BY KRISTINA PETERSON, HARLAN AMANDUS, and JAMES T. WASSELL
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health (NIOSH).
Over the past three decades, vehicle-related crashes have been the second leading cause of firefighter line-of-duty deaths (LODDs). About a quarter of on-duty firefighter LODDs occur in motor vehicle-related incidents and crashes, many while responding to or returning from an incident. More than a third of those deaths involved firefighters’ personal vehicles, and three-quarters of the victims were volunteer firefighters.1 Motor vehicle-related incidents primarily involve collisions (including those involving aircraft and boats) and rollovers (see “Fire Truck Rollover”). Other fatal events include falls from a vehicle or being struck by a vehicle while working at an emergency scene where the vehicle plays a key role in the fatality. (1)
Most of the crashes involve personal vehicles or tankers. Most of the victims are volunteer firefighters. (1) For example, personal vehicles were involved in more than a third of firefighter road crash fatalities from 1977 through 2006. (1) Some deaths are caused by falls from firefighting apparatus while responding to or returning from alarms (see “Fatal Fall”). Deaths from falls have reoccurred in recent years after virtually disappearing during the 1990s. (1)
Motor vehicle crashes have increased over the past three decades relative to other safety issues. While the average number of annual firefighter deaths dropped by one-third between 1977 and 2006 (1), the average number of firefighter deaths caused by crashes has not changed much over this period.
The National Fire Protection Association (NFPA) found that over the past 30 years, many of the firefighter fatalities caused by motor vehicle-related crashes may have been preventable. The NFPA noted that “of the 406 victims [of road vehicle crashes], 76 percent were known not to be wearing seat belts or using restraint systems. Only 13.3 percent were wearing seat belts or using other restraints.” (1) In 2007, for example, the NFPA found that 25 firefighters were killed in motor vehicle crashes while riding to or from an incident. Eleven of the victims were not wearing seat belts, and excessive speed was a factor in at least six of these crashes.2 The 30-year trend in on-duty firefighter deaths is shown in Figure 1.
Figure 1. On-Duty Firefighter Deaths in Road Crashes
Source: Reprinted with permission from NFPA Journal® 2007 (Vol. 101, #4) copyright © 2007, National Fire Protection Association, Quincy, MA. All rights reserved.
INVESTIGATING ON-DUTY FATALITIES
NIOSH investigates on-duty deaths and injuries. Investigators from NIOSH’s Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) visit the site, interview the fire crew and officers, and try to determine the causes of the crash (see “FFFIPP”).
Each investigation results in a report that describes what happened and why and includes recommendations for preventing future injuries or fatalities. NIOSH has issued hundreds of recommendations since the FFFIPP program began in 1998. They are based on scientific findings and on recommendations adopted by experts, such as NFPA and OSHA. NIOSH recommendations address many topics including training, motor vehicle safety, and apparatus specifications.
As a safety research agency, NIOSH encourages fire departments to adopt these recommendations and to follow them. Individual fire departments can use the FFFIPP recommendations as tools to develop an effective safety program.
NIOSH also publishes Alerts, which briefly present new information about occupational illnesses, injuries, deaths, and other documents that summarize patterns and lessons learned from similar incidents. Periodically, NIOSH mails the LODD investigation reports, Alerts, and other documents to the nation’s fire departments. They are also available at http://www.cdc.gov/niosh/fire/. The list of reports can be found at http://www2a.cdc.gov/NIOSH-fire-fighter-face/state.asp?state=ALL&Incident_Year=ALL&Submit=Submit.
MOTOR VEHICLE SAFETY RECOMMENDATIONS
The most common FFFIPP motor vehicle safety recommendations for fire departments involve seat belt use, driver safety, and driver training3 and are presented below.
- All firefighters riding in emergency fire apparatus should wear seat belts and be belted securely.
- Fire apparatus drivers should not move vehicles until all occupants in vehicles are secured with seat belts.
- Drivers of fire department vehicles should understand that they are responsible for the safe and prudent operation of the vehicle under all conditions.
