, and higher—some of them sitting right up here and some of them out in the audience … who may not have gone to an official chief course in their life. Through years of experience and working their way up the chain and being mentored, and maybe some artificial programs, they have evolved into fantastic ICs and great fireground chiefs with lots of tactical experience who can adequately control a fire and run a fairly safe fireground. Obviously, there’s a point somewhere between those two—having some terrific experience and maybe mandating some technical level of training—that would be an improvement from the strategic level.
Halton: When we talk about accountability, I think one of the things we need to do as chief officers is quit giving people medals and sending them to Disneyland when they do something that puts them and their crews at risk. We have a history of doing that in a lot of systems. I think that’s part of that whole accountability [issue]. That’s building that culture of heroism [in which we say] ‘If you’re the best kamikaze pilot, we make you the chief.’ We reward at times people who dodged the bullet, but do they deserve it?
Lasky: If you as chief of department were going to send your officers to a leadership school or whatever, if they don’t have those experienced people to mentor them and show them the way, where do you send them? We watch enough videos in which Mopey and another one out there with the white helmet watch these guys on a building that’s going to come down. Neither one of them says anything to these firefighters. How do you get past those people?
One thing I am very proud of this year is that at this very conference—and I think you’re going to see it take off—we’re finally offering a class that teaches people how to conduct live burns—how to do the paperwork, how to set up the house or the building, and how to go through it instead of ‘let’s just go burn the helmets off our heads.’ You’re starting to see more and more mentoring programs and leadership schools, but where do you send someone for that training once they [get up on those higher levels]? We beat on our guys to have this or that training. Everything’s not available at the National Fire Academy and through the Executive Fire Officer Program. Where is some of this stuff that is going to help them manage their people on the fireground and at different incidents back at the station? Where do we send our folks? Even if there’s a law for it … we can’t even get people to agree on four-person staffing and other things, let alone a law for training.
Goldfeder: I’m trying to shoot for the moon because we’re not getting anywhere else.
Dodson: Maybe there is room for some more accountability there. I don’t know how many times I show up for a class and hear this universal language coming from the participants: ‘Man, I wish the chief were here.’ It’s almost like in some ways we have a day-to-day command atrophy out there that maybe needs to be addressed. Maybe we do need to tighten things up; maybe we need to put more responsibility, accountability—however you want to say it—into that command and decision-making level. Maybe we need to have a red light that says, ‘This is offensive’ or ‘this is defensive.’
OFFICER TRAINING
Salka: Going back to Chief Brunacini’s comment that Indiana barbers need a license but chief officers do not, we need to have some kind of national chief—if you’re not calling it chief—incident commander-type training level.
Goldfeder: Whether it’s the Homeland Security Department or whoever. I don’t care whose label it is. If we could just get the people in charge to attend some kind of training. As mentioned, we hear students say all the time, ‘We wish our chief were here.’ A bunch of our students yesterday asked, “Can you give me tips on how I can get the message to the chief without my having to deliver it?’
The National Fire Academy should do it, but not with an upcoming 15 percent budget cut. I love Chief Dave Paulison [USFA administrator] to death. His boss I don’t know from Adam, but he’s telling us to get our act together, and they’re going to cut us by 15 percent. If Dave Paulison had not kicked and screamed a few weeks ago, we would’ve lost the FIRE funding.
Brunacini: If anyone thinks the federal government is going to come on the horizon and solve it, they’re living in a dream world. The only problem is, we die locally. We have to solve it locally. I’ll speak for Phoenix: One fatality is too many. Our objective is zero; everybody goes home. You can go to accountability. They pay us to manage that locally. I think part of the answer is for us to do what we’re doing here. Somebody said the truth will set you free, but first it will [make you angry]. Nothing’s going to change until we change it. We’ve to do something different—whatever it is, on whatever level—to keep from killing 110 firefighters a year.
Salka: Establish in FDIC by next year a National Chief Officers Academy [with] specified goals, tactics, and curriculum.
HONEST CRITIQUING OF INCIDENTS INVOLVING FATALITIES
Shouldis: The critique process for the One Meridian Plaza fire was important for learning. At that time, we had a lot of young chief officers; many were working in the downtown area. It was important to get a lot of the lessons out. The problem is that at Meridian, the people who could give the factual information were dead, and the rescue teams that went out there were really giving you some blended witness information. We put that together.
I think the part about discipline is going to be out there whether it’s a formal discipline process from the fire chief or the city manager who fires you or from peers who destroy your credibility to the point where it forces you to walk away from the organization.
One of the lessons from Meridian was that very few organizations make significant changes before such an event happens. After that event, we looked at our high-rise procedures and made some drastic changes to get teams to that upper floor so we have maximum supervision. We looked at it as a training problem because we didn’t know where we were in the building. We developed self-rescue plans.
