Career Firefighter Killed, a Police Officer and a Civilian Wounded 

When They Were Shot During EMS Incident—Wisconsin 

Page i

REPORT #F2019-13WI • January 11, 

2021

Executive Summary

On May 15, 2019, a career firefighter was killed, and a police officer and a civilian were injured after 

being shot while on an emergency medical services (EMS) incident involving a patient who overdosed. 

The firefighter was part of a three-person crew on engine 9321 that was dispatched along with a 

private ambulance company at approximately 5:30 p.m. to the report of a patient who had a seizure on 

a public bus at a bus terminal. A police officer was first on scene.

The unconscious patient was successfully treated with naloxone on the bus by a paramedic and 

regained consciousness. The patient and responders then exited the bus at 5:47 p.m. A second police 

officer arrived after the patient walked off the bus. 

The police officers, fire, and EMS crews believed that the naloxone would wear off and were 

concerned for the patient’s continued well-being. All of the responders expressed their concerns for the 

patient’s well-being to the patient multiple times. Because all of the responders believed the patient 

would need additional medical assistance and should be transported to a local hospital for follow-up 

medical care, the police officers asked the patient repeatedly if he had anything on his person that 

could harm the fire and/or EMS responders. During this conversation, the patient abruptly produced a 

concealed handgun and began firing at the responders. Police officers immediately returned fire as they 

moved to cover. The fire and EMS crews also ran for cover. The patient/shooter and police officers 

exchanged gun fire. One firefighter was shot within 3 seconds of the handgun being produced by the 

patient and collapsed while seeking cover. He was found unresponsive approximately 80 seconds later 

and treated at the scene and transported to a local hospital where he was pronounced dead. A police 

officer was shot while returning gun fire. The patient/shooter took a civilian bystander as a hostage and 

continued to fire until the patient/shooter was shot and fell to the ground. The civilian hostage was also 

shot. The patient/shooter was secured, provided medical treatment for his injuries and transported to a 

local hospital where he was pronounced dead. The wounded police officer was transported to a local 

hospital by a fellow police officer. The wounded civilian was transported by ambulance to a local 

hospital. Both the wounded police officer and civilian were treated at local hospitals and recovered. 

The first gun shot was fired by the patient at 6:09 p.m. This was 39 minutes after the arrival of 

emergency responders and 22-minutes after exiting the bus.
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Report # F2019-13

Contributing Factors 

• Medical Emergency: When firefighters first responded to the scene, the patient (prior to the 

shooting) was not breathing adequately and required emergency medical attention. An autopsy 

confirmed the patient/shooter had methamphetamine, fentanyl, and 4-anilino-N-phenethylpiperidine (4-ANPP, a metabolite of fentanyl or fentanyl analogues) in his system.

• Scene Safety and Situational Awareness: After being revived with intravenous naloxone and 

exiting the bus under his own power, the patient produced a concealed handgun and fired at 

numerous firefighters, law enforcement, EMS, other workers, and civilians. Prior to the 

shooting, police officers made multiple attempts but did not complete a search of the patient. 

Key Recommendations 

• First responders and agencies who deliver medical assistance to patients who overdose should 

train staff on standard operating procedures (SOPs) for naloxone administration, including an 

understanding of the objective of naloxone therapy and the possibility, albeit unusual, of 

agitation and combativeness from persons after receiving naloxone. 

• Fire, EMS, and police departments should take steps to help ensure scene safety including 

taking all necessary actions to protect themselves when providing lifesaving care to a patient. 

The fire service and standards setting organizations should consider developing scene safety 

SOPs and training that provide more detailed guidance on the specifics of keeping first

responders safe while providing lifesaving care to patients. 

• Authorities Having Jurisdiction (AHJs) (e.g. municipalities, areas, or departments) should 

consider developing SOPs or guides that specify when (1) a patient should receive a pat down 

to identify information that might be useful for patient care or identify items that pose a threat 

to the patient or responders and (2) a patient might be restrained if the patient poses a threat to 

themselves or the responders. These SOPs should specify who determines when a pat down is 

necessary and who is authorized to perform it. These SOPs should be operationalized, trained, 

and exercised by law enforcement, the fire service, and EMS as part of a Unified Command 

response. 

The National Institute for Occupational Safety and Health (NIOSH) initiated the Fire Fighter Fatality Investigation and Prevention Program to examine 

deaths of fire fighters in the line of duty so that fire departments, fire fighters, fire service organizations, safety experts and researchers could learn from these 

incidents. The primary goal of these investigations is for NIOSH to make recommendations to prevent similar occurrences. These NIOSH investigations 

are intended to reduce or prevent future fire fighter deaths and are completely separate from the rulemaking, enforcement and inspection activities of any 

other federal or state agency. Under its program, NIOSH investigators interview persons with knowledge of the incident and review available records to 

develop a description of the conditions and circumstances leading to the deaths inorder to provide a context for the agency’s recommendations. The NIOSH 

summary of these conditions and circumstances in its reports is not intended as a legal statement of facts. This summary, as well as the conclusions and 

recommendations made by NIOSH, should not be used for the purpose of litigation or the adjudication of any claim.

For further information, visit the program Web site at www.cdc.gov/niosh/fire or call toll free 1-800-CDC-INFO (1-800-232-4636).
Career Firefighter Killed, a Police Officer and a Civilian Wounded When 

They Were Shot During EMS Incident—Wisconsin

Page 1 

Introduction 

On May 15, 2019, a career firefighter was fatally 

shot while on an EMS call for a drug overdose on 

a public intercity bus (Photo 1). A police officer 

and a civilian were also injured. 

On June 4, 2019, the fire department contacted 

the NIOSH Firefighter Fatality Investigation and 

Prevention Program (FFFIPP) and requested 

assistance with an independent investigation of 

the incident. 

 

On July 8, 2019, a NIOSH Medical Officer in the 

Hazard Evaluations and Technical Assistance 

Branch, Division of Field Studies and 

Engineering; a Senior Industrial Hygienist and 

Captain in the U.S. Public Health Service from 

the NIOSH Emergency Preparedness and 

Response Office; an Investigator/Safety and 

Occupational Health Specialist and an 

Investigator/Engineer with the NIOSH FFFIPP in 

the NIOSH Division of Safety Research traveled 

to Wisconsin to investigate this incident. The 

NIOSH investigators met with senior staff 

officers and representatives of the fire 

department. The NIOSH investigators met with 

and interviewed the career firefighters and fire 

department officers and the private EMS ambulance crew involved in the incident. The NIOSH 

investigators obtained and reviewed fire department training records, standard operating procedures 

(SOPs), incident scene photographs and drawings, training records, and medical records. The police 

officers who responded were not available to be interviewed. However, a redacted version of the 

official police report was provided from the neighboring police department that investigated the 

incident. The neighboring police department also provided redacted body camera footage for review by 

NIOSH investigators. 

Fire Department 

The fire department involved in this incident is a career department consisting of 87 uniformed 

members that provide fire suppression and non-transport first responder level, EMS protection. The 

fire department employs a total of 96 staff including 4 personnel in administration, 3 personnel in fire 

prevention and public education and 2 personnel in resource development and special operations. 

