DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

Summary

Fire fighters are at risk of death or 

injury during training activities. The 

NIOSH Fire Fighter Fatality Investigation and Prevention Program (FFFIPP) 

recommends training in accordance 

with established standards to prevent 

life-threatening consequences.

Preventing Deaths and Injuries of Fire 

Fighters During Training Exercises 

Description of Problem

During the period from 2001 to 2014, 

the United States Fire Administration 

reported that approximately 11% (150 

out of 1,396) of fire fighter line-of-duty 

deaths were training-related. The leading cause of training-related deaths was 

heart attacks (55%), followed by traumatic injury (28%). The remaining 17% 

were other types of cardiovascular disease and other diverse circumstances. 

Physical fitness activities, apparatus/

equipment drills, and live-burn exercises were the three leading types of training-related activities associated with the 

fatalities [USFA 2015]. 

The role of the fire department has 

evolved over the years to encompass 

more than traditional fire suppression. 

Fire fighters respond to hazardous material incidents, combustible-metal 

fires, large-scale disasters, and terrorist 

events. They perform trench, high incline, and confined space rescues and 

provide emergency medical service 

calls. Even fire suppression has become 

multifaceted with changes in technology and the fireground environment. In 

addition, residential home fires have 

decreased approximately 50% over the 

past 40 years [National Fire Protection 

Association (NFPA) 2013a]. The expanded role and decrease in structure 

fire fighting experience of the fire fighter 

has made training a necessity for carrying out the mission of the fire service as 

safely as possible.

Given the inherent dangers of fire fighting, the importance of improving skill 

sets and proficiency cannot be overstated. Training is beneficial in a number of ways, including: (1) enabling 

fire fighters to become familiar with 

the strategies and tactics of fire fighting, (2) improving their responsiveness in performing essential tasks, (3) 

ensuring proficiency in the use of personal protective equipment and fire 

fighting equipment, and (4) fostering 

teamwork.

Inadequate training and training without safeguards can be life threatening to fire fighters. National consensus 

standards for training programs have 

been established for decades; however, 

some fire departments are not conducting training in accordance with these 

established standards. The reasons can 

include budgetary constraints, time 

constraints, and/or a lack of understanding the standards and the benefits 

of complying with them. Legal precedent has established that a lack of understanding of the standards will not 

absolve the department of responsibility and accountability for a fire fighter 

injury or death during training.

NIOSH FFFIPP

During 2001 to 2015, 81 training-related 

fatalities were investigated by NIOSH 

through the Fire Fighter Fatality Investigation and Prevention Program. Of 

these fatalities, 66 (81.5%) were cardiacrelated and 11 (13.5%) were traumarelated. These investigations included 

42 deaths due to physical fitness activities, 23 deaths due to apparatus/equipment drills, 10 deaths due to live-burn 

exercises, and 6 deaths due to other 

training-associated circumstances. 

Case Studies

Case 1 

On December 8, 2008, a 42-year-old 

lieutenant in a volunteer fire department died after completing live-fire 

training drills that were part of a certified Fire Fighter II training course (see 

Figure 1).
2

The live-fire training involved two separate drills: (1) extinguishing a simulated natural gas fire and (2) discharging a 

foam line. The lieutenant complained of cold symptoms during the training and became short of breath during the last 

training evolution. Upon completion of the last drill, as other students cleaned up the hoselines, the lieutenant indicated 

that he was going to his fire department vehicle to rest. Approximately 10 minutes after leaving the training area, the 

lieutenant was found between the training site and his vehicle. Cardiopulmonary resuscitation was initiated by fire 

fighters followed by advanced life support by the arriving 

ambulance personnel. Despite these efforts the lieutenant 

died. The autopsy report listed the cause of death as “cardiac 

arrhythmia following strenuous physical activity (firefighter 

training) in individual with hypertensive and atherosclerotic 

cardiovascular disease.” NIOSH investigators concluded that 

the physical exertion associated with the training drills performed in full personal protective equipment triggered the 

lieutenant’s sudden cardiac death. 

