Firefighting is inherently dangerous and filled with the potential for firefighters getting seriously injured or killed. Today’s firefighters must be aware that some risks have no tangible outcome. Each year in the United States, approximately 100 firefighters are killed in the performance of their duty while tens of thousands are injured.
While the number of firefighter fatalities has steadily decreased over the past 20 years, the incidence of firefighter fatalities per 100,000 incidents has risen. After a downward dip in the number of fatalities in the early 1990s, the number of firefighters killed each year is back to the same levels experienced in the 1980s.
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Firefighters must look at the causes associated with these injuries and deaths. This examination and a clear understanding of how these deaths and injuries occur can help identify corrective actions. We must use this information to help enhance firefighter safety, thereby helping to minimize the inherent risks.
It is equally important for firefighters to know and understand the standards associated with firefighter safety. With firefighter safety such a high priority, standards such as National Fire Protection Association (NFPA) 1500, Standard on Fire Department Occupational Safety and Health Program, provide a template for fire departments to implement a comprehensive health and safety program. Other NFPA standards also address specific areas related to health and safety.
SPRAINS AND STRAINS TOP INJURY LIST
A three-year comparison of firefighter injuries on the fireground from 2002 through 2004 shows the leading causes of firefighter injuries for the three-year period were sprains and strains (Figure 1).
 Figure 1. Firefighter Injuries on the Fireground |
Each year, tens of thousands of firefighters are injured in the line of duty. According to the NFPA, some 75,840 firefighters were injured in the line of duty in 2004. The greatest number occurred during fireground operations, 36,880 or 48.6 percent. More than 13,000 firefighters were injured at nonfire emergency incidents.
A study conducted by the National Institute of Standards and Technology and released in May 2005, which measured the economic impact of firefighter injuries, reported that about 80,000 U.S. firefighters are injured annually. The economic burden to the nation for addressing and preventing firefighter injuries is $2.7 billion to $7.8 billion per year, according to the report.
“Each year tens of thousands of firefighters are injured while fighting fires, rescuing people, responding to hazardous materials incidents, and training for their job,” states the report, titled The Economic Consequences of Firefighter Injuries and Their Prevention. “While the majority of injuries are minor, a significant number are debilitating and career-ending. Such injuries exact both a great human toll and financial toll.”
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A three-year comparison of U.S. firefighters killed in the line of duty from 2003 through 2005 shows an average of 100 plus killed each year. 2005 proved to be no different: 115 firefighters died in the line of duty. This yearly total continues to be unacceptably high. Out of the 115 firefighters killed in 2005, five died as a result of a crime; one firefighter was fatally shot; one firefighter was killed in a crash with a vehicle fleeing from police; and three firefighters were killed in arson fires.
According to the data from the United States Fire Administration (USFA), the deaths of the 115 firefighters resulted from 109 incidents. Further, there were four incidents in which two or more firefighters were killed; these four incidents claimed the lives of 10 firefighters.
STRESS, OVEREXERTION ARE DEADLY
According to the USFA, stress or overexertion is a general category that includes all firefighter deaths that are cardiac or cerebrovascular in nature. This includes heart attacks, strokes, and other illnesses such as extreme climatic heat exposure.
Sixty-two firefighters died in 2005 as a result of stress or overexertion. Of these 62 deaths, 55 were from heart attacks, six from strokes, and one from heat exhaustion.
The activities of the 55 firefighters at the time of their fatal heart attacks were as follows: 18 died after the conclusion of an incident response or on-duty period, 13 died while operating at the incident scene, seven while on duty but not assigned to an incident or training, six while responding to incidents, six while involved in training, three while assigned to nonfire emergencies, and two while returning from alarms.
Stress or overexertion continues to be the leading cause of firefighter deaths each year. From age 21 to age 35, the greatest number of deaths are a result of trauma/asphyxiation. From age 36 to 40, the number of deaths are equal between the two categories. From age 41 to 61 and older, the greatest number of deaths are from heart attacks or cerebrovascular events.
According to the USFA, 27 of the 115 firefighter deaths in 2005 occurred on the fireground. Eleven of these were during fire attack, six while conducting search and rescue, two during water supply operations, two conducting incident command, one during scene safety, and five from other causes.
