BY RITA FAHY AND JOSEPH MOLIS • LONG READ TIME
In 2018, 64 firefighters died while on-duty in the United States as a result of injuries that occurred at specific events, continuing a five-year trend of fewer than 70 deaths per year. Of those 64 firefighters, 34 were volunteer firefighters, 25 were career firefighters, four were employees or contractors for federal or state land management agencies, and one was a prison inmate.
There were four multiple-fatality incidents in 2018: two wildfires, where two firefighters died in each fire; one structure fire, where two firefighters died when the floor collapsed; and an apparatus crash, where two firefighters died while responding to a motor vehicle crash.
This annual study includes only on-duty firefighter fatalities that occurred in the 50 states and the District of Columbia. In addition, a career firefighter in the US Virgin Islands died from a cardiac event while operating at a structure fire.
NFPA’s published study of firefighter deaths focuses on the deaths that occur while firefighters are on the job, and includes both fatal traumatic injuries and deaths resulting from medical conditions. These fatalities, however, reflect only part of the overall risk to members of the fire service. Long-term health effects, both physical and emotional, also result in job-related deaths, for firefighters who are still in the fire service and those who have left. While it is not possible to enumerate more than a few of the deaths due to long-term effects, it is important to note that the firefighter fatality picture is far broader than can be reflected in this study of on-duty deaths.
Fireground deaths
Fires and explosions claimed the lives of 25 firefighters last year, with more than half (13) occurring at structure fires, 10 on wildland fires, one at a vehicle fire, and one at a gas line explosion.
Eight of the deaths were in one- or two-family dwellings, one of which was under construction. Four deaths occurred in three apartment buildings, one of which was undergoing renovations. The other structure fire death occurred on a movie set. None of the structures were reported to have an automatic sprinkler system.
Structural collapses resulted in the deaths of six of the 13 firefighters killed at structure fires. All were operating inside the structures when the collapses occurred. Two of the six firefighters were operating at a fire in a multistory apartment building under renovation when the floor collapsed and they were buried in the rubble. Five other firefighters were injured in that fire. In separate fires in single-family dwellings, two firefighters were pinned in the rubble after ceiling collapses. A firefighter fell through a collapsed floor at a basement fire in a single-family dwelling. In another fire, the porch roof of a home under construction collapsed onto a firefighter as he was exiting the structure.
A firefighter who had been operating on a fire in the cellar of a building being used as a movie set ran out of air and died of smoke inhalation while attempting to exit the building. Another firefighter became trapped on the second story of an apartment building when conditions rapidly deteriorated.
In one of the apartment building incidents, a resident set off an explosive device in his apartment in an attempt to kill his upstairs neighbor. He then fired on responding firefighters, killing one and wounding another.
One firefighter operating outside a home was struck by part of a propane tank that experienced a BLEVE (boiling liquid expanding vapor explosion). Another firefighter suffered a fatal asthma attack after exposure to smoke at a fire.
Firefighters in the Harlem neighborhood of New York City work at the scene of a overnight fire that killed one firefighter after he became separated from his unit while battling the flames. Photograph AP/WIDE WORLD
Two of the 10 deaths on wildland fires occurred in separate incidents on the Carr Fire, in Northern California: one firefighter was overrun by fire while operating a bulldozer, and the other was caught in a fire tornado while evacuating residents. Also in separate incidents, two firefighters were killed on the Ferguson Fire, which burned in California’s Sierra Nevada mountains: one was killed when his bulldozer overturned, and the other died when he was struck by a falling tree that he was assisting in cutting. A firefighter working on another wildland fire was struck by a tree that was knocked down in a retardant drop. A firefighter died of burns after falling from the open back seat of a grass truck that was accelerating from a spreading grass fire. Another firefighter died of pneumonia shortly after being released from serving on a wildland fire.
A firefighter evacuating residences and businesses in the area around a leaking gas main was killed when an explosion occurred. Several others were injured.
Sudden cardiac death claimed the lives of six firefighters working at fires: three on wildland fires, two at structure fires, and one at a vehicle fire.
