ORANGE COUNTY FATAL FIRE

ORANGE COUNTY FATAL FIRE

FATAL FIRE REPORT

Investigation and Analysis

BY ORANGE COUNTY FIRE AND RESCUE DIVISION INVESTIGATION TEAM

The following is taken from the report of an extensive investigation and analysis conducted by the Orange County, Florida Fire and Rescue Division that details the circumstances surrounding the deaths of two firefighters at the Sunrise Gifts store fire of February 24, 1989. The 235-page report, entitled Fire Investigation Report: Sunrise Gifts Structure Fire (OCFRD #89 005404), was prepared by the Orange County Fire loss Management Bureau and dated April 24, 1989, and was submitted to that jurisdictions fire administrator and sheriffs office.

IN THE AFTERNOON hours of a warm, dry, windy Friday, an alarm was received from many sources at the Orange County, Florida Fire and Rescue Division facilities. A lone engine company responded through the Lake Buena Vista shopping area toward the pluming smoke in the sky. The acting lieutenant, relief driver, and firefighter had just received verbal alarms for a location less than a mile from their station. The radio crackled confirmation. A full assignment was being dispatched to the incident.

Engine Company 36 carefully weaved its way through the busy tourist traffic. Its members wondered how long it would take for their sister company, Rescue 36, to reach the scene from its location in the field. The lieutenant and driver began to discuss their plan of action.

Less than 12 minutes later, Acting Lieutenant Todd Aldridge, Firefighter/ Paramedic Mark Benge, and Firefighter Richard Marcotte were fighting for their lives in a fireball fed by collapsing ceilings and lightweight wood truss assemblies with their load of 5/8-inch plywood. felt roofing paper, and tons of precast clay tiles. Two, Aldridge and Benge, collapsed and died within the structure, while the third, Marcotte, broke out of the glass panel of a chainlocked side entrance door.

Amid the horror of this disaster, the Orange County Fire and Rescue Division (OCFRD) began to conduct one of the most thorough and objective investigative analyses ever released to the public. The investigation team of the fire and rescue division, sheriff’s office, medical examiner’s office, and the state fire marshal’s office compiled more than 235 pages of in-depth reporting under the coordination of OCFRD Fire Loss Management’s Deputy Chief Ed Spahn. The report was based on interviews, videotape of operations as well as investigation efforts, photographs of fire and posttire operations, official building department documents, and consultations with architects and construction engineers. Its intent is to present the facts as clearly and truthfully as possible. The report writers were given three goals:

1. Detail the circumstances surrounding the deaths of two firefighters.
2. Determine the source and origin of the fire and its spread through the structure.
3. Analyze the structural performance of the fire building with emphasis on construction behavior during the fire.

THE BUILDING

Occupied for less than six months, the structure was of concrete block, 12 feet high, enclosing an area of 134 feet by 30 feet (7,180 square feet). These walls supported the 14-foot-high trussloft roof assembly. The trusses were preengineered wood, made up of 2-by6-inch cord members, with 2-by-4-inch webs attached by sheet-metal surface fasteners. The truss assemblies were all of various shapes and sizes to form the irregular hip-and-peak-designed roof. The roof was sheathed with Vs-inch CDX plywood covered with 43# roofing felt and precast clay tiles.

The structure, a Type V (Standard Building Code), received occupancy permits for a commercial venture. The shell was divided by a partition wall into two occupancy spaces: a 3,000-squarefoot restaurant and the fire occupancy, a 4,000-square-foot mercantile known as Sunrise Gifts.

The fire protection of construction features was a Vs-inch gypsum board ceiling serving as a membrane to prevent the spread of fire from the occupancy to the truss loft. Additionally, a separation wall divided the truss-loft assembly into approximately 3,000square-foot sections. However, manmade holes—pokethroughs for building services—violated this membrane and contributed to interior drafts that actually increased the intensity of the fire.

FIRE BEHAVIOR

The fire was believed to have started in the attic truss loft on the west side of the building. (See Location A on diagram above). Heat from an electrical source is believed to have ignited Class A material. Electricians had been working in that area that very day.

The fire was thought (by analysis) to have started at about 3:30 p.m. After an incipient stage of from three to five minutes, it developed into free burn prior to discovery.

