FFFIPP 2014 Progress Report 11 June 2014

FFFIPP Progress Report 1 

NIOSH Fire Fighter Fatality Investigation and Prevention Program 

(FFFIPP) Progress Report and Proposed Future Directions – 2014

The National Institute for Occupational Safety and Health (NIOSH) is committed to 

ensuring that the NIOSH Fire Fighter Fatality Investigation and Prevention Program 

(FFFIPP) is meeting the needs and expectations of the U.S. fire service. NIOSH has 

sought public input to help plan and direct the goals and objectives of the FFFIPP since 

the program was initiated in 1998. NIOSH received public comments on the FFFIPP in 

January 1998, March 2006, November 2008, and August of 2011. Records of previous 

public comment periods are available at: 

http://www.cdc.gov/niosh/fire/programreview.html.

In 2011, 26 comments were received from a variety of sources. This included 14 fire 

departments, 4 private individuals, 4 professional organizations, 2 colleges or 

universities, and 2 Federal agencies. These comments are available at:

http://www.cdc.gov/niosh/docket/archive/docket063B.html.

The primary modifications made to the FFFIPP following the August 2011 stakeholder 

comments are as follows: The FFFIPP is more attentive to selecting reviewers that have 

experience and expertise matched to the event circumstances of an investigation; in cases 

where highly specialized issues are identified as contributing factors, external fire service 

subject matter experts are consulted to assist during the investigation; and the FFFIPP is 

working closely with the National Volunteer Fire Council in conducting volunteer fire 

department fatality investigations and in obtaining reviewers for incidents involving 

volunteer fire departments. 

NIOSH is again seeking stakeholder input on the progress and future directions of the 

NIOSH FFFIPP to ensure that the program is meeting the needs and expectations of the 

U.S. fire service, and to identify ways in which the program can be improved to increase 

its impact on the safety and health of fire fighters across the United States.

Background

During fiscal year 1998, Congress identified the need to address the continuing national 

problem of occupational fire fighter fatalities and funded NIOSH to implement a fire 

fighter safety initiative. In response to stakeholders, the FFFIPP conducts independent 

investigations of fire fighter line-of-duty deaths (LODD) and formulates

recommendations for preventing deaths and injuries. 

Since the FFFIPP was initiated, 1,983 fire fighters have died in the line-of-duty through 

2013 (not counting the 343 fire fighters who died on September 11, 2001). During this 

period the FFFIPP investigated 644 fire fighter LODDs or 32 percent of the total (368

trauma and 276 medical LODDs). 
FFFIPP 2014 Progress Report 11 June 2014

FFFIPP Progress Report 2 

Investigation Priorities

Since NIOSH does not have the resources to conduct investigations of all fire fighter 

LODDs, each incident is prioritized using a decision logic that can be found on the 

NIOSH FFFIPP website at http://www.cdc.gov/niosh/fire/pdfs/FFFIP_DecisionChart.pdf. 

The current priorities for investigating traumatic LODDs include multiple fatality events, 

structure fires, motor vehicle incidents, and new or emerging hazards. The priorities for 

investigating medical LODDs include hyper/hypothermia; seizures, diabetes, and drug 

overdose; sudden cardiac death during physical fitness training; sudden cardiac death 

during emergency responder training; and sudden cardiac death on the fireground. 

NIOSH welcomes comments on these priorities along with suggestions for replacing or 

modifying them. 

Program Accomplishments 

From January 2011 through April 30, 2014, the FFFIPP has accomplished the following:

 Completed – 48 medical and 47 traumatic injury investigations;

 Published – NIOSH Workplace Solutions: Preventing Deaths and Injuries of Fire 

Fighters Operating Modified Excess/Surplus Vehicles. DHHS (NIOSH)

Publication No. 2011-125;

 Published – NIOSH Workplace Solutions: Preventing Deaths and Injuries to Fire 

Fighters by Establishing Collapse Zones at Structure Fires. DHHS (NIOSH)

Publication No. 2014-120;

 Published – Estes CR, SM Marsh and DN Castillo (2011). Surveillance of 

Traumatic Firefighter Fatalities: An Assessment of Four Systems. Pub Health 

Rep 126(4):540-51;

 Released – Fire Fighter Fatality Map Application on the NIOSH website. 