There are 6 fire stations located strategically throughout the city that serve a population of 

approximately 74,100 in a geographic area of approximately 25 square miles. These 6 stations house 8 

Photo 1. Incident scene. A career firefighter was killed, a police officer and a 

civilian were injured after being shot on an 

EMS incident after a patient who 

overdosed was revived and exited this bus.

(Photo 1, courtesy local fire department, bus 

identification markings altered by NIOSH.)
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Report # F2019-13

heavy apparatus: 5 engines, 1 ladder truck, 1 Quint, and 1 command vehicle. The department also has 

trained personnel that cross-staff a heavy rescue truck, 2 water rescue craft, and a rapid response light 

rescue/hazardous materials unit.

The department has one Chief, one Deputy Chief, five Battalion Chiefs with one Battalion Chief on 

duty per shift, one Battalion Chief of fire prevention and public education, and one Battalion Chief of 

resource development and special operations. The Battalion Chiefs and career firefighters are assigned 

to one of 3 shifts that work 48 hours on and 96 hours off duty with a daily staffing of 29 personnel. 

The fire department does not utilize chief’s aides or incident command technicians. 

In 2018, the department responded to approximately 5030 incidents with approximately 3350 of those 

listed as EMS and rescue calls. The fatally injured firefighter responded from a station that responded 

to approximately 1400 emergency calls (909 of those were emergency medical service calls and rescue 

requests) in 2018. 

The department has automatic mutual aid agreements with surrounding jurisdictions for EMS and 

structural fires. The department utilizes a county-wide computer aided dispatch system for emergency 

incidents in their city and a neighboring city and they also utilize a neighboring computerized dispatch 

system for emergency response in those counties. Under the automatic mutual aid agreements, the 

department responded to those jurisdictions 96 times in 2018. They also regularly train with those 

jurisdictions. The department also participates in the MABAS (Mutual Aid Box Alarm System) for 

statewide requests and had 9 MABAS related requests for assistance in 2018. 

All members of this department are trained and licensed as either Emergency Medical 

Responders/First Responders (EMRs with Advanced Skills), Emergency Medical Technicians-Basic 

(EMT-Bs), or Emergency Medical Technicians-Paramedic (EMT-Ps) by the state of Wisconsin. In 

2018, the department focused on training plans to upgrade their service to a full Emergency Medical 

Technician-Basic service. Emergency medical ambulance service, including transport, Basic Life 

Support (BLS), and Advanced Life Support (ALS), is provided by a private ambulance service.

In 2018, the department conducted pre-employment physical and psychological examinations for new 

hires and candidates in their promotional processes. All personnel directly involved in firefighting 

activities participate in the annual physical fitness testing.

The department reported that it has taken a proactive role in developing health and wellness programs 

that address the mental well-being and physical fitness of their firefighters. In 2018, a Health and 

Wellness Committee was formed to address the needs of firefighters, including behavioral health. 

Several fire department members participated in training on peer support and critical incident stress 

management. The department also engaged in wellness presentations with a member of the fire service 

trained in peer support and a licensed clinician that specialized in post tramatic stress disorder.

Firefighter health programs are guided by National Fire Protection Association (NFPA) 1582, Standard 

on Comprehensive Occupational Medical Program for Fire Departments [NFPA 2018a].
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Training and Experience

The state of Wisconsin requires training for firefighters that meets or exceeds the requirements of 

National Fire Protection Association (NFPA) 1001, Standard for Firefighter Professional 

Qualifications, [NFPA 2013a] for the topic areas of Firefighter I, Hazardous Materials Awareness, 

Hazardous Materials Operations, and First Responder. The state does not require annual recertification. 

The fire department involved in this incident has a process that utilizes the local technical college 

Public Safety Training Center and a regional fire department hiring process to train and hire 

firefighters. The recruits are then required to complete an internal 6-week recruit academy and 

successfully complete an 18-month probation period. 

A detailed description of the technical college’s Public Safety Training Center as well as the 

department’s training location is available in the Appendix A. 

In the state of Wisconsin, administration of intranasal naloxone is within the scope of practice for the 

EMS provider categories in this fire department [Wisconsin Department of Health Services 2019]. 

Naloxone for intranasal use is carried on the department’s EMS equipment. The department has a 

standard operating guideline for responding to “opiate overdose.” This standard operating guideline 

suggests considering the administration of intranasal naloxone in 0.5 mg increments up to a maximum 

of 2 mg to unresponsive persons suspected of having an opioid overdose. The standard operating 

guideline reminds EMS providers that the objective of naloxone therapy is to “increase respiratory 

drive.” It also informs EMS providers of the potential for a patient to become violent after receiving 

naloxone. 

The career firefighter fatally shot in this incident had 14 years of fire service experience with this 

department. Fire department training records indicated that he had received training and certification in 

Firefighter I, Firefighter II, Hazardous Materials Technician, Fire Inspector, Fire Officer, Structural 

Collapse Technician, Emergency Vehicle Operator, Pump Operator, Aerial Apparatus Operator, Truck 

Company Operations, National Fire Academy Responding to Terrorism Basic Concepts, Emergency 

Medical Technician (EMT) training and certification, and was a Certified Fire Investigator. The career 

firefighter was working on his normal shift at the time of the incident. He was assigned to be the acting 

driver/engineer on engine 9321. 

Although this incident began as a medical assist call and did not involve a known active shooter when 

it initially occurred, the following information describes the fire department’s on-going training and 

planning for an active shooter event. The fire department in this incident had an established program 

and related policies for a response to an “Active Shooter and Rescue Task Force” event or incident. 

This included working with law enforcement agencies and EMS to develop and deliver hands-on 

training and equip their personnel with personal protective equipment (PPE). Over the past six-years,

training and equipping of the fire department for an active shooter event resulted in having ballistic 

PPE issued for each riding position of all apparatus including the command vehicles. Additionally, 

members of the fire department worked collaboratively with law enforcement to provide Tactical 

Emergency Casualty Care (TECC) certified paramedics for their Special Weapons and Tactics 

(SWAT) Team. In addition to basic fire suppression training conducted in 2018, the department 

successfully developed procedures to prepare for a response to an “Active Shooter and Rescue Task 

Force” event or incident. 
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Equipment and Personnel 

Units that initially responded to the report of a seizure on a bus: 

• Engine 9321 with three personnel including an officer (lieutenant noted as FF 2), the victim 

(noted as FF 1), who was the driver of Engine 9321, and a jumpseat firefighter (noted as FF 3). 

• Private ambulance with two paramedics.

• Self-dispatched police officer. 

Timeline 

The following timeline is a summary of events that occurred as the incident evolved. Not all incident 

events are included in this timeline. The times are approximate and were obtained by studying the 

dispatch records, audio recordings, witness statements, and other information in the report from the 

neighboring police department that investigated the incident. All times are based on the redacted body 

camera footage and redacted police report that contained the transit station closed circuit television 

footage timeline. 

