by Arthur E. Washburn, Paul R. LeBlanc, and Rita F. Fahy
[--interFIRE VR Note: Tables and figures are not included
in this electronic version. Please contact the NFPA Library (617) 984-7445
or e-mail firstname.lastname@example.org for more information]
Since 1977, we've made remarkable progress in reducing the annual firefighter
death toll in the United States (see Figure 1). In 1997, for the fifth time
in six years, fewer than 100 firefighters died while on duty, and the 94
who died represent a slight decrease from the 95 who died on duty in 1996.(1)
Of these 94 firefighters, 86 were members of local career and volunteer
fire departments, 6 were contractors to state and federal forestry agencies,
1 was a seasonal employee of a state forestry agency, and 1 was an employee
of a federal forestry agency.(2) In general, the trend in career firefighter
deaths has continued downward since 1977 (see Figure 2). For volunteer firefighters,
however, the trend isn't as clear. After a downward trend from 1988 to 1994,
volunteer firefighter deaths rose in 1995 and 1996. In 1997, the number
is down slightly, but at about the same level as the plateau that occurred
in the early 1980s.
In 1997, there were eight incidents in which more than one firefighter
was killed. The most deadly of these was an explosion at a pesticide packaging
plant, which caused a wall to collapse, crushing three of the firefighters
who'd responded to the scene.3 In each of the other seven incidents, two
firefighters died. In one, a fire department apparatus crashed, killing
two men responding to a fatal motor vehicle crash. Four more firefighters
were killed in two separate dwelling fires, and another two died when an
LP-gas storage tank blew up and caused a boiling liquid expanded vapor explosion
(BLEVE). Two separate aircraft crashes killed four wildland agency contractors,
and two more firefighters were electrocuted while working at a motor vehicle
Type of duty
In the past decade, injuries sustained on the fireground have typically
resulted in half or fewer of the annual number of firefighter deaths, while
injuries sustained while responding to or returning from alarms resulted
in a quarter of the deaths. Last year, 40 of the 94 firefighters who died
did so on the fireground, and another 25 died while responding to or returning
from alarms (see Figure 3).
Of the 40 firefighters who died on the fireground, 13 succumbed to heart
attacks, 8 were asphyxiated, 7 died of crushing injuriries, 5 died of internal
trauma, 3 died of burns, 1 drowned, 1 died of heat stroke, another died
during an asthma attack, and 1 was shot. Nineteen of the victims were volunteer
firefighters, 15 were career firefighters, 4 were contractors with wildland
agencies, 1 was a career federal forestry agency employee, and 1 was a seasonal
state forestry agency employee.(3)
Another 25 firefighters, 21 of whom were volunteers, died last year on
the way to or from alarms. Twelve of them were killed in collisions or rollovers.
One was struck by an out-of-control truck as he approached a crash scene
on an icy highway. Another died when a tree fell on his vehicle and crushed
it. And 11 died of heart attacks, one suffered while returning to the station
from a malicious false alarm. Over the past 10 years, 21 firefighters have
died while responding to or returning from false alarms.
One of the firefighters who died while responding to an alarm was responding
to an incendiary or suspicious fire. He was one of four firefighters who
died in 1997 as a result of incendiary and suspicious fires. The other three
died at structure fires. These four bring the number of firefighters killed
in incendiary or suspicious fires from 1988 through 1997 to 131, a figure
that represents 13 percent of all on-duty deaths during that period. This
is a drop of more than 40 percent from the first 10 years that NFPA conducted
this study and is, in part, a reflection of the decline in incendiary and
suspicious fires over the same period.
Another 12 firefighters died at nonfire emergencies, 4 as a result of
heart attacks suffered at the scene of motor vehicle crashes. A fifth was
killed in a crash while attending to a patient in the back of an ambulance.
Three more drowned in three separate rescues. Another two were hit by vehicles
while working at the scenes of separate motor vehicle crashes. And two firefighters
were electrocuted when they touched a downed power line while carrying a
crash victim to an ambulance.
