The National Institute for Occupational Safety and Health (NIOSH) is an agency of the United States government located in the Department of Health and Human Services, and is part of the Centers for Disease Control and Prevention (CDC). NIOSH is responsible for conducting research and making recommendations for the prevention of work-related illnesses and injuries. In fiscal year 1998, NIOSH initiated a new program entitled, NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP).

Since the inception of the FFFIPP through February 2006, NIOSH, with the cooperation of fire departments and fire fighters around the country, has conducted 324 fatality investigations in 48 states. These 324 investigations accounted for 366 fire fighter deaths. Additionally, nine nonfatal injury investigations were conducted involving 19 fire fighters. Based on data reported by the U.S. Fire Administration (USFA) on the annual number of fire fighter fatalities, the FFFIPP investigated 44% of fire fighter fatalities for the period 1988 to 2004, excluding the fire fighter deaths associated with the 2001 World Trade Center attacks. The fatality investigations were conducted at 183 career and 141 volunteer fire departments. Traumatic injury incidents accounted for 175 of the investigations (71 structure fires, 53 motor vehicle-related, 16 training, 15 wildland, 9 falls, 6 explosions, and 5 "others" [i.e., helicopter crash, electrocution, homicide, drowning, and fireworks]). Cardiovascular/medical incidents accounted for 149 investigations. The investigations have taken place in all states except Idaho and Rhode Island.

Recommendations which have been made most frequently have been directed to fire departments and can be grouped into ten general categories:

• cardiovascular health (e.g. ensuring that medical evaluations screen fire fighters for coronary artery disease risk factors),
• fitness and wellness programs (e.g. implementing mandatory fitness programs that are positive, non-punitive and individualized),
• standard operating procedures/guidelines (e.g. developing and enforcing written procedures/guidelines and ensuring that all officers and fire fighters are trained and knowledgeable of the procedures/guidelines),
• communications (e.g. ensuring that two-way communication is established and coordinated between incident management and fire fighter crews),
• incident command (e.g. ensuring that the Incident Commander is clearly identified and maintains the role of directing operations and scene management),
• motor vehicle-related (e.g. enforcing policies that require all fire personnel riding in emergency vehicles to be seat-belted),
• personal protective equipment (e.g. ensuring that SCBA are properly inspected, used and maintained),
• strategies and tactics (e.g. suspending defensive exterior fire fighting operations prior to switching to interior fire fighting operations to minimize hazards to fire fighters working inside structures),
• rapid intervention teams (e.g. ensuring that a properly trained and equipped rapid intervention team is in position when other fire fighters enter a dangerous environment, such as a burning structure), and
• staffing (e.g. ensuring that adequate personnel and equipment are on scene in accordance with NFPA standards).

Recommendations in NIOSH fatality investigative reports and summary documents may be used by individual fire departments, unions, state governments, and public and private fire service agencies to identify and advocate for needed changes in: fire department policies and procedures to better protect fire fighters and ensure well-being; training to ensure that fire fighters have the necessary knowledge and skills to work safely; and consensus and mandatory standards to establish minimum conditions for fire fighter safety and health.

NIOSH recommendations have also been targeted to:

• manufacturers to enhance safety aspects of fire service equipment,
• municipalities to address organization and coordination of fire services as well as safety requirements related to buildings and structures,
• standard setting bodies to modify or develop new standards, and
• research organizations to enhance and develop technologies to improve fire fighter safety.

NIOSH-NFFF Stakeholders Meeting

NIOSH continues to seek input on the NIOSH Fire Fighter Fatality Investigation and Prevention Program to ensure that the program is meeting the needs of stakeholders, and to identify ways in which NIOSH might improve upon the program to increase its impact on the safety and health of fire fighters across the United States. NIOSH held a stakeholders' meeting on March 22nd, 2006, in Washington, D.C. The meeting was attended by 37 individuals representing fire service organizations including the National Fallen Firefighters Foundation, individual fire departments, standards setting organizations, federal agencies, and equipment manufacturers.

Information provided to NIOSH at the stakeholder meeting will be used to refine the program to ensure it meets the needs of stakeholders. Similarly, data collected from other evaluation techniques will be used to determine if adjustments to the program are needed or would be beneficial in increasing the impact of the FFFIPP on fire fighter safety and health.

Specific areas that NIOSH has asked for input by the stakeholders include the following proposals that were presented by the NIOSH representatives at the meeting:

NIOSH proposes that the primary focus of the NIOSH FFFIPP continue to be fatality investigations, but that the intensity of investigations be modestly reduced to support personnel increasing involvement in other activities described in the Dissemination, Outreach and Research Sub-sections below.

Dissemination

NIOSH proposes increasing efforts to develop educational documents summarizing specific hazards encountered across multiple investigations. Examples of such documents that are currently under development include NIOSH Alerts addressing cardiovascular deaths, motor vehicle-related events, training incidents, and risk versus gain decisions on the fireground.

NIOSH also proposes to continue to seek novel ways to disseminate findings and products, such as working with trade journals to further disseminate NIOSH reports and findings, and the biweekly quiz on the NIOSH FFFIPP Web site that directs users to answers in NIOSH publications.

Outreach

NIOSH proposes to continue to aggressively conduct outreach and partnership activities to foster increased use of NIOSH FFFIPP findings and products by fire service organizations and to pursue activities that complement and support prevention efforts of others.

Research NIOSH proposes conducting more routine and in-depth analyses of available data on fire fighter deaths and injuries (e.g. fatality data collected and reported by USFA and NFPA, data from the National Fire Incident Reporting System, and data from occupational injury and illness databases such as the Bureau of Labor Statistics' Census of Fatal Occupational Injuries and the Consumer Product Safety Commission's National Electronic Injury Surveillance System based on a nationally representative sample of hospital emergency departments). Such analyses would be used to guide NIOSH fatality investigations; add to knowledge about patterns of fire fighter injury and illness, risk factors for injury and illness, and levels of risk experienced by fire fighters; and, identify needed improvements in available surveillance data. NIOSH is interested in stakeholder input on the value and need for NIOSH to conduct these data analyses.

Additionally, NIOSH proposes to increase efforts to foster research that builds from NIOSH investigation findings and recommendations, and to leverage resources to conduct such research. This includes seeking funding opportunities through initiatives such as NORA, as well as pursuing funding through other federal agencies and the private sector. This also includes identifying partnerships in which NIOSH would conduct formal evaluations of specific intervention efforts at the national, state or local level interventions.

Program Evaluation NIOSH is currently considering objective means of measuring the performance of the FFFIPP and its impact on fire fighter safety and health. Assessing trends in fire fighter deaths and injuries is a potential performance measure; however, this measure has limitations since NIOSH is a research agency without a direct role in making changes in the workplace.