Key: 

• LEO: Law Enforcement Officer

• FF: Firefighter

• TS: Transit Station 

• CCTV: Closed Circuit Television 

EVENT TIME SOURCE

911 medical emergency call received from TS. 17:32:30 LEO 1

A TS employee boarded bus. 17:36:00 TS CCTV

TS security officer boarded bus. 17:36:48 TS CCTV

LEO 1 arrived. 17:42:30 LEO 1

Engine 9321 arrived and crew boarded bus. 17:42:35 TS CCTV

Engine 9321 crew made contact with TS employee and 

unresponsive patient. 

17:43:00 LEO 1

Firefighter (FF) 3 performed sternal rub. Patient unresponsive. 17:43:27 LEO 1

LEO 1 collected nearby bus riders’ observations. 17:43:45 LEO 1
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FF 2 and FF 3 provided medical attention to patient. 17:43:50 LEO 1

Private ambulance with Paramedic 1 and Paramedic 2 arrived 

on scene.

17:44:15 CCTV

LEO 1 contacted his supervisor. 17:45:19 LEO 1

FF 3 advised LEO 1 that the event was related to drugs, not a 

seizure as originally reported.

17:46:21 LEO 1

LEO 1 checked garbage in the bathroom of the bus for signs 

of drug use.

17:47:15 LEO 1

Paramedic 1 administered naloxone (0.5 mg) intravenously to 

patient.

17:49:45 LEO 1

Patient responded to intravenous naloxone but was dazed. 17:50:36 LEO 1

LEO 1 called police supervisor. 17:51:24 LEO 1

Paramedic 1 administered a second dose of naloxone (0.5 mg) 

intravenously to patient.

17:51:15 LEO1

LEO 1 called second person (likely police) to explain 

situation. Responders continued to talk with patient.

17:52:45 LEO 1

Paramedic advised patient he needed to go to the hospital. 17:54:40 LEO 1

LEO 1 also advised patient that he needed to go to the 

hospital.

17:54:45 LEO 1

Patient stated he took his wife’s morphine pills on the bus. 17:56:05 LEO 1

LEO 1 asked Dispatch for a second unit. LEO 2 was

dispatched.

17:56:30 LEO 1

Patient walked off the bus under his own power. 17:57:00 LEO 1

Once patient was off the bus, LEO 1 asked to check patient’s 

pockets to make sure he did not have anything sharp.

17:57:20 LEO 1
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Patient sat on cot facing LEO 1 and ignored LEO 1’s request 

for a pat down (first request).

17:57:21 LEO 1

LEO 1 asked patient if he could ‘check him out real quick’

(second request).

17:57:38 LEO 1

Patient asked to stand up. 17:57:39 LEO 1

LEO 1 stated “yes, it would be helpful if you don’t mind if I 

pat you down real quick” (third request).

17:57:41 LEO 1

Patient stated, “I have a problem with that”. 17:57:44 LEO 1

LEO 1 asked whether there is “anything on you that can hurt 

these guys?” Patient states, “No, Sir.” LEO 1 asked, “how 

come you have a problem with that?”

17:57:49 LEO 1

Patient stated, “because I don’t know what I have on me.” 17:57:54 LEO 1

LEO 1 explained to the patient what happened to him and 

wanted to triple check (fourth request).

17:58:00 LEO 1

Patient ignored LEO 1 and started to stretch. Patient stated he 

took 4 morphine pills prescribed for his wife. Patient turned 

his right side away from LEO 1 and up against the front of the 

bus.

17:58:25 LEO 1

LEO 1 told patient, “I am going to pat you down” (fifth 

statement).

17:59:05 LEO 1

Patient put his hands up to LEO 1 to avoid contact and said,

“Wait, I need to check myself first.”

17:59:07 LEO 1

Patient began emptying his pockets. 17:59:16 LEO 1

LEO 1 asked, “Can I pat you down real quick then?” Patient 

ignored this request and continued digging in his pockets. 

LEO 1 states “It doesn’t have to be a big deal. I just want to 

get you medical treatment” (sixth request).

17:59:25 LEO 1

Patient stated, “I don’t need medical treatment.” 17:59:42 LEO 1
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Patient continued to ignore LEO 1 and Paramedic 1. Patient 

stretched again and said his feet hurt.

18:00:10 LEO 1

LEO 1 advised patient to sit on the cot; patient refused. 18:01:04 LEO 1

LEO 2 arrived on the scene. 18:01:30 LEO 1

LEO 2 is briefed by LEO 1 and advised of patient’s refusal to 

be patted down.

18:02:10 LEO 2

LEO 2 observed Paramedic 1 and patient. 18:02:13 LEO 1

LEO 1 continued to talk to patient. 18:02:30 LEO 1

LEO 1 called supervisory lieutenant and explained scenario. 

Patient continued to state why he “cannot go” to the hospital.

18:02:58 LEO 1

Patient argued with responders about his medical status. 

Patient stated he did not need medical assistance.

18:03:15 LEO 2

Patient refused to sit on cot. 18:03:33 LEO 2

Patient stated he preferred not to go to hospital. 18:03:53 LEO 2

Patient stated he did not want to get checked out. Patient 

stated that he needed to get home to his wife. Arguing

continued.

18:04:20 LEO 2

Patient was told by responders and transit employee he could 

not get back on the bus if he was not medically cleared.

18:04:39 LEO 2

Patient stated he had to get home and pay rent and that his 

wife was in the hospital. Patient stated that his feet were

starting to really hurt. TS employee explained he had to be 

medically evaluated before he could get back on the bus to go 

home. 

18:05:27 LEO 2

LEO 2 advised patient to let Paramedics take him to hospital 

for an evaluation.

18:05:35 LEO 2

Patient stated his legs had been hurting for a while. 18:06:53 LEO 2
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LEO 1 re-approached patient. 18:06:59 LEO 2

LEO 1 spoke with patient and explained voluntary treatment 

versus medical detention involving a Crisis Center evaluation.

18:07:02 LEO 1

Patient again said he “cannot” go to the hospital. 18:07:14 LEO 2

LEO 1 explained to patient why he needed medical attention. 18:07:20 LEO 2

Patient said he took morphine, not opioids. 18:07:50 LEO 2

Patient took deep breaths, crossed his arms, and said, “No, 

man.” LEO 1 explained voluntary treatment versus medical 

detention involving a Crisis Center Evaluation again.

18:08:11 LEO 1

LEO 2 moved behind to view patient’s body from behind. 18:08:15 LEO 2

LEO 1 again explained voluntary treatment versus medical 

detention involving a Crisis Center evaluation.

18:08:24 LEO 2

LEO 2 asked patient, “Real quick, do you have any 

weapons?”

18:08:41 LEO 2

Patient responded, “No Sir.” 18:08:42 LEO 2 

LEO 2 asked about weapons again and identified a bulge on 

patient’s right side.

18:08:43 LEO 1/ LEO 

2

Patient stated, “that’s my phone.” 18:08:43 LEO 2

LEO 2 told patient, “don’t reach for it.” 18:08:47 LEO 2

LEO 2 attempted to pat down patient but was physically 

grabbed by patient and deflected away.

18:08:47 LEO 1

Patient stated, “I have a problem with officers touching me 

man. I get nervous and stuff.”

