While the number of structural fires in the United States continues to decline, firefighter line of duty deaths (LODD) do not exhibit the same rate of proportion decline. A review of both NFPA and USFA Firefighter LODD annual reports, statistics and retrospective studies and analysis suggest a noted change in the adverse trends noted for a number of previous years, but we are lagging in achieving the goals established by the NFFF’s Everyone Goes Home Program and initiatives.

 A recently published study and research conducted at the University of Georgia may provide insights and help explain why.

 Researchers in the UGA College of Public Health found that cultural factors in the work environment that promote getting the job done as quickly as possible with whatever resources available lead to an increase in line-of-duty firefighter fatalities.

“Firefighting is always going to be a hazardous activity, but there’s a general consensus among firefighting organizations and among scientific organizations that it can be safer than it is, “according to study co-author David DeJoy, of the Workplace Health Group in the College of Public Health.

The research, published in the May edition of the journal Accident Analysis and Prevention, examined data gathered from 189 firefighter fatality investigations conducted by the National Institute of Occupational Safety and Health between 2004 and 2009.

Each NIOSH investigation gives recommendations directed at preventing future firefighter injuries and deaths. The researchers looked at the high-frequency recommendations and linked them to important causal and contributing factors of the fatalities.

The following is the Abstract from the Line of duty deaths among U.S. Firefighters: An analysis of fatality investigations, published by Kumar Kunadharaju, Todd D. Smith and David M. Dejoy.

Inadequate preparation for/anticipation of adverse events during operations,

Abstract

More than 100 firefighters die in the line-of-duty in the U.S. each year and over 80,000 are injured. This study examined all firefighter fatality investigations (N=189) completed by the National Institute for Occupational Safety and Health (NIOSH) for fatalities occurring between 2004 and 2009.

• These investigations produced a total of 1167 recommendations for corrective actions.
•  Thirty-five high frequency recommendations were derived from the total set: six related to medical fatalities and 29 to injury-related fatalities.
• These high frequency recommendations were mapped onto the major operational components of firefighting using a fishbone or cause-effect diagram.
• Over 70% of the 30 non-external recommendations were categorized within the personnel and incident command components of the fishbone diagram.

Root cause techniques suggested four higher order causes:

1. under-resourcing,
2.  inadequate preparation for/anticipation of adverse events during operations,
3. incomplete adoption of incident command procedures, and
4. sub-optimal personnel readiness.

These findings are discussed with respect to the core culture of firefighting. (Copyright © 2011, Elsevier Publishing)

Excerpt from the study introduction

The United States depends on about 1.1 million career and volunteer firefighters to protect its citizens and property from losses caused by fire. Firefighting is considered to be one of the most stressful and dangerous occupations. Each year more than 100 firefighters die in the line of duty and over 80,000 are injured (Karter and Molis, 2009; United States Fire Administration, 2009). The fatality rate for firefighters is three times worse than for the general working population (International Association of Firefighters, 2001).

Advances in technology, personal protective equipment, engineering controls, environmental management, medical care, and safety legislation produced substantial reductions in fatalities during the 1970s and 1980s; however, these numbers have not improved during the past 25 years and have been trending upward for the past decade. Without question, firefighting is high hazard work, but it is unique beyond this. In most high hazard work situations, the goal is hazard avoidance. In contrast, for firefighting, the principal work activity is hazard engagement, which is usually further complicated by extreme time pressure.

High hazard work situations

The customary safety strategy in many high hazard work situations is to implement multiple safety measures, or what is sometimes referred to as: “defenses in depth” (Rasmussen, 1997; Reason, 1997). That is, several layers of precautions are put in place to protect the workers and the integrity of the overall system, even when components fail or errors occur. There is little protective redundancy in firefighting, and risks to personnel must continually be assessed and reassessed as the fire situation develops and changes, often with little predictability or advanced warning. Most efforts to protect firefighters fall into two general categories: preparative measures and operational measures.

Preparative measures encompass actions that prepare the firefighters to do their work in as safe a manner as possible. This would include personnel selection and placement, training, professional socialization, as well as the provision of personal protective equipment (PPE) and other safety devices. Operational measures focus on maintaining an adequate margin of safety during actual firefighting activities. This would include adherence to various standard operating procedures (SOPs), continued monitoring of risk–benefit ratios, communications, staffing, and other command and control activities.