When we talk about the task level, we talk about the company officer level; we talk about the chief. I think it’s all woven together. Discipline is certainly part of it. The informal organization, I think, puts a lot of pressure on people in terms of credibility and ability to command. Some people tend to walk away, and a lot of experience walks away after you make one mistake. Meridian taught us that you really have to stay on top of all these issues, because whether it’s a high-rise or a dwelling or standards or discipline, they’re all going to affect the morale of the organization.
Sells: People—firefighters right up to the chief—need to be accountable for their actions, but does accountability necessarily mean that you’re going to be beating this guy with a stick and it’s going to result in termination or jail time? There are ways to hold people accountable without punishing them. Involve them in solving the problem. If you don’t hold people accountable, you tend to sweep the problem under the rug or just put on blinders and pretend it doesn’t exist. There’s a fine line there. You’ve got to learn how to hold people accountable without punishing them.
Brunacini: Everyone involved in that fatality was punished. They’ve already been punished. They have been punished enough, and I think that people sitting up here can testify to that. You don’t need to put us in jail. The hard part is that until you have a significant event in any fire department, it’s hard to get the attention of that system [to make its members realize that what they’re doing may lead to one of those really tragic events]. There ought to be a different level of accountability at which we can be able to say, ‘What are we building into our operations? What [other things] have we done a thousand times before [that this time] led to this sad event?’ When you look at it, most of the time, that isn’t the first time that we did that. That isn’t the first time in Philadelphia they thought they were in one place and they were in another. It wasn’t the first time in Phoenix that we took a residential air management mentality into a commercial setting. There’s a leadership challenge for all of us; I think it’s a significant one.
Sells: So, what you’re saying is, it’s not the first time you did it; it’s just the first time you had such a bad consequence.
Brunacini: The safety guys say, ‘You do it a thousand times; you have a hundred close calls, and then you have one hit.’ How do you fix it in the thousand to say, ‘This is stupid or dysfunctional, or there’s a better way to do it, or it’s unsafe?’
CONTRIBUTING FACTORS TO FIREGROUND LODD DEATHS
Editor’s note: Moderator Coleman noted that five contributing factors are generally cited in the NIOSH LODD investigation reports—lack of an incident command system, lack of an accountability system, lack of risk management, communication problems, and building construction. Their being listed in virtually every NIOSH report has led to the reports being referred to as “rubber stamp” reports. Discus-sion centered around which of the factors is most significant and the value of such reports.
Brunacini: The incident command system is the most significant among these causes, because you use the ICS to manage the other four areas.
Salka: They are all ICS. You can’t separate those levels. I still think lots and lots of the improvements need to be made down at the tactical level.
Brunacini: The problem with having this discussion is the but. We say, ‘I know that incident command is a critical part of [what] contributes to the problems that cause firefighter fatalities, but I know chiefs who couldn’t put out a fire in a bucket of glass. I’ve noticed the real statement is after the but …. The first part is politically correct, and then we say “but,” and then it’s down south …. And, that command stuff is fine, but the problem is down there where the rubber meets the road. Now, in that peer process, the chiefs have to go back in the station and have dinner with the crew they’re protecting. Everybody is socialized to the task level. We have not created an experience that separates bosses who act like strategic-level bosses, because they want to go back and participate in the task-level war story. The most powerful process we have is the peer process, and the way we manage that is fear of rejection—I don’t want to be rejected by the authentic firefighters who get to say “but.”
Goldfeder: I push the company officer because, unfortunately, the failure occurs above in many cases. So, company officers are like Gilligan on the Island trying to get things done on their own. The reality is, it starts at the top, and there’s where you hope all this is going to come from whether it’s a small department or a very large department, but that safety factor, that RIT team saving the crew, is actually the company officer as the bottom line. If we can get more chiefs to participate and get involved—and there are many great chiefs out there—but, unfortunately, there’s also some who have nothing to do with any of this stuff. By the nature of their jobs, they’re focused on budgets or not supporting staff, or whatever the issues are. The focus seems to have gotten lost. I guess if it’s really going to happen, it’s going to happen for the overall good of an organization from the boss level, but the backup has to be the company officers taking care of their people, whether it’s in the station taking care of the training or on the fireground.
Acceptance of NIOSH Fatality Reports
Halton: NIOSH reports are excellent and important documents. However, when there’s a crash involving a Piper Cub in the woods, the National Transportation Safety Board sends well-funded engineers, technicians, scientists, pilots with campers, Cadillacs, the whole nine yards. We crashed a little plane in Albuquerque. We had this team of 60 to 100 people, every one with a badge from a different agency. They reproduced that entire crash from the pilot’s plan, to the plane, to the fuel tanks—you name it. They investigated it, documented it, and then produced the encyclopedia of that crash. We don’t get that. We don’t get, ‘What was the bunker gear’s condition? What was the quality of the hose? What was flowing? What condition was the equipment in? What condition was the pump in?’ We don’t even get to see some of the footage because the television stations tell us it’s proprietary. They don’t release it. We can’t pass the lessons learned on to our members.