- Drivers of emergency fire apparatus should come to a complete stop at intersections having a stop sign or a red signal light before proceeding through the intersection.
- Drivers of fire department vehicles should come to a complete stop at all unguarded railroad grade crossings during emergency response and nonemergency travel.
- Apparatus operators and personal vehicle drivers should observe all applicable traffic laws when responding to emergency situations.
Apparatus operators and drivers of fire department vehicles should receive initial driver training, including classroom and practical, on every vehicle and apparatus they will be required to operate and, at minimum, refresher training at least twice annually thereafter.
EVALUATING THE EFFECTIVENESS OF FFFIPP RECOMMENDATIONS
In 2006, NIOSH completed a comprehensive review of the FFFIPP to assess whether the investigation findings have been effective in getting information out to the fire service and if the recommendations have improved safety practices. Firefighters were surveyed to find out if they are aware of specific recommendations and if they follow them. More than 3,000 fire departments were contacted in the national survey. We also held a series of focus groups with frontline firefighters. Their responses revealed some important findings. The evaluation was conducted by RTI International, a trade name of Research Triangle Institute, under a contract with CDC/NIOSH.
THE 2006 FIRE DEPARTMENT SURVEY FINDINGS
Seat Belt Use
FFFIPP investigations show that, on average, three-quarters of the firefighters killed in motor vehicle crashes while responding to or returning from alarms were not wearing seat belts. The survey results show that less than two-thirds of firefighters regularly follow NIOSH’s seat belt recommendations. Only about 58 percent of firefighters use their seat belts “most of the time” or “always.” Firefighters who are most likely to use their seat belts while riding in emergency vehicles are those in large urban jurisdictions (50,000 or more persons protected), those in career fire departments, and those in the western states (Colorado and westward, including Alaska and Hawaii).
One reason for the lack of seat belt compliance could be the lack of suitable equipment. One-quarter of all fire departments reported that their firefighters are not able to fit comfortably in their seat belts while wearing turnout gear in emergency vehicles. Large urban departments are more likely than small rural departments to say that firefighters are not able to fit comfortably in their seat belts.
Other firefighters may not be using their seat belts because they are not required to do so. Although most fire departments (84 percent) require firefighters to wear seat belts while in emergency vehicles, about 16 percent of departments do not. Departments that have had a FFFIPP investigation of a firefighter fatality are more likely to require seat belt use. In addition, fire departments in the western region of the country have shown the greatest compliance in requiring the use of seat belts among firefighters, whereas departments in the Midwest are the least likely to comply with seat belt recommendations. One out of four of the midwestern departments fails to require seat belt use while riding in emergency vehicles. Fire departments in large urban jurisdictions appear to be better about requiring seat belt use, and career fire departments are more likely than volunteer departments to require seat belt use.
FFFIPP investigations also show that most firefighter fatalities in road crashes could be prevented by wearing seat belts, obeying traffic laws, and controlling driving speeds. Most fire departments ensure that firefighters responsible for driving emergency vehicles receive vehicle operations training before being allowed to operate emergency vehicles. Firefighters in most fire departments also receive refresher driver training once or more per year. Overall, 84 percent of the nation’s fire departments require driver training. In about 14 percent of departments, training is offered, but it is optional.
Departments where driver training is more likely to be optional are most often in the Midwest. By region, the proportion of departments where driver training is optional is as follows: Midwest, 23.7 percent; Northeast, 19.7 percent; South, 16.1 percent; and West, 10.9 percent. Other departments that make driver training optional tend to be in small (fewer than 5,000 persons protected), volunteer, or rural jurisdictions or in departments that never had a FFFIPP investigation. Driver safety training is more likely to be required most often in career, urban, or large (more than 50,000 persons protected) jurisdictions or in jurisdictions that had a FFFIPP investigation. Driver training is required least often among departments in the Midwest. Departments that use the FFFIPP recommendations in their training sessions tend to be large career fire departments and departments in the northeastern and western states. Departments in urban and larger (more than 5,000 persons protected) jurisdictions are more likely to offer refresher driver training.
