According to data from the United States Fire Administration (USFA), during the period 1977 through 2002, there was an average of 115 fire fighter fatalities per year, not including the 343 fire fighters who died at the World Trade Center on 11 September 2001.¹ Over the last decade, there have also been approximately 90 000 non-fatal fire fighter injuries annually, about half occurring at a fire scene.² Fire fighters face many hazards, including physical stresses, ground and air transportation risks, as well as fire scene injury hazards that are specific to the fire fighting profession. Structural fires pose particular hazards to fire fighters from structural collapse or becoming lost or disoriented and unable to escape before running out of oxygen. For the period 1977 through 2000, the number of fire fighter deaths in structure fires declined 59%; however, the rate of fire fighter deaths from traumatic injuries during structural fire fighting has actually increased over this same time period.³ Fahy reports that in the late 1970s, traumatic fire fighter deaths occurred at a rate of 1.8 deaths per 100 000 structure fires; by the late 1990s, this rate had increased to 3.0 deaths per 100 000 structure fires.³ Despite improvements in personal protective equipment and other new technologies developed for fire fighting, the profession remains one of the most hazardous.^4,5

In 1998, Congress funded the National Institute for Occupational Safety and Health (NIOSH) to develop the Fire Fighter Fatality Investigation and Prevention Program (FFFIPP). The purpose of this program is to investigate line-of-duty-deaths of fire fighters in the United States, and provide recommendations to the fire community so that future incidents can be prevented*.

This paper reviews the major causes of fire fighter fatalities from 1998 through 2001. It then focuses on those fatalities that occurred during fire fighting activities in burning structures, and presents key prevention recommendations from NIOSH investigations specific to these events. The paper presents a four year synthesis of NIOSH recommendations for preventing fatalities during structural fire fighting.

METHODS

Fire fighter fatality data for this study came from the USFA annual summary of fire fighter line-of-duty-deaths.^6–9 The USFA receives notification of and collects basic descriptive data on all fire fighter fatalities, including career and volunteer fire fighters.

Reports of investigations conducted through the NIOSH FFFIPP were also reviewed.¹⁰ NIOSH identifies fire fighter fatalities primarily through notification by the USFA, but may also include direct contact from a fire department in which a fatality occurred, or through news reports of a fire fighter’s death. The NIOSH investigations involve site visits, including a review of available fatal incident records, interviews with involved fire fighting personnel, and review of operational procedures, so these investigations provide detailed information about the circumstances of each fatal event.

For this analysis, the circumstances of all fatalities were individually reviewed and classified by the authors into three main categories: medical, motor vehicle, or non-motor vehicle trauma. It should be noted that in a few cases, the exact circumstances of death even after investigation were not clear or involved a combination of factors. However, in this analysis, each fatality is only counted once. Because of these factors, and the summary categories used, small differences may be found when comparing the data in this paper with other fire fighter fatality tabulations.

A medical fatality was defined as an acute non-traumatic medical event (such as a myocardial infarction) that led to the fire fighter’s death. Motor vehicle fatalities included deaths caused by injuries sustained in a crash as a driver or occupant of a moving fire truck or a personally owned vehicle when traveling related to fire fighter duties (either to or from an incident scene), or as an on-duty pedestrian struck by a motor vehicle. All other fatalities were grouped into a third category, non-motor vehicle trauma. The structure related fatalities were then further categorized as a subset of the non-motor vehicle trauma events. Information on potential interventions to prevent structure related fire fighter fatalities was synthesized from NIOSH investigative reports^10,11 that drew from published guidelines in the area of fire fighter safety.^12–17

RESULTS

Table 1 presents a categorization of fire fighter fatalities from 1998 through 2001. The 191 medical deaths comprised the single largest group (47% of the total); 171 (90%) of these were due to myocardial infarctions, with most other deaths caused by stroke or a cardiac arrhythmia (in a fire fighter without coronary artery disease). It should be noted that most of these fatalities occurred at, soon after, or traveling to or from the fire scene, so that the physical and psychological stresses of fire fighting were considered significant contributing causes.

