Reducing the Firefighter Injury and Death Rates, Part 1

Year after year, the fire service lays to rest about 100 brothers and sisters. For the longest time, we had this “unspoken” competition with the members of the mining service: Which was the most dangerous job? We were neck and neck until the early 1960s, when the unions for the mining industry said “This is nuts!” And today, mining deaths are down—way down! For the past three years, they have averaged fewer than 80 deaths annually; this year, they had 61. I guess the fire service showed them!

This month’s question deals with reducing firefighter fatalities and serious injuries once and for all in this country. To have an impact on the firefighter death rate, we must first and foremost implement physical fitness standards that emphasize better cardiovascular health. More than 40 percent of the fatalities annually are attributed to heart attack. We need to get out of the mindset of who is the strongest or how many “whacks” it takes to move a sled from here to there and think more in terms of better cardiovascular health and training for all members of the service.

About 25 percent of our annual fatalities are from driving-related accidents. To combat this, we need to establish and enforce safer driving practices. We’re no good if we don’t get there, and we can’t go to the next one if we don’t get back from the last one safely!

Finally, to stop firefighter fatalities we need to mandate residential sprinklers in new and existing homes. Most of the firefighter fatalities are in private dwellings, so we could eliminate approximately 15 of the 30 firefighter fireground deaths annually and have a significant impact on the 4,000 annual civilian (including 1,500 children) fire fatalities.

The answers are not the problem—implementing them are. The miners found a way to significantly reduce deaths in their industry. Someone in the fire service will have to step up, just as Chief Mike Mc-Namee did standing at the door of that cold storage warehouse in Worcester, and say, “No more! We’re not going to lose anyone else!”

John “Skip” Coleman, deputy chief of fire prevention, Toledo (OH) Department of Fire and Rescue, is the author of Incident Management for the Street-Smart Fire Officer (Fire Engineering, 1997) and Managing Major Fires (Fire Engineering, 2000). He is an editorial advisory board member of Fire Engineering and a member of the FDIC Educational Advisory Board.

Question: Each year, the number of firefighter deaths and injuries remains constant or increases. Annually, the National Fire Protection Association publishes a detailed accounting of the previous year’s death and injury statistics. What do you think are three things that departments must do to impact this record positively?

Tom Brennan, chief (ret.),
Waterbury (CT) Fire Department

Response: The firefighter death and injury rate is appalling—and increasing! What can be done to turn this trend around permanently? Look to see where the events are occurring—cardiovascular-related deaths and disabilities. Most departments do not have an adequate (or any) membership wellness programs. Step one is to address the incidents that account for 50 percent or more of firefighter deaths annually. Take care of their cardiovascular systems and any other physical preparation needed to let them address the “job” without the medical risk. Make and keep them well!

Twenty-five to 35 percent of our firefighters killed each year never get to the scene. Their statistics are compiled on the roads and highways going to and coming from fires and other emergencies. The police have had driver training for personnel for years. Ours, if existent at all, consists of a day or so at a county or state course in an apparatus that is too old for the spare pool. You practice going forward and backward through rubber cones that are close to the sides of the apparatus, water is flowed though some fixed monitor, and aerials are raised and rotated without ever demanding a target from the operator. No intersections to pass through, no pressure of the alarm and the sights as we arrive into the vicinity, no shotgun alley, no expectation of whether we are seen or heard by those around us. We almost never duplicate any actual street conditions—tight turns that cannot be made on one turn of the wheel, hills that have more than a 20-degree pitch, new rain on dry asphalt, or ice on black pavement at 3 a.m. Another problem is the driving habits of those who drive to the emergency by themselves or race to the fire station in their private vehicles.

These are two controllable areas that account for more that 75 percent of our firefighter annual death statistics!

The third contributor to the death rate is the trauma that occurs on the fireground. The leadership of our fire service is backed by management techniques lacking to the point that our fire buildings are falling on our members, exploding and flashing with killing intensity at a rate that has never been seen before. We have never been better protected, and our exposure injuries continue to rise. I never remember a firefighter’s being burned to death and declared dead at the scene during my career. There were not that many flashovers, and the “backdrafts” were mostly misnamed.

Now we have cold smoke explosions, fireballs dropping down on searching firefighters in areas so remote from the seat of the fire that you never thought there would be extension in that location. In short, the buildings are no longer behaving!

We constantly operate in an uncontrolled environment that operating forces are to make relatively safe for calculated risk by performing tactics all at once, depending on a series of needs identified by an ongoing procedure called size-up, at least for interior attack of fire buildings. If our building remains enclosed (no ventilation), a fire condition emitting water vapor and carbon dioxide will rapidly change without air to evolve explosive gases at an exponential rate as the temperature of the enclosure also rises at a similar rate: explosive gases!