18:08:51 LEO 2

LEO 1 stated twice “Lift up your shirt then.” 18:08:54 LEO 1

LEO 2 stated “Lift up your shirt then.” 18:08:55 LEO 1
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LEO 1 stated “we want to make sure everybody is safe.” 18:08:59 LEO 1

Patient reached under his shirt with his right hand, flipped

open the phone case. 

18:08:58 LEO 2

LEO 1, LEO 2, FF 1, FF 2, FF 3, TS Security Officer, 

Paramedic 1, and Paramedic 2 can all be seen gathered in 

front of bus. Patient cannot be seen by this camera.

18:09:00 TS CCTV

LEO 2 yelled “Don’t reach! Don’t reach!” 18:09:02 LEO 2

Shooting started. LEO 2 had service weapon drawn and faced

west. Everyone appeared alert and starting to move. FF 1, FF 

3, Paramedic 1, and TS Security Officer moved south. FF 2 

and Paramedic 2 moved north.

18:09:04 TS CCTV

LEO 2 continued to face west as Paramedic 2 moved north 

and FF 1 moved south. FF 1 had his back exposed to the 

shooting.

18:09:05 TS CCTV

LEO 2 continued to face west as FF 1 moved to the south with 

his arms near his torso and began to stumble to the concrete.

18:09:06 TS CCTV

TS Security Officer entered the TS. 18:09:06 TS CCTV

FF 1 stumbled to the concrete and rolled to the south. His left 

hand was near his torso.

18:09:07 TS CCTV

FF 1 tried to get up with both hands near his torso. 18:09:09 TS CCTV

FF 1 lay on his back. LEO 1 moved to the rear of bus on the 

driver’s side with handgun pointed towards the northwest.

18:09:11 TS CCTV

LEO 1 notified “shots fired.” 18:09:21 LEO 1

FF 3 went out the door of the TS and pointed toward FF 2 and 

Paramedic 2. FF 3 re-entered building, turned around, and 

went back outside. FF 3 then saw FF 1 on the ground and 

went toward him.

18:09:23 TS CCTV
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FF 3 saw FF 1 and went to him from the northwest entrance of 

the TS and waved FF 2 and Paramedic 2 over to assist. 

18:09:44 TS CCTV

FF 2 and Paramedic 2 left their cover and ran to FF 3 and FF 

1. 

18:09:56 TS CCTV

Cardiopulmonary resuscitation was started on FF 1. 18:10:25 TS CCTV

FF 1 was loaded on cot. Cardiopulmonary resuscitation 

continued. 

18:11:40 TS CCTV

FF 2, FF 3, and Paramedic 2 pushed the cot to north and 

loaded FF 1 onto an ambulance 

18:12:34 TS CCTV

Ambulance with FF 1 left the scene for the hospital. 18:13:12 TS CCTV

Personal Protective Equipment 

At the time of the incident, the victim (FF 1), was wearing his station uniform, bunker pants and boots. 

Weather 

At approximately 5:30 p.m. Central Daylight Time, the weather in the immediate area was reported to 

be approximately 72 degrees Fahrenheit with a dew point of 37 degrees Fahrenheit and relative 

humidity of 29%. Wind conditions were 6 miles per hour from the south and partly cloudy with 

visibility of 10 miles [Weather Underground 2019]. Weather was not considered to be a contributing 

factor in this incident. 

Investigation 

On May 15, 2019, a career firefighter was fatally shot by a patient who had overdosed (referred to as 

“patient” in this report and also “patient/shooter” after opening fire) while on an EMS call. A police 

officer and a civilian were also injured after being shot. 

At approximately 5:30 p.m., Engine 9321 and a private ambulance company crew consisting of two 

paramedics were dispatched to a patient who reportedly had a seizure on a public intercity bus at a 

transit station. The Engine 9321 consisted of a crew of 3 firefighters. The victim was a member of this 

crew. He was a career firefighter and was working at his normal duty station. A police officer also 

responded to the scene to assist the fire and EMS units. He was first on the scene.

Upon arrival at the scene, the responders found the patient seated in the rear of the bus. The patient 

was unresponsive. The patient had agonal (abnormal and inadequate) breathing and pinpoint pupils. 

Based on this initial assessment, the responders determined that opioid overdose was more likely than 
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seizure. The firefighters inserted a nasopharyngeal airway and provided bag-valve-mask ventilation 

with oxygen. A paramedic from the private ambulance company inserted an intravenous line. Once 

intravenous access was established, a paramedic from the ambulance company administered 0.5 mg of 

naloxone intravenously. The patient resumed spontaneous respiration and became responsive to 

stimuli. According to the private ambulance company’s patient care report, due to “the lack of practical 

extrication methods,” a second 0.5-mg dose of naloxone was given several minutes later “to allow the 

patient [to] self-extricate from the bus.” The patient become fully responsive after the second dose of 

naloxone. The nasopharyngeal airway and ventilation were discontinued. The intravenous access was 

not removed. 

The patient and responders exited the bus. A second police officer arrived as the responders and the 

patient were discussing transport to a hospital for further evaluation and treatment. The police officers 

asked the patient repeatedly if he had anything on his person that could harm the fire and/or EMS 

responders and requested to conduct a pat-down. Because the responders believed that the naloxone 

would wear off and that the patient would need further emergency medical assistance, they were 

attempting to talk the patient into being transported to the local hospital for follow-up medical care 

when the patient abruptly produced a handgun. The patient/shooter began firing shots at the EMS and 

fire crews and police officers. The EMS and fire crews and police officers ran for cover while the 

police officers returned fire. The patient/shooter and police officers exchanged gun fire while the 

patient/shooter took a civilian hostage and continued to fire until he was shot and secured in custody. 

One firefighter (the workplace victim) was shot and collapsed while running for protection. A police 

officer was shot and injured while returning gun fire. The civilian hostage was also shot and injured. 

The firefighter was found unresponsive and immediately treated at the scene. The firefighter was 

transported to a local hospital by the ambulance that was on scene and was pronounced dead. The 

injured police officer was transported to the hospital by a fellow police officer and the civilian was

transported by an additional ambulance to a hospital for care. The police officer and the civilian

subsequently recovered from their injuries. The patient/shooter was provided treatment for his injuries 

and transported to a local hospital where he was pronounced dead.

Contributing Factors

Occupational injuries and fatalities are often the result of one or more contributing factors or key 

events in a larger sequence of events that ultimately result in the injury or fatality. NIOSH 

investigators identified the following items as key contributing factors in this incident that ultimately 

led to the fire fighter fatality: 

• Medical Emergency: The incident began as a medical emergency in which the patient (prior to 

the shooting) was not breathing adequately and required emergency medical attention. An 

autopsy confirmed the patient/shooter had methamphetamine, fentanyl, and 4-anilino-Nphenethyl-piperidine (4-ANPP, a metabolite of fentanyl or fentanyl analogues) in his system. 