Other activities when fatal injuries occurred
Unlike most years, when the second-largest share of on-duty deaths occurred while responding to or returning from emergencies, in 2018 the second-largest share occurred during training activities, which accounted for 11 deaths. Sudden cardiac death claimed the lives of nine of the firefighters. Three of these nine firefighters were engaged in physical-fitness training (one as a recruit); two were involved in search-and-rescue training; one during survival training; one was involved in his annual work performance exam; one was in the station prepping for training; and one was involved in an unspecified type of training. Two firefighters were involved in motor vehicle crashes while traveling to off-site training.
Ten firefighters were killed responding to or returning from alarms. This continues the low number of deaths in this category that have been reported in four of the past five years. Eight of these 10 firefighters were killed in motor vehicle crashes. Two suffered fatal cardiac events. All of the victims were volunteer firefighters. (Crashes and sudden cardiac deaths are discussed in more detail later in this report.) The number of deaths that occurred while responding to or returning from calls has averaged 14 per year over the past 10 years and fewer than 12 per year over the past five years. The first 10 years that NFPA conducted this study, from 1977 to 1986, the average number of deaths per year while responding to or returning from alarms was 36. There has been a marked reduction in both crash deaths and cardiac-related deaths while responding to or returning from alarms over the past 40 years.
Five firefighters died at non-fire emergencies: four were operating at motor vehicle crashes and one was involved in a water rescue. Three of the five were struck by passing vehicles, one ran out of air during a water rescue, and one suffered sudden cardiac death.
The remaining 13 firefighters died while involved in a variety of normal station, administrative, or maintenance activities. Nine of these fatalities were due to sudden cardiac death and one to an unintentional drug overdose. One firefighter was working with compressed air cylinders when one failed, resulting in a fatal head injury. One firefighter died in a crash while taking a pump for its annual certification. One firefighter slipped and fell off a fire truck while repacking hose after a fire response.
Cause and nature of fatal injury or illness
To summarize the details presented above, overexertion, stress, and medical issues accounted for by far the largest share of deaths. Of the 28 deaths in this category, 25 were classified as sudden cardiac deaths (usually heart attacks) and one was due to an accidental overdose of prescription pain medication. Two firefighters collapsed and died at the fire station, but no cause of death has yet been reported in either case. In addition, a firefighter suffered a fatal asthma attack shortly after arriving at the scene of a house fire, and another died of pneumonia shortly after being released from serving on a wildland fire.
The next leading cause of death was internal trauma and crushing, with 23 deaths. Six firefighters died of asphyxia or smoke inhalation, three died of burns, and there was one each due to drowning and gunshot.
Sudden cardiac deaths
The 25 sudden cardiac deaths in 2017 with onset while the victim was on duty is the third consecutive year that the toll has been below 30, but they still account for the largest share of deaths while on duty. These are cases in which the onset of symptoms occurred while the victim was on duty and death occurred immediately or shortly thereafter. Cardiac-related events accounted for 44 percent of the on-duty deaths over the past 10 years. Though it usually accounts for the largest share of deaths in any given year, this compares to the earliest years of the study when an average of 60 firefighters a year suffered sudden cardiac deaths while on duty. In addition, the US Fire Administration (USFA) is following up on the deaths of more than a dozen other firefighters who reportedly died within 24 hours of non-routine strenuous and stressful physical activity, potentially qualifying them for federal benefits under the Hometown Heroes Act.
Vehicle-related deaths
In 2018, 12 firefighters died in vehicle crashes, three were struck by vehicles, and one fell from a moving vehicle. Deaths in road vehicle crashes, which accounted for 11 of the 12 crash deaths in 2018, have ranged over the years from a high of 25 to a low of four. Crashes have fairly consistently accounted for the second-largest share of deaths each year, but have not dropped significantly as total on-duty deaths have. With 11 road vehicle crash deaths, the death toll in 2018 is only slightly lower than the average of 13 deaths per year that have occurred in road vehicle crashes over the past 40-plus years.