The atmosphere surrounding the firefighter must be familiar and improve rapidly if injuries are to be prevented. Not only are the tactics necessary but so are the procedures and training to perform them. Hoselines must move to isolate the condition rapidly at the proper water delivery rates to positively affect the situation (hose size and number not constricted by preconnect). Sufficient personnel must arrive to do that immediately and to establish water supply. The other tactics that make a building behave—forcible entry, ventilation (adequate and ongoing), search operations (for people and information), alternate entry and exit procedures—must be accomplished. Examine those areas considered remote at the onset of the operation and interior exposures above and around as well as adjacent to and attached. What are we talking about here? Personnel and their training.

Ron Hiraki, assistant chief,
Seattle (WA) Fire Department

Response: Individual firefighters and fire departments can work toward a permanent reversal in firefighter death and injury statistics by focusing on the following areas.

1. Adjust our attitudes, learn from close calls. To get the job done, firefighters need to be aggressive. Sometimes firefighters push a little farther, or try to “squeeze” another few minutes out of an air bottle. Sometimes firefighters act on limited information, which leads to less than ideal assessments and decision making—and errors. These “close calls” are unintentional. However, real change could result if a department or station environment encouraged firefighters to share their close call experiences with other members. This attitude adjustment would also require fellow firefighters to listen to descriptions of close calls with an open mind, without ridicule and judgmental comments that disrupt an opportunity to learn.

2. Focused training. Fire departments and firefighters are required to train on so many mandatory topics that there is little time to train or practice in areas for self-improvement. Fire departments and firefighters need to dedicate some time to train on topics with which members are uncomfortable or that are infrequently discussed. The topics could be specific to a company or an individual. If a firefighter determines that he is not comfortable with building construction, reading fire conditions, or safety, that member should have an opportunity to receive that training. The opportunity is created by making time and basic resources available. By addressing these gaps in knowledge, skills, and abilities, the company will become stronger and safer.

3. Dedication toward health and wellness. Fire departments and firefighters need to internalize and live by health and wellness concepts. Fire departments need to have a health and wellness program. Firefighters need to practice a healthful lifestyle with proper eating, exercise, and preventative health measures. Implementing health and wellness programs in fire departments is thwarted by budgets and logistics. Some firefighters may have their vices, such as eating too many cheeseburgers and forgetting to exercise. However, the important thing is for fire departments and firefighters to move in the right direction. A little something today will make a big difference in the future.

Fire departments could implement these ideas. However, individual firefighters can also take action without waiting for the fire department to initiate or change a program. Firefighter death and injury statistics make their mark on the department and the individual. It is encouraging that both can effect positive change.

Rick Lasky, chief,
Lewisville (TX) Fire Department

Response: Every year the statistics are published and the causes are listed, and every year we see that it’s not some new kind of fire or reason for the fatalities—it’s usually the same causes. We lose members of our fire service family to heart attacks, driving to and from the scene of emergencies, losses on the fireground, and other causes each year, but when we look at the contributing factors leading to the fatality, we often see the same causes repeated from incident to incident and from year to year. If we don’t have SOPs that our personnel can follow—SOPs that are realistic and workable—then we’re back to not having a good “game plan.” If we’re not trying to get our people into good physical shape and fighting for wellness program funding, then most likely we won’t see the numbers pertaining to heart attacks decrease. And, we still need to train everybody on how to save our own and get out alive if we’re going to continue to fight fires and crawl into burning buildings. As much as I advocate firefighter survival training, the fact still remains that if we train our people in the basics, in how to do their job, hopefully we won’t have to use the techniques taught in those types of programs. We cannot omit good, solid training in engine and truck operations—how to lead out with an attack line, how to search, SCBA skills, ladders. No new laser beam or fancy gadget is going to get you there. But getting down and dirty and back to the basics will. To impact the fatality rate positively, departments must develop and follow realistic SOPs, ensure that all personnel receive firefighter survival training and command staff receive training on managing the Mayday, and implement a department wellness program.

I know funding can make it difficult to move in that direction, but with the availability of lesson plans, training materials, programs, and conferences, there should be very few reasons, if any, for not providing these things to our people. Many departments are doing it with the funding, and many are doing it without the funding.

Nicholas DeLia, chief/fire marshal,
Groton City (CT) Fire Department

Response: First, our departments and personnel need to equate the physical performance of firefighting with the requirements of a professional athlete. As we become busier responding to a wider variety of emergencies, the need for physical endurance becomes obvious. In addition, while some of the traditional protective clothing we wear has become lighter and more functional, we are now expected to wear the various hazardous-materials suits that do not breathe. Cardiac arrest continues to lead all other causes of firefighter deaths. Cardiovascular disease has taken the lives of too many of our personnel. Departments and their personnel need to find a way to create an atmosphere where being physically fit is a fundamental goal for everyone. This may require a variety of agreements or purchases and, in some cases, a basic shift in thinking. Just like an athlete, being fit and ready for action has dual benefits. It not only enhances your capability to perform your job, it could save your family from needless suffering.