As we can see from the statistics, the leading causes of firefighter injuries annually continue to be strains, sprains, and muscular pain. For the three-year-period 2002-2004, this category accounted for 16,000 injuries to firefighters, more than double any other category.
Stress and overexertion accounted for 53.9 percent of the total deaths in the line of duty in 2005.
HEALTH AND FITNESS PROGRAMS ARE THE SOLUTION
The U.S. fire service can and must make a profound impact on the leading causes of firefighter injuries and deaths. This can be accomplished with the implementation of health and physical fitness programs across the board, for every firefighter career and volunteer, in every fire department. These programs must include annual medicals and exercise regimens.
The career fire service in the United States and Canada has addressed one part of this issue. A group of 10 fire departments [Phoenix (AZ), New York (NY), Los Angeles (CA), Seattle (WA), Austin (TX), Charlotte (NC), Indianapolis (IN), Fairfax County Fire & Rescue (VA), Metro-Dade County (FL), and Calgary, Alberta, Canada], along with the International Association of Fire Fighters, the International Association of Fire Chiefs, and the U.S. Department of Justice have teamed together to develop the Candidate Physical Ability Test (CPAT).
The CPAT has been adopted in several states. New firefighters must pass the CPAT in some states prior to being hired; in other states, they must pass the CPAT prior to completion of the academy or within a predetermined timeframe to complete probation and retain their jobs.
The CPAT consists of eight separate events that must be completed in 10 minutes, 20 seconds. The sequence of eight events requires the candidate to progress along a predetermined path from event to event continuously. The layout of the test and equipment used are identical each time the test is given, regardless of in which state the CPAT is held.
This test was developed to allow fire departments to obtain pools of trainable candidates who are physically able to perform essential job tasks at fire scenes.
The CPAT has addressed new career firefighters, but what about these firefighters after they complete probation? What about veteran and volunteer firefighters?
If the fire service is going to make an impact on the number of firefighters injured or killed each year in the line of duty, it must take serious steps to examine and implement health and safety programs. These programs must include physical fitness regimens for all firefighters (career and volunteer) at all levels. The statistical evidence is clear: The leading cause of firefighter injuries and deaths each year is directly related to the overall fitness level of the firefighters.
EXERCISES THAT MIMIC JOB TASKS
One way to address this is with a fitness program related to the specific job functions preformed by firefighters. The exercises can be performed in the same manner, mimicking specific job tasks. By duplicating a specific task, we not only are improving total fitness, but we also are training our muscles and improving flexibility.
For example, to simulate the job-specific tasks and exercise the muscle groups related to breaching and pulling a ceiling, perform the following exercise. Modify a handle so it can be attached to a lateral pulldown on an exercise machine-now the motion of pulling with a pike pole can be duplicated. If an exercise machine is not available, use a high point with a pulley and rope; place a loop in the rope, and attach a weight bucket to the end of the rope. The firefighter can hook the loop with a pike pole and perform the exercise (photo 1).
 (1) Photos by author. |
To simulate the motion of swinging an ax for forcible entry or ventilation, place a large tire on a flat surface such as a tread table. Using a sledgehammer, the firefighter strikes the tire, moving it from one end of the table to the other.
As the firefighter becomes more proficient in this skill, increase the weight of the sledgehammer, or add weight to the inside of the tire (photo 2).
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To simulate the critical task of saving an injured partner or victim from a building while exercising the muscles needed, use a weighted manikin. The firefighter can perform carries and drags. If a weighted manikin is not available, you can make one from surplus hose (photo 3).
 (3) |
To simulate dragging a hoseline from the fire apparatus to the fire building and around obstacles, use 200 feet of 13/4-inch hose with a nozzle. Have the firefighter drag the hose through an obstacle course, stopping at a predetermined location in the course, and continue to pull 50 feet of hose to that location. As the firefighter becomes more proficient in this skill, increase the diameter of the hose; you can also increase the amount of hose pulled to the determined location (photo 4).
 (4) |
Using a pumper, firefighters can master their skills and train the muscles required for removing, carrying, raising, lowering, and returning ground ladders to the apparatus.
These job-specific task exercises will help build a firefighter’s aerobic and anaerobic endurance, build upper and lower body muscle strength and endurance, and improve balance. This will not only better prepare the firefighter for the strenuous job of fighting fires but also improve his overall heath and fitness.