• Scene Safety and Situational Awareness: After being revived with intravenous naloxone and 

exiting the bus under his own power, the patient produced a concealed handgun and fired at 
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numerous firefighters, police officers, EMS, transit workers, and civilians. Prior to the 

shooting, police officers made multiple attempts but did not complete a search of the patient. 

Cause of Death

According to the medical examiner report, the firefighter died from a gunshot wound. 

Recommendations 

Recommendation #1: First responders and agencies who deliver medical assistance to patients who 

overdose should train staff on SOPs for naloxone administration, including an understanding of the 

objective of naloxone therapy and the possibility, albeit uncommon, of agitation and combativeness 

from persons after receiving naloxone.

Naloxone is a medication that temporarily reverses the effects of opioids. It can be given through an 

intranasal spray, into a muscle (intramuscular), under the skin (subcutaneous), or injected into a vein 

(intravenous) or the bone marrow (intraosseous). It works by blocking mu-opioid receptors in the body 

so opioids cannot exert their effect. Naloxone does not reverse overdoses from other drugs such as 

alcohol, benzodiazepines, cocaine, or amphetamines. Naloxone has a serum half-life of 30–90 minutes 

[Lynn and Galinkin 2018], which means that it is possible for its effects to wear off before the effects 

of some longer-acting opioids wear off. Partly because of this, over 90% of patients in the United 

States who receive naloxone from EMS providers are transported to the emergency department for 

more definitive treatment [Faul et al. 2017]. 

The objective of naloxone therapy administration by trained first responders and other medical 

personnel is to maintain adequate oxygenation and ventilation without provoking opioid withdrawal 

[Lavonas et al. 2015; National Association of State EMS Officials (NASEMSO) 2019]. A technical 

expert panel convened by NASEMSO in collaboration with the National Association of EMS 

Physicians and the American College of Emergency Physicians does not recommend giving an initial 

dose of naloxone sufficient to achieve full consciousness. In addition, repeat naloxone dosing should 

be administered only if the initial dose was inadequate or respiratory depression recurs [Williams et al. 

2019]. The fire department’s standard operating guidelines recognized this objective by reminding 

department members that upon naloxone administration “[patients] may not wake up ... we are only 

trying to increase respiratory drive.” While the appropriate dose of naloxone is one that will restore 

and maintain respiratory function, the ideal dose of naloxone is not known [Lavonas et al. 2015]. 

Restoring full consciousness is not required for patient safety. Instead, it might precipitate withdrawal 

and agitation, reducing both patient safety and first responder safety. Symptoms of acute opioid 

withdrawal include irritability and agitation as well as body aches, increased heart rate, nausea and 

vomiting, diarrhea, increased tearing, runny nose, sweating, yawning, and goosebumps. Withdrawal 

symptoms are unpleasant but by themselves are not life-threatening to the patient [Clarke et al. 2005; 

Boyer 2012]. In addition, persons who receive naloxone might be upset that euphoric effects from 

opioids were halted [Feldman 2018]. 
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By reversing the effects of opioids, naloxone might also induce agitation and combativeness by 

unmasking the effects of other substances that patients who overdose might have also used. Regardless 

of cause, agitation and combativeness after naloxone administration can pose safety concerns to the 

patient and first responders [Williams et al. 2019]. In a previous NIOSH health hazard evaluation of 

firefighter-EMS providers, 2 of 32 firefighters (4%) who had administered naloxone in the past 12 

months as part of their job duties reported being injured on multiple occasions by a patient after 

naloxone administration. The incidents involved being kicked or being shoved downstairs or against a 

dresser [NIOSH 2017]. In a study of patients who received naloxone from EMS providers, 13% 

experienced agitation or combativeness [Belz et al. 2006].

Relevant agency SOPs should be followed in all emergency settings. To the extent feasible, naloxone 

therapy should be guided by the goal of respiratory support, and this goal should be incorporated into 

applicable SOPs. Since serious side effects from naloxone are very rare and giving naloxone to an 

unconscious person not experiencing opioid toxicity is very unlikely to cause further harm, 

considerations about dosing should not stop laypersons or first responders from giving naloxone to 

reverse opioid overdoses, which are potentially life-threatening. 

In this incident, interviews with responders and reviewing the ambulance run report indicated that the 

patient was initially unresponsive and had agonal breathing and pinpoint pupils. After an initial 0.5 mg 

dose of intravenous naloxone, the patient resumed spontaneous respiration and became responsive to 

painful stimuli. A few minutes later, responders decided to give a second dose of naloxone “to allow 

[him to] self-extricate from the bus,” which resulted in the patient becoming fully responsive and able 

to walk off the bus.

While it is not certain that stopping naloxone administration when the patient resumed breathing could 

have prevented the firefighter fatality, fire departments and other agencies that deliver medical care to 

patients who overdose should consider additional training on the objectives of naloxone therapy and 

the possibility for agitation and combativeness from persons after receiving naloxone. Fire departments 

and EMS agencies should also consider revising procedures to reinforce understanding of the objective 

of naloxone therapy and the administration of naloxone to meet the objective of respiratory support.

Background on the opioid overdose epidemic

The United States is currently in the midst of a drug overdose epidemic. First responders are likely to 

encounter drug overdoses in the course of their work, as shown by the statistics from multiple data 

sources outlined below. 

First, the number of drug overdose deaths in the United States has been increasing [CDC 2020d,e]. In 

2018, there were 67,367 drug overdose deaths, which corresponds to approximately 185 drug overdose 

deaths in the United States every day [Centers for Disease Control and Prevention (CDC) 2020a]. This 

represented a 50% increase from the drug overdose death rate in 2013, when the current wave of the 

opioid overdose epidemic marked by increases in deaths involving synthetic opioids began [CDC 

2020c]. Opioids, especially synthetic opioids such as fentanyl and its analogues, are currently the main 

driver of drug overdose deaths. Although data from 2018 showed slight declines in the number of drug 
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overdose deaths overall [CDC 2020b,c], provisional data suggest that the number of overdose deaths 

from all drug and synthetic opioids has increased in 2019 and 2020 [CDC 2020d]. Approximately 70% 

of all drug overdose deaths in 2018 involved an opioid [CDC 2020b]. 

In Wisconsin, 1,075 people died from a drug overdose in 2018, representing a 28% increase from 2013 

[Wisconsin Department of Health Services 2020]. Opioids were involved in 78% of drug overdose 

deaths in the state in 2018. Since 2013, the number of deaths involving synthetic opioids such as 

fentanyl in Wisconsin increased more than six times, from 80 deaths in 2013 to 504 deaths in 2018 

[Wisconsin Department of Health Services 2020]. 

Second, the number of emergency department visits for suspected opioid overdoses has increased 

recently. During July 2016–September 2017, the number of emergency department visits for suspected 

opioid overdoses increased approximately 30% in the United States and 109% in Wisconsin [CDC 

2018a]. 

Third, the number of EMS calls during which naloxone has been administered has increased [CDC 

2018b; Faul et al. 2017]. Based on a national database of EMS events, there was an 82% increase in 

the number of patients who received naloxone from 95,012 in 2012 to 173,016 in 2015 [Faul et al. 

