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. Earlier this year, NFPA reported that there were 64 firefighter fatalities while on duty in 2018 (nfpa.org/firefighterfatalities). A better understanding of how fatalities, nonfatal injuries, and illnesses occur can assist in identifying corrective actions that could help minimize the inherent risks of firefighter work.

Our study of last year’s firefighter injuries in the United States is based on data collected as part of NFPA’s 2018 “US Fire Experience Survey.” An earlier report, “Fire Loss in the United States During 2018” (nfpa.org/fireloss), measured the national fire experience in terms of the number of fires that fire departments responded to and the resulting civilian deaths, civilian injuries, and property losses that occurred.

Based on data reported by fire departments responding to the 2018 fire experience survey, we estimate that 58,250 firefighter injuries occurred in the line of duty in 2018. This is a decrease of one percent from 2017 and represents the lowest number since NFPA began analyzing this data in 1981.

In recent years, the number of reported firefighter injuries has been considerably lower than it was in the 1980s and 1990s, due in part to additional survey questions on exposures to hazardous conditions and infectious diseases—information that allows 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 6,175 exposures to infectious diseases such as hepatitis, meningitis, and HIV in 2018. This amounts to 0.3 exposures per 1,000 emergency medical service runs by fire departments in 2018.

We also estimate that there were 47,150 exposures to hazardous conditions such as asbestos, radioactive materials, chemicals, and fumes last year, which amounts to 14.6 exposures per 1,000 hazardous condition runs. The increase in exposures in recent years can in part be explained by the heightened awareness about cancer and other chronic illnesses in the fire service and the importance of documentation. This could have resulted in improved reporting for such exposures.

An estimated 15,500 injuries, or 27 percent of all firefighter injuries, resulted in lost time.

Methods and results

NFPA annually surveys a sample of fire departments in the US to make national projections of the fire problem. The sample is stratified by the size of the community protected by the fire department and includes all US fire departments that protect communities with a population larger than 5,000. The 8,854 fire departments in the eight highest strata protect a population of 279 million, or 85 percent of the US population, as of July 2018. The rest of the sample includes 14,338 randomly selected departments that protect populations under 5,000, for a total sample size of 23,192, or 78 percent of all US departments known to NFPA.

The estimation method used for the survey was ratio estimation with stratification by community size. For each firefighter injury statistic, a sample injury rate was computed for each stratum. This rate consisted of the total for that particular statistic from all departments reporting it, divided by the total population protected by the departments reporting the statistic. Note that this means the departments used in calculating each statistic could be different, reflecting differences in unreported statistics. The national projections are made by weighting the sample results according to the proportion of the total US 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 confident that the actual number of total firefighter injuries falls within 5 percent of the estimate.


Firefighters in New York respond to an apartment fire that injured 14 people, including 11 firefighters. The risk of injury per firefighter in departments protecting the country’s largest communities was six times that of the risk for departments in the smallest communities. Courtesy of Atilgan Ozdil/Anadolu Agency/Getty Images.

A total of 2,631 departments responded to the 2018 fire experience survey. The results are based on injuries that occurred during incidents attended by public fire departments. No state or federal firefighting entities were included in this sample and no adjustments were made for injuries that occurred during fires attended solely by private fire brigades, such as those at industrial or military installations.

Firefighters were more likely to be injured at fireground operations than at other types of duties. In 2018, 22,975 injuries, or 39 percent of all firefighter injuries, occurred at the fireground. This was a 6 percent decrease from the previous year. Injuries at the fireground have decreased from a high of 67,500 in 1981, a drop of 66 percent to 2018. The number of fires also declined steadily, for an overall decrease of 54 percent. The rate of injuries per 1,000 fires over the past 35 years has fluctuated, however, from a high of 28.3 injuries per 1,000 fires in 1990 and a low of 17.4 injuries per 1,000 fires in 2018.

