BY RITA FAHY, JAY T. PETRILLO, AND JOSEPH MOLIS
An important milestone was achieved in the United States in 2019: For the first time, fewer than 50 deaths of firefighters occurred while they were on the job.
Other important achievements included the lowest number of deaths of volunteer firefighters, the fewest deaths in road vehicle crashes, and the lowest number of cardiac deaths. There were no multiple-fatality incidents in 2019, the only time that has been the case since NFPA began conducting this study in 1977.
NFPA’s published study of firefighter deaths focuses on deaths that occur while firefighters are on the job and includes both fatal traumatic injuries and deaths resulting from medical conditions. This is, of course, 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, both for active firefighters and for people who have left the fire service. 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 what is reflected in this study of on-duty deaths.
In 2019, 48 firefighters died while on duty in the US as a result of injuries and illnesses that occurred at specific events that year. This represents a sharp drop from recent years, where deaths averaged 65 per year. Of the 48 firefighters, 25 were volunteer firefighters and 20 were career firefighters; one was an employee of a state land management agency, one was an employee of a federal land management agency, and one was a civilian employee of the military.
This annual study includes only on-duty firefighter fatalities that occurred in the 50 states and the District of Columbia.
Fire ground deaths
Fires and explosions claimed the lives of 13 firefighters last year, with 10 occurring at structure fires and three on wildland fires. This is the lowest number of deaths at fire scenes ever reported in this study, and the third time in the past four years with fewer than 20 deaths. This continues a clear downward trend since the late 1970s, when the number of fire ground deaths annually averaged more than 80 per year.
Three of the structures were one- or two-family homes, and three were apartment buildings. The type of housing was not reported for one fatal incident. The remaining structure fire deaths occurred at the scene of a hotel fire, a grain silo, and in a vacant furniture store. None of the structures in which firefighters died was reported to have an automatic sprinkler system.
Investigators work at the scene of a four-alarm house fire where Worcester, Massachusetts firefighter Lt. Jason Menard was killed on November 14, 2019. Menard died after helping two fellow firefighters to safety and searching for anyone else left inside. (Getty Images)
Of the 10 who died at structure fires, three were killed as a result of fire progress or explosion: one firefighter became trapped in a three-story apartment building during suppression operations; another became trapped in a three-story apartment building during a search for occupants; and another fell from the roof of a grain silo following an explosion while operating a handline. A firefighter fell from the snow-covered roof of a four-story apartment building while attempting to access a chimney fire. One firefighter became lost inside on the upper story of a vacant furniture store when the stairs to the ground floor collapsed as firefighters were evacuating the building. Another died when a brick gable wall collapsed, striking him as he operated at a fire at a single-family home. A firefighter died at the scene of a hotel fire when he tripped getting out of the driver’s side of his truck, fell into the path of a passing vehicle, and was run over. Three more firefighters experienced sudden cardiac death while working at structure fires.
Two of the three deaths on wildland fires resulted from burns. One firefighter was overrun while trying to escape a grass fire on foot, and the other was igniting small fires at a controlled burn when the torch attached to her vehicle over pressured and ruptured, engulfing her in flames. In the third incident, a firefighter was killed when the helicopter he was operating from crashed during a prescribed burn.
Other activities when fatal injuries occurred
Nine firefighters died at non-fire emergencies in the US in 2019.
Of those, seven were operating at motor vehicle crashes: two suffered sudden cardiac death, one suffered a stroke, two were struck by passing vehicles, one fell from an elevated roadway, and one stepped on downed power lines at a crash scene and was electrocuted.
Fatalities at non-fire emergencies also included a firefighter on a medical call who was shot and killed by the patient, and a firefighter who was killed (in addition to six others who were seriously injured) in a propane gas explosion while they were investigating a reported smell of gas.
Nine firefighters were killed responding to or returning from alarms, marking the third consecutive year with 10 or fewer deaths in this category. Five of the nine suffered fatal cardiac events, two were killed in motor vehicle crashes, one was struck by a vehicle, and one fell from the cab of a responding apparatus as it turned at an intersection. All of the victims were volunteer firefighters. (All vehicle-related and sudden cardiac deaths are discussed in more detail later in this report.) 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. Over the first 10 years that NFPA conducted this study, from 1977 through 1986, an average of 36 deaths per year occurred while firefighters were responding to or returning from alarms. The number of deaths that occurred while responding to or returning from calls has averaged 13 per year over the past 10 years and 11 per year over the past five years.
