Fire Fighter Fatality Investigation and 

Prevention Program Evaluation 

Executive Summary 

June 2008

Prepared for the 

National Institute for Occupational Safety and Health 

Prepared by 

Kristina Peterson, PhD 

Michael Witt, MA 

Katherine Morton, MS 

Murrey Olmsted, PhD 

RTI International 

3040 Cornwallis Road 

Research Triangle Park, NC 27709 

and 

Harlan E. Amandus, PhD 

Steven L. Proudfoot 

James T. Wassell, PhD 

National Institute for Occupational Safety and Health (NIOSH) 

Division of Safety Research 

Morgantown, WV 26505 

The findings and conclusions in this report are those of the authors, and do not necessarily 

represent the views of the National Institute for Occupational Safety and Health.

 

*RTI International is a trade name of Research Triangle Institute. 
NIOSH developed the original study design and contributed substantively to the 

content of the questionnaire, the sampling and analysis designs, and the data 

analysis and presentations. In collaboration with NIOSH staff, RTI developed the 

operational evaluation design, including the questionnaire and focus group guide; 

conducted the survey and focus groups; and performed all data analysis. RTI was 

responsible for developing recommendations from the study findings. All listed 

authors contributed to this report. 

Authors’ individual contributions, from RTI: Kristina Peterson, PhD., was RTI's 

Project Director for the study, had overall responsibility for the evaluation and was 

the lead author of the final report. Michael Witt, MA, was the sampling and analysis 

task leader for the study, designed the sampling and analysis approach, and oversaw 

all statistical operations. Katherine Morton, MS, is a research statistician at RTI, 

conducted the statistical analysis. Murrey Olmsted, PhD, a survey methodologist at 

RTI, led the development of the questionnaire and all focus groups activities. 

From NIOSH: Harlan Amandus, PhD, Chief of the Analysis and Field Evaluations 

Branch, provided critical review and management. James T. Wassell, PhD wrote the 

original research protocol and the request for task order proposal, was chair of the 

technical evaluation panel of proposals, and technical monitor for the RTI contract. 

Steven Proudfoot contributed to questionnaire content, provided subject matter 

expertise and was technical monitor for the RTI contract. 

About RTI International: RTI International is an independent, nonprofit research 

institute based in Research Triangle Park, North Carolina. Established in 1958 as the 

Research Triangle Institute, RTI has a distinguished history of scientific achievement 

in the areas of health and pharmaceuticals, education and training, surveys and 

statistics, advanced technology, democratic governance, economic and social 

development, energy, and the environment. RTI has ongoing projects in more than 

40 countries and a staff of more than 2,600. RTI was selected for this project by a 

technical evaluation of their proposal through a competitive process. 
Executive Summary 

The purpose of this report is to document the findings of the evaluation of the Fire 

Fighter Fatality Investigation and Prevention Program (FFFIPP). The FFFIPP is a 

program of the National Institute for Occupational Safety and Health (NIOSH) that 

conducts investigations of firefighter line-of-duty deaths and formulates 

recommendations for preventing future deaths and injuries. 

In the fall of 2003, NIOSH undertook a study to determine the extent to which 

recommendations from NIOSH investigations of fire fighter fatalities are being 

implemented by fire departments. This study was largely funded through CDC's 

evaluation program. This study, along with a public stakeholder’s meeting that was 

convened in March 2006, was part of a strategic effort by NIOSH to seek input on 

the program from across the fire service with the goal of improving the impact of this 

program. 

Through this survey, we learned that a large number of fire departments are aware 

of the FFFIPP and use findings and recommendations in efforts to improve fire fighter 

safety and health. We also learned that we need to undertake efforts to improve our 

outreach to small and rural departments. We gained numerous suggestions from 

focus groups for improving our program and products. In May 2007, NIOSH posted 

on the program's website future directions for the program based on preliminary 

findings from the 2003 study and input provided at the March 2006 stakeholders' 

meeting, http://www.cdc.gov/niosh/fire/future.html 

NIOSH communicates the findings from FFFIPP investigations via publications and 

presentations, and through collaborative research and policy activities with partner 

organizations in the fire service. Publications include Line of Duty Death reports, 

NIOSH Alerts, Health Hazard Evaluation reports, and special documents such as 

NIOSH Workplace Solutions.