Second, wear your seatbelt. You would not go into a working fire without the proper protective clothing—the conditions inside the building can be unusual or change unexpectedly. So why assume your trip to the emergency will be any less unpredictable or filled with danger? Departments, and company officers in particular, need to enforce safe driving rules including speed control and the wearing of seatbelts by everyone before the vehicle moves. Several private and public organizations offer safe driving programs.

Third, personnel need to learn how to rescue themselves from danger. One fundamental skill most of these programs miss is the firefighter safety size-up. It is critical to look for the entrapment hazards before entering the building or dangerous area. This survey is in conjunction with an evaluation of the building’s structural stability. For example, the proactive approach of determining there are bars on the windows and having them removed could eliminate the need for self-rescue. I strongly believe in providing each firefighter with the knowledge and tools to self-rescue.

Larry Anderson, assistant chief,
Dallas (TX) Fire Department

Response: It amazes me that with all the technological advancements the fire service has made in the past 30 years we have not significantly reduced the number of deaths and injuries. The fire incidents are down, and we have much better personal protective equipment than we once had. The whole situation just doesn’t make sense. What factors are killing and injuring our firefighters? Firefighters becoming lost or disoriented in IDLH situations seems to be a common theme in many of the line-of-duty death reports. People still get hurt doing unnecessary or just plain dumb stuff. Finally, the streets and freeways of this country have become the most dangerous work sites we face. That being said, I offer the following suggestions to positively impact our safety records.

1. Personnel accountability must be first in the minds of all personnel operating at the emergency scene. Take a hard look at your personnel accountability procedures and see if they are truly workable during all firefighting situations. We lose people in one-alarm events, not just major operations.

2. Incident safety officer (ISO) should be a dedicated position at all working events. This person needs to be an experienced fireground tactician and should have the authority to halt or modify an operation. The ISO should be subordinate to the incident commander but should work with the IC to ensure risks are taken only when appropriate.

3. A program of roadway safety should be initiated in every department. Positioning the apparatus, maintaining visibility, and properly utilizing law enforcement personnel can help save our people. Getting enough equipment to an emergency scene to provide early warning and creating a buffer zone between traffic and fire personnel are key. Freeways have become our war zone and can pose the biggest challenge to maintaining the safety of our personnel.

Katherine T. Ridenhour, captain,
Aurora (CO) Fire Department

Response: The single most important and far-reaching action the fire service can take to reduce firefighter injuries and deaths is to change its attitude.

The United States Fire Administration recently released firefighter death statistics for the years 1990-2000. While some of these statistics reflect situations that are not preventable, most are. The underlying theme or cause of most statistics is lack of a “Safety First” attitude. The mindset of the fire service must change if we are to alter future rates of injuries and fatalities.

The leading cause of death for firefighters is heart attack—from stress and overexertion—according to the USFA. Solution? Programs that promote and demand individual fitness regimes, event rehab, physical screening, and testing. If the fire service upholds the attitude of “saving our own,” then we must adopt meaningful health and safety programs.

Number two on the USFA list is trauma. Too many aggressive interior firefighting operations are being conducted when the building is no longer capable of supporting human occupancy—especially ours. Our industry is guilty of being ignorant of the factors that should dictate how we operate on fire scenes—how fire behaves in buildings. We need to be well versed in fire behavior concepts and ever-changing construction methods. With today’s lower incident of structure fires, our high risk/low frequency operations should stress the underlying attitude that safety comes foremost in all issues.

Perhaps the most unfortunate and easily preventable cause of firefighter deaths—especially in the volunteer sector—is the high incidence of driver/operator deaths. Last year, NIOSH investigated five firefighter fatalities involving motor vehicle collisions and found that none of the victims were wearing seatbelts. Why do we establish safety policies that we don’t universally enforce in all areas? We must demand the attitude of safe driver/operator programs that require regular training, certification, and testing.

We must change our attitude to positively impact these statistics. If the USFA’s goal of cutting firefighter deaths 25 percent by 2005 is to be a reality, then it is clearly the responsibility of all of us—the fire service, each fire department, every fire officer, and every firefighter—to define our attitude and actions as genuinely “Safety First.”