Overall, the number of injuries at non-fire emergencies has increased in recent decades, from 9,600 in 1981 to 11,625 in 2018, an increase of 21 percent. During the same period, the number of non-fire emergencies also increased 360 percent, due in large part to an increase in the number of fire department responses to medical emergencies. The injury rate per 1,000 non-fire emergencies declined between 1981 and 2018, from 1.2 to 0.3, largely because the number of non-fire emergencies increased at a higher rate than the number of injuries at non-fire emergencies.

In addition, 4,150 firefighter injuries occurred while responding to or returning from incidents in 2018. Another 8,175 firefighter injuries occurred during training activities, and 11,325 injuries occurred during other on-duty activities.

Nature and cause of fireground injuries

The major types of injuries that occurred during fireground operations were strains and sprains, which accounted for 38 percent of the injuries; smoke or gas inhalation, which accounted for 13 percent; wounds, cuts, bleeding, and bruises, which accounted for 11 percent; and thermal stress (frostbite or heat exhaustion), which accounted for 10 percent of injuries. Strains, sprains, and muscular pain were the leading type of injury in all firefighter activities and accounted for 59 percent of all non-fireground injuries, while wounds, cuts, bleeding, and bruises were the second leading cause of injury in non-fireground activities, accounting for 16 percent of non-fireground injuries.

Because fireground injuries are of particular concern from an occupational hazard perspective, we examined their causes, defined here as the initial circumstance leading to the injury. Overexertion or strain was the leading cause of fireground injuries, with 28 percent of the fireground injury total. Other major causes were falls, jumps, or slips (18 percent), and exposure to fire products (17 percent).

Fire department vehicle collisions

In 2018, an estimated 14,425 collisions involved fire department emergency vehicles responding to or returning from incidents, a figure similar to 2017. To put this number in perspective, fire departments responded to more than 36.7 million incidents in 2018, meaning that the number of collisions represents 0.04 percent of total responses. However, these collisions resulted in 575 injuries, or 1 percent, of all firefighter injuries.

Another 700 collisions involved firefighters’ personal vehicles, in which they were responding to or returning from incidents. These collisions resulted in an estimated 50 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 the number of fires the department attends.

The second point is clearly demonstrated when we examine the range of the average number of fireground injuries per year per fire department, which range from a high of 82.4 for departments that protect communities of 500,000 or more, to a low of 0.2 for departments that protect communities of fewer than 2,500.

One way to understand the risk that firefighters face is to examine the number of fireground 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 2018, the overall range of rates varied from a high of 2.5 injuries per 100 fires for departments that protected communities with populations of 500,000 or more to a low of 1.2 injuries per 100 fires for departments that protected communities with populations between 100,000 and 249,999.


The remains of a home destroyed in the Woolsey Fire last November in California. Three civilians died in the fire, and two were injured. Three firefighters were also injured. Courtesy of Robyn Beck/AFP/Getty Images.

Larger fire departments generally had the highest rates of fireground injuries per firefighter; departments protecting communities of 500,000 or more had 5.6 injuries per 100 firefighters. As the size of the community decreases, the rate of fireground injuries generally declines, to a low of 0.9 for departments protecting fewer than 2,500 people. That is a difference in risk of injury per firefighter of more than 6 to 1 between communities of 500,000 or more people and communities of fewer than 2,500.

One explanation for this difference is that, although departments protecting communities with populations of 500,000 have, on average, more than 74 times as many firefighters as departments protecting populations smaller than 2,500, larger departments attend 281 times as many fires as the smaller departments and incur considerably more fireground injuries. Different policies for documenting minor injuries and different levels of fire engagement could also explain some of this difference.

Conclusion

Since 1981, when firefighter injury data was first collected for this report, the overall trend is a decreasing number of firefighter injuries. The most common place for these injuries is at the fireground, but many firefighters are injured at other emergencies.

As the statistics in this report and previous reports attest, firefighting presents risks of personal injury to firefighters. Due to the nature of the work performed and the hazards of the incident scene environment, it is unlikely that all firefighter injuries can be eliminated. A risk management system and the application of existing technology, however, can offer options to reduce present injury levels.

RICHARD CAMPBELL is data collection and research manager at NFPA. JOSEPH L. MOLIS is an NFPA fire data assistant and a battalion chief with the fire department in Providence, Rhode Island.