Nine more firefighters died last year while performing nonemergency-related
activities. Five of them suffered fatal heart attacks, three during normal
station duty, one while directing traffic at a fire department function,
and one during a holiday parade and cemetery services. Two forestry agency
contractors were killed when their aircraft crashed during a routine fire
reconnaissance patrol. One firefighter suffered a fatal stroke during normal
station duties, and another was killed when, as a prank, a colleague brought
a leaking propane container into the squad room, where it exploded, trapping
the victim in an inner room.
Finally, eight firefighters died in 1997 during training activities.
Five suffered fatal heart attacks, two at company meetings, one during an
agility test, one at a firefighter certification class, and one during a
smoke house evolution at recruit training. Another drowned during SCUBA
training, one died as a result of asthma complications while teaching a
class, and the eighth was killed when his head got caught between the rungs
of a new 100-foot aerial ladder platform apparatus on which he was training.
Cause of fatal injury or illness
When looking at firefighter deaths, we distinguish between the cause
of the injury or illness that led to deaths, and the nature of that injury
or illness. The "cause" of a fatal injury or illness is the action,
lack of action, or circumstances that directly resulted in that injury or
illness, while the "nature" of the injury or illness refers to
the medical process by which death occurs. In other words, the cause of
a firefighter's fatal injury or illness might be falling through a floor,
which could result in asphyxiation should he or she run out of air. Asphyxiation
would then be described here as the nature of the firefighter's injury or
illness. What we call the nature of the injury is often referred to on death
certificates and in autopsy reports as the "cause of death" (see
Let's first concentrate on the cause of injury or illness that led to
the 94 firefighter deaths last year.
As it has been in almost every year of this study, the leading cause
of fatal injury for on-duty firefighters in 1997 was stress, which usually
resulted in heart attacks. Of the 38 stress-related deaths, 35 were the
result of heart attacks, 1 was the result of a stroke, 1 was caused by heat
stroke, and 1 was the result of an asthma attack.
The second leading cause of injury was being hit by, or coming into contact
with, an object, which resulted in 26 firefighter deaths, or 28 percent
of the fatalities. Eighteen of these firefighters were killed in motor vehicle
crashes, and four were hit by motor vehicles. Of the remaining four firefighters,
two were hit by falling tree limbs; one was shot when the heat of a fire
caused a rifle to discharge; and another died when a wall collapsed.
Being caught or trapped was the third leading cause of firefighter injury
in 1997, resulting in 23, or 24 percent, of the total fatalities. Six of
these firefighters were caught in explosions, five were lost inside fire-involved
structures and ran out of air, and another five were killed when the roofs
and floors of the structures in which they were working collapsed. Four
firefighters were trapped underwater and drowned, two were trapped by rapid
fire progress in structures, and one firefighter got his head caught between
the rungs of a retracting aerial ladder.
Five firefighters also died as a result of exposure to a variety of elements.
Three of them succumbed to smoke inhalation, which caused all three to suffer
fatal heart attacks. The other two were carrying a motor vehicle crash victim
when they touched downed power lines and were electrocuted.
Of the remaining two firefighters, one died during a structure fire when
he fell through a hole in the floor and drowned in the basement, and the
other died as a result of complications from asthma.
Nature of fatal injury or illness
As noted, the nature of an injury or illness refers to the medical process
by which death occurs. Heart attacks are typically the leading nature of
injury in on-duty firefighter deaths and usually account for approximately
half the total fatalities. Last year, 38 firefighters died of heart attacks
while on duty, which, at 40 percent, is the largest proportion of on-duty
firefighter deaths in 1997 (see Figure 5). The average number of heart attack
deaths for the last five years was 41.8, compared to 64.8 per year from
1977 through 1981, the first five years NFPA conducted this study. This
is a 35 percent reduction in the average number of annual heart attack deaths.
Thirty-five of these 38 heart attacks were attributed to stress or overexertion,
and 3 resulted from exposure to smoke.
Of the 38 heart attack victims, 6 were known to have had heart problems-usually
previous heart attacks or bypass surgery-and 1 had severe arteriosclerotic
heart disease. Another two were diabetic. Of the 545 heart attack victims
for which medical documentation has been available over the past 21 years,
49.9 percent had had previous heart attacks or bypass surgery, and another
32.1 percent had severe arteriosclerotic heart disease. Another 12.1 percent
had hypertension or diabetes. No medical documentation was available for
the remaining victims.