As part of the effort to reduce firefighter line-of-duty fatalities, the United States Fire Administration (USFA) collects and evaluates information regarding line-of-duty (LODD) firefighter fatalities and publishes the data in the annual firefighter fatality reports (e.g., United States Fire Administration, 2009)

In 1998, Congress appropriated funding to the National Institute for Occupational Safety and Health (NIOSH) to conduct independent, onsite investigations of firefighter line-of-duty (LOD) deaths (National Institute for Occupational Safety and Health, 2009). The investigations conducted as part of the NIOSH Firefighter Fatality Investigation and Prevention Program (FFFIPP) are voluntary and not all fatalities are investigated. Cases are selected for investigation using a decision algorithm (National Institute for Occupational Safety and Health, 2009), with the primary goal not to find fault or assign blame, but rather to learn from these events and to formulate recommendations directed at preventing future firefighter injuries and deaths.

Since the program’s inception, NIOSH has completed over 470 fatality investigations. There have been several prior efforts to compile and analyze various portions of this accumulated database. Hodous and colleagues (Hodous et al., 2004) reviewed firefighter fatalities from 1998 to 2001 and synthesized NIOSH recommendations for cases involving structural firefighting activities.  

Risk and Culture

 

These researchers identified eight frequently occurring recommendations that highlighted three general areas of concern:

(1) use and enforcement of standard operating procedures (SOPs) related to structural firefighting techniques and strategies;

(2) adequate staffing and adherence to contemporary incident command practices, and

(3) increased attention to communications and personnel accountability and rescue.

• Peterson and colleagues (Peterson et al., 2006) examined recommendations from the first five years of fatality investigations (1999–2003).
• Their analysis identified 31 “key” recommendations, 22 involving traumatic injury fatalities and 9 involving cardiovascular fatalities.
• These were further reduced to 17 sentinel recommendations involving training, standard operating procedures, safety practices, and the safety environment of fire departments.
• More recently, Ridenour and associates (Ridenour et al., 2008) reviewed all investigations completed between 1998 and 2005.
• This analysis highlighted ten categories of recommendations, two focusing on medical cases and the other eight focusing on traumatic injuries.

The clear majority of medically-related fatalities involve cardiovascular events and these have produced two predominant recommendations: the need for improvements in medical screening, and the need for wider adoption of fitness/wellness programming for firefighters.

These are both preparative measures designed to identify and address cardiovascular risk in operational personnel. Trauma cases, on the other hand, have yielded a much more diverse array of recommendations and a less clear picture of high priority needs. These recommendations address both preparative and operational measures, and cover a broad territory that includes command and control functions, operations and tactics, and equipment and resources.

• The present study continues this line of inquiry but expands it in several ways.
• The first objective was to determine the extent to which the incidents investigated by NIOSH are representative of all firefighter LOD fatalities.
• NIOSH investigations are voluntary on the part of the fallen firefighter’s organization and NIOSH does not have sufficient resources to investigate all fatalities.
• This issue has potentially important implications for the generalizability of any key recommendations extracted from the accumulated database of reports.
• The second objective was to better describe the procedures used to derive key or sentinel recommendations.

In the analyses described above, only limited procedural details were provided on how the high frequency recommendations were actually determined.

The Fire Service Culture

For example, it would be useful to know how frequent the high frequency recommendations were, not only in absolute terms but also relative to other recommendations. Since most investigations contain several recommendations, it would be useful to know how similar recommendations were handled within and across investigations. The third objective involved the issue of causation.

The recommendations contained in these reports speak primarily to the “what” – that is, what needs to be done, not done, done better, or done differently in the future to reduce risk.

These recommendations almost always draw upon contemporary knowledge and accepted best practices in the firefighting and emergency response professional communities. Logically, it should be possible to link high frequency recommendations to causal factors or clusters of causal factors. Therefore, we were interested in determining whether insights into important causal factors could be extracted from these reports.

Identification of such factors is a requisite step in the development of effective prevention strategies (Higgins et al., 2001). With these objectives forming the organizing framework, the present research sought to examine NIOSH investigations for the years 2004–2009. This time period was chosen to complement the previous analyses and to provide a current perspective.

