U.S. Fire Administration

Critical Health and 

Safety Issues in the 

Volunteer Fire Service

December 2016

Mission Statement

We provide national leadership to foster a solid foundation for 

our fi re and emergency services stakeholders in prevention, 

preparedness, and response.

U.S. Fire Administration

This project is supported by a Contract (HSFE-20-14-P-0171) 

between the U.S. Fire Administration and the National Volunteer 

Fire Council.

Disclaimer

The content of this report is for informational purposes only. It is not a substitute for advice 

from a physician. You should seek prompt medical care for any specific health issues; only 

a health care provider should diagnose a medical condition and prescribe treatment.

Acknowledgements | i

Acknowledgments

The National Volunteer Fire Council (NVFC) and the U.S. Fire Administration (USFA) would 

like to recognize and thank the following individuals and their respective organizations for 

their contributions and assistance toward the development of this document. NVFC and 

USFA would also like to thank all of the volunteer fire service men and women for their 

dedication to serve others.

Candice McDonald

International Association of Women in 

Fire and Emergency Services

Dan Gorham

Fire Protection Research Foundation

Chief Keith Padgett

Columbia Southern University

Chief Kenn Fontenot

NVFC, Health, Safety and Training 

Committee

Chief Kevin D. Quinn

NVFC, Chairman and Standards and 

Codes Committee

Kimberly Quiros

NVFC, Chief of Communications

Lori Shirley

NVFC, Project Manager

Matt E. Bowyer

National Institute for Occupational Safety 

and Health

Dr. Nattinee Jitnarin

Center for Fire, Rescue and EMS Health 

Research

Battalion Chief Quentin A. Cash

Shelby Fire-Rescue Department, North 

Carolina

Dr. Rita Fahy

National Fire Protection Association

Battalion Chief Ron Roy

NVFC, Wildland Committee

Dr. Sara A. Jahnke

Center for Fire, Rescue and EMS Health 

Research

Sarah Lee

NVFC, Deputy Chief Executive

Steve Austin

Cumberland Valley Volunteer Firemen’s 

Association, Emergency Responder 

Safety Institute

Wesley M. Keller

Pennsylvania Bureau of Forestry

Dr. William F. Jenaway

Volunteer Firemen’s Insurance Services

William J. Troup

USFA, Project Officer
ii | Critical Health and Safety Issues in the Volunteer Fire Service
Table of Contents | iii

Table of Contents

Introduction ......................................................................................................................... 1

Critical Issues ....................................................................................................................... 3

The Culture ......................................................................................................................... 3

Recruitment and Retention.............................................................................................. 9

Recruitment................................................................................................................. 9

Retention...................................................................................................................... 13

Funding ............................................................................................................................... 15

Transitioning to a Combination Department, Consolidations and Mergers ...... 15

Resources..................................................................................................................... 18

Fidelity .......................................................................................................................... 19

Expanded Role of Firefighters.......................................................................................... 22

Emergency Medical Services..................................................................................... 22

Wildland Firefighting .................................................................................................. 24

Suppression .......................................................................................................... 24

Mitigation .............................................................................................................. 27

Violence Against First Responders ........................................................................... 29

Personal Health.................................................................................................................. 31

Behavioral Health ....................................................................................................... 31

Cardiovascular Disease .............................................................................................. 34

Physicals and Fitness.................................................................................................. 36

Nutrition....................................................................................................................... 40

Cancer........................................................................................................................... 43

Alcohol, Tobacco and Prescription Drug Abuse...................................................... 47

Alcohol ................................................................................................................... 48

Tobacco.................................................................................................................. 48

Prescription Drugs ............................................................................................... 50

Safety Protocols ................................................................................................................. 53

Codes and Standards ................................................................................................. 53
iv | Critical Health and Safety Issues in the Volunteer Fire Service

Vehicle-Related Safety................................................................................................ 55

Personally Operated Vehicles............................................................................. 55

Emergency Vehicle Operations .......................................................................... 57

Traffic Incident Management.............................................................................. 58

Occupational Safety and Health Act ........................................................................ 59

Standard Operating Procedures............................................................................... 60

Role of the Company Officer in Safety..................................................................... 62

Situational Awareness................................................................................................ 62

Personal Protective Equipment ................................................................................ 63

Mutual and Automatic Aid......................................................................................... 65

Conclusion............................................................................................................................ 69

Fire Department Resources ............................................................................................... 71

References............................................................................................................................ 75

Acronyms.............................................................................................................................. 87
Introduction | 1

Introduction

Volunteer firefighters represent 69 percent of the U.S. fire service (Haynes & Stein, 2016). 

As a nation, we rely on them every day to save lives and protect property in times of 

danger and disaster. In order to do so, they must first be healthy, safe and able to respond. 

Firefighters are hurt and/or die from a number of health and occupational safety issues, 

such as heart attack, cancer and vehicle crashes. A fundamental change is needed to 

overturn these issues and revolutionize the volunteer fire and emergency services to 

create healthier and safer work environments for volunteer responders.

The causes of firefighter injuries and fatalities have been tracked for years by the U.S. 

Fire Administration (USFA) and other leading fire service organizations in an effort to 

increase awareness and understanding of such causes, with the ultimate goal to reduce 

the number of responder injuries and deaths (USFA, 2015). With this goal in mind, USFA 

and the National Volunteer Fire Council (NVFC) created a project team to review data 

and identify health and safety trends specific to the volunteer emergency services. The 

resulting document, “Emerging Health and Safety Issues in the Volunteer Fire Service,” 

was first released in 2008. This document included a formula to address the identified 

emerging health and safety issues and how to manage them going forward. It can be 

graphically represented as follows:

Figure 1. Formula to Address and Manage Emerging Health and Safety Issues

Routine 

Health

Screenings

Positive

Lifestyle 

Behaviors

A Safe

Work 

Environment

Reduced 

Firefighter 

Injuries

+ + =

Source: USFA and NVFC, 2008.

While these steps do significantly improve individual health and safety outcomes, more 

recent research shows that issues and trends that ultimately impact firefighter health 

and safety are more deeply rooted in the culture of the fire service. Additionally, the 

identified health and safety issues are no longer 

recognized as “emerging” because their longstanding nature has remained constant over 

the years and continues to concern the fire 

service, regardless of the focus placed upon 

these issues at any given time.

An updated edition, “Critical Health and 

Safety Issues in the Volunteer Fire Service,” 

was published in 2010 by NVFC and USFA to 

further report on these issues. This version 

encompassed a larger population of research 

respondents and expanded upon behavioral 

health, which was originally identified simply 

as stress management. It also benchmarked 
2 | Critical Health and Safety Issues in the Volunteer Fire Service

first responders’ perceptions of their own health and the health of other firefighters 

compared to other professions. This new information brought to light an existing gap 

between understanding that health and safety are important and actually taking action 

to create a culture of health and safety in the fire and emergency services.

USFA and NVFC have partnered once again to re-evaluate known issues, discover new or 

emerging concerns, and provide the tools and resources necessary to overcome health 

and safety concerns plaguing the volunteer fire service. Six overall critical issues affecting 

the volunteer emergency services were identified. Existing research and trend analysis, 

coupled with feedback from the industry’s leading professionals, provided an in-depth 

analysis into the foundation of these issues and placed them in context with current health 

and safety practices to encourage a true change.

The six identified critical issues are:

1. The Culture. Changing the mindset of firefighters needs to be a priority, beginning 

with leadership, in order to change the culture to effectively improve the health and 

safety of emergency responders.

2. Recruitment and Retention. Competent, qualified, healthy personnel are critical to 

performing public safety jobs. If we can’t recruit and retain personnel, the job won’t 

be done safely and successfully.

3. Funding. Funding is critical to any operational success. If there is insufficient money 

allocated to equipment, personnel, resources, and training, it can place the overall 

operation at greater risk.

4. Expanded Roles of Firefighters. The additional responsibilities of all-hazard prevention, 

response, and mitigation, including Emergency Medical Services (EMS), require greater 

training, operational preparations, and healthy personnel to fulfill expectations.

5. Personal Health. Increasing research on emergency responder health implications 

has placed greater obligations on firefighters to focus on their health and be fully 

prepared for the job, both mentally and physically.

6. Safety Protocols. Fire science is being researched like never before, and each new 

scientific verification or finding impacts firefighting safety. New protocols and standards 

must be adopted and enforced by the department in order to ensure safe operations.

The relationship between overall emergency service critical issues and firefighter/EMS 

health and safety are further detailed in the body of this document. It is important to 

note that some of the research cited in this document was conducted on the fire and 

emergency services as a whole, due to the fact that specific studies of the volunteer sector 

alone are limited; however, all research noted in this report is applicable to volunteer fire 

and emergency service departments.

This report identifies resources, provides references, suggests tools, illustrates best 

practices, and establishes goals and objectives for each issue to help departments 

improve firefighter safety, well-being and survival. Also, look for “Tools for your Toolbox” 

throughout the document with ideas on how to implement practices relevant to a 

particular subject. Visit www.nvfc.org/criticalissues for supplemental resources to help 

address the volunteer fire service critical issues identified in this report.
Critical Issues | 3





Critical Issues

The Culture

The fire and emergency services are constantly evolving. Advancing technology, industry 

research, and easy access to information are all impacting the way volunteer departments 

do business and the way firefighters do their jobs. Positive progressions to initiate cultural 

change are creating safer environments and better workplace settings, which are vital to 

the health and safety of our firefighters and emergency responders.

However, longstanding traditions influence the way firefighters think and act. Changing 

the mindset of responders to move toward risk reduction (e.g., training senior leadership, 

developing and enforcing department standard operating procedures (SOPs), or 

formulating mentoring programs) is critical but not easy.

Linda Willing, a firefighter and adjunct instructor for the National Fire Academy (NFA), 

uses the shift in mindset regarding cigarettes as an example to describe three factors that 

influence change in fire service culture.

ĵ Change is mandated and supported from the top down. Department leaders must 

set clear expectations and lead through policy, outcomes and example. The desired 

change needs to be explicitly communicated, and those in positions of authority at all 

levels, especially Company Officers (COs), need to be held accountable. Willing wrote:

In my department, eliminating smoking was an incremental process. 

First, smoking was forbidden in all living spaces in the station, but allowed 

in the apparatus bay. Then it was eliminated from the station entirely. 

Finally, smoking was not allowed anywhere on fire station property, 

inside or outside. (2012, para. 12)
4 | Critical Health and Safety Issues in the Volunteer Fire Service

ĵ The change has to make sense for people to embrace it. Even those addicted to cigarettes 

can understand the value of having a smoke-free workplace for health, safety and 

personal comfort. The sense of this change is also reinforced by society’s changing 

attitudes about smoking.

ĵ When making cultural change, there has to be a constancy of purpose over the long 

haul. Eliminating smoking from the fire stations did not happen overnight. There was 

backsliding and some pockets of resistance. People needed support to change old 

habits. (Willing, 2012)

USFA, in partnership with the International Association of Fire Chiefs (IAFC), launched the 

National Safety Culture Change Initiative (NSCCI) in 2015 to identify fire and emergency 

service cultural aspects that contribute to occupational illnesses, injuries and fatalities. 

This effort identified the need to understand the fire and emergency service culture with 

the goal to further reduce line-of-duty deaths (LODDs) and serious injuries by clearly 

identifying the individual behaviors and the organizational factors that adversely impact 

firefighter safety and health, as well as the strategies to mitigate these effects. The NSCCI 

advocates for the need for culture change for health and safety within the fire service 

through training, which includes web-based educational modules that use operational 

incident scenarios; resources, such as assessment tools with checklists, to evaluate status 

and progress; a repository of publications and additional information on the topic of 

cultural change; and a formal report — “National Safety Culture Change Initiative.”

This report was developed to specifically study behavioral motivation on reduction of risktaking behaviors in the fire and emergency services. It provides a basic understanding of 

the fire and emergency service culture, identifies individual and organizational behaviors 

that positively and negatively impact health and safety, and highlights focus areas for 

change by raising awareness about unsafe practices. Focus areas include: 

ĵ Environmental factors.

ĵ Health and wellness.

ĵ Individual responsibility.

ĵ Leadership.

ĵ Recruiting.

ĵ Seat belt usage.

ĵ Situational awareness.

ĵ Training.

ĵ Vehicle operations.

The report emphasizes that organizational leadership and personal responsibility are 

critical in creating the culture change needed in the fire service to promote firefighter 

safety (USFA & IAFC, 2015).

The NSCCI supports the National Fallen Firefighters Foundation (NFFF) Firefighter Life 

Safety Initiative (FLSI) 1. The NFFF established the 16 FLSIs to influence the critical safety 

culture in the U.S. fire service and provide a foundation for thousands of fire departments 

and EMS organizations who have a desire to ensure that their firefighters and medics 

return home safely after every shift. FLSI 1 states: “Define and advocate the need for 

a cultural change within the fire service relating to safety; incorporating leadership, 

management, supervision, accountability, and personal responsibility” (n.d., para. 1).
Critical Issues | 5

FLSI 1 is an overarching initiative, acknowledging that the organizational culture of the 

fire service must undergo a change in order for the other 15 recommendations to be 

accepted. It is likely that changes called for in the other 15 initiatives cannot be successfully 

implemented or sustained within a department’s culture without leadership from the 

executive level and supervision at the street level (USFA, 2015).

Changes in the fire service culture are needed for a variety of reasons including, but not 

limited to:

ĵ Reducing firefighter injuries and deaths.

ĵ Improving public perception and support.

ĵ Recruiting, hiring, and retaining a diverse workforce.

ĵ Reducing incidents of negative member behavior to have a positive impact on volunteer 

retention. (Paull & Omari, 2015)

Looking further at the fourth reason, the Cumberland Valley Volunteer Firemen’s Association’s 

(CVVFA) Fire Service Reputation Management White Paper highlights reputation management 

issues occurring in the fire service. CVVFA actively tracks and records instances of firefighters 

being arrested and making headlines for integrity breaches. They noted that:

Issues described in this White Paper are generally omnipresent on the fire 

service national stage; they are not isolated or limited to just the career 

or volunteer service or the urban, suburban, or rural fire service. Instead, 

these issues have been found to be present in the fire service nationwide, 

in all types of communities and within all types of fire departments. (CVVFA, 

2010, p. 6.)

The reputation management issues are:

ĵ Cheating on examinations and department policies.

ĵ Firefighter arson.

ĵ Theft and misappropriation of department funds.

ĵ Misuse of department equipment and personal information technology.

ĵ Misuse of departmental facilities.

ĵ Alcohol and other substance abuse.

ĵ Harassment and discrimination. (CVVFA, 2010, p. 5)

All of these listed behaviors work against the previously listed aims of improving public 

perception and support, maintaining a good reflection on the profession, and, of course, 

improving safety. Take firefighter arson, for example. Firefighter arson is a long-standing 

problem that negatively impacts fire departments and communities across the nation. A 

number of media reports suggest that there are likely over 100 arrests per year (NVFC, 

2011). This behavior is risky and poses dangerous and potentially deadly outcomes that 

affect the individual, department, and community. Furthermore, 2008 research from 

Hinds-Aldrich showed that the majority (95 percent) of U.S. firefighters arrested for arson 

over the last two centuries were volunteers; more disturbingly, nearly 10 percent of the 

firefighters, volunteer and paid, were ranking officers (NVFC, 2011). With 63 percent of 

Americans reporting leaders as being untrustworthy, and 83 percent indicating leaders’ 

actions were not based on public benefit, but rather on self-serving agendas (Peus, 

Wesche, Streicher, Braun, & Frey, 2012), it is important that the fire service implement 

strategies to retain stakeholder trust. In order to change damaging behavior, departments 

need to implement thorough background checks and screening processes, set and enforce 




6 | Critical Health and Safety Issues in the Volunteer Fire Service

zero tolerance SOPs, and provide rules and training upfront to set expectations. Such 

administrative actions can be applied to all personnel behaviors, which will ultimately 

influence a cultural shift toward a safer working environment.

Like many issues noted throughout this document, there are tools and resources available 

to help volunteer departments prevent or mitigate instances of poor member behavior 

and firefighter arson, including:

ĵ NVFC (with support from USFA, the NVFC Foundation, and guidance from a work group 

comprised of arson investigators and fire service professionals) examined the issue 

and developed tools and resources to help departments address and prevent cases 

of firefighter arson. These include the “Report on the Firefighter Arson Problem,” the 

“Firefighter Arson Prevention and Recovery Toolkit,” a video, and an awareness poster, 

all of which can be found on the NVFC website.

ĵ To expand beyond the Reputation Management White Paper, CVVFA, with past support 

from the NVFC Foundation, offers free training for fire departments on strategies 

to address reputation management issues. Strategies include social media policies, 

implementing the firefighter code of ethics, strong leadership skills, safeguards against 

theft, and creating an environment to support diversity and eliminate sexual harassment. 

Contact the CVVFA to schedule training.
Critical Issues | 7

Tools for Your Toolbox

National Volunteer Fire Council Health and Safety 

B.E.S.T. Practices

To help departments incorporate safe and healthy practices into their culture, 

NVFC created the “B.E.S.T. Priorities for Firefighter Health and Safety” that focus on 

protecting volunteer responders. The priorities are divided into a series of practices 

that cover four main focus areas: behavior, equipment, standards and codes, and 

training. Departments can learn more about these priorities through an online 

training offered in the NVFC Virtual Classroom. A poster is also available that can be 

hung at the station to serve as a constant reminder of the practices the department 

should be following to keep members safe. Keep these priorities in mind while reading 

through each section of this guide. Below is the list of B.E.S.T. Practices:

Behavior:

ĵ Support the physical, emotional and mental well-being of all personnel.

ĵ Operate all emergency apparatus and privately owned vehicles to conform to the 

highest road safety standards, and enforce the use of seat belts.

ĵ Develop, practice and enforce recommended health and safety standards for all 

personnel.

ĵ Monitor and ensure that all active emergency scenes maintain the utmost level 

of safety and fireground accountability.

Equipment:

ĵ Provide and require the proper use of full personal protective equipment (PPE).

ĵ Maintain all equipment based on established safety recommendations.

Standards and Codes:

ĵ Encourage the use of all smoke, fire detection and fire suppression devices, including 

fire sprinkler systems, in all structures.

ĵ Vigorously enforce all fire safety codes and ordinances.

ĵ Obtain apparatus and equipment that meet national safety standards.

Training:

ĵ Use fire training programs that conform to the highest professional standards.

ĵ Operate a safe fire training ground at all times.

ĵ Establish, maintain and deliver fire safety programs for all age groups. (NVFC, n.d.-a)
8 | Critical Health and Safety Issues in the Volunteer Fire Service

Cultural change applies to many aspects of the volunteer fire and emergency services 

and will be emphasized as other critical issues are discussed throughout this document.

 Goal: Promote cultural change in the department to influence positive 

behaviors and risk-reduction practices.

Objectives:

ĵ Provide leadership and management training regarding positive 

behaviors and risk-reduction practices.

ĵ Provide recruit-level training regarding positive behaviors and riskreduction practices to set the standard for entry-level volunteers.

ĵ Clearly define and enforce company SOPs to help promote a healthy 

and safe environment.

 Section Summary — The Culture: Understanding and implementing 

risk-reduction behaviors in local, volunteer fire/EMS departments 

will drive a cultural change, which will in turn create a safer work 

environment for department personnel. Behaviors must be clearly 

identified and enforced through SOPs, implemented from the top 

down, and taken into consideration for personal accountability. 
Critical Issues | 9

Recruitment and Retention

The importance of both recruitment and retention cannot be overstated. Although 

volunteers make up 69 percent of the fire service, the number of volunteer firefighters 

in the U.S. has decreased by nearly 12 percent in the last three decades. Meanwhile, call 

volume to fire departments has tripled since 1980 (NVFC, 2015). 

These factors pose a huge risk in relation to the health and safety of volunteer fire and 

emergency personnel. Adequate staffing levels are essential to ensure responders are not 

short-handed, compromising operating efficiency and firefighter safety.

The age of many volunteers is also a concern. The National Fire Protection Association 

(NFPA) reports that over 50 percent of volunteer firefighters protecting communities 

of less than 2,500 residents are 40 years old and above (Haynes & Stein, 2016). This is 

compared with 36.8 percent in 1987 (NVFC, 2016). As firefighters age and ultimately leave 

the service, there are fewer younger members to fill in the ranks (NVFC, 2016). Health 

may also be an issue. According to the National Council on Aging (NCOA), 90 percent of 

Americans ages 55 or older are at risk for hypertension, or high blood pressure (NCOA, 

n.d.). As highlighted later in this report under personal health, firefighters are at an even 

higher risk for various chronic and life-threatening diseases due to the nature of the job.