Of the remaining 56 firefighters who died in 1997, 20 died of internal
trauma, 12 died of crushing injuries, 9 were asphyxiated, 5 drowned, 3 died
of burns, 2 died as a result of asthma, and 2 were electrocuted. Another
succumbed to heat stroke, one to a stroke, and the last died of gunshot
Ages of firefighters
The median age of the firefighters who died in 1997 was 46. The youngest
was 18, and the oldest was 79.
As might be expected, heart attacks account for a higher proportion of
deaths among older firefighters than younger firefighters (see Figure 6).
Two thirds of the firefighters over age 45 who died in 1997 died of heart
attacks. The youngest heart attack victim was a 24-year-old firefighter
who was participating in a smoke house drill during recruit training.
More than one-third of all firefighters who died during the five-year
period between 1993 and 1997 were over 50, although firefighters in that
age group account for only one-seventh of all firefighters (see Figure 7).(5)
The death rate for firefighters in their 50s is almost twice the average,
and for firefighters age 60 and over, it's almost four times the average.
Firefighters aged 30 through 39 had a death rate one-third lower than the
average, the lowest death rate for firefighters of all ages.
Seven of the 40 firefighters who died on the fireground died in storage
properties, another 7 were killed in wildland fires, 4 died in stores, 2
died in restaurants, and 2 were killed in vacant buildings. One firefighter
died at a manufacturing plant, and one was killed at a vehicle fire. Sixteen,
or 40 percent, of the 40 died in residential structures, the largest proportion
of firefighters to die in any one type of property in 1997 (see Figure 8).
Thirteen of the 16 died in one- and two-family dwellings, 2 were killed
in apartment buildings, and 1 died in a college dormitory.
To put the hazards of structural firefighting in perspective, we examined
the number of fireground deaths per 100,000 structure fires by property
using estimates found in NFPA's annual fire loss studies from 1992 through
1996-the 1997 results aren't yet available-and in the updated firefighter
fatality data for the corresponding years (see Figure 9). Although more
firefighters die in residential structures than in any other type of structure,
fires in nonresidential structures, other than educational or health-care
and correctional properties, are, on average, more hazardous. There were
8.9 fireground deaths per 100,000 nonresidential structure fires from 1992
through 1996, compared to 3.6 deaths per 100,000 residential structure fires.
The highest death rates over the five-year period actually occurred in stores
and offices. The low rate in health-care and correctional buildings and
in educational buildings may reflect the fact that these occupancies are
well-regulated and inspected, and that their occupants are likely to report
fires in their early stages.
Motor vehicle-related incidents
Twenty-three firefighters died in motor vehicle-related incidents in
1997.(6) Fourteen were volunteer firefighters, five were contract pilots
working for wildland agencies, and four were career firefighters. Of these
23, 18 died in motor vehicle crashes, 4 were hit by vehicles, and 1 caught
his head in the rungs of a retracting aerial ladder.
Twelve of the 18 firefighters killed in collisions or rollovers were
responding to alarms when the crashes occurred. Five of the 12 were driving,
or were passengers in, personal vehicles. The other seven were killed in
six crashes involving fire department apparatus, four when the drivers of
the responding apparatus lost control of their vehicles, one when a tanker's
brakes failed, and two when a dump truck crossed the highway's center line
and hit their apparatus head on.
Another five firefighters died in three aircraft collisions. Two were
killed when their airplane crashed during a routine fire reconnaissance
patrol. The cause of the crash hasn't been reported. The other three were
killed in two crashes during water and retardant drops at wildland fires
where smoke, downdrafts, and steep terrain made for poor flying conditions.
In the remaining crash, a firefighter who was attending to a patient
in the back of an ambulance was killed when the vehicle skidded on the wet
road during heavy rain and overturned. The patient also died.
Excessive speed, failure to yield at intersections, and failure to wear
seatbelts were factors in several of the crashes. In fact, the number of
incidents in which the victims were ejected from their vehicles suggests
that even more firefighters weren't wearing seat belts than reported.
Of the four firefighters who were hit by motor vehicles, three were working
at vehicle crashes, and one was working at a car fire. One was crushed when
a truck skidded on the icy road and overturned onto him, while the other
three were hit by passing vehicles.
