. Author(s): Michael J. Karter, Jr., Joseph Molis. Published on November 1, 2012.

REPORT SUMMARY
U.S. Firefighter Injuries in 2011
Last year, 70,090 firefighter injuries occurred in the line of duty


Firefighters spray water on the fire-damaged remains of a multi-family home in Worcester, Massachusetts. One firefighter was killed and a second injured when the building partially collapsed during the blaze. (Photo: AP/Wide World)

NFPA Journal®, November/December 2012 

By Michael J. Karter, Jr. and Joseph L. Molis 

 Download "U.S. Firefighter Injuries - 2011" report (PDF, 1 MB)
 Learn more about firefighter injuries in the United States

Firefighters work in varied and complex environments that increase their risk of on-the-job death and injury. A better understanding of how these fatalities, nonfatal injuries, and illnesses occur can help identify corrective actions that could help minimize the inherent risks.

Each year, NFPA studies firefighter deaths and injuries to provide national statistics on their frequency, extent, and characteristics. In “2011 Firefighter Fatalities,” published in the July/August issue of NFPA Journal, NFPA reported that 61 firefighters died on duty. This article addresses the firefighter injuries that occurred in the United States last year.

 


A firefighter climbs atop a fire truck as it rests on its side in Dickinson, Texas. The four-man crew was responding to a call of a downed power line when the truck went off the side of the road and rolled. One firefighter was taken to the hospital with a shoulder injury. (Photo: AP/Wide World)

SIDEBAR

2011 Firefighter Injury Incidents
A selection of incidents from the full U.S. Firefighter Injuries in 2011 Report.



2011 FIREFIGHTER INJURIES
BY THE NUMBERS

• A total of 70,090 firefighter injuries occurred in the line of duty in 2011, a decrease of 2.5 percent from the year before.

• In addition to injuries, there were 9,000 exposures to infectious diseases and 23,400 exposures to hazardous conditions.

• An estimated 30,505 or 43.5 percent of all firefighter injuries occurred during fireground operations. An estimated 14,905 occurred at nonfire emergencies, 3,870 while responding to, or returning from, an incident; 7,515 occurred during training activities; and 13,295 occurred during other on-duty activities.

• The Northeast reported a higher number of fireground injuries per 100 fires than other regions of the United States.

• The major types of injuries received during fireground operations were strains, sprains, and muscular pain, which accounted for 50.7 percent; wounds, cuts, bleeding, and bruises, which accounted for 14.5 percent; thermal stress, which accounted for 6.9 percent; and burns, which accounted for 6.2 percent. Strains, sprains, and muscular pain accounted for 61.1 percent of all non-fireground injuries.

• The leading causes of fireground injuries were overexertion and strain, which accounted for 28.4 percent, and falls, slips, and jumps, which accounted for 21 percent.

Based on data collected during the 2011 NFPA Survey of Fire Departments for U.S. Fire Experience, NFPA estimates that 70,090 firefighter injuries occurred in the line of duty last year. This is a decrease of 2.5 percent from the year before and the lowest it’s been since NFPA analyses began in 1981. In recent years, the number of firefighter injuries has been considerably lower than it was in the 1980s and 1990s, due in part to additional questions on exposures that allow us to place them in their own categories. Some of these exposures might previously have been included in total injuries under other categories.

NFPA estimates that there were 9,000 exposures to infectious diseases, such as hepatitis, meningitis, and HIV, in 2011. This amounts to 0.5 exposures per 1,000 emergency medical runs by fire departments in 2011. NFPA also estimates that there were 23,400 exposures to hazardous conditions, such as asbestos, radioactive materials, chemicals, and fumes, last year. This amounts to 21.2 exposures per 1,000 hazardous condition runs in 2011.

An estimated 13,650 injuries, or 19.5 percent of all firefighter injuries, resulted in time lost from work last year.

Injuries by type of duty
We examined estimates of firefighter injuries by type of duty, dividing type of duty into five categories: responding to, or returning from, an incident, including fires and nonfire emergencies; fireground, which includes structure fires, vehicle fires, and brush fires, and refers to all activities from the moment of arrival at the scene to departure; nonfire emergency, including rescue calls, hazardous calls such as spills, and natural disaster calls; training; and other on-duty activities, such as inspection and maintenance duties.

Results by type of duty indicate that the largest share of injuries occurs during fireground operations. In 2011, there were 30,505 fireground injuries, accounting for 43.5 percent of all firefighter injuries that year. This is a decrease of 6.6 percent from the year before and the lowest it’s been since NFPA analyses began in 1981. When we examined firefighter injuries at the fireground and injury rates for the period from 1981 to 2011, we noted that injuries at the fireground dropped from a high of 67,500 in 1981 to 30,505 last year, for a decrease of 52 percent.