The fire department required a pre-employment medical 

evaluation for new members but had no annual requirement for incumbent members. The fire department had 

no formal wellness/fitness program or standard operating guidelines for training activities [NIOSH 2009a].

Case 2

On January 25, 2009, two male career fire fighters, age 28 

and age 45, died after falling from an elevated aerial platform during a training exercise. The entire duty shift reported to a college dormitory for hands-on training to 

familiarize fire fighters with the 

operation of a new 95-foot midmount aerial platform truck (see 

Figure 2). 

A group of four fire fighters were 

standing in the aerial platform, 

which was raised to the roof of an 

eight-story dormitory building at 

a local college. The platform became stuck on the concrete parapet wall at the top of the building. 

During attempts to free the platform, the top edge of the parapet 

wall gave way, and the aerial ladder sprang back from the top of 

the building and began whipping 

violently back and forth. Two of 

the four fire fighters standing in 

the platform were ejected. The fire 

fighters fell approximately 83 feet 

to the ground and died from their injuries. None of the four 

fire fighters were wearing safety harnesses. 

The fire department in this incident was in the process of writing a new standard operating procedure 

(SOP) for the ladder truck. This SOP would have required the presence of a designated safety officer at 

the training exercise, which may have positively influenced the use of fall protection while on the platform 

[NIOSH 2009b].

Controls

Fire fighting is a dangerous occupation primarily because 

the environment is typically one that poses an immediate 

threat to life. The fire fighter’s job is to gain control of a hazardous situation, which may require an extended period of 

time in a life-threatening environment. Fire fighter training 

activities, however, can be conducted in a controlled environment while still providing fire fighters with the needed 

hands-on experience. Fire departments should be aware of 

the hazards during training so they can plan, coordinate, and 

monitor activities to ensure the safety of all participants, including instructors and trainees. Standard operating procedures (SOPs) are a vital component to operating safely and 

effectively. Developing, implementing, and enforcing SOPs 

can significantly reduce the risk of injuries and deaths to fire 

fighters during training exercises. All persons involved in 

training exercises should maintain strict personal discipline 

and follow established safety, health, and operating guidelines just as in an actual event.

Figure 1. Live-fire training exercise. 
3

To minimize risk when conducting training exercises, 

NIOSH recommends that fire departments and training participants take the following precautions.

Recommendations for Fire Departments 

Before training, fire departments should do the following:

 Establish easy-to-understand, written SOPs for all training activities and ensure they are implemented and 

enforced.

 Conduct a hazard analysis before each training exercise 

to identify and address safety issues in advance.

 Ensure instructors are certified to NFPA 1041 

[NFPA 2012a].

 Ensure that a sufficient number of certified instructors 

are available to conduct the specific training and maintain optimal student-to-instructor ratios, as per NFPA 

1403 [NFPA 2012b].

 Establish a mandatory wellness/fitness program to ensure 

compliance with NFPA 1583 [NFPA 2015b].

 Ensure training participants have successfully completed 

all course prerequisites.

 Ensure that participants are screened to determine physical capacity and fitness to participate in the training.

Figure 2. Aerial platform positioned at dormitory building 

to recreate incident scene. 

 Medically clear fire fighters for respirator use and fullduty fire suppression by a physician knowledgeable about 

the physical demands of fire fighting, in accordance with 

NFPA 1582 [NFPA 2013b].

 Designate an individual, certified to NFPA 1521 [NFPA 

2015a], to be the safety officer to review SOPs and monitor all training activities.

 Ensure that all new training curricula undergo a comprehensive safety review by training supervisors before 

implementation.

 Ensure that the training environment and facilities are 

inspected for hazards.

 Ensure that adequate time is allotted to safely carry out 

the training exercise.

 Ensure that all equipment, including personal protective equipment (PPE), is inspected and in good working 

order.