As volunteers continue to age and their ranks dwindle, we must realize that customary 

models of recruitment and retention may be neither sustainable nor practical given the 

current state of the volunteer fire service. Volunteer emergency service agencies must 

challenge traditional methods of recruitment and retention, and become more strategic 

and informed in their approach. Recruiting and retaining fit and able bodies will prove 

advantageous for department operations.

Recruitment

Expecting people to volunteer simply because it is the right thing to do is not going to bring 

people to the door. Departments must take several variables into account when seeking 

to increase their ranks, including the demographics of the community, creating a culture 

where existing personnel welcome and accept new recruits, and perhaps most importantly, 

whether the community is even aware that the department is in need of volunteers.

A national survey conducted by NVFC in 2014 indicated that 80 percent of respondents 

did not know if their local department was seeking volunteers. There is also a significant 

discrepancy in the perceived and actual prevalence of volunteers. While volunteers make 

up 69 percent of the fire service, only 29 percent of respondents believed that their local 

fire department used volunteers; 41 percent did not know whether their department used 

volunteers (NVFC, 2015). The first step in a successful recruitment campaign is to make 

sure the community knows that the department is in need of volunteers.

It is also important to consider what types of volunteers to recruit. If a department 

roster is comprised of mainly older volunteers, then the focus should be on recruiting 

younger individuals to fill the gaps as the older generation looks toward retirement. Also 

think about the physical, cognitive or managerial abilities needed for the positions being 

recruited. Having the right people in the right roles is critical to health and safety.

Another factor to incorporate into a recruitment plan is the demographics of the 

community. In an ideal world, the department would closely mirror the demographics of 
10 | Critical Health and Safety Issues in the Volunteer Fire Service

the community. For example, if a community has a large population of college students, 

the department personnel should reflect a similar percentage of college students. If a 

community is made up largely of women and/or minority groups, these demographics 

should be similarly reflected in the department’s ranks.

Reaching a broader audience is an area where many departments need to improve. 

According to Bureau of Labor Statistics, the fire service is one of the least diverse 

professions. While women make up more than half of the U.S. population (50.8 percent), 

they reflect just 7.3 percent of the overall fire service and 8.9 percent of the volunteer fire 

service (Haynes & Stein, 2016). The numbers for minority groups are only available for the 

career fire service, but there is a similarly disproportionate trend, as evidenced in Figure 2. 

Figure 2. Diversity within Career Departments

0.0

10.0

20.0

30.0

40.0

50.0

60.0

Fire Service Population

U.S. Population

Women African-American Hispanic/Latinos Asian

50.8

3.7

13.2

8.4

17.4

7.8 5.4 1.1

Source: Adapted from Bureau of Labor Statistics, 2015; U.S. Census Bureau, V2014.

While women and minorities are vastly underrepresented in the fire service, it is not 

due to disinterest. In general, women are more likely to volunteer than men by a ratio 

of 3-to-1 (Waters & Bortree, 2012). However, these statistics do not hold true for the 

volunteer fire service. In the recruitment and retention research conducted by NVFC, 

women were equally interested in volunteering as a firefighter or first responder as their 

male counterparts. Similarly, minority respondents exhibited as much interest, if not 

more, in operational volunteer opportunities as Caucasian/White respondents. The study 

also found that interest in volunteering was very high among those 18 to 34 years of age, 

with 44 percent showing interest in operational volunteer opportunities (NVFC, 2015).

The results of the study suggest that the problem with recruitment is not lack of interest, 

but rather with awareness and recruitment methodologies. To be effective at recruitment, 

it is vital to identify the demographics of the community and how to best appeal to the 

target audiences in terms of messaging, imagery and avenue of outreach. What resonates 

for one demographic may not have the same appeal to another. When it comes to a field as 

challenging as firefighting, it is important that potential volunteers can visualize themselves 

in that role; otherwise, self-doubt may prevent them from taking that next step.
Critical Issues | 11

Research shows one recruitment barrier for females is tied to physical agility. According to 

one study, females had an 85 percent failure rate (versus nine percent of males) in passing 

the Candidate Physical Ability Test — a standard entry test for entering the fire service 

(Sinden et al., 2013). Another reported recruitment barrier for females entering the fire 

service is negative attitudes of male firefighters toward the female recruits (Sinden et al., 

2013). Female firefighters experience difficulty gaining a positive work environment and 

report lower job satisfaction due to negative attitudes from male counterparts (Sinden et 

al., 2013). Departments should implement strategies to address physical agility challenges 

and better prepare recruits to meet the requirements. Additionally, departments should 

create an environment that supports diversity. Knowing the department is there to 

support them and help them succeed will go a long way in encouraging a potential recruit 

to take that step to become a volunteer.

To attract prospective volunteers, first understand what drives them to volunteer and 

to continue to volunteer once recruited. NVFC’s study of recruitment and retention 

assessed several behavioral determinants of doer and non-doer attitudes toward 

volunteer firefighting:

ĵ Norms — What people think is expected of them.

Doers and non-doers cite strong support from family, friends and employers as a 

driving factor in joining and remaining a volunteer.

ĵ Self-standards — What people expect of themselves.

When considering non-doer perceptions of who volunteers are and perceptions of what 

they do, non-doers cited that they are similar to volunteers because of the following:

k They appreciate friendships and camaraderie.

k They want to help people.

k They care about their community.

k They want to learn new skills.

k They like excitement.
12 | Critical Health and Safety Issues in the Volunteer Fire Service

ĵ Efficacy — An individual’s confidence that he or she can pull off an action.

In general, interested non-doers have not applied because they perceive the following:

k They do not have the physical attributes of a volunteer.

k They cannot be fully committed to the job.

k They do not have the right skill set.

k They do not have enough information about the job expectations and the application 

process.

ĵ Environment — Surrounding influences affecting actions.

k Having friends within the department and flexibility in scheduling were key things 

cited by doers that make it easier to sustain commitment to the fire department.

k Isolation, unmet expectations, frustration with leadership, and lack of support 

from family or employers were cited as reasons by doers for what makes it harder 

to sustain commitment to the fire department.

ĵ Rewards, Risks and Penalties — Positive results of acting; actual and perceived negative 

results of acting or not acting.

k Doers cited the ability to give back to the community and save lives as significant 

rewards of serving.

k Doers cited the risk of dying or injury to self and lost time with loved ones as 

significant risks and penalties.

ĵ Feelings — Emotional benefits or barriers to action.

Emotional hooks for volunteer firefighting center around a feeling of accomplishment: 

overcoming fear of inadequacy and being overwhelmed, and a focus on camaraderie, 

accomplishment and pride.

ĵ Control — Ability to manage actions.

The non-doer perception is that you can only join or not join, when in reality the level 

of commitment is often flexible. There is little understanding of the nature of the 

volunteer opportunity and the factors at play.

ĵ Investment — All the costs, financial and otherwise, of acting.

There is an unclear perception of the amount of time it takes to train and serve as a 

volunteer. Inaccurate perceptions could lead individuals to not volunteer.

Effective recruitment also hinges on an ability to understand why people take the 

step to join a fire or emergency service department. A key outcome of this study is the 

understanding that most volunteer firefighters first started volunteering because they 

were personally invited to do so. This suggests that more traditional recruitment methods, 

such as marquees in front of the station, newspaper advertisements, or billboards, may 

not be as effective as a personal invitation.

In addition, current volunteers indicated that they were more likely to join after being 

given a taste of what it’s like to volunteer (NVFC, 2015). Much like grocery stores often 

offer samples of food and drink to influence their customers and persuade them to buy, 

volunteer departments can influence prospective volunteers by allowing them to sample 

what it’s like to be a volunteer. This allows the person to picture themselves as part of a 

team while tackling fears about their skills or abilities.

It is also critical that the department is ready for new recruits as they join, or they are 

unlikely to continue. As potential members are brought into the department, make 
Critical Issues | 13

sure current members are ready to welcome them. This ties back to the culture within 

the department. Train members in diversity and inclusion, and when new or younger 

members have ideas or input, let their voices be heard.

Many states and regions across the U.S. have implemented successful programs to help 

departments sustain or gain personnel, such as the Allegheny Mountain Firefighters 

Initiative (Pennsylvania), Recruit New York, and the Volunteer Workforce Solutions 

Everyday Hero Program (Virginia).

NVFC developed the Make Me A Firefighter recruitment and retention campaign to put 

research-based, ready-to-use tools and resources in the hands of local departments. 

The goal is to make the process of recruiting new volunteers as easy as possible for 

local departments. A free department portal allows departments to post volunteer 

opportunities, customize recruitment tools, track recruits, and more. Prospective 

volunteers can find local volunteer opportunities and learn more about the fire service. 

NVFC also offers an online recruitment webinar in its Virtual Classroom that discusses the 

challenges of recruiting volunteers, presents valuable research collected as part of the 

Make Me A Firefighter campaign, and offers ideas to help overcome recruiting challenges. 

All of these resources and additional information can be found on the NVFC website.

 Goal: Increase effectiveness of recruitment efforts.

Objectives:

ĵ Increase awareness of volunteer opportunities and types of 

opportunities.

ĵ Increase the reach and frequency of personal invitations.

ĵ Increase frequency of innovative ways for interested individuals to 

experience what it’s like to be a volunteer.

ĵ Improve tracking of conversion rates of the interested individuals 

who join.

ĵ Increase the number of flexible and innovative training options for 

volunteers, and engineer the training process for retention, making 

the necessary training attainable and achievable for interested 

volunteers.

Retention

Recruitment is just part of the challenge facing the nation’s fire and emergency services. 

With the average cost to train and equip a new firefighter estimated at $27,095, it makes 

good fiscal sense to retain these volunteers (NVFC, 2016). Outside of the financial aspect 

of training and recruiting, there is also invaluable benefit to the department by retaining 

the knowledge and experience of these volunteers over the long-term and using them to 

help train, support and mentor new recruits.

There are several factors affecting retention. Frequently cited reasons volunteers leave 

a department include poor leadership, time constraints, and rigorous training demands. 

NVFC’s recruitment and retention study supports this data with respondents indicating 

that factors leading to drop-out included:

ĵ Amount of time to volunteer.

ĵ Senior leadership’s treatment of firefighters.
14 | Critical Health and Safety Issues in the Volunteer Fire Service

ĵ Poor communication between officers and members.

ĵ Frustration with best efforts resulting in loss.

Similarly, there are several reasons why people remain volunteers, including enjoyment 

of the department and people, officers and senior firefighters have encouraged them to 

stay, and dedication to the department and the community (NVFC, 2015).

It is important that new recruits feel welcomed and included in the department, and 

that the expectations and duties before them are communicated clearly and regularly. 

Understanding that volunteering and the related training is time-consuming, consider 

ways the department can be more cognizant of time constraints. For instance, offering 

training that is online or offered at a variety of times allows volunteers to fit training into 

their already busy schedules. Similarly, offering duty shifts and department activities 

that are flexible and reasonable, or allowing volunteers to respond to emergencies 

from home, work, or other off-site locations other than the station, allows volunteers to 

incorporate their duties more easily into their schedules and communicates that their 

time is important.

The objectives listed in this section provide specific methods and activities to improve 

department retention. As with recruitment, NVFC offers a retention webinar through its 

Virtual Classroom that discusses retention challenges and offers possible solutions.

 Goal: Increase retention rates.

Objectives:

ĵ Provide flexibility and innovation in training methods, such as 

through online training or creative training schedules.

ĵ Build camaraderie through training and other department activities.

ĵ Create and practice a culture of inclusion within the department to 

ensure that all department members are treated fairly and respectfully.

ĵ Build strong leaders and have a succession plan in place to provide 

room for growth and learning for younger recruits.

ĵ Enable volunteers to have a voice. Survey members to identify 

ongoing improvements.

ĵ Offer reasonable and flexible time requirements for activities 

and calls.

 Section Summary — Recruitment and Retention: Good recruitment 

and retention practices are necessary to secure the future of the 

volunteer fire and emergency services. Increasing the number of 

volunteer firefighters and emergency personnel allows department 

duties to be shared among many rather than a few, which enhances 

safety, aids in camaraderie, and avoids burnout, disinterest, and overexhaustion. Only with effective recruitment and retention practices 

are fire departments able to maintain adequate staffing levels to 

respond safely and effectively to calls, thereby protecting individual first 

responders, as well as the community.
Critical Issues | 15

Funding

Although the economy has been improving across the U.S., many volunteer fire departments 

continue to struggle. NFPA’s national fire service needs assessment surveys consistently 

show that smaller, volunteer departments have the smallest budgets and the biggest 

financial challenges (Shea, 2015). Furthermore, firefighting is expensive. In the past 30 years, 

the costs for key pieces of equipment have jumped more than fivefold (Shafroth, 2014).

For example, a volunteer fire department in Pennsylvania that had been operating since 

1950 had to close its doors in 2015 due to a lack of funding. The chief stated they had 

exhausted their reserves and savings in order to keep up with general expenses, such as 

maintaining the building and vehicles, as well as keeping rescue equipment up to state 

code (Klaric, 2015). In another instance, leaders of seven volunteer fire departments, 

also in Pennsylvania, reported that community donations are dwindling, and they are 

having a hard time keeping up with training and equipment costs necessary to keep the 

departments running (Shea, 2015).

Many organizations simply do not have the geographic service area or population 

necessary to adequately fund operations. In some communities, multiple departments 

compete for the same fundraising dollars. In other areas, demographic shifts with aging 

populations have left less people willing and able to volunteer, as well as transitioning to 

fixed or low incomes that reduce the total tax revenue. All of these factors are significant 

and pose an increasing challenge, especially for all- or mostly-volunteer departments 

serving populations of 2,500 or less, where an average of 65 percent of their yearly 

revenue is acquired through taxes and 17 percent via fundraising (NFPA, 2011).

Expenses to maintain operations, recruit new members, train volunteers, provide 

equipment, and fulfill increased expectations of firefighter roles, such as providing 

EMS, pose real problems for many volunteer fire departments. Additionally, volunteer 

departments are expected or required to work within higher standards than they have in 

the past (e.g., Occupational Safety and Health Administration (OSHA) requirements, NFPA 

standards, and accreditation).

If volunteer departments do not have adequate funding to conform to current standards, 

responder health and safety can be compromised. This fact is evidenced in the “Third 

Needs Assessment of the U.S. Fire Service” which reports that 70 percent of departments 

serving populations of fewer than 2,500 are not able to outfit every member on shift 

with a self-contained breathing apparatus (SCBA), and 69 percent have some personal 

protective clothing that is at least 10 years old. Most communities with populations of 

2,500 or less are protected by volunteer fire departments (NFPA, 2011). Not only are first 

responders put at greater risk, but other important initiatives that may require time and 

money, such as behavioral health or physical fitness programs, take a back seat over 

immediate needs like equipment and gear.

Transitioning to a Combination Department, Consolidations and Mergers

Decreases in volunteer staffing, challenges with funding, and the need to maintain services 

have led some departments to transition to a combination department, consolidate with 

a neighboring department/agency, or reconsider their funding streams altogether.

Transitioning to a combination department can prove advantageous, as it can provide 

increased staffing levels beyond what may be available or affordable in an all-career or 

all-volunteer service, not just at peak times, but all the time (Stern, 1997). Volunteers 

benefit by being relieved of some of the time-consuming tasks in the day-to-day 
16 | Critical Health and Safety Issues in the Volunteer Fire Service

operations of the department. A lighter workload can decrease stress levels, allow 

more time for training, and positively influence morale. For these reasons, transitioning 

to a combination department improves the overall health and safety of volunteer first 

responders; however, it is more expensive to bring on paid staffing, intensifying the need 

for funding even more.

There may also be situations where conflicts arise between volunteer and paid personnel. 

These conflicts act against the teamwork necessary to perform duties in a safe and effective 

manner. It can frustrate individuals on both sides of the fence, causing departments and 

the fire service to lose outstanding individuals who become burned out from the often 

petty fighting that goes on between the paid and volunteer sides (Stern, 1997). Chiefs and 

officers should nurture the organizational development by providing visionary leadership, 

defining and enforcing expectations, and fostering constructive communication, which 

can result in a functional, cohesive, and collaborative mixed group of career and volunteer 

firefighters who are perfectly aligned with the organization’s mission (Piper, 2014).

Chief Jeff Cash from the Cherryville (North Carolina) Fire Department said it best when 

referring to the importance of firefighter equality and how that affects their safety on the 

fireground:

The most important asset you have as a Fire Chief is your people. Notice 

there was no differentiation when I said people. It doesn’t matter whether the 

members are career, part-time, or volunteer in your combination department, 

you have to depend on them all... If a star baseball player goes down with 

an injury, the game must go on. Your back-ups have to be trained, look, and 

act the same when put in that injured player’s position. Your firefighters 

should be treated the same because they could be put in that starting role 

at any moment’s notice. (2015, para. 13)




Critical Issues | 17

Tools for Your Toolbox

EQUALITY: Tips to Help Leaders Run a Combination Department 

(condensed)

Expectations: The fire chief has to set high expectations for all members of the 

department, and the expectations have to be the same whether it is a career or 

volunteer member.

Qualifications: Set equal qualifications in your department for all members. When 

individuals hold the same credentials and have been through the same training, 

mutual respect is developed.

Uniform: Uniform your personnel the same. If you buy Class A/duty uniforms for 

career, do it for volunteer also. Don’t pass down old PPE from paid or part-time staff 

to volunteers.

Authority: Give your officers the authority to act. Whether career or volunteer, 

individuals in leadership roles should be able to make and communicate decisions to 

all applicable personnel.

Lead evenly: Chiefs should lead evenly — discipline/reward career and volunteer 

members the same. A policy or safety violation and respective discipline should be 

no different for any member.

Input: Gain valuable input from all employees. If possible, committees should 

comprise of an equal number of career to volunteer members; it will help the entire 

department with “buy in” when both sides are included in big decisions.

Time: Make time for your volunteers. They may not be able to train or meet at the 

same time as your career staffing. Remember, they are in your department because 

they want to be, not because of a paycheck. So go out of your way to make time when 

they are available.

Yearly evaluations: All members need a yearly performance evaluation to see how 

well they performed throughout the year, and also to set future goals and objectives. 

Volunteer members may eventually become career staff; a yearly performance 

evaluation can help lay the ground work for their future. (Cash, 2015)
18 | Critical Health and Safety Issues in the Volunteer Fire Service

Mergers and consolidations can have the same advantages and disadvantages. For 

example, two Tennessee departments merged in 2015 in order to improve services by:

ĵ Reducing overall operating costs associated with the management of two separate 

organizations.

ĵ Using specialized rescue equipment and resources.

ĵ Consolidating fire, medical and rescue services.

ĵ Maintaining and improving the fire insurance rating.

ĵ Improving training and response plans to create safer operations. (Pleasant View, 2015)

In 2014, a struggling Virginia volunteer fire department — plagued with problems including 

poor leadership, membership, misuse of emergency equipment, and violations of health 

care privacy laws and state and local policies — merged into their county’s fire and 

rescue department to avoid being dissolved (Inside NOVA, 2014). Volunteers supported 

the merger in order to mitigate their issues. The move didn’t impact the fire and rescue 

budget because of existing equipment and staffing, and the volunteer department was 

able to improve standards, safety and operational efficiency.

In 2016, two Pennsylvania fire departments merged in order to continue to meet their 

community’s needs. One department was struggling with not having enough volunteers, 

while the other had young personnel that lacked experience. The merger allowed the 

departments to capitalize on their combined workforce and improve operations. 

They were even able to sell one of their apparatus because of the increased efficiency 

(Malongowski, 2016).

Resources

There are a variety of sources for funding volunteer fire departments — from traditional 

fundraising, to taxation, to grants. Keep in mind that grants can be risky as an ongoing 

source to fund a department and should be considered more for major purchases, 

training, special programs, or initiatives. NVFC offers resources on its website to help 

volunteer departments find grants and prepare grant applications.

Some departments have been innovative in their approach to maintaining adequate 

funding streams. One county in New York developed a unique and promising means of 

increasing cash revenues for its 42 fire departments (39 volunteer, two combination, one 

career). They raised over $6.5 million from the sale of delinquent tax certificates that had 

been issued on properties that owed back taxes (USFA, 2012).

When approaching the community or local government for assistance, it is helpful to have 

figures which support the request. NVFC has Cost Savings Calculators which will allow a 

department to determine approximately how much they save their community monetarily 

each year and, in turn, will serve as a means to justify an increase in support.

Additionally, in 2012, USFA published “Funding Alternatives for Emergency Medical and Fire 

Services” to identify grants and innovative funding methods for fire and EMS departments. 

The report offers discussions of the pros and cons of particular funding sources, along with 

examples of best practices. The report is available on the USFA website.

Whatever the method, an organization’s leaders must understand the importance of 

developing an ongoing, positive relationship with the community and elected officials to 

find the best solution that will ensure the safety of its responders and those they serve.
Critical Issues | 19

Fidelity

Another factor to consider is financial fidelity. The words “justification” and “accountability” 

will continue to loom large as departments struggle to keep up with operational costs. 