In the remaining motor vehicle incident, a firefighter died from severe
trauma when he caught his head between the rungs of a retracting ladder.
Behavioral changes needed
Once again, the number of firefighters who died in 1997 was below 100,
a tremendous improvement from 20 years ago. Much of this improvement can
be attributed to a combination of better protective clothing and equipment,
safer fire apparatus, better training, and better incident management. We
seldom see firefighters dying in falls from emergency apparatus anymore,
and we've seen a significant decrease in the number of firefighters dying
from smoke inhalation at structure fires. But there's a limit to how much
of the fatality problem can be "engineered" away. The major concerns
that remain are largely due to behaviors that must be changed.
For one thing, firefighters must pay more attention to safe driving.
Excessive speed, disregard of traffic rules, and failure to wear seat belts
repeatedly combine in a tragic and unnecessary waste of life. Better training
and driver education can help prevent these deaths.
Even though the total number of heart attack deaths has dropped since
1977, additional reductions in firefighter deaths should be possible if
we continue to stress health and fitness. Using NFPA 1582, Medical Requirements
for Fire Fighters, to screen fire service applicants, as well as veterans,
is also a step in the right direction. Properly screening fire service applicants,
making sure they meet fitness requirements throughout their careers, and
testing their health annually are essential if they're to be ready for the
stress of duty-and if we're to reduce the number of fatal heart attacks
that firefighters continue to suffer on duty each year.
We must also pay more attention to the use of personal alert safety systems
(PASS) on the fireground. All firefighters, both recruits and veterans,
should be trained to use a PASS. And a PASS should be properly maintained
and tested, just as other components of a firefighter's protective ensemble
are. In fact, testing and maintenance documentation could become critical
during injury or fatality investigations. Many departments test and maintain
their PASS equipment when they work on their SCBA equipment.
Incident management also plays a large role in protecting firefighters
at the scene. An incident management plan must include an accountability
system that tracks personnel, both by location and function. The incident
commander needs to know where each crew or team is and what it's doing,
so that if a PASS alarm is activated, a rapid intervention crew can locate
the lost or trapped firefighters.
Health and safety issues should be our first priorities in the battle
to reduce on-duty firefighter deaths. A comprehensive safety and health
program that's designed according to NFPA 1500, Fire Department Occupational
Safety and Health Program, is an important step in achieving this goal.
--note: The boxed texts below appeared as sidebars
in the original article--
U.S. Department of Justice Death and Disability Benefits
for Public Safety Officers
The Public Safety Officers' Benefits (PSOB) Act, signed into law in 1976,
provides a federal death benefit to the survivors of the nation's federal,
state, and local law enforcement officers, firefighters, and rescue and
ambulance squad members, both career and volunteer, whose deaths are the
direct and proximate result of a traumatic injury sustained in the line
In 1988, the Act was amended, increasing the amount of the benefit from
$50,000 to $100,000. To help keep inflation from eroding the benefit's effectiveness,
the 1988 amendment included an annual cost-of-living escalator. As a result,
the benefit increases on October 1 of each year. The current benefit is
PSOB covers all federal, state, and local public safety officers, although
its principal focus is firefighters, including volunteers, and law enforcement
officers. A decedent's spouse and minor children are usually the eligible
beneficiaries, although parents become eligible for the death benefit if
a decedent wasn't married and there are no eligible children.
Congress amended the PSOB benefits program in 1990 to include permanent
and total disabilities that occurred on or after November 29, 1990. PSOB
is reserved for those few tragic cases in which an individual barely survives
a traumatic, line-of-duty injury and is permanently unable to perform any
gainful employment. Only then, in the presence of the program's statutory
and regulatory qualifying criteria, will PSOB's disability benefit be awarded.
The bill's supporters anticipated that PSOB would approve only a small number
of cases annually.
To initiate a claim for death benefits, to receive additional information
on filing a disability claim, or to receive additional information about
coverage, write the Public Safety Officers' Benefits Program, Bureau of
Justice Assistance, U.S. Department of Justice, Washington, DC 20531; or
call (202) 307-0635.