In focus group discussions, frontline firefighters said that there is room for improvement in the driver training provided and that they need to be trained to the “class of the vehicle.” Home responders (from the volunteer fire service) also need additional training in department safety requirements for responding to emergency calls using their personal vehicles.
Many fire departments have used FFFIPP recommendations to train firefighters on traffic hazards and to develop SOPs. Across the country, 29.3 percent of fire departments train to the FFFIPP recommendations, and 78.8 percent have SOPs consistent with these recommendations in place. Not surprisingly, departments that have experienced a fatality (regardless of whether they have had a FFFIPP investigation) are more likely to make direct use of the FFFIPP findings for training purposes and SOPs. Also, departments in large jurisdictions are more likely to use the FFIPP recommendations for training as well as for SOPs. Finally, departments in urban jurisdictions are also more likely than those in rural jurisdictions to use FFFIPP recommendations on motor vehicle safety for SOPs.
REDUCING FIREFIGHTER DEATHS
In 2007, 23 firefighters were killed on duty as a result of motor vehicle crashes and other related events: 11 of the victims were not wearing their seat belts. (2) These deaths represent almost one-quarter of all on-duty firefighter fatalities that year. We believe that future incidents of this type are preventable. As the NFPA recently concluded, “Driver and passenger safety, particularly the use of seat belts, can have a direct and immediate impact on reducing some of the particularly preventable firefighter fatalities.”4
Reducing the number of fatalities will first require raising awareness of safety recommendations. The fire service appears to have been successful at increasing the use of safety equipment on the fireground. For example, the results of the 2006 fire department survey show that firefighters in 88 percent of the nation’s fire departments use their Personal Alert Safety System (PASS) devices regularly and 91 percent use their self-contained breathing apparatus (SCBA) regularly. However, inasmuch as only 55 percent of firefighters are thought to regularly use their seat belts, work remains to be done in regard to using safety equipment and implementing safety practices while traveling to and from the emergency scene.
One important step is for all fire departments to make the use of seat belts mandatory through SOPs and enforcement. If firefighters are required to don turnout gear prior to boarding the apparatus, they must be able to fit comfortably and safely in their seat belts. Moreover, emergency vehicle drivers must be well trained in the operation of each vehicle and apparatus they will be required to operate. It is also imperative that volunteer firefighters who routinely respond to incidents in their personal vehicles know that they are required to follow safe driving techniques, including wearing seat belts and operating within the traffic laws of their jurisdiction.
The overall downward trend in on-duty firefighter fatalities over the past three decades is partly the result of a decrease in the number of structure fires. However, the number of deaths caused by motor vehicle crashes and other related events has not declined during this period. The evaluation of FFFIPP suggests that firefighter deaths caused by motor vehicle incidents could be reduced by enforcing the use of seat belts at all times the vehicle is in motion and by providing additional driver/operator training, appropriate safety equipment, and effective compliance monitoring.
The authors gratefully acknowledge the contributions of Rita Fahy, National Fire Protection Association; Chief David Daniels, City of Renton (WA) Fire Department; and Virginia Lutz, NIOSH, who provided helpful reviews of this manuscript. The authors alone accept responsibility for the final content.
1. Fahy, RF, PR LeBlanc, JL Molis. (2007). “Firefighter Fatalities Studies 19772006. What’s changed over the past 30 years?” NFPA Journal, 101:(4), 4855.
2. Fahy, RF, PR LeBlanc, JL Molis. (2007). “Firefighter fatalities in the United States2007,” NFPA Journal, 102:(4), 74-92.
3. National Institute for Occupational Safety and Health. (2004). NIOSH Fire Fighter Fatality. Investigation and Prevention Program, Eight Years of Recommendations to Prevent Fire Fighter Fatalities Summarized: 19982005. Centers for Disease Control and Prevention, NIOSH Publication No. 2009-100. Retrieved April 21, 2009: http://www.cdc.gov/niosh/docs/2009-100/pdfs/2009-100.pdf/.