The publications are disseminated to fire departments through the mail, e-mail, 

conferences, and other venues and are available on the Internet through the NIOSH 

home page (http://www.cdc.gov/niosh/fire). The NIOSH reports are produced in 

both hard copy and electronic formats. Periodically, NIOSH sends a packet of five or 

six reports to all 30,000 fire departments in the United States. Summaries of the 

NIOSH reports are also published in fire service trade journals. 
The purpose of this evaluation was to 

1. assess the effects of FFFIPP recommendations and information products on the 

safety knowledge, attitudes, and behavior of the nation’s firefighters, 

2. gain insight into the impact of FFFIPP recommendations and information products 

on the safety knowledge, attitudes, and behavior of the nation’s firefighters; and 

3. identify possible strategies for improving the impact of the FFFIPP, including 

improvements in the approaches used by NIOSH to disseminate the findings from 

FFFIPP investigations. 

The evaluation is based on data from two sources: (1) a national survey of fire 

departments and (2) a series of focus groups with frontline firefighters. 

NIOSH has issued several hundred recommendations. Although circumstances of 

investigations are varied, similar recommendations may often apply in multiple 

investigations. For this evaluation, NIOSH identified 31 “key” recommendations, 22 

involving traumatic injury fatalities and 9 involving cardiovascular disease (CVD) 

fatalities. From this list, 17 recommendations were selected to serve as sentinel 

recommendations for the evaluation. The selections were based on frequency of 

mention in FFFIPP reports, specificity of the recommendation, and balance among 

the categories of safety recommendations. The evaluation focused on the impacts of 

these sentinel FFFIPP recommendations in firefighter training, standard operating 

procedures, safety practices, and the safety environment of the fire departments. 

FIRE DEPARTMENT SURVEY 

The Fire Department Survey was mailed to the Fire Chiefs of a stratified random 

sample of 3,000 fire departments across the country during spring 2006. The sample 

includes 

 all 208 fire departments that had experienced a FFFIPP investigation as of 

December 31, 2003, 

 a random sample of 215 fire departments where a firefighter fatality had 

occurred but no FFFIPP investigation had been conducted, 

 the 10 largest fire departments, because of their unique status, and 

 a stratified random sample of 2,575 fire departments where there had not been a 

fatality as of December 31, 2003. This sample includes representative 

subpopulations defined by geographic location, department type (career and 

volunteer), jurisdiction size, and population density. 

The overall response rate for the survey was 54.9%. 

FIREFIGHTER FOCUS GROUPS 

A series of six focus groups was conducted with frontline firefighters in order to 

collect additional information. The focus groups took place during March and April 
2006 and included participants from both career and volunteer fire departments and 

from departments in both rural and urban jurisdictions. 

FINDINGS 

Awareness of the FFFIPP. The picture that emerges from the evaluation suggests 

that the FFFIPP is only moderately known. Most officers are familiar with NIOSH, and 

most have seen and read a FFFIPP report. Over half, however, are not familiar with 

the FFFIPP itself, particularly with the process of identifying incidents to investigate, 

conducting the investigation, and reporting findings. 

Fire department officers learn about FFFIPP recommendations primarily through 

NIOSH mailings, trade publications, and websites. NIOSH recommendations have 

been used by some 11,000 fire departments to update the content of their training 

programs on personal protective equipment (PPE), Self-contained Breathing 

Apparatus (SCBA), Personal Alert Safety System (PASS) devices, Incident Command 

System, traffic hazards, radio communications, and other topics. Fire departments 

also post information from NIOSH on fire station bulletin boards and brief firefighters 

about the recommendations during regular staff meetings. Nevertheless, two fifths of 

fire departments do not disseminate information from NIOSH to frontline firefighters 

at all. 

Implementation of FFFIPP Recommendations. The majority of fire departments 

in the country require firefighters to be trained on five of the six types of 

recommendations addressed in this evaluation: use of PPE, fighting structure fires, 

driving safety, use of radio communication devices, the Incident Command System, 

and maintenance of SCBA. However, only 7% of the fire departments have a 

required physical fitness training program, and most fire departments do not require 

firefighters to be screened for CVD risk factors and CVD. 