Special 10-Year Analysis of Fatalities Among
Firefighters Wearing PASS Devices
Personal alert safety systems (PASS) are designed so that firefighters
can signal for help if they're incapacitated while operating at an emergency.
NFPA 1500, Fire Department Occupational Safety and Health Program, requires
that everyone involved in rescue, firefighting, and other hazardous duties
use a PASS.
Of course, properly using a PASS isn't a guarantee that a downed firefighter
will survive. There are situations, such as structural collapse or severe
fire conditions, that make rescue impossible. And to be effective, the devices
must be used in conjunction with an accountability and incident command
system that tracks all members operating at an emergency.
According to information available in NFPA's database of firefighter
fatalities, 36 firefighters died from 1988 through 1997 while wearing PASS
in 27 incidents. One of the 36 died when he suffered a fatal heart attack
during a live fire training exercise; the others were all operating at structure
Over the same 10-year period, 425 firefighters were killed at structure
fires. Of those, we know that 35 were wearing PASS when they died. The actual
number is probably higher, but submission of information on that subject
tends to be incomplete, and we can only examine documented cases where PASS
use was reported. However, the limited reporting on the use of these devices
reinforces information we've heard informally-that is, large numbers of
firefighters aren't wearing the devices or are wearing them but not turning
Of the 35 firefighters who died while were wearing a PASS at structure
fires, 13 became lost inside the structures, 12 were caught or trapped in
collapses, 7 were trapped by rapid fire progress, 1 fell through a hole
in the floor, 1 was trapped in an elevator, and 1 suffered an aneurysm.
We took a closer look at these incidents to see if the devices had actually
been turned on and tried to determine how the proper use of the devices
might have affected the outcome.
In four of the incidents, the PASS devices were worn and had been turned
on. In the first two incidents, collapsed debris or intensifying flames
made rescues impossible. In the third, there was no accountability system
in place, so approximately one and a half hours elapsed before anyone even
realized the firefighter was missing. His partner had been rescued from
the building when someone heard his device operating, but he wasn't able
to report that his partner was still in the building. In the fourth case,
several unsuccessful attempts were made to rescue the victim from collapsed
In seven of the incidents, PASS devices were worn, but they hadn't been
turned on. In two of those cases, other firefighters knew exactly where
the victims were. In another case, it took firefighters more than 45 minutes
to find the victim, who was operating alone on the third floor, even though
they knew he was on that level. In the fourth incident, two firefighters
were killed, and other firefighters actually stepped over one of them without
realizing it. In another incident, a firefighter who went in to help fight
the blaze didn't even realize that two of his colleagues had collapsed in
the same area. The two died. In the sixth incident, a firefighter who fell
into a building when its roof collapsed could have been found by rescuers
if his PASS device had been operating, according to the investigation report.
In the seventh incident, fire and debris prevented rescuers from reaching
two victims once others realized they were missing.
In the remaining incidents, it wasn't reported whether the PASS units
had been turned on. In one case in which it seems unlikely that they were,
three firefighters died in a small room, but a fourth was rescued when the
low air alarm on his SCBA was heard. If the victims had been using their
units properly, rescuers should have heard them as well. In other cases,
PASS couldn't have had an impact even if they had been turned on, such as
when the victims died instantly in collapses or flashovers.
Two years ago, NFPA's Technical Committee on Respiratory Protection and
Personal Alarm Equipment conducted an informal survey to address the problems
with PASS. More than 60 percent of nearly 1,000 respondents reported that
they didn't activate their devices at every fire. More than half of them
said that they "forgot to," and another third said that the operations
were "routine, not thought to be dangerous." Other firefighters
have complained about "false alarm" problems, particularly with
older units. These problems have been addressed by equipment manufacturers
and by the committee in the proposed 1998 edition of NFPA 1982, Personal
Alert Safety Systems (PASS) for Fire Fighters, which should be available
What the committee and the equipment manufacturers can't directly address
are the behaviors that result in failure to use protective equipment to
its fullest potential. Our files are full of deaths that occurred in seemingly
"routine" incidents. Firefighters shouldn't view the sounding
of the pre-alert signal in a benign situation, such as awaiting assignment
or taking a breather, as an inconvenience or "false alarm." The
devices are merely checking to make sure that the firefighter is okay, and
simply by moving it, it should reset.
