1 

Training on the Rapid Removal of an Unresponsive Firefighter from 

Turnout Gear and Self-Contained Breathing Apparatus

RECOMMENDATIONS 

The National Institute for Occupational Safety and Health (NIOSH) 

recommends fire departments and fire training facilities ensure all 

firefighters, fire officers, and fire instructors: 

 Are aware of the common causes of a firefighter becoming

unresponsive while wearing turnout gear and self-contained

breathing apparatus (SCBA)

 Know why the rapid removal of an unresponsive firefighter from

turnout gear and SCBA is important

 Receive training on when and how to rapidly remove turnout gear

and SCBA and routinely practice the rapid removal methods

 Understand other recommendations such as appointment of a

safety officer, inclusion of emergency medical services (EMS),

and adherence to certification requirements for Basic Life

Support for Healthcare Providers

FIRE FIGHTER FATALITY INVESTIGATION AND PREVENTION PROGRAM INVESTIGATION 

On March 3, 2021, a 21-year-old firefighter recruit suffered a medical emergency which led to their heart

stopping, or sudden cardiac arrest, during SCBA Confidence training. The firefighter was maneuvering

through a tunnel prop wearing personal protective equipment (PPE), which had the SCBA facepiece covered

to simulate visual disruption. Upon identifying cardiac arrest, rescuers rapidly removed the firefighter’s PPE

using a modified Firefighter Down CPR technique. This rapid removal of PPE allowed for early 

cardiopulmonary resuscitation (CPR) intervention until they placed the automated external defibrillator (AED) 

electrodes and completed cardiac analysis. The firefighter was transferred to a Level 1 hospital for advanced

specialized care, until succumbing to brain injury from reduced oxygen on March 12, 2021. Prompt removal

of PPE allowed for early access for CPR. While the firefighter still succumbed, this cardiac event highlights the

importance of removing the downed firefighter from the hazard zone and providing early access for the AED 

and starting CPR as soon as possible. Details of this event are available in the full NIOSH report.

Firefighters training on how to perform

the Firefighter Down CPR technique

using three rescuers. Photo courtesy of

Oil City Fire Department.
2 

Training on the Rapid Removal of an Unresponsive Firefighter from 

Turnout Gear and Self-Contained Breathing Apparatus

QUESTIONS & ANSWERS

What are common causes of a firefighter becoming unresponsive while wearing turnout gear and SCBA? 

Unresponsiveness can result from many different medical issues including reduced oxygen supply to the brain

(decreased blood flow or inadequate inhaled oxygen), elevated core body temperature (heat stroke), severe 

dehydration, or neurological problems. Intense exertion and heat exposure while wearing turnout gear and 

SCBA increase the workload on the heart, thereby increasing a firefighter’s chance of experiencing a cardiac 

medical emergency that can result in unresponsiveness. 

Why is the rapid removal of an unresponsive firefighter from turnout gear and SCBA important? 

An unresponsive firefighter’s PPE can create a delay in performing a primary assessment of their airway, 

breathing, and circulation. It can also hinder a rescuer’s ability to provide immediate emergency medical care 

such as effective chest compressions or attachment of AED electrodes in the event of sudden cardiac arrest / 

arrythmia. Removing PPE in an uncoordinated and panicked manner can consume time and delay emergency 

medical care. Rescuers need to know how to rapidly remove PPE from an unresponsive firefighter so 

emergency medical care can start quickly. PPE removal should only begin after rescuers remove the 

unresponsive firefighter from any hazard zone or immediately dangerous to life or health environment.

What is Firefighter Down CPR and what does it consist of? 

Firefighter Down CPR is a 10-step rapid removal method that involves multiple rescuers working together to 

remove an unresponsive firefighter from turnout gear and SCBA in less than 30 seconds. This 10-step process

ensures that CPR compressions can be started quickly and AED electrodes can be placed to enable heart 

rhythm analysis and treatment. Resources such as a training presentation and instructional video can be found 

on the Firefighter Down CPR website. 

What other rapid removal method should fire departments and fire training facilities consider? 

Fire departments and fire training facilities should also consider cutting the turnout gear off of an unresponsive 

firefighter using manual shears or scissors or battery-powered fabric cutters. This option should be recognized 

as a potential sharps hazard. If used, it should be routinely practiced with appropriate tools and equipment. 

How can fire departments and fire training facilities train on these rapid removal methods? 

Fire departments and fire training facilities should practice these rapid removal methods as standalone

training and as part of other training scenarios (e.g., structural fire rescue). Training should include appropriate 

tools and any necessary changes due to their specific equipment and those of mutual aid partners. They 

should also consider including these methods in their standard operating procedures or guidelines. 

What other recommendations should be considered? 

Fire departments and fire training facilities should consider appointing a safety officer and including EMS 

providers at all emergency response and training activities where firefighters are performing strenuous physical 

work while wearing turnout gear and SCBA. Firefighters should follow basic life support certification 

requirements from the American Heart Association or American Red Cross, and receive continued education on 

warning signs or symptoms of heat illnesses. 

Banner: Photos by Shutterstock and ©kali9/Getty Images

Find NIOSH products and get answers to workplace 

safety and health questions:

1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348

cdc.gov/cdc-info | cdc.gov/niosh/programs/pubsaf

DHHS (NIOSH) Publication No. 2024-104 | January 2024 

DOI: https://doi.org/10.26616/NIOSHPUB2024104

Scan here for more information on the 

NIOSH Public Safety Program

SAFETY AND HEALTH ADVISORY