Five deaths occurred during training activities. Sudden cardiac death claimed the lives of four firefighters, and one died of heat stroke. One of the victims had been the instructor at a Rapid Intervention Team (RIT) drill. One was involved in vehicle extrication training at the fire station. One firefighter passed away overnight while attending a conference. One firefighter, a recruit, was participating in search-and-rescue training at a regional training center. The firefighter who died of heat stroke was engaged in a training hike.
The remaining 12 firefighter fatalities in 2019 involved a variety of normal station, administrative, or maintenance activities. Six of these fatalities were due to sudden cardiac death and one to stroke while firefighters were working around the station. One firefighter suffered sudden cardiac death after conducting a pump test at the department’s training facility. A fire chief suffered sudden cardiac death at the funeral of another firefighter. One firefighter who had been diagnosed with post-traumatic stress disorder died by suicide at the fire station. One firefighter was killed in an explosion that occurred while firefighters were preparing fireworks for their community’s holiday firework display. A firefighter driving from one fire station to another for an overtime shift was killed in a motor vehicle crash.
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 firefighter fatalities in 2019. Of the 26 deaths in this category, 22 were classified as sudden cardiac deaths (usually heart attacks), two were due to strokes, one was heat stroke, and one death was by suicide.
The next leading cause of death was internal trauma and crushing, with 14 deaths. Additionally, four firefighters died of burns, two died of asphyxia or smoke inhalation, one was electrocuted, and one died of a gunshot.
Sudden cardiac deaths
The 22 sudden cardiac deaths in 2019, with onset while the victim was on duty, mark the fourth consecutive year that the toll has been below 30, but they still account for the largest share of on-duty deaths. 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 have 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 U.S. Fire Administration (USFA) is following up on the deaths of almost 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 2019, four firefighters died in vehicle crashes, four were struck by vehicles, and one fell from a moving vehicle. In the past, crashes of road vehicles consistently accounted for the second-largest share of on-duty deaths, but the number has dropped in recent years, with fewer than five deaths in three of the last 10 years. Deaths in road vehicle crashes, which accounted for three of the four crash deaths in 2019, have ranged over the years from a high of 25 to this year’s low of three.
Two of the four firefighters who died in crashes were killed while responding to emergencies: one to a motor vehicle crash and one to a wildland fire. One firefighter was driving his own vehicle from his shift at one fire station to an overtime shift at another station. None of the drivers was wearing a seatbelt, and speed was a factor in the two of the response deaths.
In the one crash that did not occur on a road or highway, the firefighter was killed in a helicopter crash during operations at a prescribed burn. The pilot and another crew member were injured.
Four firefighters were killed when struck by vehicles: two while operating at crash scenes, one at the scene of a structure fire, and one while returning from a fire. One was assessing the condition of the driver of one of two vehicles involved in a crash when he was struck in the head by the side mirror of a passing semi-tractor trailer truck and pinned between the two vehicles. He was wearing a traffic safety vest but no other details about scene security were reported. Another firefighter was struck at the scene of a pre-dawn crash when the driver of a semi-tractor trailer failed to stop and struck two parked cars at the scene before striking the firefighter who was standing near the original crash. The driver said that he thought the emergency lights of the parked emergency vehicles ahead of him were the lights of an oncoming ambulance, and that faulty brakes on his truck prevented him from stopping in time. A third firefighter was retrieving a tool from his fire truck at the scene of a structure fire when he tripped getting out of the driver’s side of the truck, fell into the path of a passing vehicle, and was run over. The driver did not have time to react and could not avoid him. In the fourth incident, two firefighters were in a tanker returning from a fire call when they got out of the truck to check the tires after hearing a strange noise. While standing on the dark, unlit narrow road, they were struck by the personal vehicle of another returning firefighter who did not see them standing in the road. One of the firefighters was killed and the other was injured.
A firefighter responding to a motor vehicle crash in the front passenger seat of a fire engine fell to the ground and struck his head when the cab door opened as the vehicle slowly made a left-hand turn from a stop sign. There was no mechanical problem with the door or its latch. The victim’s seatbelt was unfastened.
Other findings
In 2019, a firefighter collapsed and died at the scene of a fire that was set on the porch of a single-family home. From 2010 through 2019, 31 firefighters (4.6 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 2019, one firefighter fatality was associated with a false call. Over the past 10 years, five firefighter deaths have resulted from false calls, including malicious false alarms and alarm malfunctions.