Lasky: There is lots of sweeping under the carpeting. How do you have a committee of people—half of whom are not firefighters and half of whom have been out of it so long and when they were in it never were on the fireground—investigating fatalities? In many cases, there is no sharing of information. In the Hackensack fire, for example, the members said they didn’t know of the dangers of truss roofs. We’re not killing our firefighters with laser beams. We’re killing them the old-fashioned way. We have to get the information and talk about it. How dare a chief say when there’s a fatality, ‘I would do the same thing again’? The incident must be investigated, and we must be told what happened, or it’s a waste of time.
Halton: We want to see more in-depth reports—more details, more information. Tell us what happened.
Goldfeder: There are significant differences in the reports, depending on who is preparing it. The sharing of this information is critical. There ought to be a law that says if somebody gets killed in your jurisdiction, this is what’s going to happen [spell out the investigation procedure].
Dodson: How many times have you looked at a NIOSH report [the details, not just the red summary comments] and thought, ‘This could happen in my department’? Some departments do a better job investigating than NIOSH, but the NIOSH report is a starting point. It still serves a purpose.
Shouldis: We have to take the information in the report and internalize it. Sometimes it’s easy to throw stones at another department and say, ‘It won’t happen here.’ Look at the full report, and internalize the information. Just don’t say, ‘It can’t happen to us.’
Sells: You can look at the reports and choose to react or not react to them. [I have to commend the Phoenix Fire Department LODD report] that evaluated the effectiveness of RIT teams. Many departments are compliant with the RIT in concept. But is compliance enough? You have to test the equipment and work with your people to find out what the shortcomings are.
FIRE SPRINKLERS
Sells: Residential sprinklers and commercial sprinklers alike statistically stop 96 percent of the fires. The fires are held in check with one or two heads. If we’re serious about stopping firefighter fatalities in the United States, why doesn’t the fire service take a more active role in legislating that sprinklers be installed in every building? As an example, should the state of Rhode Island mandate retrofitting old nightclubs? The fact is that a building that is old or was built before some code was written doesn’t negate the fact that people are going to be in there.
Goldfeder: Sprinklers will solve the problems and give us less to talk about at places like this, but try dealing with the local politicians and the construction industry and the builders. I’ve done it twice in my career, and I just don’t feel like doing it anymore. I know it will help my firefighters. I’m not beaten yet on the issue, but I’m drowning a little bit. Twice, I’ve tried. Since I’m not politically savvy, I got people who are better at speaking to people to [spearhead the movement]. I tried everything in the book. It came down to, ‘Well, it’s going to cost this builder this. It’s going to cost this homeowner that’; honestly they’d rather put a hot tub in than sprinklers.
I don’t want it to die. This is a big issue, but I’m looking for answers. I’ve talked to the fire marshals in North America. I’ve talked to the American Sprinkler Association, everybody and their brother, and nobody really has a good solution.
Buckman: The International Association of Fire Chiefs has pushed for residential sprinklers for many years. We were instrumental in founding Operation Life Safety, a residential fire sprinkler organization, which we passed off to the National Association of State Fire Marshals. There’s now some debate about whether the program is still viable. Sprinklers would be a solution for the long term. Even if we started tomorrow sprinklering every building that’s built, in 100 years, 50 percent of the buildings in America would be sprinklered. Part of the problem is, whether it’s the fire service or the builders, we’re only thinking about tonight, about tomorrow. We can’t see 100 years down the road. We’re not looking at the big picture. Politicians in Washington are not looking at the big picture. The politicians in our states don’t look at the big picture. They look at what’s facing them today.
Halton: Even if we legislated sprinklers everywhere, we’ve got so many other problems and such limited funding that I think the American fire service doesn’t have the resources. If you look at how many problems we have and how much money we have and how many people we have, that’s a tough issue to push.
Dodson: If we want to stop firefighter on-scene fatalities as a direct result of the building, the fire, asphyxiation, whatever, we have to reintroduce the ability to read that building, read that smoke, and adjust our plans to changing conditions. We have to adjust on the fly. We need to recapture some incredible instinct, some incredible sense that existed in the ’70s. We need to recapture that, twist it, and make it fit for our high fuel loads and our lightweight buildings and start changing our basic tactical approach based on what the conditions are telling you, not what a tactics book says.
Sells: It’s hard to argue that if you’ve got lightweight construction and airtight buildings and all the other problems that modern building construction is presenting to us, sprinklers are not a very good answer. The best smoke to read is the smoke [of the fire] the sprinkler has already put out.
Salka: The intent of sprinklers is good, but it’s not our industry. We’re talking about operating and getting into somebody else’s industry, and we can’t even regulate our industry. We don’t have the funds to fund our own industry, as positive as the result would be. We need to spend our time and resources improving how we fight the fires in these buildings that aren’t sprinklered and go from there.
Sells: Our reason for being here and getting paid to do our jobs is to reduce suffering in the community, reduce loss of life, and loss of people’s property. If our advocating sprinklers accomplishes that, that’s a tool in our toolbox we have to avail ourselves of.
