NFPA Journal

• Read the full report on firefighter injuries in 2013
• Read a selection of firefighter injury narratives.

FIREFIGHTERS WORK IN VARIED AND COMPLEX ENVIRONMENTS that increase their risk of on-the-job death and injury. Each year, NFPA studies firefighter deaths and injuries to provide national statistics on their frequency, extent, and characteristics. We believe that a better understanding of how these fatalities, injuries, and illnesses occur can help identify corrective actions that could help minimize the job’s inherent risks.

Based on data reported by fire departments during the NFPA Survey of Fire Departments for U.S. Fire Experience (2013), NFPA estimates that 65,880 firefighter injuries occurred in the line of duty in 2013. This is a decrease of 5.1 percent from the year before and is the lowest it’s been since NFPA analysis began in 1981. In recent years, the number of firefighter injuries has been considerably lower than it was in the 1980s and 1990s, but this is due, in part, to additional questions on exposures that allow us to place them in their own categories. Previously, some of these exposures might have been included in total injuries under other categories.

NFPA estimates that there were 7,100 exposures to infectious diseases such as hepatitis, meningitis, and HIV in 2013. This amounts to 0.3 exposures per 1,000 emergency medical runs by fire departments last year. We also estimate that there were 17,400 exposures to hazards such as asbestos, radioactive materials, chemicals, and fumes in 2013, amounting to 16.7 exposures per 1,000 hazardous condition runs. An estimated 10,000 injuries, or 15.2 percent of all firefighter injuries in 2013, resulted in time away from the job.

Injuries by type of duty
The type of duty firefighters were performing when they were injured is divided into five categories: responding to, or returning from, fires and non-fire emergencies; fire ground activities at structure fires, vehicle fires, and brush fires, from arrival to departure; non-fire emergencies, including rescue calls, hazardous calls such as spills, and natural disasters; training; and other on-duty activities such as inspections or maintenance duties.

Not surprisingly, the largest share of injuries last year were sustained during fire ground operations, when 29,760, or 45.2 percent, of all firefighter injuries occurred. This was a decrease of 5.5 percent from the year before and is the lowest it has been since NFPA analysis began in 1981. Injuries at the fire ground decreased from a high of 67,500 in 1981 to 29,760 in 2013, a decrease of 55.9 percent, although the rate of injuries per 1,000 fires has not shown any consistent trend up or down for the period. The number of fires also declined steadily during that period, for an overall decrease of 57.1 percent. This suggests the fire ground injury rate risk has not changed much since 1981.

Overall, the number of injuries at non-fire emergencies between 1981 and 2013 rose from 9,600 to 12,535, for an overall increase of 31 percent. During the same period, the number of non-fire emergencies increased by a substantial 294 percent due, in large part, to an increase in the number of medical aid incidents. When the injury rate per 1,000 non-fire emergencies is examined, the rate declined from 1.24 in 1981 to 0.41 in 2013, because the number of non-fire emergencies increased at a higher rate than the number of injuries incurred at non-fire emergencies.

In addition, 4,015 firefighter injuries occurred in 2013 while firefighters were responding to, or returning from, an incident; 7,770 occurred during training activities; and 11,800 occurred during other on-duty activities.

Nature and cause of fire ground injuries
The major types of injuries that occur during fire ground operations are strains and sprains, which account for an estimated 55.3 percent of the injuries; wounds, cuts, bleeding, and bruising, which account for an estimated 13.8 percent; burns, which account for an estimated 5.1 percent; and smoke or gas inhalation, which account for an estimated 5 percent. These results were fairly consistent with all non-fire ground activities, for which strains, sprains, and muscular pain accounted for 58.4 percent of the injuries, and wounds, cuts, bleeding, and bruising accounted for 17.8 percent.

The leading causes of fire ground injuries were overexertion and strain, which led to 26.5 percent of the injuries, and falls, jumps, and slips, which led to 22.7 percent. Other major causes included coming in contact with object, which led to 12 percent of fire ground injuries, and exposure to fire products, which led to 10.4 percent. The definition of cause here refers to the initial circumstance leading to the injury.

Fire department vehicle collisions
In 2013, an estimated 12,350 collisions involved fire department emergency vehicles responding to, or returwning from, incidents. To put this number in perspective, fire departments responded to more than 31.7 million incidents in 2013, meaning that the number of collisions represents about one tenth of 1 percent of total responses. However, these collisions resulted in 730 firefighter injuries, or 1.1 percent of all firefighter injuries.

Another 830 collisions involved firefighters’ personal vehicles in which they were responding to, or returning from, incidents. These collisions resulted in an estimated 185 injuries.

Average fires and fire ground injuries per department by population protected and region
The number of fires a fire department responds to is directly related to the size of the population it protects, and the number of fire ground injuries a department incurs is directly related to its exposure to fire—that is, to the number of fires the department attends. The second point is clearly demonstrated when we examine the range of the statistics, which range from a high of 120.1 for departments that protect communities of 1,000,000 citizens or more to a low of 0.2 for departments protecting communities of less than 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 fire ground injuries that occur for every 100 fires they attend. This takes into account relative fire experience and allows more direct comparison between departments protecting communities of different sizes. In 2013, the overall range of rates varied from a high of 3 injuries per 100 fires for departments protecting communities of 250,000 to 499,999 people to a low of 1.3 per 100 fires for departments that protect communities of 5,000 to 9,999. Thus, the wide range noted in average fire ground injuries by the size of the population protected narrows when relative fire experience is taken into account. The overall injury rate last year for departments protecting communities with a population of 50,000 or more was 2 injuries per 100 fires, which is 25 percent higher than the injury rate for departments protecting communities of less than 50,000.