Available at http://wwwn.cdc.gov/wisards/fffmap/;

 Provided information and data from a series of LODD investigations regarding 

the thermal degradation of Self-Contained Breathing Apparatus face piece lenses 

to the National Fire Protection Agency (NFPA) Technical Committee on 

Respiratory Protective Equipment. This contributed to decisions to raise the 

temperature requirements for heat and flame tests including an additional radiant 

heat test effective in the 2013 edition of NFPA 1981 Standard on Open-Circuit 

Self-Contained Breathing Apparatus (SCBA) for Emergency Services;

 Provided information and data from several recent cardiovascular disease (CVD)

related investigations associated with left ventricular hypertrophy to the NFPA 

Technical Committee on Fire Service Occupational Safety and Health;
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FFFIPP Progress Report 3 

 Provided information and data from heat stroke fatality investigations to the 

NFPA and the National Wildland Coordinating Group;

 Provided information and data from a recent training-related LODD investigation 

involving an elevated aerial platform to the NFPA Technical Committee on 

Automotive Fire Apparatus;

 Provided information and data from recent LODD investigations involving land 

mobile radio design and operational issues to the NFPA Technical Committee on 

Electronic Safety Equipment. A new standard is currently being developed 

entitled NFPA 1802 Standard on Two-Way, Portable (Hand-held) Land Mobile 

Radios for Use by Emergency Services Personnel.

 Provided information and data to NFPA from recent LODD investigations which 

supported the revision of NFPA 1561 Standard on Emergency Services Incident 

Management System and Command Safety (Effective date: December 2, 2013). 

The standard’s title now includes “Command Safety” and the addition of a new 

chapter, Command Safety. This chapter will provide a foundation on how to 

incorporate the incident management system at all emergency incidents;

 Provided information and data to NFPA from recent transportation-related LODD 

investigations which were used to support the pending NFPA 1091 Standard for 

Traffic Control Incident Management Personnel Professional Qualifications. 

Final approval by the full committee is anticipated in the Fall of 2014. 

 Disseminated findings from NIOSH investigations via presentations at multiple 

fire service and medical conferences.

In addition, the FFFIPP continues to receive examples of the fire service using program 

findings and recommendations to improve fire fighter safety. For example: 

 During 2011, 2012, and 2013 there were a total of 383,952 visits to the FFFIPP 

webpage; 

 Fire departments regularly report using FFFIPP investigation reports and 

publications to support fire fighter training and during promotional examinations;

 The 2012 International Residential Code requires the application of a drywall or 

structural wood membrane to the underside of floor systems in non-sprinkler 

residential dwellings. The International Association of Fire Fighters (IAFF) 

proposed this code modification based in part on findings from NIOSH LODD 

investigations and recommendations that lightweight construction systems be 

protected with a fire-resistant barrier;

 Fire service publications frequently reference and encourage the use of NIOSH 

fatality investigation reports and recommendations to improve fire fighter safety.
FFFIPP 2014 Progress Report 11 June 2014

FFFIPP Progress Report 4 

Strategic Plan

Since 2009, the Strategic Plan for the NIOSH FFFIPP has been used to guide the research 

and continued implementation of the program (available at

http://www.cdc.gov/niosh/fire/strategicplan2009.html). The Strategic Plan addresses the

mission of the FFFIPP, strategic goals to improve fire fighter health and safety, program 

activity/output goals, and performance measures by which the program can be evaluated. 

Progress Toward Goal Achievement

The following table summarizes the FFFIPP implementation progress since January 2011

related to individual activity/output goals and performance measures in the Strategic 

Plan.

FFFIPP Progress

Activity/Output Goals

Performance Measures

Progress (January 2011

through April 2014)

Comments

Goal A: Conduct fatality 

investigations as the principal 

activity of the FFFIPP

95 fatality investigations 

completed (48 medical and 

47 traumatic)

NIOSH proposes that 

LODD investigations 

remain the highest 

FFFIPP priority

A.1: Investigations will be 

finalized each year at a minimum

of 3 investigations per fulltime 

investigator.

8 investigators (7 fulltime

and 1 half-time) completed 

84 investigations (3 per 

investigator per year for 

traumatic and 10 per 

investigator per year for 

medical)

The program is 

currently staffed with 

7 fulltime 

investigators, 5

assigned to traumatic

investigations.
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FFFIPP Progress Report 5 

FFFIPP Progress

Activity/Output Goals

Performance Measures

Progress (January 2011

through April 2014)

Comments

A.2: 90% of investigations 

through 2013 will involve CVDs, 

structure fires, or motor vehicle 

accidents (MVA) incidents.

85% of all cases involved 

CVDs, structure fires, or 

MVA incidents.