Most fire departments ensure that firefighters responsible for driving emergency 

vehicles receive driver training before being allowed to operate the vehicles, though 

frontline firefighters say they need to be trained to the class of the vehicle, and 

home responders need additional training. Most fire departments require their 

firefighters to wear seat belts while in emergency vehicles, though frontline 

firefighters say many still are not using them. 

The survey results also suggest that most fire departments 

 have enough PASS devices for all of their firefighters to use when fighting 

structure fires. Almost all fire departments report that their firefighters use their 

PASS devices at least “most of the time.” 

 have SCBA for their firefighters and perform SCBA maintenance “at least several 

times a year”. Firefighters in almost all fire departments reportedly use their 

SCBA at least “most of the time” while fighting structure fires. Many fire 

departments, however, say that their firefighters still have to share facepieces. 
 have Automated External Defibrillators (AEDs) and perform routine maintenance 

on the AEDs. The AEDs are usually kept on the emergency vehicles and/or at the 

fire station. 

 have radios or other two-way communication devices while responding to 

structure fires at least “most of the time.” 

According to the Fire Department Survey, Incident Command is established by most 

fire departments on a routine basis when responding to structure fires. The tasks 

that fire departments most often say are part of an Incident Commander’s 

responsibilities include all three of the tasks identified in NIOSH recommendations: 

conduct an initial assessment, monitor location of all firefighters at the scene, and 

develop and initiate a risk management plan. Incident Commanders in only about 

half of all fire departments usually assign an Incident Safety Officer (ISO). However, 

focus group participants identified the failure to implement Incident Command as 

one of their most common safety concerns. 

Barriers and Facilitators. 

Among the barriers that many fire departments face in implementing FFFIPP 

recommendations is insufficient funding for equipment, personnel, and training. For 

example, a third of all fire departments do not have enough funding for personally 

fitted SCBA facepieces for all of their firefighters. The lack of adequate equipment 

also hinders some departments from implementing other FFFIPP-recommended 

safety practices. For example, a quarter of all fire departments say their firefighters 

are not able to fit comfortably in their seat belts while wearing turnout gear in 

emergency vehicles. Other barriers identified are not enough personnel available at 

the scene and the situation on the fireground (e.g., the fire is not large enough). 

About a third of all fire departments say they are sometimes unable to establish 

Rapid Intervention Teams (RITs) because there are not enough firefighters at the 

scene of the fire. Firefighter resistance does not appear to be a significant reason 

FFFIPP-recommended safety practices are not followed. 

Among the factors that can encourage safe practices are experience with an on-duty 

firefighter fatality, experience with a FFFIPP investigation, financial and legal 

penalties, an officer’s attention to specific safety issues, and union representation. 

FFFIPP investigations, for example, appear to reduce perceived barriers to using 

PASS devices and individual SCBA facepieces. 

The kinds of fire departments that most likely follow NIOSH’s safety guidelines are 

career fire departments in large, urban jurisdictions in the Northeast. Fire 

departments that have experienced a firefighter fatality are also more likely than 

others to implement many of the NIOSH recommendations. 

Dissemination Methods. Firefighters say that learning about specific incidents 

helps them develop safer work practices, and they appreciate that the Line of Duty 

Death (LODD) reports are unbiased. About two thirds of officers who are aware of 
the NIOSH reports agree that they are practical, easy to understand, specific, and 

concrete. Nevertheless, officers suggest that the recommendations be made 

stronger, more straightforward, and less generic, and that they take into 

consideration the size and resources of the department. Some also recommend 

outside expert review of FFFIPP reports. 

Firefighters think the LODD reports are generally well designed, but recommend 

making it easier to skim through them by making more effective use of headings and 

headlines, adding more visual aids to clarify the fire scene (a timeline, a diagram of 

the fire scene, and more photos), and including information about the victim(s). 

They also recommend that NIOSH prepare more summary documents with statistics 

showing the number of deaths and injuries due to specific unsafe practices, using 

communication techniques employed by the print media. Firefighters also want to 

receive the LODD reports as soon as possible after an incident. 