If the PASS is mounted to the SCBA harness,
it should be activated as part of the SCBA donning procedures. If it's
attached to firefighters' protective clothing, a procedure should be developed
for activating it, and the procedure should be implemented.
Fire departments must make proper use of PASS devices mandatory, fire
officers must see that the rules are enforced, and firefighters must understand
that these devices are essential to their protection while operating on
Heart Attack Deaths in Perspective
While technological advancements in firefighting equipment and significant
changes in command structure have greatly reduced firefighter fatalities
over the last 20 years, the number one cause of firefighter deaths remains
cardiac arrests and strokes.
We've almost eliminated deaths caused by falls from apparatus by requiring
firefighters to be seated and belted in an enclosed cab. Devices such as
positive-pressure SCBA and personal alert safety systems have greatly reduced
traumatic fireground deaths. And the incident command system has significantly
reduced injuries and fatalities by placing more emphasis on safety awareness.
But we must recognize that engineered improvements in firefighter safety
have their limits. Protecting a firefighter from his or her own medical
state, whether it's behavioral or hereditary, is a difficult task.
So what do we do about the heart attacks and strokes that kill on-duty
firefighters each year? This is a difficult question because the job is
not only filled with danger and stress, but it's also labor-intensive. However,
some factors are fairly obvious. We must make sure our firefighters keep
physically fit, we must monitor their health, and we must recognize health
issues that might keep them from emergency scene functions.
But we can't stop there. NFPA's annual collection of data looks closely
at risk factors identified by medical documentation. The information clearly
shows that a vast number of the firefighters who died of heart attacks and
strokes had serious, pre-existing medical conditions. More often than not,
the condition was known, at least, to the victim. We need to acknowledge
their conditions, and we must act to get those in danger off the fireground.
This is a difficult issue to discuss, let alone to act on. But it is,
an issue we must address if we're to make significant progress in further
the annual number of firefighter deaths.
Arthur E. Washburn is a member of the NFPA Fire Analysis and Research
Division and a retired lieutenant of the Lexington, Massachusetts, Fire
Department. Paul R. LeBlanc, also a member of the Fire Analysis and Research
Division, is a career lieutenant with the Boston, Massachusetts, Fire Department.
Rita F. Fahy is manager of NFPA Fire Data Bases and Systems.
1. NFPA's files on fatal injuries to on-duty firefighters
are updated continually for all years. The current total of 95 deaths for
1996 is three more than the number identified in the July/August 1997 issue
of NFPA Journal.
2. For this report, the term "volunteer" refers
to any firefighter who isn't a full-time, paid member of a fire department.
The term "career" refers to full-time, paid fire department members
or employees of career organizations whose assigned duties include firefighting.
3. West Helena investigation report.
4. These categories are based on the 1981 edition of NFPA
901, Uniform Coding for Fire Protection.
5. Michael J. Karter, Jr., "U.S. Fire Department Profile
Through 1995," NFPA Fire Analysis and Research Division, Quincy, Massachusetts,
November 1996, unpublished. The analysis shown here assumes that the number
of firefighters adequately estimates exposure and that the age distribution
of career and volunteer firefighters is similar.
6. For this report, the term "motor vehicle-related
incident" refers to collisions and rollovers involving motor vehicles,
including aircraft and boats, as well as incidents in which firefighters
fall from, or are struck by, vehicles where the involvement of the vehicle
played an integral role in the incident.
This study is made possible by the cooperation and assistance
of the U.S. fire service, the Public Safety Officers' Benefits Program of
the Department of Justice, the Forest Service of the U.S. Department of
Agriculture, and the Bureau of Indian Affairs and the Bureau of Land Management
of the U.S. Department of the Interior. We would also like to thank Stephen
G. Badger of the Fire Analysis and Research Division and Stephen Foley,
Carl Peterson, and Bruce Teele of Public Fire Protection for their assistance.
Reprinted from NFPA Journal, July/August 1998,
p 50-62. Reprinted by permission of NFPA Journal.
Please contact the NFPA Library (617) 984-7445 or e-mail email@example.com
for more information.