When we calculated the risk of fire ground injury per 100 firefighters by size of community protected, we found that larger departments generally had the highest rates. Departments protecting communities of 250,000 to 499,999 had the highest rate in 2013, with 6.8 injuries per 100 firefighters. As community size decreased, the rate dropped quite steadily to a low of 1 per 100 firefighters for departments protecting less than 2,500 people. That is more than a six-to-one difference in risk of injury between communities of 250,000 to 499,999 and the smallest communities.

This difference can be easily explained: although a department protecting a community with a population of 250,000 to 499,999 has, on average, more than 21 times as many firefighters than a department protecting a population under 2,500, the larger department attends more than 98 times as many fires. As a result, it incurs considerably more fire ground injuries.

This also holds true when the region in which the department is located is taken into account. In each region of the country, the number of fires a fire department responds to is directly related to the size of the population it protects, and the number of fire ground injuries incurred by a department is directly related to the number of fires it attends. The Northeast reported a higher number of fire ground injuries per 100 fires for most community sizes where all departments reported sufficient data by region.

Improving firefighter safety
As the 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 at the local level can help reduce the current injury levels.

NFPA recommends that the top levels of fire service management commit to reducing injuries by following the requirements found in Section 4.3 of NFPA 1500, Fire Department Occupational Safety and Health Program, and by establishing a safety committee headed by a safety officer to recommend a safety policy and the means of implementing it, as recommended in Section 4.5. Fire departments should also develop and implement an investigation procedure to examine all accidents, near misses, injuries, fatalities, occupational illnesses, and exposures involving members, as found in subsections 4.4.4 and 4.4.5, and provide appropriate protective equipment and a mandate to use it, as recommended in Sections 7.1 through 7.8.

In addition, fire service management should develop and enforce a program on the use and maintenance of SCBA, as detailed in Sections 7.9 through 7.14, and develop and enforce policies on safe practices for drivers and passengers of fire apparatus, per Sections 6.2 and 6.3.

The development of procedures to ensure response of sufficient personnel for both firefighting and overhaul duties can be found in subsection 4.1.2 of NFPA 1500, as well as in 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 addresses adoption and implementation of an incident management system, as does NFPA 1561, Emergency Services Incident Management System. Information on training and education related to emergency operations for all members can be found in Chapter 5 of NFPA 1500.
Information on implementing programs for the installation of 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®. Such systems allow fires to be discovered at an earlier stage, exposing the firefighter to a less hostile environment.

Finally, fire safety education programs that fire departments can undertake to make citizens aware of measures to prevent fires and of reacting correctly to fires are discussed in Chapter 6 of NFPA 1201, Providing Emergency Services to the Public.

Other NFPA standards that may help reduce firefighter injuries include the 2008 edition of NFPA 1584, Rehabilitation Process for members During Emergency Operations and Training Exercises, particularly Chapter 4, “Preparedness,” and Chapter 6, “Incident Scene and Training Rehabilitation”; the 2010 edition of NFPA 1002, Fire Apparatus Driver/Operator Professional Qualification Risk Management, particularly Section 4.8; and the 2010 edition of NFPA 1620, Pre-Incident Planning, Chapters 4, 5, 7, and 8.

By making it a priority to follow these recommendations, fire service organizations can make significant strides towards reducing the number and impact of firefighter injuries.

Definition of terms
Fire: Any instance of uncontrolled burning. This excludes combustion explosions and fires that are already out when the fire department arrives, whether authorized or not; overpressure ruptures without combustion; mutual aid responses; smoke scares; and hazardous materials responses.
Incident: The movement of a piece of fire service apparatus or equipment in response to an alarm.
Injury: Physical damage suffered by a person that requires—or should require—treatment by a physician, nurse, paramedic, or EMT within one year of the incident, regardless of whether treatment was actually received, or that results in at least one day of restricted activity immediately following the incident.

Description of NFPA survey and data collection method
NFPA annually surveys a sample of fire departments in the United States to make national projections of the fire problem. The sample is stratified by the size of the community protected by the fire department. All U.S. fire departments that protect communities of 50,000 people or more are included in the sample, because they constitute a small number of departments that protect a large share of the total population. 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. Any estimate based on a sample survey contains a confidence interval that measures the statistical certainty of the estimate. We are very confident that the actual number of total firefighter injuries falls within 5 percent of the estimate.

A total of 2,637 public fire departments across the country responded to the 2013 NFPA fire experience survey. The results in this article are based on injuries that occurred during incidents they attended. 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 incident summaries was enhanced by a form that was sent to departments requesting information. The form included questions on type of protective equipment worn, the ages and ranks of the 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 (2013) for their continuing efforts to provide in a timely manner the data so necessary to make national projections of firefighter injuries. The authors wish to thank the many NFPA staff members who worked on this year’s survey, including Frank Deely, Myles O’Malley, and John Conlon for editing and keying the survey forms and their follow-up calls to fire departments, and Norma Candeloro for processing of survey forms and typing this report.

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.