Fire department officers also want help translating FFFIPP recommendations into 

actionable items for their departments. There is particular interest in receiving 

ready-made training material (including PowerPoint presentations and lesson plans) 

based on the LODD reports. Other management tools that would be helpful include 

sample standard operating procedures based on FFFIPP recommendations. 

The most common recommendation from firefighters is for improvements in the 

ways FFFIPP materials are disseminated and marketed. For example, firefighters 

recommend that NIOSH update the FFFIPP mailing list and e-mail listserv, implement 

procedures for refreshing these lists regularly, and better advertise the lists. Most 

firefighters have not visited the NIOSH website. One recommendation is that NIOSH 

create a banner with the NIOSH website address to post on fire station bulletin 

boards and redesign the website to make it more firefighter-friendly. 

Finally, firefighters suggest that NIOSH develop coordinated campaigns around 

specific issues, focusing on one issue at a time, to raise awareness throughout the 

fire service. 

IMPLICATIONS 

Following are the key implications from the evaluation: 

 Small, volunteer departments have the greatest challenges to following safety 

guidelines. 

 Existing resources limit safety practices. 

 Gaps in knowledge and attitudes also limit safety. 

 FFFIPP investigations and LODD reports provide useful information. 

 Fire departments need additional information to enhance the effectiveness of the 

LODD reports. 
 Firefighters and fire departments need information presented in additional 

formats. 

 FFFIPP materials need to be better marketed and distributed. 

 Increasing awareness will likely improve safety practices. 

RECOMMENDATIONS 

The recommendations that emerge from these findings are as follows: 

Outreach Efforts 

1. Enhance outreach efforts to small, rural, and volunteer fire departments. 

Technical Assistance 

2. Develop documents about recommended equipment, training, or procedures that 

could be used to justify budget requests. 

3. For smaller, volunteer departments, provide additional technical assistance for 

preparing grant applications. 

NIOSH Web Site 

4. Improve the FFFIPP website with a firefighter-friendly page that connects broad 

topics with recommendations and action items, with links to specific FFFIPP LODD 

reports and other FFFIPP materials and resources. 

Outreach 

5. Contact fire departments that experience a firefighter fatality or “near miss” 

incident, regardless of whether an investigation is planned. Partnering with other 

organizations as needed, provide relevant FFFIPP materials and offer technical 

assistance to help address safety issues. 

LODD Reports 

6. Continue developing and disseminating LODD reports. 

7. Continue providing all four sections of the current reports, including a summary, 

investigation results, discussion, and recommendations. 

8. Consider the use of formatting, headings, and headlines to enhance the 

messages communicated both in individual LODD reports and over the LODD 

series. 

Content of the LODD Reports 

9. To improve accessibility and information, incorporate more photos, timelines, 

diagrams, and other visual aids into FFFIPP reports. 

10. Review the investigation protocol, particularly the sources used for developing 

technical recommendations. Consider using an outside panel of experts to review 

findings. 
Ancillary Materials 

11. Help transfer knowledge gained from FFFIPP investigations by creating training 

tools based on FFFIPP reports, including PowerPoint slides and lesson plans. 

Incorporate photos, timelines, diagrams, and other visual aides. 

12. Expand the production of existing publications such as Safety First, Workplace 

Solutions, and Hazard IDs to include additional topics. Make use of graphics, 

statistics, and other tools to communicate the level of risk and practical steps 

firefighters and fire departments can take to promote safety. 

13. Explore new technology for disseminating the findings of FFFIPP investigations in 

a public service campaign format. Use videos, public service channels, and 

Internet streaming video to present safety messages on each key FFFIPP 

recommendation. These messages should draw from multiple fatality 

investigations and should employ public safety advocacy techniques. 

Distribution of FFFIPP Materials 

14. Ensure NIOSH materials reach all fire departments by instituting new measures 

to maintain a complete and up-to-date mailing list. 

15. Ensure that NIOSH e-mail lists are up to date. 

Marketing 

16. Improve the promotion of the FFFIPP website. Create a poster suitable for fire 

department station bulletin boards with the NIOSH website featured prominently. 

17. Consider coordinated promotional campaigns on single themes. 

18. Develop additional mechanisms for raising awareness about the FFFIPP across 

the fire service and the public.