2017]. Most of the 911 calls that resulted in naloxone administration (83.3%) did not specify drug 

ingestion or poisoning as the medical emergency [Faul et al. 2017]. 

Opioid overdose deaths have been described as occurring in three waves [CDC 2018c]. The first wave 

began with increased prescribing of opioids in the 1990s, which was associated with increases in 

overdose deaths due to prescription opioids. In the second wave, there were rapid increases in overdose 

deaths due to heroin, starting in 2010. The third wave, which began in 2013, corresponds to increases 

in overdose deaths involving synthetic opioids. In particular, fentanyl and fentanyl analogues have 

been implicated in this third wave, which is currently evolving. 

Recommendation #2: Fire, EMS, and police departments and agencies who deliver medical 

assistance should develop SOPs that address the possibility of polydrug overdoses. 

Recent reports suggest that opioids are commonly used with other substances. A recent analysis found 

that deaths from illicitly manufactured fentanyl increased in 2017–2018 and that stimulants were also 

present in approximately 60% of opioid-involved deaths [CDC 2019, 2020 a,b,c]. During January–

June 2019, almost one-third of drug overdose deaths involved a combination of opioids and stimulants 

such as cocaine, methamphetamine, other illicit stimulants, and prescription stimulants [CDC 2020a]. 

Among non-fatal drug overdoses treated in emergency departments, the rate of overdoses that involved 

both opioids and amphetamines increased from 2018 to 2019 [CDC 2020d]. In addition, among urine 

drug tests done as part of routine medical care, the percentage of cocaine-positive and 

methamphetamine-positive samples that were also positive for fentanyl increased over time. By 2018, 

the percentage of co-positive samples ranged from 7.9% for methamphetamine and fentanyl to 17.6% 

for cocaine and fentanyl [LaRue et al. 2019]. Law enforcement data sources also suggest that fentanyl 

is being mixed with other drugs such as cocaine and methamphetamine [CDC 2018d]. Acute effects of 

stimulants such as cocaine and methamphetamine can be associated with agitation, restlessness, and 

anxiety [Aronson 2016; Cruickshank and Dyer 2009].
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In this incident, postmortem toxicology reports for the patient/shooter indicated the presence of 

methamphetamine, among other compounds. In general, amphetamines stimulate the central nervous 

system. Acute effects of methamphetamine include euphoria, elevated heart rate and blood pressure, 

increased alertness, behavioral disinhibition, and anxiety. At higher doses, methamphetamine can 

induce psychosis [Cruickshank and Dyer 2009]. 

The relationship between the patient/shooter’s actions and the presence of methamphetamine detected 

on postmortem toxicology cannot be determined with certainty. The presence of methamphetamine 

during testing at a single point in time does not indicate that the patient/shooter used methamphetamine 

chronically. While some studies suggest an association between methamphetamine use and homicide 

[Ellinwood 1971; Stretesky 2009], these studies involved individuals with chronic methamphetamine 

use, which is associated with changes in the brain [Cruickshank and Dyer 2009]. While 

methamphetamine use might be associated with several mechanisms that may motivate violence, such 

as inhibition of cues that normally control behavior, increased arousal, interference with interpersonal 

communication, and intensification of emotions, violent behavior is not inevitable even with chronic 

methamphetamine use [Sommers and Baskin 2006]. The presence of methamphetamine during testing 

at a single point in time does not indicate that the patient/shooter was a chronic methamphetamine 

user. 

Furthermore, it is not possible to estimate the time of last use or methamphetamine concentration in the 

blood or brain prior to death from a postmortem toxicology test. Reasons include uncertainties about 

the dose used, timing of last use, route of administration, and rate of drug movement from other parts 

of the body into the bloodstream after death, a phenomenon called postmortem redistribution [Logan 

2001; Schepers et al. 2003]. 

Additionally, recognizing the potential for agitation and combativeness from persons who have 

received naloxone, fire, EMS, and police departments should develop ways to coordinate responses to 

ensure scene safety if necessary. Other recommendations in this report provide guidance on actions 

that fire, EMS, and police departments can take to ensure scene and personnel safety. 

Recommendation #3: Fire, EMS, and police departments should take steps to ensure scene safety 

including taking all necessary actions to protect themselves when providing lifesaving care to a 

patient. The fire service and standards setting organizations should consider developing scene safety 

SOPs and training that provide more detailed guidance on the specifics of keeping first responders 

safe while providing lifesaving care to patients. 

Every situation is unique and has the potential to be unpredictable and should be treated as such by all 

responders, including the fire service. This event began with providing lifesaving care to a patient. 

The situation then very abruptly developed into an incident of workplace violence that resulted in the 

death of a firefighter by firearm homicide. Scene safety is critical to every response and should be an 

ongoing process throughout every response. 

There are many references to scene safety in numerous trade journals for firefighters and EMS 

providers. Guidance about scene safety is generally outlined in NFPA 1500 [NFPA 2018a]. NFPA 

3000 [NFPA 2018b] provides an outline of what an Active Shooter/Hostile Response (ASHER) 
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program should include. There are many different sources and variations of information and training 

that responders can receive regarding scene safety. A generic SOP template that could be adapted by 

each Authority Having Jurisdiction (AHJ) could be useful to the fire service as well as EMS providers

to help standardize some of this information. The fire service and standard setting organizations should 

collaborate to develop best practices and training standards and/or SOPs that provide more detailed 

guidance on the specifics of scene safety assessment and the process of re-evaluating a scene as it 

changes throughout a response. Such an approach benefits both responders and members of the public. 

At a minimum the SOPs should include all local resource capabilities, i.e., agencies and entities such 

as law enforcement, fire, EMS, and local hospitals. The SOPs should be based on a current risk 

assessment and should provide information on the scope and purpose of the SOP, how the health and 

safety of responders will be maintained, a guide for response actions, and mental health and recovery 

of the responders after an incident. The AHJ should ensure that plans are developed, maintained, 

evaluated by training and exercises, and updated as needed by all fire, EMS and police departments. 

In this incident, while the patient was receiving medical assistance on the bus, it was clear that the 

scene was safe for law enforcement, firefighters, and paramedics to perform their duties. However, a 

scene should be re-evaluated periodically as the situation evolves. After the patient exited the bus 

under his own power, two law enforcement officers spoke with the patient about the need to determine 

if he had anything on him that could harm the paramedics or firefighters at the scene when they 

transported him to the hospital for further medical evaluation. This was part of the ongoing scene 

safety assessment. 

In addition to the two law enforcement officers performing a scene safety assessment, there were two 

private ambulance company paramedics, three firefighters, two transit station employees, and one bus 

driver within several feet of the patient. Therefore, a total of 10 people were working within a few feet 

of the patient before this phase of the scene safety assessment was complete. Of those 10 workers, it 

appears that everyone except the bus driver was actively engaged in the conversation with the patient 

or monitoring the situation. (The bus driver did not engage the patient; he was preparing to back the 

bus away from the scene when shots were fired.)