4. Fahy, RF, PR LeBlanc, JL Molis. (2007). “Firefighter fatalities in the United States2006.” NFPA Journal, 101:(4), 58-71.
Fire Truck Rollover
On July 8, 2008, a 25-year-old male volunteer firefighter (the victim) was fatally injured after being ejected in a fire truck rollover. The crash occurred as the fire truck was returning to the station after a call for a propane gas fire. The driver lost control of the fire truck, swerved off the left side of the road, returned to the pavement, and overturned on the right side of the road. The firefighter was the only truck occupant. The victim was transported to a local hospital, where he died from his injuries. National Institute for Occupational Safety and Health (NIOSH) investigators determined that lack of seat belt use and inadequate driver training were among the contributing factors in the victim’s death.
(1) Fire truck rollover. (Photo courtesy of NIOSH and County Sheriff’s Office.)
Reference: NIOSH (2008). “Fire Fighter Dies After Being Ejected from a Pumper in a Single Vehicle Rollover Crash – New York,” Morgantown, WV: U.S. Department of Health and Human Services (HHS), Public Health Service (PHS), Centers for Disease Control and Prevention (CDC), NIOSH Fire Fighter Fatality Investigation and Prevention Program Report No. F2008-25.
(2) Victim seating area and door. (Photo courtesy of NIOSH and the Texas State Fire Marshal.)
On April 23, 2005, a 27-year-old male career firefighter (the victim) sustained a fatal head injury when he fell from an enclosed-cab quint. The incident occurred shortly after leaving the station while the truck was en route to a reported structure fire. It is believed the victim reached to close a rear passenger door that had opened during a turn to the right when he fell out of the quint and landed on the pavement. The victim was treated at the scene and transported to a local hospital by ambulance. He died from his injuries two days later. NIOSH investigators determined that the victim was not secured in a seat belt at the time of the incident and that this was a contributing factor in his death.
Reference: NIOSH . “Career Fire Fighter Fatally Injured in Fall from ApparatusTexas.” Morgantown, WV: U.S. HHS, PHS, CDC, NIOSH Fire Fighter Fatality Investigation and Prevention Program Report No. F2005-15.
Investigators from the NIOSH FFFIPP visit the LODD incident scene to take photographs and diagram the area. They obtain reports from or speak with other entities having jurisdiction of the incident such as police, fire marshals, and the Occupational Safety and Health Administration (OSHA). Investigators travel to the fire department to interview emergency personnel who were on the scene at the time of the incident and obtain department standard operating procedures (SOPs) and training records. They gather weather data, road conditions, and all other documentation required to determine the cause of the fatality.
KRISTINA PETERSON, Ph.D., is a senior research director at RTI International, a private not-for-profit research organization. She has conducted numerous workplace safety and health surveys, program evaluations, and policy studies over her 30-year career. Her studies have focused on a variety of occupational groups including mineworkers, firefighters, factory and forestry workers, truck drivers, restaurant workers, military veterans, and health care industry staff. She is the author of numerous scientific papers, journal articles, book chapters, and monographs.
HARLAN AMANDUS, Ph.D., serves as chief, Analysis and Field Evaluations Branch, Division of Safety Research, National Institute for Occupational Safety and Health. This branch is responsible for evaluating injury interventions to reduce risk of occupational injuries. He has more than 30 years of experience as an epidemiologist and more than 15 years of experience in the epidemiology of occupational injuries. He has authored papers on occupational lung disease, cancer, and workplace violence.
JAMES T. WASSELL, Ph.D., is a research mathematical statistician who has been with the National Institute for Occupational Safety and Health for 16 years. His publications include work in statistical methodology, occupational injury, back injury, and risk assessment. His publications have been recognized through the 2001 NIOSH Alice Hamilton Award and the 2000 CDC and ATSDR Statistical Science Award.