The firefighters who died in 2019 ranged in age from 21 to 81, with a median age of 46.5. In firefighter deaths from 2015 through 2019, the lowest death rates were for firefighters between the ages of 20 and 29. Their death rate was about a quarter of the all-age average. The death 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 volunteer firefighters in 2019 is the lowest reported in all the years of this study, and represents a sharp drop from the annual average of 36 over the previous 10 years. It is also far lower than the annual average of 67 deaths in the earliest years of this study. The 20 deaths of career firefighters while on duty in 2019 is the third time in the past four years that the total has been 20 or fewer. In the earliest years of this study, the annual average number of deaths of career firefighters while on duty was 57.
Effects of long-term exposures
While NFPA’s study focuses on on-duty deaths tied to specific events that occur while firefighters are at work, the hazards of firefighting also include long-term exposure to carcinogens and other contaminants, as well as physical and emotional stress and strain. While it is not possible to fully capture the number of deaths that result from these long-term effects, there are sources to provide some insight into the magnitude of the problem.
The Firefighter Behavioral Health Alliance (FBHA) has reports on 119 firefighters and 20 EMTs and paramedics who died by suicide in 2019. For 2019, the USFA is processing almost a dozen fatalities that potentially qualify for federal death benefits under the Hometown Heroes Act—deaths that occurred within 24 hours of non-routine strenuous or stressful physical activity. We know from reseach conducted 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 lists more than 130 firefighter cancer deaths in 2019 on its website.
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.
The 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 real-time particulate and toxic gas sensors to alert firefighters to hazards in the air. A foundation report on the development and implementation of a fire service contaminant control campaign is posted on NFPA’s website. 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, this is a problem that follows firefighters after their careers end, whether in retirement or some other form of separation from the fire service. Many programs are available to firefighters and retired firefighters that address behaviorial issues. The National Volunteer Fire Council (NVFC), for example, has a program for firefighters, EMTs, and their families called Share the Load, which points them to resources and support for mental well-being. In June, NVFC launched a directory, available at nvfc.org, of licensed behavioral health professionals familiar with the fire service culture, part of an effort to help improve access to behavioral health care for firefighters.
Additionally, the International Association of Fire Fighters (IAFF) offers advice on establishing a peer support program. In October 2019, the IAFF launched a suicide reporting system for its members, and it has also developed material on coping in the aftermath of a friend or colleague’s 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.”
Both the U.S. House and Senate have introduced bills to establish a public safety officer suicide reporting system at the CDC in order to collect information on the incidence of suicide in this group and 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. The legislation was introduced in the House in 2019 and in the Senate in January 2020.
Heart disease 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 the 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, including the Fire Service Joint Labor-Management Wellness-Fitness Initiative, an effort of the IAFF and the International Association of Fire Chiefs, and the NVFC’s Heart-Healthy Firefighter Program, launched in 2003 to address heart attack prevention for all firefighters and EMS personnel through fitness, nutrition, and health awareness.
Summary and acknowledgements
Last year was marked by historic lows for deaths of firefighters while on duty. The 48 on-duty firefighter deaths in the US in 2019 was by far the lowest death toll reported for this study. Sudden cardiac death, though accounting for almost half of the fatalities, was also at the lowest level ever. The 22 sudden cardiac deaths in 2019 is almost one-third lower than the annual average over the previous 10 years. Deaths at structure fires continued the recent trend of fewer than a dozen. Deaths in road vehicle crashes and deaths of volunteer firefighters were at record lows. Although deaths of career firefighters were not at their lowest level ever, the total has been 25 or fewer for nine of the past 10 years.
It is important to note that one year’s experience cannot be interpreted as evidence of a trend, and we know already that the death toll in 2020 will likely be higher as a result of COVID-19 deaths that have already been reported. But there are promising indications that real, sustained progress has been achieved in the reduction of deaths in some categories, such as cardiac-related issues, structure fires, and vehicle crashes. Other findings are not as positive, however; a firefighter was shot and killed at an EMS call in 2019, the ninth firefighter to be murdered on duty in the past 10 years.
This study is made possible by the cooperation and assistance of the United States fire service, the CDC's National Institute for Occupational Safety and Health, the USFA, the Forest Service of the US Department of Agriculture, and the Bureau of Indian Affairs and the Bureau of Land Management of the U.S. Department of the Interior.
Rita F. Fahy, Ph.D., is a manager in NFPA’s Applied Research Division. Jay T. Petrilo is a fire data assistant at NFPA and a captain with the fire department in North Providence, Rhode Island. 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