In this incident it was clear from the multiple requests by law enforcement to search the patient that the 

responders did not know if the patient had anything on his person that could harm the patient or the 

responders. During the interviews, some of the fire and EMS responders indicated they stayed near the 

patient in order to either provide further medical assistance to the patient and/or to assist law 

enforcement. Fire department company officers and unit leaders should help to ensure that while some 

of the responders may need to be in close proximity of the patient, they may not all need to be. All of

the responders should be aware of and act in their specific roles as needed by each event.

Given that any situation can change rapidly, unit or company officers should continually alert their 

crews to threats and position crews accordingly. There should be an ongoing assessment of an incident 

until the incident is determined to be under control. It is prudent to limit the number of firefighters, 

EMS providers, and other workers who are not actively engaged in scene safety assessment or patient 

care to be in close proximity until law enforcement has been able to determine if the scene is secure 

and safe. 
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Scene Safety Background

Additional information from the annex of NFPA 1500 Standard on Fire Department Occupational 

Safety, Health, and Wellness Program states that:

• Fire department members should not enter an environment where there is ongoing violence, or 

the threat of violence such as a person with weapons, without coordination with law 

enforcement personnel. This does not necessarily limit the ability of cross-trained fire/law 

enforcement personnel or specialty trained EMS providers from entering a violent scene to 

assist the law enforcement or fire department responders.

• Such situations include but are not limited to civil unrest, fights, violent crimes, drug-related 

situations, family disturbances, persons with altered mental status, and people interfering with 

fire department operations.

• The Firefighting Resources of California Organized for Potential Emergencies (FIRESCOPE) 

has developed ICS-701, Emergency Response to Tactical Law Enforcement Incidents

[Firescope 2015], which might be useful in developing a standard operating procedure as per 

NFPA 1582 [NFPA 2018a].

Incidents that appear routine in nature can turn into a violent or hostile environment after the arrival of 

responding crews. A standard communication phrase, known only by communications personnel and 

other responders, can warn others of the dangers of the situation without triggering violence or 

hostilities. The “Mayday” or emergency button on a portable radio can also be used for responders to 

gain attention in a rapidly changing or escalating event. In many of the newer portable radios, once 

depressed, the emergency button provides an open airway (without the need for the responder to push a 

transmit button) for a number of seconds followed by a priority transmitting availability. This 

emergency button activates a signal at the emergency communications center requiring an action by a 

dispatcher.

The Essentials of Fire Fighting and Fire Department Operations defines situational awareness as “an 

awareness of the immediate surroundings” [IFSTA 2013]. All emergency responders operating at an 

incident need to maintain situational awareness and conduct a continuous risk assessment throughout 

the incident, reporting unsafe or changing conditions to the incident commander. Firefighters and 

emergency responders need to understand the importance of situational awareness and personal safety 

on the fireground. 

On any emergency scene, every responder should be trained in situational awareness to be constantly 

alert for changing and unsafe conditions and be trained to avoid complacency. Situational awareness is 

a cognitive learned skill and it can be taught [NIOSH 2018]. This applies not only to conditions found 

directly related to the emergency scene (i.e., crash scene), but other hazards and dangers to the 

responder(s) from outside events or unsafe conditions or hostile environments. In order to have 

situational awareness, you must be able to perceive the threat, comprehend the threat, and predict what 

effect that threat may have on you. These elements—Perceive, Comprehend, and Predict—form the 

cornerstone of maintaining complete situational awareness [Brennan 2009, Gasaway 2013].
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Recommendation #4: Authorities Having Jurisdiction (AHJs) (e.g. municipalities, areas, or 

departments) should consider developing SOPs or guides that specify when (1) a patient should 

receive a pat down to identify information that might be useful for patient care or identify items that 

pose a threat to the patient or responders and (2) a patient might be restrained if the patient poses a 

threat to themselves or the responders. These SOPs should specify who determines when a pat down 

is necessary and who is authorized to perform it. These SOPs should be operationalized, trained, 

and exercised by law enforcement, the fire service, and EMS as part of a Unified Command 

response. 

Conducting pat downs when warranted is an important part of patient care and scene safety 

assessments. Pat downs may reveal information that can more quickly identify potential causes of the 

medical issue (e.g., finding a bottle of nitroglycerine tablets in the patient’s pocket) or provide other 

information that is important for patient care (e.g., medical alert bracelet or emergency contact 

information). Pat downs may also reveal an item that can be immediately harmful, such as a weapon 

(e.g., knife or firearm) as well as items that can inadvertently be harmful to responders (e.g., a sharp 

object such as a needle). A risk assessment should be performed to determine if a pat down is 

appropriate according to the AHJ’s laws and SOPs. Identifying a potential harm to the patient or 

responder can save the life of the patient, first responder, or both. 

In this incident, the police were attempting to perform a search of the patient when the patient 

produced a concealed handgun and fired at the first responders. If permissible under the AHJ’s laws 

and SOPs, one possible option could have been to perform a pat down of the patient after life-saving 

therapy was performed on the bus (e.g., airway management and administration of the first dose of 

naloxone), but before he was able to walk off the bus on his own power without his weapon being 

secured by law enforcement. 

While some practitioners recommend the use of physical restraints before naloxone administration to 

protect patients and EMS providers [Gaddis and Watson 1992], most patients do not become agitated 

or combative after naloxone therapy. Fire and EMS departments should carefully weigh considerations 

such as patient distress associated with being restrained upon reversal with naloxone, respect for 

patient dignity and patient rights, and other concerns against the likelihood of agitation and 

combativeness that would result in patient or EMS provider injury in their restraint protocols to guide 

restraint use on a case-by-case basis.

Recommendation #5: Public or mass transportation companies should consider equipping their 

terminals/stations with transfer/evacuation devices that are capable of fitting down the aisles for 

patient removal.

A public or mass transportation company’s emergency evacuation plan should include provisions for 

assisting personnel in moving people who have mobility issues. Numerous states have adopted 

legislation that requires building owners or operators to provide a means of egress for people with 

mobility impairments with minimum risk to the staff and the individual with impairments. Often this is 

accomplished by utilizing a transfer chair (see Photo 2). The general dimensions of transfer chairs vary 

but they are designed to fit narrow aisles on aircraft when assisting mobility impaired individuals on a 
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daily basis. Evacuation sleds or blankets could be another consideration for safely removing a mobility 

impaired patient depending on circumstances. 

In this incident, the patient was unconscious and sitting in a window seat on the bus. The patient was 

above average in size and weight and there were concerns about being able to move him safely off the 

bus. The patient was brought out of his unconscious state primarily so that he could ambulate off the 

bus. If a narrow space transfer chair had been available, either on the bus or at the transit station, it 

may have been able to be used in the narrow aisle. The wheelchair hydraulic lift on the bus may have 

been able to be used to get the patient off the bus, thus avoiding administration of the second dose of 

naloxone. 

Photo 2. An example of a transfer chair ready for use in a transportation terminal. (Photo by © 

Kukota, Kateryna 2020/Getty Images).

Note: Although there is no evidence that the following recommendation would have prevented this 

fatality, it is being provided as a reminder of best practices for the fire service and other public safety 

agencies. 