Eight of the 11 road crash deaths occurred while firefighters were responding to emergencies: three to motor vehicle crashes, two to structure fires, and one each to a wildland fire, an EMS call, and a water rescue. Two firefighters were driving to training events, and one was on a maintenance errand. Of the firefighters who died in crashes on roads, other than one operating a motorcycle, three were using seatbelts, one was not, and no details on seatbelt use were reported for the other six.
In the one fatal crash that did not occur on a road or highway, the firefighter was operating a bulldozer on a wildland fire when it overturned.
Three firefighters were killed when struck by vehicles while operating at crash scenes. One firefighter had just arrived at a highway crash scene when a tractor trailer rear-ended his fire apparatus, which then struck the victim and two other firefighters who were standing in front of it. Another firefighter in the truck suffered minor injuries. All emergency lights on the apparatus reportedly were operating, and firefighters followed all standard operating procedures. A firefighter who had responded to a crash on an icy highway was struck by a second vehicle whose driver lost control and crashed into the scene, pinning the victim under a vehicle. The third victim was directing traffic at a crash scene on a highway on-ramp when he was struck by a passing vehicle. No other details are available.
A firefighter died of burns after falling from the open back seat of a grass truck that was accelerating from a spreading grass fire. The victim, who was wearing no protective clothing or equipment, was pulled from the truck, through an unlatched door, by a section of hose draped over his shoulder.
Other findings
The one intentionally set fire resulting in a firefighter fatality in 2018 was an incident where an explosive device was detonated and a responding firefighter was shot. From 2009 through 2018, 38 firefighters (5.4 percent of all on-duty deaths) died in connection with intentionally set fires, either at the fire or while responding to or returning from the fire.
In 2018, one firefighter death resulted from a response to a false call. Over the past 10 years, six firefighter deaths have resulted from false calls, including malicious false alarms and alarm malfunctions.
One firefighter was killed when a tractor-trailer rear-ended a firetruck on an interstate highway in Virginia. The fire engine and its crew were responding to a crash when they were stuck. In 2018, three firefighters in the US died when they were struck by vehicles. Photograph: AP/WIDE WORLD
The firefighters who died in 2018 ranged in age from 17 to 86, with a median age of 43.5 years. In firefighter deaths from 2014 through 2018, the lowest death rates were for firefighters between 20 and 29. Their death rate was less than one-third the all-age average. The rate for firefighters aged 60 and over was almost three times the average. Firefighters aged 50 and over accounted for just over half of all firefighter deaths over the five-year period, although they represent only one-quarter of all career and volunteer firefighters in the US.
The 25 deaths of career firefighters while on duty in 2018 is slightly above the average for the past 10 years. In the earliest years of this study, the annual average number of deaths of career firefighters while on duty was 57. The 34 deaths of volunteer firefighters, on the other hand, is lower than the annual average for volunteer firefighters over the past 10 years, and far lower than the average of 67 deaths per year in the earliest years of this study.
In summary
There were 64 on-duty firefighter deaths in the US in 2018, the eighth time in the last 10 years that fewer than 70 on-duty deaths have occurred. The death toll is less than half what it was in the first five years that NFPA conducted this study. Sudden cardiac death, though also far lower than reported in the earlier years, continues to account for the largest share of deaths.
While the number of firefighters struck and killed by vehicles was unusually high in 2017, with 10 such deaths, that was not repeated in 2018, with three deaths.
A firefighter was shot while responding to a structure fire in 2018, the tenth on-duty firefighter murdered in the past 10 years. The murder of a responding firefighter has already occurred in 2019, showing that this trend continues.
NFPA’s study focuses only on the deaths tied to specific events that occur while firefighters are at work. A complete picture of the hazards of firefighting would also include deaths and injuries due to long-term exposure to carcinogens and physical and emotional stress and strain. There are other sources that can provide insight into those hazards.