Motor vehicle fatalities constituted the second largest single cause of death (75 or 18% of the total). Twenty eight (37%) of the 75 motor vehicle related deaths occurred in single-vehicle crashes, often involving loss of control at a road curve and subsequent fire truck rollover. Twenty four (32%) of the motor vehicle incidents occurred to fire fighters as pedestrians, often at the site of a prior motor vehicle crash.

The remaining 144 fatalities were due to varying types of traumatic events, but were not motor vehicle related. Table 2 presents the specific circumstances surrounding these non-motor vehicle trauma fatalities, including those that were structure related. Because the catastrophic loss of 343 fire fighter lives on 11 September 2001 would substantially change typical patterns, these fatalities are not included in the analysis.

Within this general category of non-motor vehicle trauma, the most common (69 out of 144; 48%) cause of death was asphyxiation or burns, followed by struck by/fall, and air transportation. Sixty eight of these 144 fatalities were structure related, with 57 (83%) of the fatalities due to asphyxia/burn, and another eight (30%) due to a struck by/fall. Nearly all the air transportation deaths were related to wildland fire fighting efforts.

Of the 57 structure related fatalities that were categorized as asphyxia/burn, a building collapse resulted in 17 deaths (30%); flashover† or rapid fire progression resulted in 15 deaths (26%); a fire fighter becoming lost and/or running out of air resulted in nine of the deaths (16%), with the remaining 16 either due to multiple factors or the specific cause was unclear. Eight fatalities were included in the struck by/fall category. Injury scenarios for these cases included fatal crushing injuries due either to a collapse of the structure onto the fire fighter, or falling through a floor or roof of a burning structure. The disintegration of the structure was commonly involved, with collapse of building components onto fire fighters (either inside or outside the structure), or fatal falls from or through floors or rooftops. Boxes 1 and 2 highlight two investigations from the NIOSH FFFIPP which illustrate the hazards fire fighters face while fighting structural fires.

NIOSH recommendations for structure related fire fighting

NIOSH conducted an investigation of 58 (85%) of the 68 fatal events that were structure related. In focusing on the structure related fatalities, it should be noted that the NIOSH recommendations are specific to the incidents studied; however, all of the investigations identified multiple contributing factors, and several general themes have developed. Box 3 provides key recommendations from past NIOSH investigations.^10,11 On average, each investigative report had five different recommendations.

The recommendation for developing and implementing standard operating procedures (SOPs), which in some sense, could encompass essentially all of the recommendations, address a variety of issues. SOPs provide the primary basis for fire fighting activities at a scene, and are essential in ensuring fire fighter safety. Examples of SOPs for structural fire fighting include donning and checking for the proper operation of personal protective equipment; ensuring that all interior attack activities are conducted in full turnout gear, with personal alert safety system devices and self contained breathing apparatus on and charged; and defining procedures for conducting interior fire fighting activities. SOPs for an interior attack could consist of: fire fighters advancing one hoseline to the interior for a fast, offensive attack; conducting support activities, such as roof ventilation; completing a primary search; and advancing a second hoseline to the interior to back up the first hoseline.

Where possible, adequate and continuous communication on the scene should be provided through the use of portable radios to ensure the incident commander can communicate instructions to interior fire fighting crews, as well as changes in strategy and tactics during the course of the fireground attack. Portable radios also allow interior fire fighting crews to communicate changing conditions back to the incident commander for continual evaluation of the risk versus gain of maintaining an interior fire attack. Additionally, these communications help the incident commander identify the locations of interior fire fighting crews which assists in maintaining fire fighter accountability on the scene—a key function of incident command.

One of the most important aids for maintaining fire fighter accountability is the Incident Management System. This is a tool that defines the roles and responsibilities of all units responding to an incident. It enables the incident commander to have better control of the incident scene, and works on an understanding among fire fighting crews that the incident commander will be “standing back” from the incident, focusing on the entire scene, making decisions as conditions dictate.