The number of fires also declined steadily, for an overall decrease of 54.8 percent. The rate of injuries per 1,000 fires has not shown a consistent trend up or down.

These results suggest that, even though the number of fires and fireground injuries declined similarly during the period, the injury rate did not, and when there is a fire, the fireground injury rate risk has changed little over the 1981–2011 period.

Overall, the number of injuries at nonfire emergencies increased from 9,600 in 1981 to 14,905 in 2011, for an overall increase of 55 percent between 1981 and 2011. The number of nonfire emergencies increased a substantial 274 percent during the same period, due in large part to an increase in the number of medical aid responses. When we examine the injury rate per 1,000 nonfire emergencies, we see that the rate declined from 1.24 in 1981 to 0.5 in 2011 because the number of nonfire emergencies increased at a higher rate than the number of injuries that occurred at such incidents.

In addition, 3,870 firefighter injuries occurred in 2011 while firefighters were responding to, or returning from, an incident. Another 7,515 occurred during training activities, and 13,295 occurred during other on-duty activities.

Nature and causes of fireground injuries
We also examined estimates of 2011 firefighter injuries by nature of injury and type of duty. The major types of injuries that occur during fireground operations are strains and sprains, which account for 50.7 percent; wounds, cuts, bleeding, and bruises, which account for 14.5 percent; thermal stress, which accounts for 6.9 percent; and burns, which account for 6.2 percent.

Results were fairly consistent during all non-fireground activities, with strains, sprains, and muscular pain accounting for 61.1 percent of all non-fireground injuries, and wounds, cuts, bleeding, and bruises accounting for 14.6 percent.

Because fireground injuries are of particular concern, we examined their causes. The definition of cause here refers to the initial circumstance that led to the injury. The leading causes of fireground injuries are overexertion and strains, which accounted for 28.4 percent, and falls, jumps, and slips, which accounted for 21 percent. Other major causes were coming in contact with an object, which accounted for 11.7 percent, and exposure to fire products, which accounted for 8 percent.

Fire department vehicle collisions
In 2011, there were an estimated 14,850 collisions involving fire department emergency vehicles, where departments were responding to, or returning from, incidents. To put this number into perspective, fire departments responded to more than 30.1 million incidents in 2011, so the number of collisions represents about one tenth of 1 percent of total responses. However, these collisions resulted in 970 firefighter injuries, or 1.4 percent of all firefighter injuries.

Another 790 collisions involved firefighters’ personal vehicles that were being used to respond to, or return from, incidents. These collisions resulted in an estimated 190 injuries.

Average fires and fireground injuries per department by population protected
The number of fires a fire department responds to is directly related to the population protected and the number of fireground injuries incurred by a department is directly related to its exposure to fire — that is, the number of fires the department attends. The second point is clearly demonstrated when we examine the range of the statistics, from a high of 120.1 for departments that protect communities of 1 million or more to a low of 0.2 for departments that protect communities of with populations under 2,500.

A useful way to look at firefighter injury experience and to obtain a reading on the relative risk that departments face is to examine the number of fireground injuries that occur for every 100 fires attended. This takes into account relative fire experience and allows more direct comparison between departments protecting communities of different sizes. The overall range of rates varied less, from a high of 2.8 for departments that protect communities of 250,000 to 499,999 to a low of 1.2 for departments that protect communities of 2,500 to 4,999 population. Thus, the wide range noted in average fireground injuries by population protected narrows when relative fire experience is taken into account. The overall injury rate for departments protecting communities of 50,000 population or more was 2.5 injuries per 100 fires, or 67 percent higher than the injury rate for departments protecting communities of less than 50,000.

We also calculated the risk of fireground injury per 100 firefighters by size of community protected. Larger departments generally had the highest rates, with departments protecting communities of 250,000 to 499,999 having the highest rate at 6.9 injuries per 100 firefighters. As community size decreases, the rate drops steadily, to a low of 0.9 for departments protecting less than 2,500 people. That is a more than a seven-to-one difference in risk of injury between communities of 250,000 to 499,999 and the smallest communities of less than 2,500.

Although a department protecting a community with a population of 250,000 to 499,999 has, on average, more than 22 times as many firefighters than a department protecting a population of less than 2,500, the larger department attends more than 86 times as many fires and, as a result, incurs considerably more fireground injuries.

Where all departments reported sufficient data by region for the number of fires a fire department responds to and the number of fires attended, the Northeast reported a higher number of fireground injuries per 100 fires for most community sizes than any other region of the United States.