Organizational leaders will continue to face questions from elected officials and members 

of the public about the cost of doing business. Leaders need to be accountable and be 

able to clearly articulate the need for basic operating funding and capital equipment. They 

also need to make sure there is a proper financial management system in place to avoid 

potential fidelity issues.

Dr. William Jenaway, Vice President of the Volunteer Firemen’s Insurance Services (VFIS), 

had this to say regarding fidelity in the fire service:

Fidelity is defined as the strict observance of promises, duties, etc. or 

adherence to fact or detail. Unfortunately, some officers and managers 

are not always honest and may be tempted to divert money and other 

financial assets from the emergency services organization for personal gain. 

This would be known as a fidelity claim. Directors, managers, chief officers, 

treasurers, financial secretaries, and special event managers all could become 

a financial drain on any organization if they do not perform with fidelity. 

The real problem for an organization is that when these losses occur, they 

generally occur over relatively long periods of time. This may result in the 

losses being staggeringly high. The loss of funds can jeopardize high-quality 

response, equipment, and services to the community. (2015, para. 15)

The damage to the department’s reputation or future funding streams may also be 

high and, in some cases, unrepairable. There are several strategies and procedures 

departments can use to prevent and manage fidelity issues. Leaders should be well versed 

on what these are and be stringent in ensuring these procedures are followed.




20 | Critical Health and Safety Issues in the Volunteer Fire Service

Tools for Your Toolbox

Tips to Decrease Fidelity Claims in Departments

For people with purchasing, fund management, and check writing responsibilities:

ĵ Checks should always require two signatures, signed only after they have been 

written in full. Never sign blank checks or allow the use of signature stamps — even 

for convenience.

ĵ Have your organization’s bank require signature cards to be kept on file. Your 

organization should keep these up-to-date.

ĵ Bank statements should be received and reconciled by someone who does not 

have check-writing authority.

ĵ Have an independent third party audit your books annually.

ĵ Whenever possible, do not permit people with close personal ties (husband/wife; 

brother/sister; business partners) to have control over organizational check writing 

or reconciliation.

ĵ Require purchase orders and invoices for all purchases of property or service. 

Have these compared to the written checks.

ĵ Separate financial functions as much as practical.

ĵ Conduct background checks on all new officers and members.

ĵ Have all financial policies in writing.

ĵ Review your organization’s insurance policies to assure proper fidelity coverages 

are in place.

For people who handle fundraising or special events cash:

ĵ Conduct background checks on all new officers and members.

ĵ Do not permit people with close personal ties (husband/wife; brother/sister; 

business partners) to handle cash without a third party present.

ĵ For large amounts of cash or for events occurring over a long period of time, 

have frequent pick-up and accounting of cash. Collected money should be bank 

deposited to limit the amount of on-hand cash.

ĵ Have at least two people responsible for reconciliation and deposit of cash.

ĵ Whenever possible, have some form of paper trail (ticket stubs, bill of sale, 

sign-in sheet) so that a close estimate of the anticipated cash can be obtained 

and confirmed.

ĵ Have all financial policies in writing. (Hess, 2012)
Critical Issues | 21

Training in the development of an annual report, financial management, and effective 

communications will allow leaders to be proactive when dealing with decreases in funding 

and also when searching for different funding sources or methods to increase or maintain 

operations. Overall, the goal is to establish a financially sound institution to uphold a safe 

and effective work environment.

 Goal: Establish a financially sound fire department to uphold a safe 

and effective work environment.

Objectives:

ĵ Identify a variety of funding sources and alternative funding methods. 

Look into diversifying funding streams, and do not put all your “eggs 

in one basket.”

ĵ Use grant-writing resources.

ĵ Research and review funding best practices and lessons learned — 

both in nearby community successes and out-of-state departments.

ĵ Provide administrative financial training.

ĵ Implement procedures to decrease possibility of fidelity claims.

 Section Summary — Funding: If a department does not have 

adequate funding to sustain operations, then the health and safety 

of volunteer responders can be compromised. Departments must 

consistently assess the cost of doing business, continuously search for 

appropriate funding streams, and evolve to meet demands. Leadership 

is pivotal in this area, both to provide the means to function and also 

to uphold the ethical standards for how business is conducted. 
22 | Critical Health and Safety Issues in the Volunteer Fire Service

Expanded Role of Firefighters

Today’s fire service is expected to handle a greater variety of threats and emergencies than 

in the past. Departments are often called upon for medical emergencies, terrorist threats, 

lost individuals, chemical explosions, and other incidents. The additional responsibilities 

of all-hazard prevention, response and mitigation require greater training demands, 

operational preparations, and healthy personnel in order to reduce line-of-duty injuries 

and deaths. Volunteers must determine which responsibilities they can handle safely and 

effectively, and keep up with the standards necessary for these additional operations.

Emergency Medical Services

There were over 33.6 million fire department calls in 2015. Of these, 1.3 million were 

fire-based, while nearly 21.5 million were medical (Fire Department Calls, 2015). In fact, 

61 percent of all fire departments provide EMS (Haynes & Stein, 2016). Many volunteer 

fire departments in the U.S. are the primary — and sometimes only — provider of EMS 

in their community.

Departments have adapted over the years as standards have changed and complexities 

increased. So what does providing EMS mean for many volunteer departments?

Some departments expand into providing emergency ambulance service because they 

believe that the revenue generated by ambulance billing can help pay for fire department 

operations. In many cases, this is true, and in many cases, it is not (Maruca, 2015). One 

example comes from Chief Joe Maruca from the West Barnstable (Massachusetts) Fire 

Department:

Our total ambulance revenue for FY 2014 was $181,998. This is a lot of money 

and many firefighters and chiefs would love to get this kind of revenue stream. 

It probably represents three or four times the fire department operational 

budget of many similar sized communities. The problem is that it costs our 

department $900,000 to provide the service at the level of quality demanded 

by our citizens. This is where public policy, public safety, and public service 

collide with the financial aspects of providing ambulance service. (2015, para. 10)

It was mentioned in the previous section that the health and safety of firefighters and 

emergency personnel can be compromised if the department does not have adequate 

funding. Similarly, health and safety programs may become secondary or be completely 

eliminated if department personnel are overwhelmed with other priorities, such as 

providing additional services like EMS. Using volunteer fire staff to expand EMS services 

may also cause added wear and tear on volunteers. Even departments that have a few 

full-time staff will still rely heavily upon their volunteer force to respond to EMS calls and 

to cover for overlapping emergency calls (Maruca, 2015). This can be both mentally and 

physically exhausting on individuals, and may even cause burnout.

The provision of EMS is changing in many ways, and volunteer fire departments must be 

aware of current and future challenges. The Affordable Care Act and changes in traditional 

methods of reimbursement may affect this potential source of revenue. Additionally, 

as the population continues to age, call volumes will rise, and the need for additional 

ambulances will be essential.

Public awareness and injury prevention programs may be helpful to reduce call volume, 

or at least make the public aware of the issues the department faces when providing EMS.




Critical Issues | 23

Departments should have an ongoing method to assess needs and predict changes. 

A proactive approach is always better than reacting to a situation. Departments may 

need to increase the number of volunteer personnel to meet demands for EMS. Effective 

recruitment and retention is critical for system survival, or other measures may need to 

be adopted, such as consolidations, mergers, or the addition of paid staffing.

The decision of whether or not to expand services in a community starts with three 

questions:

1. Is there a market for the services? Can the agency offer something that either addresses 

an unmet need or that improves on how the need is being met presently? Is there 

competition from private/for-profit companies?

2. Will government, insurance and private payers compensate the agency for providing 

those services? As an example, hospitals may find that paying an outside agency for 

discharge, follow-up home visits for high-risk patient groups costs less than the financial 

penalties incurred by excessive patient readmission rates.

3. Can agency staff and infrastructure absorb the additional workload and the increased 

cost of required training? (Mund, 2015)

It is important to remember that factors which serve as an advantage for one agency could 

just as easily be a disadvantage for another. The expanded services model works well for 

a large, for-profit agency with paid staff. However, for smaller agencies, and especially 

volunteer agencies, expanding services can quickly overwhelm responders’ available time 

and the capacity of the agency’s infrastructure (Mund, 2015). As mentioned before, this 

can lead to overtired personnel and a financially drained department, compromising both 

health and safety of responders.

Department leaders should use the listed objectives to consider whether providing EMS is 

right for their agency and in the best interests of their personnel. NVFC has an EMS/Rescue 

Section to provide volunteers in an EMS or rescue delivery system with information, 

education, services and representation to enhance their professionalism.

 Goal: Evaluate and meet demands for EMS.

Objectives:

ĵ Review community demographics, and collect call volume data.

ĵ Assess system performance in regard to response time and volunteer 

participation.

ĵ Establish a strategic planning team who can be used to identify future 

trends.

ĵ Establish partnerships with local health care organizations, including 

hospitals, clinics, short- and long-term care homes, and home health 

agencies.

ĵ Effectively communicate system issues with community and elected 

leaders.

ĵ Implement recruitment and retention efforts in addition to strategies 

that prevent overexertion of existing personnel.

ĵ Implement community campaigns targeting injury prevention and 

awareness.
24 | Critical Health and Safety Issues in the Volunteer Fire Service

Wildland Firefighting

Volunteer firefighters that live in the wildland urban interface (WUI) — defined as the 

line, area or zone where structures and other human development meet or intermingle 

with undeveloped wildland or vegetative fuels — have an added expectation to protect 

their community from wildfires. Wildfires are a natural occurrence; however, as more 

communities are built in the WUI, more firefighters will be called upon to protect those 

homes when a wildfire strikes.

In 2015, over 68,000 fires scorched a record-breaking 10.1 million acres — making it one 

of only four years since 1960 to see more than 9 million acres burn (National Interagency 

Fire Center, 2015). According to the National Interagency Coordination Center (NICC), a 

total of 4,636 structures were destroyed by wildfire in 2015, which is 69 percent above 

the annual average of 2,750 (2015). More than 72,000 U.S. communities are now at risk 

from wildfire (Wildfires, n.d.).

In 2015, NFPA published results from a pilot study, “Wildland/Urban Interface: Fire 

Department Wildfire Preparedness and Readiness Capabilities.” This report, based on 

46 fire chief and senior line officer interviews, describes how some fire departments 

are addressing the wildfire peril and making the transition to becoming better prepared 

and ready to control and mitigate a wildfire incident in their communities. It includes 

information about equipment, training, communicating with the public, community risk 

reduction, relationship building and cooperation, and more. The results of this study 

will be beneficial to departments in the WUI for insight into best management practices 

(Haynes, Garcia, & Madsen, 2015).

Suppression

Wildfires create a significant safety threat for firefighters. From 2005 to 2014, 175 firefighters 

were killed during activities involving brush, grass or wildland firefighting. This total includes 

part-time and seasonal wildland firefighters, full-time wildland firefighters, and municipal 

or volunteer firefighters whose deaths are related to a wildland fire (USFA, 2015).
Critical Issues | 25

The Wildland Fire Lessons Learned Center (WFLLC) publishes wildland firefighter incident 

reports that are used for increased awareness and system improvements. The report 

does not distinguish between volunteer and paid firefighters. The 2015 Incident Review 

Summary noted that 16 of the 93 reported incidents by activity were driving related, 

followed by chainsaw operations at 15 incidents, and physical training at 13 incidents. 

Those three activities made up nearly half of all the incidents reported, and therefore 

offer an idea of where attention and training should be focused.

The report also detailed incidents by outcome. Over one-third of incidents resulted in 

burns or medical emergencies, followed by vehicle accidents as 13 outcomes, and hit 

by tree as 8 outcomes. While water tenders were only involved in one incident in 2015, 

rollover data shows that they pose a risk. The report urges anyone involved with their 

operation to consider the terrain in each case and determine whether their use is worth 

the risk (WFLLC, 2015).

Additionally, smoke exposure is another risk factor affecting wildland responders. The 

National Wildfire Coordinating Group (NWCG) provides national leadership to develop, 

maintain and communicate wildfire standards, guidelines, qualifications, training and 

other capabilities that enable interoperable operations among both federal and nonfederal 

entities (NWCG, n.d.). The NWCG has various committees and subcommittees that focus 

on particular initiatives in the wildland arena. The NWCG’s Smoke Committee’s Training 

Subcommittee and the University of Idaho (Idaho) College of Natural Resources produced 

the “Wildland Fire Personnel Smoke Exposure Guidebook” to help wildland fire personnel 

identify smoke constituents and symptoms, recognize what positions are frequently at risk 

from wildland fire smoke exposure, and put into practice mitigation efforts to minimize 

risks. The guidebook notes that “smoke is just one of the potential risks faced by wildland 

firefighters; when instituting these recommendations, it is important to evaluate and 

balance all the risks associated with the operational objective” (NWCG & Idaho, 2016, p.10).

There are several actions that can be taken to minimize smoke exposure, thereby minimizing 

health impacts. Three general ways this can be accomplished are through the following:

ĵ Elimination — moving to an area outside of the smoke or rotating crews in and out 

of the smoke.

ĵ Engineering — setting up a tent or mobile unit with clean air for breaks or planning 

periods.

ĵ Administration — cutting back on mop-up activity whenever possible or choosing to 

use a location that is not inundated by smoke. (NWCG et al., 2016)

Data indicates that mop-up and holding positions receive the highest exposure levels, so 

those are areas necessitating attention. Another factor to consider is use of equipment 

which generates exhaust, such as saws, bulldozers and pumps, which may increase carbon 

monoxide exposure to the operators (NWCG et al., 2016).
26 | Critical Health and Safety Issues in the Volunteer Fire Service

Tools for Your Toolbox

Recommended Practices for Wildland Firefighters (condensed)

ĵ Maintain situational awareness.

ĵ Know the Fire Orders and Watch Out Situations.

ĵ Stay healthy.

ĵ Take breaks.

ĵ Drive safely.

ĵ Wear appropriate PPE.

ĵ Report injuries, illnesses and hazards.

ĵ Be aware of increased risks of heat-related illness and rhabdomyolysis. (National 

Institute for Occupational Safety and Health (NIOSH), 2013)

In regards to wildland suppression operations and safety, existing and critical issues 

correspond with standard volunteer fire and emergency services. Statistics show a 

need for improved training in areas of apparatus, chainsaw operations, and situational 

awareness. The “Wildfire Preparedness and Readiness Capabilities” report mentioned 

earlier noted several problems regarding wildland/WUI fire training. These are:

ĵ The need to transition from traditional training practices which emphasized structural 

as opposed to wildland/WUI fire training.

ĵ Wildland/WUI fire training may be adopted inconsistently, with local and regional 

variations in the level and adequacy of training.

ĵ Fitness levels may not always be adequate to the rigors of wildland/WUI fire events. 

(Haynes et al., 2015)

Strategies to improve these problems included participating in interagency simulations 

and drills, many that include other wildland fire and incident command positions; adding 

wildland/WUI training to refresher training programs or continuing education programs; 

conducting training needs assessments; encouraging personnel to participate in external 

complex wildland/WUI fire assignments; creating wildfire divisions and programs 

within their departments; and getting all firefighters on par with NWCG recommended 

wildland fire training and fitness guidelines (Haynes et al., 2015). The universal issue of 

annual medical evaluations and the need for regular fitness routines are also applicable 

to wildland firefighters to ensure they are fit and ready to perform in physically 

demanding environments.

The emphasis on creating a culture of safety from the top down is equally important in the 

wildland arena. Leaders and officers, including heavy equipment supervisors, task force 

leaders, division supervisors, and Incident Commanders (ICs), should influence behaviors 

and enforce SOPs that will positively impact their teams in order to minimize prevalent 

risks and reduce wildland injuries and fatalities.

The NWCG Risk Management Committee (RMC) develops, promotes and facilitates universal 

risk management principles that help firefighters and fire managers mitigate or eliminate 

conditions that lead to accidents, illnesses, injuries and deaths of incident personnel. The 

RMC created a unique training and safety tool called 6 Minutes for Safety. The concept is 

managed by the 6 Minutes for Safety Subcommittee. The tool was created with the purpose 

of troubleshooting known high risk situations encountered on the fire line. It includes an 
Critical Issues | 27

online calendar with a specific safety topic assigned for each day. Supervisors or firefighters 

can access training resources that can be used for a daily safety briefing (NWCG, n.d.).

As stated earlier, fire departments must be financially sound in order to create a healthy 

and safe environment for personnel. It’s no secret that wildfire seasons are becoming more 

severe, and subsequently, fighting wildfires is becoming more expensive (Gorte, 2013). 

Costs to purchase and maintain apparatus, as well as properly train and equip wildland 

firefighters with the necessary tools and resources, are on the rise. Financial management 

and planning is essential to continue to improve and sustain wildfire suppression efforts 

at the local, state and federal levels. Federal wildfire suppression cost projections are 

expected to substantially increase over the next decade, as shown in Figure 3.

Figure 3. The Rising Cost of Wildfire Operations

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2,000,000

2012 2014 2016 2018 2020 2022 2024 2026

$1,789,900

$1,096,302

Source: U.S. Department of Agriculture, 2015.

The more money needed to suppress wildfire means less money for nonfire work, such 

as mitigation programs; after-fire recovery; watershed protection; and more, which affects 

everyone in the wildfire arena — from local fire departments to state forestry and the 

communities they are serving. It is essential for local departments to be part of the wildfire 

planning process — create or collaborate with stakeholder groups that consist of government 

agencies at the city, county, state and federal levels to pool resources; potentially build 

regional cost sharing opportunities; and capitalize on existing programs or services.

Mitigation

The other part of the wildfire safety equation is mitigation. Bloms (n.d.) describes 

mitigation in this way: “Managing risk is the primary means by which agencies achieve 

safety. Risk management is a process for assessing risk and developing strategies to 

mitigate it. This enables leaders to make improved organizational and operational 

decisions.” Wildfire agencies encourage homeowners to manage their risks by creating 

defensible space — the area around a home or other structure where fuels and vegetation 

are treated, cleared or reduced to slow the spread of wildfire.
28 | Critical Health and Safety Issues in the Volunteer Fire Service

Wildfire mitigation efforts can mean improved survivability chances for homes in the WUI 

and also reduce risk and improve safety for the firefighters and emergency personnel 

who must respond to these fires. Fuels reduction and landscape vegetation, along with 

building design, materials improvements, and maintenance, increase a property’s safety 

in wildfire-prone areas (Quarles et al., 2012). However, residents in the WUI tend to rate 

the risk of wildfire lower than professionals or experts. While fire departments can’t keep 

the WUI from expanding, they can help change this perception. In a 2013 two-county 

survey in Colorado, it was found that one of the most important sources of information for 

WUI residents that spurred action was guidance from local fire departments and county 

wildfire specialists (Miller, Champ, & Brenkert-Smith, 2013).

NVFC studied resource gaps in the area of wildfire preparedness for volunteer fire 

departments. The challenges facing volunteers in WUI communities are similar to other 

volunteer firefighters, and include increased time commitment and lack of personnel as 

the top factors that hinder mitigation efforts. Volunteers are in need of free resources 

to distribute to homeowners, training for department members to be able to conduct 

property assessments in order to make mitigation recommendations, and willingness of 

homeowners to comply with said recommendations.

One free resource is NVFC’s Wildland Fire Assessment Program (WFAP) — a joint effort 

between the U.S. Forest Service (USFS) and NVFC to provide volunteer fire departments 

with free training and resources to properly conduct assessments for homes located in 

the WUI. This is the first program targeted to volunteers that specifically prepares them to 

evaluate a home and provide residents with recommendations to protect their property 

and increase the chances of survivability from wildfires in order to become a more fireadapted community (FAC).

FACs also provide resources for communities in wildfire prone areas. FACs incorporate 

people, buildings, businesses, infrastructure, cultural resources and natural areas to 

prepare for the effects of wildfire. USFA and NVFC are both members of the FAC Coalition, 

a group of partners committed to helping people and communities in the WUI adapt to 

living with wildfire and reduce their risk for damage, without compromising firefighter or 

civilian safety. The coalition provides information and expertise on the development of 

this website and other activities related to FACs.

In 2015, more than 2,638 residences were destroyed by wildfire (NICC, 2015). The FAC (n.d., 

para. 2) warns, “Neighbors are linked by their wildfire risk. If one home is inadequately 

prepared, the risk level to the entire neighborhood increases and everyone’s safety is 

impacted.” This coincides with the idea of a communitywide approach to combat wildfire 

risks. Similar to funding suppression costs, fire departments need to be part of the 

wildfire planning process in regards to mitigation — work with government and corporate 

stakeholder groups, get community members involved, and capitalize on existing programs 

or services. For example, 18 member organizations of the Tahoe Fire and Fuels Team

recently collaborated with the public to develop an updated Community Wildfire Protection 

Plan (CWPP) for the Lake Tahoe Basin. Their plan is tied to the National Cohesive Wildland 

Fire Management Strategy, which has a goal to create FACs where agencies, organizations, 

groups and individuals join together to prepare for wildfire (Schafer, 2015). More information 

about CWPPs, the National Strategy and best practices can all be found on the FAC website.
Critical Issues | 29

 Goal: Improve safety of firefighters that respond to properties located 

in the WUI.