Exterior and interior size-up provide the foundation for all subsequent operations, helping the incident commander to plan the initial attack. One of the most important size-up duties of the first-in officers is locating the fire and determining its severity. This information lays the foundation for the entire operation, helping to determine the number of fire fighters and the amount of apparatus and equipment needed to control the blaze. Size-up also assists in determining the most effective point of fire extinguishment and the most effective method of venting heat and smoke. As interior conditions change during the course of a fire, it is essential that this information be communicated back to the incident commander so that important decisions regarding the attack strategy or tactics can be made. For example, information communicated back to the incident commander could result in a decision to shift from an interior (offensive) attack to an exterior (defensive) attack, requiring an immediate evacuation of all fire fighters from a structure.

Other recommendations in addition to those identified in box 3 include the immediate use of an audible evacuation tone or alert when interior conditions become unsafe for fire fighters; appropriate and timely structure ventilation tactics, and the use of exit markers or other guides to help fire fighters escape a burning structure. For example, fire departments should consider using guide ropes (or tag lines) securely attached to permanent objects at entry portals to assist lost or disoriented fire fighters in emergency escape from smoke filled environments. Additionally, placing high intensity floodlights at entry portals may assist fire fighters in locating exits in emergency situations.

DISCUSSION

Most fire fighting SOPs involve, after an initial size-up and with adequate and capable resources, an offensive (interior) search and attack to locate and rescue possible civilians, better assess the fire and its origin, and to effectively provide fire suppression.^13,16,17 Particularly when civilians are known or thought to be inside a burning structure, fire fighters will take significant risks to themselves to save the lives of others. Accepting this approach, it then becomes a difficult matter to determine when the risk to a fire fighter outweighs the benefits of initiating or continuing an interior attack. Unfortunately, there are no absolutely reliable approaches here, and the NIOSH fatality investigations indicate that catastrophic conditions commonly developed with great rapidity in a number of the fatal fires. For example, in only 20% of the incidents investigated by NIOSH had the fire fighters begun an evacuation of the structure. The data reported in this analysis reinforce structural fire dangers which have been noted by experts for some years.^12–14

To a large extent, a key problem is determining, in time for fire fighters to safely escape, when a catastrophic, life threatening event (such as major collapse, floor failure, or rapid fire progression) will occur. At present, there are no uniformly accurate assessment tools to make this determination, and incident commanders and fire fighters must often rely primarily on past experience and good judgment in deciding when to exit a burning structure. As well, there are many factors that can contribute to a structural collapse or rapid fire progression which make such assessments complex. These factors include the type of construction, age of the structure, presence of combustible materials, fire origin, and hidden fire in void spaces.^11–13

It is important to note that the safety recommendations provided with this analysis are based primarily on recommendations from the NIOSH investigative reports which include reference to published experts in the safety community, consensus standards, and recommended procedures by national fire safety organizations. More quantitative data and intervention evaluation studies would significantly advance our understanding of the critical elements that lead to fire fighter fatalities in structure fires.

In addition, future improvements in the safety of fire fighters in burning buildings may come from improved training and technology. Training will help fire fighters better appreciate the unpredictability of some fires, their rapidity of progression, and early danger indicators. Improved technologies may be able to provide earlier warning signs, as well as improve communication, personal protective equipment, detection of hidden fires, location of downed fire fighters, and identification of egress paths for quicker escape.

CONCLUSIONS

Assessing the integrity of a burning structure, and its potential for collapse on the scene of a working fire, can be an exceedingly complex task as many factors can contribute to a structural collapse. There are no uniform assessment tools to accurately determine when a structure will collapse, thus, there are no hard and fast rules on when to exit a burning structure. Future technological innovations may provide the fire service with advanced tools to make better assessments on the fire scene. At present, however, additional efforts must be directed to more effectively use what we have learned through the NIOSH investigations and recommendations from published experts in the safety community, consensus standards, and national fire safety organizations within the fire service.

In order to effectively reduce the risk to fire fighters from structural collapse and other hazards, prevention efforts must include a comprehensive set of strategies (including those outlined in box 3) that are consistently implemented for each response. However, the decision to assess when the risk to fire fighters outweighs the benefits of initiating or maintaining an interior attack typically rests on the shoulders of the incident commander at the scene. Additional training for incident commanders and fire fighters may enhance awareness of the hazards of structural fires and be useful in guiding critical decision making on the fire ground.