After gaining a foothold, the fire, driven by winds of up to 22 mph entering the vents in the eaves, proceeded up the hip portion of the attic toward the dormer opening on the south side of the structure. It then continued to the ridgeboard of the main peaked-roof assembly. (See Locations B and C on diagram.)

This fire path was modeled after studying wind direction and air current behavior within a similar loft space. Venting was provided in the entire soffet length at the rate of 48 square inches per running foot. High pressure on the windward side and low pressure on the leeward side provided these theoretical air patterns. Photographs of the fire support this theory.

Fire continued to travel south and east toward the peak—uncontrolled. Structural members were attacked and the entire structure progressively weakened. During these early stages there was adequate oxygen (air) to sustain free burn. However, as fire volume increased the air/fire ratio became marginal. According to bystanders, flame behavior at the louvers in the dormer before the arrival of the firefighters “showed and disappeared as if the building inhaled and exhaled the flames.”

Eventually, the entire west and central sections of the roof volume were involved in rolling flames. At this point in the burn/time curve, structural failure was imminent.

THE FIRE Discovery:

Earliest at 16:09:36 hours, February 24, 1989, by multiple sources. A state trooper’s statement indicates that he was stopped on SR 535 by a motorist telling of the smoke conditions at the .structure. He notified his dispatcher forthwith at approximately the earliest recorded time. He then drove to the scene and notified the gift shop manager of the fire. He also evacuated the public and employees from both establishments. He further states that upon his arrival the manager of the gift shop was on the phone, believed to be reporting conditions to 911 operators.

The fire was also reported verbally to the quarters of Engine and Rescue 36, nine-tenths of a mile from the scene. More than one citizen stopped to report the fact of fire at this location.

COLLAPSE FACTORS

The collapse of the truss and roof assembly was accelerated by factors not covered by current codes and laws:

1. Fire started above the protective membrane of ⅝-inch gypsum board. It grew relatively undetected. The membrane is only designed to retard fire extension into the truss loft from the floor below it and not the reverse.
2. Fire started low in the windward part of the truss loft. Wind currents combined with the natural convection of heated gases and drove fire upwards and across unprotected truss assemblies.
3. Air(draft) force fed the fire.
4. Roofing felt broke down, providing petroleum-type liquids (distilled out of the felt) as additional fuel. Note black smoke in photographs on following pages.
5. Violated partition wall in the truss loft contributed to fast spread. These holes provided paths for air currents driven by outside winds.

This series of photographs captures the sequence of events leading to the entrapment and death of two Orange County, Florida firefighters. The structure shows evidence of fire at the time of the alarm before arrival of Orange County Fire and Rescue Division. Members of Engine Company 36 arrive and stretch a preconnect handline. After quick examination, they reposition the handline outside in an attempt to knock down some flame spread. The firefighters, assisted by members of Rescue Company 36, decide to attempt an interior attack.

After firefighters reenter the structure, the ventilation dormer begins to fail and falls into and through the ceiling below (perhaps the popping noise heard by Firefighter Marcotte). Flames drop into the occupancy.

Fire quickly spreads within the truss loft and through the roof. Flaming debris drops and surrounds the firefighters as the structure begins to collapse. Firefighter Marcotte makes his way to the side wall and breaks through a glass panel of the chainlocked exit door. Firefighters then attempt to position another handline in an effort to protect their brothers still within the building. The roof structure becomes totally involved and continues to collapse upon the two trapped firefighters.

Orange County 911 agency also received at least eight reports of the fire.

Response:

Engine Company 36, manned bv Acting Lieutenant Todd Aldridge, Relief Driver Dan Bonacci. and Firefighter Richard Marcotte, responded to a verbal alarm (Rescue Company 36 was on the air at another location within the district). Firefighter/Paramedics Mark Benge and Chris Grieb of Rescue Company 36 were notified by central dispatch to respond to the location along with the balance of the first-alarm assignment of two engines, one ladder (tower), and a battalion chief.