Improving firefighter safety
As these statistics attest, firefighting presents great risks of personal injury to firefighters. Moreover, because of the kind of work performed and the hazards of the incident scene environment, it is unlikely that all firefighter injuries can be eliminated. However, a risk management system and the application of existing technology can offer options to reduce current injury levels.

NFPA 1500, Fire Department Occupational Safety and Health Program, contains information that can be of help in developing such systems. Section 4.3 addresses ways in which top fire service management can commit to reducing injuries, while Section 4.5 discusses the establishment of a safety committee, headed by a safety officer, to recommend a safety policy and the means of implementing it.

Paragraphs 4.4.4 and 4.4.5 address the development and implementation of an investigation procedure that includes all accidents, near misses, injuries, fatalities, occupational illnesses, and exposures involving fire department members. Sections 7.1 through 7.8 provide information on choosing appropriate protective equipment and a mandate to use it, while Sections 7.9 through 7.14 contain information on developing and enforcing an SCBA use and maintenance program. Sections 6.2 and 6.3 address the development and enforcement of policies on safe practices for drivers and passengers of fire apparatus, while Chapter 5 contains information about training all members for emergency operations.

Paragraph 4.1.2 of NFPA 1500 covers the development of procedures to ensure that sufficient personnel respond for firefighting and overhaul duties, as do NFPA 1710, Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, and NFPA 1720, Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Volunteer Fire Departments.

Sections 10.1 through 10.3 of NFPA 1500 address the implementation of regular medical examinations and a physical fitness program, as do NFPA 1582, Comprehensive Occupational Medical Program for Fire Departments, and NFPA 1583, Health-Related Fitness Programs for Firefighters. Section 8.1 of NFPA 1500 contains information about the adoption and implementation of an incident management system, as does NFPA 1561, Emergency Services Incident Management System.

Information about the implementation of programs for installing private fire protection systems can be found in NFPA 1, Fire Code; NFPA 101®, Life Safety Code®; and NFPA 5000 Building Construction and Safety Code, while NFPA 1201, Providing Emergency Services to the Public, addresses fire safety education programs that can be used to increase citizens’ awareness of measures to prevent fires and react correctly to a fire. Other NFPA standards that may help reduce firefighter injuries include NFPA 1584, Rehabilitation Process for Members During Emergency Operations and Training ExercisesNFPA 1002, Fire Apparatus Driver/Operator Professional Qualifications; and NFPA 1620, Pre-Incident Planning.

Firefighter injuries can be reduced. By addressing these priorities, the fire service can make significant strides towards reducing the number and impact of such injuries.

Description of NFPA survey and data collection method
NFPA annually surveys a sample of departments in the United States to make national projections of the fire problem. The sample is stratified by the size of the community the fire department protects. All U.S. fire departments that protect communities with a population of 50,000 or more are included in the sample because they constitute a small number of departments with a large share of the total population protected. For departments that protect fewer than 50,000 people, stratifying the sample by community size permits greater precision in the estimates.

The national projections are made by weighting sample results according to the proportion of total U.S. population accounted for by communities of each size. Around any estimate based on a sample survey, there is a confidence interval that measures the statistical certainty or uncertainty of the estimate. We are very confident that the actual number of total firefighter injuries falls within 5 percent of the estimate.

The results in this article are based on injuries that occurred during incidents attended by public fire departments, 2,790 of which responded to the 2011 fire experience survey. No adjustments were made for injuries that occurred during fires attended solely by private fire brigades, such as those at industrial or military installations.

Data collection for the selected incidents was enhanced by a form that was sent to departments requesting information. The form included questions about type of protective equipment worn, the age and rank of firefighters injured, and a description of the circumstances that led to injury.

Acknowledgments
NFPA thanks the many fire departments that responded to the NFPA Survey for U.S. Fire Experience 2011 for their continuing efforts in providing in a timely manner the data so necessary to make national projections of firefighter injuries.

The authors also thank the many NFPA staff members who worked on this year’s survey, including Frank Deely, John Baldi, and John Conlon for editing and keying the survey forms and for their follow-up calls to fire departments, as well as Norma Candeloro for processing survey forms and preparing the report on which this article is based.

We are also grateful to the U.S. Fire Administration for its work in developing, coordinating, and maintaining NFIRS.


Michael J. Karter, Jr. is senior statistician with NFPA’s Fire Analysis and Research Division. Joseph L. Molis is a fire data assistant and a lieutenant with the Providence, Rhode Island, Fire Department.