Objectives:

ĵ Conduct training and awareness programs that can be used to 

increase safety.

ĵ Partner with current wildland firefighting organizations to monitor 

best practices.

ĵ Provide annual physicals and wellness programs.

ĵ Provide leadership training to encourage a culture of safety.

ĵ Provide financial management training.

 Goal: Increase mitigation efforts in the WUI.

Objectives:

ĵ Improve recruitment and retention efforts to provide personnel 

for wildfire mitigation efforts.

ĵ Use free and low-cost resources that focus on wildfire mitigation.

ĵ Enhance wildfire awareness programs that encourage action and 

engagement from community members.

ĵ Cooperate with local and state agencies on a communitywide 

approach to mitigate wildfire risks.

Violence Against First Responders

Fire departments respond to a number of emergency calls; unfortunately, they don’t 

always know what they will be walking into. In 2012, in New York, two firefighters were shot 

and killed, and two others were injured by an ex-convict who intentionally set his house on 

fire to lure in the responders. In 2013, five firefighters in Georgia were taken hostage after 

responding to a phony medical call. The captor specifically targeted firefighters because 

he knew they would be unarmed. In 2015, a firefighter was deliberately struck and killed 

by an agitated driver during a fundraising event in Michigan. In 2016, two firefighters in 

Maryland were checking on a man’s well-being when they were shot; one died. Trenton, 

New Jersey, firefighters began wearing ballistic vests in 2016 to protect themselves on the 

job when they respond to medical incidents. On average, one firefighter per year dies as 

a result of a violent act (FLSI 12, n.d., para. 2).

In 2006, fire chief and martial arts instructor Howard Munding compiled a report for the 

NFA that showed more than 50 percent of firefighters admit to having been assaulted on 

the job (Holdsworth, 2013). He does not specify whether these are volunteer or career. 

Munding said that all responders need to have a sense of awareness — how to approach 

a scene, house or vehicle. Firefighters should also be trained to look for nonverbal cues, 

such as facial expressions and body language, and taught physical skills, like deflecting a 

punch or disarming someone, in order to get out of violent situations (Holdsworth, 2013).

The NFFF’s FLSI 12 specifically addresses violent incident response to “help reduce the 

likelihood of fire service members being injured or killed during a response to a violent 

incident” (n.d. para. 4).
30 | Critical Health and Safety Issues in the Volunteer Fire Service

Tools for Your Toolbox

Firefighter Life Safety Initiative 12 — Strategies

ĵ Improve understanding and application of Dynamic Risk Management.

ĵ Initiate or improve communication with the local law enforcement.

ĵ Define and expand role of dispatchers in reducing risk.

ĵ Prohibit single (person) resource response to violent incidents.

ĵ Require use of an Incident Management System for law enforcement.

ĵ Communicate directly with law enforcement component prior to operating at an 

incident of violence.

ĵ De-commit personnel and equipment, and leave if violence commences or reoccurs 

during fire department operations.

ĵ Obtain stakeholder understanding and buy-in of response and deployment policies, 

including nonresponse and nonengagement at incidents of violence.

ĵ Ensure department duty uniforms are not similar to, or could be mistaken for, 

those of law enforcement personnel. (FLSI 12, 2013)

With reports of increasing violence directed toward first responders, it is important for 

fire departments to prepare personnel for the possibility of an attack or assault while 

on duty. In support of Initiative 12, USFA is partnering with the International Association 

of Fire Fighters (IAFF) and Drexel University to research best practices in preventing and 

mitigating violence against first responders. This study will be published in early 2017 and 

will: (a) examine the circumstances surrounding these acts and their effects on personnel, 

(b) look at technological and operational ways to prevent violent workplace/on-duty 

incidents, (c) determine ways to mitigate violent workplace/on-duty incidents when they 

occur, and (d) provide examples of current best practices.

 Goal: Reduce the likelihood of injury or death from responding to 

incidents of violence.

Objectives:

ĵ Conduct self-defense and awareness training.

ĵ Incorporate FLSI 12 strategies into department SOPs

 Section Summary — Expanded Role of Firefighters: Volunteer 

firefighters are faced with ever-increasing roles and responsibilities. 

Departments must evolve in order to meet these demands. Training, 

comprehensive SOPs that cover all applicable functions, community 

awareness and injury prevention programs, and best practices from 

other organizations are essential in order to not only meet community 

expectations, but to safeguard volunteer departments and their 

responders who are expected to fulfill these roles. 
Critical Issues | 31

Personal Health

Although health, fitness and wellness are terms that are used somewhat interchangeably 

in the fire and emergency services, “most people think of fitness as physical fitness 

(exercise), whereas health and wellness are perceived as more comprehensive terms 

encompassing medical, emotional, mental and even spiritual components that make 

up a person” (Perry, 2002). In the past, it was widely believed that firefighter health 

and wellness was comparable to that of the normal population. However, recent and 

cumulative studies demonstrate that they may actually be at a higher risk for many chronic 

diseases, such as heart attack and cancer, along with various behavioral health problems, 

such as post-traumatic stress disorder (PTSD) and depression.

As stated in the 2010 critical issues guide (USFA & NVFC, 2010), risk factors predispose 

individuals to certain chronic diseases and are divided into two categories: modifiable 

and nonmodifiable. A nonmodifiable risk factor, such as age, gender, or genetics, cannot 

be changed. Conversely, modifiable risk factors, such as physical activity, tobacco use, 

and diet, can be changed. Many modifiable risk factors contribute to the leading causes 

of death and disability in the U.S. Therefore, improving one’s modifiable risk factors — by 

increasing physical activity or making healthy food choices, for example — could decrease 

the likelihood of several chronic diseases and improve overall health and well-being.

This section will explore various personal health issues that affect volunteer firefighters 

on a daily basis.

Behavioral Health

Behavioral health is just as important as physical health. “In developed countries, mental 

illness causes more disability than cancer and heart disease according to the World Health 

Organization (WHO). In fact, mental illnesses such as depression may even contribute to 

heart disease, cancer and other chronic illnesses” (Norris, 2011). According to the Substance 

Abuse and Mental Health Services Association, 42.5 million Americans experience some 

form of mental illness each year (2014). Firefighters, emergency medical technicians 

(EMTs), and rescue personnel experience a number of work-related stressors and repeated 

exposure to traumatic events that can put them at even greater risk of suffering from 

behavioral health issues, such as anxiety, depression, burnout, PTSD, addiction and suicidal 

thoughts. The risk of mental health issues is also higher among female firefighters than 

their male counterparts (Jahnke et al., 2012; Sinden et al., 2013).

There are a variety of factors that can influence firefighter behavioral health, including, 

but not limited to:

ĵ Joining the emergency services at a young age.

ĵ Competing priorities of trying to balance daily schedules, family and work life, 

unexpected calls, and unplanned events.

ĵ Significant life events — these can be both positive and negative, like a birth or death 

in the family, or getting promoted or laid-off from work.

ĵ Physical pain that hampers performance.

ĵ Shift changes or sleep disturbances.

ĵ Loss and grief, such as LODDs, experiencing a series of events back-to-back, or close 

calls.

ĵ Holding a supervisory rank. (Pignataro, 2013)

Furthermore, a 2012 study done on a cohort of female volunteer firefighters noted that 

more than a third (38.5 percent) were within the range of concern on the Center for 
32 | Critical Health and Safety Issues in the Volunteer Fire Service

Epidemiological Studies Short Depression Scale, suggesting they are at risk for depression. 

Job stressors for women were not dissimilar to those of their male counterparts, citing 

sleep disturbances as the most frequent, along with wage/benefit, safety, equipment, 

and job skill concerns. Women did report “experiencing significantly more occupational 

discrimination than their male peers,” and the study noted “social pressures associated 

with working in a male-dominated profession may contribute to the elevated rates of 

concerning (risk for depression) scores” (Jahnke et al., 2012, para. 42).

If left unaddressed, behavioral health issues can have tragic consequences on a 

firefighter’s personal and professional life. Relationships can be damaged or destroyed, 

dangerous habits or addictions could form, and the person may act recklessly, which 

also endangers their fellow responders. In some cases, behavioral health issues result in 

suicide. Firefighter suicide is three times more likely to occur compared to those working 

in other occupations (Gulliver et al., 2015). The Firefighter Behavioral Health Alliance 

(FBHA) reports that from 2012 to 2015, 395 firefighters committed suicide (data accessed 

November 2016). However, this number reflects only the suicides reported to FBHA, so 

the actual number is likely much higher (FBHA, n.d.). Also, the data does not specify how 

many of the firefighters were paid versus volunteer.

According to Ken Holland, a first responder who also serves as a senior emergency services 

specialist at NFPA, as well as staff liaison for NFPA 1500, Standard on Fire Department 

Occupational Safety and Health Program, behavioral health remains a difficult topic for all 

emergency responders for a variety of reasons. Among these reasons is a perceived stigma 

surrounding firefighters and behavioral health. As Holland stated in a 2014 article, “The 

thinking is, ‘we’re called on to help everyone else — we aren’t the ones who should need the 

help. ... No one wants to admit that they have a concern or an issue’” (Wilmouth, para. 7).

Industry and department leaders need to promote a cultural shift to ensure first 

responders are mentally ready to perform such a dangerous and stressful job, and they 

are able and willing to seek help if needed. There has been an increased awareness 

of firefighter behavioral health over the past several years. Bringing the issues to the 

forefront is necessary in order to change attitudes, remove the stigma surrounding 

behavioral health, and prevent tragic outcomes. Behavioral health should be incorporated 

into a department’s training and culture so that firefighters and emergency personnel 

know what factors influence behavioral health, how to recognize symptoms, and what 

resources are available to help those who may be experiencing symptoms.

Removing the stigma around behavioral health is a process, and it starts at the top. Some 

ideas for department heads include:

ĵ Set an example. Acknowledge and share emotions after tough calls. Seek help when 

needed, and listen attentively when someone shares a struggle.

ĵ Create a peer support team. Depending on the size of the department, select a few 

individuals that are widely trusted to be point people for responders and their families 

to go to when they need to talk. Provide the team members with training to handle 

certain issues and know when to seek additional help.

ĵ Contract with a behavioral health professional. Find a person experienced with the fire 

service or knowledgeable about the issues that are most common for first responders.

ĵ Make resources readily available. Display information for support groups, suicide 

hotlines and warning signs. (Willing, 2016)
Critical Issues | 33

Tools for Your Toolbox

RAILS: Top Five Behavioral Health Warning Signs to Look for in 

Yourself or Your Colleagues

1. Reckless/Impulsive: change in actions.

2. Anger: displacement.

3. Isolation: becoming distant.

4. Loss of confidence: skills/abilities.

5. Sleep deprivation: beyond the station. (FBHA, n.d.)

Behavioral health affects everyone in the department. If firefighters are not equipped with 

the right tools to deal with stressors of the job or obtain help if needed, it can negatively 

impact performance and safety for all — the responders, their colleagues, and those they 

are trying to protect. The key is developing an environment of acceptance, both at the 

leadership and peer-to-peer levels, and developing programs, tools and services to help 

prevent and cope with behavioral health issues.

NVFC launched the Share the Load program in 2014 to help first responders and 

departments proactively address behavioral health and get help if needed. The program 

includes the Fire/EMS Helpline, which is a free, confidential number firefighters and EMTs 

(whether they are career or volunteer), as well as their families, can call 24/7 for assistance 

with a variety of behavioral health issues. Available at 1-888-731-FIRE (3473), the Helpline 

is provided in partnership with the American Addiction Centers and is answered by trained 

counselors with fire service experience. Additional resources through Share the Load 

include training modules, resource guides, awareness materials, and more.

To educate spouses, children, parents, siblings and significant 

others about the volunteer firefighter lifestyle, NVFC created 

“What to Expect: A Guide for Family Members of Volunteer 

Firefighters.” Behavioral health can have a deep impact on loved 

ones, so this guide provides support to keep family relationships 

strong and contains an array of tips and resources to help first 

responder families understand and manage the mental and 

physical stressors that volunteer firefighting brings.

NFPA has revised NFPA 1500 to include chapters for behavioral 

health programs and occupational exposure to atypically stressful 

events. The standard specifies the minimum requirements for an occupational safety and 

health program for fire departments or organizations that provide rescue, fire suppression, 

EMS, hazardous materials mitigation, special operations, and other emergency services, and 

includes a protocol for using professional services when addressing exposure to atypical 

stressful events (NFPA 1500, n.d.).

Initiative 13 of the NFFF’s FLSI specifically addresses behavioral health and states that 

firefighters and their families must have access to counseling and psychological support 

(FLSI 13, n.d.). The Foundation has also released a Recommended Protocol for Exposure 

to Occupational Stress. One of the steps includes a Trauma Screening Questionnaire that 

helps identify whether or not the responder should seek additional help in recovering 

What to Expect: A Guide for Family Members of Volunteer Firefighters

Supporting Those Who Serve

139506_FamilyGuide.indd 1 8/5/14 1:31 PM
34 | Critical Health and Safety Issues in the Volunteer Fire Service

from a traumatic event. Assessments can be completed by the agency’s Behavioral Health 

Assistance Program (BHAP), which may lead to referral to a specialist. NFFF offers a guide 

to help fire departments develop BHAPs using the NFPA 1500 Standard (NFFF, n.d.).

 Goal: Increase awareness of behavioral health issues and provide 

resources to help those who need assistance.

Objectives:

ĵ Implement a behavioral health program in the department.

ĵ Require behavioral health training for all responders and department 

leaders.

ĵ Incorporate mental health screenings during physicals at both the 

recruit and veteran levels.

ĵ Include tools, such as the Recommended Protocol for Exposure 

to Occupational Stress, Trauma Screening Questionnaire, etc., in 

department’s SOPs.

ĵ Utilize the Share the Load program resources, including materials 

to promote the Fire/EMS Helpline and support tools.

 Goal: Increase reporting of behavioral health issues.

Objectives:

ĵ Use the FBHA’s Confidential Firefighter Suicide Report to record 

responder suicides.

ĵ Participate in firefighter national studies and research efforts.

Cardiovascular Disease

One in every four Americans dies of a heart attack each year (Centers for Disease 

Control and Prevention (CDC), 2015). USFA releases annual firefighter fatality reports 

that consistently show heart attacks as the leading cause of death. In fact, over the last 

decade, over half (54.5 percent) of on-duty volunteer firefighter deaths were the result 

of a heart attack (USFA, n.d.). NFPA, which also releases annual firefighter fatality data, 

reported 32 on-duty volunteer deaths in 2015; 18 of those (56 percent) were sudden cardiac 

deaths (Fahy, LeBlanc, & Molis, 2016). This demonstrates that firefighters and emergency 

personnel are at an even greater risk of cardiovascular disease (CVD) than the general 

population. Addressing heart disease and heart disease risk factors is key in protecting 

firefighters and emergency personnel from life-altering or life-threatening outcomes.

There are many factors that put firefighters and emergency personnel at increased risk 

for heart disease. Research has identified that responders face additional occupational 

hazards, including smoke exposure, noise, psychological stress, shift work, and physical 

workload. NFPA reported that overexertion/strain caused 27.7 percent of fireground 

injuries in 2015 and that heart attack or stroke specifically caused 920 (1.4 percent) of all 

injuries (Haynes & Molis, 2016).
Critical Issues | 35

Tools for Your Toolbox

Risk Factors You Bring to a Fire That May Increase Your Risk for 

a Heart Attack or Stroke

ĵ High blood pressure (>140/>90).

ĵ High cholesterol (total cholesterol >200).

ĵ Poorly controlled blood sugar (fasting >100) or diabetes (HbA1C >7 percent).

ĵ Age (over 45 in men and over 50 in women).

ĵ Family history of heart attack or stroke (at ages ≤ 55 in a father, brother or son, or 

at ages ≤ 65 in a mother, sister or daughter).

ĵ Poor lifestyle habits that increase your risk for a heart attack, including:

k Poor dietary choices.

k Lack of regular exercise.

k Tobacco use.

k Overweight or obesity. (Ashen, 2014)





Researchers at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease

and the Johns Hopkins Center for Vascular Medicine believe that disability and death from 

a heart attack in firefighters is preventable. Risk factors, such as family history, obesity, 

elevated blood pressure, blood sugar, and cholesterol, as well as poor lifestyle habits, 

can lead to CVD (Ashen, 2014). Johns Hopkins studies also show that “traditional first-line 

checks of heart disease, such as cholesterol, blood pressure, and smoking habits, are 

not good enough to identify CVD in otherwise healthy, young firefighters” and that more 

in-depth methods — cardiovascular imaging, CT scanning, or ultrasound testing — may be 

necessary to find plaque buildup or thickening of the carotid artery (Williams, 2014, para. 4).

In an article about firefighter heart health, NFFF Executive Director Ronald Siarnicki noted:

If more firefighters are aware of their potential risks for cardiovascular disease 

and receive guidance on how to manage their lifestyles, the fire service 

may continue to see fewer incident-related deaths. ... There will always be 

incidents that are beyond our control, and there will continue to be line-ofduty deaths, but when there is something like this that can be corrected, it 

just makes sense to take those preventative steps. (Ashen, 2014, para. 23)

Firefighters can decrease their chances of heart disease and related complications through 

early detection and changing modifiable risk factors. Annual health screenings starting 

at an early age, diet, exercise, not smoking or abusing alcohol or other drugs, and other 

positive behavioral elements, such as using medication if necessary, can significantly 

reduce chances of developing CVD.

NVFC’s Heart-Healthy Firefighter Program provides education, awareness and resources to 

help combat heart disease. The program promotes fitness, nutrition and health awareness 

for all members of the fire and emergency services, both volunteer and career.
36 | Critical Health and Safety Issues in the Volunteer Fire Service

 Goal: Combat heart disease and heart disease risk factors to reduce 

death and injuries caused by heart attack.

Objectives:

ĵ Administratively from the department:

k Provide personnel with resources to know their numbers (e.g., 

blood pressure, cholesterol, weight). Read the next section 

on physicals and fitness for ideas about implementing health 

screenings and wellness initiatives.

k Create a positive environment to encourage personnel to change 

modifiable risk factors, such as enforcing a no-smoking policy on 

or off department property, providing healthy snacks and meals, 

incorporating functional fitness regimens into training, etc.

k Promote fitness, nutrition and health awareness specifically 

related to heart disease.

k Lead by example.

ĵ Personally from the volunteer:

k Get in-depth screenings starting at a young age (and regularly) 

to stay abreast of potential risks.

k Alter modifiable risk factors to engage in a healthy lifestyle, 

such as eating healthy, exercising, not smoking, etc.

k Take personal responsibility for your health, and use resources 

provided by the department and other sources.

Physicals and Fitness

USFA reported 51 on-duty volunteer firefighter deaths in the U.S. during 2014. The largest 

share (72.5 percent) of these deaths was caused by stress/overexertion, which is up from 

an average of 56.4 percent from 2005 to 2013.

NIOSH conducts investigations into firefighter LODDs and creates reports to provide 

recommendations to increase safety and prevent future deaths and injuries. One of these 

reports investigated the death of a 52-year-old male volunteer chief on April 21, 2014. 

He was at a fire scene pulling hose when he collapsed. High blood pressure, coupled 

with atherosclerotic CVD, which is the narrowing of arteries because of plaque buildup, 

was determined by the assistant medical examiner as the cause of death. NIOSH’s 

investigators acknowledged that the physical strain and exertion likely provoked the heart 

attack (NIOSH, 2015).

Included in that report were several recommendations by NIOSH:

ĵ Provide preplacement and annual medical evaluations to all firefighters in accordance 

with NFPA 1582, Standard on Comprehensive Occupational Medical Program for Fire 

Departments, to identify firefighters at increased risk for coronary heart disease (CHD).

ĵ Ensure exercise stress tests are performed on firefighters with an increased risk for CHD.

ĵ Ensure that firefighters are cleared for duty by a physician knowledgeable about the 

physical demands of firefighting, the PPE used by firefighters, and the components 

of NFPA 1582.

ĵ Phase in a mandatory, comprehensive wellness and fitness program for firefighters. 