INVESTIGATION OPERATIONS

1. Team Concept – The Orange County Sheriff’s Office (OCSO) supplied assistance in public information; scene, crowd, and traffic control; and technical services. Usual services were delivered by the county medical examiner and the county legal department. The State of Florida Fire Marshal’s Office provided assistance in determining source and origin.
2. Documentation – Fire Loss Management Division (FLM) personnel immediately began to gather statements concerning the circumstances of the fire. The entire overhaul, recovery, and investigative phases of the fire scene were videotaped. One investigator was assigned to taping operations. Others were assigned to various investigative tasks. Still photographs were taken by FLM investigators and OCSO technical deputies. Other investigators worked with spectators in search of photographs taken by civilian bystanders.

Inspection files, permit records, and applicable building plans were brought to the scene. A building department official was summoned to the scene also.

1. Scene Management – The fire scene was designated a crime scene and the area isolated. Investigation procedures were immediately initiated by the deputy chief of FLM. A fire scene manager was designated and all agencies were required to coordinate activities through him. The investigation process extended from Friday evening, through the weekend, to Thursday morning. During this period the scene was under the supervision and control of FLM officers. All measures were taken to ensure that no breach of scene security was allowed.
2. Private Sector Involvement – On the day following the incident, members of the insurance industry approached scene management to determine to what degree they would be allowed to participate in the examination of physical evidence. The scene manager allowed participation only as approved by the sheriff’s office.
3. After Release of the Scene – All evidence and documentation gathered up to that time was sequestered under the shield of the sheriff’s office. At the time of the publication of this report, it has been determined that no criminal charges will be filed.

Note: It is estimated that by this time the fire had been attacking the truss members and sheathing assembly for 25 to 30 minutes.

Initial Operations:

Heavy smoke was observed by members of Engine 36 as they responded. They took position in front of the fire building and notified the dispatcher. Although the nearest hydrant was 100 feet away, the officer elected to supply the 1 3/4-inch handline with tank water (750 gallons) from this 1,500-gpm pumper.

Their initial investigation into the structure’s interior selling floor revealed little or no heat and smoke. The officer ordered that the charged line be returned to the outside and operated into the dormer. From the photographs. it appears that this stream had very little effect on the fire condition.

PERFORMANCE OF TURNOUT CLOTHING AND OTHER PROTECTIVE EQUIPMENT

The turnout equipment of Firefighter Richard Marcotte, who escaped, was collected after operations. This presented the unique opportunity to evaluate equipment presently in use in OCFRD to determine how it withstood an extreme case of heat and stress.

1. Helmet – The face shield is distorted. However, the damage was not during the escape; it occurred later when the firefighter was attempting to get close enough to apply a handline to the last known location of the lost firefighters. His extraordinary efforts exposed him to severe radiant heat conditions.
2. No damage was sustained to other parts of the helmet to render it unusable in the subsequent firefighting operation.
3. Turnout Coot Jacket – The jacket and liner survived the heat and flame exposure well. The only significant damage was to reflective trim. Nevertheless, the damage was not so extensive so as to render the coat useless. It held up well enough for use in subsequent firefighting activities.
4. Turnout Bunker Pants – There was no significant damage to the bunker pants. A tuft of melted carpet was affixed to the knee area. Conditions at the floor level were so hot that the floor covering melted and adhered to the knees of the bunker pants with no adverse effect to Marcotte.

1. Engineer Boots – These boots survived the heated environment very well. There was no damage to the boots that would prevent their use in subsequent fire activity. The soles and treads were undamaged.
2. Protective Neck and Head Hood – No damage to the piece of equipment.
3. Protective Gloves – No damage. However, melted carpet tuft was affixed to the palm side of both gloves.
4. Self-Contained Breathing Apparatus (SCBA) – The bottle is a composite bottle. The bottle and mechanical parts of the unit survived the incident. However, the shoulder straps melted on both the left and right side. This condition occurred while Firefighter Marcotte was inside the structure, struggling to escape. The left strap melted through and failed. The right partially melted and Marcotte was able to shift its center of gravity and hold it in position with some difficulty (see photo above). There is evidence to support the proposition that the same failure occurred in the cases of firefighters Aldridge and Benge. Benge’s SCBA was found at his feet, in line with body, with valve and nozzle pointing toward his feet as if the assembly had fallen backward off him while he was in an upright position. Aldridge’s SCBA was found relatively distant—approximately 13 feet-from his location.