SIDEBAR
2011 FIREFIGHTER INJURIES

Burned at Structure Fire
Four firefighters were injured while fighting a fire that started in the kitchen of an 1,800-square-foot (167-square-meter), single-family, wood-frame home at approximately 1 a.m. The cause of the fire was listed as undetermined. The house had no operating smoke alarms.

The fire department responded with two pieces of apparatus and six firefighters, who asked for additional assistance as soon as they arrived. The first person they encountered was a woman who was leaning out of a second-floor window with thick black smoke billowing over her head. She was the last of the home’s five occupants still in the house. To rescue her, the incident commander, a police officer, and neighbors placed a ladder to the second-floor window, while three firefighters advanced a hose line through the front door. Once they got her outside, the incident commander cared for the five fire victims, all of whom were suffering from smoke inhalation, while waiting for more help to arrive.

While the three-person entry team was operating inside the building 10 or 15 feet (4.5 meters) from the seat of the fire, the glass on the patio sliding door suddenly failed, causing rapid fire spread that forced the interior crew to retreat. As they neared the front door, the fire came roaring through the doorway, overtaking the last firefighter, who was unable to get out in time. The other two, who managed to escape, reached into the burning doorway, grabbed him, and dragged him to the front lawn, where they began treating his injuries.

One of the two firefighters who escaped suffered burns on his arm while reaching into the burning doorway, while the other burned his ungloved hand while turning off the rescued firefighter’s SCBA cylinder. The rescued firefighter, who was wearing a full protective ensemble, suffered burns to his neck, face, arms, shoulders, and back. The 33-year veteran was hospitalized for three weeks and returned to full firefighting activities six months after the incident. 

The fourth injured firefighter strained his back while pulling ceilings during overhaul operations.

Struck by Vehicle
An ambulance staffed by two firefighters and a rescue company staffed by four was dispatched to a motor vehicle crash on a five-lane highway just after midnight. After placing the apparatus in a blocking position, they immediately began establishing a traffic control zone, consisting of signs and reflective cones, and assessing the scene. Due to recent rains, the pavement was wet and slippery.

Two firefighters, both of whom were wearing turnout pants, firefighting boots, fire helmets, gloves, and reflective vests, left the traffic control zone and approached a police cruiser parked nearby to check on the vehicle’s driver, who was slightly injured in the crash. As they were walking toward the car, a vehicle drove through the crash scene, hitting them.

One of the men, who had three years’ experience, fractured his ankle and was out of work for more than six weeks. The other, a 46-year-old with 24 years’ experience, suffered a knee injury and could not perform firefighting duties for 15 weeks. Both were cleared to perform firefighting duties after their rehabilitation.

The department did not provide specific information on the location of the crash relative to the roadway, the size of the control zone, the location of the apparatus, or the way the response was coordinated with law enforcement.

Rollover While Responding
Three firefighters were taken to local hospitals after they were involved in a crash while responding to a structure fire in a 3,500-gallon (13,249-liter) tanker with baffles. As they approached the scene, the driver began slowing down to turn into a driveway when the tanker lost traction on a patch of ice. It began to skid and then rolled over twice before coming to rest on its wheels.

The driver, who was wearing his seatbelt, suffered lacerations and contusions. A second firefighter, who was sitting in the middle of the front seat and also wearing a seatbelt, suffered lacerations. The third firefighter, who was sitting in the passenger seat, was not wearing a seatbelt and was fortunate to suffer only minor lacerations and contusions. All three were treated at the emergency room, released, and cleared for firefighting duties.

Injured While Responding
The driver of a fire engine was seriously injured in a crash while responding in “emergency mode” to an unreported type of situation when an oncoming vehicle hit the apparatus, causing it to careen into a telephone pole.

Traffic on both sides of the road was yielding to the fire engine, which was traveling eastbound on a two-lane road, when a vehicle in the westbound lane began passing traffic stopped around a curve in the road and drove at the oncoming fire apparatus. The fire truck turned to the right in a defensive maneuver and a glancing collision occurred, sending the apparatus off the roadway and into a telephone pole, crushing the driver’s compartment and trapping the driver in the wreckage.

The fire department reports that all five firefighters in the engine were wearing seatbelts, which helped minimize the injuries of all but the driver, who suffered a severe, crushing leg injury and is unable to return to the fire service.

Training Demonstration
A 35-year-old firefighter suffered severe head injuries when he slipped and fell 20 feet (6 meters) as he descended an aerial ladder, landing headfirst onto the turntable during a public relations demonstration. There was a mist and drizzle during the event when the victim was on the ladder, which the department reported was at an angle of approximately 30 degrees. The only protective clothing the 11-year-veteran was wearing was a pair of gloves. He was hospitalized for 10 days and is no longer able to perform firefighting duties.