 Ensure that a 360-degree size-up is conducted for all 

training activities as would be done in an actual event.

 Establish and follow a pre-training checklist.

 Provide pre-training safety briefings, including a facility 

walk-through, for all participants.

During training, fire departments should do the following:

 Adopt and follow the North American Fire Training 

Directors Rules of Engagement for Safe Fire Service 

Training [NAFTD 2014].

 Ensure that sufficient numbers of fire suppression apparatus and equipment are readily available and inspected 

for live-burn training evolutions. 

 Ensure that the proper types and adequate amounts of 

extinguishing agents are available for live-burn training 

evolutions.

 Ensure adequate space is provided for proper placement 

of all necessary apparatus.

 Ensure that all established NFPA standards and fire 

department procedures are followed. 

 Monitor participants’ physical stress and watch for signs 

of overexertion. 

 Establish and maintain a rehab area stocked with appropriate hydration and nutrition supplies per NFPA 1584 

[NFPA 2015c].

 Ensure all training participants wear the appropriate 

personal protective equipment at all times.

 Ensure that appropriate personnel (e.g., rapid intervention team) and equipment are available for assistance, 

rescue, emergency treatment, and transport.
4

 Ensure that a fully staffed and equipped vehicle (e.g., 

Advanced Life Support ambulance) is on scene and ready 

to respond in case of an emergency.

 Provide adequate supervision and monitoring of activities by the training instructors.

 Maintain strict on-scene training discipline, adhering to 

established safety protocols, in accordance with NFPA 

1403 and NFPA 1584 [NFPA 2012b, 2015c].

 Require the use of sunscreen if prolonged exposure to 

the sun is anticipated.

After training, fire departments should do the following:

 Ensure that participants, PPE, equipment, and the inside 

of the apparatus are adequately decontaminated before 

leaving the training site, particularly if live fire training 

was conducted. 

 Conduct an evaluation of the training to document any 

potential issues that may have occurred, in accordance 

with the applicable NFPA standards (e.g., NFPA 1403 

and NFPA 1584 [NFPA 2012b, 2015c]).

Recommendations for Training 

Participants

Prior to training, participants should do the following:

 Participate in a mandatory wellness/fitness program in 

compliance with NFPA 1583 [NFPA 2015b].

 Know the potential hazards of training exercises, such as 

toxins, explosive materials, falls and entanglements, and 

indicators of structural collapse, flashover, and backdraft.

 Be aware of emergency exit routes and alternative emergency escape plans.

 Understand your role in the exercise.

 Complete all course prerequisites for the specific 

training.

During training, participants should do the following:

 Conduct the training exercise according to established 

fire department SOPs and applicable NFPA standards.

 Maintain personal discipline and accountability for 

actions during training exercises.

 Recognize the signs and symptoms of personal medical 

emergencies and know the appropriate course of action.

 Personnel experiencing a medical issue during training 

should immediately self-report and be formally evaluated 

by trained medical personnel.

After training, participants should:

 Decontaminate PPE and the inside of the apparatus prior 

to leaving the training site, particularly if live fire training 

was conducted. 

 Adequately wipe their skin using cleansing wipes.

Acknowledgments

Principal contributors to this publication were Matt Bowyer, 

Virginia Miles, Tommy Baldwin, and Thomas Hales, NIOSH 

FFFIPP; Linda Frederick, NIOSH Office of the Director; Stephen Berardinelli, U.S. Public Health Service; and John S. 

Jackson, Department of the Navy. Rita Fahy, National Fire 

Protection Association, provided the NFPA data. 

References

NAFTD [2014]. Rules to live by: North American fire training 

directors http://naftd.org/Documents/Rules%20You%20Can%20

Live%20By.pdf.

NFPA [2012a]. NFPA 1041 standard for fire service instructor professional qualifications. Quincy, MA: National Fire Protection 

Association.