Recommendation #6: Fire, EMS, police departments and dispatch agencies should ensure that all 

responders have the information needed for their response and safety. 
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All agencies receiving calls for assistance should ensure important information for the response and 

responder safety is asked during the call taking process and that information is transferred into the 

dispatch and communicated to individual responding units. Critical information, such as the suspected 

presence of weapons, that can assist first responders with their safety needs, should be obtained and 

transmitted to all of the responding units to an emergency if known. This information can help 

establish the proper response urgency and prepare responders to more fully consider their own safety

[NIOSH 2005, 2016]. It may also be a communication benefit to relay this information by radio as well 

as putting notes in the warning or information section of the Mobile Data Terminal (MDT). 

Firefighters and EMS providers may not be sitting in front of an MDT or be able to scroll through and 

read important case notes such as this during an emergency response. These important messages 

should have a priority screen presence with some sort of visual stimuli to ensure it is noticed. This is 

not only important for the primary units assigned, but also fire department and EMS supervisors for 

those units.

When sensitive information cannot or should not be transmitted over the radio, the dispatcher should 

verbally prompt responding units to check and acknowledge case notes to complete the 

communications loop.

In this incident, the communications center received a call for assistance for a patient who reportedly 

had a seizure. There were no signs of a hazardous or dangerous scene, nor were there any indications 

of the patient being armed with a handgun. Given the information available at the time, the responding 

fire engine, ambulance crew, and police officers had no reason to expect that the patient was armed 

with a handgun based upon the information provided in the call.
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Investigator Information

This incident was investigated by Stephen T. Miles, Investigator/Safety and Occupational Health 

Specialist, and Matt Bowyer, Investigator/General Engineer with the Firefighter Fatality Investigation 

and Prevention Program, Surveillance and Field Investigations Branch, Division of Safety Research, 

NIOSH located in Morgantown, West Virginia. Additional NIOSH investigators and report co-authors 

were Dr. Sophia Chiu, Medical Officer, Hazard Evaluations and Technical Assistance Branch, 

Division of Field Studies and Engineering in Cincinnati, Ohio, and CAPT Jennifer Hornsby-Myers, 

industrial hygienist, U.S. Public Health Service, NIOSH Emergency Preparedness and Response 

Office in Morgantown, West Virginia. 
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An expert technical review was provided by Matthew Tobia, Fire Chief with the City of Harrisonburg, 

Virginia Fire Department. Chief Tobia is a thirty-year student of the fire service and past Chair of the 

of the International Association of Fire Chiefs Safety, Health and Survival Section. 

A technical review was also provided by the National Fire Protection Association, Public Fire 

Protection Division. 

Disclaimer 

Mention of any company or product does not constitute endorsement by the National Institute for 

Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention. 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. All web addresses referenced in this document were accessible as of the publication 

date. 

Appendix A. Detailed description of the Public Safety Training Center. 

The Public Safety Training Center sits on 80 acres of land leased from the airport. This training center 

serves law enforcement, fire protection, and EMS professionals. The $34.5 million project was made 

possible through a partnership with the AHJ airport and was funded through a district-wide 

referendum. It includes the following major elements: 

• A 96,000 square-foot tactical lab and classroom building, which includes two indoor firing 

ranges, defensive tactics rooms, a fully equipped forensic laboratory, jail training area, EMS 

classrooms with an ambulance simulator, computer/dispatch laboratory, and an apparatus bay 

containing five double bays including a high bay for aerial trucks. 

• A full emergency vehicle operation (EVOC) range with skid pad, skills pad, and pursuit 

track.

• Simulated village containing streets, intersections, two full-size residential homes and three 

commercial venues: gas station/convenience store, drive-up bank, and hotel/motel/bar. An additional 

building is designed for training forced entry, search and rescue, and tactical clearing. 

• Comprehensive fire training ground, including a 6-story live burn tower, ladder training 

structure, numerous gas- or propane-fired props (e.g. car fire, residential and commercial gas meter 

fire, etc.), and technical rescue training facilities, including trench rescue, confined space and high- and 

low-angle rescue.

• A decommissioned Boeing 727 to be used for training on-board emergencies, such as 

medical emergencies, disruptive passengers, hostage situations, and so forth. A 3-car tank car 

simulated derailment to train response to hazardous material release.
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• Four fully baffled outdoor firing ranges, including 50-yard, 100-yard, and a 300-yard sniper 

range with elevated platform.

• Currently under construction is a $14 million addition in the form of an Aircraft Rescue and 

Fire Fighting (ARFF) live-burn training facility. When complete, it will contain an administrative 

building with two classrooms, three-bay apparatus room and a propane fueled aircraft frame (B-777) 

with multiple burn scenarios.

The fire department has a fire training site located at station 6 (also designated as the Special 

Operations Station). It houses most of the city’s hazardous materials response capability along with 

their tactical hands-on training grounds. It contains county-wide assets that include an all-terrain

vehicle and foam trailer. The Resource Development and Special Operations Division is located at 

Station 6 and under the direct supervision of a Battalion Chief. The division also includes a Training 

and Resource Development Specialist to assist in the day-to-day operations of the division. 

The tactical training grounds consist of a 4-story concrete training tower. The building was developed 

to provide different building elevation on each side of the structure; including residential and 

commercial appearances. The facility is not designed for live fire but is able to provide simulated 

smoke conditions and utilize a Digital Fire Attack System which allows firefighters to locate and 

extinguish a simulated fire. There are additional venues that allow for ground and aerial ladders, 

ventilation, forcible entry, confined space rescue, rope rescue, building shoring, lifting and moving and 

concrete breeching.

In 2018, the department’s division of training oversaw the annual basic skills assessment training that 

every member in the operations division completed. The division also oversaw the monthly safety 

committee facilitation and monthly training for firefighter, driver/engineer and company officer 

training. In 2018, the department recorded 12,558 hours of training. Annually, the department 

internally delivers a 6-week recruit fire academy for probationary firefighters. This academy is held at 

the training facility at Fire Station 6 and utilizes the Technical College’s Public Safety Training Center 

for live burn and other specialty venues. Instructors in the academy include fire operations personnel 

assigned to fire stations throughout the city. Academy curriculum includes an orientation, lessons in 

fire behavior, the use of extinguishers, study of tools and equipment, discussions on communications 

and department policy, instruction on the use of ropes and knots, extensive training on personal 

protective equipment (PPE) and self-contained breathing apparatus (SCBA).

The academy utilizes classroom and practical training in ladders, fire hose, water supply, fire streams, 

forcible entry techniques, ventilation, search and rescue, salvage and overhaul, self-survival, and fire 

tactics. Members of the Fire Prevention and Public Education Division teach classes on fire detection 

and alarm systems, pre-plans, the basics of fire prevention, and about the many fire prevention and 

safety programs the department offers. The Special Operations Division teaches courses and practical 

evolutions in the areas of rope rescue and mechanical advantages, confined space rescue, hazardous 

materials response, and special equipment and techniques used in special operations.

In 2018, 31 department members trained at a higher level of water rescue and served as swift water 

rescue team members and rescue boat operators. Twenty-eight department members are designated as 
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swift water technicians. All members of the operations division receive annual in-the-water refresher 

training for water and ice rescue.