Structure Fire
A firefighter suffered a serious foot injury while fighting a fire in a vacant, single-family house that started at ground level on an exterior wall of the garage. By the time the fire department arrived, the fire had spread into a stairwell and compromised the attic. Due to the extent of the fire and the condition of the two-story, wood-frame house, the incident commander decided to conduct defensive operations, fighting the blaze mainly from the exterior of the structure using two aerial ladders and exterior water streams.

At one point during operations, the incident commander decided that crews should open part of the gable roof end and a portion of the roof to better access the burning structure. Two firefighters and the aerial ladder operator discussed their new task on the turntable of the aerial, and the two firefighters began climbing the ladder. At some point, they turned around and it appeared as though they were talking to the ladder operator. As they continued climbing, the operator began to extend the ladder, crushing the foot of one of the firefighters between the rungs.

The 27-year-old victim, who was wearing a complete protective ensemble, suffered crushing injuries to his foot and toes. He was hospitalized for two months and has undergone several surgeries. He has been unable to perform firefighting duties since the incident, and it is uncertain if he will return to the fire service at all.
The cause of the fire is undetermined.

Structure Fire
A firefighter was knocked over by a 5-inch (12-centimeter) water supply hose while operating at a fire in a single-family home. The 47-year-old, who had two years’ experience, was knocked over near the rear of the apparatus when the supply line was pulled after her feet became entangled in the hose. As the hose became taut, she fell over onto her right side, fracturing her arm and shoulder. She was wearing all protective clothing except self-contained breathing apparatus and is still undergoing therapy. She is unable to perform firefighting duties.

Roof Collapse
The fire department received numerous calls around 7:30 p.m. reporting a house fire with children trapped inside. When firefighters arrived at the scene, they encountered a fire in the rear attic of the two-and-a-half-story, single-family home. Bystanders reported that the children were trapped on the top floor of the wood-frame house.

The first engine company, which consisted of a lieutenant and two firefighters, placed a 1.75-inch (4-centimeter) hand line into operation and headed towards the top floor to locate the children and the seat of the fire. When the incident commander arrived, the engine company reported that there was a medium smoke condition on the top floor with heat present and that they had not located the seat of the fire.

Several minutes later, neighbors told the incident commander that the children were safe at their home and that all occupants were out of the burning house. The crews on the top floor then began concentrating their efforts on locating the seat of the fire in the attic.

As they searched, a drywall ceiling collapsed onto the lieutenant and one of the firefighters, engulfing them in flames and toxic gases. The lieutenant sent two maydays, neither of which was acknowledged. The collapse debris blocked their means of escape, and they began scrambling to find a secondary means out. They crawled to the opposite end of the building where they found some windows and jumped out headfirst, landing on the roof of a porch 12 feet (3.6 meters) below.

A rapid intervention team was deployed to the porch roof, where they rescued the victims and transferred them to ambulances.

The lieutenant, a 41-year-old with 18 years’ experience, fractured his hip when he jumped from the window. The 37-year-old firefighter, who had 17 years’ experience, sustained second- and third-degree burns and musculoskeletal injuries to his hip and lower back. He was hospitalized for nearly a week. Both men, who were wearing a full protective ensemble, were eventually cleared for firefighting activities.

The other member of the three-man crew was in the stairwell leading into the top floor supporting hose line operations when the ceiling collapsed. He fell backwards down the stairs, spraining his knee and ankle. He was cleared for firefighting activities two weeks after the incident.

The origin and cause of the fire is reported as undetermined, and the house had no smoke alarms.

Although the fire department report did not explain why the lieutenant’s maydays were missed, the fire department did outline in its investigation several ways to improve firefighter safety.

Structure Fire
Three firefighters suffered injuries while fighting an incendiary fire that started in a back bedroom of a vacant, single-family, wood-frame house that covered 1,300 square feet (121 square meters).
A 25-year-old rookie suffered second-degree burns to the back of his neck while pulling ceilings, and a 28-year-old firefighter with four years’ experience suffered steam and heat burns on his wrist while operating a hose line inside the house. Both were cleared to resume firefighting activities after the incident.

The third man, a 47-year-old seasoned veteran with 25 years’ experience, suffered burns to his head and face after falling through the roof and first-floor ceiling while performing vertical ventilation. He was found by the interior companies, who helped him outside to be checked by EMTs. The firefighter, who was not wearing self-contained breathing apparatus when he fell through the roof, returned to firefighting activities nearly a month after the incident.

Once the injured were removed from the building, the incident commander switched to a defensive stance and performed a personnel accountability roll call to account for all firefighters on scene.