The goal of 90% of 

investigations 

involving CVDs, 

structure fires, or 

motor vehicles was 

not met because of 

NIOSH investigating 

several incidents 

involving other 

serious medical 

conditions (e.g., heat 

stroke) and unique 

trauma events (e.g., 

training related 

fatalities, explosions)

at the request of the 

fire service. 

A.3: Initial site visits will be 

conducted within 3 weeks of the 

fatality in 80% of fatal traumatic 

injury incidents.

Site visits were conducted 

for 63% of traumatic injury

incidents within 3 weeks. 

Site visits are often 

delayed at the request 

of the fire 

department, in 

deference to funeral 

and memorial 

services

A.4: Input will be obtained to 

improve the design and format of 

fatality investigation reports by

Fiscal Year 2010.

Report format revisions 

were implemented during 

2009 and 2010. 

NIOSH continues to 

welcome stakeholder

comment on reports 

to improve their 

utility to the fire 

service.

A.5: Investigation priorities will 

be revisited and input sought for 

proposed changes by 2010. 

Stakeholder input from the 

2011 docket is being 

addressed.

CVDs, structure fires, 

and motor vehicle 

incidents continue to 

be leading causes of 

LODD in the fire 

service.
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FFFIPP Progress Report 6 

FFFIPP Progress

Activity/Output Goals

Performance Measures

Progress (January 2011

through April 2014)

Comments

Goal B: Individual fatality 

reports will be generated for 

each investigation and 

investigation findings will be 

reported and summarized in 

additional publications. 

A report is completed for 

each investigation and 

additional NIOSH 

publications are developed

as issues are identified.

The Program will 

continue producing 

LODD reports and 

NIOSH publications, 

such as the recently 

released Workplace 

Solutions document 

on building collapse 

zones. 

B.1: 50% of investigation reports

will be completed within 6 months 

of the site visit, 95% will be within 

12 months.

41% of the investigation

reports were completed 

within 6 months and 75% 

were completed within 12 

months. 

The Program will 

continue efforts to 

reduce the

completion time for 

investigations. 

Incidents involving 

larger departments, 

multiple fatalities,

criminal charges, and 

delays in autopsy

reports frequently 

result in longer 

completion times.

B.2: One document (other than a 

fatality report) will be published 

annually

NIOSH Workplace 

Solutions were published in 

2011 and 2014. 

While NIOSH has

not released at least 

one such document 

annually, several new 

documents are in 

various stages of 

development. 

Goal C: Seek peer and 

stakeholder input to improve the 

quality of products and the 

impact of the program.

C.1: 75% of traumatic fatality

reports will be reviewed by

external experts and 100% of 

publications will be reviewed by 

peers and/or stakeholders

100% of traumatic LODD 

reports were reviewed by

one or more external fire 

service subject matter 

experts. Also, 100% of all 

publications were reviewed

by peers and stakeholders.
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FFFIPP Progress Report 7 

FFFIPP Progress

Activity/Output Goals

Performance Measures

Progress (January 2011

through April 2014)

Comments

C.2.: Expert consultation and/or 

testing will be sought on all 

investigations suggestive of 

personal protective technology

malfunctions or failures. 

External expert consultation 

was sought for 4 cases

involving the possibility of 

equipment malfunctions. 

NIOSH’s National 

Personal Protective 

Technology

Laboratory (NPPTL) 

assesses Personal 

Protective Equipment 

(PPE) and SCBA 

issues.

C.3: Stakeholder input will be 

sought at least every two years 

through a public meeting and/or 

docket.

NIOSH last received written 

comments from an open 

docket in 2011. 

NIOSH proposes to 

seek stakeholder 

input through public 

meetings and/or 

dockets every five 

years. 

Goal D: Increase fire service 

expertise of FFFIPP personnel

D.1: Each trauma investigator will 

take at least one fire service 

training course or attend a fire 

service conference specifically for 

training annually.

Each investigator attended 

one or more fire service 

training sessions annually.

D.2: Announcements for

investigator positions will require 

fire service and occupational 

safety and health experience.

The team includes 4 

investigators with fire 

service experience 

Goal E: Ensure FFFIPP 

recommendations and products 

are used to improve fire fighter 

safety and health

E.1: The program will be involved 

in at least 2 outreach activities 

annually.

The program actively 

supports the National 

Volunteer Fire Council 

Safety and Health Week and 

the International 

Association of Fire Chief’s

Safety, Health, and Survival 

Week annually.
FFFIPP 2014 Progress Report 11 June 2014

FFFIPP Progress Report 8 

FFFIPP Progress

Activity/Output Goals

Performance Measures

Progress (January 2011

through April 2014)

Comments

E.2: FFFIPP investigators will 

meet annually with the National 

Personal Protective Technology

Laboratory (NPPTL) staff to 

discuss investigation findings 

related to personal protective 

technology.