(NIOSH, 2015)
Critical Issues | 37

Firefighters are subjected to rigorous physical exertions in the line of duty. Some 

responders are required to complete an initial examination to determine their ability to 

do the job; however, many volunteer departments do not require follow-up annual or 

biannual testing to ensure their members stay fit over the course of their tenure. In a 

2014 independent study conducted by NVFC, only 18 percent of volunteer respondents 

said that their department required an annual health screening. NVFC has adopted a 

position that supports annual medical assessments. Aging volunteer populations, intense 

physical demands of firefighting, and firefighting health-related injuries, such as heart 

attack, stroke, and cancer, make periodic medical evaluations a critical component to 

the health and safety of personnel and to those they are serving. Departments should 

evaluate the current health of their team on a regular basis and have reactive measures 

in place to help those who need it.

In addition to periodic physicals, an ongoing fitness program is essential for members. 

Exercises should include functional fitness and target areas firefighters use when 

training and responding. The program should include strength, conditioning, and proper 

stretching. Many firefighters assume they are getting exercise simply because they are a 

firefighter. However, the exercise they get from fire service activities is often not enough. 

Many volunteer departments do not require their personnel to stay physically active and 

maintain a healthy physical condition. On-duty firefighters frequently have large amounts 

of sedentary time in between calls. Additionally, volunteer firefighters often have other 

jobs that are less physically demanding than being a firefighter (NVFC, n.d.-b).

To expand research on the health and safety issues experienced by female firefighters, 

the International Association of Women in Fire and Emergency Services is leading a 

project funded by USFA. The goal of the project is to develop initiatives, programs and 

strategies to enhance their health and safety aimed to reduce on-duty female firefighter 

fatalities. Resources created from this project to assist fire departments are projected to 

be available in fall of 2017.
38 | Critical Health and Safety Issues in the Volunteer Fire Service

Tools for Your Toolbox

Know Your Health: Tips for an Active Lifestyle

ĵ Talk with your physician, and have your blood lipid profile checked to determine 

if you should be more active based on your disease risk factors.

ĵ Participate in a minimum of 30 to 60 minutes of moderately intense activity five 

times per week.

ĵ Fit in exercise when you can by breaking it in to multiple smaller sessions each 

day, instead of all at once.

ĵ Aim for 150 minutes of cardio exercise per week. Any kind of consistent movement 

is beneficial.

ĵ Resistance training can help improve your numbers, as well as range of motion, 

muscular strength, and endurance.

ĵ Being flexible helps you move. Some flexibility exercises (stretching, yoga or Pilates) 

can also help relieve muscle soreness and/or stress.

ĵ Try functional fitness training that involves movements associated with everyday 

life and your fireground activities.

ĵ Incorporate functional fitness into firefighter training activities; for example, run 

multiple “reps” of a drill dragging a hose or lifting equipment to burn more calories.

ĵ Fit in more exercise time at the station by challenging your fellow firefighters to a 

game of basketball or flag football.

ĵ Make exercise a family affair; spend your valued time at home on a family walk, 

hike or bike ride.

ĵ Realize that every bit counts, and the most important thing is to just get moving. 

(NVFC, n.d.-c)

One challenge in implementing periodic physicals and an overall health and wellness 

program in volunteer departments is cost. According to the NVFC study, less than 1 

percent of the volunteers that do get an annual screening said that the department pays 

for it — the rest is either paid out-of-pocket, or it is covered under their personal health 

insurance. Departments can use NVFC’s “Securing Sponsors for Department Health and 

Wellness Programs” toolkit that is available on the NVFC website to help offset costs. The 

toolkit walks you through the steps of soliciting sponsors and community support for 

your program, and includes information on getting started, reaching out, and following 

up with potential benefactors.

There are other numerous resources to help departments start or enhance a wellness 

and fitness program. USFA and NVFC developed the “Health and Wellness Guide for the 

Volunteer Fire and Emergency Services” to address health and fitness topics, including:

ĵ An overview of national wellness initiatives geared toward the volunteer emergency 

services.

ĵ Common issues and factors that impact first responder health and wellness.

ĵ Example health and wellness programs from across the country.

ĵ Information on developing and implementing a health and wellness program in a 

volunteer department. (2009)
Critical Issues | 39

The NVFC’s Hear t-Healthy Firefighter 

Program provides a variety of fitness 

resources, such as video demonstrations of 

functional fitness exercises and guides to 

help departments implement a health and 

wellness program.

N F PA 15 0 0 s p e c i f i e s t h e m i n i m u m 

requirements for an occupational safety 

and health program for fire departments 

or organizations that provide rescue, fire 

suppression, EMS, hazardous materials 

mitigation, special operations, and other 

emergenc y ser vices. Protocols cover 

firefighter training, apparatus, protective clothing and equipment, medical and physical 

requirements, and health and wellness programs (NFPA 1500, n.d.).

NFPA 1582 outlines an occupational medical program to reduce risks and provide for 

the health, safety and effectiveness of firefighters operating to protect civilian life and 

property. To help fire departments ensure that personnel are medically capable of 

performing their required duties, the latest NFPA 1582 edition incorporates current 

research and knowledge to present the latest provisions for a comprehensive occupational 

medical program. The standard provides separate chapters for the medical evaluation 

of candidates/prospective employees and for the occupational medical and fitness 

evaluations for fire department members. Requirements are equated against the essential 

job tasks based on several NFPA Professional Qualification Standards and apply to career, 

volunteer, private, industrial, governmental and military fire departments (NFPA 1582, 

n.d.). Discussions to tie behavioral health into the annual fire service physical may also 

be included in future NFPA 1582 revisions.

NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members, 

outlines a complete health-related fitness program for members of fire departments 

involved in emergency operations to enhance their ability to perform occupational 

activities and reduce the risk of injury, disease and premature death. Requirements 

apply to all aspects of the development, implementation and management of a program, 

including roles and responsibilities, health and fitness coordinators, peer fitness trainers, 

fitness assessments, exercise and fitness training programs, health promotion education, 

and data collection. It also includes a sample fitness plan and self-assessment tool (NFPA 

1583, n.d.).

IAFC and IAFF also developed the Wellness-Fitness Initiative (WFI). WFI is dedicated 

to creating a stronger fire service, starting with well and fit firefighters. Information is 

collected from fire departments in the U.S. and Canada to determine best practices for 

committing to a wellness-fitness program (IAFF, n.d.).

IAFC also offers “A Healthcare Providers Guide to Firefighter Physicals.” This free guide 

helps healthcare providers in the evaluation and treatment of the health and wellness of 

firefighters and also serves as an important new tool for firefighters to manage their own 

healthcare (IAFC, 2016).
40 | Critical Health and Safety Issues in the Volunteer Fire Service

 Goal: Provide annual physicals and/or periodic health screenings.

Objectives:

ĵ Require and provide initial health screenings for all recruits.

ĵ Require and provide routine/annual health screenings for all 

members.

ĵ Provide resources, training and wellness programs to help those 

struggling to pass periodic screenings.

ĵ Require health trainings/seminars for all responders and department 

leaders to communicate health risk factors and health risk-reduction 

techniques.

ĵ Work with government officials, community organizations, insurance 

companies, hospitals/health care providers, and other key leaders 

to offset costs to implement health screenings in the department 

at no cost to firefighters.

 Goal: Implement a health and wellness program in the department.

Objectives:

ĵ Provide health and wellness training that includes information 

about core and functional strength, along with demonstrations for 

proper form and sample exercises (these could be communicated 

via posters and/or handouts).

ĵ Provide an exercise area at the station, or work with local gyms to 

secure discounted or free memberships for personnel.

ĵ Work with government officials, community organizations, insurance 

companies, hospitals/health care providers, and other key leaders 

to offset costs to implement a health and wellness program in 

the department.

Nutrition

Proper diet is a contributing factor to firefighter health and safety. According to the NVFC 

study “Addressing the Epidemic of Obesity in the United States Fire Service,” rates of 

overweight and obese individuals in the fire service are higher than those found in the 

general public, ranging from 73 to 88 percent of all firefighters (Haddock, Poston, & Jahnke, 

2011). The nation spends an estimated $190 billion a year treating obesity-related health 

conditions (Cawley & Meyerhoefer, 2012). Healthy eating can improve blood pressure and 

cholesterol levels and decrease obesity — major factors that contribute to heart disease 

and other chronic illnesses in firefighters and the general population.
Critical Issues | 41

Firefighters must make a conscious effort to eat natural, 

whole foods and avoid processed carbohydrates and 

sugar. Eliminate sugary beverages, such as soda, sports 

drinks and energy drinks. Avoid high sodium-enriched 

foods, most of which come from fast food. The 2015 

U.S. Department of Health and Human Services and U.S. 

Department of Agriculture (USDA) update to the dietary 

guidelines that form the basis of U.S. nutritional policy 

focuses on five guidelines in order to encourage healthy 

eating patterns:

1. Follow a healthy eating pattern across the lifespan.

2. Focus on variety, nutrient density, and amount.

3. Limit calories from added sugars and saturated fats, and reduce sodium.

4. Shift to healthier food and beverage choices.

5. Support healthy eating patterns for all.

Education is monumental. Courtney Fulton, a health and safety assistant in the IAFF 

Department of Occupational Health and Safety, writes:

Part of staying healthy is learning what to eat and sustaining a well-balanced 

diet. This in turn can help strengthen the immune system, boost energy 

levels, enhance recovery, and fuel the body for strenuous work. It can help 

firefighters and emergency responders become more physically capable 

of withstanding the stress and demands of the job and enhance their 

performance and quality of life. (2010)

Pressures to purchase inexpensive foods, consume large portions, the temptations of 

unhealthy snacks at the firehouse, and peer pressure are all challenges firefighters face 

when trying to implement healthy eating habits (Haddock et al., 2011). Other studies have 

shown that time management and the need to have quick meals also impedes healthy 

choices. Researcher and Associate Professor Larry Cheskin from the Johns Hopkins 

Bloomberg School of Public Health noted that “it can be very difficult to alter the culture 

inside the station and that the change has to start from the top in order to change the 

environment” (Peluso, 2012, para. 27). An occasional celebration can be harmless, but 

regularly eating unhealthy foods only contributes to the obesity epidemic in the fire and 

emergency services (Haddock et al., 2011).

Cost may also be a concern. Registered dietician Sally Kuzemchak wrote, “A 2013 study 

from Harvard School of Public Health found that eating a healthy diet rich in fruits, 

vegetables, fish, and nuts costs about $1.50 more per day per person than eating an 

unhealthy diet full of processed foods and refined grains” (2015, para. 2). That can 

significantly increase an annual volunteer department’s budget, especially if they are 

operating on minimal funds to begin with. However, an improved diet can potentially 

save departments money by minimizing illnesses and keeping responders on the front 

lines and out of doctor’s offices. Departments could consider working with local grocers, 

businesses, or other agencies to offset some of the expenses associated with purchasing 

better foods. For example, the USDA National Institute of Food and Agriculture offers the 

Expanded Food and Nutrition Education Program (EFNEP). Land-grant universities conduct 

the EFNEP program in all states. EFNEP programs place emphasis on food-decision skills, 

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42 | Critical Health and Safety Issues in the Volunteer Fire Service

such as how to stretch food dollars and safely prepare healthy meals. EFNEP programs 

offer interactive lessons at no cost to participants. Lessons cover dietary quality; physical 

activity; food resource management (how to make healthy foods affordable); food 

safety; and food security (USDA, 2013). The EFNEP program was delivered in 2013 by 

The Ohio State University (OSU) Extension Office to members and family members of 

the Winona (Ohio) Volunteer Fire Department. OSU Extension Program Specialist Yvette 

Graham indicated noted behavior changes among participants from the department, with 

members reporting in 2016 that behavior changes have continued.

Department leaders and firefighters need to inspire a change at the station through 

positive adjustments, such as purchasing healthy snacks, meal planning, creating 

nutritional challenges, and rewarding positive eating behaviors. Also get firefighter families 

and community members involved in the department’s healthy eating campaign. It’s easy 

to revert back to an unhealthy diet when it’s provided and fortified by others. Firefighters 

should carry their healthy eating habits back home and get the whole family involved. 

Consider inviting families and community members to the station for educational 

seminars or trainings about health and wellness so they understand the importance of 

an “all-hands on deck” approach to this lifestyle change.

Tools for Your Toolbox

10 Steps to Take Control of Your Nutrition (modified)

1. Decide to get serious about nutrition. Think carefully about what you eat, plan 

ahead, and stock the kitchen at the firehouse with healthy foods and snacks.

2. Get informed. Regularly visit reputable nutrition websites by individuals who 

have worked and/or are popular with firefighters and other industrial athletes.

3. Encourage a culture of healthy eating in the department. Publicly support 

a firefighter who suggests having healthier snacks at the firehouse. Ask local 

dietitians or fitness professionals to come speak at department meetings about 

healthy eating to discuss ways to overcome barriers to healthy eating, such as 

cost and access.

4. Reduce the amount of processed foods (e.g., foods that come in a wrapper 

or box) and refined sugars in the home and the firehouse. In particular, avoid 

white flour, white flour products, and white rice.

5. Eat high-quality vegetables and fruits. Focus on eating the highest-quality food 

that you can find. Food is one area where cheap is not a bargain.

6. Focus on high-quality meats and eggs, and limit processed meats. Select 

meats and eggs that are naturally and locally produced. Avoid highly processed 

meats, such as cold cuts.

7. Round off your diet with nuts and seeds. Nuts and seeds are packed with healthy 

nutrients and help to keep you feeling full and energetic. Try to avoid eating peanuts.

8. Eliminate trans-fats and high-fructose corn syrup from your diet. This is 

getting easier to do as more and more food manufacturers eliminate both of these 

problematic ingredients.

9. Drink plenty of water and unsweetened tea. Come to work hydrated, and stay 

that way throughout the day.

10. Rethink treats and snacks. Behavioral scientists talk about using “stimulus 

control” to help change a habit. Fill your environment with healthy foods, and get 

rid of those that will ultimately make you sick. (Haddock et. al., 2011)
Critical Issues | 43

 Goal: Incorporate healthy nutrition and eating habits into the 

department’s environment.

Objectives:

ĵ Provide and require nutrition training/seminars for firefighters. 

Include family members and invite the public to encourage all-in 

participation of a healthy eating environment.

ĵ Require department leaders to spearhead nutrition campaigns and 

nutrition challenges.

ĵ Purchase nutritious foods and snacks for the station. Have healthy 

yet appealing meals ready-to-eat or available at the department to 

encourage firefighters to bypass fast food and other unhealthy options.

ĵ Communicate the station’s healthy eating campaign to the public.

ĵ Work with local grocers and businesses to offset healthy eating costs.

ĵ Work with local, healthy-oriented restaurants to provide discounts 

to fire and EMS personnel.

Cancer

More and more firefighters are being diagnosed with cancer, and recent medical studies 

have demonstrated that firefighters are at a significantly higher risk for many types of 

cancer than the general population. This is due to the high levels of carcinogens and 

other toxins found in burning buildings and the other hazardous environments in which 

firefighters routinely work.

A 2013 white paper, “Taking Action Against Cancer in the Fire Service,” released by the 

Firefighter Cancer Support Network (FCSN) indicated that the two routes of greatest 

concern for entry of carcinogens into the body are through the lungs when firefighters 

do not wear (or prematurely remove) SCBA and through dermal absorption when toxins 

are absorbed through the skin. Also, the most permeable piece of PPE is the hood.

NIOSH and USFA have been working on a multiyear study since 2010 to see if 

firefighters are at a higher risk for cancer deaths due to job exposures. “The study 

was designed to address limitations of previous firefighter cancer research” (NIOSH 

& USFA, 2015). An intermediary 2013 report from the study provided evidence 

that there is a correlation between firefighting and cancer. “The new finding of 

excess malignant mesothelioma in this report was noteworthy, given that asbestos 

exposure is a known hazard of firefighting” (Daniels, Kubale, Yiin, et al., 2013, 

p. 1). Two years later, another report noted “lung cancer and leukemia mortality risks were 

modestly increasing with firefighter exposures. These findings added to evidence that 

there is a causal association between firefighting and cancer” (Daniels, Bertke, & Dahm, 

2015, p. 1). Finally, the latest fact sheet that was released in July 2016 stated that, based 

on U.S. cancer rates:

ĵ Firefighters in the study had a greater number of cancer diagnoses and cancer-related 

deaths — mostly digestive, oral, respiratory and urinary cancers.

ĵ There were about twice as many firefighters with malignant mesothelioma, a rare type 

of cancer caused by exposure to asbestos. Exposure to asbestos while firefighting is 

the most likely explanation for this.
44 | Critical Health and Safety Issues in the Volunteer Fire Service

ĵ There were more cases of certain cancers among younger firefighters. For example, 

firefighters in the study who were under 65 years of age had more bladder and prostate 

cancers than expected.

When comparing firefighters in the study to each other:

ĵ The chance of lung cancer diagnosis or death increased with amount of time spent 

at fires.

ĵ The chance of leukemia death increased with the number of fire runs.

In summary, the “study provides further evidence that fire fighters are at increased risk 

of certain types of cancer as a result of occupational exposure” (NIOSH, 2016, p. 1). It is 

important to note that the study could not determine, for the firefighters that currently 

have cancer, if their cancer was specifically fire service related.

FCSN used NIOSH research and other studies to identify the types of cancer that pose 

greater risks for firefighters. They include:

ĵ Testicular cancer (2.02 times greater risk).

ĵ Multiple myeloma (1.53 times greater risk).

ĵ Non-Hodgkin’s lymphoma (1.51 times greater risk).

ĵ Skin cancer (1.39 times greater risk).

ĵ Prostate cancer (1.28 times greater risk).

ĵ Malignant melanoma (1.31 times greater risk).

ĵ Brain cancer (1.31 times greater risk).

ĵ Colon cancer (1.21 times greater risk).

ĵ Leukemia (1.14 times greater risk).

ĵ Breast cancer in women (preliminary study results from the San Francisco Fire 

Department). (FCSN, 2013)

Most of the cancer research in the U.S. has been conducted on career firefighters; 

however, cancer studies and research can be applied to volunteers as well since they 

perform the same duties. These types of studies highlight the critical need for increased 

awareness and implementation of certain mitigation measures. In the FCSN white paper, 

Chief Tim Wall stated:

Cancer does not discriminate between firefighters. Volunteers routinely 

transport bunker gear in their vehicles, wear clothing contaminated after 

a fire into their homes and expose their families to these carcinogens. This 

is a terrible problem that requires our full attention and immediate action. 

(2013, p. 4)

There are often delayed, long-term effects of toxic hazard exposures in emergency 

responders. Unfortunately, on-duty firefighter exposure to toxic hazards is not sufficiently 

tracked, and exposures firefighters may receive while off-duty are unknown (USFA, 2015). 

Additionally, cancer rates are potentially under-reported among firefighters because 

many firefighters do not discover they have cancer until they retire and are subsequently 

considered to be part of the general population comparison group. Also, volunteers may 

list their profession as something other than firefighter and therefore are not reported 

as cases of firefighter cancer.

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Critical Issues | 45

Volunteers should be proactive in tracking personal exposures by using exposure recordkeeping systems provided by the department or by establishing their own method of 

capturing the necessary exposure information (smartphone, computer, pen and paper, 

etc.). This documentation is important in allowing firefighters to better understand 

their risks and more effectively communicate these risks to their health care provider. 

In addition, in states where cancer presumption laws have been implemented, having 

exposure records bolsters the claim for the impacted firefighter as more cases are being 

challenged and presumptive legislation is coming under re-examination. Presumption laws 

designate cancer as an occupational hazard for firefighters, thus allowing firefighters who 

contract cancer to file worker’s compensation claims.

The FCSN white paper described the role organizational leaders play in reducing cancer 

exposure: 

The company officer, as the leader of the most operational working group in 

the fire service, is the single most influential person concerning the team’s 

attitude, operations and willingness to change. In this key role, the company 

officer must lead by example and set clear expectations concerning cancer 

awareness, prevention, tracking of exposure and the essential operational 

changes necessary to minimize exposure to carcinogens and other toxins. As 

a second set of eyes, the next level of supervision and the person in charge 

of multiunit operations, the Battalion Chief (BC) has the responsibility of 

overall command and situational awareness. This key position allows the 

BC to provide reinforcement of SOPs, SOGs and other operational practices 

concerning cancer exposure reduction. (2013, p.5)

Department leaders should also evaluate station conditions and administrative policies, 

and make sure they promote cancer risk reduction practices.

ĵ Is there an exhaust removal system, decontamination station, and other provisions 

that can reduce cancer-causing carcinogens? FCSN reports that WHO, NIOSH, OSHA, 

NFPA, and many other national organizations regard diesel exhaust as an occupational 

carcinogen.

ĵ Do personnel have more than one set of gear? Proper care and maintenance of PPE, 

wearing SCBA in active and post-fire environments, use of tobacco products and 

smoking, and other cancer-reduction methods should be covered in SOPs and fully 

enforced by leadership.