The engine officer then decided to attack the fire from below. He ordered that pike poles be brought into the structure and a 24-foot portable ladder be placed at the roof near the dormer location. (This ladder was never used.)

Rescue 36 arrived and added to Engine 36’s manning. Firefighter/Paramedic Mark Benge joined Aldridge and Marcotte about 15 feet inside the structure.

The ceiling was being pulled and dropped in 3-bv-3-foot sections to the floor. Marcotte directed the nozzle, on fog pattern, into the truss loft, and operated it intermittently.

The three firefighters observed heavy rolling fire and were sure that it was over them and to the door area. The officer decided to back out to the main entrance. Marcotte handed the nozzle to Benge and relieved him of the pike pole. Marcotte was expanding the original hole when Aldridge again ordered the firefighters to retreat to the door. This was the instant of collapse.

The Collapse:

Firefighter Marcotte was thrown to his back and covered over with his clothing immediately after hearing a “popping” noise. Spreading the clothing, he could see structural timbers above him. The flames rolled overhead. Rolling to his left, he could see light from glass windows and a glass-andmctal exit door and crawled toward it. He reached the door and turned to use his air bottle as a battering ram. The metal bar held fast —the exit door was chained and padlocked. Dropping lower, he tried again. Weakened by his ordeal. Marcotte smacked the glass three times before it gave way. and he tumbled to the safety of the outside perimeter.

Inside, the overhead structure continued to collapse. Acting Lieutenant Aldridge and Firefighter Benge moved about until overcome by the flames. These activities were supported by the investigation that found up to seven inches of ceiling, glass, and roofing under their bodies. Firefighter Benge was struck by falling debris and suffered two skull fractures—he was trapped. He fell facedown over the roofing debris. His SCBA was off his back, near his feet, with the bottle turned upside down as it would have had it pivoted from his shoulders to the ground below his feet. His helmet and facepiece, however, were near his head. The fire investigation team believes that his air pack assembly fell from his back before he succumbed to his surroundings.

Lieutenant Aldridge, also trapped, fell to the ravages of flames faceup on the piles of roofing and other debris. His helmet and facepiece were 13 feet from him. The air pack assembly was 13 feet in another direction, in line with his travel —back near the location of the nozzle.

It is assumed from the investigation that the SCBA assembly also fell from his back as he was fighting his way out of the structure. Hie investigation team measured the amount of debris under the SCBA assembly (less) and the amount of debris under the lieutenant’s body (more).

Autopsy tests further showed that the firefighters’ pulmonary passages were seared by high heat and evidenced particles of carbon. Levels of carbon monoxide were also found in the blood streams of Firefighter Benge and Lieutenant Aldridge: 21.3 percent and 10.8 percent, respectively.

Editor’s analysis after reviewing the report and conferring with OCFRD:

The ceiling attached to the underside of the lower truss cord blows down as a result of smoke explosion. The rolling flame and heat stratum, previously contained by the gypsum membrane, drops to the level of the first floor, enveloping the three fire service members. Structural timbers and roofing material begin to collapse. Firefighter Marcotte gets to his feet and escapes through the glass door. Moving through the flames and collapsing debris, the firefighters lose hold of the nozzle. (The nozzle is eventually found 13 feet from the nearest firefighter in the “on” position.) The shoulder straps of the SCBA harnesses of both firefighters melt and the air bottles fall off their backs. Aldridge loses a boot as he tries to step out of the restricting waist strap of the SCBA harness. Aldridge is overcome, twisting and falling faceup, while his partner only has a few more moments left. Receiving at least one blow to his head from collapsing construction materials, Benge falls facedown, unconscious, on top of collapsed structural members.

LESSONS, REINFORCEMENTS, AND DIRECTIONS

• Existing building codes only require fire protection within truss lofts if they are exposed directly to the occupancy. Assemblies with a lower-cord protective membrane (gypsum board) installed between the occupancy and the loft do not have to be protected. Fire initiated in this area can burn, relatively undetected, for a considerable amount of time.
• Early detection and warning systems are not required in buildings of dtis size above the protective membrane.
• Compartmentation of the truss loft at 3,000 sq. ft. was violated by sloppy installation of building services. These openings will allow passage of flame, heat, and other products of combustion to unaffected areas. In this case, diey also permitted wind currents to accelerate fire growth.
• The value of continual inspections during the construction of structures within the district is obvious. Approved plans can and will in all probability be changed with “minor” revisions during the construction cycle.