The Firefighter Behavioral Health Alliance has reports on 82 firefighters and 21 EMTs and paramedics who died by suicide in 2018. For 2018, the USFA is processing more than a dozen fatalities that potentially qualify for federal death benefits under the Hometown Heroes Act (deaths within 24 hours of non-routine strenuous or stressful physical activity). We know from research by the National Institute for Occupational Safety and Health (NIOSH) that firefighters are 9 percent more likely to have a cancer diagnosis, and 14 percent more likely to die of cancer, than the general population. The International Association of Fire Fighters (IAFF) lists on its website 120 firefighter cancer deaths in 2018.
In 2018, Congress passed legislation directing the Centers for Disease Control and Prevention (CDC) to develop and maintain a voluntary registry of firefighters in the US that can be used to monitor the incidence of cancer in the fire service. This data will be linked to data in state cancer registries and will be available to researchers. NIOSH will develop and maintain the registry, which will be open to all current and former firefighters.
NFPA’s Fire Protection Research Foundation is involved in a 30-year cohort study to track exposures and effects, as well as a study to develop prototypes for a real-time particulate and toxic gas sensor to alert firefighters to hazards in the air. The foundation released a report last year on the development and implementation of a fire service contaminant control campaign. The findings from these studies will inform relevant NFPA standards for the fire service as well as educational and training programs aimed at reducing firefighter exposures.
Recognition of the importance of behavioral health programs and peer support for firefighters has become widespread in recent years. As with heart disease and cancer, behavioral issues can follow firefighters after their careers, whether in retirement or in some other form of separation from the fire service. Many programs exist to address these problems, including Share the Load, an effort by the National Volunteer Fire Council (NVFC) that connects firefighters, EMTs, and their families with resources and support for mental well-being. The IAFF offers advice on establishing a peer-support program; it also plans to launch a suicide reporting system in 2019, and is developing handouts to provide psychoeducation to fire departments when they experience a death by suicide. In collaboration with the National Fallen Firefighters Foundation, the Medical University of South Carolina has developed a training course for counselors who work with firefighters. NFPA 1500, Standard on Fire Department Occupational Safety and Health Program, requires access to a behavioral health program that provides assessment, counseling, and treatment for issues including “stress, alcohol and substance abuse, anxiety, depression, traumatic exposure, suicidality, and personal problems.”
In March, a bill was reintroduced in Congress to establish a public safety officer suicide reporting system at the CDC to collect information on the incidence of suicide in this group, as well as to aid in the study of ways to reduce deaths by suicide among firefighters and other first responders by improving detection, prevention, and treatment of behavioral health issues. It would also allow funding for peer support programs.
Heart disease, of course, has long been recognized as a significant factor in firefighter on-duty deaths, as sudden cardiac death consistently accounts for approximately half the on-duty fatalities. Several NFPA standards focus on health risks to firefighters. NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire Departments, outlines for fire departments the medical requirements that must be met by candidate firefighters and incumbent fire department members. NFPA 1500 calls for fire departments to establish a firefighter health and fitness program that meets NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members, and requires that firefighters meet the medical requirements of NFPA 1582. Information on developing a wellness-fitness program is available from other organizations, such as the Fire Service Joint Labor-Management Wellness-Fitness Initiative created by the IAFF and the International Association of Fire Chiefs. The NVFC developed its Heart-Healthy Firefighter Program, launched in 2003 to address heart attack prevention for firefighters and EMS personnel through fitness, nutrition, and health awareness.
On-duty firefighter fatalities have arrived at a new plateau, with approximately 70 or fewer deaths per year. While that represents an impressive improvement compared to the death toll in the late 1970s, as this report shows, there are still areas where progress can continue.
This study is made possible by the cooperation and assistance of the United States fire service, CDC's National Institute for Occupational Safety and Health, the United States Fire Administration, the Forest Service of the US Department of Agriculture, the Bureau of Indian Affairs, and the Bureau of Land Management of the US Department of the Interior.
Rita F. Fahy, Ph.D., is a manager in NFPA’s Applied Research Division. Joseph L. Molis is a fire data assistant at NFPA and a batallion chief with the Providence, Rhode Island, Fire Department. Top photograph: AP/WIDE WORLD