Early detection has been proven to increase cancer survival rates. It may also decrease 

overall costs for the department (i.e., loss of a qualified member, training, higher 

insurance). Firefighters should undergo annual health screenings and participate in cancer 

awareness training.

Most importantly, firefighters should be proactive and take pre-emptive measures 

to reduce their modifiable risks. They are responsible for their personal health, and a 

behavioral change is vital for each individual. Practice strategies to prevent and detect 

cancer — do not take pride in having dirty gear, eat healthier, maintain a reasonable 

weight, exercise functionally and regularly, limit alcohol consumption, do not use tobacco 

products, wear sunblock, and track your exposures.

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46 | Critical Health and Safety Issues in the Volunteer Fire Service

Tools for Your Toolbox

11 Immediate Actions to Protect Against Cancer

1. Use SCBA from initial attack to finish of overhaul. (Not wearing SCBA in both active 

and post-fire environments is the most dangerous voluntary activity in the fire 

service today.)

2. Do gross field decontamination of PPE to remove as much soot and particulates 

as possible.

3. Use Wet-Nap or baby wipes to remove as much soot as possible from head, neck, 

jaw, throat, underarms and hands immediately and while still on the scene.

4. Change your clothes, and wash them immediately after a fire.

5. Shower thoroughly after a fire.

6. Clean your PPE, gloves, hood and helmet immediately after a fire.

7. Do not take contaminated clothes or PPE home; do not store them in your vehicle.

8. Decontaminate fire apparatus interior after fires.

9. Keep bunker gear out of living and sleeping quarters.

10. Stop using tobacco products.

11. Use sunscreen or sunblock. (FCSN, 2013)

FCSN provides assistance to all fire service members and their immediate families in the 

event of a cancer diagnosis. They also provide awareness/prevention education to the fire 

service about the importance of cancer prevention and screening.

NVFC also offers a multitude of resources to help responders and their departments 

take action specifically against cancer, including tools and templates, training and videos, 

research, and more.

 Goal: Implement cancer mitigation methods and promote cancer 

awareness.

Objectives:

ĵ Administratively from the department:

k Evaluate station conditions and administrative policies to ensure 

they promote cancer risk-reduction practices.

k Provide periodic health screenings.

k Provide exposure forms, and encourage personnel to use them.

k Provide cancer awareness training and resources.

ĵ Personally from the volunteer:

k Get screened regularly to stay abreast of potential risks.

k Persistently practice the 11 immediate actions noted in the Tools 

for Your Toolbox section to protect against cancer.

k Document exposures and keep exposure records, both shortand long-term.
Critical Issues | 47

Alcohol, Tobacco and Prescription Drug Abuse

Substance abuse and addiction are ongoing problems among first responders, both career 

and volunteer. For emergency response professionals, as well as for anyone who struggles 

with a drug or alcohol use disorder, the causes are often varied and complex.

Michael Healy, a seasoned firefighter and treatment consultant for American Addiction 

Centers, described the relationship between service members and substance abuse:

For many firefighters, police officers, EMTs, and other first responders, 

the urge to drink or use drugs may be related to the job they do every day. 

Experiencing post-traumatic stress disorder (PTSD) as a result of trauma on 

the job is exceedingly common. The symptoms of PTSD can be significant 

and severe. Many prefer to attempt to escape them by drinking or getting 

high rather than seeking treatment, believing that the problems may go 

away on their own in time. (2015, para. 2)

Unfortunately, chronic drug abuse may actually serve to:

ĵ Increase the severity of PTSD symptoms.

ĵ Lengthen and/or increase the frequency of PTSD episodes.

ĵ Cause the new problem of addiction.

ĵ Make it more difficult to connect with therapy and other treatment help. (Healy, 2015)

Tools for Your Toolbox

Questions to Ask Yourself to Identify if You Have an Alcohol or 

Drug Problem

ĵ Do you drink or use drugs on the job?

ĵ Do you often drink more than you intend to? That is, do you often start out saying 

you’ll only have one, but ultimately drink until you are drunk?

ĵ Do you use any illegal substances or abuse a prescription given to you, a family 

member, or friend?

ĵ Do you have problems with your significant other due to your behavior while 

under the influence?

ĵ Do you ever drive while under the influence? (Healy, 2015)

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The NVFC’s Share the LoadTM program offers the Fire/EMS Helpline that first responders 

and their families can call 24/7 to seek help for a variety of behavioral health issues, 

including alcohol or drug addiction and PTSD. An online chat feature is also available. 

Depending on individual needs, callers can speak with a trained fire service member who 

can refer local resources to help with specific problems, or callers can be admitted to a 

treatment facility, if desired, where there are licensed counselors trained in the fire service 

culture. If a treatment center is needed, the Fire/EMS Helpline counselors will work to 

make sure there is no cost to those needing service (NVFC, n.d.-d).
48 | Critical Health and Safety Issues in the Volunteer Fire Service

IAFC has adopted a position that encourages all fire and emergency service agencies/ 

organizations to develop written policies and have procedures in place to support and 

enforce a drug and alcohol free environment. Their position states:

Agencies should have drug and alcohol testing procedures, including provisions 

for random testing, testing for cause, and critical event testing as a result of 

any incident that causes measurable damage to apparatus or property or 

injury/death of civilians or agency/organization personnel. (2012, p. 1)

Alcohol

In several studies conducted from 2013 to 2015, it was determined that male firefighters 

drink alcohol more frequently than the general male population, and nearly twice as 

many firefighters reported recently binge drinking as compared to the general population 

(Jahnke, 2015). An article titled “Perceptions of Alcohol Use Among U.S. Firefighters” noted:

Limited epidemiologic evidence is available regarding the rates and patterns 

of alcohol use among U.S. firefighters, although what has been published 

presents a compelling picture of high rates of consumption and binge drinking. 

For instance, in a population-based sample of firefighters from the central 

U.S., it was found that 85 percent of career and 70 percent of volunteers 

reported consuming alcohol in the previous 30 days, and 56 percent of 

career and 45 percent of volunteer firefighters reported binge drinking in the 

past 30 days. In a sample of 112 firefighters from the northeast, 58 percent 

reported binge drinking behavior. In comparison, the national rate of current 

drinking and binge drinking in the past 30 days for men is 67.6 percent and 

approximately 20 percent, respectively. These statistics demonstrate that 

binge drinking is substantially higher among firefighters than the general 

population. (Jahnke, Poston, & Haddock, 2014, p. 1)

The article also provided factors that contribute to alcohol consumption, citing shift 

schedules, camaraderie/bonding, stress, and traditions. However, on-the-job incidents 

involving alcohol were extremely rare. “Most fire departments have taken a strong 

stance against on-duty intoxication. ... When asked what accounted for the low rates of 

negative occupational outcomes, most participants reported zero-tolerance policies at the 

department level that were strictly and consistently enforced” (Jahnke et al., 2014, p. 3).

The American Heart Association reports that excessive alcohol intake has been shown 

to raise the levels of triglycerides in the blood and lead to high blood pressure and heart 

failure (2015). When more than the recommended amount of alcohol (two drinks per day 

for men and one drink per day for women) is consumed, the risk of alcoholism, high blood 

pressure, obesity, stroke, breast cancer, suicide, and accidents increases.

Tobacco

Research has shown smoking rates among firefighters to be lower than the general 

population and similar occupation groups, such as the military (Haddock, Jitnarin, Poston, 

Tuley, & Jahnke, 2011; Jitnarin, Poston, Haddock, Jahnke, & Day, 2015). When studying tobacco 

use among a national cohort of 677 firefighters, researchers found that more volunteer 

firefighters smoked than career firefighters, 17.4 percent and 13.6 percent, respectively. 

Furthermore, career firefighters who smoked consumed an average of 10 cigarettes per day, 

while volunteers smoked an average of 15 cigarettes per day (Haddock, Jitnarin, et al., 2011).

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Critical Issues | 49

It’s also important to note that while smoking in the fire service may be lower than in the 

general population, the use of smokeless tobacco (SLT) is still very prevalent. Haddock, 

Jitnarin, et al., (2011) reported that 16.8 percent of volunteer firefighters were current users 

of smokeless tobacco compared to the CDC’s national use rate of 6.7 percent among adult 

males (Smokeless Tobacco, n.d.). The prevalence of SLT use among all male firefighters has 

been estimated between 17.4 percent and 18.4 percent (Haddock, Jitnarin, et al., 2011). 

Thus, the prevalence of SLT use among firefighters is the highest of any occupational group 

reported for the U.S. civilian work force (e.g., 10.5 percent prevalence in farm workers is 

the next highest reported rate) (Dietz et al., 2011). Note that approximately 95 percent of 

firefighters are primarily male, and SLT use differs substantially by gender in the U.S. (6.7 

percent males versus .3 percent females) (CDC, n.d.-a).

SLT use in the fire service is even greater than the high rates found for military personnel 

(15.6 percent among males in the Department of Defense) (Bray et al., 2009). SLT use 

among all firefighters is more than three times higher than the populations they protect 

and the highest of any occupational group. Being a firefighter raises the risk of SLT 

use even more for minority groups, creating a substantial racial/ethnic disparity for 

African-American, Asian and Hispanic firefighters. For example, while SLT prevalence is 

generally very low (one percent or less) among these minority groups, minority male 

firefighters are between 10 to 13 times more likely to use SLT than male minorities in the 

general population, depending on whether they served in minority- or white-dominated 

communities (Poston, Haddock, Jahnke, Jitnarin, & Day, 2014).

Tools for Your Toolbox

Quit Tips for Tobacco Users (adapted)

ĵ Remember that you are not alone. About 22 percent of American adults are former 

smokers. Find a support group or mentor to help you through the process.

ĵ Nibble on low calorie snacks like fruits and veggies.

ĵ Chew gum when a craving hits.

ĵ Remove unnecessary reminders, such as ashtrays and lighters, from your house, 

car and office.

ĵ Write a list of reasons why you want to quit smoking or using smokeless tobacco, 

so you can remind yourself of why you are going through this process.

ĵ Find a type of exercise that you enjoy, and steadily work it into your routine.

ĵ Keep a log of when you most often crave tobacco so that you can plan a strategy 

to avoid the triggers. For example:

k Carry a book, magazine or crossword puzzle with you to help you endure 

breaks, waiting for a bus, or other moments when you may be bored and 

would normally smoke, dip or chew.

k After dinner, suck on a hard candy, sip your favorite beverage, or use a toothpick 

to substitute tobacco use.

k Stock your car with simple snacks, such as sunflower seeds.

ĵ Visit https://www.ucanquit2.org/HowToQuit/SavingsCalculator.aspx to see how 

much extra money you will have available in the coming days, months and years, 

just by quitting tobacco.

ĵ Don’t be discouraged if you give in. Most ex-tobacco users tried to quit several 

times before they succeeded. Wipe your slate clean, and try again. (NVFC, n.d.-e)
50 | Critical Health and Safety Issues in the Volunteer Fire Service

One alternative to traditional smoking has been the advancement of the e-cigarette. “The 

e-cigarette, also called a personal vaporizer (PV) or electronic nicotine delivery system, is 

a battery-powered device that simulates tobacco smoking by producing a heated vapor, 

which resembles smoke” (USFA, 2014, p. 1). USFA released the report “Electronic Cigarette 

Fires and Explosions” to look at the safety aspects of this smoking alternative and found 

that “the health effects of the vapor and the danger of nicotine overdose by ingestion 

or dermal contact with the juice are the subject of ongoing review by various agencies, 

according to the World Health Organization” (USFA, 2014, p. 2). In addition to the potential 

health concerns, the safety associated with PVs has been put into question as fires have 

been reported due to e-cigarettes overheating or lithium-ion batteries failing.

Numerous studies link tobacco-use directly to cancer. Because of the increased risk 

of cancer for firefighters, there has been a strong emphasis on addressing modifiable 

risk factors, including encouraging personnel to be tobacco free. Given the critical role 

firefighters play in the public safety net, and their status as role models to our nation’s 

youth, firefighters should take proactive measures to quit using tobacco products or 

other alternatives altogether. Leaders should establish a department nontobacco (not just 

nonsmoking) policy to deter members from this bad habit and also to provide a healthy 

environment for all at the station.

FCSN offers sample policies from local departments regarding tobacco use, and specifically 

smokeless tobacco use. These sample policies and other resources are available on the 

FCSN website.

The NVFC’s Heart-Healthy Program has also 

created a series of resources to help first 

responders quit smoking and remain smoke free. 

Families, departments and state associations 

can also use these resources to inform and help 

emergency responders take the first step toward 

a smoke-free life and support them as they 

maintain their healthier lifestyle. The website 

includes a sample department no-smoking policy.

Prescription Drugs

According to the CDC (n.d.-b), 78 people in the U.S. die every day from overdose of opioids, 

and many more become addicted. The most common drugs involved in prescription 

overdose deaths include:

ĵ Hydrocodone (e.g., Vicodin).

ĵ Oxycodone (e.g., OxyContin).

ĵ Methadone.

People who take prescription painkillers can become addicted with just one prescription. 

Taking too many prescription painkillers can stop a person’s breathing, leading to death.

No studies have been identified to associate this epidemic specifically to the fire and 

emergency service population, but fire service trends tend to mimic or closely resemble 

that of the general population. Furthermore, departments need to consider that 

firefighters are under greater stress than most people, both mentally and physically. Injury 

and anxiety could potentially contribute to this problem in the responder population. 
Critical Issues | 51

Drugs, whether prescribed or illicit, are often used as self-medicating, occupational stress 

management despite the inherent risks associated with addiction. Departments need to 

be aware of this potential risk among their personnel.

Tools for Your Toolbox

Warning Signs of Drug Abuse Among Colleagues (modified)

Drug abusers often try to conceal their symptoms and downplay their problem. If 

you’re worried that a friend or family member might be abusing drugs, look for the 

following warning signs.

Physical warning signs of drug abuse:

ĵ Bloodshot eyes, pupils larger or smaller than usual.

ĵ Changes in appetite or sleep patterns.

ĵ Sudden weight loss or weight gain.

ĵ Deterioration of physical appearance, personal grooming habits.

ĵ Unusual smells on breath, body or clothing.

ĵ Tremors, slurred speech or impaired coordination.

Behavioral signs of drug abuse:

ĵ Drop in attendance and performance on the job.

ĵ Unexplained need for money or financial problems.

ĵ Engaging in secretive or suspicious behaviors.

ĵ Sudden change in friends, favorite hangouts, and hobbies.

ĵ Frequently getting into trouble (fights, accidents, illegal activities).

Psychological warning signs of drug abuse:

ĵ Unexplained change in personality or attitude.

ĵ Sudden mood swings, irritability or angry outbursts.

ĵ Periods of unusual hyperactivity, agitation or giddiness.

ĵ Lack of motivation; appears lethargic or “spaced out.”

ĵ Appears fearful, anxious, or paranoid, with no reason. (HelpGuide, n.d.)
52 | Critical Health and Safety Issues in the Volunteer Fire Service

 Goal: Eliminate tobacco use and drug and alcohol abuse.

Objectives:

ĵ Establish and enforce no-tolerance policies relating to each 

substance.

ĵ Create awareness and prevention programs on the risks associated 

with each substance.

ĵ Provide tools, resources and support groups to help those struggling 

with substance abuse; ensure resources to get help are clearly 

visible and available at the department.

ĵ Provide information to families to identify risk factors and warning 

signs associated with each substance.

 Section Summary — Personal Health: Medical, mental, physical and 

emotional well-being are all critical aspects to the health and safety of 

firefighters. Departments are responsible for creating an environment 

that provides resources for both physical and behavioral health to 

ensure members are taken care of and able to do their job safely and 

effectively. Multiple programs, services and standards are available to 

implement at the local level. Leaders must lead by example, and also 

set and enforce regulations that will benefit their members’ well-being. 

Firefighters must also take responsibility and use the opportunities 

given by the department to improve their own personal health.
Critical Issues | 53

Safety Protocols

The NSCCI study advocates that a culture shift is needed to change adverse behaviors 

in the fire and emergency services and to reduce LODDs and injuries. The study focuses 

on leadership, situational awareness, safe vehicle operations, and other firefighting 

behaviors — all of which have been identified as critical issues in the volunteer fire service, 

specifically in regards to safety.

As mentioned earlier, the NFPA reported 32 

on-duty volunteer firefighter deaths in 2015. 

While most of the those were attributed to 

personal health (e.g., heart attack, stroke), 

the second-leading cause was being struck 

by a vehicle, followed by motor vehicle 

crashes, structural collapse, lost inside the 

structure, falls, or struck by an object, as 

noted in Figure 4. Fortunately, volunteer 

fatalities over the last five years have 

continued to remain low in comparison to 

the average of 42 deaths per year since the study was first conducted in 1977 (Fahy et al., 

2016). Proactive measures can be taken to continually reduce these numbers year after 

year by focusing on factors that influence change to improve safety.

Figure 4. 2015 Volunteer Fatalities by Cause

Overexertion/

Stress/Medical

63%

Struck 

by vehicle

13%

Motor vehicle crash

9%

Structural collapse

6%

Lost inside structure

3%

Fall

3%

Struck by object

3%

Source: Statistics adapted from NFPA (Fahy et al., 2016).

Codes and Standards

Codes and standards provide a roadmap that fire departments and local governments 

can implement to improve health and safety. Generally speaking, codes tell you what 

you need to do, and standards tell you how you should do it. Many organizations create 

codes and standards, each having a different process for developing documents. All of the 

processes, on some level, use stakeholder and participant feedback to regularly update 

and improve their texts.
54 | Critical Health and Safety Issues in the Volunteer Fire Service

One of the principal organizations generating codes and standards for the fire and 

emergency services is NFPA. NFPA maintains hundreds of codes and standards, some 

of which have already been mentioned throughout this report, covering topics regarding 

firefighter training, equipment and apparatus. NFPA Technical Committees and panels 

represent a balance of interests and serve as the principal consensus bodies responsible 

for developing and updating all NFPA standards (NFPA, n.d.). NFPA also encourages 

public input and comment for each standard revision. Additionally, NVFC partnered with 

NFPA to develop standard implementation guides specifically aimed at helping volunteer 

departments understand and successfully implement select NFPA standards. The guides 

are available on both the NVFC and NFPA websites.

One code that can greatly improve volunteer department safety operations is NFPA 1, 

Fire Code. NFPA 1 establishes a reasonable level of fire safety and property protection of 

new and existing buildings through comprehensive, integrated approaches to fire code 

regulations and hazard management. It pulls many of its requirements from 57 other NFPA 

codes and standards that can be used in conjunction with NFPA 1, and addresses distinctive 

areas like fire department access, required fire flow, and fire hydrants (NFPA 1, n.d).

The International Code Council (ICC) is another primary code-making organization that 

develops model-building construction and fire safety codes, including the International 

Fire Code (IFC). IFC establishes “minimum regulations for fire prevention and fire 

protection systems using prescriptive and performance-related provisions” to address 

“conditions hazardous to life and property from fire, explosion, handling or use of 

hazardous materials, and the use and occupancy of buildings and premises” (Overview of 

the IFC, n.d., para. 1, 2). The IFC and other ICC codes are coordinated to create a systematic 

approach to building safety and work hand-in-hand with the fire safety code. NVFC and ICC 

created a guide and supplemental training, “Understanding & Utilizing the International 

Fire Code,” to help volunteer fire chiefs and firefighters gain a basic understanding of how 

to use a model fire safety code to ensure an acceptable level of safety for the public and 

firefighters (NVFC & ICC, 2014).

To understand the value of codes and standards in a fire service context, consider a world 

in which they did not exist at all. Every fire chief would be responsible for developing their 

own training program, based on whatever he or she felt was appropriate. Departments 

would have to purchase equipment and apparatus that they knew to be safe based solely 

on the guarantees of manufacturers. Firefighters would respond to and rescue people 

from burning buildings that were constructed in whatever manner the builder felt best, 

probably without much, if any, concern for fire safety.

There are several problems with the scenarios described above. How much time would 

be wasted reinventing the wheel if every fire chief were to develop their own training 

program? How effective would those training programs be if they each relied only on 

the expertise and experiences of one or a handful of fire service leaders in a single 

community? How could we be confident that profit-seeking manufacturers and builders 

would incorporate necessary safety features in their products?

Codes and standards are the solution to these problems. Organizations like NFPA and ICC 

bring together experts from across the world, including the fire service, who spend far 

more time than the average fire chief, manufacturer or builder to identify best practices 

and write codes and standards that fire departments and local governments can adopt, 

ensuring that they have up-to-date and comprehensive measures in place to protect the 

health and safety of the community.
Critical Issues | 55

It is important to recognize, however, that codes and standards are not a cure-all. It can be 

expensive to adopt them, particularly in smaller communities that have limited funding to 

pay for new equipment and training. As training requirements based on NFPA standards 

have increased, many volunteer fire departments have found it harder to recruit and 

retain personnel. Adopting codes is important, but unless they are enforced, having codes 

on the books can actually be counterproductive by giving fire department and community 

leaders a false sense of safety.