Preplans must reflect the construction of today’s occupancies. The old concepts of what is and what is not a target hazard are to be rejected. Today’s construction practices can cause every structure to be thought of as a target hazard and planned for. Inspection, record keeping, and communication are the keys to successful and dynamic training, and all are part of effective and safer fireground operations.

• Although there was no violation of existing department policy or operating procedures at that time, the fire chief has formed a review committee to revise, update, and in some cases change or establish operating procedures that reflect today’s fire load, construction, and operations. The committee is charged to continue to exist so that preplans can be drawn and communicated for future trends and problems.
• Orange County Fire and Rescue Division was satisfied with the quality of the protective clothing. It performed well in the worst situation.
• The value of hoods and their use was underscored. The firstand seconddegree burns suffered by Firefighter Marcotte were only to those areas of his body that became unprotected intermittently during his escape.
• A firefighter’s protective envelope is only as strong as its weakest link — in dtis case, the shoulder straps of the SCBA assembly. Our investigation is ongoing as to w’hy and how these straps failed on the assemblies of all three firefighters. We will immediately explore the means necessary and available to prevent this failure from happening in the future.
• Orange Count)’ Fire and Rescue Division feels that it has presented all the facts surrounding this disaster in as factual and straightfow ard a manner as possible. There are no interior or exterior biases. The reader, therefore, is encouraged to use his own imagination, experience, training, and critique to evolve any and all further lessons that may be applicable. It is the goal of the department to make the rest of our fire service family safer because of our experience and make sure that the lessons gained here will not have to be learned anew on your fireground.

All of these events occurred approximately eight or nine minutes after the arrival of Engine Company 36. The fireground was out of water; the 750gallon booster tank was dry.

The Firefight:

Firefighter Marcotte rejoined the remaining two members of Engine 36 and Rescue 36. Assistant Chief Lyon, interrupted during his arrival report by the collapse, ordered second and third alarms in rapid succession after what he determined was a backdraft. He also ordered that another handline be stretched and a master stream be directed toward the last known location of the fallen firefighters. Since Engine 36 had not laid a hydrant supply line and was out of water, this took some time.

By the time water supply was established, the fire in the gift shop was so intense that approach could not be sustained nearer than 20 feet because of the radiant heat.

Chief Lyon ordered additional master streams to the firefighters’ location and from a tower ladder to protect the exposure—the restaurant.

Once water and manning problems were solved, extinguishment and overhaul went smoothly. Efforts were simultaneously directed toward locating the fallen comrades.

RECOVERY

Recovery of the two bodies was started as soon as firefighters were able to withstand the heat of the fire debris. The firefighters’ bodies were located and the area was secured for the investigation.

The next of kin were immediately notified by the fire administrator and a division chief. The deputy chief of operations supervised overall scene activities. The deputy chief in charge of logistics supervised the task of locating and recovering the bodies. With that phase completed, the medical examiner and sheriffs office were allowed to proceed with their part of the investigation.

The contents of this report are intended to relate the finding of facts and probable occurrences as viewed by the investigation team. The reader should not read any absolute conclusions into this disclosure. From time to time, as evidence is closely reviewed and other information becomes available, the OCFRD investigative report will be revised.

Orange County Fire and Rescue Division Deputy Chief Edwin J. Spahn would like to thank in particular the following individuals who contributed to the investigation of the fatal fire at the Sunrise Gifts store:

Captain Richard Shultz (Investigation Scene Manager)

Commander Donald D. Payne (Photographer of Record) Commander Joseph E. Jones (Cause & Origin)

Lieutenant Howard P. Williams (Cause & Origin)

Captain Glenn E. Micheltree (Forensics)

Deputy Sheriff Ronald R. Stucker (Forensics)

Lieutenant David R. Hollenbach (Administration)

Linda Lockwood, secretary (Clerical)

John L. Boyd, electrical contractor (Technical Advisor)

John Gehrig, Assistant County Attorney

Dr. Ruiz, County Medical Examiner