Annual meetings were held

to discuss findings related to 

personal protective 

equipment (PPE). FFFIPP 

and NPPTL routinely 

collaborate on PPE 

evaluations related to fire 

fighter LODDs.

NPPTL has 

established labs at the

NIOSH Morgantown 

site to better support 

and collaborate with

FFFIPP investigators 

on investigationrelated PPE 

evaluations.

E.3: Investigation findings will be 

communicated to the National Fire 

Protection Association (NFPA) 

and other standards setting 

agencies annually.

FFFIPP and NIOSH staff

members participate on 4

NFPA Technical 

Committees. NIOSH 

documented issues 

involving land mobile 

(portable hand held) radios 

to NFPA by letter in 2012.

FFFIPP staff also 

participated in the 

IAFF/IAFC Wellness 

Fitness committee meetings 

NIOSH proposes

continued 

participation on 

NFPA committees; 

however, travel 

restrictions may limit 

NIOSH staff face-toface participation in 

all meetings.

E.4: Relevant investigation 

findings will be communicated to 

PPE manufacturer groups and 

Certification Organizations as 

needed, and at least every two 

years.

Findings related to thermal 

degradation of SCBA lenses

and portable radios were

provided to NFPA.

Manufacturers of fire 

service equipment, 

including SCBA and 

radios are represented 

on the corresponding 

NFPA committees.

E.5: Implement improved 

communications strategy to reach 

small and volunteer departments

by 2011.

FFFIPP team members and 

the National Volunteer Fire 

Council (NVFC) have 

discussed ideas for 

improving outreach to 

volunteer departments. 

NVFC is serving as a liaison

to facilitate volunteer 

department LODD 

investigations.

NIOSH continues to 

work with NVFC to 

identify approaches 

to increase outreach 

activities with 

volunteer fire 

departments in the 

US. The Division of 

Safety Research is in 

the process of hiring 

a Health 

Communication 

Fellow which will 

help to better address 

this goal in the future.
FFFIPP 2014 Progress Report 11 June 2014

FFFIPP Progress Report 9 

FFFIPP Progress

Activity/Output Goals

Performance Measures

Progress (January 2011

through April 2014)

Comments

E.6: Implement input from a web 

publishing consultant to improve 

the FFFIPP Web site by 2011.

Work has not been 

completed on this 

effort because the 

FFFIPP has focused

on competing 

priorities. The 

Division of Safety

Research is in the 

process of hiring a 

Health 

Communication 

Fellow which will 

help to better address 

this goal in the future.

E.7: Develop a survey that would 

be provided to all departments 

following a NIOSH fatality

investigation that would provide 

feedback on the investigation and 

departmental changes made as a 

result of the investigation will be 

developed by Fiscal Year 2011 

and implemented by 2013. 

A pilot survey was 

developed and is being pilot 

tested. An initial 

assessment has been 

completed by the medical 

investigation team. 

E.8: Seek funding to conduct a 

study assessing the FFFIPP impact

on fire department training, 

policies and practices by Fiscal 

Year 2012.

Work has not been 

conducted on this

effort because the 

FFFIPP has focused

on competing 

priorities.

Proposed Future Directions

The FFFIPP proposes to continue the emphasis on independent investigations of fire 

fighter line-of-duty deaths as it first priority. NIOSH participation on standard-setting 

committees, such as NFPA technical committees, may take a lessor priority, including 

not attending meeting in person. Attendance at conferences, workshops, training, and fire 

service stakeholder meetings may be reduced or eliminated. Electronic versions of reports 

and publications will continue to be available through the NIOSH and FFFIPP web 

pages. NIOSH welcomes comments on proposed priorities for the FFFIPP. 

Specific Topics for Stakeholder Input in 2014 
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FFFIPP Progress Report 10 

The NIOSH FFFIPP welcomes comments on any aspect of the FFFIPP. Additionally, 

specific comments are being solicited on the following topics:

 FFFIPP priorities for conducting investigations;

 Changes to the format of FFFIPP investigation reports;

 Changes to the FFFIPP website;

 Changing the frequency of public meeting/docket solicitation for suggested 

improvements to the program to five years;

 Examples of how FFFIPP investigation reports and products are used by fire 

service organizations, fire departments and fire fighters, and fire service safety

and health researchers; 

 Examples of FFFIPP impact on fire fighter safety and health; and

 Whether NIOSH should contact a family member of the victim to update them on the 

NIOSH investigation.