NFPA [2012b]. NFPA 1403 standard on live fire training evolutions. 

Quincy, MA: National Fire Protection Association.

NFPA [2013a] Home fires. Quincy, MA: National Fire Protection Association, http://www.nfpa.org/research/reports-andstatistics/fires-by-property-type/residential.

NFPA [2013b]. NFPA 1582 standard on comprehensive occupational medical program for fire departments. Quincy, MA: 

National Fire Protection Association.

NFPA [2015a]. NFPA 1521 standard for fire department safety officer professional qualifications. Quincy, MA: National Fire Protection Association.

NFPA [2015b]. NFPA 1583 standard on health-related fitness programs for fire department members. Quincy, MA: National Fire 

Protection Association.

NFPA [2015c]. NFPA 1584 standard on the rehabilitation process 

for members during emergency operations and training exercises. Quincy, MA: National Fire Protection Association.

NIOSH [2009a]. Lieutenant suffers a fatal cardiac event after completing live-fire training—Wisconsin. Morgantown, WV: U.S. 

Department of Health and Human Services, Centers for Disease 

Control and Prevention, National Institute for Occupational 

Safety and Health, Fatality Assessment and Control Evaluation (FACE) Report F2009-16, https://www.cdc.gov/niosh/fire/

reports/face200916.html.

NIOSH [2009b]. Two career fire fighters die after falling from 

elevated aerial platform—Texas. Morgantown, WV: U.S. Department of Health and Human Services, Centers for Disease 

Control and Prevention, National Institute for Occupational 

Safety and Health, Fatality Assessment and Control Evaluation (FACE) Report F2009-06, https://www.cdc.gov/niosh/fire/

reports/face200906.html.

USFA [2015]. Firefighter fatalities in the United States in 2014. 

Washington, DC: U.S. Department of Homeland Security, Federal Emergency Management Association, U.S. Fire Administration, http://www.usfa.fema.gov/downloads/pdf/publications/

ff_fat14.pdf. 
For More Information

The National Fire Protection Association (NFPA) develops 

voluntary consensus standards for the fire service. A number 

of these standards describe the performance requirements for 

fire fighter trainees and fire service instructors. Available training and brief descriptions of NFPA standards for training and 

fitness can be viewed at http://www.nfpa.org/aboutthecodes/

list_of_codes_and_standards.asp.

The U.S. Fire Administration (USFA) maintains a website with 

related training and education courses offered by the National 

Fire Academy: https://www.usfa.fema.gov/training/. 

The National Volunteer Fire Council (NVFC) maintains a 

website on training offered through the NVFC Academy: 

http://www.nvfc.org/training-digest-on-first-responderhealth-and-fitness/.

To receive documents or other information about occupational 

safety and health topics, contact NIOSH at

Telephone: 1-800-CDC-INFO (1-800-232-4636)

TTY: 1-888-232-6348 ■ E-mail: cdcinfo@cdc.gov

or visit the NIOSH website at www.cdc.gov/niosh.

For a monthly update on news at NIOSH, subscribe to NIOSH 

eNews by visiting www.cdc.gov/niosh/eNews.

Mention of any company or product does not constitute 

endorsement by NIOSH. In addition, citations to websites 

external to NIOSH do not constitute NIOSH endorsement of 

the sponsoring organizations or their programs or products. 

Furthermore, NIOSH is not responsible for the content of these 

websites.

This document is in the public domain and may be freely copied or reprinted. NIOSH encourages all readers of 

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interested employers and workers.

As part of the Centers for Disease Control and Prevention, 

NIOSH is the Federal agency responsible for conducting 

research and making recommendations to prevent workrelated illnesses and injuries. All Workplace Solutions are based 

on research studies that show how worker exposures to hazardous agents or activities can be significantly reduced.

DHHS (NIOSH) Publication No. 2017-113

Preventing Deaths and Injuries of Fire Fighters During 

Training Exercises

December 2016