The study analyzed the investigations in terms of the core culture of the firefighting profession. Firefighting culture should not be construed as one of negligence, said DeJoy, but one based on a long-standing tradition of acceptance of risk. A job that relies on extreme individual efforts and has too few resources leads to the chronic condition of doing too much with too little, he said.

• “If you get used to taking risks, it’s easy to take a little more risk,” DeJoy said.
• “Most of the time when we take risks, like walking across the street or driving a car, nothing bad happens.
• This level of risk gets ratcheted up and becomes part of normal activity.” Acceptance of risk becomes extremely perilous in a situation in which adverse events can happen at any time and margins of safety are very thin, he added.

Firefighter deaths dropped in the 1970s and 1980s, largely due to improvements in protective clothing, breathing equipment and radio communication, explained DeJoy. In the last decades, fatality numbers actually edged upward while the number of fires has gone down, he said.

On average, more than 100 firefighters die on the job in the U.S. each year, which is three times higher than the fatality rate for the general working population. The number one cause of death identified in the study was not smoke inhalation or traumatic injury, but cardiovascular events.

• Eighty-seven of the 213 deaths examined in the study were cardiac-related.
• Deaths from cardiovascular events resulted in two predominant recommendations from the researchers: the need for improvements in medical screening and the need for wider adoption of mandatory fitness/wellness programming.

Many of the recommendations can be traced to a lack of finances the report states. Not only does under-resourcing affect the ability of a fire department to acquire innovative technology, it can lead to a shortage of personnel at a fire, compromising rapid intervention and the ability to maintain command and control functions during operations, according to the authors.

The authors also acknowledged that there is a certain amount of subjective interpretation that goes into analyzing incident investigations. In addition, NIOSH investigations are not mandatory and can be refused by a fire department. NIOSH also mostly investigates deaths involving career, or paid, firefighters, although a majority of firefighters in the U.S. are volunteers and a majority of line-of-duty deaths involve volunteers. The authors further stated they hoped NIOSH will do more investigations of volunteer firefighter fatalities, as those organizations may have the greatest need for evaluation and technical assistance.

 The entire report is available at a nominal fee, HERE;

Journal Reference:

1. Kumar Kunadharaju, Todd D. Smith, David M. DeJoy. Line-of-duty deaths among U.S. firefighters: An analysis of fatality investigations. Accident Analysis & Prevention, 2011; 43 (3): 1171 DOI: 10.1016/j.aap.2010.12.030

• Science Daily Article HERE  
• University of Georgia (2011, April 14). Comprehensive study reveals patterns in firefighter fatalities. ScienceDaily. Retrieved April 16, 2011, from http://www.sciencedaily.com­ /releases/2011/04/110412171208.htm

Other Report Links of Interest

• Reducing Firefighter Deaths and Injuries: Changes in Concept, Policy, and Practice Contributing Factors in Firefighter Line-of-Duty Deaths in the United States.  HERE
• Fire Fighter Fatality Investigation and Prevention Program: Leading Recommendations for Preventing Fire Fighter Fatalities, 1998–2005
  DHHS (NIOSH) Publication No. 2009-100
  This document is a synthesis of the 1,286 individual recommendations from the 335 FFFIPP investigations conducted from 1998 to 2005.
• Fire Fighter Fatality Investigation and Prevention Program Evaluation  NIOSH report of findings from its national survey of U.S. fire departments.
• 2011 Fatality Summary Statistics (PDF, 14 Kb)
• 2010 Fatality Summary Statistics (PDF, 11 Kb)
• Fire-Related Firefighter Injuries Reported to NFIRS (PDF, 945 Kb, Volume 11, Issue 7 – February 2011)
• Firefighter Fatalities in 2000 (PDF, 110 Kb, Volume 1, Issue 20 – December 2001)
• Firefighter Injuries (PDF, 119 Kb, Volume 2, Issue 1 – March 2002)
• Firefighter Injuries in Structures (PDF, 95 Kb, Volume 2, Issue 2 – March 2002)
• Fire-Related Firefighter Injuries in 2004 (PDF, 2.4 Mb – February 2008)