Motivated local leaders will find that implementing codes and standards may not be 

easy, but it is certainly possible, even in a low-resource environment. Feasibility of 

implementation is always a significant consideration in the codes- and standardsdevelopment process. Additionally, organizations like NFPA and ICC are able to help end 

users with implementation. After all, it is in their best interest to do so in order to create 

more users of the products that they develop.

Ultimately, codes and standards are the most efficient and affordable way to provide 

maximum protection to communities. Fire service leaders should invest time and 

resources in learning about and implementing codes and standards in their communities 

in order to keep themselves, their personnel, and the public safe.

 Goal: Improve firefighter safety and operational efficiency by adopting 

and enforcing current, applicable codes and standards.

Objectives:

ĵ Use guides and supplemental resources to help with code and 

standard implementation.

ĵ Stay informed about codes and standards that have been updated 

or are currently in review.

ĵ Use NFPA and ICC for implementation guidance when necessary.

Vehicle-Related Safety

Driving a vehicle is one of the most common types of transportation in the U.S. Getting 

to a desired location that requires vehicle transport shouldn’t be a life or death situation 

no matter if you are a civilian or first responder. Unfortunately, as previously mentioned, 

the second-leading cause of on-duty volunteer firefighter deaths was being struck by a 

vehicle, followed by motor vehicle crashes. Vehicle-related 

incidents are unnecessarily causing injuries and deaths in 

the fire and emergency services. While not all accidents can 

be avoided, proper practices can drastically improve vehicle 

safety operations.

Personally Operated Vehicles

Most volunteer emergency service departments rely heavily 

on the ability of their members to respond to calls, either 

to the scene or the station, in their personal vehicles. 

While this is essential to the organization’s ability to react 

to emergencies in a timely manner, there are also inherent 

risks. Responders who may be coming from outside the 

station must be provided training on safe personal vehicle 
56 | Critical Health and Safety Issues in the Volunteer Fire Service

operations. Personal vehicle operators need to understand that reduced speed, use of 

seat belts, and following current motor vehicle laws will significantly decrease risk.

From May 2004 to December 2014, 40 volunteer firefighters died in motor vehicle crashes 

that involved personal vehicles. A NIOSH incident investigation report provides one example:

A 30-year-old male volunteer firefighter was fatally injured after his personally 

operated vehicle (POV) hydroplaned and struck a billboard signpost. The 

victim was responding in his POV to the fire department to pick up a fire 

apparatus when the incident occurred. According to the state police report, 

he drove over a large pool of water that caused him to hydroplane and lose 

control. (2004)

In response to that incident, NIOSH advised fire departments to encourage drivers to 

“drive at speeds appropriate for the conditions to prevent hydroplaning and loss of vehicle 

control and ... wear seat belts when responding to emergencies in their POVs” (2004).

Emergency service organizations need to have comprehensive operating policies and 

procedures regarding POV response. VFIS advises that these procedures should include, 

but not be limited to, the following:

ĵ Volunteers responding in a personal vehicle must obey their state’s motor vehicle code 

with respect to courtesy lights and siren privileges.

ĵ Courtesy lights must not be used by volunteers as a license to operate their personal 

vehicles as if they are emergency vehicles. All courtesy lights should be approved by 

the chief of the department and a written permit issued. The permit should include 

the “rules of the road” that apply.

ĵ Volunteers responding in personal vehicles should never exceed the posted speed limit.

ĵ Volunteers responding in personal vehicles should come to a complete stop at all stop 

signs and red traffic signals, and must wait for normal right of way before proceeding.

ĵ Procedures for at-the-scene parking/staging should be included in all SOPs.

ĵ Individual volunteers must have personal auto liability insurance with appropriate 

liability limits that protect not only the volunteer but also the organization. (2011, para. 2)

Additionally, VFIS suggests that vehicle-related SOPs be included in all new-member 

orientations and driver training sessions. Every member should receive a written copy of 

the SOPs and sign off that they have received them and understand them. In addition, the 

organization should develop written enforcement and progressive discipline guidelines 

for any member who violates the procedures and should make these guidelines known 

to all members.

To address the issue of POV response, NVFC and IAFC released the guide “Let’s Make a 

Difference: Best Practices to Minimize Injuries and Deaths while using Privately Owned 

Vehicles for ESO Responses.” This guide provides model policies and recommended 

procedures departments can adopt to minimize injuries and deaths while responders are 

using their own vehicles during emergencies (Eggleston, n.d.).

When volunteers respond to calls, they need to understand that, first and foremost, they 

must arrive at the emergency scene or station safely in order to be of any help to the public.




Critical Issues | 57

Emergency Vehicle Operations

USFA summary incident reports showed that in 2014, approximately 27 percent of on-duty 

volunteer firefighter fatalities occurred while responding to or returning from incidents, 

with over half of these fatalities resulting from vehicle crashes. In fact, vehicle collision is 

typically one of the leading causes of firefighter fatalities (USFA, 2015).

The USFA (2014) study “Emergency Vehicle Safety Initiative” consolidates past research and 

provides best practices and recommendations for safer emergency vehicle and roadway 

incident response. Topics covered in this report include:

ĵ Common crash causes and crash prevention.

ĵ The impact of vehicle design and maintenance of safety.

ĵ Internal and external factors for improving response-related safety.

ĵ Regulating emergency vehicle response and roadway scene safety.

ĵ Roadway incident scene safety.

In today’s emergency services organizations, there is a need for the development and use 

of standard operating guidelines (SOGs) and issue-specific training. One area that requires 

a great deal of attention is the operation of emergency vehicles.

Chiefs, officers and directors, as well as supervisors and drivers, need to recognize the 

fact that the emergency vehicle response is the basis for the success or failure of all 

other emergency functions. These expensive vehicles carry all of the portable emergency 

equipment, in addition to all of the personnel of the organization. Without the safe 

conveyance of these vehicles to the emergency scene, the emergency service organization 

cannot achieve its mission of saving lives and protecting property (VFIS, 2011).

USFA partnered with the Department of Transportation’s (DOT) Intelligent Transportation 

System and NVFC to create the guide “Emergency Vehicle Safe Operations for Volunteer 

and Small Combination Emergency Service Organizations.” The objective was to take 

recommendations from USFA’s “Emergency Vehicle Safety Initiative” and develop targeted 

outreach implementation strategies specifically for the volunteer and combination fire and 

emergency services. In addition, information from the NFFF’s FLSI; NFPA 1451, Standard for 

a Fire and Emergency Service Vehicle Operations Training Program; and existing best practices 

in the emergency service community were integrated into the research and development 

of this report (NVFC, 2014).

The guide outlines several aspects to improve driver safety, including behavior 

management/motivation and SOGs. Multiple sample SOGs are identified and provide 

purpose, scope, responsibility/rationale, and key points to consider. These SOGs include:

ĵ Backing apparatus.

ĵ Collision investigation.

ĵ Crash and injury investigation.

ĵ Driver qualifications.

ĵ Driver selection.

ĵ Drug and alcohol policy.

ĵ Highway safety.

ĵ Intersection navigation.

ĵ Limitation of warning devices.

ĵ Motor vehicle record check.
58 | Critical Health and Safety Issues in the Volunteer Fire Service

ĵ On-the-quiet response.

ĵ Priority dispatching.

ĵ Reflective striping and roadway vests.

ĵ Regulatory and statute compliance.

ĵ Responding in private vehicles.

ĵ Routine maintenance.

ĵ Safe driving award program.

ĵ Seat belt and hearing protection use policy.

ĵ Speed limitations.

ĵ Traffic incident management — optimum vehicle placement.

ĵ Traffic preemption.

ĵ Use of personal electronic devices.

ĵ Vehicle design and construction.

ĵ Vehicle inspection.

ĵ Vehicle safety program management. (NVFC, 2014)

Traffic Incident Management

T.J. Nedrow is the NVFC’s Washington Director; the NVFC primary representative to the 

NFPA 1091, Standard for Traffic Control Incident Management Professional Qualifications 

committee; and a CVVFA Emergency Responder Safety Institute member. He said:

A byproduct to effective management of a traffic incident on our roadways is 

the promising notion that commuters, commerce, and our very own families 

can go about their travels as a result of first responders partnering so we all 

go home. (2015, para. 6)

In 2014, there were an estimated six million police-reported motor vehicle crashes where 

33 thousand people died and over two million were injured, according to the National 

Highway Traffic Safety Administration (NHTSA, 2016). That means emergency personnel, 

whether they are paid or volunteer, are responding to over 11 accidents every minute. 

Sadly, an average of five firefighters die every year as a result of being struck at a motor 

vehicle accident (Fahy, 2014).

“Roadway-related incidents constitute some of the greatest safety concerns for first 

responders” (NFPA 1091, n.d., para. 1). NFPA 1091 is a tool that helps reduce the risks to 

response personnel and the public through proper traffic control training (NFPA 1091, n.d.). 

It promotes safer operations with minimum job performance requirements (JPRs) that 

help ensure personnel are adequately prepared to carry out the duties of the assignment. 

NFPA 1091 is unique in the fact that its composition offers JPRs for all responders.

In 2004, NFPA 1091 was preceded by an all-inclusive initiative that remains the foundation 

of safety and performance for roadway incident responses — the National Unified Goal 

(NUG) on Traffic Incident Management (TIM). It was crafted with three objectives:

ĵ Responder safety.

ĵ Safe, quick clearance.

ĵ Prompt, reliable, interoperable communications.

These three objectives are succinctly embraced by 18 related strategies covering a variety 

of situations, such as partnerships, goals for performance and progress, awareness, 

availability, time goals, technology, and more. These strategies are meant to deliver on the 

overarching objectives, but to do so, require partnerships with planned and coordinated 




Critical Issues | 59

multidisciplinary processes in order to protect the protectors. The plan to accomplish the 

NUG is training — training the trainers to train responders.

The TIM training has been deployed on many fronts and with many methods. Training by 

way of the classroom and the internet are prevalent and accessible. As of August 2016, over 

200,000 total first responders have received the Federal Highway Administration’s (FHWA) 

TIM training (U.S. DOT, 2016); however, only 69,000 of the estimated 1.1 million firefighters 

in the U.S. have received this crucial training (FHWA, 2016). Information about how to 

participate in TIM training can be accessed from the National Highway Institute’s website.

CVVFA’s Emergency Responder Safety Institute, supported by USFA and the U.S. 

Department of Justice, developed a comprehensive traffic incident safety website that 

provides educational materials and resources to support responder safety training and 

offers a free online opportunity to earn the FHWA TIM Training Certificate.

 Goal: Decrease death and injury caused by unsafe vehicle operations.

Objectives:

ĵ Create and enforce SOPs around all areas of vehicle safety, including 

emergency vehicle operations and POVs.

ĵ Develop written enforcement and progressive discipline guidelines 

for any member who violates procedures, and make sure all 

personnel are aware of these guidelines.

ĵ Provide training and certification for all areas of vehicle safety.

ĵ Enforce standards, and influence behavior from the top down.

ĵ Participate in the FHWA’s TIM training.

ĵ Adopt NFPA 1091.

Occupational Safety and Health Act

Under the Occupational Safety and Health Act of 1970, employers are responsible for 

providing safe and healthful workplaces for their employees. OSHA’s role is to ensure 

these conditions for America’s working men and women by setting and enforcing 

standards, and providing training, education, and assistance. OSHA standards are not 

meant to further burden departments, but rather to provide safety practices that include 

engineering out the problem, providing PPE when a safety problem cannot be engineered 

out, and using administrative practices like training and SOPs to supplement PPE and 

engineering safeguards (NIOSH, 2010).

Approximately half the states fall under federal OSHA authority. The other states have 

their own State Plan occupational safety and health programs and have adopted their 

own regulations which must, at minimum, meet the standards set by OSHA at the federal 

level. The OSHA State Plans cover only state public employees. However, in an effort to 

include volunteer responders, some states have extended their regulations to cover those 

working in the public sector.

Although career fire departments in all OSHA-approved State Plan jurisdictions must 

comply with state OSHA standards, the question of volunteer compliance in these 

jurisdictions varies from state to state. If volunteer firefighters are considered “employees” 

under the state’s OSHA law, they must be protected under the state OSHA standards. If 

they are not considered “employees,” state OSHA standards do not apply. Federal law 

allows each State Plan jurisdiction to determine for itself whether volunteer firefighters 
60 | Critical Health and Safety Issues in the Volunteer Fire Service

are “employees” and, therefore, whether their departments must comply with state OSHA 

standards. For states that do fall under OSHA guidelines, violations can result in fines and 

negative public perception; more importantly, compliance can reduce firefighter injury 

and loss of life (Bentivoglio, 1996).

As of summer 2016, OSHA was in the process of updating existing regulations. The impact 

of new regulations on volunteer firefighters is yet to be determined, but they will more 

than likely remain state-specific unless Congress passes a new law. Department leaders 

need to keep up-to-date with current and future OSHA regulations for the protection of 

the department, as well as for the health and safety of members.

 Goal: Comply with OSHA standards.

Objectives:

ĵ Include OSHA standards in department SOPs and training.

ĵ Use other departments in your state and region for best practice 

implementation of current OSHA standards.

ĵ Keep abreast of new regulations.

Standard Operating Procedures

SOPs, sometimes called SOGs, are fundamental for fire departments. They prevent chaos 

through written communication, explaining the rules and setting clear expectations for 

which personnel will be held accountable. They exist not only to perform the job efficiently, 

but also to protect first responders and those they are serving.

For example, a volunteer firefighter died in 2012 when the driver of the engine lost control 

and crashed into trees. The victim was ejected from the engine and pronounced dead at 

the scene. He was not wearing a seat belt. A contributing factor noted in the NIOSH report 

was “inadequate SOPs for seat belt usage” (NIOSH, 2013). Not establishing and adhering 

to pertinent SOPs, such as seat belt usage, tragically cost him his life. This is just one 

example of too many incidents that could have been prevented had SOPs existed and 

been enforced.

A 1999 USFA document, “Developing Effective Standard Operating Procedures,” notes the 

importance of SOPs in fire departments that still holds true today.

Fire service organizations must meet these growing requirements in an 

environment that itself is a challenge ... As a result, the decisions that personnel 

face are more complex and controversial. Mistakes have greater repercussions 

and costs. Emergency service providers need help understanding and 

navigating the maze of regulatory and administrative requirements. Managers, 

on the other hand, need a mechanism to convey operational guidance to the 

members and ensure departmental compliance with laws, regulations and 

standards. They need tools to direct and control the rapid pace of change. Welldesigned standard operating procedures help fill both needs. For individual 

workers, SOPs clarify job requirements and expectations in a format that can 

be readily applied on the job. They explain in detail what the department wants 

them to do in the situations they are most likely to encounter. The result is 

improved safety, performance, and morale. For department managers, the 

advantages are equally great. SOPs provide a mechanism to identify needed 


Critical Issues | 61

changes, articulate strategies, document intentions, implement regulatory 

requirements, enhance training, and evaluate operational performance. The 

result is improved operational efficiency, greater accountability, and reduced 

liability. Everybody’s a winner! (p. 4)

Fire departments should have an understanding of SOPs versus policies. Below are 

specific definitions to better grasp the difference.

ĵ Standard: applies to any definite rule, principle or measure.

ĵ Operating: used or engaged in performing operations.

ĵ Procedures: an act or a manner of proceeding in any action or process; conduct.

SOPs address activities at an emergency incident, training, or are used for safety purposes. 

An SOP dictates the manner in which activities are to be performed, and there should not 

be any deviation. A policy is a plan or course of action designed to influence and determine 

decisions and actions (Cook, 1999). Policies are generally used for administrative purposes. 

Policies address issues, such as tardiness, sick leave, social media, and other routine 

day-to-day department administrative activities.

A similarity between the two is that neither is eternal. Time and circumstance may call 

for updates to SOPs and policies, as best practices and lessons learned come to light, 

technology enhances or communities shift.

Firefighter safety is greatly enhanced when good SOPs are developed, trained on and 

enforced. SOPs should reflect federal, state and local laws and standards. If these 

requirements do not address the issues, then departments should consider creating new 

SOPs applicable to fire service best practices.

The Fire Protection Research Foundation is currently undertaking a project on behalf 

of the Technical Committee for NFPA 1700, Guide for Structural Firefighting, that involves 

collecting SOPs/SOGs from fire departments in North America “to determine similarities, 

differences, and trends that will help guide the development of a model SOP/SOG 

template” (Review of SOP/SOG, 2016, para. 2). The contributed SOPs/SOGs will be analyzed 

for key features and characteristics, and then information about the contributing fire 

department and the results of the analysis will be put into a database for the NFPA 

1700 technical committee to use to draft an annex that will provide a template for fire 

departments to use to develop their own SOPs/SOGs. It is not the intent of this project 

to develop standard SOPs for adoption by fire departments. The project deliverable will 

be a report that describes the method of collection, the analysis methodology, and the 

results of the analysis. The project should be completed and the final report should be 

published by the end of December 2016.

 Goal: Reduce firefighter death and injury through SOPs.

Objectives:

ĵ Generate and enforce SOPs that create improved operational 

efficiency, greater accountability and reduced liability.

ĵ Update and amend SOPs as necessary.

ĵ Stay informed of practices that may affect existing SOPs or require 

creating new SOPs.

ĵ Use best practices.


62 | Critical Health and Safety Issues in the Volunteer Fire Service

Role of the Company Officer in Safety

One of the most important roles of a CO is safety. COs who are responsible for day to day 

supervision of personnel play a critical role in setting safety expectations and determining 

placement of a crew in a hazard zone. Behavior of that supervisor will directly impact 

the crew. If the CO refuses to use a seat belt or places a crew on an unstable roof, the 

crew will begin to model this behavior. Although much is to be said about individual 

responsibility, it is still the supervisor/CO who monitors day-to-day activities of members 

and is responsible for enforcing SOPs.

Situational Awareness

Situational awareness is defined as “the perception of the elements in the environment 

within a volume of time and space, the comprehension of their meaning, and the 

projection of their status in the near future” (Endsley, 1988). In the fire service, situational 

awareness involves being aware of what is happening at an incident. It could be the total 

incident scene, a location on the fireground, or in a room.

Reichenbach says that when situational awareness is compromised, the potential for 

human error increases. Confusion, lack of a safety officer, procedural violations, unmet 

goals, unresolved discrepancies, fixation/tunnel vision, overload, complacency, and fatigue 

all hinder situational awareness. The concept is more of a mindset and not necessarily a 

skill, but there are definite factors that can help develop proper situational awareness to 

improve safety (2009).

Tools for Your Toolbox

Four Factors That Can Help You Maintain Awareness

1. Clear communication. Effective communication may be the most important 

factor in achieving and maintaining situational awareness. Clearly communicate 

a course of action to follow as needed; clearly verbalizing any intended action. 

Understand that the proper situational awareness achieved depends on the level 

and quality of communication among all personnel. Clarifying the expectations of 

all personnel eliminates doubt. Understand that clear expectations that create a 

shared understanding of the situation ensure personnel will have high levels of 

situational awareness.

2. Task performance awareness. Awareness of how your job and the jobs of other 

team members contribute to the overall mission is essential. Although it may not 

be necessary to know the technical aspects of other team members’ jobs, you must 

be aware of what actions, information, and so forth you can provide to them so 

they can do their jobs effectively, and what would happen if you did not.

3. Status awareness. Ensure that your performance reflects an understanding and 

awareness of the mission or task performed. Effective leaders plan ahead and 

communicate the plan to all personnel. This ensures that everyone is aware of 

the plan and fosters a clear understanding of the established goals.

4. Continual reassessment. Assess and reassess the incident’s progress in relation 

to established goals to determine if the team is on track to safely and effectively 

accomplish the mission goals. (Reichenbach, 2009)
Critical Issues | 63

Shupert states:

Situational awareness is a lot like the weather — people talk about it a 

lot, but many people don’t prepare for it properly. We forget or forego 

things like sunscreen, umbrellas, hats, or gloves because we’re in a hurry or 

because we’re not really convinced we’ll need them. The same can be said 

for our reaction to situational awareness. Some people forget about it on 

the fireground at times because they think there are more pressing issues 

at hand, or they don’t think it’s important. However, fire service has loads 

of data on how, when and where we get hurt. And many times, properly 

managed situational awareness could have made a difference. (2012, para. 2)

The five leading casual factors related to firefighter deaths, often referred to as the 

NIOSH 5, include:

1. Improper risk assessment (poor size-up).

2. Lack of incident command.

3. Lack of accountability.

4. Inadequate communications.

5. Lack of SOPs or failure to follow SOPs.

An analysis of firefighter injuries showed that, from 2012 to 2014, volunteers (52 percent) 

were more likely to receive injuries at the fireground than all firefighters combined (41 

percent) (Haynes, 2016). Situational awareness can mean life or loss. Leaders and training 

officers must identify measures, enforce SOPs, and train personnel to improve situational 

awareness.

