Firefighter Fatalities

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 library@nfpa.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 crash.

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 Figure 4).(4)

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 wounds.

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.

Fireground deaths

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 of duty. 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 $141,556, tax-free. 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 fires. 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 them on. 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 debris. 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 in August. 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 the fireground.

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, unquestionably, an issue we must address if we're to make significant progress in further reducing 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.

References

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.

Credits

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 library@nfpa.org for more information.