Firefighters are creative and resourceful. With a little effort, many job-specific tasks can be duplicated. Also, changing the exercise regimen from time to time will help maintain interest in this vital program. These exercises can be turned into a friendly competition among crews or companies while increasing each firefighter’s health and abilities. As the firefighters increase their strength and abilities, they can add a weighted vest, an SCBA, and eventually full gear to these exercises.
Dietary habits also are a critical component of overall fitness. Let’s face it: Many firehouse meals resemble Thanksgiving feasts. We must be more aware of what and how much we eat. Several cookbooks written by and for firefighters address this issue. Again, why not make this a friendly competition among firefighters or crews. Challenge each other to see who can come up with the best healthful firehouse meal.
RISK/BENEFIT ANALYSIS
It is important for firefighters to understand that certain actions or risks have no tangible results. This understanding is referred to as risk management. A risk vs. benefit analysis must start with the receipt of the alarm. When conducting this analysis, consider that we risk a lot to save a lot, such as a life, and we risk a little to save a little, such as a vacant structure.
Using a risk/benefit analysis approach to emergency operations will help limit the risk of death and injuries to firefighters. The risk/benefit analysis is undertaken by comparing the positive results or potential outcome that can be achieved with the probability and severity of a potential negative outcome.
Every emergency, fire, or rescue operation involves a degree of unavoidable, inherent risk to firefighters. Firefighters at times will encounter operations that will involve a high degree of personal risk. This high degree of risk is only acceptable when there is a reasonable probability of saving a life.
An example of a risk vs. benefit analysis philosophy fire departments can adopt follows:
- Our firefighters will not risk their lives under any circumstances for lives and property already lost.
- Our firefighters will accept a limited degree of risk, under controlled and measured conditions, to save property.
- Our firefighters will accept a high degree of risk in those situations where there is a realistic and reasonable possibility of saving lives.
A good working knowledge of risk/benefit analysis, as well as an understanding of the causes of firefighter injuries and deaths, will have a direct impact on firefighter safety. With this knowledge, firefighters can perform with intelligence and skill rather than with reckless freelancing, which is directly related to firefighter injuries and deaths.
TRAINING TOPS THE LIST OF SAFETY INITIATIVES
Of all the firefighter safety initiatives, the single most important action firefighters can take to reduce firefighter injuries and deaths is training on a regular basis.
“Train like you fight; fight like you train.” This statement could not be truer with regard to firefighter safety. If we allow horseplay during training, when it is time to perform under pressure we will be lacking knowledge and skill.
Training does not end on completion of probie school. With the ever-changing types of building materials, building construction, terrorism, and weapons of mass destruction that we may need to confront, training is a career-long commitment.
Training should be as realistic as possible, but safety must be paramount at all times.
Evolutions should simulate realistic operations whenever possible. Operating power saws for ventilation on a simulated pitched roof, for example, is a much better learning experience than cutting pallets on flat ground.
Another important skill firefighters need to master in training is mask confidence.
Simulating emergency situations under controlled conditions will ensure that if the procedure is needed at a true emergency, it will be second nature to the firefighter.
Although it is unrealistic to think we could create a training prop or simulation for every possible situation, a solid training program will prepare for and guide us through those situations. Attitude, department culture, employee assistance programs as well as the development of SOPs all are critical factors in the reduction of firefighter injuries and deaths.
We will continue to kill 100 plus firefighters and injure tens of thousands each year unless the U.S. fire service takes a hard stance. We must strive to ensure firefighter health and safety. This can be accomplished through training and education and by implementing training and fitness programs that address all aspects of the functions that firefighters and their departments perform.
The development of SOPs and the understanding and implementation of standards such as NFPA 1500 that address firefighter health and safety will help us attain this goal.
The fire service is proud and rich with tradition, but there is one tradition that we must change: Killing 100 plus firefighters and injuring tens of thousands each year is nothing to be proud of.
PAUL R. GERARDI is a 31-year veteran of the fire service and is deputy chief of the Fairview Fire Department in Westchester County, NY, where he is the training, safety and special operations officer. He is a New York State fire instructor and a Westchester County fire instructor. He is a former director of the Westchester Career Fire Academy, New York. He received his bachelor of science degree in public safety/fire science and his master of science degree in organizational leadership from Mercy College. He is a nationally certified fire officer level II, fire service instructor level II, and firefighter level II.