NVFC offers training through its Virtual Classroom about situational awareness to educate 

fire and rescue personnel about reducing responder casualty and injury incidents by 

improving the ability to develop and maintain situational awareness under stress. The 

course provides the attendee with a thorough understanding of situational awareness — 

what it is, how challenging it can be to develop, and how easy it can be to lose.

 Goal: Increase and improve situational awareness.

Objectives:

ĵ Clearly identify, enforce and train around situational awareness 

SOPs.

ĵ Identify situational awareness best practices.

ĵ Integrate situational awareness concepts into initial and continuing 

education.

Personal Protective Equipment

PPE is designed to safeguard firefighters from coming into contact with hazards that could 

lead to injury or illness.

To ensure that your department has adequate PPE, survey the needs for each member. Does 

every firefighter have the appropriate PPE available for the job function they are expected 

to perform? For instance, the person assigned to traffic control should have at minimum 

a reflective vest, helmet and hand lights for giving direction. EMS personnel should have 

available to them body substance isolation equipment and appropriate duty wear to 

perform this function. SCBAs should be available to all personnel expected to work in the 

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64 | Critical Health and Safety Issues in the Volunteer Fire Service

immediate danger to life or health area of an emergency 

scene. Not only should each firefighter be equipped with 

the necessary PPE to do the job safely, but they should also 

ensure that the necessary PPE is worn properly and when 

mandated per department SOPs.

With the widespread awareness of cancer in the fire 

service, proper care and maintenance of PPE is critical 

to the safety and well-being of all responders. A checklist 

should be developed that addresses the issue of proper 

cleaning and storing of PPE. It is suggested that PPE be 

thoroughly cleaned after each exposure to materials of 

combustion resulting from a structure fire. The checklist 

should also include inspection of the PPE to determine if 

it is still within the service life of 10 years as is required by 

NFPA 1851, Standard on Selection, Care, and Maintenance 

of Protective Ensembles for Structural Fire Fighting and Proximity Fire Fighting. Additionally, 

frequent inspections should be conducted looking for tears, rips, burned areas, and other 

damage to the PPE. PPE that does not meet the requirements set forth in NFPA 1851 is to 

be taken out of service.

SCBAs should be inspected daily, or at the very least weekly, for operational functionality. 

Inspections should asses the condition of all straps and fasteners, battery operated 

components, operation of low air and emergency bypass indicators, personal alert safety 

systems (PASS), and the pressure of the breathing air in the cylinder. Masks should be 

attached to the regulators and the cylinder opened, ensuring that the end of service alarm 

is functioning. The emergency bypass and PASS alarm should be activated, ensuring they 

work properly.

Record keeping is a vital component of PPE inspections, maintenance and repairs. In 

the event of failure of PPE, fire departments will need to have written proof that the PPE 

had been inspected, maintained or repaired. Remember, if it is not documented, it did 

not happen.

NVFC created a video series that provides short, simple tips and ideas for cleaning, 

maintaining, replacing and funding PPE in order to prevent injury, illness and death from 

improper use of PPE. The videos can be accessed from the NVFC’s YouTube channel — 

NVFCCommunications.

 Goal: Decrease death and injury caused by inadequate PPE.

Objectives:

ĵ Survey member needs to ensure everyone has the proper PPE.

ĵ Regularly inspect, repair and replace PPE as needed, according to 

NFPA 1851.

ĵ Document PPE inspections and their results.

ĵ Develop a checklist to properly clean and store PPE.

ĵ Enforce SOPs regarding inspections, cleaning and storing of PPE.

ĵ Enforce SOPs regarding when and how to wear the proper PPE.
Critical Issues | 65

Mutual and Automatic Aid

A 2012 NIOSH firefighter fatality investigation reported a 34-year-old volunteer lieutenant 

lost his life during a roof collapse at a theater. Lack of fireground communications between 

departments was listed as a contributing factor to his death, and a key recommendation 

to avoid future incidents of this nature was for fire departments to work together “to 

develop mutual-aid SOPs for fireground operations that support interagency operability 

and accountability, and train on those procedures” (NIOSH, 2012, para. 3).

Another NIOSH report made the following recommendations in response to a 31-year-old 

volunteer firefighter who died while responding to a basement fire at a residential building 

in 2003:

ĵ Fire departments should develop and coordinate preincident planning protocols with 

mutual-aid departments.

ĵ Fire departments should implement joint training on response protocols with mutual-aid 

departments.

ĵ Municipalities should establish one central dispatch center to coordinate and 

communicate activities involving units from multiple jurisdictions.

ĵ Municipalities should ensure that companies responding to mutual-aid incidents are 

equipped with mobile and portable communications equipment that are capable of 

handling the volume of radio traffic and allow communications between all responding 

companies within their jurisdiction. (2004)

Many volunteer fire departments rely on mutual (dispatched upon request) or automatic 

(dispatched automatically) aid in order to provide their communities with the most 

efficient and effective service, as well as to ensure the health and welfare of responders. 

Each should be defined by a written agreement. Mutual and automatic aid is a cooperation 

between two agencies to help when necessary and should not exist to supplement 

regularly inadequate operations.
66 | Critical Health and Safety Issues in the Volunteer Fire Service

Michael Capoziello, former Chief of the Elmont (New York) Fire Department, wrote:

Well-thought-out mutual-aid planning should take into consideration the 

following four areas of concern, which can be remembered by using the 

acronym PATS:

ĵ Proximity — Proximity is the distance of neighboring departments and 

the shortest travel time a mutual-aid company has to get to a response 

area or to the scene of an incident.

ĵ Availability — Volunteers have varying schedules. Chief officers should 

not only evaluate their own department’s response times and staffing 

to alarms but also those of their mutual-aid partners.

ĵ Training — Officers should also know the training levels of their mutual-aid 

partners to ensure the right people are available for the incident at-hand. 

Departments in a geographic area should strive to achieve the same 

training and credentials. Regular mutual-aid partners should drill with 

each other on a consistent basis.

ĵ Special needs and considerations — This may include the community’s 

geographic makeup, hazardous materials sites, and high-occupancy 

target buildings, as well as special procedures, apparatus, or equipment 

needs. (2015, para. 3)

In addition to PATS, mutual- or automatic-aid agreements should also have an effective 

incident management system and capable communications as noted in the NIOSH 

recommendations. Also take into account personal vehicle response, which is very 

common for volunteer firefighters. Captain Stan Merrett, volunteer firefighter and founder 

of Emergency Technology & Tactics (ETT), recommends that mutual-aid personnel respond 

on fire apparatus and not in their private vehicles, to cause less congestion on-scene. This 

will also help the IC in three major areas:

ĵ It will cut down on the IC having to assign personnel to companies.

ĵ Personnel in preset companies will be more familiar with skills and limitations of 

each other.

ĵ It will reduce the chances of personnel freelancing. (ETT, n.d.)

The relationships of volunteers and career personnel of neighboring departments should 

also be considered. Chief Brandon Loboschefski states:

Issues that separate departments, such as union and non-union, career and 

volunteer, can be challenging when forming an automatic-aid agreement. If the 

departments have worked together effectively in previous situations, the job at 

hand will be much easier. If there’s been a history of conflict, however, or if the 

departments are largely unfamiliar with one another, you must anticipate what 

types of conflict could occur and ensure that the agreement resolves them. 

(2009, para. 15)

The importance of training cannot be overstated. Fireground accountability becomes 

very critical on mutual-aid emergencies. Companies assisting each other must cohesively 

train and drill together to build a foundation of trust, cooperation, and over-all safety and 

effectiveness for each organization, and more specifically, for each firefighter who responds.








Critical Issues | 67

Cohesive SOPs and policies that cover specifics (e.g., dispatching, incident command, 

training, staffing, and POV response) should be developed and included in the agreement 

for all agencies (e.g., law enforcement, EMS, emergency management agencies, and 

any state and federal government agencies and officials). These will ensure maximum 

efficiency, fireground accountability, and safe operations where multiple jurisdictions are 

involved. Once a department develops a mutual- or automatic-aid agreement, it should be 

reviewed by organizational leadership and the department’s legal counsel before being 

put into action. Also, department’s should periodically review and update agreements as 

resources, staffing and geography change.

NFPA 1201, Standard for Providing Fire and Emergency Services to the Public, Section 4.6, 

discusses Intercommunity Organization (Mutual Aid and Automatic Aid) and aid agreement 

specifications that address indemnity, liability, staffing levels, resources and more.

IAFC provides sample mutual-aid plans covering Intrastate Mutual-Aid Systems, state 

fire service plans, and regional fire service compacts and agreements. They also provide 

a Mutual Aid 101 PowerPoint to help first responders develop an awareness of the basic 

tenets and challenges of mutual aid. The PowerPoint covers guidelines on how to be a 

good host and a good guest; an overview of the documentation, resources, and response 

operations necessary for mutual aid; and the framework for safe and effective mutual-aid 

operations. All of these resources are available on their website.

 Goal: Create proficient mutual- or automatic-aid agreements to 

decrease firefighter death and injury.

Objectives:

ĵ Establish one central dispatch center to coordinate and communicate 

activities involving units from multiple jurisdictions.

ĵ Implement the Incident Command System.

ĵ Establish joint training between mutual-aid agencies, and train 

regularly.

ĵ Equip mutual-aid responders with proper communication systems.

ĵ Develop and enforce policies and SOPs that can be used by all 

agencies involved.

ĵ Create staffing and capabilities index of assisting departments/

agencies.

 Section Summary — Safety Protocols: Occupational safety injuries 

and deaths can be prevented. Refer back to the issue of culture 

change — change the mindset to reduce injury and loss. The running 

theme of strong leadership; leadership by example; comprehensive 

standards and enforcement of those standards; training; and personal 

accountability, along with the implementation of applicable codes and 

standards, will directly reflect the safety structure of a department’s 

environment.
68 | Critical Health and Safety Issues in the Volunteer Fire Service
Conclusion | 69

Conclusion

Creating a healthy and safe work environment in volunteer fire departments is dependent 

upon implementing risk-reduction behaviors that require strong leadership, personal 

accountability, training, and enforceable safety protocols. Volunteer departments must 

understand that good recruitment and retention practices, a financially sound fire 

department, and the ability to evolve to meet current standards and expectations are 

also necessary to secure the future of the volunteer fire and emergency services, and 

more importantly, to protect the men and women who devote themselves to volunteer 

as firefighters.

The critical issues that must be addressed are:

ĵ The Culture: changing the mindset.

ĵ Recruitment and Retention: competent, qualified and healthy personnel.

ĵ Funding: alternative funding methods, resources and fidelity.

ĵ Expanded Role of Firefighters: EMS, wildland firefighting, and violence against responders.

ĵ Personal Health: behavioral; cardiovascular disease; physicals and fitness; nutrition; 

cancer; and alcohol, tobacco, prescription drug abuse.

ĵ Safety Protocols: codes and standards; OSHA; SOPs; CO role; vehicle-related safety, 

including POVs, emergency vehicle operations, and TIM; situational awareness; PPE; 

and mutual and automatic aid.

Multiple tools, resources, programs and standards are available to implement at the local 

level to help departments and their responders make the necessary changes to reduce 

volunteer firefighter injuries and deaths. As written in the 2010 critical issues report: 

 “The challenge is great, but the reward is far greater.” 
70 | Critical Health and Safety Issues in the Volunteer Fire Service
Fire Department Resources | 71

Fire Department Resources

B.E.S.T Practices for Health and Safety: NVFC’s Volunteer Firefighter Health and Safety 

Priorities are set forth in a series of B.E.S.T. practices divided into four main focus areas: 

Behavior, Equipment, Standards and Codes, and Training. The priorities were developed by 

the NVFC’s Health, Safety, and Training Committee to further NVFC’s focus on protecting 

first responders. Departments can learn more about these priorities through an online 

training and can also download a poster that can be hung at the station (http://www.nvfc.

org/b-e-s-t-practices-for-health-and-safety).

Emergency Responder Safety Institute: Emergency Responder Safety Institute serves 

as an advisory group of public safety leaders and transportation experts committed 

to reducing deaths and injuries to America’s emergency responders by developing 

educational materials and resources to support responder safety training; promoting 

the NUG for TIM; encouraging the development of TIM Teams; promoting collaboration, 

communication, and cooperation among the nation’s emergency responders; and keeping 

emergency responders up-to-date on national rules, regulations and trends related to safe 

roadway incident operations (http://www.respondersafety.com/).

Everyone Goes Home Program: The Everyone Goes Home Program, founded by NFFF, 

provides free training, resources and programs to champion and implement the 16 FLSIs. 

The goal of the program is to reduce the number of preventable firefighter line-of-duty 

injuries and deaths (http://www.everyonegoeshome.com/).

Firefighter Arson Prevention: NVFC (with support from USFA and the NVFC Foundation, 

and guidance from a work group comprised of arson investigators and fire service 

professionals), developed tools and training to help prevent future cases of firefighter 

arson and to help guide departments through mitigation in the event an incident does 

happen. These include the “Report on the Firefighter Arson Problem, the Firefighter Arson 

Prevention and Recovery Toolkit,” a video, and an awareness poster (http://www.nvfc.org/

firefighter-arson).

Firefighter Behavioral Health Alliance: FBHA collaborates, develops and implements 

behavioral health awareness, prevention, intervention and post crisis strategies to provide 

firefighters with an easily accessible and confidential source of information. FBHA also 

provides workshops to fire departments and EMS organizations that focus on behavioral 

health awareness with a strong emphasis toward suicide prevention and promoting 

resources available to firefighters, EMTs and their families (http://www.ffbha.org).

Firefighter Cancer Support Network: FCSN provides timely assistance to fire service 

members and their families in the event of a cancer diagnosis. They maintain and 

continuously update a roster of mentors who have personal experience with many types 

of cancers and who will personally guide those in need through the process of dealing 

with their specific illness. FCSN also provides awareness about the importance of cancer 

prevention and screening by coordinating educational opportunities with various health 

programs (http://www.firefightercancersupport.org).
72 | Critical Health and Safety Issues in the Volunteer Fire Service

Firefighter Life Safety Initiatives: NFFF and representatives of the major fire service 

constituencies developed these 16 initiatives in 2004. Since then, the initiatives have 

informed the emerging safety culture in the U.S. fire and emergency services and 

have become the bedrock foundation for thousands of departments who have a 

desire to ensure that their firefighters and EMTs return home safely after every shift. 

NFFF also develops materials to support the initiatives’ implementation (http://www.

everyonegoeshome.com/16-initiatives).

Heart-Healthy Firefighter Program: NVFC launched the Heart-Healthy Firefighter 

Program in 2003 to reduce the number of firefighter and EMS deaths from heart 

attack. This mission is accomplished by promoting a healthier lifestyle and by providing 

firefighters with fitness, nutrition, cholesterol and other pertinent information and 

resources to assist them on the road to becoming heart-healthy. It is the nation’s only 

heart attack awareness and prevention program targeted at all firefighters and EMS 

personnel, both volunteer and career (http://www.healthy-firefighter.org).

Make Me A Firefighter Campaign: NVFC, through a federal SAFER grant, developed 

the Make Me A Firefighter recruitment and retention campaign to put research-based, 

ready-to-use tools and resources in the hands of local departments. The goal is to make 

the process of recruiting new volunteers as easy as possible for local departments (http://

portal.nvfc.org).

National Fire Protection Association Codes and Standards: NFPA develops consensus 

standards and codes to provide the fire and emergency services with ways to prevent 

disasters from occurring, to manage their impact, and to protect responders. Over 300 

codes and standards can be viewed for free at www.nfpa.org/freeaccess. Administered 

by more than 250 Technical Committees comprising more than 8,500 volunteers, these 

codes and standards are adopted and used throughout the world (http://www.nfpa.org/

codes-and-standards).

National Institute for Occupational Safety and Health: NIOSH creates projects, 

programs, publications and resources to improve the health and safety of structural and 

wildland firefighters. The NIOSH Fire Fighter Fatality Investigation and Prevention Program 

conducts independent investigations of firefighter LODDs and provides recommendations 

to prevent deaths and injuries. View NIOSH studies and publications at www.cdc.gov/

niosh/fire.

National Safety Culture Change Initiative: Led by IAFC, in partnership with USFA, 

NSCCI advocates for the need for a health and safety culture change within the 

fire service. NSCCI identifies individual behaviors and organizational factors that 

adversely impact firefighter safety and health and strategies to mitigate these effects 

(http://www.ffsafetyculture.org/).

National Volunteer Fire Council Virtual Classroom: This online learning center features 

free and low-cost courses designed and delivered by fire service members and industry 

professionals. The courses are on-demand and self-paced. They cover a variety of topics, 

such as leadership, retention and recruitment, grant writing and funding, health and 

safety, and more (http://www.nvfc.org/firefighters/education/).
Fire Department Resources | 73

Responder Safety Learning Network: The Emergency Responder Safety Institute of 

CVVFA provides the Responder Safety Learning Network to further the NUG for TIM by 

providing free, vetted, multidisciplinary training and resources to all roadway emergency 

responders — fire, police, EMS, Fire Police Units, DOT, and towing and recovery (http://

learning.respondersafety.com).

Share the LoadTM Support Program for Fire and Emergency Medical Services: 

Firefighters and EMS providers face the risk of many behavioral health concerns, such 

as anxiety, depression, burnout, PTSD, and addiction, among others. The NVFC’s Share 

the Load program provides access to critical resources and information to help first 

responders and their families manage and overcome personal and work-related problems. 

This includes the Fire/EMS Helpline at 1-888-731-FIRE (3473), which offers free 24-hour 

assistance with a variety of behavioral health issues (http://www.nvfc.org/help).

U.S. Fire Administration Fire Service Operational Safety Resources: USFA sponsors 

research and provides resources on a variety of topics to create safer operational 

environments for firefighters. These include the following: voice radio communications, 

building construction during fires, emergency incident rehabilitation, firefighting 

techniques and tactics, risk management capabilities, and violence against first responders 

(https://www.usfa.fema.gov/operations/ops_safety.html).

Wildland Fire Assessment Program: NVFC, in partnership with USFS, created WFAP to 

train fire service volunteers on how to properly conduct safety assessments for homes 

in the WUI to encourage communities to become more fire adapted. WFAP prepares 

volunteers to identify steps homeowners can take to better protect their property from 

the next wildfire (www.nvfc.org/wfap).
74 | Critical Health and Safety Issues in the Volunteer Fire Service
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86 | Critical Health and Safety Issues in the Volunteer Fire Service
Acronyms | 87

Acronyms

BC Battalion Chief

BHAP Behavioral Health Assistance Program

CDC Centers for Disease Control and Prevention

CHD coronary heart disease

COs Company Officers

CVD cardiovascular disease

CVVFA Cumberland Valley Volunteer Firemen’s Association

CWPP Community Wildfire Protection Plan

DOT Department of Transportation

EFNEP Expanded Food and Nutrition Education Program

EMS Emergency Medical Services

EMTs emergency medical technicians

ETT Emergency Technology & Tactics

FAC fire-adapted community

FBHA Firefighter Behavioral Health Alliance

FCSN Firefighter Cancer Support Network

FHWA Federal Highway Administration

FLSI Firefighter Life Safety Initiative

IAFC International Association of Fire Chiefs

IAFF International Association of Fire Fighters

ICs Incident Commanders

ICC International Code Council

IFC International Fire Code

JPRs job performance requirements

LODDs line-of-duty deaths

NCOA National Council on Aging

NFA National Fire Academy

NFFF National Fallen Firefighters Foundation
88 | Critical Health and Safety Issues in the Volunteer Fire Service

NFPA National Fire Protection Association

NICC National Interagency Coordination Center

NIOSH National Institute for Occupational Safety and Health

NSCCI National Safety Culture Change Initiative

NUG National Unified Goal

NVFC National Volunteer Fire Council

NWCG National Wildfire Coordinating Group

OSHA Occupational Safety and Health Administration

OSU Ohio State University

PASS personal alert safety systems

POV personally operated vehicle

PPE personal protective equipment

PTSD post-traumatic stress disorder

PV personal vaporizer

RMC Risk Management Committee

SCBA self-contained breathing apparatus

SLT smokeless tobacco

SOGs standard operating guidelines

SOPs standard operating procedures

TIM Traffic Incident Management

USDA U.S. Department of Agriculture

USFA U.S. Fire Administration

USFS U.S. Forest Service

VFIS Volunteer Firemen’s Insurance Services

WFAP Wildland Fire Assessment Program

WFI Wellness-Fitness Initiative

WFLLC Wildland Fire Lessons Learned Center

WHO World Health Organization

WUI wildland urban interface