Steve Kreis, assistant chief,
Phoenix (AZ) Fire Department

Response: Slow down, train more and smarter, and do what we say we are going to do. How many haz-mat technician line-of-duty deaths (LODDs) have there been in the past 10 years? Zero. There are a bunch of differences, but one of the most important is that haz-mat techs take the time to do a more thorough size-up of the situation and are much slower to act, making it more likely that they will make better decisions. For most fire departments in America, the same folks respond to structural fires and hazardous-materials incidents, but many times these same members act completely differently at the incident scenes. I’m not saying that we should slow down the pace of a structural firefight to the pace of a typical haz-mat incident, but we should take a few extra seconds or minutes, if necessary, to act like professionals and do the job right. Slow is safe, safe is smooth, smooth is fast.

Many times (for a lot of good reasons) departments drift away from training for structural fires. Except for actual delivery of service (firefighting, EMS, or special operations), there isn’t anything more important for a fire department than training. Oftentimes, we say it’s because there is not enough time or money or we just don’t have the resources to commit to training. A department that finds itself in this position is “living on borrowed time” (in some cases, literally). Sooner or later, it will have a LODD. With the numbers of fires down, we MUST train more and smarter. Along with more training comes smarter training. Once a department makes the commitment to train, the training groups must develop high-quality training programs. We need to train in the same context as we fight fires. It really doesn’t do most fire companies any good to train on structural firefighting in the “drill tower.” Get out of the training academy and train in the community in which you work. Conduct your training in a local commercial building; you’ll be surprised at what you will learn.

Command officers must also receive more and better training. So many times after an LODD, fire departments revert to “back to basics” training and stop there. We need to examine LODDs from task, tactical, and strategic points of view and fix things at all three levels. It doesn’t do much good to correct problems at the task level if the incident commander is just going to make the same mistakes at the strategic level.

Finally, we need to do what we say we are going to do. We all say that nobody should die for property, but we don’t act that out on the fireground. Look at the NIOSH and NFPA reports on LODDs. How many personnel died for property? I don’t know the exact numbers, but I would guess that close to 90 percent of the LODDs that took place during a structural firefight died after they had an “all clear” on the building. The risk management model in NFPA 1500 says it pretty simply: We will (and should) risk our lives a lot for “savable” people, we should risk our lives a little for savable property (within a structured plan/system), and we shouldn’t risk our lives at all for lives or property already lost. This risk assessment model is easy to describe but very, very hard to act out. These areas for improvement require cultural changes in the way we operate on the fireground.

Bob Oliphant, lieutenant,
Kalamazoo (MI) Department of Public Safety

Response: Firefighter fatalities can be lumped into three general categories: cardiac health, vehicle operation, and unnecessary risks.

Among the USFA findings was that the leading cause of death for firefighters is heart attack. Was anyone really surprised? We work in a job that makes it easy to eat and become sedentary. Our killing ground is the kitchen and TV lounge. My own reaction to this is not what departments should do to reverse this trend but what each one of us must do to stay fit. I think that management and labor are a long way off from agreeing on how to approach this issue. Department-sponsored physicals, wellness programs, and workout facilities are important, but it is ultimately up to each one of us to manage our own health.

If departments have not adopted an emergency driving policy similar to that of the St. Louis (MO) Fire Department, they should. Slowing down the response of emergency vehicles makes it safer for us and safer for the citizens we protect. What chance does the average vehicle have in a collision with an engine or truck? Another benefit is that it reduces liability. The seconds saved by excessive speeds and blasting through traffic signals are not worth it. Arriving safely is more important than arriving quickly. My department has followed the St. Louis example for four years. The first-due engine for an alarm is the only apparatus that responds in the emergency mode. All other apparatus respond directly to the scene obeying all traffic laws without the use of emergency equipment. The response is upgraded if the first-arriving unit reports an actual fire. I can’t recall any occasion where the slower response of other apparatus affected the outcome.

Most of the fires we fight are extinguished using a quick, aggressive interior attack directed at the seat of the fire. The evolving technology of personal protective equipment allows us to go farther and stay longer inside burning buildings. Ironically, the same equipment that protects us is exposing us to more danger. Maybe it’s time to replace technology with risk management. A “blitz attack” from the outside of a building can knock down a substantial amount of fire before personnel go inside.

Why should buildings be routinely searched when it is unlikely that anyone is inside? Firefighters should not be dying where there is no one to save. Should we go inside buildings that will quickly succumb to fire because of design, age, or neglect? Francis L. Brannigan continuously reminds us that the building is the enemy—not the fire—but are we listening? Now is the time to reevaluate what we are doing, how we are doing it, and the risks we are willing to take to accomplish it.

Simply put, we have to take responsibility for our health, drive safely, and reduce risks on the fireground. We’ve been doing it wrong and have to change. If we continue with business as usual, we will continue to suffer the consequences.

Editor’s note: More answers to this question will appear in the February Roundtable.

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